bluuebunny/crossref_metadata_2025 huggingface dataset:
Ethnic differences in normal electrocardiographic findings in elite brazilian football players: b-pro foot ECG pilot study
Authors: Ferrari F , Donelli Da Silveira A , Gustavo Marin Emed L , Dalcin Dilda G , Guimaraes F , Bianchini Cardoso F , Freitas Teixeira M , Faria Isfer De Lima G , Machado Arantes M , Bassan F , Otavio Bougleux Alo R , Torres V , Dornelles M , Christo Aleixo H , Stein R
Published: May 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): CNPq, CAPES, FIPE-HCPA.

Introduction

The 12-lead electrocardiogram (ECG-12) is a useful tool in the assessment of athletes. The prevalence of normal electrocardiographic findings in elite Brazilian football players (EBFP) of different ethnicities is not well described.

Purpose

To compare the prevalence of normal ECG-12 findings in Caucasian, Mixed-race (MR), and Afro-Brazilian (AB) EBFP.

Methods

A multicenter cross-sectional descriptive study was conducted with exams performed on EBFP as a pre-participation assessment from February 18, 2002, through October 20, 2022.

Results

4,363 EBFP from 51 professional clubs (from all five regions of Brazil; 15 states, and 21 cities), aged 15-35 years (median: 19 years; IQR: 16-23) were evaluated. 2,027 were Caucasians, 1,324 were MRs, and 1,012 were ABs. In general, we recorded 4,155 ECG-12 with normal variations (95.2%). Positive Sokolow-Lyon criteria for left ventricular hypertrophy was more prevalent in ABs (41.8%) than in Caucasians (33.4%), or MRs (32.7%). The prevalence of early repolarization in ABs (41.5%) was higher than in Caucasians (34.6%), or MRs (35.5%). The PR interval was longer in ABs (157.1 ms) than in Caucasians (151.4 ms), or MRs (153.3 ms), and the first-degree atrioventricular block was more frequent in ABs compared to MRs (4.2% vs. 2.3%, respectively). On the other hand, Caucasians had a higher prevalence of incomplete right bundle branch block (14.2%) than MRs (11.2%), or ABs (9.7%). In our sample, only three EBFP showed second-degree atrioventricular block Mobitz type I (0.07%; one Caucasian and two AB athletes).

Conclusions

This is the first large study to compare the prevalence of ECG-12 findings in EBFP from different ethnic groups. Those of AB origin have a significantly higher prevalence of ECG-12 findings compatible with the athlete's heart than Caucasians and MRs.
Psychosocial outcomes after a home cardiac rehabilitation program
Authors: Parada Barcia J , Maria Sol Bravo Amaro M B A , Cristina Prieto Fernandez C P F , Maria Concepcion Abreu Pazo M C A , Antonio Chamorro Comesana A C C , Iria Sanchez I S , Cristina Fernandez Caamano C F C , Maria Jesus Garrido Ferrero M J G , Marisol Samartin Ucha M S U , Isabel Caride Gonzalez I C G , Inmaculada Gonzalez Bermudez I G B , Noa Pineiro Fernandez N P F , Jose Manuel Olivares J M O , Enrique Cespon Outeda E C , Andres Iniguez Romo A I R
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardiac Rehabilitation Programs (CRP) still do not reach all patients with this indication. In the context of COVID-19 pandemic, the new home-CRP model has been introduced.

Purpose

To evaluate the results in terms of improvement of psychosocial outcomes and changes in employment situation with home-CRP.

Methods

Cross-Sectional Observational study that included patients of both sexes, ≥ 18 years, after acute coronary syndrome or after coronary revascularization, included in home CRP. Information was collected from the computerized clinical history of the patients (diseased vessels, degree and type of revascularization, risk stratification). Data was collected at the beginning and in the end after 2 months of the home CRP: smoking habit, weight, abdominal perimeter, anxiety/ depression (measured by HADS: Hospital Anxiety and Depression scale) and employment status.

Results

A total of 173 patients has been studied. Mean age was 51.6 (SD: 7.94), 15.6% women. Indication for home CRP was non ST elevation myocardial infarction (NSTEMI) in 45.7%, 31.8% had STEMI, 17.9% after elective coronary interventions ,3.5% after cardiac arrest, and 1.2% corresponded to other causes. Patients were at low risk in 50%, 48% moderate and 2% high risk. With 1, 2, or 3 vessels disease in 38.1%, 28.3%, and 33.5% respectively. Coronary revascularization was obtained by percutaneous interventions in 80.9%, by surgery in 14.5% and 4.6% of patients received only medical treatment. At baseline, 33.5% obese and 55% smoked at index admission. After two months of home PRHC we obtained a reduction of 85.5% in smoking (p<0.001), a loss of 4.6 kg of weight in obese people (p=0.125), reduction of anxiety (p= 0.0012) and depression (p=0.0013) amongst those who had a HADS scale higher than 10, and improvement in employment status with return to work in 61,2% (p<0.001).

Conclusions

The present study indicates that home- cardiac rehabilitation programs reduce anxiety, depression and improve return to work after acute coronary syndrome.
More likely normal lungs in nowadays children with a congenital heart defect?
Authors: Hock J , Bessar M , Dalla Pozza R , Ewert R , Hager A
Published: May 2023

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Stiftung KinderHerz Weserstr. 101 45136 Essen.

Background

For the last decades, surgical progress lead to better functional outcomes in patients with congenital heart defect (CHD), which may also affect lung function. Reduced lung volumes were found in about half of all patients with a CHD.

Purpose

This prospective study investigated lung function with spirometry and body plethysmography in children with CHD. Data reported were FVC, FEV1, and its ratio (spirometry), together with total lung capacity (TLC), and residual volume, presented as its ratio to TLC (RV/TLC) from body plethysmography.

Methods

From April 2018 to October 2022 fifty-eight young patients (14.0 ± 2.5 years, 16 girls) with CHD participated in the study. Their results are presented as z-scores, sticking to the latest Global Lung Initiative reference values (2021). Values of z-scores <-1.645 in FVC, normal FEV1/FVC-z>-1.645, and a reduced TLC (z<-1.645) represent a restrictive pattern. A reduced FVC-z<-1.645, normal FEV1/FVC-z>-1.645, and an increased RV/TLC-z>1,645 represent a non-specific pattern. FEV1/FVC-z <-1.645 represent an obstructive pattern that can be approved with an increased RV/TLC.

Results

Results in FVC-z were -1.0 ± 1.3, FEV1-z -1.0 ± 1.2, and its ratio 0.0 ± 1.0. TLC-z was -0.4 ± 1.1 and RV/TLC-z reached 0.7 ± 0.7. Sixty-seven percent had normal results. However, 33% had a reduced FVC in spirometry. Only three patients showed decreased FEV1/FVC ratio. However, only five children show restriction (TLC<-1,645), representing 9% of all investigated patients.

Conclusions

Still, about one-third of children with CHD show striking results in lung volumes. Although studies suggest better results in nowadays patients, children’s lung function with spirometry and body plethysmography should be tested regularly in children with congenital heart disease. Since lung function is trainable, these patients might benefit from early diagnosis.
Cardiometabolic risk factors in young adults diagnosed with acute myocardial infarction
Authors: Fernandes R , Kevin Forey K F
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background/introduction

Morbidity and mortality associated with atherosclerotic cardiovascular diseases are prevalent in young patients. Meanwhile, traditional cardiovascular risk calculators underestimate disease risk in young adults.

Purpose

To characterize cardiometabolic risk factors and lipid levels in young adults with acute myocardial infarction.

Setting: A multicenter, population-based analysis of patients diagnosed at our hospitals in Arizona, as well as our clinic health system spanning Minnesota and Wisconsin.

Methods

This is a retrospective cohort study including patients 18 to 50 years old diagnosed with acute myocardial infarction from October 1, 2015, to December 31, 2018. Parameters obtained included: Age, sex, ethnicity, body mass index, tobacco use, comorbid medical conditions, fasting blood glucose, hemoglobin A1c, lipid levels, and prescribed lipid-lowering therapy.

Results

Among 553 young patients diagnosed with acute myocardial infarction, the mean age at the time was 44.4 years, with men accounting for 69.1% of cases. The mean body mass index was 32.2 kg/m2. Hypertension, diabetes mellitus, and tobacco use were present in 64.7%, 25.9%, and 36.2% of patients. Insulin resistance, elevated triglycerides, and low HDL-C were present in 29.8%, 51.0%, and 62.8% of patients, respectively. Approximately 61.3% of patients within this cohort met World Health Organization criteria for diagnosis of metabolic syndrome. Mean LDL-C was 116 mg/dL and mean triglycerides were 190 mg/dL. Statin therapy was prescribed to 92 (16.6%) of patients prior to diagnosis of acute myocardial infarction, whereas 359 (67.3%) of patients met ACC/AHA criteria for lipid-lowering therapy. Within this subgroup receiving statin therapy, the mean serum LDL-C was 101 mg/dl, 26.1% had levels below 70 mg/dL, and 56.5% had LDL-C levels below 100 mg/dL. Thirty-four patients (6.1%) with LDL-C levels greater than 190 mg/dL, and 29 (85.3%) were not on lipid-lowering therapy.

Conclusions and Relevance

Multiple treatable risk factors were present in most young adults with acute myocardial infarction, including many with LDL-C levels below 100 mg/dL. Being overweight or obese was the most prevalent risk factor, while elevated non-HDL cholesterol was the most common lipid panel abnormality. In addition to known cardiometabolic risk factors, these findings build upon a growing body of evidence implicating triglyceride-rich lipoproteins in non-HDL and remnant cholesterol as an independent risk factor of ASCVD, which were common in this cohort of young patients presenting with myocardial infarction. In this cohort, lipid-lowering therapy was underutilized in young patients with known cardiometabolic risk factors, elevated estimated 10-year ASCVD risk, and individuals with phenotypic Familial Hypercholesterolemia.
External validation of Systematic COronary Risk Evaluation 2 - Older Persons (SCORE2-OP) in the EPIC-Norfolk prospective population study
Authors: Van Trier T , Snaterse M , Boekholdt S M , Scholte Op Reimer W J M , Visseren F L J , Hageman S H J , Dorresteijn J A N , Wareham N J , Peters R J G , Jorstad H T
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): EPIC Norfolk was supported by the Medical Research Council UK (programme grants numbers MRC G0401527, MRC G0701863, MRC G1000143) and Cancer Research UK (programme grant number CRUK 8257).

Introduction

The Systematic COronary Risk Evaluation 2 – Older Persons (SCORE2-OP) algorithm is developed to assess 10-year risk of fatal and non-fatal cardiovascular disease (CVD) in apparently healthy individuals aged ≥70 years. We evaluated the performance of SCORE2-OP in the European Prospective Investigation of Cancer Norfolk (EPIC-Norfolk) prospective population cohort.

Purpose

To validate the SCORE2-OP model in men and women aged 70-80 years without prior myocardial infarction or stroke.

Methods

We included individuals aged 70-80 without prior myocardial infarction or stroke. We compared SCORE2-OP (low-risk algorithm) calculated 10-year risk with 10-year observed event rates in the EPIC-Norfolk cohort. SCORE2-OP was calculated using baseline EPIC-Norfolk data (1993-1997). Cardiovascular events were defined as a composite outcome of (i) death due to ischemic heart disease, cardiac failure, cerebrovascular disease or peripheral-artery disease, (ii) non-fatal myocardial infarction or (iii) non-fatal stroke. Observed rates were adjusted for competing fatal events. We evaluated discriminative power using C-statistic and calibration by plotting predicted versus observed event rates and calculating the observed/predicted ratios.

Results

SCORE2-OP was evaluated in 3,712 individuals (54% women) with a median (IQR) age of 73 (72-75) years. Ten-year SCORE2-OP was 10.3% (95% confidence interval (CI) 10.2-10.4) versus observed CVD of 16.8% (95% CI 15.6-18.0), yielding a ratio of 1.6 (95% CI 1.5-1.7). Observed events consisted of 9.4% (95% CI 8.4-10.3) fatal CVD events, 10.6% (95% CI 9.6-11.5) non-fatal myocardial infarctions, 10.5% (95% CI 9.5-11.5) non-fatal strokes, adjusted for 68.9% (95% CI 67.4-70.4) competing mortality events. C-statistic was 0.60 (95% CI 0.58-0.63), with a calibration plot demonstrating underestimation of risk across sex and risk groups.(Figure).

Conclusion

SCORE2-OP underestimates risk in individuals aged 70-80 years, and demonstrates suboptimal discriminative ability. However some underestimation of risk is to be expected given the EPIC-Norfolk baseline between 1993-1997, a low SCORE2-OP calculated risk should not be used as a standalone argument to withhold preventive efforts in older individuals.
The effects of catheter choice on accessory pathway mapping efficiency
Authors: Mariucci E M , Gamboa D , Laranjo S , Gass M , Papagiannis J , Matlock N , Wenzel E
Published: May 2023

Funding Acknowledgements: Type of funding sources: None.

Recent studies have assessed the use of a novel high density (HD) mapping catheter in pediatric patients, finding that the catheter is safe and effective in this population. However, there is a lack of understanding on use patterns of HD mapping technologies in this population and how these patterns affect intraprocedural workflows.

The objective of this analysis was to assess the role of mapping catheter choice on the efficiency of accessory pathway localization and ablation in patients with structurally normal hearts treated in a pediatric EP setting.

Acute data from 61 accessory pathway ablation cases in patients treated in a pediatric EP setting were prospectively collected from 14 hospitals in 6 countries in Europe and the US. Choice of mapping tools and strategy was left to physician discretion. Procedure data such as map collection duration and statistics were compared across three mapping catheter choices: Ablation Catheter (AC) (n=42), Linear Catheter (LC) (n=9), and HD Grid Catheter (HDC) (n=10).

Of the 61 procedures, 16 cases were patients aged 0-12 years (26%), 34 aged 13-17 years (56%), and 5 aged 18+ years (18%). Distribution of catheter use was similar across age groups with HDC use of 13%, 15%, and 27%, respectively. Pathway location did not correlate with catheter choice. There was 0% incidence of congenital heart disease.

Mean mapping times in the AC, LC, and HDC groups were 20.6±15.8, 18.8±12.9, and 14.2±13.8 minutes, respectively; differences in mapping times were not statistically significant but trended lower with higher density mapping. The mean number of mapping points used in each group was 44±46, 101±62, and 1521±908 points, respectively (p<.01). Ablation was attempted in 57 (93%) of cases with 100% acute success eliminating accessory pathway conduction. Ablation time was analyzed in patients receiving RF ablation (93% of treated; n=53); mean RF time was 526s in the AC group, 369s in the LC group, and 367s in the HDC group; differences were not statistically significant (p>.05). All groups had similar ablation target technique distributions including timing map and signal morphology. Mean procedure time was 2:11 (h:mm) in the AC group, 1:56 in the LC group, and 1:44 in the HDC group; differences were not statistically significant.

Analysis of this cohort of pathways in a pediatric setting shows multipolar catheters may provide more mapping information in shorter times. RF ablation and procedure times also trend shorter in procedures with HD Grid used for mapping, regardless of anatomic location of pathway. Further analysis in a larger cohort may be warranted to validate these findings and explore use of open window mapping described elsewhere.
Long term longevity of defibrillator leads: a prospective follow-up over 25 years
Authors: Davril C , Hammache N , Blangy H , Freysz L , Benali K , Girerd N , Sadoul N
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The implantable cardioverter defibrillator (ICD) lead is the most fragile part of the device. Several studies have focused on both the longevity of ICD and the factors associated with lead malfunction but long-term data (i.e., ≥ 10 years) are limited.

Purpose

We report our experience on the very long-term longevity of ICD leads.

Methods

Data from all patients ≥18 years implanted with an transvenous ICD at our university hospital between 1988 and May 2021 were prospectively collected and analyzed. Follow-up was censored in July 2022. Data included patient characteristics, lead characteristics and follow-up data. The primary endpoint of the study was the survival rate without lead failure defined by the 2017 HR consensus . Factors influencing longevity were analyzed.

Results

2093 ICD leads were included in our study. During follow-up (mean = 72.6±56.9 months, range = 11-299), there were 84 lead dysfunction. Lead survival rate was 97% at 5 years, 92% at 10 years, 88% at 15 years and 85% at 24 years respectively. In the multivariate analysis, factors associated with a higher risk of lead dysfunction revealed were: younger age (p = 0.001), channelopathy (p = 0.037), Linox leads (p = 0.041), Riata leads (p = 0.022) and Fidelis leads (p = 0.001). On the other hand, polyurethane coated leads (p < 0.001), Durata leads (p = 0.036), Endotak reliance leads (p = 0.016) and Sprint quattro 6935 leads (p = 0.026) were associated with less lead dysfunction.

Conclusion

The survival rate of the leads decreased progressively between 1 and 24 years after implantation but the risk of lead rupture seems to be maximal within the first 10 years after implant with little increase thereafter.
Predictors of the efficacy of AV-optimised His bundle pacing in patients with a prolonged PR interval: a stratified analysis of the HOPE-HF clinical trial
Authors: Keene D , Kaza N , Arnold A D , Howard J P , Tanner M , Foley P , Chandrasekaran B , Moore P , Bassi S , Muthumala A , Adhya S , Agarwal S , Francis D P , Whinnett Z I , Shun-Shin M J
Published: May 2023

Funding Acknowledgements

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

Background

HOPE-HF was a randomised, placebo-controlled, cross-over trial of AV-optimised His bundle pacing in patients with heart failure (LVEF ≤40%), a PR interval (≥200ms) and without left bundle branch block.1,2.

In this analysis we studied the impact of baseline PR interval and acute blood pressure change at the optimal AV-delay on the placebo-controlled effect of His bundle pacing on the trial endpoints of peak VO2 (primary) and patient symptoms (using the Minnesota Living with Heart Failure Questionnaire).

Methods and Results

167 patients were successfully implanted and randomised to 6 month blocks of pacing and placebo. We performed a non-invasive, high-precision protocol to calculate the optimal AV delay and associated acute blood-pressure response at randomisation.

To test the impact of the baseline PR interval and acute BP response on the placebo-controlled effect of AV-optimised His bundle pacing on endpoints we compared Bayesian ordinal regression models and the relative explained variance (REV) of variables in the model.

There was weak evidence that His-bundle pacing improved peak VO2 across all patients (OR 1.31, 95% CrI 0.86 to 2.01, Pr(OR > 1)=89%). The baseline PR interval had little impact on this benefit (REV 0%), and the blood pressure response was more likely (88% vs 12%) to be predictive.

However, there was strong evidence that overall AV-optimised His-bundle pacing improved patient symptoms as compared to placebo (OR 1.58, 95% CrI 1.04 to 2.40, Pr(OR>1)=98%). Again, the baseline PR interval had little impact on this benefit (REV 0%) and the blood pressure response was much more likely (97% vs 3%) to be predictive.

Higher acute BP increments led to greater placebo-controlled improvements in MLWHF at 6-months.

Conclusion

An individual’s acute BP response with AV-optimised His-pacing is a powerful predictor of their placebo-controlled improvement in symptoms (MLWHF) at 6-months. This can form the basis of patient selection for future studies and clinical practice.
Reorganizing the device clinic: remote monitoring-only of cardiac implantable electronic devices during the Covid-19 pandemic
Authors: Ebrille E , Amellone C , Lucciola M T , Suppo M , Antonacci G , Gotta F , Birolo M , Giammaria M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

COVID-19 pandemic has caused a necessary reorganization of the elective outpatient device clinic. Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) has already been validated as a safe and effective tool to follow patients, limiting the need for in-person visits. Aim of our study was providing a snapshot of the current clinical practice in a tertiary electrophysiology center in Italy and suggesting a potential model of care for patients with CIEDs.

Methods and Results

Before the COVID-19 pandemic, patients with implantable cardioverter defibrillators/cardiac resynchronization therapy (ICD/CRTs) were evaluated in the device clinic twice a year and patients with pacemakers (PMs) once a year; loop recorder (ILR) patients were followed remotely only. In the COVID-19 period (March 2020-February 2021) RM was implemented for all compatible CIEDs. Patients with RM were not seen in clinic anymore and were followed with RM.

In the COVID-19 period, 100% of newly implanted devices received RM (82 ILR, 194 PMs, 80 ICDs/CRTs), compared to 68% in the same months of 2019 (106/106 ILR, 83/203 PMs, 78/82 ICD/CRTs), p<0.01. In addition, 502 previously implanted patients with RM compatible devices were contacted and received RM in the COVID-19 period.

By the end of February 2021, a total of 1676 patients were remotely monitored at our Institution, with a potential saving of outpatient visits of 1683 visits/year, against an average of 8514 RM transmissions/year needing evaluation.

During the study period, we observed 213 clinical events that triggered an urgent manual transmission and/or required physician’s intervention (table 1), successfully resolved over the following 24 h. None of the 1676 patients presented to the emergency room with a problem that went unnoticed by the RM system.

Conclusion

RM of CIEDs is an essential tool to reduce in-person visits during the COVID-19 pandemic and seems to be safe in terms of events detection. The potential for elective outpatient appointments reduction has to be counterbalanced by the sustainability of a large number of transmissions and data to analyze.
Pulsed-field ablation in patients with permanent pacemaker or implantable cardioverter defibrillator: Is it safe?
Authors: Lennerz C , Oconnor M , Schaarschmidt C , Reents T , Bourier F , Lengauer S , Bahlke F , Krafft H , Knoll K , Englert F , Telishevska M , Hessling G , Kolb C , Deisenhofer I , Kottmaier M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Aims

Pulse field ablation (PFA) is a novel catheter ablation technology with safety benefits due to its tissue selectivity. The risk of physical damage or electromagnetic interference (EMI) of PFA with cardiac implantable electronic devices (CIEDs) is unknown. The aim of our study was to assess the risk of PFA for CIEDs.

Methods

PFA lesions (45 per CIED) were applied to CIEDs (<5cm from the lead tip and <15cm from the generator). All devices were checked before and after PFA application for sensing and pacing parameters as well as integrity of shock circuits in ICDs using a heart simulator. Devices were interrogated for any spontaneous reprogramming, mode switching or other EMI effects.

Results

In total, 44 CIEDs were tested (16 pacemaker, 21 ICDs, 7 CRT-P/D) with 1,980 PFA applications. There was no change in device settings, functionality, electrical parameters and there was no visible damage to the CIEDs or leads. The risk on a device-based analysis is 0/44 (95% CI 0%-8%) and on a PFA pulse-based analysis is 0/1,980 (95% CI 0%-0.2%). Clinically relevant EMI appeared with oversensing and pacing inhibition, but not tachycardia detection.

Conclusions

Bipolar PFA appears safe and does not result in damage to CIEDs or leads. Clinically relevant EMI does occur, but appropriate peri-procedural programming may mitigate this. In-vivo studies are needed to confirm our findings.
Implantable cardioverter-defibrillator implantation should be considered in high-risk patients with apical hypertrophic cardiomyopathy as the same manner with the septal type
Authors: Park Y M , Seo J , Shim J , Choi J I , Park S W , Kim Y H , Choi I S
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Apical hypertrophic cardiomyopathy (HCM) is considered to have a benign prognosis in terms of cardiovascular mortality. Sudden cardiac arrest and ventricular fibrillation (VF) in patients with apical HCM is rarely reported.

Methods

Between July 2001 and May 2021, 96 HCM patients who had undergone implantable cardioverter-defibrillator (ICD) implantation from three tertiary hospitals were reviewed. We evaluated the prevalence of aborted sudden cardiac death and/or documented VF in apical HCM and known risk markers for sudden cardiac death in those populations.

Result

Fifteen patients (15.6%) were apical HCM in total population. Among apical HCM, seven patients (40.0%) presented with aborted sudden cardiac death or documented VF, therefore received ICD implantation for the secondary prevention. All seven patients had at least one risk marker suggested either 2020 ACC/AHA guideline or 2014 ESC guideline. One patient had three risk factors and two patients had two risk factors and four patients had one risk factor. Late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR), personal history of unexplained syncope and non-sustained ventricular tachycardia (VT) were the common risk factors.

Conclusions

Clinical outcomes in patients with apical HCM are not always as benign as previously thought. ICD implantation should be considered in high-risk patients with apical HCM as the same manner with the septal type of HCM according to the current guideline recommendations.
The feasibility of utilising a cloud-based storage and analysis software in multicentre clinical electrophysiology research
Authors: Kailey B S , Calvert P , Wood M , Tyler A , Stewart R , Morgan M , Kemp I , Golosovs A , Balasundram A , Ganesananthan S , Borbas Z , Whitaker J , Kanagaratnam P , Gupta D , Luther V
Published: May 2023

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): BioSense Webster Investigator Initiated Study (IIS) Grant.

Introduction

The COVID-19 pandemic enforced long-term changes in healthcare towards remote working, implementing digital systems that support the safe online sharing of clinical information. A cloud-based storage and analysis software has been developed that uploads 3D mapping cases within the CARTO-3 system for remote review. In addition, it uses artificial intelligence/ machine learning to analyse large procedural datasets. We tested the feasibility of this technology as a future research tool in analysing the first 8 cases recruited to the Ripple AT PLUS study.

Methods

The Ripple AT PLUS trial is a planned multicentre randomised trial comparing ablation outcomes in scar based atrial tachycardia (AT) using different CARTO mapping approaches. The study recently commenced recruitment (September 2022). The CARTO files for the first 8 cases recruited into this study from different hospitals were securely transferred from CARTO 3 workstations to the Siemens teamplay gateway. Patient identifiers were removed, and anonymized datasets were successfully uploaded onto CARTONET Microsoft Azure cloud. A secure Web-site (https://eu.cartonet.net/login) was accessed for remote review by the research team.

Results

Uploaded study cases were readily separated from other clinical cases using a research filter. Figure 1 summarises graphical datasets for these study cases presented by CARTONET, (including total procedural duration, mapping vs ablation times, ablation lesions). Their corresponding numerical values were exportable as a Microsoft Excel spreadsheet for individualised review. More detailed mapping and ablation analytics within each case was feasible – this is exemplified in figure 2A, which presents a histogram of the proportion of acquired electrogram bipolar voltages below a modifiable cut-off (0.20mV in this example). Individual case data was easily extracted and combined from all study cases to test different hypothesis – again exemplified in figure 2B, which ascertains how tissue voltage might affect the amount of ablation delivered.

Conclusion

CARTONET is a secure, simple to use, and efficient cloud-based AI/machine learning system that offers access to clinically relevant data-sets from the CARTO system remotely from the hospital premises. This allows for a variety of rapid analytics, with the potential to improve the efficiency of multicentre clinical electrophysiology research collaboration.
Very-early detection of atrial fibrillation in patients after ablation evaluated by a home-based wearable ECG-patch
Authors: Marques Antunes M , Silva Cunha P , Lacerda Teixeira B , Alves S , Portugal G , Valente B , Delgado A S , Bras M , Coutinho Cruz M , Paulo M , Lousinha A , Guerra C , Cruz Ferreira R , Martins Oliveira M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Evaluation of atrial fibrillation (AF) recurrence after AF ablation has been validated by routine ECG and ambulatory 24-h Holter monitoring after a 3-month blanking period. However, assessment of heart rhythm after AF ablation, conducted with the use of intermittent or continuous recording systems, has shown that early recurrences are common, often asymptomatic, and may predict late AF recurrences. The E-Patch (Bio Tel Heart) is an innovative thin, single-use adhesive electrode with extended continuous ECG monitoring for up to 120 hours.

Aim

To describe and characterize predictors of early AF recurrence based on the very- early blanking period after AF ablation.

Methods

Single-centre, prospective, longitudinal study, including consecutive patients (P), 24 hours after AF ablation, monitored with the E- patch. Baseline characteristics at the time of AF ablation as well as the effectiveness of the device in continuously recording within 5 days after ablation were analyzed. A logistic regression model was used to derive predictors of very-early AF recurrence.

Results

A total of 40P were included (60% male, 62±9 years). AF ablation was performed with radiofrequency energy in 23P and with cryoballoon in 17P. All P were in sinus rhythm at the beginning of the E- patch recording. The mean number of hours of recording was 113±18. During E-patch recording

11P (27.5%) presented AF (AF burden 27.4% of the recording, IQR 5.5-32.3%) and 7P (18%) had sinus pauses. In a multivariate logistic regression model, a higher CHADS2VAS2C index and a higher average heart were associated with an OR 3.0 (95% CI 1.13-8.1, p = 0.027) and OR 1.23 (95% CI 1.02-1.48, p = 0.025) for AF recurrence, respectively. No significant differences were found between ablation modalities. There were no complaints about discomfort in the use of the device, and there were no artefacts compromising the quality or the interpretation.

Conclusions

The use of the E-patch recording very-early after AF ablation is effective for AF detection. A higher CHADS2VAS2C index and average heart appear to be significantly predictive of very-early AF recurrence post-ablation.
Lesion formation in irrigated RF-ablation is not linear, but monoexponential
Authors: Bahlke F , Wachter A , Krafft H , Popa M , Englert F , Erhard N , Risse E , Telishevska M , Lengauer S , Lennerz C , Reents T , Hessling G , Deisenhofer I , Bourier F
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Radiofrequency ablation remains one of the most important ablation techniques in the EP lab. Creating durable lesion is difficult, as progression of lesion formation cannot be observed directly. Surrogate parameters, as force-time-integral and indices, as the ablation index or lesion size index, help distinguishing the efficacy of a RF-application, but several deficiencies are known. The aim of this study was to further investigate dynamic changes in ablation parameters and lesion growth in RF-ablation.

Methods

RF-lesions were created using an ex vivo porcine cardiac model with a force and local impedance sensing catheter. A second catheter was used for lesions up to 70 Watts. The experimental setup consisted of a saline-filled container, a dispersive electrode, a heated thermostat and a circulation pump to imitate in vivo conditions. Global impedance was kept at 120 Ohm as well as the temperature at 37°C. RF-lesions were created using identic values of RF duration and electrode tissue coupling. RF power of 20W, 30W, 40W, and 50W was used in the local impedance sensing catheter, while RF power of 30W, 40W, 50W, 60W, and 70W were used in the second catheter.

All parameters (power, temperature, global impedance, ETC, lesion diameter and lesion depth) were measured once per second during application of RF-current, enabling real-time correlation of RF parameters and lesion size. In case of an audible steam pop, RF application was stopped.

Results

In total, 61 lesions were included in the analysis. Due to at least 60 measurements per lesion, 3321 data points with all ablation parameters (power, temperature, global impedance, lesion diameter and lesion depth) were collected and analyzed.

Throughout the application, lesion progression was highest in the first seconds of RF application and showed a slowing approximation to a maximum (Figure 1 and 2). Potential maximum lesion size seems to be defined by selected power level (s. Figure 3). Interestingly, these findings were seen in all power levels from 20 – 70 W (s. Figure 3).

75 % of final lesion size was achieved after 12-25 seconds, depending on selected power levels (s. Figure 4). In high power ablation (> 50 W), 75% of final lesion size was reached significantly earlier compared to lower power levels (20-40 W, s. Figure 4).

Conclusion

In RF-ablation, lesion growth is not linear. A slowing approximation of lesion diameter and depth to a maximum is observed. This finding should be considered in clinical settings to avoid steam pops and collateral damage due to a long RF duration despite little changes in lesion size. Further investigation is needed for a surrogate parameter, which is able to assess declining lesion growth after the first seconds of RF-application.
Evolutionary barriers to horizontal gene transfer in macrophage-associatedSalmonella
Authors: Bhatia Rama P , Kirit Hande Acar , Lewis Cecil M , Sankaranarayanan Krithivasan , Bollback Jonathan P
Published: May 2023

Horizontal gene transfer (HGT) is a powerful evolutionary force facilitating bacterial adaptation and emergence of novel phenotypes. Several factors, including environmental ones, are predicted to restrict HGT, but we lack systematic and experimental data supporting these predictions. Here, we address this gap by measuring the relative fitness of 44 genes horizontally transferred from Escherichia coli to Salmonella enterica in infection-relevant environments. We estimated the distribution of fitness effects in each environment and identified that dosage-dependent effects across different environments are a significant barrier to HGT. The majority of genes were found to be deleterious. We also found longer genes had stronger negative fitness consequences than shorter ones, showing that gene length was negatively associated with HGT. Furthermore, fitness effects of transferred genes were found to be environmentally dependent. In summary, a substantial fraction of transferred genes had a significant fitness cost on the recipient, with both gene characteristics and the environment acting as evolutionary barriers to HGT.
The Sources of Bacillus cereus Contamination and their Association with Cereulide Production in Dairy and Cooked Rice Processing Lines
Authors: Yang Shuo , Wang Yating , Ren Fanchong , Wang Xu , Zhang Wantong , Pei Xiaoyan , Dong Qingli
Published: May 2023

Bacillus cereus, a spore-forming bacterium and frequent cause of food poisoning, poses a safety threat to dairy and rice industries due to its high contamination rates and ability to produce toxins such as cereulide. Because of widespread presence and thermal resistance of the spores, B. cereus cannot be eliminated from the environment and may survive in processing plants. Surviving spores can develop into vegetative cells, leading to a heightened risk of cereulide production in the processing environment. Both spores and vegetative cells have the ability to adhere to the surfaces of dairy plants and form biofilms, serving as the site for cereulide production and accumulation. Therefore, it is crucial for the food industry to address potential sources and pathways of B. cereus contamination and their connections to cereulide production in processing lines. In this review, sources of contamination of B. cereus, including spores, vegetative cells, and biofilms and their potential role in cereulide production at each stage of dairy and cooked rice processing were analyzed. In addition, control methods to prevent B. cereus contamination and cereulide production in processing lines were proposed, offering valuable insights for improving microbial risk management in the food industry.
Effects of Healthy and Neuropathological Aging on Autobiographical Memory: A Meta-Analysis of Studies Using the Autobiographical Interview
Authors: Simpson Stephanie , Eskandaripour Mona , Levine Brian
Published: May 2023

Objectives

A meta-analytic review was conducted to assess the effects of healthy aging, amnestic mild cognitive impairment (MCI), and Alzheimer’s disease (AD) on naturalistic autobiographical memory using the Autobiographical Interview, a widely used, standardized assessment that derives measures of internal (episodic) and external (nonepisodic) details from freely recalled autobiographical narratives.

Methods

A comprehensive literature search identified 21 aging, 6 MCI, and 7 AD studies (total N = 1,556 participants). Summary statistics for internal and external details for each comparison (younger vs older or MCI/AD vs age-matched comparison groups) and effect size statistics were extracted and summarized using Hedges’ g (random effects model) and adjusted for the presence of publication bias.

Results

The pattern of reduced internal and elevated external details in aging was robust and consistent across nearly all 21 studies. MCI and—to a greater extent—AD were associated with reduced internal details, whereas the external detail elevation faded with MCI and AD. Although there was evidence of publication bias on reporting of internal detail effects, these effects remained robust after correction.

Discussion

The canonical changes to episodic memory observed in aging and neurodegenerative disease are mirrored in the free recall of real-life events. Our findings indicate that the onset of neuropathology overwhelms the capacity of older adults to draw upon distributed neural systems to elaborate on past experiences, including both episodic details specific to identified events and nonepisodic content characteristic of healthy older adults’ autobiographical narratives.
Simulation-based training in cardiac surgery: a systematic review
Authors: Arjomandi Rad Arian , Hajzamani Dorfam , Sardari Nia Peyman
Published: May 2023

OBJECTIVES

The increase in the complexity of operations, the rising quest for improved outcomes and the scrutiny of surgical practice and its associated complications have led to a decreased educational value of in-patient surgical training within cardiac surgery. Simulation-based training has emerged as an adjunct to the apprenticeship model. In the following review, we aimed to evaluate the currently available evidence regarding simulation-based training in cardiac surgery.

METHODS

A systematic database search was conducted as per PRISMA guidelines, of original articles that explored the use of simulation-based training in adult cardiac surgery programs in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to 2022. Data extraction covered the study characteristics, simulation modality, main methodology and main outcomes.

RESULTS

Our search yielded 341 articles, of which 28 studies were included in this review. Three main areas of focus were identified: (i) validity testing of the models; (ii) impact on surgeons’ skills; and (iii) impact on clinical practice. Fouteen studies reported animal-based models and 14 reported on non-tissue-based models covering a wide spectrum of surgical operations. The results of the included studies suggest that validity assessment is scarce within the field, being carried out for only 4 of the models. Nonetheless, all studies reported improvement in trainees’ confidence, clinical knowledge and surgical skills (including accuracy, speed, dexterity) of trainees both at senior and junior levels. The direct clinical impact included initiation of minimally invasive programmes and improved board exam pass rates, and creating positive behavioural changes to minimize further cardiovascular risk.

CONCLUSIONS

Surgical simulation has been shown to provide substantial benefits to trainees. Further evidence is needed to explore its direct impact on clinical practice.
Improved uniform error bounds on time-splitting methods for the long-time dynamics of the weakly nonlinear Dirac equation
Authors: Bao Weizhu , Cai Yongyong , Feng Yue
Published: May 2023

Improved uniform error bounds on time-splitting methods are rigorously proven for the long-time dynamics of the weakly nonlinear Dirac equation (NLDE), where the nonlinearity strength is characterized by a dimensionless parameter $\varepsilon \in (0, 1]$. We adopt a second-order Strang splitting method to discretize the NLDE in time, and combine with the Fourier pseudospectral method in space for the full-discretization. By employing the regularity compensation oscillation (RCO) technique, where the high frequency modes are controlled by the regularity of the exact solution, and the low frequency modes are analyzed by phase cancellation and energy method, we establish improved uniform error bounds at $O(\varepsilon ^{2}\tau ^{2})$ and $O(h^{m-1}+ \varepsilon ^{2}\tau ^{2})$ for the second-order Strang splitting semidiscretization and full-discretization up to the long-time $T_{\varepsilon } = T/\varepsilon ^{2}$ with $T>0$ fixed, respectively. Furthermore, the numerical scheme and error estimates are extended to an oscillatory NLDE, which propagates waves with $O(\varepsilon ^{2})$ wavelength in time and at $O(\varepsilon ^{-2})$ wave speed in space. Finally, numerical examples verifying our analytical results are given.
Self-efficacy and self-management mediate the association of health literacy and quality of life among patients with TB in Tibet, China: a cross-sectional study
Authors: Liu An-kang , Liu Yu-yao , Su Jin , Gao Jing , Dong Li-juan , Lv Qi-yuan , Yang Qiao-hong
Published: May 2023

Background

This study aimed to analyze the relationship between health literacy and quality of life in patients with TB in Tibet and explore the mediating effects of self-efficacy and self-management in the relationship between health literacy and quality of life.

Methods

We used a convenience sampling method to select 271 cases of patients with TB in Tibet to conduct a survey of their general information, health literacy, self-management, self-efficacy and quality of life, and to construct structural equation models.

Results

The total health literacy score of patients with TB in Tibet was 84.28±18.57, while the lowest score was for information acquisition ability (55.99±25.66). Scores for quality of life were generally lower than the norm (patients with chronic diseases from other cities in China) (p<0.01). Moreover, self-efficacy and self-management mediated the relationship between health literacy and quality of life (p<0.05).

Conclusions

In Tibet, patients with TB have a low level of health literacy and an average level of quality of life. Emphasis should be placed on improving information access literacy, role-physicals and role-emotional to improve overall quality of life. The mediating roles of self-efficacy and self-management between health literacy and quality of life may provide a basis for further interventions.
Forum: Navigating the Global South Landscape: Insights and Implications for Representation and Inclusion in ISA Journals
Authors: Chagas-Bastos Fabrício H , Resende Erica , Ghosn Faten , Lisle Debbie
Published: May 2023

The International Studies Association (ISA) is widely recognized as an American-European-centric professional organization, with Global South scholars traditionally representing a minority of its membership. This pattern largely reflects the development of the International Relations (IR) discipline and its publication trends. In this Forum, we examine the progress made in the representation of Global South scholars within the IR discipline over the past decade, specifically focusing on the ISA as the primary professional body for IR scholars. We tackle some issues the Global South Task Force (GSTF) highlighted to a more assertive representativeness of the Global South within the ISA. Our analysis concentrates on ISA's journals data tracking to capture the current state of affairs and foster dialogue on developing inventive solutions to enhance diversity, intellectual plurality, and scholarly cultures within the IR discipline. Rather than resorting to outright criticism, we adopt a constructive stance, discussing attempted solutions and proposing steps to advance the discipline.
Drivers of inappropriate antibiotic use in low- and middle-income countries
Authors: Otaigbe Idemudia Imonikhe , Elikwu Charles John
Published: May 2023

Antimicrobial resistance (AMR) is a global security threat that accounts for about 700 000 deaths annually. Studies have shown that antimicrobial resistance could result in a 2% to 3.5% reduction in global Gross Domestic Product by 2050 and a loss of between 60 and 100 trillion US dollars, worth of economic output resulting in significant and widespread human suffering. Low- and middle-income countries (LMICs) will be worse hit by an unchecked rise of AMR. For example, it is predicted that AMR could kill about 4.1 million people in Africa by 2050 if it is not curbed. Similarly rising rates of AMR will lead to increased treatment costs and an inability to attain universal health coverage, in LMICs with fragile health systems. Sadly, AMR is driven by the inappropriate use of antimicrobials, especially antibiotics. Inappropriate antibiotic use is a pertinent problem in LMICs where regulatory frame works are weak. Inappropriate antibiotic use in LMICs is a multifaceted problem that cuts across clinical and veterinary medicine and agriculture. Therefore, efforts geared at curbing inappropriate antibiotic use in LMICs must identify the factors that drive this problem (i.e. inappropriate antibiotic use) in these countries. A clear knowledge of these factors will guide effective policy and decision making to curb inappropriate antibiotic use and ultimately AMR. The focus of this review is to discuss the factors that drive inappropriate antibiotic use in LMICs.