bluuebunny/crossref_metadata_2025_split huggingface dataset:
250Efficacy of multi-electrode linear irreversible electroporation
Authors: Buist T J , Groen M H A , Wittkampf F H M , Loh K P , Doevendans P A , Van Es R , Elvan A 
Published: June 2020

Abstract

Background
We investigated the efficacy of linear irreversible electroporation (IRE) ablation in a porcine model.

Methods
The study was performed in 6 pigs (weight 60-75kg). After median sternotomy and opening of the pericardium, a pericardial cradle was formed and filled with blood. A linear 7 polar 7F electrode catheter with 2.5mm electrodes and 2.5mm inter-electrode spacing was placed in good epicardial contact. A single IRE application was delivered using 50 Joules (J) at 1 site and 100 J at 2 other sites, in random sequence, using a standard monophasic defibrillator connected to all 7 electrodes connected in parallel. The pericardium and thorax were closed and after 3 weeks survival animals were euthanized. 82 histological sections from all 18 electroporation lesions were analyzed.

Results
A total of seven 50 J and fourteen 100 J epicardial IRE applications were performed. Mean peak voltages at 50 J and 100 J were 1079.2 V ± 81.1 and 1609.5 V ± 56.8, with a mean peak current of 15.4 A ± 2.3 and 20.2 A ± 1.7, respectively. Median depth of the 50J and 100J lesions were 3.2 mm (interquartile range [IQR], 3.1 – 3.6) and 5.5 mm (IQR, 4.6 – 6.6) (P &lt; 0.001), respectively. Median lesion width of the 50J and 100J lesions were 3.9 mm (IQR, 3.7 – 4.8) and 5.4 mm (IQR, 5.0 - 6.3), respectively(P &lt; 0.001). Longitudinal sections showed continuous lesions for 100J lesions.

Conclusion
Epicardial linear application of IRE pulses is effective in creating continuous deep lesions.
Ablation characteristics and lesion size Peak voltageV Peak currentA Peak resistanceΩ SlicesN Depthmm Widthmm 50 J 1079.2 ± 81.1 14.5 ± 2.3 71.8 ± 15.6 26 3.2 (3.1 - 3.6) 3.9 (3.7 - 4.8) 100J 1609.5 ± 56.8 20.2 ± 1.7 80.0 ± 9.5 56 5.5 (4.6 - 6.6) 5.4 (5.0 - 6.3) P-value† &lt;0.001 &lt;0.001 Data is displayed as mean ± SD or median (interquartile range) where appropriate.†assessed by general linear mixed models
Abstract Figure. Transversal histological sections
237Role of wearable device recordings in clinical decision making - The wEHRAbles Young EP survey
Authors: Manninger M , Zweiker D , Njeim M , Antolic B , Kosiuk J , Svennberg E , Vanduynhoven P , Duncker D 
Published: June 2020

Abstract

Multiple wearable devices for rhythm analysis have been developed using either photoplethysmography (PPG) or handheld ECG. The aim of this survey was to assess how these technologies impact on physicians’ clinical decision-making regarding initiation of diagnostic steps, drug- and interventional therapy.

Methods
The present survey is conducted with support of the scientific network of EHRA Young EP and will be running from October 1st until December 31st, 2019. The online survey includes 10 questions on types of devices, advantages and disadvantages of wearable devices, gaps in evidence as well as case scenarios for patients with supraventricular arrhythmias, symptomatic and asymptomatic atrial fibrillation (AF). Here, we present preliminary data of the survey.

Results
So far, a total of 178 physicians from 34 different countries completed the survey. Mean age was 37 ± 8 years. Most participants work in university hospitals (66%) as electrophysiologists (69%) or cardiologists (21%).
Most participants would trigger further diagnostic steps if a patient with regular palpitations presented a recording of a regular tachycardia (89% for single-lead ECG vs. 86% for PPG), while a single-lead ECG would be sufficient to perform an invasive EP study in most participants (56% vs. 25% for PPG). Participants would be more reluctant to prescribing antiarrhythmic drug therapy in these patients (29% vs. 10%).
In a case scenario of a patient presenting a 30 seconds tracing from a single-lead ECG or PPG device suggesting AF, most participants would trigger further diagnostic steps, Figure 1. A single-lead ECG tracing from a symptomatic AF patient would trigger anticoagulation treatment to a higher extent than in asymptomatic patients (65% vs. 47%). As expected, initiation of antiarrhythmic drug therapy or ablation was suggested to a greater extent in symptomatic patients, Figure 1. PPG tracings would only rarely lead to further therapeutic steps regardless of symptomatology. As main advantages of wearable devices, participants stated faster diagnosis (66%), continuous monitoring opportunities (65%), patient involvement (64%), facilitation of screening (60%) and public availability of monitoring (53%). Main disadvantages participants stated were data overload (67%) and patient-driven instead of clinician-driven screening (43%). Most participants would like to see scientific society recommendations on the use of wearable devices (53%).

Conclusion
In this ongoing survey the preliminary results show that tracings from wearable devices suggestive of arrhythmias are most likely to trigger further diagnostic steps, and in the case of PPG recordings rarely therapeutic interventions. A majority of participants wanted scientific society recommendations on the use of wearables.
Abstract Figure 1
P993Incidence of atrial fibrillation early after cavotricuspid isthmus ablation
Authors: Krisai P , Streicher O , Meyre P , Haemmerle P , Steiner F , Reddiess P , Zeljkovic I , Pavlovic N , Ammann P , Roten L , Reichlin T , Madaffari A , Kuehne M , Novak J , Sticherling C 
Published: June 2020

Abstract

Background
Atrial fibrillation (AF) is a common finding in patients undergoing cavotricuspid isthmus ablation for isthmus dependent right atrial flutter (RAF). Little is known about the time of its occurrence.

Purpose
We aimed to investigate the incidence of AF early after RAF ablation in a well-defined, prospective cohort.

Methods
A total of 255 participants with RAF ablation from 5 centers and at least one completed follow-up were included. Structured clinical follow-up was performed at 3, 6 and 12 months including a 24 hour Holter-ECG. The endpoint was incidence of AF detected clinically or by Holter-ECG. Risk factors associated with the occurrence of AF were assessed using separate, univariate Cox proportional-hazards models.

Results
Mean age was 67 years, 80% were male and previous episodes of AF were known in 40%. Over a mean follow-up of 7.4 (±4.4) months AF was detected in 35 (13.7%) participants after RAF ablation (Figure A). After 3, 6 and 12 months AF was detected in 18 (7.1%), 30 (11.7%) and 34 (13.3%) patients. No difference in the incidence of AF after RAF ablation was found comparing patients with and without a history of AF (log-rank p value = 0.44) (Figure B). Comparing patients with and without AF during follow-up, there was no difference in age (68 vs 66 years, p = 0.36), sex (69 vs 81% male, p = 0.08), prior heart failure (29 vs 19%, p = 0.20), hypertension (43 vs 38%, p = 0.56) or left atrial volume (46.6 vs 39.6 ml, p = 0.10), but patients with previous AF had a lower left ventricular ejection fraction (LVEF) (45.7 vs 52.3%, p = 0.02). In separate, univariate Cox proportional-hazards models only increasing LVEF (Hazard ratio 0.97, 95% confidence interval (0.95; 0.99, p = 0.02)) was associated with a lower risk of incident AF after RAF ablation, but no other risk factor.

Conclusions
AF occurred in 13.7% of patients early after cavotricuspid isthmus ablation for RAF. There was no difference in the occurrence of AF between patients with and without previously known episodes of AF. Only impaired LVEF was associated with AF occurrence.
Abstract Figure
P1111Arrhythmogenic substrate detection in ischemic patients undergoing ventricular tachycardia ablation using multi-detector computed tomography: compared evaluation with cardiac magnetic resonance
Authors: Jauregui B , Soto-Iglesias D , Zucchelli G , Teres C , Ordonez A , Chauca A , Penela D , Acosta J , Fernandez-Armenta J , Linhart M , Perea R J , Doltra A , Ortiz-Perez J T , Bosch X , Berruezo A 
Published: June 2020

Abstract

Background
Cardiac magnetic resonance (CMR) is capable of accurately identifying arrhythmogenic substrate (AS), leading to longer arrhythmia-free survival when used to guide ventricular tachycardia (VT) substrate ablation procedures. However, the use of CMR may be limited in certain centers or patient subsets.

Purpose
To evaluate the performance of multidetector cardiac computed tomography (MDCT) imaging in identifying heterogeneous tissue channels (HTCs) detected by CMR in ischemic patients undergoing VT substrate ablation.

Methods
Thirty ischemic patients undergoing both CMR and MDCT before VT substrate ablation were included. Using a dedicated post-processing software, two blinded operators, assigned either to CMR or MDCT analysis, characterized the presence of CMR- and CT-channels, respectively. CMR-channels were classified as endocardial (layers &lt;50%), epicardial (layers ≥50%) or transmural. CMR- vs. CT-channel concordance was considered when the orientation was the same and they were located in the same AHA segment.

Results
Mean age was 69 ± 10 years; 90% were male. Mean left ventricular ejection fraction (LVEF) was 35 ± 10%. All patients had CMR-channels (n = 76), whereas only 26/30 (86.7%) had CT-channels (n = 91). Global sensitivity (Se) and positive predictive values (PPV) for detecting CMR-channels were 61.8% and 51.6%, respectively. MDCT performance improved in patients with epicardial CMR-channels (Se 80.5%), and transmural scars (Se 72.2%). In 4/11 (36%) patients with subendocardial MI, MDCT was unable to identify the AS.

Conclusion
MDCT fails to detect the presence of AS in 36% of patients with subendocardial MI and shows a modest sensitivity identifying the presence of HTCs, although its performance improves in patients with transmural scar.
Abstract Figure. Multimodality imaging AS detection
P339Ser49Gly of beta1-adrenergic receptor is associated with hereditary sick sinus syndrome
Authors: Chernova A , Nikulina S , Shulman V , Voevoda M , Maksimov V 
Published: June 2020

Abstract

PURPOSE
The human beta(1)-adrenergic receptor (ADRB1), an important therapeutic target in cardiovascular diseases, has functional polymorphism on Ser49Gly. Our study aimed to confirm that beta(1)-adrenergic receptor polymorphisms affect hereditary sick sinus syndrome.

METHODS
Polymerase chain reaction-restriction fragment length polymorphism was used to screen for Ser49Gly. We genotyped polymorphism Ser49Gly of the beta1-AR in 108 patients with hereditary sick sinus syndrome, 59 their healthy relatives and 198 control subjects. Structure of primers was as follows: common 5’-TTGCT-GCCTC-CCGCC-AGCGA-TG-3’, wild 5’-TTGCT-GCCTC-CCGCC-AGCGA-CA-3’, mutant 5’-TCACG-CACAG-CACGT-CCACT-GA-3’.

RESULTS
Patients with the Ser49Gly genotype shaved associat with hereditary sick sinus syndrome more frequently than in controls and those with Ser49Ser and Gly49Gly (P &lt; 0.01).The patients carrying 49 Gly in the ADRB1 gene was significantly higher odds in SSS than in patients without this allele (p &lt; 0.05). Presence of a Gly49 allele was associated with an increased odds of having hereditary sick sinus syndrome.

CONCLUSIONS
Our data suggest that patients with the Ser49Gly genotype and Gly49 allele of the beta(1)-adrenergic receptor gene are at increased risk to develop hereditary sick sinus syndrome.
1267Relationship between polymorphism of ADRA2B gene and primary cardiac conduction disorders
Authors: Chernova A , Nikulina S , Shulman V , Voevoda M , Maksimov V 
Published: June 2020

Abstract

Background
Cardiac conduction system (CCS) disease resulting in disrupted conduction and impaired cardiac rhythm is common with significant morbidity and mortality. Current treatment options are limited and rational efforts to develop cell-based and regenerative therapies require knowledge in molecular networks that establish and maintain CCS function. Recent genome-wide association studies (GWAS) have identified numerous loci associated with adult human CCS function, including ADRA2B.

Materials and methods
A family examination was performed for 71 patients with atrioventricular block (AVB). The control group was formed by 657 patients without clinical ECG manifestations of cardiac diseases. All the examinees underwent ECG, echocardioscopy, electrophysiological examination of the heart.

Results
by results of research, it has been established that the frequency of carriers of a homozygous genotype on rare allele (DD) among patients with AVB (43.7%±5.9) was higher in comparison with the controls (16%±1.4). The obvious tendency to decrease in carriers of a heterozygous genotype (ID) among patients with AVB (23.9%±5.1) in comparison with the control group (51.1%±2.0) has also been noted.

Conclusions
In this work, we revealed association between hereditary disturbances of cardiac conduction and polymorphism of 2-adrenergic receptor gene using clinical - genetic material for the first time.
Genotypes: AVB (n = 71) Control group (n = 657) р n %±m n %±m II 23 32,4 ± 5,6 216 32,9 ± 1,8 р&gt;0,05 ID 17 23,9 ± 5,1 336 51,1 ± 2,0 р&lt;0,001 DD 31 43,7 ± 5,9 105 16 ± 1,4 р&lt;0,001 Allels: Allel I 63 32,9 ± 1,8 768 58,4 ± 1,4 р&lt;0,001 Allels D 79 51,1 ± 2,0 546 41,6 ± 1,4 р&lt;0,001 ОR; 95% CI OR 1,764;1,244-2,5 Genotype II 23 32,4 ± 5,6 216 32,9 ± 1,8 р&gt;0,05 Genotypes ID + DD 48 67,6 ± 5,6 441 67,1 ± 1,8 р&gt;0,05 ОR; 95% CI OR 0,978;0,58-1,65
P534Central sleep apnea in pacing-induced cardiomyopathy: prevalence, improvement by upgrading to cardiac resynchronisation therapy and impact on structural responder rates and long-term outcome
Authors: Barbieri F , Adukauskaite A , Heidbreder A , Brandauer E , Bergmann M , Senoner T , Rubatscher A , Schgoer W , Stuehlinger M , Pfeifer B , Bauer A , Hintringer F , Hoegl B , Dichtl W 
Published: June 2020

Abstract

Funding Acknowledgements
ÖNB Jubiläumsfondsprojekt Nr. 15974, ISR grant by Boston Scientific, St. Paul, MN, USA

Background
Central sleep apnea (CSA) in pacing induced cardiomyopathy (PICM) is poorly studied. Specifically, it is unknown whether upgrading from right ventricular pacing (RVP) to cardiac resynchronisation therapy (CRT) improves CSA.

Methods
Fifty-three patients with impaired left ventricular ejection fraction, frequent right ventricular pacing due to high-grade atrioventricular block and heart failure symptoms despite optimal medical therapy underwent upgrading to CRT. Within one month after left ventricular lead implantation (but still not activated), sleep apnea was assessed in all participants by single-night polysomnography (PSG). Nineteen patients with moderate or severe CSA defined by an apnea hypopnea index (AHI) &gt; 15 events per hour were re-scheduled for a follow up PSG 3-5 months after initiation of cardiac resynchronization therapy. Of this cohort, thirteen patients with stable mild heart failure agreed to be randomized to CRT versus RVP in a cross-over design.

Results
CSA (AHI &gt; 5 events per hour) was diagnosed in 26 (49.1%), OSA in 16 (30.2%) patients suffering from PICM . Eleven (20.8%) patients did not have any form of sleep apnea. Moderate to severe CSA (AHI &gt; 15 events per hour) was significantly improved (without specific CPAP therapy) by 102 (96-172) days of CRT: AHI decreased from 39.4 events per hour at baseline to 21.6 by CRT (p &lt; 0.001). Furthermore, CRT led to a substantial decrease in left ventricular endsystolic volumes: baseline 141 ml (103-155), significant improvement under CRT (102 ml, 65-138; p &lt; 0.001), whereas no effect with ongoing RV-pacing (147 ml, 130-161; p = 0.865). Preexistent CSA did not affect the structural response of CRT (56.5% in patients with CSA, 62.5% of patients with obstructive sleep apnea and 54.5% in patients without sleep apnea; p = 0.901) and had no impact on major adverse cardiac events (p = 0.412) and/or survival (p = 0.623) during long-term follow-up.

Conclusions
CSA is highly prevalent in patients with PICM and is significantly improved by upgrading to CRT. Preexistent CSA does not hamper structural improvement and long-term outcome after upgrading to CRT. Thus, CSA seems to occur as a consequence of PICM, rather than as a pathophysiological mediator.
Abstract Figure.
911Which patients are most likely to benefit from the wearable cardioverter-defibrillator? Findings from the Swiss WCD registry
Authors: Kovacs B , Reek S , Linka A , Ammann P , Mueller A S , Reichlin T , Haegeli L , Steffel J , Saguner A M , Burri H , Duru F 
Published: June 2020

Abstract

OnBehalf
Swiss WCD Registry

Introduction
The wearable cardioverter-defibrillator (WCD) has established itself as a temporary protection from sudden arrhythmogenic death in selected patients at risk. However, it is still of debate which patients and for what duration benefit from its use. Therefore, appropriate patient selection is key. Purpose: This study reports the results of the Swiss WCD registry with an emphasis on implantable cardioverter-defibrillator (ICD) implantation rate and ICD therapies.

Methods
We retrospectively reviewed the indications, baseline characteristics and administered therapies in patients prescribed a WCD at 12 participating centers rom 2014 until 2018 in Switzerland. Further data on medical therapy, WCD therapy adherence, and ICD implantation rates were collected.

Results
456 patients were included in our study comprising of 66% of all Swiss patients prescribed a WCD in the examined time period. The mean age was 57 ±14 years, 18% were female and the mean ejection fraction (EF) was 32% ± 13. Indications for WCD use and appropriate shock rate are shown in the figure. Patients wore the WCD over a median of 58 days (range 1-455) with a median daily average wear-time of 22.6 hours (range 0.6-23.8). 17 appropriate therapies were administered by the WCD to a total of 12 patients leading to a therapy rate of 2.6% over a median wear-time of 16 days (range 2-79) and to a therapy rate of 3.9% in patients with ischemic cardiomyopathy (ICM) with an EF ≤35%. ICM with an EF ≤35% and bridging to ICD-implantation or heart transplantation as indication for WCD prescription were significantly associated with an appropriate therapy (p = 0.046 and 0.003, respectively). One patient with non-ischemic cardiomyopathy (NICM) received an appropriate therapy (0.8%). The mean EF in patients receiving an appropriate therapy by the WCD was also significantly lower (p = 0.04). No patient with wearing the WCD for congenital/inherited heart disease or risk stratification with an EF &gt;35% had a therapy administered by the WCD. There were no inappropriate therapies during the investigated time period. After cessation of WCD use EF improved to 38% ±13; ultimately, 212 patients (46%) were implanted with an ICD. During a follow-up of 476 days (range 7-2347) 22 (9.8%) patients received an appropriate therapy by their ICD. Four of the 22 had prior appropriate therapy by the WCD.

Conclusions
ICM with severely reduced EF was the most common indication for WCD use leading to a high rate of appropriate therapy by the WCD. This, however, did not translate in a higher rate of appropriate ICD-therapies during follow-up in this subpopulation possibly due to significant improvements in their ejection fractions. Patients with NICM or congenital/inherited heart disease seldom had an appropriate therapy by the WCD.
Abstract Figure. Indications for WCD use and therapy rate
P1187Pocket-Hematoma after cardiac implantable electronic devices surgery: a single centre study
Authors: Spighi L , Notaristefano F , Annunziata R , D"ammando M , Zingarini G , Verdecchia P , Cavallini C 
Published: June 2020

Abstract

Intro
Pocket hematoma is a common complication after pacemaker (PMK) or implantable cardioverter defibrillator (ICD) surgery. In this clinical setting anticoagulant and antiplatelet therapy are associated with an increased risk of hemorrhagic complications, but data are sparse.

Purpose
We examined the impact of antiplatelet therapy and anticoagulation with vitamin K antagonists (VKA) or heparin on the risk of pocket hematoma. Materials and method: between august 2017 and june 2019, a total of 639 devices were implanted or replaced at our centre. Predictors of hematoma occurrence were determined by multivariate regression analysis. We used a specific definition of pocket hematoma: a) any palpable swelling in the pocket area requiring an unscheduled visit or prolonged hospitalization &gt; 24 h or re-hospitalization for hematoma, b) interruption of antithrombotics, c) reoperation, d) hemoglobin drop &gt; 2 g/dl or blood transfusion. The above criteria were assessed during hospitalization and up to 10 days after discharge. Results: the incidence of pocket hematoma was 7.5%. Among 639 patients (pts) including in the study 33.5% (214 pts) didn’ t take any antithrombotic therapy, 40.2 % (257 pts) were on single antiplatelet therapy (SAPT), 8.8 % (56 pts) were on dual antiplatelet therapy, 11.1 % (71 pts) were on uninterrupted VKA (mean INR 2). Heparin bridging was administered in 6.4% (41 pts). Ejection fraction (43 ±13 %) and hemoglobin value before implantation (12.3 ±2.6 g/dL) in patients who developed hematoma were significantly lower compared with whose without hematoma. Patients with hematoma had a higher prevalence of congestive heart failure, ischemic cardiomyopathy and intake antithrombotic therapy. After adjusting for confounding factors with multivariate logistic regression only the use of dual antiplatelet therapy (OR 5.9 95% CI 1.5-21 p = 0.008) and the bridging with enoxaparin (OR 5.6 95% CI 1.4-22 p = 0.013) increased the risk of pocket hematoma. Single antiplatelet therapy (OR 2.6 95% CI 0.8-8.4 p = ns) and uninterrupted VKA (OR 0.9 95% CI 0.7-11 p = ns) did not increased the risk of pocket hematoma compared to no antithrombotic therapy. Pulse generator change and new device implant/upgrading (OR 1.8 95% CI 0.6-5.2 p = ns) carried the same haemorrhagic risk.

Conclusion
the use of DAPT or bridging with enoxaparin are highly predictive for the occurrence of perioperative pocket hematoma in patients scheduled for pmk/icd surgery. In contrast, single antiplatelet therapy and uninterrupted VKA did not increase the risk of hematoma.
P421Efficacy of radiofrequency ablation and drug therapy of atrial fibrillation in patients with heart failure
Authors: Seliutskii S , Savina N , Chapurnykh A 
Published: June 2020

Abstract

Objective
to compare the efficacy of radiofrequency ablation (RFA) and drug therapy in patients with atrial fibrillation (AFib) and heart failure (HF) within 12-month follow-up.

Materials and methods
130 patients (men-75%, average age-62.8 ± 11.8 years) with AFib and HF with left ventricular ejection fraction (LVEF)&lt;50% were included in a prospective study. In 107 (82%) of the included patients, intermediate LVEF was detected (40-49%). At the time of inclusion, paroxysmal AFib (PaAFib) was recorded in 60 (46%) of patients and persistent AFib (PeAFib) in 70 (54%). AFib RFA was performed in 65 patients, 65 patients continued to receive optimal antiarrhythmic therapy. Prior to the intervention and after 12 months, all patients underwent transthoracic echocardiography and quality of life (QoL) assessment using the SF-36 questionnaire.

Results
the freedom from AFib within 12 months follow-up period was registred in 49 (75%) of patients in the RFA group and 26 (40%) in the drug therapy group. After 12 month follow-up period we revealed increase of LVEF (p &lt; 0.001), decrease of anteroposterior size (p &lt;0.001) and volume (p &lt; 0.001) of left atrium (LA), improvement of mental (p = 0.008) and physical (p = 0.048) health components according to the SF-36 questionnaire in the RFA group. In the group of drug rhythm control, after 12 months there was only the improvement of mental (p = 0.006) and physical p = 0.016) health components and it was much less than in RFA group (р&lt;0.001). Similar results were received in patients who were free from Afib within 12 months in both groups.

Conclusions
in patients with AFib and HF with LVEF &lt; 50%, restoration and maintenance of sinus rhythm using RFA was accompanied by an increase in LVEF, decrease of LA size, and an improvement of QoL. In the group of drug therapy, there was a lower freedom from AFib and there was the slight improvement only in QoL.