bluuebunny/crossref_metadata_2025_split huggingface dataset:
P6553Contemporary pacemakers and oncologic radiotherapy courses: a real-time, wireless-enabled observation
Authors: Di Girolamo E , Furia N , Faustino M , Appignani M , Marini M , Genovesi D , Di Carlo C , Delana A , Barbareschi A , Falco M D 
Published: October 2019

Abstract

Background
The effects of high dose oncologic radiotherapy on cardiac pacemakers (PMs), at even less than 6MV power, are unpredictable, depending on multiple factors. Normal PM function may be impaired during photon exposure, with potentially life-threatening consequences in PM-dependent patients, and, unlike in magnetic resonance imaging setting, both manufacturer statements and guidelines discourage direct exposure.

Purpose
To evaluate transient PM malfunctions by direct exposure to doses up to 10 Gy during radiotherapy course, actually not recommended or considered even unsafe, 17 wireless-telemetry-enabled PMs obtained after upgrade or extraction of the system, with sufficient residual battery charge for the purpose of the study (at least 1 year to elective replacement indicator, E.R.I.) were evaluated in a real-time in-vitro session.

Methods
All PMs underwent baseline interrogation. Single chamber devices were programmed in VVI/40 mode while dual or triple chamber devices were programmed in DDD/40 mode. Rate adaptive function was disabled to avoid the “run-away” phenomenon during exposure. A centering computed tomography was performed to build the corresponding treatment plan and the PMs were blinded randomized to receive either 2, 5 or 10 Gy exposure by a low photon-energy linear accelerator (6MV) in a homemade water phantom (600 MU/min). The effective dose received by the PMs was assessed by an in-vivo dosimetry. During radiotherapy course, the devices were observed in a real-time session using manufacturer specific equipment, and PM function (pacing and sensing, programmed parameters) was recorder by a videocamera in the bunker before (5 minutes), throughout, and after (5 minutes) the entire radiation exposure.

Results
During radiotherapy course, non of the PMs reported spontaneous changes in parameter settings. 13 PMs (76.5%) recorded non clinically relevant minor transient electromagnetic sensing interferences. No atrial and/or ventricular oversensing nor base-rate-pacing inhibition were observed. Only 4 PMs (23.5%) reported neither transient malfunction nor minor noise, withstanding direct radiation exposure. Transient oversensing-related malfunctions were observed regardless of either 2, 5 or 10 Gy exposure.

Conclusions
Minor, non clinically relevant electromagnetic sensing interferences were observed in most of the PMs during direct exposure. Nevertheless, to avoid potentially life-threatening PM malfunctions, magnet application on the PM pocket site or reprogramming in the asynchronous mode are still suggested in PM-dependent patients ongoing even low energy radiotherapy exposure.

Acknowledgement/Funding
None
P6561Diagnostic yield of implantable loop recorders: a comparison of arrhythmia nurse specialists versus clinicians
Authors: Lee J D , Eftekari H , Paul G , Zhupaj A , Panikker S , Dhanjal T , Yusuf S , Hayat S , Osman F 
Published: October 2019

Abstract

Background
Implantable loop recorders (ILR) are recommended in guidelines to determine symptom-rhythm correlation. Arrhythmia Nurse Specialists (ANS) play a critical role in the assessment of such patients. Their effectiveness at risk stratification for ILR implantation is unknown. The ESC 2018 Syncope guidelines recommend more research in this field.

Aim
To evaluate the diagnostic yield of consecutive ILR implants at a tertiary centre over a 2year period and compare ANS versus Clinicians.

Methods
A retrospective study of all patients undergoing ILR implant between April 2016 and April 2018. Data collected included baseline patient demographics, referral source and management changes made by ILR findings.

Results
305 patients had an ILR; median age was 71yrs (interquartile range 52–81), 55% male. Median follow-up time was 15months. Referrals were from general cardiology (GC) = 98 (32%), electrophysiology (EP) = 105 (34%), and ANS-led syncope clinic = 102 (34%). Indications for ILR implant were syncope = 203 (65.9%), palpitation = 21 (6.9%), pre-syncope = 16 (5.2%), cryptogenic stroke = 35 (11.5%) and others 7 (8.9%) (falls, channelopathies). Of the entire cohort, 102 (34.0%) experienced arrhythmias recorded on the ILR that resulted in a change of management. This included: pacemaker implant = 49 (16.1%), complex-device implant = 7 (2.3%), AF=28 (9.2%), SVT=14 (4.6%), VT=1 (0.3%). Of those with a syncope indication (n=203), findings on ILR altered management in 73patients (36.0%) over a median follow-up of 18months; a pacing indication in this syncope group was present in 44 (21.9%) patients (median time to diagnosis: 2.7 months) with 24 receiving a pacemaker indication within 3 months of ILR insertion. ANS had a higher pacemaker implant rate. Overall, an ILR resulted in a diagnostic yield of 34.1% (n=104). Specialist nurse referral resulted in an overall greater trend towards change of management in 38.2% of patients compared with GC (32.7%) and EP (31.0%) (p=0.593 nurse vs. consultant).

Conclusion
The overall diagnostic yield of ILR insertion was 34% in our study. ANS had a trend towards a greater diagnostic yield compared with clinicians, and significantly more pacemaker indications. Our data suggests that ANS patient selection for ILR insertion are at least comparable to clinicians.
P6563Time trends in incidence rates of atrial fibrillation in Norway 2004–2014. A CVDNOR project
Authors: Kjerpeseth L J , Igland J , Selmer R , Ellekjaer H , Berge T , Kalsto S M , Christophersen I E , Myrstad M , Skovlund E , Egeland G M , Thell G S , Ariansen I 
Published: October 2019

Abstract

Background
The reported incidence and prevalence of atrial fibrillation (AF) has been inconsistent among studies.

Purpose
We aimed to study time trends in incidence (first time) of AF hospitalizations or AF deaths in Norway in the period 2004–2014 by age and sex.

Methods
Nationwide hospital discharge diagnoses in the Cardiovascular Disease in Norway (CVDNOR) database and in the National Patient Registry were linked to the National Cause of Death Registry. All hospitalizations with AF as primary or secondary diagnosis and out-of-hospital deaths with AF as underlying cause (ICD-9: 427.3 or ICD 10: I48; AF or atrial flutter) in individuals ≥18 years were obtained during 1994–2014. Incident AF was defined as first hospitalization or out-of-hospital death due to AF with no previous hospitalization for AF the past 10 years. Age-standardized incidence rates with 95% confidence intervals (CIs) were calculated using direct standardization to the age-distribution in the Norwegian population per Jan 1st 2004. Age-adjusted average yearly incidence rate ratios (IRR) with 95% CIs were estimated by Poisson regression analyses. Accumulated prevalence during 1994–2014 was assessed in Norwegian residents 18 years and older per Dec 31st 2014.

Results
During 39,865,498 person years of follow up from 2004 to 2014 we identified 175,979 incident AF cases of which 30% were registered with AF as primary diagnosis, 69% as secondary diagnosis and 1% as out-of-hospital cause of death. The age-standardized incidence rate of AF hospitalization or out-of-hospital death per 100,000 person years was stable at 433 (426–440) in 2004 and 440 (433–447) in 2014. IRR were stable or declining across age groups of both sexes, except for the youngest age group 18–44 years, where incidence rates of AF hospitalization or out-of-hospital death increased by 2% per year, IRR 1.02 (1.01, 1.03). By 2014, the prevalence of AF assessed from hospital or death records was 2.9% in the adult population 18 years and older.

Conclusion
We found overall stable incidence rates of AF from 2004 to 2014 in the adult Norwegian population. Increased incidence rates of AF in the population 18–44 years are worrying and need further investigation.

Acknowledgement/Funding
The Norwegian Atrial Fibrillation Reseach Network
P6569Additive value of evaluating patients with syncope by an implantable loop recorder: diagnosis of subclinical atrial fibrillation
Authors: Olivella San Emeterio A , Francisco Pascual J , Rivas Gandara N , Perez Rodon J , Santos Ortega A , Benito Villabriga B , Llerena Butron S I , Rodriguez Garcia J , Garcia-Dorado D , Ferreira Gonzalez I 
Published: October 2019

Abstract

Background
Few information exists about the additive value of implantable loop recorders (ILR) for the diagnosis of subclinical atrial fibrillation or flutter (AF) in patients (p) studied for syncope and its therapeutic and prognostic implications.

Purpose
To evaluate the burden of new onset AF diagnosed by ILR in patients studied for syncope and its therapeutic and prognostic implications.

Methods
We conducted an observational cohort study in a tertiary center. From April 2014 to January 2019, 355 ILR were implanted in patients with syncope according the ESC syncope guidelines. We excluded the ones with previous known AF and younger than 18 years old (yo), with a final cohort of 197 patients. All of them were therefore followed in outpatient clinic and treated according to current clinical guidelines. New AF diagnosis and consequent therapeutic changes and related clinical events were recorded.

Results
Of 197p, 38 had a first episode of AF (19.29%), with a mean AF burden of 4.19%, and a median of 0.15%. The incidence rate of AF detection was 10.67patients/year (p-y), with higher incidence among patients older than 65 yo (14.17p-y vs 5.27p-y, p<0.05). Only 1 patient out of 38 had a symptomatic episode that triggered consultation to the emergency room (2.63%). Oral anticoagulants (OAC) were started in 30 of 38 patients with new onset AF (78.94%). Only one stroke was reported secondary to new onset AF before OAC were started. 2 mayor bleedings were reported (1.01%), both of them related to OAC start for new AF diagnosis. 4 patients died (2.03%), all of them from non-cardiovascular causes.
Kaplan Meier survival from AF

Conclusions
New onset AF is frequent in patients with ILR implanted for syncope, especially among those older of 65 yo, with the vast majority consisting in short paroxysms. Following AF detection, generally OAC are initiated.
P6574Symptomatic palpitations causing anxiety in women, what are the underlying arrhythmias
Authors: Insulander P , Carnlof C , Jensen-Urstad M , Schenck-Gustafsson K 
Published: October 2019

Abstract

Background
Highly symptomatic palpitations are common, particularly in women, and may cause disturbing symptoms including anxiety, depression, and decreased health related quality of life. Palpitation in this context has been considered generally benign and caused by premature atrial or ventricular beats or stress-induced sinus tachycardia. However, how often arrhythmias of clinical importance such as atrial fibrillation and supraventricular or ventricular tachycardia is the cause is unknown.

Purpose
To evaluate to what extent symptomatic palpitation in women is caused by clinically important arrhythmias.

Methods
A new Swedish digital technique was used. The system uses a well-validated algorithm to analyze heart rhythm (both thumbs and chest recordings), is connected to the user's smartphone and provides immediate response to the user. The result is simultaneously available for the supervising physician. In cases of non-benign arrhythmias, the result was also analyzed manually. In all, 909 women (age 56±11 years) with palpitations causing anxiety were included. ECG was recorded twice a day and at symptoms for 60 days. Participants with known atrial fibrillation were excluded.

Results
In all, 6 861 ECG recordings were done due to symptomatic palpitation. Underlying heart rhythms were as follows: normal sinus rhythm (73%), sinus tachycardia (12%), premature atrial beats or ventricular beats (7%), atrial fibrillation (4%), benign sinus bradycardia and second-degree AV block type 1 (4%), and supraventricular tachycardia (1%). In 1% of recordings, quality was too poor for analysis. No ventricular tachycardia was recorded. In all, 19 women with previously undiagnosed atrial fibrillation and 12 women with undiagnosed supraventricular tachycardia were found.

Conclusions
In the great majority of episodes causing symptomatic palpitation in women, the underlying arrhythmia is benign. However, in 5% previously undiagnosed atrial fibrillation or supraventricular tachycardia were found.
P6581Association of neuro-psycho-behavioral troubles to catecholaminergic polymorphic ventricular tachycardia: a more severe arrhythmic phenotype?
Authors: Placide L , Sacher F , Maury P , Probst V , Pasquie J L 
Published: October 2019

Abstract

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is defined by bidirectional or polymorphic ventricular tachycardia during adrenergic situations and is associated to a poor long-term prognosis. Clinical cases suggest an association between epilepsy and/or neuro-psycho-behavioral troubles (NPBT) to cardiac channelopathies.

Methods
This is a retrospective observational study based on case analysis from the INTEGRALIS database of the referral center for inherited cardiac arrythmias in Nantes. Epidemiological and clinical-biological features of the population have been studied. Patients with Presence or Absence of NPBT were compared. Results:From 8306 pts in the whole database, 533 presented with VT and 71 pts were diagnosed with CPVT and genotyped. Symptom onset occurred at a medium age of 17.1±13.5 years. Median LVEF was 65% (IQR 9,8%) and median corrected QT interval (QTc) was 399 ms (IQR 27 ms). 77.5% of pts had fainting and/or syncopes, and there were 28.2% patients with a history of cardiac arrest. Time to diagnosis was below1 year for 44.2% of symptomatic pts. Symptoms occurred during exertion for 42.3% of pts including swimming. The prevalence of NPBT was 23,9%. 74% of NPBT were convulsive seizures, 21% psycho-behavioral troubles and 5% epilepsy proved by EEG. Median age of symptom onset was younger in the group “NPBT” (12.2±4 yo vs 19.2±15.5 yo). The rate of patients with symptoms during exertion was higher in the group “NPBT” (29.4 vs 7.4% P=0.031). A mutation in the gene of Ryanodine receptor-2 was found in 64.8% of pts.
Comparisons patients w/wo NPBT NPBT (N=17) Without NPBT (N=54) Familial history of Sudden death 7/17 (41.2%) 24/54 (44.4%) NS Familial history of CPVT 5/17 (29.4%) 29/54 (53.7%) NS Medium age of symptom onset (yo) 12.1±4 19.2±15.5 P=0.021 Time to diagnosis <1 year 4/17 (23.5%) 16/54 (27.8%) NS Malaises and/or syncopes 17/17 (100%) 38/54 (70.4%) P=0.035 Cardiac arrest 9/17 (52.9%) 11/54 (20.4%) P=0.025 ICD Implantation 6/17 (35.3%) 12/54 (22.2%) NS Supraventricular arrhythmias 3/17 (17.7%) 6/54 (11.1%) NS Antiepileptic treatment 5/17 (29.4%) 2/54 (3.7%) P=0.009

Conclusion
NPBT appears to be associated to a younger age of symptom onset and a higher rate of serious cardiac events particularly during swimming. This study will serve as preliminary data for further clinical and experimental protocols.
P6582Control and stability theory, modelling ventricular dynamics in superficial 12-lead ECG as a novel contribution to non-invasive risk stratification of Brugada ECG patterns(?)
Authors: Sabatini A 
Published: October 2019

Abstract

Background
Brugada syndrome (BrS) risk stratification in asymptomatic subjects is still currently the most important yet unresolved clinical problem to determine the subset of patients with BrS requiring ICD implantation. The underlying pathophysiological mechanisms responsible for BrS ECG patterns remain unknown, as well as the mechanisms of the sudden onset of polymorphic ventricular tachycardia which leads to ventricular fibrillation and sudden cardiac death (SCD).

Purpose
This study aims to analyze from a totally alternative perspective, superficial 12-lead ECG signals. It departs from the numerous and various attempts to characterize and measure single morphology of specific and individual ECG segments, intervals and waves, rather focusing on and studying the dynamics and stability of the superficial 12-lead ECG signal as a whole to determine stability parameters able to contribute to BrS ECG pattern risk stratification and differential diagnosis of BrS.

Methods
A quantitative stability control closed loop system has been designed to model the electrophysiology dynamics of the cardiac conduction system with a 12-lead superficial ECG signal being the input and output of the system (Fig. 1). A normal ECG signal and a type-1 coved Brugada pattern ECG-V2 portion have been scanned, digitized and quantitatively processed to obtain stability parameters (poles and zeros in the S-plane). Scanning was performed by Digitizeit – Digital River GmbH. Processing in the S-plane was performed by ©2019 Wolfram Demonstrations Project & Contributors, http://demonstrations.wolfram.com/, poles and zeros and Microsoft Excel software was also used.

Results
Poles and zeros of the system for type-1 coved Brugada pattern ECG-V2 and for the normal ECG-V2 are shown in Fig. 2, together with stability.

Conclusions
Based on our data,
1. It appears that portions of the ECG patterns, approximated by mathematical continuous time models representing, at the infinitesimal limit, every possible pattern and behaviors of an ECG signal, such as repolarization patterns, may exhibit interesting dynamics characteristics of stability and can be stratified as stable, marginally stable or unstable.
2. Such a classification may then be implemented to risk stratify repolarization patterns. When tending to instability, such patterns seem to be associated to high risk repolarization patterns such as BrS coved type-1 pattern, hence indicating higher risk of developing polymorphic VT or SCD.
In conclusion, more work will be needed to further this methodology to improve the understanding of the effects of the various physiological and pathological substrates involved with malignant arrhythmias and to improve risk stratification strategies to determine the subset of patients with Brugada syndrome requiring ICD insertion. Control systems and stability theory may indeed indicate an interesting and effective procedure for future work.
P6590Androgenic effects on ventricular repolarization: a translational study from pharmacovigilance databases to iPSC-cardiomyocytes
Authors: Salem J E , Yang T , Moslehi J J , Waintraub X , Gandjbakhch E , Bachelot A , Hidden-Lucet F , Hulot J S , Knollmann B C , Lebrun-Vignes B , Funck-Brentano C , Glazer A M , Roden D M 
Published: October 2019

Abstract

Aim
Male hypogonadism, arising from various etiologies including androgen-deprivation therapies (ADT), has been reported as a risk-factor for acquired long-QT (aLQT) and Torsades de pointe (TdP). A full description of clinical features of aLQTS associated with ADT and of underlying mechanisms are lacking.

Method and results
We searched the WHO pharmacovigilance database for men (n=6,560,565) presenting with aLQT, TdP or sudden death (SD) associated with ADT. We identified 184 cases of aLQTS and/or TdP (11% fatal), and 99 with SD. Of the 10 ADT examined, 7 had a disproportional association (reporting-OR=1.4–4.7, p<0.05) with aLQT, TdP or SD. The minimum time to SD was 0.25 days. Enzalutamide (Enza, androgen antagonist) was associated with more deaths (17%, p<0.001) than other ADT used for prostate cancer (8.1%,Table). In cardiomyocytes derived from induced pluripotent stem cells (IPS-CMs) from men, we studied electrophysiological effects of enza and dihydrotestosterone (DHT). Acute and chronic enza (25μM) prolonged action potential durations (APD90-paced0.5Hz; 414±63 (control) vs. 951±67 (acute, p<0.01) and 1028±63msec (chronic, p<0.01), and generated early/delayed afterdepolarizations and/or triggered activity in drug treated cells (4/7 acute and 3/5 chronic). Enza acutely and chronically inhibited IKr, and chronically enhanced INa-L. DHT (30nM) reversed enza effects on IPS-CMs. In 7 men with aLQT and hypogonadism, ECGs showed low amplitude, bifid T-waves typical of IKr block which resolved with testosterone.
Table 1 ndeath/ntotal (%) aLQT TdP SD n/naLQTS±TdP±SD (%) with ADT considered suspect by reporter Leuprorelin 1,871/22,113 (8.5%) 33 16 18 28/55 (50.9%) Goserelin 471/5,821 (8.1%) 8 2 15 17/22 (77.3%) Triptorelin 52/1,517 (3.4%) 6 3 2 5/8 (62.5%) Degarelix 82/2,787 (2.9%) 7 4 3 10/11 (90.9%) Bicalutamide 724/10,144 (7.1%) 23 16 11 28/41 (68.3%) Flutamide 163/4075 (4%) 4 2 3 3/7 (42.9%) Enzalutamide 5,430/31,896 (17%) 19 4 13 30/32 (93.8%) Abiraterone 1,240/14,261 (8.7%) 19 7 10 29/31 (92.5%) Finasteride 1,062/33,877 (3.1%) 52 20 32 20/87 (23%) Dutasteride 248/15,177 (1.6%) 26 7 11 5/38 (13.2%) Total ADT* 10,540/127,385 (8.3%) 168 68 99 137/283 (48.4%) Number (n) of case reports in men in the WHO international pharmacovigilance database (VigiBase) by ADT through 08/09/2018. *Some patients were on combination ADT.
Enzalutamide electrophysiology IPS-CMs

Conclusion
ADT is a risk factor for aLQT and TdP. Androgens may be useful in TdP treatment of hypogonadic men.

Acknowledgement/Funding
INSERM
P6592Novel heart-specific LncRNAs identified by deep sequencing contribute to pathogenesis in arrhythmogenic cardiomyopathy
Authors: Chen L , Song J , Hu S 
Published: October 2019

Abstract

Background
Arrhythmogenic Cardiomyopathy (AC) is one of main causes of sudden cardiac death in young people with limited understanding of molecular mechanism. LncRNAs are emerging as important regulators of cardiovascular diseases, but their roles in AC remain elusive.

Purpose
This study is to identify novel lncRNAs in AC genome wide and investigate their functions.

Methods and results
Extremely deep RNA-seq was performed for AC right ventricles (RVs, n=9) and left ventricles (LVs, n=6), normal RVs (n=5) and LVs (n=6), and dilated cardiomyopathy (DCM) RVs (n=4). Novel lncRNAs were accurately identified with epigenetic annotations. In comparison with normal and DCM, 1,925 novel lncRNAs transcripts specifically upregulated in AC RVs were identified. Most of AC-specific lncRNAs were highly expressed in heart, located in distal regions (>3 kb) from coding gene and marked by H3K4me1 or H3K27ac, indicating that these lncRNAs might act as cis-elements to regulate gene expression. Enrichment analysis revealed that AC-specific lncRNAs were associated with AC phenotypes like RV enlargement and dysfunction. Interestingly, their potential target genes were significantly enriched in lipid metabolism and calcium signaling pathways. In-vitro experiments demonstrated that LncRNA AC1, a novel AC-specific lncRNA, was significantly positively correlated with adipogenic genes expression. And overexpression of LncRNA AC1 promoted adipogenic genes expression and droplet deposition in human derived iPSC-CM and cardiac fibroblast.
ESC-AC lncRNA study abstract

Conclusion
We identified novel AC-specific lncRNAs related to adipogenesis and validated them in-vitro. Our findings also provide fundamental resource for the potential development of basic translation study for AC.

Acknowledgement/Funding
This study was supported by CAMS Innovation Fund for Medical Sciences (2016-I2M-1-015)