bluuebunny/crossref_metadata_2025 huggingface dataset:
Network of compression networks to extract useful information from multivariate time series
Authors: Walker David M , Corrêa Débora C
Published: May 2023

Compression networks are the result of a recently proposed method to transform univariate time series to a complex network representation by using a compression algorithm. We show how a network of compression networks can be constructed to capture relationships among multivariate time series. This network is a weighted graph with edge weights corresponding to how well the compression codewords of one time series compress another time series. Subgraphs of this network obtained by thresholding of the relative compression edge weights are shown to possess properties which can track dynamical change. Furthermore, community structures—groups of vertices more densely connected together—within these networks can identify partially synchronized states in the dynamics of networked oscillators, as well as perform genre classification of musical compositions. An additional example incorporates temporal windowing of the data and demonstrates the potential of the method to identify tipping point behaviour through the analysis of multivariate electroencephalogram time series of patients undergoing seizure.
Cardiovascular risk factor profile in patients admitted to a community-based cardiac rehabilitation program after one year: what risk factors are not being controlled?
Authors: Salgueiro D , Borges M , Pires M , Guerreiro C , Pinto F , Abreu A , Pinto R
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiac rehabilitation (CR) is a multidisciplinary intervention designed to reduce cardiovascular (CV) risk, encourage healthy behaviors, reduce physical impairment, and promote an active lifestyle. After completing a phase II CR program, it is important to maintain long-term CV risk factor control. However, many patients do not achieve or maintain lifestyle and risk factor targets on a long-term basis. Therefore, it is of interest to understand which risk factors are not reaching the targets to better understand and personalize long-term community-based CR programs.

Purpose

To characterize the modifiable CV risk factors profile in coronary artery disease (CAD) patients admitted to a community-based phase III CR program, including lipid profile, overweight/obesity, physical activity (PA) and sedentary behaviour (SB), at the beginning and after completing the first year of the CR program.

Methods

This retrospective cohort study included CAD patients that attended for 1-year a community-based phase III CR program. At the beginning (M0) and after one year (M1) of the CR program, all patients performed a risk profile assessment including: Lipid profile [total cholesterol (total-c), high density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL)], body mass index (BMI), PA and SB. BMI was assessed with the patient's weight in kilograms divided by the square of height in meters and lipid profile values were obtained from blood testing. PA and SB were objectively measured by using an accelerometer. All participants attended supervised exercise sessions, 3x week, 60 mins, including aerobic and resistance exercises, 3 educational sessions and a nutritional counseling consultation per year.

Results

In the sample of 159 patients at baseline (81.8% male, mean age 61±10 years, BMI: 28.3±4.3 kg/m²), overweight and obesity proved to be the most prevalent risk factor (80.7%), followed by uncontrolled LDL levels (74.8%). After a 1-year intervention (n=48, 90% male, mean age 62±10 years), LDL levels were kept above the targets (M0: 73.3±28.9 mg/dL and M1: 68.6±19.6 mg/dL, p=0.186), BMI did not change (M0: 27.5±3.9 kg/m² and M1: 27.8±4.0 kg/m², p=0.168) and SB remained high (M0: 11.50±2.90 hours/day and M1: 11.58 ± 2.71 hours/day, p=0.908). Although, moderate to vigorous PA (MVPA) decreased (M0: 343±195 mins/week and M1: 293±164 mins/week, p<0.001), participants were still on target, between 150 to 300 mins MVPA week.

Conclusion

Our findings show that after a 1-year of a phase III CR program intervention CVD patients maintained MVPA recommended levels, but did not reach body composition, lipid profile, and SB targets. Future strategies should be implemented in long-term CR programs to better control LDL, body composition and SB.
Overview of Cardiac Rehabilitation (OCRE) in European Society of Cardiology (ESC) Member Countries
Authors: Ruivo J R , Trine Moholdt T M , Abreu A A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Despite unambiguous guideline recommendations, the implementation of Cardiac Rehabilitation (CR), a cost-effective strategy of secondary prevention with the potential to reduce cardiovascular morbi-mortality, remains heterogeneous, mostly suboptimal, in Europe. A previous "Overview of CR in ESC member countries" (OCRE) analysis reported on diverse national uptake rates and singled out possible common CR provision and quality surrogates contributing to the distinct performances. However, an integrated understanding of the overall status and concomitancy of the provision and quality indicators (or the lack thereof) in each country was still lacking.

Purpose

The present OCRE analysis aimed to further characterize and compare ESC affiliated national CR settings, by scoring the national overall provision and quality status, and to describe the matching between both.

Methods

An online survey concerning key CR provision and quality indicators was sent to the network of National CVD Prevention Coordinators of ESC member states, whose answers were supported by published evidence and/or national expert consensuses. To summarize the findings from the OCRE study, we assigned participating countries based on their provision of CR and their CR quality, to three different categories: lacking, average, and good. Provision was rated considering the following indicators: uptake rate, dropout rate, average start time, average duration, and public funding. CR quality was sought by scoring the presence of: guidelines, guidance documents, coordination by cardiology, mandatory rotation in cardiology training, national accreditation, and electronic database registry.

Results

The data suggested that although provision of CR is at an encouraging level in Europe (Fig.1), it often is of suboptimal quality (Fig.2), signalling the need for improvement in the allocation of human and monetary resources.

Conclusions

This study provides a comprehensive characterisation of CR in Europe, generating important insights on the current provision and quality of CR in Europe, highlighting its sucesses and shortcomings, and discussing important strategies to overcome current obstacles.

Particularly, we consider that European CR programs need to be based upon the same minimal quality standards. However, we acknowledge the differences in economy, culture, religion, health system, climate, and literacy across the different countries. These need to be considered and respected, and a shared CR plan should contemplate the diver sity and promote adjustments for each country while also preventing it from falling short of the common set goals.
Baseline pr internal prolongation and elevated diastolic blood pressure are predictors of new-onset atrial fibrillation in hypertensive patients
Authors: Papakonstantinou P , Andrikou I , Konstantinidis D , Tsioufis K
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

One of the most significant risk factors for atrial fibrillation is hypertension (HTN) (AF). Although the PR interval is a factor in the Framingham risk score for AF, it has been linked to an elevated risk of incident AF. However, there is a lack of consistency in the findings identifying PR prolongation as a risk factor for AF.

Purpose

In a large cohort of HTN patients, we seek to assess the predictive value of the PR interval for the emergence of AF.

Methods

The average follow-up time for consecutive individuals with essential hypertension and no known AF at baseline was 5.3 years. Each patient underwent a 12-lead ECG, an echocardiogram examination, and a 24-hour Holter rhythm monitoring in the event of arrhythmia complaints. These tests were done at baseline and once a year. The European Society of Cardiology/European Society of Hypertension guidelines for HTN therapy were followed during the follow-up period, including routine clinical and paraclinical assessments and drug administration. The baseline ECG was used to determine the PR interval and P wave length.

Results

We included 1807 hypertensives (mean age 57±11 years; 49% men) with office systolic/diastolic blood pressure of 144±17/89±11 mmHg. A total of 65 occurrences of new-onset AF (3%) were reported during the follow-up period. P wave duration and PR internal time were longer at baseline in patients with new-onset AF (n=67) compared to those without AF (n=1740) (P wave, 115 vs 110 ms) (PR interval, 174 vs 157 ms). A multivariate Cox regression analysis showed that baseline P wave duration had no significant prognostic value for the occurrence of new-onset AF, but baseline PR internal was substantially linked with the development of AF (HR = 1.01, 95% CI = 1.01-1.02; p = 0.01). A greater incidence of AF was linked to baseline elevated diastolic blood pressure (HR 1.05, 95% 1.003-1.091; p=0.037).

Conclusions

Baseline PR internal and elevated diastolic blood pressure were significant predictors of new-onset AF in hypertensive patients. PR prolongation may be a marker for cardiovascular degenerative aging caused by vascular inflammation and myocardial fibrosis.
Clustering of cardiovascular and renal comorbidities and risk of incident atrial fibrillation in the community-based PREVEND cohort
Authors: Van Deutekom C , Geelhoed B , Van Munster B C , Bakker S J L , Gansevoort R T , Van Gelder I C , Rienstra M
Published: May 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): The PREVEND study is supported by the Dutch Kidney Foundation and the Netherlands Heart Foundation.

Background

Atrial fibrillation (AF) is a condition that occurs in the presence of comorbidities. With the accumulation of comorbidities over time, certain comorbidities may more often occur together than others, i.e. clustering of comorbidities. Acknowledging clustering of certain comorbidities may have implications for diagnosing previously unrecognized comorbidities, and clusters of comorbidities may carry differential risks of diseases, like AF. Albeit that the individual cardiovascular risk factors and comorbidities are well known, information on the impact of clustering of these on incident AF is sparse.

Purpose

We aimed to investigate the presence of clusters of cardiovascular and renal comorbidities and study the association between comorbidity clusters and incident AF.

Methods

We used the community-based Prevention of Renal and Vascular ENd-stage Disease (PREVEND) cohort in which 8,592 individuals participated. We excluded individuals with prior AF or missing ECG data, leaving 8,265 individuals for analysis. Atrial fibrillation was diagnosed if either AF or atrial flutter was present on a 12-lead ECG during one of the study visits, or at an outpatient visit or hospitalization. Latent class analysis was performed to assess clustering of 10 cardiovascular and renal comorbidities. The optimum number of classes was determined by the number of classes for which the Bayesian information criterion (BIC) reached a minimum value. As secondary analysis, latent class analysis was repeated with additionally including age, sex, and ethnicity. Kaplan-Meier analysis was performed to calculate the cumulative probability of incident AF, stratified by the latent classes.

Results

In the total population, the mean age was 48.9±12.6 years and 50.2% were women. During 9.2±2.1 years of follow-up, 251 individuals (3.0%) developed AF. Latent class analysis resulted in a model with three clusters as the optimal model, with one cluster being young (44.5±10.8 years) and healthy, carrying a low (1.0%) risk of incident AF; one cluster being older (63.0±8.4 years) and multimorbid, carrying a high (16.2%) risk of incident AF and a third middle-aged (57.0±11.3 years), obese and hypertensive cluster carrying an intermediate risk (5.9%) of incident AF. When adding age, sex and ethnicity to the latent class analysis, similar results were observed.

Conclusion

We identified three clusters of individuals in the community-based PREVEND cohort. The three clusters contained different amounts of comorbidities carrying different risks of incident AF. However, there were no differences between clusters regarding specific combination(s) of comorbidities.
Effectiveness of electrical cardioversion for persistent atrial fibrillation in the ongoing protocolenergy: hawthorne effect trial
Authors: Jiravsky O , Rucki L , Spacek R , Szmek B , Ranic I , Hrosova M , Neuwirth R , Hudec M , Sknouril L , Chovancik J
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Electrical cardioversion (DCCV) is a long-used and proven method for the acute termination of atrial fibrillation episodes. The methodology for optimal performance of DCCV with the highest level of effectiveness while maintaining maximum safety is still under investigation. To validate our proposed methodology for performing DCCV, we have initiated the PROTOCOLENERGY clinical trial, which is currently ongoing.

Objective

To test the effect of conducting a clinical trial on the effectiveness of cardioversion in patients who were not included in the study for any reason.

Methodology

A retrospective analysis of the DCCV registry from the indications of persistent atrial fibrillation (long-term persistent excluded) from 2015-8/2022. Statistical comparison of the demographics and overall effectiveness of the DCCV cohort before and after study initiation and comparison of the cohort, enrolled and not enrolled since study initiation (no interim analysis of the study cohort proper). Heart rate 1 min after the last discharge is assessed.

Cohort

A total of 2402 procedures were analyzed in 829 women (34.5%) and 1573 men (65.5%) aged 67 (+/-10) years, with CHADSVASC score of 3,0 (+/− 1), BMI 31.2 (+/-7.7).

Results

DCCV efficiency in the whole cohort was 91.1%. Before the study, SR was achieved in 90% of the 1981 patients; since the start of the clinical trial, DCCV efficacy increased to 96.4% (in a cohort of 421 patients) (p <0.001). There was no statistically significant effect in efficacy between patients included in the clinical trial (312 pt.) and those not included (109 pt.) (96.5% vs. 96.3% p=0.944).

Conclusion

The presented data suggest an effect of developing and controlling the methodology of DCCV performance in a clinical trial on increasing the efficacy of DCCV, even in the cohort of patients not enrolled in the clinical trial. That phenomenon is called the HAWTHORNE effect and is related to the improvement of the outcome of the investigated phenomenon due to the influence of the actual investigation. In this case, probably due to strict adherence to the study protocol ( paddle pressure during DCCV, cardioversion in expiration, adherence to predetermined cardioversion energies, etc. even in patients not included in the study).
Using computed tomogram atrial myocardial thickness maps in high-power short-duration radiofrequency pulmonary vein isolation: a prospective randomized clinical study
Authors: Hwang T , Kwon O , Yang S , Kim D , Yu H , Kim T , Uhm J , Joung B , Lee M , Hwang C , Pak H
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by a grant [HI21C0011] from the Ministry of Health and Welfare, a grant [NRF-2020R1A2B5B01001695] from the Basic Science Research Program run by the National Research Foundation of Korea (NRF) which is funded by the Ministry of Science, ICT & Future Planning (MSIP), and a grant [RS-2022-00141473] from Cross-ministerial tasks.

Background

High-power short-duration (HPSD) ablation generates wide and contiguous but shallow lesions by radiofrequency (RF) resistive heating. It is unknown whether RF energy titration has additional benefits depending on the atrial wall thickness.

Purpose

We aimed to compare the efficacy and safety of HPSD energy titration depending on left atrial wall thickness (LAWT) during circumferential pulmonary vein isolation (CPVI) in patients with paroxysmal atrial fibrillation (PAF).

Methods

We prospectively randomized 224 patients with PAF (69.2% males, 59.3±12.0-years-old) into either the LAWT-guided CPVI group (WT, n=113) or the conventional CPVI group (Control, n=111). We delivered 15s of constant RF (contiguous lesion 2mm dots, FlexAbility) at 60W in the Control group but titrated the RF duration in the WT group (15 s at LAWT>2.1mm, 13s at 1.4–2.1mm, and 11s at <1.4mm) referencing the computed tomogram-myocardial thickness color map. The primary endpoints were safety and AF recurrence after a single procedure; the secondary endpoints were the procedure time, cardioversion rate, and response to anti-arrhythmic drugs (AADs).

Results

After a mean follow-up of 13.4±7.0 months, the clinical recurrence rate (13.3% vs. 8.1%, log-rank p=0.302) and the complication rate (8.0% vs. 4.5%, p=0.427) did not differ between the two groups. The total procedure time (p=0.391) and cardioversion rate (p=1.000) did not significantly differ between the two groups. During the final follow-up, sinus rhythm was maintained without AADs in 72.6% of the WT group and 80.2% of the Control group (p=0.237).

Conclusions

LAWT-guided energy titration resulted in efficacy and safety equivalent to that of constant 15s 60W-HPSD CPVI in patients with PAF.
Pulsed field ablation based pulmonary vein isolation utilizing a simplified approach
Authors: Tilz R R T , Feher M F , Kirstein B K , Vogler J V , Eitel C E , Phan H L P , Hatahet S H , Popescu S S P , Kuck K H K , Heeger C H
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Pulsed field ablation (PFA) is a novel non-thermal energy source with promising safety and efficacy advantages compared to standard ablation technologies.

Purpose

We aimed to develop a safe, effective and fast pulmonary vein isolation (PVI) utilizing a single shot PFA catheter via a single femoral vein puncture and a venous closure system approach.

Methods

Forty-eight consecutive AF patients underwent first-time PVI via PFA under deep sedation. A single ultrasound guided femoral vein puncture and a single transseptal puncture was utilized for left atrial access. After pulmonary vein (PV) angiography eight pulse trains (2kV/2.5 sec, bipolar, biphasic, each 4x basket/flower configuration) were delivered to each PV. Extra pulse trains in the flower configuration (8x) were added to the posterior wall for very wide antral circumferential ablation (vWACA). Continuous intraluminal esophageal temperature (TESO) was monitored with a s-shaped esophageal temperature probe. A venous closure system was utilized on the single access site. A Donati suture was performed. The pressure bandage was removed after 1h.

Results

Patients (mean age: 64 +/-11 years) presented with AF (paroxysmal 58% or persistent AF (42%). A total of 192 PV were identified and isolated via PFA (100%). A mean of 40 pulse trains for PVI and vWACA have been used. The mean procedural time was 27 +/- 7 minutes, the mean catheter dwell time was 14 +/- 6 minutes and the median fluoroscopy time was 6 +/- 2 minutes. No relevant esophagus temperature rise occurred. One patient (2%) experienced a transient phrenic nerve palsy which recovered until the end of the procedure. Two patients (4%) experienced a superficial bleeding which was treated by a figure of eight suture. No severed hematoma, transfusion or intervention was necessary. No pericardial effusion or tamponade occurred.

Conclusion

The combination of a single vein single transseptal puncture approach resulted in a 100% rate of acute PVI and an extraordinary fast procedure and dwell time. The rate of periprocedural complications was low.
Effectiveness and safety of a time to isolation strategy of cryoballoon ablation of atrial fibrillation
Authors: Tsiachris D , Doundoulakis I , Antoniou C K , Sougiannis D , Zafeiropoulos S , Tsioufis P , Kordalis A , Gatzoulis K A , Chierchia G B , De Asmundis C , Tsioufis K
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Complete electrical isolation of all pulmonary veins is the cornestone of the ablation procedure.

Purpose

We conducted a systematic review and meta-analysis of randomized and observational studies with a control group to evaluate the effectiveness and safety of a time to isolation (TTI)-based strategy of cryoballoon ablation (CBA) in the treatment of atrial fibrillation (AF).

Methods

Three electronic databases (MEDLINE, Cochrane Central Register of Controlled Trials, and Embase) without language restrictions were searched. The intervention assessed was a TTI-based strategy of CBA in the treatment of AF. TTI was defined as the time from the start of freezing to the last recorded pulmonary veins' potential. The comparison of interest was intended conventional protocol of CBA. The primary endpoint was freedom from atrial arrhythmia.

Results

Nine studies were deemed eligible (N = 2289 patients). Eight studies reported freedom from atrial arrhythmia and pooled results showed a marginally similar success rate between the two protocols (odds ratio [OR]: 1.24; 95% confidence interval [CI]: 0.98-1.56). A prespecified subgroup analysis verified that a high dose TTI strategy (with >120 s duration of cryotherapy post-TTI) compared to the conventional protocol could significantly increase the patients without atrial arrhythmia during follow-up (OR: 1.39; 95% CI: 1.05-1.83). TTI strategy could also significantly decrease total procedure time (SMD: -26.24 min; 95% CI: -36.90 to -15.57) and phrenic nerve palsy incidence (OR: 0.49; 95% CI: 0.29-0.84).

Conclusion

Moderate confidence evidence suggests that an individualized CBA dosing strategy based on TTI and extended (>2 min post-TTI) duration of CBA is accompanied by fewer recurrences post-AF ablation.
Evaluation of redo procedures in blanking period following atrial fibrillation catheter ablation
Authors: Coteli C , Menemencioglu C , Ates A H , Yorgun H , Aytemir K
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background and Objective

Although early recurrence after atrial fibrillation catheter ablation (AFCA) is a risk factor for late recurrence, 3 months blanking period (BP) is generally an accepted period to wait for re-do intervention. In this study, we aimed to evaluate the cases of early recurrences in BP after AFCA using either radiofrequency (RF) or cryo-balloon (CB).

Method

One thousand fifty patients who had undergone AFCA between January 2017 and January 2022 were evaluated retrospectively. Seventy-five patients had documented tachyarrhythmia episodes in the BP. Among these, 33 patients underwent electrophysiologic study (EPS) and re-do catheter ablation for atrial tachyarrhythmia.

Results

The index procedure was performed with CB in 15 (45.5%) patients and RF in 18 (54.5%). 20 (60.1%) patients had paroxysmal atrial fibrillation before the index procedure. EPS was done routinely in all patients after the recurrence. In 3 patients, typical AVNRT was induced in EPS, the slow pathway was ablated, and substrate mapping (SM) was not performed. In 19 patients, atrial tachycardia, whose 3 were typical atrial flutter, was induced. Pulmonary vein (PV) reconnection was detected in 7 patients whose three also had non-PV triggers.

Conclusion

PV reconnection is responsible for the recurrence during the period of BP in a small percentage of patients. However, additional triggers are present in most. The optimal approach for the recurrence occurring in BP is still controversial. Performing EPS and SM may reduce the recurrence rate in this patient group.
Cardioneuroablation for asystolic reflex syncope-left or right atrial approach? A randomized prospective Roman II study-preliminary results
Authors: Piotrowski R , Zuk A , Baran J , Sikorska A , Niedzwiedz M , Krynski T , Kulakowski P
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Centre of Postgraduate Medical Education

Background

Cardioneuroablation (CNA) by means of radiofrequency ablation of ganglionated plexi (GP) has emerged as a new promising therapeutic tool in patients with asystolic reflex syncope, however, optimal procedural strategy has not yet been established.

Purpose

To compare acute efficacy of CNA using right atrial (RA) versus left atrial (LA) approach.

Methods

This prospective randomized study included 36 patients (age: 40±13 years, 14 males) who were randomized to the RA group (n=19) or LA group (n=17). Intra-procedural efficacy of CNA was measured using extracardiac vagal stimulation [(ECVS) [50 Hz, 0.05 ms, 1 V/kg (<70V), 5 s)]. If RF applications in the RA group occurred ineffective (firstly, paraseptal GPs - RAGP and PMLGP, followed by Ao-SVC GP and PMLGP from coronary sinus) there was a crossover to the LA where further applications were performed. Similarly, if RF applications in the LA group (paraseptal GPs, followed by LSGP and LIGP) did not cause complete vagal denervation on ECVS, there was a crossover to the RA.

Results

Both groups were comparable concerning clinical and demographic parameters. In the RA group complete vagal denervation confirmed by ECVS was achieved in 7 (37%) patients versus 14 (82%) patients from the LA group (p=0.008). Of 12 crossovers from RA to LA, 7 (58%) were due to ineffective CNA, 2 (17%) due to permanent nodal rhythm precluding accurate localization of sinus node, and 3 (25%) due to earliest sinus node activation and/or phrenic nerve course at the site of potential RF applications. In the LA group, all 3 crossovers were due to lack of complete vagal denervation on ECVS. Finally, after all crossovers, in all patients lack of response to ECVS was achieved. Procedural time (107±24 vs 106±24 min), x-ray dose (2,12±2,72 vs 2,08±2,64 Gycm2 and 17,43±20,38 vs 17,22±40,08 mGy), and electrophysiological parameters measured before and after CNA were similar in both groups. No complications were noted.

Conclusions

CNA in the LA is more often associated with complete vagal denervation compared with the RA approach only. CNA performed in both atria (after crossovers) resulted in unresponsiveness to ECVS in all patients. Thus, biatrial CNA may be a preferable approach. Whether these results translate to long-term efficacy of CNA needs to be established.
Anatomy of the isthmus: unraveling tissue composition of ventricular tachycardia diastolic pathway
Authors: Bisbal F , Aranyo J , Sanchez-Quintana D , Martinez-Falguera D , Rodriguez-Leor O , Fadeuihle E , Bazan V , Sarrias A , Villuendas R , Bayes-Genis A , Galvez-Monton C
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Spanish Ministry of Science and Innovation

Background

Unequal tissue composition of post-myocardial infarction (MI) scar (viable myocardium, fibrosis, fatty infiltration) leads to heterogeneous conduction properties and excitability. The presence of a protected diastolic, slow-conducting pathway (isthmus) is the electrophysiological landmark of post-MI reentrant ventricular tachycardia (VT). Contemporary histological studies evaluating the tissue features needed for slow, protected conduction during VT are lacking.

Purpose

To characterize tissue composition singularities of confirmed VT isthmuses (VTI) in a chronic MI swine model, and to compare it to non-isthmus scar (NIS).

Methods

One-month after a non-reperfused anterior MI, 9 Landrace X Large White pigs (4 female; 33.6±2.2 Kg) with inducible VT underwent high-density activation mapping to define the diastolic corridor. VTI was defined as part of the diastolic pathway exhibiting mid-diastolic potentials. Discrete radiofrequency applications were delivered in the vicinity of the VTI and used as tissue landmarks to guide the ex vivo isthmus localization. Tissue transverse samples (5 mm) from the labelled VTI and NIS were obtained for further histological and immunohistochemical analysis. Dense scar and border zones were analyzed.

Results

Compared to NIS, border zone of VTI showed significantly higher fatty infiltration (p=0.016) and dense scar displayed less Collagen I (p=0.053), Collagen III (p=0.043), and Collagen Volume Fraction (p=0.027), without differences in the overall fibrotic deposition (P=0.119). Immunohistochemical studies revealed greater vascular density (Isolectin B4-positive vessels) at VTI, compared to NIS (p=0.018). Arteries and veins at the VTI were mostly surrounded by preserved cardiomyocytes (figure 1). Viable cardiomyocytes and fibroblasts at VTI displayed higher density of Cx43 and Cx40, respectively, compared to those at NIS (p=0.022 and p=0.004, respectively), despite no differences in cTnI, SERCA2 and Vimentin expression (figure 2).

Conclusion

The VTI exhibits distinctive tissue features compared to NIS. Unique electrophysiological properties of the VTI may be driven by increased adipocytic deposition, vascular density and Cx43/Cx40 expression, as well as lower presence of Collagen III and Collagen Volume Fraction.
Sepsis is the most frequent trigger for electrical storm in structural heart disease: results from a tertiary referral centre prospective registry
Authors: Parollo M , Mazzocchetti L , Sbragi S , Barletta V , Di Cori A , Segreti L , De Lucia R , Grifoni G , Soldati E , Viani S , Cellamaro T , Zucchelli G
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Electrical storm is a specific clinical presentation yielding to high morbidity and mortality. Acute development of electrical storms results from the underlying myocardial substrate, autonomic activation, and trigger factors. Main therapeutic approaches range from pharmacological to interventional treatment.

Methods

We enrolled in a prospective single center registry all patients admitted from March 2018 to March 2022 at our Centre who satisfied diagnostic criteria for electrical storm. Demographic, instrumental, and interventional data were obtained from local electronic health record.

Results

A total of 87 patients (79% male sex, mean age 72,21±10,49 years) were enrolled. Mean left ventricular ejection fraction was 37,27±11,62%. Underlying cardiomyopathy was ischemic in 57,47%; dilated cardiomyopathy in 20,69%, arrhythmogenic cardiomyopathy in 8%, other in 13,84%. A definite trigger was identified in 34 cases (39%), most frequent ones were sepsis (11 events, 32,4%), acute heart failure (6 events, 17,6%), myocardial ischemia (5 events, 14,7%), thyrotoxicosis (5 events, 14,7%), ionic disorder (4 events, 11,8%). An ICD was already implanted in 89,66% of patients, all remaining patients were implanted during index hospitalization. An ablation strategy was pursued in 65,52% of cases. Mean days from hospitalization to ablation were 7±5. Median hospital stay was 11 days (IQR 8-18).

Conclusion

In our single referral centre experience, in patients with electrical storm, ischemic cardiomyopathy was the dominant underlying heart disease. An identifiable trigger was found in a large cohort of patients, with sepsis being the most frequent. An ablation strategy was pursued in most cases.
Incidence and predictors of new-onset sustained ventricular tachycardia in patients with cardiac sarcoidosis and high-grade AV block as first cardiac symptom
Authors: Dinov B , Henftling C H , Ebbinghaus H E , Latuscynski K S , Kluge T K , Hindricks G H , Laufs U L , Ueberham L U
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiac sarcoidosis (CS) is infrequently affecting the heart and may cause heart failure and dangerous arrhythmias. If left untreated, it usually progresses to end-stage heart failure or can cause sudden cardiac death. A frequent initial presentation is AV block, but malignant ventricular arrhythmias can occur in the course of the disease, as well. Ventricular tachycardia or fibrillation (VT/VF) can occur even in patients with normal or nearly normal ejection fraction. Therefore, the current guidelines recommend implantation of ICD devices whenever a pacemaker implantation is needed, such as in case of AV block, although there are little data supporting this opinion.

Purpose

The purpose of this study was to establish the risk for occurrence of VT/VF in patients with CS, initially presenting with AV block. Furthermore, we sought to establish possible predictors for occurrence of VT/VF.

Methods

We analyzed 128 patients diagnosed with CS according to the latest JCS criteria. Patients with AV block as initial cardiac presentation were selected and were followed for occurrence of VT/VF or death. We analyzed the differences between the baseline characteristics and the cardiac imaging between those with and without VT/VF.

Results

Out of 128 patients with CS, 30 (23%) patients (13 female, age 50 ± 10 y; EF 48 ± 12%) with high-grade AV Block as initial cardiac symptom were identified. In 7 of them, a permanent pacemaker had already been implanted. In 15 (50%) patients the diagnosis was confirmed histologically. Cardiac MRI showed presence of LGE in 10 patients with mean LGE volume of 14±8%, and RV involvement in 5 cases. 18FDG-PET showed abnormal tracer enhancement in 12 (40%) patients with SUVmax 9 ± 5.

A new sustained VT/VF occurred during the follow up in 10 (30%) patients; and non-sustained VT in other 4. Death occurred suddenly in 2 patients, both without an ICD device. In the univariate analysis, the following baseline characteristics were not associated with occurrence of VT: age, LVEF, amount of LGE, SUVmax, ACE and sIL2-R. Patients with new VT/VF during FU had more frequently RV involvement ( 50% vs. 0 %); LGE in CMR (100% vs 50%) and positive PET ( 100% vs. 57%).

Conclusions

Patients with cardiac sarcoidosis and AV block as initial presentation have a very high risk of developing sustained VT/VF. Death occurred only in patients without an ICD. ICD implantation, instead of pacemaker, should be considered in all patients with AV block, especially in presence of LGE in CMR, abnormal 18FDG PET and RV involvement.
Ventricular tachycardia substrate ablation in patients with slightly depressed left ventricular ejection fraction. Predictors of VT-free survival in a prospective multicentre registry
Authors: Falasconi G , Penela D , Fernandez-Armenta J , Soto-Iglesias D , Acosta J , Linhart M , Bisbal F , Marti-Almor J , Alderete J , Ordonez A , Viveros D , Bellido A , Francia P , Mont L , Berruezo A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

There is no consensus about the need for ICD implantation in patients with slightly depressed left ventricle ejection fraction (LVEF) after catheter ablation for hemodynamically tolerated ventricular tachycardia (VT).

Purpose

This study aims to investigate predictors of mortality VT-free survival in this population.

Methods

We evaluated predictors of VT-free survival in patients with LVEF>40% from a prospective multicenter register of patients undergoing VT substrate ablation for hemodynamically tolerated VT. Decision to protect with ICD implantation at hospital discharge was performed according to the judgment of the treating cardiologist. The patients included in the study were followed every six months. Ventricular arrhythmia-free survival was the primary endpoint. Any episode of sustained VT (> 30 s) or appropriate ICD therapy was considered VT recurrence.

Results

One-hundred thirty-two patients [67±13 years, 91% male, 50±8% mean LVEF, 85 (65%) with ischemic heart disease] with a LVEF>40% were identified. Twenty-one (16%) of them were non-inducible at the end of the procedure and were discharged without ICD implantation as they were considered to have a low risk of recurrences. After a mean follow-up of 26±23 months, 32 (24%) patients had VT recurrences. A complete arrhythmogenic substrate elimination [HR: 0.34 (0.16-0.7), p<0.01] and the use multiple ventricular extrastimuli for hidden slow conduction (HSC) identification and ablation [HR: 0.51 (0.27-1.1), p=0.09] were related with VT-free survival (Figure 1). 53 (40%) patients fulfilled both criteria, having a 8% recurrence rate during the follow-up. Compared with the clinical decision making of ICD implantation at hospital discharge, the use of these two variables better identify patients at risk for VT recurrences, with a net reclassification improvement of 23% (Figure 2).

Conclusions

VT recurrence after VT substrate ablation in patients with slightly depressed LVEF remains high. However, complete substrate elimination and HSC analysis and ablation are related with higher VT-free survival and identify a subgroup of patients in whom ICD might be not beneficial.
Electrocardiographic characteristics of definite drug induced Brugada patients
Authors: Ensam B , Scrocco C , Batchvarov V , Behr E
Published: May 2023

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The Robert Lancaster Memorial Fund sponsored by McColl’s Research Group British Heart Foundation.

Background

Clinical, electrocardiographic, and genomic factors associated with the development of the drug induced type 1 Brugada pattern (DI-T1BP), in response to sodium channel blocker provocation (SCBP) have been investigated. However, these prior analyses have mostly been concerned with the prediction of the DI-T1BP rather than the strength or validity of the diagnosis of Brugada syndrome (BrS). We sought to analyse and compare the ECG response to SCBP with Ajmaline in a cohort of healthy subjects (Healthy Controls) and clinical patients with a DI-T1BP and a Shanghai Score (ShS) >3.5 (Definite-BrS group).

Methods

From an existing clinical cohort of consecutive patients investigated at our centre between 2010 - 2022, we identified those with a DI-T1BP and a ShS >3.5. Respondents to a national advertisement, completed an online medical questionnaire. Those fulfilling the inclusion criteria were invited to undergo further evaluation with eligible subjects being recruited to the healthy control group.

All subjects received a diagnostic AP (1mg/kg max. 100mg over 5 minutes). A continuous ECG was recorded in the standard and high right precordial lead (HRPL) position. Automated analysis of conventional and novel ECG measurements were made at baseline and at peak drug effect, which was defined as the point of maximum QRS duration (excluding precordial leads).

Results

One hundred healthy controls and 166 patients with definite BrS were recruited, Table 1.0. This included 51 (31%) BrS probands. In the definite BrS group, the mean pre-ajmaline ShS was 2.1 (± 0.80) and mean final ShS was 4.3 (± 0.75). In comparison to healthy controls, the time to peak drug effect was significantly earlier in definite BrS patients, 05:18 (±02:05) vs. 05:59 (± 01:20).

Whilst the increase in global QRS duration was greater in the definite BrS group, ∆37.78ms (± 18.16ms) vs. ∆25.66ms (±11.98) P<0.01, the increase in PR interval was greater in the healthy control group, ∆43.36ms (±17.27ms) vs. ∆20.77ms (±31.64ms), P<0.01. Compared to the healthy controls, the definite BrS group experienced a pronounced increase in anterior ST-J point amplitude ∆27.58µV (±27.70) vs. 115.37µV(±106.41), P<0.01, respectively. In contrast, whilst there was a reduction in inferior and lateral ST-J point amplitude in the definite BrS group, healthy controls demonstrated an increase in amplitude in these regions, Table 2.0.

Mean QRS area was significantly greater at peak drug effect in the definite BrS group, ∆0.14V/s (±0.31) vs. ∆-0.20 (±0.18), P <0.01, whilst T wave area showed a reduction.

Conclusion

In addition to the DI-T1BP patients with definite BrS experience a number of ECG characteristics that might allow for a quantitative refinement of the diagnosis.
Machine learning based prediction of 1-year arrhythmia recurrence after ventricular tachycardia ablation in patients with structural heart disease
Authors: Komlosi F , Toth P , Bohus G Y , Tokodi M , Vamosi P , Szegedi N , Sallo Z , Piros K , Perge P , Osztheimer I , Abraham P , Szeplaki G , Merkely B , Geller L , Nagy K V
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Project no. NVKP_16-1–2016-0017 (’National Heart Program’) - National Research, Development and Innovation Fund of Hungary

Thematic Excellence Programme (2020-4.1.1.-TKP2020) of the Ministry for Innovation and Technology in Hungary

Background

Ventricular tachycardia (VT) is a life-threatening condition. Catheter ablation treatment is often successful, however post procedural VT recurrence still remains an issue. Therefore, there is a demand for an accurate risk stratification system to assess the probability of arrhythmia recurrence after the procedure.

Objective

We aimed to implement a machine learning (ML) pipeline to predict 1-year VT recurrence in patients with structural heart disease (SHD) undergoing VT ablation.

Methods

For 297 patients who underwent VT ablation, we collected medical history, laboratory, echocardiography, and procedural data. Following manual and ML-based feature selection, we trained several supervised machine learning models to predict 1-month and 1-year recurrence. The area under the receiver operating characteristic curve (AUC) was calculated to quantify the models’ performance.

Results

1-year VT recurrence was observed in 107 (36%) cases. The best predictions of VT recurrence were demonstrated by random forest models utilizing 7 input features [1-month AUC: 0.74; 1-year AUC: 0.76]. These models significantly outperformed a previously published risk score, the I-VT score [AUC: 0.63, p=0.024] on our data. The most important predictors of recurrence were the number of VT morphologies during the procedure, electrical storm, left ventricular ejection fraction, left ventricular end systolic diameter, and the severity of mitral regurgitation.

Conclusion

Our machine learning model can efficiently predict VT recurrence in SHD patients undergoing VT ablation. Thus, it could facilitate the prompt identification of high-risk patients and the personalization of treatment and follow-up strategies, ultimately leading to improved outcomes.
Stereotactic Arrhythmia Radioablation (STAR) for refractory ventricular tachycardia (VT) - A preliminary report from the German multicenter RAVENTA study
Authors: Krug D , Hohmann S , Boda-Heggemann J , Mehrhof F , Grehn M , Lyan E , Merten R , Rudic B , Boldt L H , Kirstein B , Rades D , Bonnemeier H , Dunst J , Tilz R , Blanck O
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): The multicenter RAdiosurgery for VENtricular TAchycardia (RAVENTA) study (NCT03867747) is part of the STOPSTORM.eu consortium project

Background

Stereotactic Arrhythmia Radioablation (STAR) has been shown to be a promising treatment option for refractory ventricular tachycardia (VT) in initial reports of monocentric clinical studies and case series.

Methodology

The multicenter RAdiosurgery for VENtricular TAchycardia (RAVENTA) study is part of the STOPSTORM.eu consortium project and investigates STAR with 25 Gy in one session for patients with refractory VT without further treatment options. The primary endpoint is to evaluate the feasibility and safety of the procedure with an incidence of ≤ 5% of severe (grade ≥ 3) treatment-related side effects within 30 days after therapy. We now present an analysis after enrolment of 10 of the 20 planned patients.

Results

Ten patients were included in the RAVENTA study at four treatment centers between 10/2019 and 10/2022. STAR was performed without complications in all patients. To date, there were no acute (≤ 30 days) or late (> 30 days up to one year) grade ≥ 3 side effects which were possibly treatment-associated. Significant reduction in VT burden and ICD interventions was observed in most patients. In 7/10 (70%) of the patients, sustained freedom from VT was achieved up until last follow-up.

Conclusion

RAVENTA is the world's first multicenter study for STAR of refractory VT. We did not observe any treatment-related severe side effects in the current analysis. Most patients benefited from significant reductions in VT burden.
Testing radiofrequency energy delivery and catheter entrapment in three left ventricular assist device models in mock circulation
Authors: Simsek E , Yagmur B , Kahraman U , Candemir A , Engin C , Yagdi T , Nalbantgil S , Ozbaran M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The use of Left Ventricular Assist Devices (LVAD) as a bridge to heart transplantation (HTx) or as a destination therapy is increasing. Near half of the patients had ventricular arrhythmias (VA) in the first year of LVAD support. Ablation is common method for recurrent ventricular tachycardias in LVAD patients. Even there are many case reports about successful VT ablations in LVAD patients there is no report about consequences of RF energy delivery inside LVAD or ablation catheter contact – entrapment to the rotor of the LVAD.

Method

Mock circulation models were created for three mostly used LVAD models ( Figure 1) (HeartMate3, HeartMate2, HVAD) Sheep heart was located inside the mock circulation model and 4mm non-irrigated RF ablation catheter and RF generator used for RF energy delivery tissue ( sheep heart) , ostium, mid and rotor of the LVAD)(Figure 1). During RF delivery flow parameters of the LVAD systems were noted also external noncontact flow monitor located out flow canula of the LVAD. All LVADs out flows were tested for 24 hours after RF energy delivery for long term malfunction. Also RF ablation catheters were tested for mechanical and functional disfunctions after contact of the LVAD rotors.

Results

No malfunctions were observed during and after RF energy delivery inside the LVADs. Only LVAD flow parameters temporary decreased in HeartMate 3 when the catheters had a contact to the rotor of the LVAD. This phenomenon occurred irrespective of RF energy delivery status. There were no changes in HVAD and Heartmate 2. After 24 hours continuous testing of the flow of the LVADs any changes were not observed . Impedance changes were noticed during RF energy delivery. Impedance values were dropped when RF catheter moved from tissue to the ostium of the LVAD in all models. Small increases observed during contact to the rotor of the LVAD in HeartMate 3 ( Figure 2). No mechanical damage were observed on the tip of the catheters after contact to the rotors also RF lesion dimensions were compared before and after the contact and there were no differences.

Conclusion

RF energy delivery and catheter entrapment of the RF catheters to the rotors of the LVADs caused no changes in LVAD functioning in ex-vivo conditions in a mock circulation.