bluuebunny/crossref_metadata_2025 huggingface dataset:
May Measurement Month 2019: an analysis of blood pressure screening results from Saudi Arabia
Authors: Aljuraiban Ghadeer S , Al Slail Fatima Younis , Aldhwailea Shatha Khalid , Badawi Ann Adnan , Beaney Thomas , Clarke Jonathan , Poulter Neil R
Published: May 2021

High blood pressure (BP) is a major risk factor for cardiovascular diseases and was identified as the most significant single preventable cause of mortality. The prevalence of hypertension in Saudi Arabia is high. To raise awareness and identify undiagnosed hypertension, the Saudi Ministry of Health participated in the May Measurement Month (MMM) 2019 global screening initiative of the International Society of Hypertension. Ninety-two primary care centres across the Kingdom recruited respondents aged ≥18 years through opportunistic sampling, from 1 May to 30 August of 2019. Data collection included sociodemographic, lifestyle habits, environmental, and anthropometric indicators. Blood pressure was measured twice using automated BP devices. A total of 25 023 adults were screened with a mean age of 42.4 (16.7) years and a mean body mass index of 27.5 (6.0) kg/m2. In total, 43.6% of participants were females and 56.4% were males. Of all the participants with hypertension, 60.8% were aware, 60.8% were on antihypertensive medication, and 39.3% had controlled BP (systolic BP <140 mmHg and diastolic BP <90 mmHg). Moreover, out of 4440 participants on antihypertensive medication, only 64.6% had controlled BP. The high numbers of individuals with hypertension and with undiagnosed hypertension highlight the importance of BP screening campaigns to increase awareness, detection, and target treatment on a national level. Findings from this study can form a baseline by which to measure progress in future iterations of MMM.
May Measurement Month 2019: an analysis of blood pressure screening results from the United Kingdom and Republic of Ireland
Authors: McDonnell Barry J , Rees Emma , Cockcroft John R , Beaney Thomas , Clayton Bethan , Le Kieu Phuong , Brady Adrian J B , Padmanabhan Sandosh , McCallum Linsay , Dolan Eamon , O’Brien Eoin , Tomaszewski Maciej , Schutte Aletta E , Poulter Neil R , Cappuccio Francesco P ,   the International Society of Hypertension and British and Irish Hypertension Society, Watkeys L M , Munnery A , Seckam F V , Pavino D S , Bhullar E , Ellins C , Barciela
Published: May 2021

In the UK, heart and circulatory diseases account for 29% of all deaths (14% through coronary heart disease and 8% through stroke). In 2015, the prevalence of hypertension was 20% in the UK and 23% in the Republic of Ireland. In 2019, 14% of people registered with a UK general practice had hypertension and yet it was the attributable risk factor for around half of all deaths from coronary heart disease or stroke. We participated in May Measurement Month 2019 to increase awareness of blood pressure (BP) measurement, and to identify the proportion of undiagnosed hypertension and degree of uncontrolled hypertension in the community. The 2019 campaign set up screening sites within the community at places of worship, supermarkets, GP surgeries, workplaces, charity events, community pharmacies, gyms, and various other public places. We screened 10194 participants (mean age 51 ± 18 years, 60% women) and found that 1013 (9.9%) were on antihypertensive treatment, while 3408 (33.4%) had hypertension. Of the 3408 participants with hypertension, only 33.5% were aware of their condition despite 98.8% having previous BP measurements. In those on antihypertensive medication, only 38.2% had controlled BP (<140 and <90 mmHg). Our UK and Republic of Ireland data demonstrate concerning levels of undiagnosed hypertension and sub-optimal BP control in many individuals with a diagnosis. This evidence supports a critical need for better systematic community and primary care screening initiatives.
Blood pressure screening results from May Measurement Month 2019 in Vietnam
Authors: Minh Huynh Van , Poulter Neil R , Viet Nguyen Lan , Sinh Cao Thuc , Hung Phan Nam , Ngoc Nguyen Thi Mong , Hung Ngo Van , Son Tran Kim , Dong Nguyen Ta , Thang Doan Chi , Thuan Nguyen Duc , Tuan To Anh , Beaney Thomas , Partington Giles , Tien Hoang Anh
Published: May 2021

Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. May Measurement Month (MMM) is a global initiative to raise awareness of high BP and act as a temporary solution to the lack of screening programmes worldwide. We aimed to screen for hypertension and cardiovascular risk factors in people aged ≥18 years in the community, thereby defining the proportion of subjects with elevated BP and assess the awareness and the effectiveness of its treatment. An opportunistic cross-sectional survey of volunteers aged ≥18 years was carried out in May 2019. Blood pressure measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. From May 2019 to June 2019, through 10 cities/provinces in Vietnam, 25 887 individuals with mean age 48.7 (SD ±17.7) years were screened. After multiple imputations, 8758 (33.8%) had hypertension. Of individuals not receiving antihypertensive medication, 3025 (15.0%) were hypertensive. Of individuals receiving antihypertensive medication, 2800 (48.8%) had uncontrolled BP. Raised BP [systolic BP (SBP) ≥140 mmHg and/or diastolic BP (DBP) ≥90 mmHg] was also associated with additional risk factors including smoking, alcohol intake, previous hypertension in pregnancy, and obesity. May Measurement Month 2019 was the most extensive BP screening campaign ever undertaken in Vietnam. Undiagnosed and uncontrolled hypertension in Vietnam remains a substantial health problem. Local campaigns applying standardized methods such as MMM 2019 will be beneficial to screen for the significant number of individuals with raised BP and increase the awareness of hypertension.
May Measurement Month 2019: an analysis of blood pressure screening results from Colombia
Authors: Lopez-Jaramillo Patricio , Lopez-Lopez Jose P , Otero Johanna , Alarcon-Ariza Natalia , Mogollon-Zehr Margarita , Camacho Paul Anthony , Sanchez Gregorio , Narvaez Claudia , Casanova Maria , Arcos Edgar , Aroca Gustavo , Quintero Adalberto , Beaney Thomas , Partington Giles , Poulter Neil R
Published: May 2021

Hypertension awareness and control is poor in low- and middle-income countries. Thus, implementing strategies to increase hypertension detection is needed. Colombia participated as one of the 92 countries involved in the third campaign of the May Measurement Month in 2019. Blood pressure (BP) was measured in 48 324 volunteers from 13 departments in Colombia. In total, 27.9% individuals were identified with hypertension. Of those with hypertension, 63.7% were aware of their condition, 60.0% were on antihypertensive medication, and 38.4% had controlled BP. These results showed low levels of awareness, treatment, and control of hypertension in this sample of subjects volunteered to participate, suggest the urgent necessity of implementing programmes to improve the diagnosis and management of hypertension in Colombia.
May Measurement Month 2019: an analysis of blood pressure screening results from Poland
Authors: Sęk-Mastej Anna , Banach Maciej , Mastej Mirosław , Jankowski Piotr , Małyszko Jolanta , Filipiak Krzysztof J , Nowicki Michał P , Tomasik Tomasz , Windak Adam , Olszanecka Agnieszka , Tomaszewski Maciej , Beaney Thomas , Xia Xin , Poulter Neil R , Jóźwiak Jacek
Published: May 2021

May Measurement Month 2019 is the third edition of a global initiative organized by the International Society of Hypertension aimed at raising awareness of hypertension and the need for blood pressure (BP) screening. We present data analysis from Poland. To evaluate the potential of opportunistic BP measurements as a tool for cardiovascular disease prevention programmes. To collect new country data for further annual comparisons. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in 201 sites in May 2019. BP was measured in 7072 subjects (mean age: 54 ± 15 years; 62.3% females). After multiple imputation, the age- and sex-standardized systolic BP (SBP) and diastolic BP (DBP) was 125.4/78.5 mmHg in the whole group, 133.3/82.8 mmHg in individuals on antihypertensive medication and 123.3/77.7 mmHg in those not taking antihypertensive drugs. The proportion of subjects with high BP (≥140/90 mmHg) were 41.8% in subjects taking antihypertensive drugs, and 19.6% in those not taking any antihypertensive drugs. Overall, hypertension was present in 55.4% of participants (3917 out of 7072), of whom 83.0% were aware of their diagnosis. 80.4% of hypertensives were taking antihypertensive medication. 46.7% of all hypertensives had BP controlled to target (<140/90 mmHg). Higher BP correlated with body mass index and age but not tobacco smoking. SBP but not DBP was higher in diabetic participants. These data provide evidence on the current epidemiology of hypertension and may serve as a source of information to introduce primary and secondary prevention programmes to reduce cardiovascular risk in Poland.
May Measurement Month 2019: an analysis of blood pressure screening results from India
Authors: Patil Mansi , Jose Arun Pulikkottil , More Arun , Maheshwari Anuj , Verma Narsingh , Shah Rohan , Kaur Amrit , Kaushik Aprajita , Sepat Priyanka , Beaney Thomas , Clarke Jonathan , Bagadia Leena , Jadhav Swati , Poulter Neil R , Prabhakaran Dorairaj
Published: May 2021

Aims

May Measurement Month is a global screening campaign to raise awareness regarding elevated blood pressure (BP). With the growing burden of hypertension, it is imperative to regularly assess the disease’s prevalence, risk factors, and awareness levels in a country. The current prevalence of hypertension in India as per the National Family Health Survey Data stands at 25.3%. May Measurement Month mobilizes healthcare professionals and sensitizes them to regularly measure BP, and impart lifestyle modification advice to the community. It also complements the deficiency in screening programmes at a national and international level.

Methods and results

May Measurement Month was carried out in May 2019 as an opportunistic screening campaign for adults (≥18 years). It was carried out by over 5000 trained volunteers across approximately 1000 screening sites (hospitals, public places, pharmacies, villages, and malls) in India. A total of 362 708 (57% males and 42.7% females) people were screened, among whom 68.1% had never measured their BP, and 29.4% (n = 106 522) were found to have hypertension. Of these, only 42.0% were on antihypertensive medication and 23.3% had controlled hypertension.

Conclusion

Almost a third of the screened population had hypertension, and less than half of those with hypertension were aware of it or on treatment for it. Among those on antihypertensive drugs, BP was controlled in only half of them. These results support the need for greater impetus on BP screening initiatives to detect hypertension early in the community and prevent complications due to uncontrolled BP.
May Measurement Month 2019: an analysis of blood pressure screening results from Botswana
Authors: Tlhakanelo John Thato , Makwati Obuile , Beaney Thomas , Xia Xin , Kebadiretse Dineo , Ntoni Lisani , Poulter Neil R , Masupe Tiny
Published: May 2021

The May Measurement Month (MMM) 2019 campaign aimed to raise awareness of the health issues surrounding raised blood pressure (BP) among the general public. It also sought to identify and facilitate reduction of BPs of participants who require intervention to lower their BP according to current country treatment guidelines. Participants aged ≥18 years were recruited on site through interactions with the study team, educational fliers, and as voluntary walk-ins in response to the media engagement prior to the campaign. Blood pressures were measured using validated upper-arm cuff electronic devices provided by Omron Healthcare in partnership with International Society of Hypertension. With the participant seated, their back supported and legs resting uncrossed on the ground, three BP and heart rate readings were taken and recorded, 1 min apart. Participants’ basic demographic data were also collected. Hypertension was defined as being on treatment for hypertension, or a systolic BP ≥140 mmHg and/or a diastolic BP ≥90 mmHg (based on the mean of the last two of three readings). Of the 5459 screened participants, 1750 (32.1%) had hypertension, of whom 784 (44.8%) were aware they were hypertensive and 726 (41.5%) were on antihypertensive medication. Among those on antihypertensive treatment, 47.0% had their BP controlled (<140/90 mmHg). Only 19.5% of all those with hypertension had their BP controlled. A total of 1024 (21.6%) of the 4733 participants not on antihypertensive treatment were hypertensive. Intensified preventive and treatment measures to control BP at the health system, individual and population levels remain a critical requirement for Botswana.
QT interval in patients receiving HCQ in SARS-CoV-2- A study on risk factors and correlation of baseline QTc with delta QTc in Pakistani population
Authors: Saadia S , Hassan M , Ejaz T , Shaikh A , Saeed Y , Ahsan S
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Hydroxychloroquine(HCQ) use alone or in combination with Azithromycin (AZM) in SARS-CoV-2 infection is associated with QTc prolongation and risk of arrhythmias.

Objectives

To determine changes in QTc interval and factors predictive of extreme QTc prolongation in patients receiving HCQ alone or in azithromycin combination in Pakistani patients.

Methodology

Retrospective review of records of hospitalized patients with SARS-Cov2 RT-PCR positive result who received HCQ or HCQ/Azithromycin in combination from March-May 2020. Baseline ECGs as well as post drug use ECGs data was recorded. Tisdale score was calculated for predicting risk of QTc prolongation,QTc interval was calculated using Bazett formula. Data entry and analysis was done in SPSS version 23. 

Results

A total of 134 patients were included in the study.  82.1%(110) were males and 17.9%(24) were females, mean age was 54.9 ± 13.7 years. 61.2% (82) had severe disease and 38.8 %(52) had non-severe disease. 14.2%(19) had history of cardiac disease, 35.8%(48) had hypertension and 35.1%(47) had diabetes mellitus. 70.1% (94) patients had received HCQ, AZM, or HCQ/AZM in combination. 40(29.9%) patients had not received any drug. Median baseline QTc among controls and non-control group was 383.5 (IQR 342.25-413.75)msec  and 379(IQR 358-402)msec respectively. HCQ alone was administered to 26.9%(36) and HCQ/AZM to 33.6%(45) patients. 55.6% (45/81) developed QTc prolongation(QTc> 480 msec) or delta QTc increase > 60 msec. 6.2%(5/81) had absolute QTc > 500 msec post-drug administration. 55.6%(25/45) and  30.6%(11/36) (p-value 0.024) developed QTc prolongation in combination and HCQ alone groups respectively. Delta QTc increased to >60msec in 42.0% (34/81); 53.3%(24/45) in  combination group and in 27.8%(10/36) of those receiving HCQ alone( p-value 0.021). Median delta change was 63( IQR 25-81) and 48.5(IQR 26.25-66.75) msec; Median Day 2 QTc  was 413.5 msec (IQR 377.5-436) and 413 msec (IQR361-447); and median maximum QTc was 447(IQR391-471) and 429.8(IQR401.5-45.75) msec in those receiving HCQ/AZM combination and HCQ alone respectively. 9%(12/134) had arrhythmias during hospital stay, in  8.9% (4) and 5.6%(2) patients of those receiving HCQ/AZM combination and HCQ alone respectively, no patient developed torsade de pointes, one patient had non-sustained VT. There was no statistically significant association of QTc prolongation  with mortality, acute kidney injury, myocardial injury or severity of disease. Diuretic use was found to be statistically significant association with QTc prolongation(p-value 0.038). There was a weak correlation of baseline QTc with Δ QTc(r = 0.207 and p-value 0.017)

Conclusion

QTc prolongation was observed in a significant population of patients receiving HCQ and HCQ/AZM combination, however, no significant life threating arrhythmias occurred.
Home fitting of electrocardiogram (ECG) ambulatory monitors during covid-19
Authors: Muddassir Z , Padmadas H , Khan S , Krishnathasan K
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Interruption of health services during COVID-19 leading to increased risk to patients and a backlog for vital outpatient cardiac diagnostic services.

Purpose

To safely deliver ambulatory ECG monitors whilst reducing risk to patients and staff by providing monitors to be fitted at home.

Methods

A system was developed whereby monitors were set up for the patient/carer to collect a preassembled pack and fit at home using videos/written instructions. A retrospective evaluation was undertaken over four months (12/4/20 – 12/08/20) through feedback questionnaires containing closed and open-ended questions.

Results

Of a total of 726 ECG ambulatory monitors fitted in this period 60% were self-fitted. 97 patients gave feedback (13.3%). 84.4% of patients were satisfied with the process. 58.33% felt safer fitting it at home as 40% were fitted in-house due to limitations e.g. elderly/wheelchair/pregnant patients and/or those without access to view the videos. 6 monitors (<1%) were refitted due to artefact/early disconnection. Improvement suggestions implemented included simplifying instructions and adding specific information for female electrode placement.

Conclusions

This project enabled vital cardiac diagnostics whilst maintaining social distancing - reducing infection risk and achieving high patient satisfaction. Implementing a locker system will decrease differing instructions and positively impact waiting times to further reduce viral transmission risks.
Implantable loop recorders in patients with a structural or electrical heart disease: comparison of the clinical value in patients with and without a history of syncope
Authors: Assaf A , Sakhi R , Michels M , Roos-Hesselink JW , Verhagen JMA , Baghwandien RE , Szili-Torok T , Theuns DAMJ , Yap SC
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background Patients with structural and electrical heart disease are at increased risk for sudden cardiac death. Guidelines recommend the use of an implantable loop recorder (ILR) in symptomatic patients when symptoms are sporadic and suspected to be related to arrhythmias. In clinical practice, an ILR is mainly used in patients with unexplained syncope.

Purpose To compare the clinical value of an ILR in patients with a heart disease and a history of syncope versus those with non-syncopal suspected arrhythmia-related symptoms.

Methods In this observational single-center study we included symptomatic patients with structural or electrical heart disease who received an ILR. The primary endpoint was an actionable event which was defined as an arrhythmic event leading to a change in clinical management. The secondary endpoint was an event leading to implantation of a pacemaker or implantable cardioverter-defibrillator (ICD).

Results A total of 120 patients (mean age 47 ± 17 years, 49% men) were included. Underlying disease substrate was inherited cardiomyopathy (31%), congenital heart disease (28%), channelopathy (23%), and other structural heart disease (18%).There were 43 patients with a history of syncope (group A) and 77 patients with non-syncopal symptoms (group B) such as palpitations, dizziness and/or near-syncope at baseline. During a median follow-up of 19 months (IQR 8-36), a primary endpoint was reached in 14 patients (33%) of group A, and in 28 patients (36%) of group B (logrank P = 0.54, Figure A). There was also no significant difference in the cumulative rate of cardiac device implantation between group A and B, 14% versus 10%, respectively (logrank P = 0.97, Figure B).

Conclusion Our results show no differences in ILR yield in patients with structural or electrical heart disease who present with any suspected arrhythmia-related symptom, including those with non-syncopal symptoms. Abstract Figure.
Late gadolinium enhancement as a predictor of arrhythmias in patients with hypertrophic cardiomyopathy
Authors: Castelo A , Rosa S , Fiarresga A , Marques M , Portugal G , Cunha P , Bras P , Ferreira V , Mendonca T , Oliveira M , Ferreira R
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Patients with hypertrophic cardiomyopathy (HCM) are at increased risk of arrhythmias and sudden cardiac death (SCD). The Late gadolinium enhancement (LGE) in cardiovascular magnetic resonance (CMR) has been associated with the occurrence of arrhythmic events.

Purpose

The aim was to analyze the association between LGE burden and location and arrhythmic events in HCM patients (P).

Methods

Retrospective analysis of P with HCM in a single tertiary center. Baseline clinical, echocardiographic and CMR characteristics were collected. On follow up arrhythmias (ventricular fibrillation (VF), sustained ventricular tachycardia (SVT), non-sustained ventricular tachycardia (NSVT), paroxysmal supraventricular tachycardia (PSVT), atrial fibrillation (AF) and atrial flutter (AFL)) were identified. LGE on CMR was compared between patients with and without arrhythmias.

Results

61P (59% male) were included, with a mean age of 58 ± 2 years. The HCM risk-SCD score was 3.35 ± 0.28%. On echocardiography mean left ventricle ejection fraction was 62.16 ± 1.36% and maximum wall thickness 20.59 ± 0.596mm. 31.1% had systolic anterior movement of mitral valve and 26.7% had left ventricle outflow tract obstruction. LGE was present in 88.5% P with a median number of 5 ± 7 segments involved. Interventricular septum (IVS) was involved in 78.7% P, anterior wall

in 57.4%, inferior wall in 54.1%, lateral wall in 52.5%, posterior wall in 9.8%, basal segments in 62.3%, median segments in 68.9% and apical segments in 63.9%. On follow up 3.3%P died, 45.8% had hospitalizations (22,2% because of an arrhythmia) and 75% had arrhythmias (1.6% VF, 6.6% SVT, 50% NSVT, 9.8% PSVT, 37.7% AF and 6.6% AFL). The number of segments with LGE correlated with arrhythmias (p = 0.05 for arrhythmias, p = 0.03 for SVT, p = 0.008 for NSVT and p = 0.042 for PSVT). A cut off of 5 segments involved was a good predictor of arrhythmias (p = 0.002), NSVT (p= 0.006), PSVT (p = 0.024) and AF (p = 0.0029). For SVT the best cut off was 9 (p = 0.003). Considering the LGE location, we found an association between the segments involved and the occurrence of different arrhythmias (table 1).

Conclusion

Supraventricular and ventricular Arrhythmias are frequent in patients with HCM, with the most frequents being NSVT and AF. The LGE burden (>5 segments) and location (median inferior IVS, median anterior IVS, median anterior wall, basal anterior IVS, apical anterior wall, median inferior wall, apical anterior wall and basal inferior IVS) were correlated with arrhythmic events. Abstract Figure.
Buccal mucosa cells as a diagnostic tool in patients with arrhythmogenic cardiomyopathy
Authors: Van Der Voorn SM , Driessen HE , Van Lint FHM , Bourfiss M , Mirzad F , El Onsri L , Vos MA , Van Veen TAB
Published: May 2021

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Netherlands Cardio Vascular Research Initiative (CVON): the Dutch heart foundation

Background

Arrhythmogenic cardiomyopathy (ACM) is predominantly caused by mutations in genes encoding desmosomal proteins (most often multiple different mutations in plakophilin-2), however also mutations in non-desmosomal proteins like phospholamban (PLN, PLNR14Del) are found. Previous investigations showed that plakoglobin protein levels and localization in cardiac tissue of ACM patients is disturbed and this could be a valuable additional tool to discriminate between non-affected family members and those being at risk during progression of the disease. Information about cardiac plakoglobin status can only be obtained via endocardial biopsies, however, this technique has major draw-backs and risks, and therefore an alternative is needed. A promising new non-invasive tool is the use of buccal mucosa cells (BMC), as it has been reported that effects of mutations in desmosomal proteins are additionally reflected in non-cardiac tissues like buccal mucosa smears that do also express those desmosomal genes.

Purpose

To investigate the clinical usability of BMC as tool to classify patients at risk of developing ACM by comparing healthy controls with asymptomatic and symptomatic classical ACM patients, and patients carrying a PLNR14Del mutation.

Methods and results

BMC of 84 human subjects, 33 ACM patients (19 males, 28 with a PKP2 mutation), 17 PLN patients (6 males) and 34 healthy controls (14 males), were collected on glass slides, fixed and labelled with anti-plakoglobin antibodies diluted 1:5.000, 1:10.000, 1:20.000 and 1:40.000, and scored for their membrane labelling. Data revealed that for each applied dilution, plakoglobin protein levels at the membrane were significantly reduced in BMC obtained from ACM patients compared to healthy controls. This effect appeared independent from age and sex of the patients. Furthermore, dilutions 1:5.000 and 1:10.000 showed a moderate correlation with the revised 2010 Task Force Criteria Score (TFC) which are commonly used for ACM diagnosis (Rs -0.67, n = 64, p <0.0001 and Rs -0.71, n = 64, p < 0.0001 resp.) In contrast, plakoglobin scores of PLN patients were similar to controls.

Conclusion

On the population level, there is a significant reduction of plakoglobin protein in BMC membranes of ACM patients but not for patients bearing the PLNR14Del mutation when compared to healthy controls. However, for clinical diagnosis of the individual patient, this method is most likely not discriminative enough to distinguish patients from healthy controls, because of the high interindividual variability.
A novel non-invasive electrocardiographic imaging technique facilitates the preprocedural diagnostic workup of patients with infrequent ventricular arrhythmias
Authors: Lesina K , Hoogendijk MG , De Wit A , Peters E , Szili- Torok T
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Catheter ablation (CA) fails in considerable numbers of patients with ventricular arrhythmias (VAs). Possible reasons include absence and non-inducibility, multifocal origin and anatomically difficult locations of premature ventricular complexes (PVCs) and ventricular tachycardias (VTs). A novel non-invasive electrocardiographic imaging (ECGI) diagnostic tool may help to determine the best treatment strategy of these patients.

Purpose

To evaluate outpatient ECGI (VIVO, View Into Ventricular Onset, Catheter Precision, NJ) to tailor treatment of patients with infrequent ventricular arrhythmias referred for CA.

Methods

Thirteen patients in an outpatient setting with VAs were included in this pilot-study. All patients underwent ECGI mapping using VIVO. It is a novel technique that localize the origin of VAs using a combination of 12-lead ECG and a patient specific 3D anatomical reconstruction of the heart and thorax using cardiac magnetic resonance imaging (MRI) or cardiac computed tomography imaging (CT). The technique is based on virtual simulation of pace-mapping and has a unique feature that the imaging can be performed independently from recording of the arrhythmias. Suitability for ablation was based on the VIVO mapping in this cohort.

Results

Among the 13 patients enrolled (10 female, 3 male, age 39 ±15 years), a total of  16 PVC/VT morphologies were analyzed using VIVO. Ten of them had a low PVC burden (<8%). Ten patients underwent pre-procedural cardiac MRI and 4 had CT imaging. Seven of the patients had structurally normal hearts, while the remaining 6 had non-ischemic cardiomyopathy. Based on the VIVO mapping findings the patients were divided in two groups. Group A: 7 patients in whom ablation was considered suitable. In this group a VIVO based anatomy CA was attempted in 3 patients for  PVCs. Two out of these were successful. Three patients were offered CA but was declined by patient decision (suboptimal balance between burden, complaints and the offered success rates without procedural hard endpoint). Another patient is offered and is waiting for CA. The other group B: 6 patients in whom VIVO mapping was consistent with an unacceptable chance for treatment success were not offered CA. This included: 4 patients with a multifocal origin and a low burden of PVCs. One patient had different diagnosis (atrial fibrillation) and another had no PVC’s during 12-lead ECG monitoring.

Conclusions

Non-invasive ECGI pace-map is a unique tool that can identify the origin of infrequent VAs in an outpatient clinical setting in order to screen out patients not feasible for CA. Low burden PVCs maybe attempted to be ablated when the source is clearly associated of certain anatomical structures.
Impact of the COVID-19 pandemic on electrophysiological procedures at a national referral center
Authors: Cueva-Parra A , Munoz-Benavides G , Ortiz-Solis W , Gomez-Flores J , Marquez MF , Morales JL , Levinstein M , Nava S
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background - Introduction: The COVID-19 pandemic has generated serious repercussions on the health system, reducing the number of all cardiology procedures worldwide.

Objectives

Describe the impact of the COVID-19 pandemic on the procedures performed by the electrophysiology department in a national referral center. 

Methods

We made a retrospective review of our data base and we compared procedures made in the last 3 years since 2017 to 2019 with the procedures made in the 2020. We divide the procedures into two large groups: Cardiac Implantable Electronic Devices (CIED) related procedures (which included implants, revisions, changes, upgrades and extractions) and electrophysiological studies and ablations (which included conventional and complex procedures). Other types of procedures were no included.

Results

There was a significant reduction in all procedures, the average of procedures performed in the last 3 previous years was 467 (there were 479 in 2017, 411 in 2018 and 511 in 2019), while in 2020 we performed only 319 (p = 0.01); this represents a reduction of 33.4% in the total number of procedures performed in our center. There was no statistical difference regarding the CIED related procedures, the average of procedures of the last 3 previous years was 174 (there were 186 in 2017, 148 in 2018 and 188 in 2019), and in 2020 we performed 189 procedures, this value is near to the average of the last 3 previous years and very close to the value of the 2019 (p = 0.46).

Regarding the electrophysiological studies and ablations, the average of procedures of the last 3 previous years was 293 (there were 293 in 2017, 263 in 2018 and 323 in 2019), while in 2020 we performed only 129 procedures, considerably decreasing compared to the previous years (p < 0.01). The reduction in the electrophysiological studies and ablations was 55.97%. The most affected months were April, May and June.

Conclusions

The COVID-19 pandemic considerably affected the number of electrophysiological procedures in our center, reducing it by 33.4% compared to the previous years. The reduction of procedures fundamentally affected the electrophysiological studies and ablations, reducing them by 55.97%. The number of CIED related procedures were no affected. Electrophysiological procedures Procedures2017201820192017-2019 average2020CIED related procedures186148188174189Electrophysiological studies and ablations293263323293129Total479411511467319Comparative table of the electrophysiological procedures performed in our center in recent years.Abstract Figure. Comparison of the procedures.
The dose-dependent effect of chronic Verapamil treatment on cardiac function in isolated rat heart with Hypertension
Authors: Simovic S , Jeremic J , Davidovic G , Srejovic I , Zivkovic V , Ravic M , Nikolic M , Iric-Cupic V , Vucic R , Sreckovic M , Miloradovic V , Andjic M , Rankovic M , Draginic N , Jakovljevic V
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Verapamil, a calcium channel blocker, is used for treatment of hypertension, paroxysmal supraventricular tachycardia  and angina pectoris. It primarily blocks L-type calcium channels preventing excessive influx of calcium into cardiomyocytes, leading to negative inotropic effect, and smooth muscle cells resulting in reduced relaxation of vasculature. With calcium antagonism it also causes negative chronotropic effect. However, there is no data on it’s dose-dependent effects on cardiac dynamic parameters and heart rate on isolated rat heart with hypertension.

Purpose

To investigate chronic, dose-dependent effects of Verapamil on cardiodynamic parameters in isolated rat heart with hypertension.

Methods

The present 4-week study was carried out on 24 spontaneously hypertensive Wistar Kyoto male rats  (6 weeks old): Control (n = 6), rats treated with 0.5 mg/kg/day of Verapamil (n = 6), rats treated with 5 mg/kg/day of Verapamil (n = 6) and rats treated with 50 mg/kg/day of Verapamil (n = 6). Isolated rat hearts were perfused on Langendorff perfusion apparatus.

Results

Chronic, low-dose Verapamil treatment significantly depressed function of all cardiodynamic parameters of the hypertensive heart when compared to the rats treated with higher doses of Verapamil (p < 0.001), except on the coronary flow and heart rate when compared to the Control (p= 0.137; p = 1.000, respectively). There was no significant differences between Verapamil in middle dose (5 mg/kg/day) and the Control group in inotropic (p = 0.415) and lusitropic (p = 1.000) effects, while it significantly lowered values of coronary flow (p = 0.002). It achieved significantly lower inotropic, lusitropic and chronotropic effects (p < 0.001) than high Verapamil dose and significantly better inotropic (p = 0.017), lusitropic (p < 0.001), but not chronotropic effects than low-dose Verapamil treatment (p = 0.179). High-dose, chronic treatment with Verapamil significantly intensified function of  the isolated rat heart with hypertension when compared to Control and lower doses of Verapamil (p < 0.001), without significant effects on coronary flow (p = 0.363).

Conclusions

Chronic treatment with Verapamil in high dose achieved better inotropic, chronotropic and lusitropic effects than treatment in low and middle doses of Verapamil, without significant effects on coronary flow. There is dose-depended effect of chronic Verapamil treatment on cardiac function of isolated rat heart with hypertension.
Second and fourth generation Cryoballoon based left atrial appendage isolation for the treatment of persistent atrial fibrillation
Authors: Heeger CH , Meyer-Saraei RMS , Fink TF , Sciacca VS , Vogler JV , Eitel CE , Kuck KHK , Ouyang FO , Tilz RRT
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Although pulmonary vein isolation (PVI) is an effective treatment strategy for patients with paroxysmal atrial fibrillation (AF), it is associated with limited success rates in patients with persistent AF (PersAF). In this context the left atrial appendage (LAA) was recently identified as a target of catheter ablation especially in PVI non-responders. Although effective, this strategy may cause electromechanical dissociation and was therefore assumed to be associated with an increased risk of thromboembolism despite oral anticoagulation (OAC). Since RF based LAAI showed increased rates of thromboembolism and stable LAAI is difficult to achieve in some cases, Cryoballoon-based LAAI might offer a valuable option to achieve safe and durable LAAI. Recently the fourth generation cryoballoon was introduced. Additionally, the 40% shorter tip potentially increases the safety profile as well as efficacy of CB-based LAAI.

Objective

To assess safety and efficacy on CB2 vs CB4 based LAAI.

Methods

Cryoballoon based PVI and LAAI was performed in 20 patients with PersAF and long-standing PersAF. The first 10 consecutive patients were treated by the second-generation cryoballoon (CB2) the last 10 patients were treated by the CB4. LAAI was performed by utilizing a bonus freeze protocol (freezing time 300 seconds + another 300 seconds after LAAI).

Results

Stable LAAI was achieved after a mean of 2.6+/- 1.7 cryoballoon applications with a mean minimal temperature of -52+/-6 °C. Unless one phrenic nerve palsy (5.6%) of the left phrenic nerve no further periprocedural complications occurred. Successful LAAI was performed in 19/20 (95%). TEE after 6 weeks detected LAA thrombus in 3/10 (30%) patients (CB2 group) and 3/10 patients (30%) (CB4 group), p = 0.99. Successful LAA-closure was performed in 16/20 patients (80%) after a mean of 75+/-59 days. The LAA was durable isolated in 8/9 patients (89%, CB2) and 6/8 patients (75%, CB4), p = 0.56). AF recurrence after 6 weeks was 1/10 (10%, CB2) and 3/9 (33%, CB4), p = 0.26.

Conclusions

Here we used – to our knowledge – for the first time a CB4 for LAAI, followed by a combined check for LAAI and LAA-closure after 6 weeks, compared to the CB2. LAAI was successfully isolated by both cryo-balloons in the majority of patients. Hence the use of newest cryo-balloon generation for LAAI seems a safe and successful procedure compared to earlier balloon generations. However, a relatively high rate of LAA-Thrombus was detected after LAAI. Therefore, LAA closure is mandatory in this population.
Predictive value of early AF recurrence after cryoballoon ablation
Authors: Boehmer AA , Rothe M , Soether CM , Abboud J , Dobre BC , Kaess B , Ehrlich JR
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Early recurrence of atrial fibrillation (ERAF) during a blanking period of 90 days after radiofrequency ablation has been associated with worse long-term outcome. However, the impact of ERAF after cryoballoon pulmonary vein isolation (cryoPVI) is less clear.

Objective

A prospective comparison of long-term ablation success after cryoPVI between patients who had ERAF during the blanking period and patients who remained free of AF recurrence during this period.

Methods

We analyzed consecutive patients who underwent cryoPVI in a single-center cohort between 2018 and 2020. Follow-up was performed at 3, 6, 12, 18 and 24 months after ablation. Primary endpoints were: symptomatic AF recurrence after a 90-day blanking period for efficacy and bleeding, phrenic nerve injury, stroke or death for safety.

Results

472 consecutive patients with paroxysmal or persistent AF who underwent cryoPVI in a single-center cohort were analyzed. Mean follow-up time was 15 months. 64 patients presented with ERAF during blanking period (age 70 ± 8 years, 52% male gender, CHA2DS2-VASc 2.9 ± 1.5) while 408 patients demonstrated freedom from AF within the first 90 days after cryoPVI (age 69 ± 10 years, 57% male gender, CHA2DS2-VASc 2.7 ± 1.4). At 24 months, Kaplan-Meier estimates showed a significantly higher AF recurrence in patients with ERAF compared to patients without ERAF (74.6 % vs. 33.3%, P < 0.0001, Figure). Cox-regression analysis confirmed ERAF as independent predictor of impaired long-term ablation success after cryoPVI for both paroxysmal and persistent AF (P < 0.0001). Primary safety endpoint occurred in form of pericardial effusion or transient phrenic nerve palsy in one patient with ERAF (1.5%) and five patients without ERAF (1.2%). No deaths or strokes were observed.

Conclusion

ERAF during blanking period predicts long-term sucess of patients undergoing cryoPVI. Prospective studies addressing outcome optimisation in this particular cohort of patients are needed. Abstract Figure.
Radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia using standardized voltage mapping system protocol
Authors: Bulian F , Manfrin M , Rauhe W
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

 according to European guidelines, ablation has become the treatment of choice in patients with symptomatic atrioventricular nodal reentry tachycardia (AVNRT). Despite the high procedure success rate, anatomical variations can affect the outcome in terms of relapses and complications. As recently demonstrated, low-voltage bridge visualization allows low pathway identification and therefore a new ablation strategy.

Purpose

our purpose was the validation of standardized ablation protocol within the low-voltage bridge area. 

Methods

70 consecutive patients with inducible AVNRT were evaluated and a three-dimensional voltage map of the right atrial septum and Koch Triangle was constructed by means of contact mapping. Ablation site was identified as the low-voltage area below the His bundle, adjusting the high-voltage slider to 1,5 mV and dynamically adjusting the slider of low-voltage. Radio-frequency energy (with an average number of nine lesions per patient) was then delivered within this area until the appearance of junctional beats. The results were tested at the end of the procedures and during the observational period (the mean follow-up was 10,5 months). 

Results

the slow pathway was identified by the low-voltage bridge in 60 patients (85,6%) and in these patients, the target lesions in that area finally prevented induction of AVNRT in 100% of cases. A zero-fluoroscopy approach was possible for 50 patients (83%). Compared with standard AVNRT ablation, no complications as well as no statistical differences in terms of total procedure time were observed (p = 0,056). 59 patients (98%) had no relapses during the follow-up. 

Conclusions

voltage gradient mapping successfully targeted the slow pathway in most of our cases. Lesions on the voltage bridge led to effective ablation of AVNRT and to a drastic x-ray exposure reduction in the absence of acute or long-term complications. Abstract Figure. Last lesion on low-voltage bridge.
Benefits of catheter ablation of typical cavotricuspid isthmus-dependent atrial flutter using half-normal saline
Authors: Vecchio N , Militello C , Lopez Diez JC , Schnetzer N , Dorado J , Basile F , Bochoeyer A
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Radiofrequency catheter ablation (RFA) of cavotricuspid isthmus–dependent atrial flutter (AFL) is a procedure with a high success rate and a low complication rate. The anatomical variation and irregularity of the isthmus, with the high local blood flow, can reduce the effectiveness of the lesion and consequently of the procedure.

Recent data suggests that deeper ablation lesions can be created using open-irrigated catheters (CA) with half-normal saline (HNS).

Purpose

To assess the acute efficacy and safety of RFA of AFL with half-normal saline (HNS). Compare the results with CA irrigated with normal saline (NS).

Methods

Randomized, prospective, observational and single-center study. Consecutive patients with first AFL RFA between June 2019 and December 2020 were included. CA with HNS or NS were used, with a limit of 40 watts  and 40° C. An RFA line was performed under fluoroscopic guidance or electroanatomic mapping. If necessary, the lesion was repeated until the arrhythmia was interrupted and the bidirectional block was achieved (success).

Acute success, total radiofrequency time (RT), number of radiofrequency applications, and complications were analyzed.

Results

 

38 patients with RFA of AFL were analyzed. 19 in the HNS and 19 in the NS group. There were no significant differences between the baseline characteristics of each group. (Table 1)

The accute success rate was 100% with a median of 2 RFA applications in both groups. The mean RT in HNS was 7:10 vs 09:16 min in NS group; the t-test analysis did not show a significant difference (p = .2).

A subanalysis was performed in those patients who required more than 2 lines of RFA; a mean of 4 in the HNS group vs 6 in the NS group (p = .4). In the HNS group, RT was significantly shorter; 8:17 vs 13:17 min in the NS group (p = .011). (Figure 1)

There was a steam pop in the HNS group and no complications or steam pop in the NS group (p = .53).

Conclusions

 

RFA of AFL using HNS is an effective and safe procedure. In patients with unfavorable anatomy who required a greater number of applications, the radiofrequency time was significantly shorter using HNS. Baseline characteristicsHNS (19 p)NS(19 p)pAge56 ± 12.3 years61 ± 10.8 years.22Male16 p (84%)16 p (84%)1Heart Disease7 p (36.8%)5 p (26.3%).68Ejection Fraction57.1 ± 11%56 ± 14.3%.49Ejection Fraction < 50%2 p (10.5%)2 p (10.5%)1Electroanatomic mapping10 p (52.6%)8 p (42.1%).7Abstract Figure. Fugure 1
Characterization of atrial lesion safety and efficacy utilizing a circular catheter and the IRE generator with an in vivo porcine model
Authors: Hsu J , Gibson D , Banker R , Doshi SK , Gidney B , Gomez T , Berman D , Datta K , Govari A , Natale A
Published: May 2021

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): Biosense Webster, Inc.

Introduction/Objectives:

Pulsed field ablation (PFA) is a non-thermal ablative method that delivers high voltage, very-short duration pulses that cause pore formation in the cytoplasmic membrane and cell death. The tissue selectivity of PFA is expected to reduce the risk of collateral tissue injury compared to radiofrequency catheter ablation (RFCA), while maintaining effectiveness.  The objective of this study was to perform pulmonary vein (PV) isolation in a porcine model to characterize the safety and performance of a novel, fully-integrated biphasic PFA system. The system is comprised of a multi-channel generator, a variable loop circular catheter, and an integrated irreversible electroporation (IRE) mapping software module.

Methods

The study evaluated safety and efficacy of IRE in 8 healthy swine. First, to evaluate safety, multiple ablations were performed at various cardiac structures, including within the lumen of the right pulmonary vein (RIPV), at the right superior pulmonary vein (RSPV) ostium, and adjacent to the esophagus. Second, to evaluate efficacy, animals were recovered and followed for 30 (±3) days, then re-mapped. Gross pathological and histopathological examinations were performed to assess for procedural injury, chronic thrombosis, tissue ablation, depth of penetration, healing, and level of inflammatory response.

Results

All 8 swine survived for the 30 (±3) day follow up (FU) period. There were no acute (day of procedure) incidents of pulmonary vein narrowing of >70%, nor at 30 d follow-up (FU), even when ablation was purposefully performed directly deep to the ostium of the vein. No injury was seen grossly or histologically in the adjacent esophagus. All PVs were durably isolated as confirmed by bidirectional block at the 30 (±3) day re-map procedure, and histological examination showed complete, transmural necrosis around the entire circumference of the ablated section of the right PVs [Figure].

Conclusion(s): This pre-clinical evaluation of a fully integrated PFA system demonstrated effective and durable ablation of cardiac tissue and PV isolation with no collateral damage to adjacent structures. Notably, histological staining confirmed complete transmural cell necrosis around the circumference of the ostial PV at 30 days. Abstract Figure. PVI maps (A) histology (B) and safety(C)