bluuebunny/crossref_metadata_2025_split huggingface dataset:
P375The impact of hypothyroidism on hospitalization frequency and cost-effectiveness among patients with atrial fibrillation
Authors: Lutsenko L , Panova T , Bukina G , Lebed O 
Published: June 2020

Abstract

Background
thyroid disorders are a well-known fact of high risk developing of atrial fibrillation (AF). While it is established that hyperthyroidism increases AF incidence, data of the effect of hypothyroidism on AF and heart failure is contradictory.

Purpose
to examine effect of untreated hypothyroidism on frequency of paroxysmal AF, state of the permanent AF and chronic heart failure (CHF) which is the main cause of high rate repeated hospitalizations.

Methods
This retrospective study was conducted among patients (pts) with AF, who were admitted to the hospital from June 2018 till June 2019. They were divided into 2 groups: 1-st group – pts with AF and hypothyroidism and 2-nd group – euthyroid pts (by using hormonal replacement therapy) with AF. All pts were surveyed about their age, gender, medical history, therapy, number and reasons for hospitalization for the past 12 months. Reference range of TSH was 0,4-4,0 mU/L.

Results
A total of 75 pts, 57,3% (n = 43) women, 41,3% (n = 31) men, mean age 70,5 years (SD 6,7) were enrolled in the research. 1-st group consist of 66,7% (n = 24) women, 33,3% (n = 12) men, mean age 70,3 years (SD 6,8), paroxysmal AF 38,9% (n = 14), permanent AF 61,1% (n = 22), first diagnosed hypothyroidism during hospitalization 61,1% (n = 22), mean TSH 9,3 mU/L (SD 3,7), 33,3 % (n = 12) were re-admitted 2 and more times, mean hospitalization duration 7,1 day (SD 1,1).
2-nd group consist of 51,3% (n = 20) women, 48,7% (n = 19) men, mean age 70,6 years (SD 10,6), paroxysmal AF 35,9% (n = 14), permanent AF 64,1% (n = 25), mean TSH 2,1 mU/L (SD 1,12), 17,9 % (n = 7) were hospitalized 2 times, mean hospitalization duration 5,9 day (SD 0,9). Reasons for hospitalization in the 1-st group were pharmacological cardioversion (n = 8) and decompensated CHF (n = 4), in the 2-nd group were pharmacological cardioversion (n = 2) and decompensated CHF (n = 5).
Average cost of whole hospitalization in the 1-st group was 252$ (SD 8,1), in the 2-st group – 221 $ (SD 5,2). As an example, average cost for patient with CHF and AF per month in Ukraine is 45 $.

Conclusion
Tight control of thyroid function ensures optimal dose of hormonal replacement therapy and decrease number of repeated hospitalizations and average hospitalization duration in patients with AF and hypothyroidism. As a result, we receive improving of cost-effectiveness of hospitalization AF pts.
130Long-term outcomes of ventricular tachycardia substrate ablation incorporating hidden slow conduction analysis
Authors: Acosta Martinez J , Soto-Iglesias D , Jauregui-Garrido B , Fernandez-Armenta J , Penela D , Frutos-Lopez M , Arana-Rueda E , Pedrote A , Berruezo A 
Published: June 2020

Abstract

Introduction
Ventricular tachycardia substrate ablation (VTSA) incorporating hidden slow conduction (HSC) analysis allows further arrhythmic substrate identification. This study evaluates whether the analysis and elimination of HSC electrograms (HSC-EGMs) during VTSA procedures result in better short and long-term outcomes.

Methods
Consecutive patients (n = 70, 63% ischaemic, 64 ± 14.6 years) undergoing VTSA were prospectively included. Bipolar EGMs with &gt;3 deflections and duration &lt;133 ms were considered as potential HSC-EGM, if located within/surrounding the scar area. Whenever a potential HSC-EGM was identified, a double ventricular extrastimulus was delivered. If a local potential showed up as a delayed component, it was annotated as HSC-EGM. The incidence of HSC-EGM in core, border-zone, and normal-voltage regions was determined. Ablation was delivered at conducting channel entrances and HSC-EGMs. Procedure time, radiofrequency time, VT inducibility after VTSA and VT recurrence at 12 months after the procedure were compared with data from a historic control group (n = 66, 70% ischaemic, 65.2 ± 12 years).

Results
5076 EGMs were analyzed. 1029 (20.2%) qualified as potential HSC-EGM, and 453 of them were tagged as HSC-EGMs. Scars in patients with HSC-EGMs (n = 43, 61.4%) were smaller (39.66 ± 28.2 vs 69.4 ± 38.2 cm2; p = 0.005) and more heterogeneous (core/scar area ratio 0.24 ± 0.2 vs 0.43 ± 0.17; p = 0.03). 29.6% of HSC-EGMs were located in normal-voltage tissue; 83.5% were targeted for ablation. Patients undergoing VTSA incorporating HSC analysis needed less procedure time (213 ± 75 vs 242 ± 60 min; p = 0.018), less RF time (15.9 ± 10 vs 25 ± 12,7 minutes; p &lt; 0.001), had a lower rate of VT inducibility (27.5% vs 51.5%; p = 0.005) and a higher 2-year VT/VF-free survival (82.8% vs 59.7%; log rank p = 0.047) after VTSA than the historic controls .

Conclusion
VTSA incorporating HSC analysis allowed further arrhythmic substrate identification (especially in normal-voltage areas) and resulted in increased VTSA efficiency and better short and long-term outcomes.
Abstract Figure. VT Recurrence-Free Survival
P551Permanent cardiac implantable device damage during direct photon exposure for oncologic radiotherapy: a multicentre, in-vitro observation
Authors: Di Girolamo E , Faustino M , Furia N , Appignani M , Marini M , De Filippo P , Leidi C , Delana A , Barbareschi A , Andreoli S , Genovesi D , Falco M D 
Published: June 2020

Abstract

Funding Acknowledgements
None
Backgroung. Direct photon exposure of cardiac implantable devices (CIEDs), both pacemakers (PMs) or implantable cardioverter defibrillators (ICDs), during oncologic radiotherapy (RT) courses may transiently or permanently affect normal device function.

Purpose
To evaluate CIED damage by direct exposure to doses up to 10 Gy in oncologic RT, commonly considered unsafe or even potentially harmful, 206 CIEDs (143 PMs and 63 ICDs) from three different centres, with at least 4 months to Elective Replacement Indicator (E.R.I.) were observed.
Methods. All CIEDs had a baseline telemetry interrogation. Single chamber devices were programmed in the VVI/40 mode and dual or triple chamber ones were programmed in the DDD/40 mode. Rate adaptive function was disabled. In ICDs, antitachycardia therapies were disabled with the ventricular tachycardia/fibrillation window left enabled. A centering Computed Tomography was performed to build the corresponding treatment plan and CIEDs were blinded randomized to receive either 2, 5 or 10 Gy (direct exposure) by a 6 MV linear accelerator in a home-made water phantom. An in-vivo dosimetry randomly assessed the effective dose received by the CIEDs. All CIEDs were interrogated immediately after exposure and monthly during a three-month follow-up.
Results. Immediately after photon exposure, no changes in device setting or software errors were observed in 205 CIEDs (99·5%). Reset to emergency back-up mode was observed in a PM (0·49% overall; 0·7% among PMs). Seven PMs reached the E.R.I immediately after exposure (3·4% overall; 4·9% among PMs). Sixteen ICDs (7·8% overall; 25·4% among ICDs) reported multiple ventricular tachycardia/fibrillation detections stored in the device memory. During follow-up, a non-reprogrammable software reset (emergency backup VVI/65 mode) was observed in one PM after a single dose of 2 Gy (0·49% overall; 0.7% among PMs), whereas an abnormal battery drain was observed in 6 PMs (2.9% overall; 4.2% among PMs). No battery issues were observed in ICDs. All reported events occurred regardless of either 2, 5, or 10 Gy direct exposure. Malfunctions were observed in only older CIEDs.
Conclusions. Recent CIEDs have shown to be safe during oncologic RT, withstanding direct exposure up to 10 Gy, commonly considered not recommended or even unsafe by manufacturers statements and clinical guidelines. Malfunctions occurred solely in older devices.
848Ultrasound-guided axillary vein puncture feasibility for complex cardiac devices implantation
Authors: Bun S-S , Squara F , Scarlatti D , Theodore G , Latcu D G , Hasni K , Benaich F A , Enache B , Saooudi N , Allouche E , Diakite M , Ferrari E 
Published: June 2020

Abstract

Background
The axillary route use for cardiac devices implantation has recently expanded either with fluoroscopy or ultrasounds guidance. Few studies included defibrillators (ICD), cardiac resynchronization therapy (CRT) and upgrade procedures for ultrasound-guided axillary vein puncture (UGVP).

Puropose
To assess the feasibility/safety of UGVP for complex cardiac devices implantation including CRT/ICD.

Methods
Consecutive patients eligible for a pacemaker or ICD implantation were included.
All procedures were performed by three operators (one experienced and two fellows). Guidewires insertion time (from lidocaïne administration), and complications were systematically studied. A group of patients implanted with alternative techniques was used for comparison (cephalic, subclavian).

Results
In 176 consecutive patients in whom UGVP was used, a total of 68 complex procedures were analyzed (74 ± 8 y, male 61 %) with 138 leads implanted including 42 ICD, 48 CRT and 16 upgrade procedures. A majority (83 %) was under anti-thrombotic therapy. UGVP was successful in 96.8 %. Mean insertion time for 1.78 guidewires per patient was 4.4 ± 4.4 min. Guidewires insertion time reached its plateau after 10 patients. One pocket hematoma (1.4 %) was drained during a mean follow-up of 12 ± 5 months. The control group included 28 patients (12 subclavian, 16 cephalic; 15 ICD, 18 CRT, 4 upgrade procedures), with a mean insertion time of 10 ± 8 min, for 1.95 guidewires per patient (p &lt; 0.0005).

Conclusion
UGVP is feasible and safe even for complex device implantations including CRT/ICD and upgrade procedures.
P557Does the reduced left ventricle ejection fraction affect the results of transvenous lead extraction?
Authors: Polewczyk A , Jachec W , Segreti L , Bongiorni M G , Kutarski A 
Published: June 2020

Abstract

Background
Reduced left ventricle ejection fraction (LVEF) is a common risk factor of complications in patients undergoing different procedures.

Aim of study
The aim of the study was to assess efficiency and safety of transvenous lead extraction (TLE) procedures in patients with reduced LVEF (&lt; 40%) compared to patients with mid-range reduced and preserved LVEF (≥40%).

Study group
Data from 3434 of TLE procedures (patient"s age during TLE-65,5 ± 15,5 years, female; 1168 (34,01%), performed in two high volume European Centers (PISA – Italy, Lublin-Zamość – Poland) were analysed.

Results
In group with reduced LVEF (A) compared to the group of patients with LVEF ≥ 40% (B) the smaller number of female was found (p &lt; 0,001). The number of devices with ICD leads was higher in group A (p &lt; 0,001). Dwelling time for oldest lead and the oldest extracted lead were longer in group B (p &lt; 0.001). There were no differences in indications for TLE between presented groups. The procedure duration time was similar in both groups. There were no statistically significant differences in complete procedural success, clinical success, major and minor complications and procedure related death occurrence. Complete results are presented in Table.1

Conclusion
The effectiveness and safety of TLE in patients with reduced left ventricle ejection fraction does not differ from the results of the TLE procedures in patients with mid-range reduced and preserved LVEF.
Abstract Table
P1014The natural history of atrial fibrillation after the first clinical episode: a prospective observational study via implantable loop recorders
Authors: Papakonstantinou P , Simantirakis E , Kanoupakis E , Parthenakis F , Vardas P 
Published: June 2020

Abstract

Funding Acknowledgements
The study was supported by Medtronic Inc
Background
The natural history of paroxysmal atrial fibrillation (AF) after the first clinical AF episode is not well known. AF burden is of clinical significance as it may have clinical implications concerning the long-term management of the arrhythmia and the decision-making on AF patients.
Purpose
To observe the natural history of AF in patients after their first clinical paroxysmal AF episode.
Methods
Thirty consecutive patients (age 66.9 ± 10 years; 14 men) received an implantable loop recorder (ILR) after their first symptomatic paroxysmal AF episode. We recorded the AF recurrences and burden (clinical and subclinical AF) during a follow-up period of three years. We excluded patients with persistent or permanent AF and patients with an episode of AF attributed to reversible or transient causes.
Results
Eight patients (26.6%) did not present any AF recurrence during the first year of the follow-up period. Five patients (16.6%) did not also suffer any AF episode during the second year, while in three patients (10%) no AF episode was recorded during the three-year follow-up period. In 16 patients (53.3%) the AF burden was increased during the second year of follow-up period while in 9 patients (30%) the AF burden was decreased. During the third year of follow-up period the AF burden was increased in 19 patients (63.3%), decreased in 7 patients (23.3%) and remained almost the same in 4 patients (13.3%). Five patients (16.6%) presented at least one episode of persistent AF during the follow-up period. Seven patients (23.3%) suffered only from symptomatic AF episodes, while in nine patients (30%) only asymptomatic AF episodes were recorded. Eleven patients (36.7%) had both types of AF episodes (symptomatic and asymptomatic).
Conclusions
The AF recurrence and burden increased in most AF patients during the three-year follow-up period. However, some patients did not suffer any AF recurrence or they presented a decrease in AF burden. Paroxysmal AF clinical profile differs among the AF patients significantly and this indicates that an individualized approach via long-term rhythm monitoring may be of clinical significance, at least in some newly diagnosed AF patients.
P575Usefulness of late gadolinium enhancement cardiac magnetic resonance to predict appropriate therapies in implantable cardioverter defibrillator patients in primary prevention
Authors: Sanchez Somonte P , Zaraket F , Quinto L , Garre P , Alarcon F , Tolosana J M , Guasch E , Arbelo E , Doltra A , Ortiz J M , Borras R , Prat S , Martin Sanchez G , Mont L , Roca Luque I 
Published: June 2020

Abstract

Funding Acknowledgements
No funding acknowledgements

OnBehalf
VT and sudden cardiac death

Background
The scar and the amount of border zone measured by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) has been proposed as an independent predictor of ventricular arrhythmias in patients with ischemic and non-ischemic cardiomyopathy. However, at the present time, the guidelines are based only on the ejection fraction to recommend an implantable cardioverter defibrillator (ICD) in primary prevention, and only a minority of these patients receive appropriate therapies. So, prevention needs to be improved.

Purpose
To identify predictors of appropriate therapies in patients with a primary prevention ICD using cardiac magnetic resonance imaging and a dedicated software (ADAS-3D) to characterize the scar.

Methods
All consecutive patients who underwent a LGE-MR prior to ICD implantation in primary prevention were prospectively included. Clinical and cardiac imaging characteristics were collected. The myocardium was segmented with ADAS-3D software in 10 layers (from endocardium to epicardium). The scar, border zone, core and conducting channels were automatically measured in grams by the software.

Results
Since 2008 to 2017, 206 patients were included. Mean age was 67 +/- 28 years, 80% men, mean ejection fraction 26%+/-9, 52% with ischemic cardiomyopathy and 48% non-ischemic. The primary endpoint was appropriate therapies and/or sudden cardiac death (SCD). Median follow-up was 46,33 months. 46 patients (22%) reached the primary endpoint. Greater scar mass (36,05 grams vs 21,5 grams; HR 1.04; 95% CI (1.03-1-05), p &lt;0.001), core mass (9,8 grams vs 5,6 grams; HR 1.06; 95% CI (1.04-1-09), p &lt;0.001), border zone mass (26,2 grams vs 15,9 grams; HR 1.05; 95% CI (1.04-1-09), p &lt;0.001) and channel mass (3,0 grams vs 1,6 grams; HR 1.15 95% CI (1.06-1.25), p &lt;0.001) were associated with appropriate therapies and SCD. A border zone mass &gt;5.3 grams was independently associated with the primary endpoint (HR: 4.77; 95% CI (1.15-19.73), p = 0.03).

Conclusions
The amount of border zone, core and channel mass measured by LGE-MR and ADAS software are independent predictors of appropriate therapies and SCD in patients with ICD in primary prevention.
Abstract Figure. Scar characterization
P1497Digoxin in patients with advanced heart failure and sinus rhythm - Is there any benefit?
Authors: Lopes J , Fernandes C , Madeira M , Antonio N , Elvas L , Goncalves L 
Published: June 2020

Abstract

Background
Digoxin is one of the oldest drugs used in heart failure treatment. It is recommended in patients in sinus rhythm with still symptomatic heart failure with reduced ejection fraction. However, a controversy regarding digoxin use has risen with recent studies demonstrating an increased mortality and arrhythmias rate in patients taking this drug.

Purpose
The purpose of this study is to assess the prognostic impact of digoxin in patients in sinus rhythm with a CRT device, concerning all-cause mortality, hospitalizations due to acute heart failure and rate of ventricular arrhythmias.

Methods
A cohort of 297 consecutive P with advanced HF, sinus rhythm and a CRT device (80% with defibrillator) implanted between February 2004 and January 2016, in a single centre, was included in this retrospective study.
Patients were divided in two groups regarding digoxin prescription (digoxin (DG) and without digoxin (NDG)). A mean clinical follow-up of 5.3 ± 3.4 years regarding long term outcomes was performed. Cox regression was used to identify independent predictors of outcomes.

Results
Digoxin was prescribed in 104 P (35%). In this cohort 67% of P were males and the mean age was 64 ± 11 years. Patients in DG were younger (60 ± 11 vs 66 ± 10, p &lt; 0.001). The 2 groups had similar prevalence of comorbidities, with exception of chronic kidney disease (GD 27.5% vs GND 33.3%, p = 0.05). The etiology was similar between the 2 groups (42% ischaemic).
In the qui-square analysis, there was a statically significant association between the use of digoxin and mortality (DG 42.3% vs NDG 25.4%, p= 0.003), and also between digoxin and hospitalization with acute heart failure (DG 36.5% vs NDG 21.4%, p = 0.005). There was no association between digoxin use and the occurrence of ventricular tachycardia (DG 31.7% vs 40.1%, p = 0.155).
In the Cox proportional hazards regression, accounting for the potential confounders, the use of digoxin was an independent predictor for all-cause mortality (HR = 2.80, CI 95 [1.07 – 7.31], p = 0.036) and also for hospitalization with acute heart failure (HR = 5.82, CI 95 [1.54 – 22.06], p = 0.010).

Conclusion
The use of digoxin was an independent predictor of all-cause mortality and hospitalizations due to acute heart failure. Randomized trials are needed to clarify the impact of digoxin and determine if it is only an indicator of disease severity and worse prognosis or if the drug has a direct negative influence in the natural history of P with heart failure.
Abstract Figure.
P994Does AF always beget AF? Retrospective study in patients with complex cardiac devices
Authors: Briosa E Gala A , Pope M , Leo M , Betts T R 
Published: June 2020

Abstract

Introduction
Atrial fibrillation (AF) is conventionally divided in paroxysmal AF (PAF) and persistent AF (PersAF) according to episode duration, with a perceived inevitable progression of the arrhythmia in most patients: "AF begets AF". This dichotomous classification of AF is currently being challenged by continuous monitoring with implantable cardiac monitors and pacemakers which suggest different patterns of AF with considerable variation in AF burden.

Purpose
This study sought to examine the long-term progression of AF burden in patients with complex cardiac devices (implantable cardiac defibrillators [ICD] and cardiac resynchronisation therapy-defibrillators [CRT-D]).

Methods
This retrospective study examined the weekly AF burden in patients with ICDs and CRT-Ds and on remote monitoring between January 2010 and July 2019. All transmissions and electrograms were assessed for the presence of AF lasting more than 6 minutes. The first episode of AF determined was considered follow-up year 0. PersAF was defined as a weekly AF burden of 100%. Medical records were reviewed for baseline characteristics at the time of the first episode of AF and interventions that may affect burden such as direct current cardioversion (DCCV) and catheter ablations.

Results
Of 331 patients on remote monitoring, 106 (32%) had evidence of AF. Of these, 89% were male, age 64 ± 12 years, BMI 30 ± 6 kg/m2, LA diameter 4.5 ± 0.8 cm, 58% had an ICD, 10% had previous AF ablation and 27% had antiarrhythmic medication. Forty-six (43%) had PersAF and 60 (57%) had PAF over a total follow-up of 393 patient years (mean follow-up 4.6. ±2.1). The mean AF burden was 1.2 ± 4.4% in PAF and 66.4 ± 35.3% in PersAF at the end of the first year of follow-up. When compared to year 1, the mean annual AF burden did not increase in the PAF and PersAF groups. Moreover, the PersAF patients had a significant reduction in the mean annual AF burden up to year 7 of follow-up. In year 8, the mean annual AF burden remained below year 1; however, due to a low number of patients (5) it did not reach statistical significance (mean difference 15.1%, p = 0.06) . To further assess individual progression in PersAF patients, the annual AF burden was subdivided in 4 categories (&lt;25%, 25%-50%, 50%-75% and &gt;75%). In 30 (65%) patients it remained unchanged, in 5(11%) it worsened and in 11 (24%) it improved (Figure ). Moreover, 35 (76%) patients reverted to sinus rhythm following their first episode of PersAF (5 following DCCV and 2 after catheter ablation).

Conclusions
In this cohort, the mean AF burden did not increase; in fact, we observed a significant reduction in patients with PersAF despite a low rate of interventions. These findings reinforce the emerging concept of AF as a heterogenous disease with various phenotypes that challenge the current simplistic binary classification.
Abstract Figure