bluuebunny/crossref_metadata_2025_split huggingface dataset:
P498External validation of a field termination-of-resuscitation rule for refractory out-of-hospital cardiac arrests in Japan
Authors: Goto Y , Funada A , Maeda T , Okada F , Goto Y 
Published: June 2020

Abstract

Background
A universal basic life support termination-of-resuscitation (BLS-TOR) rule was developed to identify patients with out-of-hospital cardiac arrest (OHCA) eligible for field termination of cardiopulmonary resuscitation (CPR). In Japan, however, emergency medical service (EMS) providers are not allowed field termination of CPR and must transport all patients with OHCA to hospitals, regardless of return of spontaneous circulation (ROSC). Therefore, we previously developed a Japanese TOR (JP-TOR) rule in the field for refractory OHCAs using data from the All-Japan Utstein registry between 2011 and 2015, when CPR was performed according to the 2010 guidelines. The JP-TOR rule recommends CPR termination when patients meet all the following criteria: initial asystole, unwitnessed arrest, age ≥81 years, no bystander interventions before EMS arrival, and no ROSC after EMS-initiated CPR for 14 min.

Purpose
To validate the JP-TOR rule using more recent data where CPR was performed according to the 2015 guidelines, comparing the relevance of JP-TOR rule with the BLS-TOR rule, which consists of the following criteria: no prehospital ROSC after 6-min EMS-initiated CPR, arrest unwitnessed by EMS providers, and no shock received.

Methods
We analysed the records of 242,184 patients (age ≥18 years) who experienced OHCA treated by EMS providers. Data were obtained from a prospectively recorded Japanese nationwide Utstein-style database from 2016 to 2017. The primary endpoints were specificity and positive predictive value (PPV) for predicting the 1-month mortality after OHCA with the JP-TOR and BLS-TOR rules.

Results
The overall 1-month survival rate was 5.3% (12,847/242,184). The proportions of patients with OHCA fulfilled the JP-TOR and BLS-TOR criteria were 10.4% and 89.3%, respectively. The specificity and PPV of the JP-TOR and BLS-TOR rules for predicting 1-month mortality were 99.5% (95% confidence interval [CI], 99.4%–99.5%) and 99.8% (95% CI, 99.7%–99.8%) and 44.7% (95% CI, 43.8%–45.5%) and 96.7% (95% CI, 96.6%–96.8%), respectively.

Conclusions
The JP-TOR rule for EMS providers treating patients with OHCA in the field was successfully validated using more recent data from a Japanese registry where CPR was performed according to the 2015 guidelines. The JP-TOR rule was superior to the BLS-TOR rule in Japanese EMS systems, having both high specificity and PPV of &gt;99% for predicting 1-month mortality. The JP-TOR rule may help EMS providers decide whether to terminate resuscitation efforts for unresuscitable patients with OHCA in the field. Prospective validation studies and establishment of prehospital EMS protocol are required before implementing this rule in Japan.
P1384Radiation safety and electrophysiologists: radiation protection status
Authors: Krzowski B , Gawalko M , Peller M , Balsam P , Lodzinski P , Grabowski M , Opolski G , Kosiuk J 
Published: June 2020

Abstract

INTRODUCTION
Ionizing radiation is typically used during variety electrophysiological (EP) procedures, although it may contribute to deterministic effects especially for staff.

PURPOSE
The purpose of this study was to perform an analysis of EP operators’ radiation protective devices for occupational exposure.

METHODS
Data reported herein were gathered from international, multi-site, prospective, Go 4 Zero Fluoroscopy registry. The registry encompassed 25 European EP centers, and up to 5 operators from each center. The presence of operators’ X-ray protection tools was examined to determine the level of operators’ protection. Additionally, the tests included availability of measures to decrease radiation output and exposure control measures. Finally, the analysis of correlation between the X-ray protection and degree of operators’ experience (&lt;5, 5-15,&gt;15 years) as well as number of procedures performed per month (1-9, 10-19, 20-39, &gt;40 procedures/month) was performed.

RESULTS
Our analysis included 95 operators (median age: 39 years, 85% of male, median training time: 5 years). The whole study group performed annually medical examinations due to radiation exposure and 56% of them received dosimetry reports once a month, 5% - once every 3 months, and 39% - once a year. Irrespectively of experience or number of performed procedures the most frequently used X-ray protection tools (used by &gt;80% of group) were lead apron, thyroid shields, screen below the table, glass in the lab, and least often (used by &lt; 6% of group) – protective gloves and cabin. The most often exposure control measures used were chest (95%) followed by collar (31%), ring (24%) and eye (7%) dosimeters. The inverse correlation between level of experience and measures to decrease radiation output was observed (collimation: 84%, 80% and 78%; minimizing the tube-to intensifier distance: 100%, 93% and 91% of operators with &lt;5, 5-15 and &gt;15 years of experience, respectively). There were not observed differences between type of radiation protection equipment and operators’ level of experience or number of procedures. Additionally, there were no differences between male and female operators regarding protective equipment, expect eyeglasses or cabin that were more often used by men. Operators who were protected by &gt;4 X-ray protection tools were exposed for higher radiation levels as compared to those protected by &lt;4 X-ray protection tools (median [IQR] radiation exposure: 0.6 [0.2-1.1] vs 0.2 [0.1-0.2] mSv per month, p &lt; 0.0001; 1.1 [0.1-12.0] vs 0.5 [0.1-1.1] mSv per year, p &lt; 0.0001). There were no differences between the type of (universitary vs non-universitary) or institution’s localization (Eastern vs Central vs Western Europe) and used protective equipment.

CONCLUSIONS
Both proper radiation protective equipment, and regular medical examination due to professional exposure are mandatory to reduce radiation exposure in practice.
P1391Plasma aldosterone level in different forms of atrial fibrillation
Authors: Shevelyok A , Vatutin N 
Published: June 2020

Abstract
Background. Hyperactivation of the renin-angiotensin-aldosterone system plays a key role in the development of structural remodeling underlying the atrial fibrillation (AF). Nevertheless, the role of excessive aldosterone production in AF development has not been studied.
Purpose. The study aims to evaluate the aldosterone levels in different forms of AF and sinus rhythm.
Methods. The study included 130 patients (the main group) with non-valvular AF. Of these, 40 (30.8%) patients had permanent, 50 (38.4%) – persistent and 40 (30.8%) – paroxysmal AF. The control group consisted of 40 patients with cardiovascular pathology, who did not have a history of AF episodes. Plasma aldosterone levels were measured by immunoenzyme method. In patients with paroxysmal and persistent AF measurement was perfomed during AF episode before restoration of sinus rhythm. Aldosterone reference values was considered as 40-160 pg/ml.
Results. Aldosterone levels were significantly higher in patients of the main group compared to the control (141.5 ± 41.8 pg/ml vs 105.0 ± 33.1 pg/ml, P &lt; 0.001). It was the highest in paroxysmal and persistent AF and lower – in permanent AF. Hyperaldosteronemia (&gt;160 pg/ml) prevalence was significantly higher among all patients of AF group compared to the control (32.3% vs 7.5%, respectively, P = 0.004), however multiple comparisons showed significant differences between paroxysmal AF (47.5%) and sinus rhythm only.
Conclusion. Plasma aldosterone level is significantly higher in AF compared to sinus rhythm. In patients with paroxysmal and persistent AF it’s concentration is higher than in patients with permanent AF.
P1421Assessment of intraatrial conduction during staged catheter ablation of persistent AF
Authors: Kovalev A , Filatov A G , Kovalev S A , Bockeria L A 
Published: June 2020

Abstract
Goal. To evaluate the electrophysiological changes in the LA myocardium between the stages of sequential RFA of persistent AF.
Materials and methods. From 2015 to 2018 43 patients (27 men and 16 women) underwent sequential ablation (second intervention in a period of 3 to 6 months) of persistent AF. The routine isolation was performed in the first stage. During the second stage additional lesions were performed in the areas of the restored conduction and posterior wall isolation. All patients underwent a routine EP before each stage with measurements of the atrial myocardial refractory periods, as well as intraatrial conduction.
Results. The EP parameters before the first and second stages had significantly changed: refractory periods in the areas of previously performed RFA had increased from 184 (166; 208) ms to 212 (174; 249) ms, respectively, p &lt;0.001, the dispersion of refractivity decreased from 34 (18; 48) ms to 21 (16; 29) ms, p = 0.017. According to ECG, the duration of intraatrial conduction also decreased by 34 (24; 51) ms, p = 0.034.
Conclusion. Electrophysiological markers of intra- and interatrial conduction show a tendency to reverse modeling of atrial functions in patients passing through the staged treatment of persistent AF.
P1050General anesthesia improved rate of first-pass pulmonary vein isolation by radiofrequency ablation in patients with atrial fibrillation
Authors: Narikawa M , Kiyokuni M , Kino T , Taguchi Y , Yano H , Hosoda J , Matsumoto K , Sugano T , Ishigami T , Ishikawa T , Tamura K , Kimura K 
Published: June 2020

Abstract

Background
Pulmonary vein isolation (PVI) with radiofrequency ablation (RFA) is one of the important procedures for atrial fibrillation (AF). Attaining the stability of RFA, respiratory management and pain control during the procedure are required.

Purpose
We compared the characteristic parameters and procedural outcomes between general anesthesia and moderate (conscious) sedation in patients with AF performed RFA.

Methods
We performed a retrospective, 2-center observational study to compare the general anesthesia with moderate sedation during RFA on AF from January 2018 until December 2018. In general anesthesia group, we administrated propofol and muscle relaxants under mechanical ventilation. In moderate sedation group, we administrated dexmedetomidine and/or propofol with analgesic drug. Procedural time of AF ablation, first-pass PVI (pulmonary vein isolation after completing the right or left circle) were assessed.

Results
A total of 98 patients with mean age 66 ± 11 years were enrolled (80 males, 81%). Of these, 19 patients were performed RFA under general anesthesia and 79 patients were performed under moderate sedation. Age, gender, BMI, medications before admission and CHADs2 score (general anesthesia:1.9 ± 1.2 vs moderate sedation:1.5 ± 1.1, p = 0.14), left atrium diameter (40.2 ± 6.2 vs 40.6 ± 6.8 mm, p = 0.81) and proportion of paroxysmal AF (47.4 vs 54.4%, p = 0.61) were similar between two groups. Our study found catheter RFA with general anesthesia to be associated with reduced procedural time (161 ± 29 vs 241 ± 58 minutes, p &lt; 0.01) and improved the rate of first-pass PVI (left pulmonary vein: 84.2 vs 59.5%, p = 0.06 and right pulmonary vein: 84.2 vs 58.2%, p =0.04).

Conclusions
RFA under general anesthesia improved first-pass PVI (quality of PVI) and shortened procedural time. General anesthesia may attribute to attaining the catheter and patient stability during RFA for PVI.
P1467Ambulatory implantation of cardiac rhythm management devices: a retrospective safety and cost-minimization analysis in a developing country
Authors: Laso Bayas J L , Ibarra Castillo R , Arias Cardenas V K , Zapata Coronel J A 
Published: June 2020

Abstract

Introduction
The monetary costs and safety of ambulatory implantation of cardiac rhythm management devices (CRMD) has been previously studied in many developed countries, but few of these analyses come from developing countries. Here we present a summary of complications and comparative costs of ambulatory implantation of CRMDs sourced from a set of cases logged in a large database of a public facility from a developing country, over a period of 6 years.

Purpose
To determine the number and type of complications in ambulatory implantation of CRMDs and to perform a cost-minimization analysis of the outpatient versus the implantation with hospital admission.

Methods
We performed a retrospective study using the database of CRMDs that included implantation procedures of unicameral (UNI) and bicameral (BI) pacemakers, implantable cardiac defibrillators (ICD) and generator replacements (RPL) from September 2012 to December 2018, in order to determine the number of patients that received the device in ambulatory and hospitalization regimens. Then, we reviewed the medical records to determine the complication rate during the first month in both modalities. Finally, we compared the ambulatory implant costs, including hospital day-care, against the costs of a two-day hospitalization, one of these being spent in an intermediate-care unit and the other in general hospitalization.

Results
We identified a total of 541 procedures; mean age 70 ± 14 years; 227 (42%) female patients. From these, 361 were ambulatory (66,7%), 45% being BI implantation, 38% RPL, 9% UNI implantation and 8% ICD implantation. Of this, 81% of the procedures were for AV block, 7% for sinus node dysfunction and 12% for sudden death prevention (primary or secondary). There were a significant lower number of complications in the ambulatory group (3,9%, n = 14) compared with the hospitalization group (11,6%, n = 15) p = 0,006 (X²) , with no CRMDs emergencies, fatal complications or emergency readmissions in either group. Complications included pneumothorax, deep venous thrombosis, endocarditis, lead displacement and local hematoma. The cost of an ambulatory CRMD implantation was 65 USD whereas the same procedure with hospital admission was 675 USD, according with the payment units valid for our country.

Conclusion
Ambulatory implantation of all CRMDS is feasible and safe. This modality implies a significant monetary saving that directly benefits the patients and the social security system. It can be done in a tertiary level hospital that can reach the whole quality standards for these interventions.
219A machine learning classification algorithm to detect patients with paroxysmal atrial fibrillation during sinus rhythm
Authors: Tachmatzidis D , Filos D , Chouvarda I , Mouselimis D , Tsarouchas A , Bakogiannis K , Antoniadis A , Fragkakis N , Maglaveras N , Vassilikos V 
Published: June 2020

Abstract

Background
Atrial fibrillation (AF) - the most common sustained cardiac arrhythmia - while not a life-threatening condition itself, leads to an increased risk of stroke and high rates of mortality. Early detection and diagnosis of AF is a critical issue for all health stakeholders.

Purpose
The aim of this study is to identify P-wave morphology patterns encountered in patients with Paroxysmal AF (PAF) and to develop a classifier discriminating PAF patients from healthy volunteers.

Methods
Three-dimensional 1000Hz ECG signals of 5 minutes duration were obtained through the use of a Galix GBI-3S Holter monitor from a total of 68 PAF patients and 52 healthy individuals. Signal pre-processing, consisting of denoising, QRS auto-detection, and ectopic beats removal was performed and a signal window of 250ms prior to the Q-wave (Pseg) was considered for every single beat. P‑wave morphology analysis based on the dynamic application of the k‑means clustering process was performed. For those Pseg that were assigned in the largest cluster, the mean P-wave was computed. The correlation of every P-wave with the mean P-wave of the main cluster was calculated. In case that it exceeded a prespecified threshold, the P-wave was allocated to the main morphology. For the remaining P‑waves, the same approach was followed once again, and the secondary morphology was extracted (picture). The P-waves of the dominant morphology were further analyzed using wavelet transform, whereas time-domain characteristics were also extracted.
A Support Vector Machine (SVM) model was created using the Gaussian Radial Basis Function kernel and the forward feature selection wrapper approach was followed. ECGs were allocated to the training, internal validation, and testing datasets in a 3:1:1 ratio.

Results
The percentage of P-waves following the main morphology in all three leads was lower in PAF patients (91.2 ±7.3%) than in healthy subjects (96.1 ±3.5%, p = 0.02). Classification between the two groups highlighted 7 features, while the SVM classifier resulted in a balanced accuracy of 91.4 ± 0.2% (sensitivity 94.2 ± 0.3%, specificity 88.6 ± 0.1%)

Conclusion
An Artificial Intelligence based ECG Classifier can efficiently identify PAF patients during normal sinus rhythm.
Abstract Figure.
P1475Impact of automatic screening and parasternal rights positions in the eligibility of patients with hypertrophic cardiomyopathy for subcutaneous automatic cardioverter defibrillator implant
Authors: Quesada Dorador A , Fernandez C , Quesada-Ocete B , Sancho-Peluz P , Quesada-Ocete J , Martinez J G , Jimenez-Bello J G , Climent Paya V , Paya R , Bochard B , Palanca V , Vano-Bodi J , Simon J M , Perez-Bosca J L , Belchi J 
Published: June 2020

Abstract

Background
A high percentage of failures in the detection of QRS and T wave in patients (pts) with hypertrophic cardiomyopathy (HCM) have been reported. This finding would prevent them from being eligible for an implantable subcutaneous automatic defibrillator (S-ICD). However, recently 2 changes in the detection have been proposed, automatic screening and the use of right parasternal position of the lead.
The aim of our work was to study if the elegibility proportion of patients was increased with both 2 advacements.
Methods
We included 31 patients (18 male)with a diagnosis of HCM and at least 1 risk factor for sudden death, in follow-up at the outdoor clinic of of 2 cardiology centers. We performed elegibility screening test in supine position and standing using both the automatic screening (AS) obtained by Boston Scientific Zoom Latitude programmer) and the manual (MS), to simulate the detection of the 3 vectors utilized in S-ICD detection. And both screens were registered with the surface electrodes in parasternal left and right position. A pte was considered eligible if at least one vector was correct in supine position and in standing position, well in parasternal left or right position.

Results
Using MS with left parasternal position, 22 patients (71%) were eligible. Adding the right parasternal lead, the eligibility increased by 10%, reaching 81%. In addition, in automatic screening, eligibility in right shifts (81%) it is 7% more than in the left and, with the addition of the rights to the left, the eligibility reaches up to 84%. Figure shows the three-lead ECG factors influencing screening pass vs failure.

Conclusion
AS, right parasternal lead position and the combination of right and left parasternal lead position, increase the eligibility of sICD candidates with HCM.
Abstract Figure. ECG factors influencing screening pass
853Could baseline electrical parameters be a marker of arrhythmia occurrence and poorer prognosis in implantable cardioverter defibrillator patients?
Authors: Zecchin M , Solimene F , D"onofrio A , Zanotto G , Iacopino S , Pignalberi C , Calvi V , Maglia G , Della Bella P , Quartieri F , Curnis A , Biffi M , Giacopelli D , Gargaro A , Pisano" E 
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: Parameters routinely measured during cardiac devices implantation also depend on bioelectrical properties of the myocardial tissue.

Purpose
To explore the potential association of electrical parameters with clinical outcomes in implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy defibrillators (CRT-D) recipients.

Methods
In the framework of the Home Monitoring Expert Alliance, baseline electrical parameters for all implanted leads were compared by occurrence of all-cause mortality, adjudicated ventricular arrhythmia (VA) and atrial high rate episode lasting ≥7 days (7day-AHRE).

Results
In a cohort of 2,976 patients (58.1% ICD) with a median follow-up of 25 months, events rates were 3.1/100 patient-years for all-cause mortality, 18.1/100 patient-years for VA and 8.9/100 patient-years for 7day-AHRE.
At univariate analysis baseline shock impedance was consistently lower in groups with events than in those without, with a 40 Ohm cut-off better identifying patients at high risk, but at multivariable analysis the adjusted-hazard ratios (HRs) lost statistical significance for any endpoint.
Baseline atrial sensing amplitude during sinus rhythm was lower in patients with 7-day AHRE as compared to those without (2.40 [IQ: 1.62-3.71] Vs 3.50 [IQ: 2.35-4.66] mV, p &lt; 0.01). The adjusted-HR for 7-day AHRE in patients with atrial sensing &gt;1.5 mV versus those with values ≤1.5 mV was 0.44 (95% CI:0.27-0.72), p = 0.001.

Conclusion
Despite in patients with events a lower baseline shock impedance was observed at univariate analysis, the association lost statistical significance at multivariable analysis. Conversely, low sinus rhythm atrial sensing (≤1.5 mV) measured with standard transvenous leads could identify subjects at high risk of long-lasting atrial arrhythmia.
Abstract Figure. AHRE occurrence by atrial sensing