bluuebunny/crossref_metadata_2025_split huggingface dataset:
P378Heart rhythm disorders in Acromegaly
Authors: Melkozerov K , Przhiyalkovskaya E , Tarbaeva N , Kalashnikov V , Belaya Z , Vorontsov A , Belousov L , Alferova P 
Published: June 2020

Abstract

Aim
to evaluate the prevalence of heart rhythm disorders among hospitalized patients with acromegaly

Methods
we enrolled patients with acromegaly hospitalized in our Endocrinology Research Center in 2018. Acromegaly was established based on the clinical signs and symptoms, elevated levels of insulin-like growth factor-1 (IGF-1) and presence of pituitary adenoma. All patients underwent clinical examination, routine electrocardiogram (ECG). In patients with changes in the resting ECG and/or complaints of heart rhythm disorders, echocardiography and Holter ECG monitoring were performed. We also performed cardiac magnetic resonance imaging (MRI) with contrast in cases of arrhythmia confirmation.

Results
Among 107 enrolled patients with acromegaly (61 women, mediana of age 51 [40; 58] years) arrhythmia was first diagnosed in 21 (19,6%) patients: 7 patients had sick sinus syndrome, 5 patients suffered from atrial fibrillation, 4 patients had AV block, 5 patients - ventricular arrhythmias (1 patient had sustained ventricular tachycardia). The median level of the GH was 1,77 [0,8; 5,4] ng/ml, and the median of IGF-1 - 348,95 [233,4; 557,4] ng/ml, 16 (76,1%) patients with arrhythmia had active acromegaly. 21 patients underwent MRI of the heart: median of ejection fraction 54 [48; 60] %, in 8 patients we revealed focal fibrosis of left ventricle myocardium. Diffuse accumulation of contrast agent was observed in 11 patients of different severity and localization, mainly endocardium of mitral and tricuspid valves. We didn’t find a clear correlation between the levels of hormones, changes in the MRI of the heart and the type of cardiac arrhythmia. We implanted pacemakers in 4 patients, 1 patient – implantable cardioverter defibrillator.

Conclusion
The prevalence of cardiac arrhythmia in hospitalized patients with acromegaly is about 20%. New cases of arrhythmia could occur despite normal level of GH and IGF-1 in patients with acromegaly. Patients with acromegaly and cardiac arrhythmia often have abnormalities in MRI of the heart, which requires further investigation.
P1077Late gadolinium enhancement with cardiac magnetic resonance imaging demonstrates left ventricular involvement is under-recognized in arrhythmogenic right ventricular cardiomyopathy
Authors: Mohamed S , Kunz M , Casey S , Katsiyiannis W , Abdelhadi R , Storey K , Berg A , Schmidt C , Sengupta J 
Published: June 2020

Abstract

Funding Acknowledgements
The study is partially funded by Medtronic and the Minneapolis Heart Institute Foundation.
Background/Introduction: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by replacement of the myocardium with fibrous and fatty tissue that may lead to an increased risk of ventricular arrhythmias and heart failure. Although left ventricular (LV) and biventricular forms have been identified post-mortem resulting in the increased use of the term arrhythmogenic cardiomyopathy, there is only inclusion of right ventricular wall motion abnormalities in the taskforce diagnostic criteria.

Purpose
The aim of our study was to examine the utility of cardiac magnetic resonance (CMR) imaging in characterizing LV or biventricular involvement with late gadolinium enhancement (LGE) in a large cohort of patients with suspected ARVC.

Methods
Retrospective, single-institution, chart review of 76 patients diagnosed with ARVC between January 2009 and July 2019. Data collection and analysis included baseline demographics and parameters specific to diagnosis (definite, borderline, or possible) and risk stratification of ARVC based on 2019 modified taskforce criteria, as well as detailed CMR evaluation.

Results
Of the 76 patients with ARVC, 66 (87%) had at least one CMR with gadolinium administered. In that subset of patients, 27 (41%) had LGE. Of those with LGE, LV involvement was identified in 23 (85%) patients. The pattern of LGE was not localized to one myocardial region but demonstrated variable LV enhancement patterns including anterior, inferior, lateral, septal, basal, mid, apical, and from the sub-epicardium into the mid-myocardium.

Conclusions
Left ventricular involvement reflected by LGE was identified in a high percentage of patients with suspected ARVC, and there was significant variation in the pattern of distribution in terms of region and depth of myocardial involvement. While post-mortem examination of patients with ARVC demonstrates a high prevalence of left ventricular involvement, this study shows that CMR can consistently detect late gadolinium enhancement, and ARVC should be considered in the differential diagnosis for biventricular cardiomyopathy. The identification of variable locations of LGE within the LV suggests there is more than one phenotype, and this imaging modality may help to clarify the implications of left ventricular involvement in disease progression.
P506Brugada Syndrome: is the addition of the electrocardiographic risk markers the clue?
Authors: Tronconi A , Carnero G , Mysuta M , Bozza A , Peltzer M , Labin B , Gavilan L , Ramirez D , Alvarez M , Gonzalez J L , Galizio N 
Published: June 2020

Abstract

Background
Risk stratification in Brugada Syndrome (BS) remains a clinical challenge. Several electrocardiografic (ECG) risk markers had been described, as a spontaneous type 1 Brugada pattern (ST1B), maximal time interval between the peak and the end of the t wave in precordial leads (Tpe Max), the presence of an S Wave on DI, a PR interval (PRi) ≥ 200ms and fragmented QRS (f-QRS).

Purpose
Evaluate the association of ECG risk markers with sudden cardiac death (SCD) or appropriate shocks (A-Sh) by implantable cardioverter defibrillator (ICD) in patients (p) with BS.

Methods
From a registry of 97 p with BS with a median follow up of 2.3 years (Q1 0.7-Q3 7.8), 12 lead ECG were recorded in every p. QT peak interval (QTp) was measured between the QRS onset and the peak of the T wave. Tpe was calculated between the difference of QT and QTp in precordial leads (V1 to V6). TpeMax was defined as the most prolonged Tpe. If an S-DI was present, duration and amplitude was measured. PRi was measured on DII. Baseline characteristics: Age 44 ± 13 years, male 74 (76%), secondary prevention 2 (3%), malignant syncope 10 (10%), inducible electrophysiology study 22/43 (51%), SCD on first grade family &lt; 35 years 12 (12%) and ICD 34 (35%). A-Sh and SCD were compared among p with ST1B vs no ST1B, TpeMax≥100 vs &lt;100ms, S-DI ≥0.4 vs &lt;0.4ms, S-D ≥0.1 vs &lt;0.1mV, PRi≥200 vs &lt;200ms and presence of f-QRS ≥ 2 spike ≥ 2 leads. Variables that were associated with A-Sh or SCD were combined. For variables with significant difference sensibility (Sen) and specificity (Spe) was calculated.

Results
During follow up 6 p presented A-Sh and no p SCD. Results are described in the Table.

Conclusion
In our study population, there was a significant higher incidence of A-Sh in p with ST1B, Tpe Max ≥ 100ms and S-DI ≥ 0.1mV. We found that the presence of one ECG risk marker had a high sensibility to predict A-Sh. The presence of the 3 ECG risk markers highly increased specificity to predict A-Sh. Further trials should be carried out to asses if ECG risk markers would allow us to differentiate which asymptomatic patients could benefit from electrophysiological study for risk stratification (high sensibility - One ECG Risk marker) or would benefit from ICD implantation (high specificity - 3 ECG Risk markers).
Abstract Figure.
P355Complete non-inducibility after radiofrequency ablation for electrical storm improves survival rates
Authors: Nastasa A , Cojocaru C , Radu D A , Goanta E , Iliese V , Badiu A , Bogdan S N , Iorgulescu C N , Dorobantu M , Vatasescu R G 
Published: June 2020

Abstract

Background
Electric storm is a life threatening condition, that can complicate multiple cardiac pathologies and is associated with high mortality. Catheter ablation has been shown to reduce ventricular tachycardia (VT) burden in patients with electrical storm but the optimal procedural endpoint and the therapeutic particularities required by different etiologies are still under debate.

Purpose
Our objective was to determine if there are any periprocedural factors that influence midterm outcomes. We also sought if there were any significant differences between the results for ischemic and nonischemic patients.

Methods
The study included 66 consecutive patients, mean age 60 years, 82% males, treated for electrical storm in our center with endocardial/endo-epicardial radiofrequncy catheter ablation (with or without remote magnetic navigation). Acute success was defined as elimination of the clinical tachycardia with complete non-inducibility (including ventricular fibrillation) or non-inducibility for monomorphic VT with programmed ventricular stimulation using up to 4 extrastimuli. Mean follow-up duration was 9.4 months and the type of recurrence was catalogued in 3 categories: initial VT (isolated), electric storm and other sustained VT.

Results
The overall acute success rate was 93%, complete non-inducibility was achieved in 64.5% and non-inducibility for monomorphic VT in 87.5% of the cases. Epicardial approach was used in 44% of the non-ischemic cases vs 10.5% of the ischemic ones (p = 0.005). There were no significant differences between complete noninducibility rates and recurrence/death rates of the ischemic vs nonischemic groups. Among the variables analysed for predicting noninducibility, only two reached statistical significance: mean QRS duration of the clinical tachycardia (160 ± 32 ms vs 240 ± 63.3ms, p = 0.02) and shortest RS complex (124 ± 14.7 ms vs 210 ± 12ms, p = 0.02). Recurrent ventricular arrhythmia occurred in 25% of the patients during follow up, from which: 27.2 % initial VT (isolated), 36.4% electric storm and 36.4% other sustained VT. Death rate was 10.6% (7 patients). Kaplan Meier plot showed that the lot with complete noninducibility after programmed ventricular stimulation had better survival rates (p = 0.01).

Conclusions
Ablative therapy had a good acute success rate, without significant differences between ischemic and noninschemic patients in our study. Complete noninducibility after programmed ventricular stimulation after ablation was associated with better survival rates. Unsuccessfull ablation is a predictor of inhospital death of these patients.
244An automated beat exclusion algorithm to improve beat-to-beat P-wave morphology analysis
Authors: Tachmatzidis D , Filos D , Chouvarda I , Tsarouchas A , Mouselimis D , Bakogiannis C , Antoniadis A , Fragkakis N , Maglaveras N , Vassilikos V 
Published: June 2020

Abstract

Background
A manually beat-to-beat P-wave analysis has previously revealed the existence of multiple P-wave morphologies in patients with paroxysmal Atrial Fibrillation (AF) while on sinus rhythm, distinguishing them from healthy, AF free patients.

Purpose
The aim of this study was to investigate the effectiveness of an Automated Beat Exclusion algorithm (ABE) that excludes noisy or ectopic beats, replacing manual beat evaluation during beat-to-beat P-wave analysis, by assessing its effect on inter-rater variability and reproducibility.

Methods
Beat-to-beat P-wave morphology analysis was performed on 34 ten-minute ECG recordings of patients with a history of AF. Each recording was analyzed independently by two clinical experts for a total of four analysis runs; once with ABE and once again with the manual exclusion of ineligible beats. The inter-rater variability and reproducibility of the analysis with and without ABE were assessed by comparing the agreement of analysis runs with respect to secondary morphology detection, primary morphology ECG template and the percentage of both, as these aspects have been previously used to discriminate PAF patients from controls.

Results
Comparing ABE to manual exclusion in detecting secondary P-wave morphologies displayed substantial (Cohen"s k = 0.69) to almost perfect (k = 0.82) agreement. Area difference among auto and manually calculated main morphology templates was in every case &lt;5% (p &lt; 0.01) and the correlation coefficient was &gt;0.99 (p &lt; 0.01). Finally, the percentages of beats classified to the primary or secondary morphology per recording by each analysis were strongly correlated, for both main and secondary P-wave morphologies, ranging from ρ=0.756 to ρ=0.940 (picture)

Conclusion
The use of the ABE algorithm does not diminish inter-rater variability and reproducibility of the analysis. The primary and secondary P-wave morphologies produced by all analyses were similar, both in terms of their template and their frequency. Based on the results of this study, the ABE algorithm incorporated in the beat-to-beat P-wave morphology analysis drastically reduces operator workload without influencing the quality of the analysis.
Abstract Figure.
P1451Catheter ablation in adults with Wolff-Parkinson-White syndrome: a "real-life" experience
Authors: Ying A , C L S D Nubila B , Divulwewa K , Agarwal S , Begley D , Grace A , Heck P , Martin C , Mellor G , Virdee M , Fynn S 
Published: June 2020

Abstract
Introduction. Radiofrequency catheter ablation (RFA) is 1st line treatment in symptomatic adult patients with Wolff-Parkinson-White syndrome (WPW). Patients with WPW are often quoted a high success rate for RFA but does this reflect reality? There is a paucity of recent literature and ongoing service developments in the UK may have a negative impact on success by reducing individual operator experience of adult WPW cases (i.e. increasing numbers of cardiac electrophysiologists in each department, patients more likely to undergo RFA as children). In contrast, technological developments (e.g. 3D mapping, steerable sheaths) may have a positive impact on success of RFA in WPW.
Methods. We collected data on all patients with WPW scheduled for 1st time ablation between Jan 2006 and Dec 2018. All patients undergoing re-do RFA during this time were excluded. For comparison, we divided this timeframe into three periods: 2006-9, 2010-13 and 2014-18.
Results. The number of patients scheduled for RFA and the outcome is listed in the Table. The overall success rate was 86.5% and this figure remained constant throughout the 13 year time-frame. Significant complications occurred in 1.17% of cases. 19.9% of patients scheduled for an ablation had no ablation attempted for various reasons (‘safe’ pathway, proximity to AV node etc).
Conclusion. In our centre, the number of adult cases of WPW scheduled for RFA year-on-year remains constant. The complication rate is in line with published literature. The RFA success rate is lower than the published data. As expected, success rate of RFA for WPW varies according to accessory pathway location. 1 in 5 cases scheduled for ablation did not proceed to ablation. This highlights an area where more effective resource planning from the outset can be undertaken.
Table 2006-9 2010-13 2014-18 Patients scheduled for RFA, n 181 152 179 Patients who underwent RFA, n 162 121 127 Overall RFA success rate, % (n) 85.6 (160) 86.6 (119) 87.4 (127) Success rate by AP location, % (n) Free wall Left 91.5 (71) 91.8 (49) 95.3 (64) Right 76.9 (13) 77.8 (9) 60.0 (5) Septal Anterior 77.8 (9) 88.9 (9) 100.0 (4) Mid 75.0 (8) 90.0 (10) 66.7 (3) Posterior 86.0 (57) 82.9 (41) 79.6 (49) RFA success rate in patients with Wolff-Parkinson-White syndrome. AP = accessory pathway, RFA = radiofrequency catheter ablation
224Wireless ECG embedded in a necklace enables reliable detection of atrial fibrillation
Authors: Santala O E , Lipponen J A , Jantti H , Rissanen T T , Halonen J , Hartikainen J , Kolk I , Pohjantahti-Maaroos H , Tarvainen M P , Valiaho E-S , Martikainen T 
Published: June 2020

Abstract

Funding Acknowledgements
Goverment grant, Heart2save Ltd cooperation.
Background/Introduction:
Atrial fibrillation (AF) is the most common arrhythmia and a fast-growing public health problem worldwide. Main and the most severe complication of AF is an embolic stroke. Approximately 25% of all strokes are caused by AF. AF is often symptomless and intermittent, making its detection and diagnosing challenging. Many AF patients have both symptomatic and asymptomatic periods of arrhythmia. In addition, during the early stage of the disease, AF is often paroxysmal making the diagnosis of AF a major clinical challenge.

Purpose
Wearable ECG devices could enable repetitive rhythm monitoring over a long term and thus improve the probability of AF detection. Wearable devices have the advantage of being easily available. However, they also need to be reliable and their design should appeal customers. Our aim was to study the suitability and reliability of novel measurement technique (necklace-ECG, Figure1) for the diagnosis of AF.

Methods
The study population consisted of 145 adult volunteers at Kuopio University Hospital emergency department (66 AF and 79 sinus rhythm (SR), diagnosed from continuous 3-lead ECG recording. All study subjects performed a thirty-second self-performed ECG recording with a single-lead necklace-embedded ECG recorder (necklace-ECG) keeping the recorder between palms of their hands. The ECG recordings were analyzed with automatic AF detection algorithm. Two cardiologists interpreted independently in blinded fashion the necklace-ECG recordings and simultaneously registered 3-lead ECGs which served as golden standard for the final rhythm diagnosis.

Results
Necklace-ECG produced an interpretable ECG recording in 91.0%/86.2% patients (Doc1/Doc2, respectively). Additionally, 93.1% of ECG recordings were interpretable by the automatic analysis service (98.7% in SR patients and 86.4% of AF patients).
Base on the necklace ECG recording, cardiologists were able to diagnose AF with sensitivity of 98.2%/96.3% (Doc1/Doc2, respectively) and specificity of 100% (Doc1 and Doc2, respectively). The automatic arrhythmia algorithm diagnosed AF with sensitivity of 94.7% and specificity of 100%.

Conclusions
The necklace-ECG device produces ECG recording with sufficient quality for the detection of AF with good sensitivity and specificity as evaluated both by cardiologist and automated AF-detection algorithm. Thus, wearable necklace-ECG provides a new and easy method for screening, identifying and diagnosing AF.
Abstract Figure 1
P497Arrhythmic burden in patients with filamin C (FLNC) truncating variant associated cardiomyopathy
Authors: Zupan Meznar A , Zizek D , Breskvar Kac U D , Writzl K , Jan M , Toplisek J , Baraga M , Sinkovec M 
Published: June 2020

Abstract

Background
Truncating variants in FLNC gene are associated with an overlapping phenotype of arrhythmogenic and dilated cardiomyopathy. There are reports of high arrhythmia propensity with sudden cardiac death (SCD) often being the first symptom of the disease. It has been suggested that the current European guidelines primary prevention (PP) recommendation about implantable cardioverter-defibrillator (ICD) implantation might not be applicable in these patients and that earlier intervention should be considered.

Purpose
We sought to investigate the arrhythmic burden in FLNC truncation carriers in our centre.

Methods
Adult FLNC truncation carriers diagnosed in our centre between the years 2018 and 2019 were included in the study. We retrospectively analysed clinical data, and ICD follow-up reports in the cohort. Patients implanted with an ICD were divided in 3 groups: group A (secondary prevention ICD implantation), group B (PP indication according to the current guidelines – left ventricular ejection fraction (LVEF) below 35%) and group C (early PP– FLNC truncation carrier, LVEF &lt; 50% and late gadolinium enhancement on cardiac magnetic resonance). We report the number of patients experiencing SCD and the number of appropriate and inappropriate ICD therapies per group.

Results
Twenty-four adult patients from 3 different families with three distinct FLNC truncating variants were identified. Ten (42%) were male; the average age was 45 ± 14 years. There were 3 (13%) SCDs in one family (2 male and one female, 29-42 years old) and two (8%) aborted SCDs in the remaining two families (one male and one female, 66 and 51 years old). Altogether eleven (46%) patients were implanted with an ICD. There were three patients in group A (2 aborted SCDs and 1 sustained ventricular tachycardia (VT)), two patients in group B and six patients in group C. Average ICD follow-up times were 42, 48 and 6 months for groups A, B and C, respectively. Eight appropriate ICD therapies occurred in 3 patients (27%). In group A, there were four sustained VT episodes successfully converted with an anti-tachycardia pacing (ATP) in two patients (67%); the average time to first therapy was 33 months. In group B, there was one appropriate shock for ventricular fibrillation (VF), and three sustained VT episodes in one patient (50%), time to first therapy was 60 months. After six months follow-up, there were no appropriate therapies registered in group C. Two patients (18%) experienced inappropriate shocks due to sinus tachycardia, one in group A and one in group C.

Conclusion
One-fifth of FLNC truncation carriers in our cohort experienced SCD. When patients received an ICD according to the current guidelines, majority experienced appropriate ICD therapy. Further clinical studies with longer follow-up will be needed to define appropriate risk stratification and optimal timing for prophylactic ICD intervention in these patients.
P531Cardiac resynchronization therapy in patients with permanent atrial fibrillation: insights from the HMEA database
Authors: Rapacciuolo A , Solimene F , Iacopino S , D"onofrio A , Pisano" E , Zanotto G , Curnis A , Capucci A , Senatore G , Pignalberi C , Maglia G , Santamaria M , Giacopelli D , Gargaro A , Della Bella P 
Published: June 2020

Abstract

Funding Acknowledgements
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Background/Introduction: The benefits of cardiac resynchronization therapy with defibrillator (CRT-D) in heart failure are well established. However, a gap of evidence is still present for patients with permanent atrial fibrillation (perm-AF)

Purpose
To investigate outcomes of CRT-D patients with perm-AF in terms of appropriate shock for ventricular arrhythmia and all-cause mortality in a long-term time horizon.

Methods
We used the Home Monitoring Expert Alliance (HMEA) database, a nationwide data repository of daily remote monitoring transmissions. The episodes with delivered shock were adjudicated by a board of 3 electrophysiologists.

Results
Among 1226 CRT-D patients (mean age 71.2 ± 10.0 years; 75.5% males), 276 (22.5%) had perm-AF at device implantation. These patients had more frequently rate responsive function (19.7% vs 64.1%) and higher basic rate (median value 60 bpm vs 70 bpm) as compared to all other patients (p &lt; 0.001). The CRT pacing percentage calculated over the first 2 months was slightly lower for perm-AF patients (median value 96.0% vs 98.8%, p &lt; 0.001).
At 5-year appropriate shock incidence was 34.2% (95% confidence interval [CI], 25.1%-45.3%) for perm-AF and 19.9% (15.6%-25.1%) for all other patients. All-cause mortality was 27.7% (17.7%-41.8%) for perm-AF and 15.6% (12.2%-19.9%) for all other patients.
The age- and sex-adjusted hazard ratio between perm-AF and all other patients was 1.81 (95% CI: 1.25-2.64, p = 0.002) for appropriate shock and 0.92 (95% CI: 0.57-1.50, p = 0.748) for all-cause mortality.

Conclusion
Although a higher incidence of appropriate shock, perm-AF at the time of CRT-D implantation was not associated with increased long-term mortality,
Abstract Figure. Appropriate shock and mortality