bluuebunny/crossref_metadata_2025 huggingface dataset:
May Measurement Month 2019: an analysis of blood pressure screening results from Armenia
Authors: Zelveian Parounak , Hayrumyan Samvel , Gourgenyan Svetlana , Hakobyan Zoya , Kzhdryan Hovhannes , Avagyan Avag , Minasyan Arsen , Gharibyan Heghine , Ustyan Tsiala , Aroyan Siranush , Vatinyan Susanna , Beaney Thomas , Clarke Jonathan , Poulter Neil R
Published: May 2021

Elevated blood pressure (BP) is an enormous public health problem and a growing burden worldwide and the biggest single risk factor for cardiovascular death. May Measurement Month (MMM) is a global initiative aimed to raise awareness of high BP and to act as a temporary solution to the lack of screening programmes worldwide. An opportunistic cross-sectional survey of volunteers aged ≥18 years was carried out in May to July 2019. Blood pressure measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. The study was conducted in public areas (23 sites in the capital city Yerevan and 13 in other regions), both indoor and outdoor, as well as in primary and secondary healthcare centres. In total, 9818 individuals (11.3% participated in either MMM2017/2018 or both) were screened of which 9786 had three BP measurements available, 1.6% of them reported never having had their BP measured. The mean age of screened participants was 47.6 (SD ± 16.5) years, 61.9% were female. After multiple imputation, 41.6% of participants had hypertension and 72.8% of them were aware of their high BP, 65.4% were on treatment, and of those treated, 46.5% had controlled BP (<140/90 mmHg). Of 4088 participants with hypertension, 30.4% had controlled BP. Of all risk factors analysed, reported use of anti-hypertensive medication and a previous diagnosis of hypertension were the strongest predictors of higher levels of BP. We found that the prevalence of hypertension, untreated and treated, but uncontrolled hypertension is still substantial in Armenia, which maybe a vital contributor to the growing burden of non-communicable diseases.
Atrial edema in patients with atrial fibrillation with chronic heart failure
Authors: Kirillova VV , Mochula OV , Garganeeva AA , Usov VYU , Batalov RE , Meshchaninov VN , Popov SV
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Objective

to investigate the intensity of the atrial septum by T2-weighted magnetic resonance imaging (MRI) in patients with chronic heart failure (CHF), with and without atrial fibrillation (AF). Materials and methods. In patients with CHF with atrial fibrillation (n = 23, including 11 patients with paroxysmal form, and 12 patients with constant forms) and without (n = 9) of arrhythmias in the control group – almost healthy (n = 6) we evaluated the signal intensity (SI) of the interatrial septum, the interventricular septum, and skeletal muscle at MRI T-2 weighted images. An increase in the value of SI in 2 times or more compared with the SI of skeletal muscle was regarded as an MRI signs of myocardial edema. Results. The SI of the atrial septum in patients with CHF who have constant forms of atrial fibrillation is higher than in the control (2775.58 ± 383.61 relative to the control - 1448.57 ± 291.30, p < 0.05). The MPP gain index in patients with paroxysmal AF equal to 1.59 ± 0.10 did not differ in comparison with patients with CHF who do not have rhythm disorders - 1.53 ± 0.12. An index of atrial septal enhancement greater than 2, indicating the presence of MRI signs of atrial septal myocardial edema  was detected only in patients with a constant form of AF (2.39 ± 0.18) than in patients with CHF with paroxysmal AF, in patients with CHF without rhythm disturbances and in the control group (1.59 ± 0.23; 1.53 ± 0.28 and 1.15 ± 0.16, respectively,  p < 0.05). Summary. In patients with CHF who have a constant form of atrial fibrillation, according to T2-weighted MRI images, signs of edema of the myocardium of the atrial septum were revealed in comparison with the control group and patients with CHF who have a paroxysmal form of atrial fibrillation and without rhythm disturbances.
Usefulness of Goldberger"s triad to select dilated cardiomyopathy
Authors: Chung I
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Background: In 1982, Goldberger described an electrocardiographic triad (SV1 or SV2 +RV5 or RV6 ≥3.5mV, total QRS amplitude in limb leads ≤0.8mV, and R/S ratio < 1 in lead V4) that was 70% sensitive and >90% specific for detecting severe left ventricular (LV) dysfunction. The pathophysiology of this highly specific ECG triad probably relates to a number of mechanical and vectorial factors associated with congestive heart failure of a variety of etiologies. Left ventricular enlargement causes increased precordial voltage. The horizontal plane vector shifts posteriorly, orthogonal to the frontal plane, causing poor R wave progression and low limb lead voltage. Finally, increased extracellular fluid may preferentially attenuates QRS voltage in the limb leads.

Objective

To test the sensitivity of this triad in patients with non-ischaemic cardiomyopathy and severe left ventricular systolic dysfunction

Methods

Methods: 386 patients mean age 62.45 ± 13.96 years, male 72%, NYHA II-IV, with non-ischaemic cardiomyopathy, 70 had bundle branch block (18%) and mean left ventricular ejection fraction(EF) 22.57 ± 8.62%. 76% hypertension, 39% diabetes mellitus, 32% atrial fibrillation. The electrocardiographic triad was sought in the ECG recorded at time of the echocardiographic study. The mean LV end-diastolic diameter was 5.81 ± 1.53 cm.

Result

Results: 56% patients had SV1 or SV2 +RV5 or RV6 ≥3.5mV, 85% patients had R/S ratio < 1 in lead V4, 19% had total QRS amplitude in limb leads ≤0.8mV. 50% patients had SV1 or SV2 +RV5 or RV6 ≥3.5mV and R/S ratio < 1 in lead V4. Only 6% patients fulfilled the triad.

Conclusions

Conclusion: Goldberger"s triad is an insensitive marker for severe LV dysfunction. Using SV1 or SV2 +RV5 or RV6 ≥3.5mV and R/S ratio < 1 in lead V4 had a sensitivity of 50%. 85% patients had R/S ratio < 1 in lead V4. R/S ratio < 1 in lead V4 is a simple way to select dilated LV.
Instrumental markers of frequent symptomatic atrial fibrillation in patients with arterial hypertension
Authors: Danilevych TD , Ivanov VP
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Great attention of researchers is focused on the study of the features of electrical and structural remodeling of the heart in patients with atrial fibrillation (AF) and arterial hypertension (AH). Holter monitoring of the electrocardiogram (HM ECG) and echocardiography are used as methods for evaluating these changes.

Objectives

to determine instrumental markers of frequent symptomatic AF in patients with AH.

Methods

146 patients with AH stage II with AF (males 68 (46.6%)) and 26 patients with AH stage II (males 11 (42.3%)) were examined in Vinnitsa regional center of cardiovascular pathology. Mean age of patients with AH and AF was (61.2 ± 0.7) years and in group with AH (59.3 ± 2.2) years. The duration of AF was (5,7 ± 0,5) years. The frequency of AF attacks was (23,6 ± 1,2) days. Paroxysmal AF was in 56 (38.4%) patients and persistent AF was in 90 (61.6%) patients. 31 (21.2%) patients have vagal, 70 (47.9%) patients have adrenal and 45 (30.9%) patients have mixed variant of AF (by Coumel). All patients underwent HM ECG and transthoracic echocardiography according to the standard protocol.

Results

ECG markers of frequent symptomatic AF are: amount of frequent supraventricular premature beats (SPB) (2198 vs 24, p < 0,0001), including paired and group SPBs (83,3% vs 0, p < 0,0001), presence of short asymptomatic episodes supraventricular paroxysmal tachycardia (SVPT)(33,3% vs 0, p < 0,0001) or AF (41,1% vs 0, p < 0,0001), increasing dispersion of QT interval (90 vs 70, p = 0,03) and decreasing dispersion ratio PQ/QT (0,50 vs 0,73, p = 0,03). Using the method of multiple linear regression, we determined the most informative combination of these markers: presence of SPBs more than 330 episodes/day + presence of pair and group SPBs and + presence of asymptomatic episodes of SVPT/AF (R = 0,52, p = 0,00002). Hemodynamic markers of frequent symptomatic AF are: significant increasing of absolute and relative indices of size/volume of left atrium (LA) (p < 0,0001), increasing of LA/right atrium (1,12 vs 0,92, p < 0,0001) and LA volume (LAV)/left ventricular myocardial mass (LVMM) (0,27 vs 0,21, p < 0,0001), decreasing Ve/Va (0,82, vs 0,92, p = 0,01) and isovolumic relaxation time (IVRT)(88 vs 97, p = 0,01); mitral (72,2% vs 46,2%, p = 0,01) and tricuspid (48% vs 23,1%, p = 0,02) regurgitation. Using the method of multiple linear regression, the most informative combination of these markers is: the ratio of LAV/LVMM > 0.23 ml/g + LA> 40 mm + presence of mitral regurgitation (R = 0,49, p = 0,00009).

Conclusions

As the most informative ECG markers of frequent symptomatic AF in patients with AH is combination of frequent SPBs (> 330 episodes/day) with pair and group SPBs and asymptomatic episodes SVPT/AF (R = 0,52, p = 0.00002 ), while echocardiography combination of markers is ratio of LAV/LVMM > 0.23 ml/g + LA> 40 mm + presence of mitral regurgitation (R = 0.49, p = 0.00009).
Prevalence and clinical characteristics of patients presenting with phase 4 atrioventricular block
Authors: Bun S-S , Heme N , Asarisi F , Squara F , Scarlatti D , Ferrari E
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

The prevalence of phase 4 atrioventricular block (4AVB) is not known.

Objective

To assess the exact prevalence of 4AVB in a population of patients with high-degree AVB.

Methods

All the ECG from patients admitted for high-degree AVB (2 to 1 and complete) were collected at the University Hospital of Nice. The ECG tracings (12-lead surface and telemonitoring during hospitalization) were reviewed by an electrophysiologist.

Results

From Sept 2019 to Sept 2020, 65 patients were admitted for high-degree AVB. 8 patients (12 %) with 4AVB were identified (3 men; 88 ± 5 years). Arterial hypertension was present in 7/8 (87 %), and a syncopal episode - 4AVB-related - was noticed in 6/8 patients (75 %), mean left ventricular ejection fraction 54 ± 13 %. Baseline QRS width and corrected QT intervals were respectively 131 ± 30 ms and 469 ± 34 ms). 4AVB sequence was induced by a: premature atrial contraction (5/8), premature ventricular contraction (1/8), conduction block in a branch (1/8), sinus rhythm acceleration (1/8). All patients received a dual-chamber pacemaker during hospitalization.

Conclusion

The exact prevalence of 4AVB is not rare (12 %), and may be underestimated. 4AVB is usually observed in an elderly population, treated for arterial hypertension, and with baseline conduction disorders. Abstract Figure. Phase 4 AVB induced by PAC
Development and validation of an algorithm to assist in the interpretation of the electrocardiogram
Authors: Pallikadavath S , Watts J , Gay S , Sandilands A
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background and Purpose

Interpretation of the electrocardiogram (ECG) is often poorly performed, affecting time critical patient care. There are no reliable methods that consistently bridge the gap between novices and competency. However, the development of a framework allowing a step-wise approach to interpret the ECG based on relevant signals might help. Indeed, in addition to expert teaching, a pilot study of this algorithm significantly improves sustained ECG interpretation in medical students. This study aimed to validate the ECG algorithm tool by confirming the appropriateness of its step-wise components through expert cardiologists.

Methods

A Modified Delphi Exercise protocol was used. Cardiologists were invited to participate in a questionnaire through an online survey tool. Expert participants evaluated each stage of the ECG algorithm through multiple levels of agreement and explained their decision making with the option of free-text comments. These were collated and analysed by the four authors and changes subsequently made. The process was repeated, with evaluation of the changes from each round until a predetermined level of agreement was achieved.

Results

This Modified Delphi Exercise produced two rounds. Overall, 55 responses from experts was achieved (first round = 33, round two = 22). The average agreement in round one was 85.8%  with 25 changes from 124 comments. Round two achieved 93.4% agreement with 12 changes from 57 comments. After discussion by four authors, a consensus was reached and a final algorithm was achieved. Figure 1 shows the bradycardia section of the final algorithm (tachycardia and ST/T-wave/ischaemia sections not shown).

Conclusions

We have validated an ECG algorithm through a rigorous development and review process in a multi-institutional and multi-national Modified Delphi study. The completed expert reviewed algorithm may be a safe, informative tool for novice users to improve ECG interpretation. However, further validation in user groups is now mandated to refine the tool. Abstract Figure 1- Algorithm one of three
Incidence and type of arrhythmias recorded by one-month continuous ECG monitoring in stroke patients
Authors: Castrejon Castrejon S , Ruiz-Ares G , Martinez Cossiani M , Rigual R , Gutierrez Zuniga R , Alonso De Lecinana M , Tebar D , Fernandez Gasso L , Fuentes B , Merino JL
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

BACKGROUND

The incidence of atrial fibrillation (AF) following stroke has been studied with implantable loop recorders.  However, these devices do not record short lasting AF episodes (<30-120 seconds [s]). In addition, the incidence and type of other clinically relevant arrhythmias is poorly understood in this clinical setting.

PURPOSE

To evaluate the incidence, type and clinical relevance of arrhythmias detected by one-month continuous ECG monitoring in patients after cryptogenic stroke.

MATERIAL AND METHODS

Consecutive patients (p) with stroke and no previous AF or other cardioembolic or atheroembolic causes were prospectively enrolled in the study. An external wearable 2-lead ECG monitoring system (NUUBO) was used for 30 days (d) in all of them after the acute phase of the stroke. In the absence of documented AF, a parafibrillatory status was defined as >3000 atrial ectopic beats/d or >2 "micro AF" episodes (fibrillatory burst <30 s)/d or ≥1 episode of "micro AF" >14 s.

RESULTS

130 p. were included in the study (age 73 ± 12, 57% males, 19% previous stroke, 7% ischemic cardiopathy, CHA2DSVA2Sc pre-stroke 3.1 ± 1.7).  3 were withdrawn from the study due to inadequate use (recording time <14 d) and 1 due to stroke during SARS-CoV2 infection. Total recording time was 28 ± 3 d, total analyzable ECG time was 23 ± 5 d. ECG monitoring was repeated in 12 (9.5%) p due to poor ECG quality in 6 p or high suspicion of AF despite an initial negative result in 6 p.  AF >30 s was detected in a total of 27 (21.4%) p, average AF duration was 52 hours (range 30 s-22 d). AF >30s was detected in 2 (17%) p with repeated monitoring. All these patients were placed on anticoagulation. Sustained paroxysmal supraventricular tachycardia (SVT) was documented in 4 (4.4%) p without AF. All episodes of AF and SVT were asymptomatic. Mobitz I second degree AV block in 4 (3.2%) p. 3 (2.4%) p had a pacemaker implanted: 2 for severe sinus dysfunction and 1 for AV block. High-density ventricular ectopy (>3000/d) was present in 7 (6%) p and ≥1 episode of non-sustained ventricular tachycardia was detected in 26 (21%) p. A parafibrillatory status was identified in 27 (21%) p with no AF >30 s. At 1-year follow up 4/22 (18%) of patients with parafibrillatory status and 3/59 (5%) without parafibrillatory status suffered a new stroke (p = 0.08).

CONCLUSIONS

AF and other potentially relevant arrhythmias are frequent after stroke and easily detectable with one-month non-invasive continuous ECG monitoring. Patients with a parafibrillatory status could benefit from longer monitoring time to detect AF.
Cardiac Magnetic Resonance as a diagnostic tool in arrhythmias
Authors: Caldeira Da Rocha R , Picarra B , Pais J , Santos AR , Carrington M , Dias Claudio F , Fernandes R , Trinca M
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Etiology of cardiac arrhythmias is often difficult to determine.As the gold standard to anatomical and functional cardiac evaluation,Cardiac Magnetic Resonance(CMR)can be a fundamental technique for accurate assessment of myocardial arrhythmic substrates or for arrhythmias management.

Purpose

The aim of this study is to determine diagnostic and arrhythmic risk stratification impact of CMR performed in patients with suspected or confirmed arrhythmias.

Methods

We performed a six-years prospective study of patients with suspected or confirmed arrhythmias which evaluation with other techniques did not provide a definitive diagnosis.These patients underwent CMR for diagnostic and risk stratification assessment.We applied a protocol to evaluate both ventricles’ morphology and functional and late gadolinium enhancement (LGE) presence.

Results

A total of 93 patients were included,of which 66% were male, with a mean age of 45 ± 17 years old. The indications for patients with suspected or confirmed arrhythmias performing CMR evaluation were the following: 33% (n = 31) of the patients had very frequent premature ventricular complexes, 23% (n = 21) had sustained ventricular tachycardia (VT), 5%(n = 5) non-sustained VT, 17%(n = 16) suspected structural heart disease with high arrhythmic potential,10%(n = 9) unexplained recurrent syncope,9 %(n = 8) supraventricular tachycardia and 3% (n = 3) aborted sudden cardiac death. Depressed ejection fraction (EF)(<50%) was present in 10% (n = 9) for LV(mean EF 38 ± 9%) and 15%(n = 14) for RV (mean EF 42 ± 7%). Dilation of LV was found in 25% of patients (n = 23, mean LV volume: 115 ± 7ml/m²), with RV dilation being present in only 1 patient, who had right ventricle arrhythmogenic dysplasia (RVAD) (RV volume: 152ml/m²). In total, 16%had interventricular septum hypertrophy (mean 15 ± 4mm/m2).We found slight anterior leaflet prolapse of mitral valve in 10% (n = 9) of the cases and mild mitral regurgitation in 15% (n = 14). Left atrium dilation was observed in 17% (n = 16) of patients (mean area of 18 ± 2cm2/m2), as right atrium was dilated in only two. In 20% of the patients, CMR contributed to establish a previously unknown diagnosis: 6% (n = 5) have hypertrophic cardiomyopathy,4%(n = 4)a myocarditis sequelae and 2%(n = 2)had RVAD. LV non-compaction,a silent myocardial infarction scar and non-ischemic dilated cardiomyopathy were diagnosed in 3%of the cases each. In 15%(n = 14)we found nonspecific variations, which deserve follow-up. On the remaining patients, CMR was considered normal.

Conclusion

 As a high reproducible, accurate and versatile technique, CMR allowed an increase on diagnosis in 20% of the patients with suspected or confirmed arrhythmias. Consequently, it contributed to the risk stratification of our study population with suspected high arrhythmic potential when the first-line complementary exams were inconclusive.
Noninvasive unipolar electrogram T-wave upslope is an accurate marker of local refractoriness in explanted hearts with drug-induced repolarization dispersion
Authors: Stoks J , Bear L , Volders PGA , Cluitmans MJM
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): French National Research Agency Matthijs Cluitmans is supported by a Veni grant from the Netherlands Organization for Scientific Research

Background

The relationship between T-wave morphology in local unipolar electrograms (UEGs) as mapped with noninvasive electrocardiographic imaging (ECGI) and local repolarization time (RT) has not been validated in pronounced RT dispersion.

Purpose

To study the time of upslope of the T-wave (Tup) in epicardial UEGs mapped with ECGI as a marker of time of local refractoriness (trefr, a surrogate for RT) in intact hearts with RT dispersion.

Methods

Six pig hearts were Langendorff-perfused with selective perfusion of the LAD artery and submersed in a torso-shaped tank containing 256 electrodes on the torso surface (panel A). RT was prolonged in the non-LAD regions by infusing dofetilide (‘Dof’) and shortened in the LAD region using pinacidil (‘Pin’). Tup was determined in both invasive UEGs (recorded with epicardial electrodes) and in noninvasive UEGs (reconstructed with ECGI). Programmed stimulation was used to determine trefr, defined as the shortest coupling interval with capture. Both metrics were determined relative to the common pacing spike.

Results

In all six hearts, selective dofetilide and pinacidil infusion resulted in delayed trefr and Tup in the non-LAD region, and shortened invasive trefr and noninvasive Tup in the LAD region, respectively (panel B and C). Over all 59 observations, Tup showed high agreement with trefr (values close to line of identity, panel D) with strong correlation (r = 0.91). This finding was independent of T-wave polarity (positive, negative or biphasic).

Conclusion

The moment of steepest upslope of the T-wave in a noninvasively reconstructed UEG accurately reflects end of local refractoriness in intact hearts, in case of pronounced RT dispersion. Under these circumstances, when local RT is defined by moment of re-excitability (allowing to link it to conduction block and re-entry), ECGI T-wave upslope can be taken as a truthful marker for local RT. Abstract Figure. Results
Non-invasive predictors for infranodal conduction delay in patients with left bundle branch block after transcatheter aortic valve replacement
Authors: Auberson C , Badertscher P , Madaffari A , Malushi M , Bourquin L , Spies F , Aeschbacher S , Fahrni G , Kaiser C , Jeger R , Osswald S , Sticherling C , Kuehne M , Knecht S
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Left bundle branch block (LBBB) is the most common conduction disorder after transcatheter aortic valve replacement (TAVR) with an increased risk of atrioventricular (AV) block. The aim of the current study was to identify non-invasive predictors for infranodal conduction delay in patients with LBBB.

Methods

We analyzed consecutive patients undergoing TAVR with pre-existing or new-onset LBBB between August 2014 and August 2020. His ventricular (HV) interval measurement was performed on day 1 after TAVR. Baseline, procedural, as well as surface and intracardiac electrocardiographic parameters were included. Infranodal conduction delay was defined as HV interval >55 ms.

Results

Of 825 patients screened after TAVR, 151 patients (82 ± 6 years, 39% male) with LBBB were included. Among these, infranodal conduction delay was observed in 25%. ΔPR (difference in PR interval after and before TAVR), PR and QRS duration after TAVR were significantly longer in the group with HV prolongation. In a multivariate analysis in patients with sinus rhythm (n = 131), ΔPR (OR per 10 ms increase: 1.52; 95% CI: 1.19-2.01; p = 0.002) was the only independent factor associated with infranodal conduction delay. The AUC of the ROC curve was 0.724 (95% CI) for ΔPR. A change in PR interval by 20 ms yielded a sensitivity of 26% and specificity of 83% with a positive predictive value of 45% and a negative predictive value of 84% to predict HV prolongation.

Conclusions

Simple analysis of surface ECG and a calculated ΔPR <20ms can be used as predictor for the absence of infranodal conduction delay in post-TAVR patients with LBBB. Abstract Figure HV
ECG wearable rhythm monitoring in covid-19 patients
Authors: Garkina S , Orshanskaya V , Simonova K , Arzhelas S , Mineeva E , Lebedev D
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Wearable monitors and external smart-phone enabled devices represent the new era in remote patient management during covid-19 pandemy. There is growing evidence showing that arrhythmias are one of the major complications of SARS-CoV-2 infection especially in high risk group of patients. 

Methods

We enrolled 34consecutive patients with confirmed diagnosis of SARS-CoV-2 (mean age62.45 ± 5.25years, 16male). Remote wireless rhythm monitoring was performed using portative ECG sensor.Average follow-up period was 21 days during in-hospital stage and 2 months after discharge.

Results

Among hospitalized patients with verified SARS-CoV-2 some presented different arrhytmias before admission (9 patients had atrial fibrillation and 11 patients had history of ventricular extrasystoles and non-sustained ventricular tachycardia). One patient underwent cardiac transplantation 1.5 years ago (female 38 years old with a history of dilated cardiomyopathy) and one patient had implanted CRTD device as primary prevention (male 54 years old with a history of myocardial infarction and low LVEF 28%). Other 12 patients did not experience any cardiac arrhythmias before admission. During monitoring period one patient demonstrated asymptomatic pauses longer than 6 seconds (Figure 1) revealed by portative device. After 2 months of follow up he continued to have hemodinamycally significant rhythm pauses and underwent pacemaker implantation. One patient had spontaneus AF conversion into sinus rhythm (Figure 2) also confirmed by wireless monitoring. Other patients did not demonstrate clinically significant arrhythmias. The duration of QT interval was also monitored during in-hospital period in all patients, average score was 451 ± 12 msec.

Conclusions

Using of wearable electronic devices may contribute to better monitoring of the state of patients and control of symptoms. Abstract Figure. Hemodynamically significant rhythm pause
Antiarrhythmic effect of 9-week hybrid cardiac telerehabilitation - subanalysis of the TELEREHabilitation in Heart Failure patients - TELEREH-HF randomized clinical trial
Authors: Orzechowski P , Piotrowicz R , Zareba W , Pencina MJ , Kowalik I , Komar E , Opolski G , Banach M , Glowczynska R , Szalewska D , Pluta S , Irzmanski R , Karalus Z , Piotrowicz E
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The National Centre for Research and Development, Warsaw, Poland.

Background. Cardiac rehabilitation is a component of heart failure (HF) management but its effect on ventricular arrhythmias is not well recognized.

Purpose. We analyzed the antiarrhythmic effect of a 9-week hybrid cardiac telerehabilitation (HCTR) and its influence on long term cardiovascular mortality in HF patients taken from the TELEREH-HF trial.

Methods. We evaluated the presence of non-sustained ventricular tachycardia (nsVT) and frequent premature ventricular complexes ≥10 beats/hour (PVCs ≥10) with 24-hour ECG monitoring at the baseline and after 9-week HCTR or usual care (UC) of 773 HF patients (NYHA I-III, LVEF ≤ 40%).

Results. Among 143 patients with nsVT, arrhythmia subsided in 30.8% after HCTR, similarly among 165 patients randomized to UC who had nsVT 34.5% did not show them after 9 weeks (p = 0.481). There was no significant difference in the decrease in PVC ≥10 over 9 weeks between randomization arms (14.9% vs. 17.8%, respectively p = 0.410). Functional response for HCTR (Δ peak oxygen consumption [pVO2] in cardiopulmonary exercise test >2.0 ml/kg/min) did not affect occurrence of arrhythmias. The multivariable analysis of the entire population did not identify HCTR as an independent factor determining improvement in terms of nsVT or PVCs >10.  However, only in the HCTR group, the achievement of the antiarrhythmic effect significantly reduced the cardiovascular mortality in 2 years follow-up (Logrank p = 0.0009) (Figure).

Conclusions. Significant improvement in physical capacity after 9 weeks of HCTR did not correlate with the antiarrhythmic effect in terms of  incidence of nsVT or PVCs ≥10. An antiarrhythmic effect after the 9-week HCTR affected long term cardiovascular mortality in HF patients. Abstract Figure
Oral procainamide as pharmacological treatment of recurrent and refractory ventricular tachyarrhythmias
Authors: Toniolo M , Grilli G , Proclemer A , Rebellato L , Muser D , Daleffe E , Facchin D
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

The antiarrhythmic therapy of recurrent ventricular arrhythmias in patients having undergone catheter ablation and in whom amiodarone and/or beta blockers were ineffective or contraindicated, is a controversial issue.

Purpose

The present study sought to evaluate the efficacy and tolerability of oral procainamide in patients with recurrent ventricular arrhythmias, when the standard therapy strategy failed.

Methods

All patients with an implantable cardioverter defibrillator (ICD)  treated with oral procainamide for recurrent ventricular tachycardia (VT) or ventricular fibrillation (VF) in our institution between January 2010 and May 2019 were enrolled. The primary endpoint was the total number of ICD interventions after the beginning of procainamide therapy. Secondary endpoints were total number of VTs and VFs recorded on the ICDs controls, and discontinuation of therapy. The events occurring during procainamide treatment were compared with a matched duration period before the initiation of therapy with procainamide. Patients therefore served as self-controls.

Results

A total of 33 consecutive patients (31 males, 93.3%; mean age 73.3 ± 10 years) were included in the retrospective analysis. The mean time of procainamide treatment was 12.5 ± 13.5 months. The mean dose of procainamide was 1194 ± 495 mg/die. Procainamide therapy significantly decreased ICD interventions (DC shock: 102 vs 132; anti-tachycardia pacing: 418 vs 603; 12 patients manifested DC shock after the beginning of treatment vs 25 patients before treatment). Procainamide also decreased the total number of VT/VF episodes (514 vs 1078 episodes) [p < 0,01]. Only 2 patients (6%) presented severe side effects (hypothension) requiring discontinuation of therapy.

Conclusions

Procainamide was associated with a significant decrease of ICD therapies and ventricular arrhythmias showing an optimal profile of tolerability.
11-year follow-up outcomes of catheter ablation of para-hisian accessory pathways
Authors: Xu L , Chen Q , Zou T , Cheng K , Ling Y , Xu Y , Pang Y , Liu G , Zhu W , Ge J
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Ablation of para-hisian accessory pathways (APs) remains challenging due to anatomic characteristics and few studies have focused on the causes for recurrence of radiofrequency ablation of para-hisian APs.

Objective

This retrospective single center study was aimed to explore the risk factors for recurrence of para-hisian APs.

Methods

113 patients who had a para-hisian AP with an acute success were enrolled in the study. In the 11-year follow-up, 15 cases had a recurrent para-hisian AP. Therefore 98 patients were classified into success group while 15 patients were classified into recurrence group. Demographic and ablation characteristics were analyzed.

Results

Gender difference was similar in two groups. The median age was 36.2 years old and was younger in recurrence group. Maximum ablation power was significantly higher in success group (29 ± 7.5 vs 22.9 ± 7.8, p < 0.01). Ablation time of final target sites was found to be markedly higher in success group (123.4 ± 53.1 vs 86.7 ± 58.3, p < 0.05). Ablation time less than 60 seconds was detected in 12 (12.2%) cases in success group and 7 (46.7%) cases in recurrence group (p < 0.01). Occurrence of junctional rhythm was significantly higher in recurrence group (25.5% vs 53.3%, p < 0.05). No severe conduction block, no pacemaker implantation and no stroke were reported. Junctional rhythm during ablation (OR = 3.833, 95%CI 1.083-13.572, p = 0.037) and ablation time <60s (OR = 5.487, 95%CI 1.411-21.340, p = 0.014) were independent risk factors for the recurrence of para-hisian AP.

Conclusions

Considering the long-term safety of ablation of para-hisian AP, proper extension of ablation time and increase of ablation power could be applied during operation.
The efficacy and safety of non-fluoroscopic catheter ablation of arrhythmias in pregnancy after mid-long-term follow-up: a single- center experience
Authors: Abdrakhmanov A , Ainabekova B , Nuralinov O , Bakytzhanuly A , Smagulova A
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Despite the incidence of arrhythmias in pregnancy data on non-fluoroscopic catheter ablation in pregnant women and perinatal outcomes is limited.

Purpose

the aim of this study is to prospectively assess the efficacy and safety of non-fluoroscopic catheter ablation in pregnant women with arrhythmias.

Methods

44 pregnant women (mean age of 28,2 ± 4,2 years, mean gestation age 24,4 ±3,8 weeks) indicated for catheter ablation were enrolled. The ablation was performed under the guidance of CARTO (n = 20; 45%) and Ensite Precision systems (n = 24; 55%) without fluoroscopy. Ablation characteristics, procedure-related complications and clinical outcomes were evaluated during 18 months follow-up.

Results

all 44 cases of ablation were successful.  There were 14 (31,8%) ablation of accessory pathways - in left free wall (n = 8),  in right free wall (n = 5), posteroseptal (n = 1). 19 patients (43,2%) underwent ablation for atrioventricular nodal reentrant tachycardia. In 3 cases (6,8%) were combination of accessory pathways with slow conduction ways. Ablation of the right ventricular outflow tract was performed in 8 cases (18,2%) of frequent premature ventricular contractions and idiopathic ventricular tachycardia.  The median procedural time was 71 minutes (interquartile range 54-97). Procedural complication was documented in 1 patient (2,3%), who developed an ileofemoral thrombosis. Perinatal outcomes: spontaneus vaginal (n = 35; 79.5%) or vaginal-assisted (n = 4; 9.1%) delivery were in the majority. Five pregnancies (11.4%) were delivered by cesarean section. Mean median gestational age at delivery was 39 ± 1,12 weeks. In one case was placental abruption (2,3%).  Maternal cardiac events was none declared. There were 44 live births (in all pregnancies). Fetal birth weight was 3324,39 ± 625,1 grams, 5 minute Apgar was 8,81 ± 1,9. There were no maternal and fetal mortality. During follow-up there were no arrhythmia recurrence.

Conclusions

non-fluoroscopic catheter ablation of arrhythmias is feasible and can be safety performed in pregnancy. Our data suggests that these pregnancies were with good perinatal and neonatal outcomes.
Pulmonary vein isolation for AF: does technique influence outcome?
Authors: Reddy SA , Nethercott SL , Khialani BV , Virdee MS
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Over the last 20 years various techniques have been developed striving for safer and more durable pulmonary vein isolation (PVI). The three most commonly used tools are pulmonary vein ablation catheter (PVAC) and cryoballoon (‘single-shot’ techniques), and point-by-point (PBP) radiofrequency ablation using 3D electroanatomical mapping (EAM).

Objective

Evaluate the safety and efficacy of the different techniques in an unselected population undergoing de-novo ablation for persistent or paroxysmal atrial fibrillation (AF) at a single high-throughput centre.

Method

Retrospective, single-centre study of consecutive AF ablations between March 2017 and April 2018. Demographic, procedural and outcome data were analysed.

Results

Over the study period 329 first-time PVI procedures were performed. 37.4% were performed using PBP, 39.8% using cryoballoon and 22.8% using PVAC. There was no significant difference in age or sex between different ablation technique groups. 238 procedures were performed for paroxysmal AF and 91 for persistent AF. A higher proportion of the persistent cases were performed using point-by-point techniques compared to paroxysmal cases (58.2% vs 29.0%, p < 0.05).

Procedural times were significantly longer in the group undergoing PBP ablation compared to cryoballoon or PVAC. However, there was no statistically significant difference in 12-month freedom from symptomatic AF or procedural complications between the groups.

Conclusions

PBP, PVAC and cryoballoon AF ablation all appeared equally efficacious in an unselected population, though PVAC and cryoballoon procedures were shorter. All procedures were associated with a low adverse event rate. Prospective examination is required to substantiate this finding. Table 1CARTOn= 123Cryoballoonn= 131PVACn = 75p-valueAge/years61.7 ± 9.259.5 ± 10.661.7 ± 9.70.14Male92 (74.8)88 (67.2)49 (61.3)0.80Paroxysmal AF70 (56.9)106 (78.6)62 (82.7)0.14Cardiovascular risk factors Hypertension Diabetes Ischaemic heart disease Cerebrovascular disease Heart failure Dyslipidaemia73 (59.3)23 (18.7)40 (32.5)2 (1.6)0 (0) 12 (9.8)79 (60.3)19 (14.5)45 (34.4)0 (0)1 (0.8)16 (12.2)43 (57.3)16 (21.3)22 (29.3)1 (1.3)0 (0)10 (13.3) 0.58 0.24 0.62 - - 0.71Left atrial diameter/cm4.2 ± 0.74.1 ± 0.73.9 ± 1.00.69Procedure time/mins191.3 ± 39126.7 ± 24117.4 ± 30<0.056 month success Paroxysmal Persistent50/66 (75.8)32/51 (62.7)78/103 (75.7)18/24 (75.0)48/61 (78.6)10/12 (83.3) 0.99 0.80Complications9 (7.3)3 (2.3)1 (1.3)0.07Patient demographics, procedural characteristics and outcomes for Carto, cryoballoon and PVAC cases. Values presented as mean ± SD or n (%)Abstract Figure. Time to arrhythmia recurrence
A minimally fluoroscopic approach in AVNRT ablation reduces radiation exposure and number of RF applications without compromising safety, effectiveness and procedural time
Authors: Kasbari R , Robaye B , Dormal F , Ballant E , Collet B , Deceuninck O , Blommaert D , Xhaet O
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Radiofrequency ablation (RF) of atrioventricular nodal reentry tachycardia (AVNRT) using conventional fluoroscopy is associated with a significant radiation exposure to both patients and operators. 3D electro-anatomical mapping systems (EAMS) can reduce radiation exposure, but specific clinical studies on their use in AVNRT ablation still lack.

Purpose

The aim of this study was to determine if EAMS use in AVNRT ablation can reduce radiation exposure and to analyse its effects on clinical and procedural outcomes.

Methods

We selected 277 patients who underwent AVNRT RF ablation in a single center in Belgium between July 2015 and November 2019 and performed a retrospective analysis of 136 and 141 patients who respectively and consecutively underwent AVNRT ablation with a conventional fluoroscopic approach (Conventional group) and a minimally fluoroscopic approach using a 3D electro-anatomical mapping system to guide the procedure (Minimal fluoroscopy group). Conventional fluoroscopy was used in both groups to confirm AVNRT induction to avoid costs related to the use of EAMS catheters in case of non-induction.  We compared radiation dose, acute success/complication rates, procedural time and the number/time of RF applications in both groups.

Results

Radiation dose in the minimal fluoroscopy group was significantly lower compared to the conventional group (1179 vs. 2686 mgray.cm2, p < 0,0001) and fluoroscopic time was shorter (2,5 vs. 8,6 minutes, p < 0,0001). Procedural time (70 vs. 69 min, p = NS) and acute success rate (99% vs. 98%, p = NS) were not significantly different in the minimal fluoroscopy group compared to the conventional group, and no complications were observed in both groups. The number of RF applications was significantly lower when EAMS was used (6,2 ± 4,8 vs. 8,6 ± 7,6 RF application, p = 0,01) while the RF application time was not significantly different (56,8 ± 51,2 1 vs. 65,3 ± 86 seconds, p = NS).

Conclusion

AVNRT catheter ablation using a minimally fluoroscopic approach with 3D electro-anatomical mapping systems reduces radiation exposure without compromising safety, effectiveness and procedural time. EAMS use is associated with a reduction in the number of RF applications suggesting a higher precision and stability of ablation catheters during RF application.
Ablation Index guided high power (50W) short duration for anterior line and roof line ablation: feasibility, procedural data and lesion analysis
Authors: Chen S , Zanchi S , Bordignon S , Bianchini L , Tohoku S , Bologna F , Chun KRJ , Schmidt B
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Objectives

To evaluate the feasibility, procedural data, and lesion characteristics of anterior line (AL) and roof line (RL) ablation by using ablation index (AI) guided high-power(50W) among patients with recurrent atrial fibrillation (AF) or atrial tachycardia (AT) after pulmonary vein isolation (PVI).

Methods

35 consecutive patients with macro-reentrant left atrial tachycardia (LAT) or substrate at LA anterior wall or roof after previous PVI were enrolled. Ablation power was set to 50W, targeting AI 500 for AL and 400 for RL. First-pass conduction block (FPB) was evaluated. The AL was arbitrarily divided into 3(caudal, middle and cranial) segments to analyze the location of conduction gaps in non-FPB patients.

Results

A total of 32 AL and 17 RL were deployed and FPB was achieved in 24 (75%) and 14 (82%) of them respectively. In non-FPB group, the most frequent gap location along the AL was the middle third. Final block of AL was achieved in 97%, and block of RL was achieved in 100%. The RF ablation time was short (2,9 ± 0,8 min for AL and 46,2 ± 15,6 sec for RL). For AL, female gender was significantly more frequent in FPB than in non-FPB patients(p 0,028); patients with non-FPB were associated with significantly longer RF time as compared to patients with FPB (204 ± 47 sec vs 161 ± 41 sec; p = 0,02). No procedural complications occurred.

Conclusion

AI guided high-power(50W) ablation appears to be a feasible, effective and fast technique for AL and RL ablation.
Remote operation for non-fluoroscopic navigation of complex tachycardias
Authors: Garcia-Bolao I , Monino D , Marsal R , Ramos P , Erkiaga A , Irezabal J , Albarran-Rincon R
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Non-fluoroscopy navigation systems have evolved and it has had a positive impact on the electrophysiological procedures. Non-medical staff as field clinical specialists (FCS) have been essential in obtain these results, nevertheless, they need to provide their duties on-site. In some situations as a Pandemic sceneries, remote operation of the navigation system could avoid unnecessary exposure of this staff to a high-risk hospital environment.

Purpose

Remote system operation technology was developed and applied to a non-fluoroscopic navigation system in order to overcome Spanish mobility restrictions caused by Covid-19 pandemic infection and subsequently used routinely.

Methods

Fifty consecutive complex ablations were performed in different days using this technology. All these procedures were assisted remotely with the only intervention of a field clinical specialist located at his home who took full control of the navigation system (keyboard, mouse and screen) and had bidirectional real time audio/video feedback with the operating physician. Once the connection was established, the remote field clinical specialist replicated the Rhythmia screen at the remote location with all its features, and interacted identically with the physician, essentially with no perceptible differences from being physically present.

Results

There were neither interruptions nor perceptible delays in the bidirectional communications between the remote field clinical specialist and the operating physician during the procedures. Video signal delay ranged from 265 to 325 milliseconds. All the procedures were uneventful.

Conclusions

Remote System Operation allowed full teleoperation of a non-fluoroscopic navigation system (keyboard, mouse and screen) as well as bidirectional real time audio/video feedback with the operating physician, providing a fully autonomous remote assistance in 50 complex ablation procedures. This technology ensures workflow continuity and optimal workforce flexibility and has relevant and promising implications in the field of training, teaching and resource optimization that deserves further development. Latency measurements.Hospital LocationPamplonaPamplonaPamplonaRemote operator locationBilbaoMadridTarragonaT1 (s/ms)58s 120ms28s 340ms33s 380msT2 (s/ms)58s 680ms28s 960ms33s 940msT2-T1 (ms)560 ± 32620 ± 33560 ± 30Latency = (T2-T1)/2 (ms)280 ±15310 ± 15280 ± 10Measurements of the video delay ranged from 265 to 325 milliseconds.Abstract Figure. Local and Wide area network architecture
Prevalence and ablation of different anatomic locations of atrial tachicardias in the electrophysiology lab of a single large center
Authors: Toniolo M , Rebellato L , Muser D , Daleffe E , Proclemer A , Facchin D
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Focal atrial tachycardias (ATs) can arise from several different anatomic regions both in the right atrium (RA) and left atrium (LA). The prevalence of focal atrial tachycardia is not well known. A European study of young males applying for pilot licenses demonstrated that 0.34% had asymptomatic atrial tachycardia and 0.46% had symptomatic atrial tachycardia1. It is well-recognized that these foci do not occur randomly throughout the atria but tend to cluster at characteristic anatomic locations. However, the distribution of these sites in the total amount of ATs is not well recognized.

Purpose

The objective of this study was to determine the prevalence of different anatomic locations of ATs in the electrophysiology lab of a single large center (300 ablations per year) and to verify the site of ablation.

Methods

We collected 150 consecutive patients submitted to catheter ablation of ATs between January 2010 to December 2020. Anatomic localization of the atrial focus was performed during tachicardia by analysis of endocardial activation sequence.

Results

The distribution of the different anatomic locations is rappresented in the figure. In 134 patients (89%) ATs were localized in the RA. In the RA, these foci mainly occured along the crista terminalis (32%), the perinodal region (22,6%), the anterior right sided septum, near the foramen ovale (9,3%), the posterior right-sided septum (8%), the ostium of the coronary sinus (5,3%), the tricuspid annulus (5,3%), the superior vena cava (4,6%), the infero-lateral wall (2,5%), the right atrial appendage (0,6%) and the cavotricuspid histhmus (0,6%). In the LA (11%), foci occur predominantly at the pulmonary vein ostia (5,2%) and less commonly at the mitral annulus (2,5%), the left sided septum (0,6%), the appendage ridge (0,6%), the roof (0,6%) and the anterior wall (0,6%). For each location of AT, the ablation was performed at the earliest activation site, but about the perinodal ATs, the ablation was performed at the non coronary sinus of Valsalva of the aortic root, regardless the earliest activation site, for avoiding to create damages to the atrio-ventricular (AV) conduction system.

Conclusions

ATs mainly arise from the RA. Crista terminalis is the most common site but the perinodal region is the second more frequent site. The ablation of ATs from the perinodal region is challenging for the risk of damages to the AV conduction system. The relatively low prevalence of ATs arising from the pulmonary veins could be explained for the likely degeneration of these ATs in atrial fibrillation. Abstract Figure.