bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1152Health-related quality of life among implantable cardioverter defibrillator patients compared to age- and sex-matched norms
Authors: Magnusson P , Karlsson J , Wallhagen M , Mattsson G 
Published: June 2020

Abstract
Background The decision to implant an ICD integrates presumed health-related quality of life (HRQL).
Purpose To assess HRQL in ICD patients using the questionnaire SF-36, and compare it to a Swedish age- and sex-matched population.
Methods SF-36 of ICD patients 2007-2017 (response rate 77.2%) were analysed using the Mann-Whitney U-test and effect size (ES).
Results In total, 223 patients (mean age 71.1 ±9.7 years) were included of whom 33.6% had a CRTD. A majority were men 82.1% (n = 183) and 60.1% (n = 134) had an ICD due to primary prevention. SF-36 score are summarized as Table 1. Mean age was similar between men and women (71.1 vs 70.9 years) and there were no significant difference score at any domain, including both component scores. Primary and secondary prevention patients (mean age 70.3 vs 72.3 years) scored similar except for worse GH in PP (p = 0.016, ES 0.35). A history of atrial fibrillation at baseline was associated with worse PF (ES 0.41) and PCS (ES 0.38). Neither appropriate therapy, inappropriate shock, nor complications requiring surgery, were associated with lower scores in any domain. In primary prevention due to ischemic vs non-ischemic cardiomyopathy no domain were significantly different. PCS decreased with higher age strata (p = 0.002) in contrast to MCS (p = 0.986).
Conclusion Patients with ICDs have lower physical and mental HRQL than age- and sex matched norms; however the effect sizes are small. HRQL is similar regardless of sex, primary vs secondary prevention indication, appropriate therapy, inappropriate shock or complications but decreases with age.
Table 1. SF-36 ICD patients(n = 223) Swedish Norms (n = 171) Mean (SD) Mean (SD) p-value Effect size Physical Functioning (PF) 65.1 (28.1) 75.5 (26.0) 0.0002 0.38 Role Physical (RP) 56.9 (44.1) 66.7 (40.4) 0.0466 0.23 Bodily Pain (BP) 71.9 (29.9) 71.0 (27.2) 0.6395 NS General Health (GH) 56.2 (21.7) 65.9 (25.3) ≤0.0001 0.41 Vitality (VT) 58.0 (24.8) 68.1 (27.2) ≤0.0001 0.39 Social Functioning (SF) 80.1 (24.4) 85.9 (22.9) 0.0025 0.25 Role Emotional (RE) 72.2 (39.9) 76.7 (35.7) 0.3730 NS Mental Health (MH) 76.2 (19.4) 83.8 (20.9) ≤0.0001 0.38 Physical Component Summary (PCS) 40.7 (12.3) 44.4 (11.6) 0.0052 0.31 Mental Component Summary (MCS) 48.6 (10.8) 51.9 (10.5) 0.0010 0.31 Health-related quality of life among ICD patients compared to age- and sex-matched Swedish norms.
P1033Cryo-ablation vs radiofrequency ablation: is there a difference between the two technologies - A single centre analysis of the sites pulmonary vein reconnection
Authors: Sidhu B , Antoun I A , Mistry A M , Vali Z V , Pooranachandran V P , Li X L , Newton M N , Ng G A N 
Published: June 2020

Abstract

Funding Acknowledgements
Nil

Introduction
Pulmonary vein isolation (PVI) remains the most common initial ablation strategy for management of atrial fibrillation (AF). The two main methods of creating these lesions include cryo-ablation or radiofrequency ablation (RFA). In both methods, gaps in the encircled lesions have the potential to cause recurrences of AF. The aim of this analysis was to determine whether there is a difference in the number of gap lesions when comparing cryoablation to RFA.

Methods
A retrospective single tertiary centre analysis was performed in 1152 patients who had an AF ablation between January 2015 to June 2019. Patients who required a redo-PVI were included for analysis (n = 155). Demographic (gender, age), clinical (BMI, type of AF, hypertension, DM, left atrial volume) and procedural (PVI method, fluoroscopy time, procedural time) data was collected. For the redo cases, the number of gap lesions by region were analysed by looking at electromechanical maps to determine where the most common gaps occurred for both technologies

Results
A total of 155 redo procedures (Cryo-RF, n= 46, RF-RF, n = 109) were analysed. There was no statistically significant difference or linear correlation between being obese and number of gaps in the cryo-RF or RF-RF group (R = -0.042, p = 0.351, R = 0.153, p = 0.110 respectively). The total number of gaps in the in the Cryo-RF group = 232 and RF-RF group = 564. There was no significant difference between the two groups (p = 0.963). There was no significant difference or correlation between the use of contact force and the number of gaps in the RFA group (p = 0.644, R = -0.045).

Conclusion
Each of these PVI technologies have previously been found to be effective in treating AF. Avoiding gaps during PVI remains challenging. This retrospective analysis has demonstrated that overall there is no difference in the number of gap lesions that occur after using either of these current ablation technologies.
Cryo-RF vs RF-RF: group comparison CRYO-RF (n = 46) RF-RF (n = 109) P Value Male (%) 28 (60.1) 80 (73) 0.197 Age at 2nd procedure (mean +/- SD) 61.5 +/- 8.9 59.8 +/- 11.6 0.008 Time between procedures (days - mean +/- SD) 497.5 +/- 228.2 1007.7 +/- 924.8 &lt;0.001 Obese (%) 17 (37) 58 (53) 0.073 LA volume (ml/m2 - mean +/- SD) 59.6 +/- 23 57 +/- 26 0.996 Contact force used in index procedure (%) 68 (62) 0.644 Total number of gaps 232 564 0.963 Table representing difference between and significance level for Cryo-RF and RF-RF groups.
P391Estimated glomerular filtration rate levels and risk of stroke in individuals with diabetes mellitus and atrial fibrillation
Authors: Westreich R , Barrett O , Kezerle L , Leventer Roberts M , Avgil Tsadok M , Akriv A , Ohana R , Feldman B , Haim M 
Published: June 2020

Abstract

Funding Acknowledgements
pfizer

Background
Diabetes mellitus (DM) is associated with increased risk of embolic complications in non-valvular atrial fibrillation (NVAF). Chronic kidney disease (CKD) has been shown in some studies to increase the risk of stroke. This finding is not consistent among all studies. Therefore the relationship between kidney function, diabetes and stroke risk is complex and warrants further investigation.

Purpose
To assess the incidence rates and risk of ischemic stroke and mortality by baseline Estimated Glomerular Filtration Rate (eGFR) levels among individuals with AF and DM.

Methods
A prospective, historical cohort study using our electronic medical records database. The study population included all members 21 years old, with a first diagnosis of NVAF between January 1, 2010 to December 31, 2016 and a minimal follow-up period of 1 year. Among those patients identified as diabetics, we compared three groups of patients according to eGFR levels at the time of AF diagnosis: eGFR ≥ 60, between 30-60 and ≤ 30 or chronic dialysis or kidney transplant.

Results
A total of 17,567 cases were included in the final analysis, of them, 11013 (62.7%) had eGFR ≥ 60, 4930 (28%) with eGFR between 30-60 and 1624 (9.24%) with eGFR ≤30 . The median age was 75 years (IQR 65-83) with a majority of females in all groups, 52.5%, 51.2% and 55.5% respectively. The incidence of stroke per 100 person-years in the three study groups was: 1.88 in patients with eGFR ≥ 60, 2.69 in patients with eGFR between 30-60 and 3.34 in those with eGFR ≤ 30 . Impaired renal function was associated with increased risk of stroke in univariate analysis, but not found in the adjusted model (Adjusted Hazard Ratio (AHR) = 1.04 {95% 0.89-1.23} for eGFR 30-60 and 1.16 {95% CI 0.88-1.51} for eGFR ≤ 30 compared to GFR ≥ 60). incidence of mortality per 100 person-years was 10.78 in patients with eGFR ≥ 60, 21.49 in patients with eGFR 30-60 and 41.55 in those with eGFR ≤ 30. In both univariate and multivariate analyses, decreased levels of eGFR were associated with increased mortality risk compared to subjects with normal renal function (AHR 1.22 {95%CI 1.14-1.27} and AHR 2.09 {95%CI 1.95-2.24} for eGFR between 30-60 and for eGFR ≤ 30, respectively).

Conclusion
In this observational prospective cohort of patients with newly diagnosed NVAF, impaired renal function was not found to be associated with increased risk of stroke. Lower eGFR levels were associated with an increased mortality risk.
838Premature Cardiac Conduction Disease in families, potential role for Implantable Loop Recorder in screening? A Case Series
Authors: Sharif Z , Murphy L M , Al-Harbi K A H , Brennan C B , Connaughton H C , Green A G , Ward D W 
Published: June 2020

Abstract

OnBehalf
Cardiac Risk in the Young (CRY) Ireland

Background
Cardiac conduction disease (CCD) is a potentially fatal entity. The spectrum ranges from benign clinical course to potentially precipitating sudden cardiac death. Permanent pacemaker (PPM) may benefit affected individuals but the genetic basis of CCD may be underestimated. No prior study has investigated the utility of screening relatives of victims of Sudden Arrhythmic Death Syndrome (SADS) with implantable loop recorders (ILR).

Methods
We describe 7 families referred to our inherited cardiac conditions service with a family history of SADS, in whom we identified premature CCD. ILR was utilized in screening the majority of families.

Results
Of 63 individuals screened, 31 (49%) had ILR insertion with 7 (11%) requiring PPM implant. 2/31 had normal baseline tests, and were identified post ILR implant. Other CCD not yet meeting clinical significance was detected in 10/31 (32%) individuals. These findings (documented 11 to 330 days post implant) included pauses of 3-5.8 seconds (n = 7), nocturnal bradycardia &lt; 34 bpm (n = 2) and non-sustained polymorphic ventricular tachycardia. Of families undergoing mutation analysis, conventional genetic panels have been negative to date.

Conclusions
Inherited premature CCD with variable penetrance may be an under-recognized cause of SADS. To date 12/31 (39%) of individuals with ILR have findings suggesting inherited CCD. As inheritance pattern suggests autosomal dominant transmission, longer follow up may identify more affected individuals. Clinicians involved in SADS family evaluations should consider adding ILR implantation to routine assessment to improve diagnostic yield. We suggest a larger prospective study of consecutive families whose initial investigations following a SADS death have not identified a cause.
Summary of Findings Screening Abnormality Family 1 Family 2 Family 3 Family 4 Family 5 Family 6 Family 7 Bradycardia Yes Yes Yes Yes Yes Yes Yes PR &gt;200 Yes No No No No No No &lt;90% PTHR EST No No No No No No No Arrhythmia on EST Yes No No No No Yes No Pauses &gt; 3s Holter/Telemetry Yes No Yes No Yes No Yes High grade AV block Holter Yes Yes No No No No No ILR: significant to date Yes Yes No No No No - ILR: findings to monitor Yes No Yes Yes No Yes - Provocation Testing No Negative No No No No No Genetics Negative Negative Awaited Awaited Awaited Awaited Negative PTHR predicted target heart rate, EST: exercise stress test
1326Identification of arrhythmic isthmus in patients with transposition of the great arteries treated with atrial switch surgery using a new high-definition wavefront-activation-orientation grid catheter
Authors: Francisco Pascual J , Llerena Butron S , Perez Rodon J , Santos Ortega A , Benito B , Rodriguez Garcia J , Dos Subira L , Pijuan Domenech A , Subirana M T , Miranda Barrio B , Roses Noguer F , Gonzalez Fernandez V , Ferreira Gonzalez I , Rivas Gandara N 
Published: June 2020

Abstract

INTRODUCTION
Patients with D- transposition of the great arteries (TGA) treated with Senning or Mustard surgeries have several atrial scars that predispose them to develop atrial tachycardias (AT). Identification of scar zones and possible arrhythmic isthmus in voltage mapping will help to guide the ablation.

AIM
To describe the feasibility of using a specific mapping catheter to identify possible arrhythmic isthmus in this set of patients.

METHODS
Prospective observational study in patients with history of SVT and atrial switch surgery, that underwent electrophysiologic study (EP) and electroanatomic (EA) mapping with a new 8Fr deflectable, multipoint wavefront-activation-orientation independent Grid catheter, in a third level hospital since April 2018 until May 2019, with medium-term follow-up.

RESULTS
A total of 8 EPs were performed in 7 patients (3 (57%) Female, median age 35 ± 6,3 y.o.). Figure 1A shows the localization and percentage of scar identified in both atria. A total of 6 AT were induced. In this, an arrhythmogenic isthmus was identified and, in all patients, at least one non-arrhytmogenic isthmus was documented. Figure 1B shows anatomical and electrophysiological characteristics of the isthmus. Arrhythmogenic isthmus had slower conduction velocity than non-arrhytmogenic ( mean 0,44m/s (IQI 0,17-0,62) vs 1,05 m/s (IQI 0,86-1,39) p = 0.008) and fractionated potentials were detected more frequently (100% vs 50% p = 0.089)

CONCLUSION
EA mapping with a new a multipoint, high-definition, Grid Cather is feasible and allows the identification and electrophysiological characterization of arrhythmogenic and non-arrhytmogenic isthmus in patients with TGA treated with atrial switch surgery.
Abstract Figure 1
P947dST-Tiso index, a new shallow ECG marker in response to ajmaline for predicting ventricular fibrillation induction in Brugada patients
Authors: Iacopino S , Sorrenti P , Fabiano G , Campagna G , Petretta A , Pardeo A , Placentino F , Filannino P , Artale P , Santarpino G 
Published: June 2020

Abstract
Introduction - No study has been performed to investigate the role of drug-induced ECG morphology modifications as potential risk factors for the development of malignant arrhythmias in patients with Brugada syndrome.
Purpose - The aim of this study is to introduce a new index to improve asymptomatic patient stratification and to report the first case of a patient with Brugada syndrome undergoing ajmaline testing that has been evaluated using a diagnostic 252-lead ECG vest.
Methods - From December 2018 to April 2019, 26 consecutive patients [mean age 39.9 (30–59) years, 18 male] with no cardiovascular risk factors underwent ajmaline testing. By evaluating ECG recordings after ajmaline administration, we calculated an index that we called "dST-Tiso", that is the duration of the positive component of the ST-T wave to the isoelectric line, in V1 and/or V2.
Results- Out of 26 patients, 16 (61.5%) had a positive test, with type 1 (coved-type) ECG diagnostic pattern in leads V1-V2 from the 2nd, 3rd and 4th intercostal spaces. The mean recorded dST-Tiso value was 239 ± 76 ms. The ECG showed T-wave above the isoelectric line in 5 patients with a significantly higher dST-Tiso value (on average 360 ± 56 ms), and biphasic T-waves below the isoelectric line in 11 patients with a dST-Tiso value of 209 ± 42 ms (Mann-Whitney, p = 0.039). All patients with positive ajmaline test underwent programmed electrical stimulation (PES). Ventricular fibrillation was induced during PES in all 5 patients with stretched dST-Tiso. In the remaining 11 patients without stretched dST-Tiso, no ventricular arrhythmia was induced by PES. Fig 1 Moreover, using non-invasive high-density electrocardiographic mapping (252-lead ECG vest), 3 patients with dST-Tiso positive pattern received a second ajmaline protocol, with assessment of both the depolarization and repolarization phases.
Conclusion - The ECG pattern of prolonged dST-Tiso seems to have a significant impact on safety during PES and may have potential for stratifying risk of sudden death in patients with PES-induced ventricular tachycardia/fibrillation.
Abstract Figure 1. Patients’ flowchart.
P1010Association between left atrial fibrosis detected by cardiac magnetic resonance and endocardial electroanatomic mapping in the evaluation of the electrophysiological substrate in atrial fibrillation
Authors: Caixal G , Alarcon F , Nunez M , Garre P , Soto D , Borras R , Gunturitz C , Perea R , Roca I , Guasch E , Mont L 
Published: June 2020

Abstract

Background
Atrial fibrillation (AF) is related to left atrial fibrosis, but its identification by late magnetic resonance imaging (LGE) with gadolinium (LGE) persists in controversy due to heterogeneous results in its correlation with the electroatomic map (EAM) and the difficulty of perform histological studies in humans.

Purpose
We try to examine the point-by-point association between high density EAM and LGE-MRI using an automatic and reproducible method.

Methods
A LGE-MRI was performed in 16 patients prior to ablation. Three different areas were established depending on the intensity of normalized enhancement for each patient according to their blood group with the image intensity ratio (IIR) (healthy &lt;1.20, border area (BZ) ≥1.20 &lt;1.32 and scar ≥1.32). The high density electroanatomic maps of the left atrium (LA) were projected onto the MRI, obtaining an automatic correlation point by point.

Results
The study obtained significant differences (p &lt; 0.001) between voltage (mV) and CV (mm/ms) among healthy, BZ and scar areas, as well a significant inverse correlation (p &lt; 0.001) between voltage and IIR (R=-0.39). It obtained too a significant correlation between CV and IIR (R=-0.24), but this showed a greater correlation in those patients who have the least dilated LA (p = 0.02).

Conclusions
LGE-MRI and EAM showed good correlation in delineating potential pathologic substrate in AF, but left atrium dilation could reduce the performance of the CMR in this task. Conduction velocity could be more sensitive than voltage and LGE-MRI to detect incipient substrate in AF.
Voltage and conduction velocity values Area /IIR Velocity (mm/ms) Voltage (mV) I / &lt;.20 1.036(0.913-1.158) 1.593(1.489-1.696) 2 / ≥1.20 and &lt;1.32 0.722(0.590-0.850) 0.792 (0.649-0,935) 3 / ≥1.32 0.623(0.473-0,733) 0.444(0.245-0.642) Voltage and conduction velocity values in the three areas of the LGE-RMN.
Abstract Figure. Correlation among voltage, VC and LA
P527Ultrasound-guided serratus anterior plane block for S-ICD implantation using the intermuscular technique
Authors: Migliore F , De Franceschi P , De Lazzari M , Miceli C , Crescenzi C , Migliore M , Iliceto S , Bertaglia E 
Published: June 2020

Abstract

Funding Acknowledgements
NONE

Background
operative anesthetic requirements and peri-operative discomfort are barriers to wide adoption of the subcutaneous implantable cardioverter defibrillator (S-ICD) system expecially when the intermuscular technique is used due to the greater amount of tissue dissection. The procedure is most commonly performed under general anesthesia (GA). There is growing interest in transitioning away from the routine use of GA and towards several alternative anesthesia modalities implifying the anesthetic management of the S-ICD implant procedure without the involvement of an anesthesiologist.

Purpose
we assessed the feasibility of ultrasound-guided serratus anterior plane block (US-SAPB) in patients undergoing S-ICD implantation with the intermuscular two-incision technique. Methods: the study population included 38 consecutive patients (84% male; median, 53 [46-62] years) who received S-ICD implantation using the intermuscular two-incision technique. All procedures were performed under US-SAPB and sedoanalagesia without the involvement of an anesthesiologist.

Results
the average procedure time was 67 ± 14 minutes.No patient experienced significant hemodynamic changes or oxygen desaturation during the period of US- SAPB procedure and sedation; there was no need for pharmacological interventions. The whole procedute was well tollerated without discomfort and complications in the absence of needing GA except in one (2.6%) patient who required GA with laryngeal mask airway. Patients remained always able to respond appropriately to neurological monitoring during S-ICD implantation procedure. There were no procedure-related complications.

Conclusion
US-SAPB and the intermuscular two-incision technique may be a safe and feasible promising combination for S-ICD implantation overcoming potential barrier to wieder S-ICD adoption in the clinical practice.
P1438Predictors and clinical impact of bleeding events after left atrial appendage closure in patients with high risk or a history of bleeding
Authors: Sano M , Fink T , Sciacca V , Vogler J , Saad M , Joost A , Heeger C-H , Eitel C , Keelani A , Langer H , Eitel I , Tilz R 
Published: June 2020

Abstract

Background
Left atrial appendage closure (LAAC) has emerged as an alternative to oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation and may be especially attractive in patients with high risk or a history of bleeding. However, data of clinical benefit and incidence of post-procedural bleeding in patients with both high risk of bleeding and ischemic cerebral stroke after LAAC are lacking.

Objectives
This study sought to identify predictors and the prognostic impact of post-LAAC bleeding in patients at high risk and/or history of bleeding in the direct oral anticoagulant therapy (DOAC) era.

Methods and results
We retrospectively enrolled a total of 195 patients (75 ± 8.7 years, 38% female, 47% with previous major bleeding, mean CHA2DS2-VASc score 4.3 ± 1.6 and mean HAS-BLED score 2.7 ± 1.1) undergoing endocardial (91%) or epicardial (9%) LAAC during a mean follow-up of 339 ± 319 days. Twenty-three (11.9%) patients developed procedure-unrelated bleeding events after a median of 147 (43, 362) days after LAAC, in 12/23 (52%) patients under single antiplatelet therapy (SAPT), 6/23 (26%) dual antiplatelet therapy (DAPT), 1/23 (4%) DOAC, 1/23 (4%) VKA, 2/23 (9%) dual therapy (SAPT and DOAC/VKA) and 1/23 (4%) triple therapy (DAPT and DOAC/VKA). (Figure) Diabetes mellitus and previous major bleeding were identified as the independent predictors of post-LAAC bleeding (Odds ratio 2.65 [95% CI:1.04-6.73], p = 0.041, and 5.50 [95% confidence interval:1.72-17.5], p = 0.004). Post-LAAC bleeding was associated with all-cause death (9/23 [39%] vs 18/171 [11%], p = 0.001), but not ischemic stroke/TIA (1/23 [4%] vs 6/171 [4%], p = 0.593) nor device thrombus (2/23 [9%] vs 3/171 [2%], p = 0.108). Kaplan-Meier curve estimated that patients with post-LAAC bleeding had a worse mortality than those without post-LAAC bleeding (3-year mortality; 35.6% [95%CI; 11.6-61.0%] vs 68.7% [45.0-83.8], p = 0.029)

Conclusions
In AF patients with high bleeding risk or history of bleeding undergoing LAAC, bleeding events are common and may occur even after long-term duration after LAAC. Previous major bleeding history strongly predicts subsequent bleeding events following LAAC and is associated with unfavorable mortality. Further investigations are required to identify optimal post-procedural antithrombotic strategies for patients undergoing LAAC with previous major bleeding.
Abstract Figure. The association between time to bleeding