bluuebunny/crossref_metadata_2025_split huggingface dataset:
P974Efficacy of plaque debulking for bifurcated or ostial lesion by directional coronary atherectomy before 2nd generation drug eluting stent (PERFECT2)
Authors: Habara M , Tsuchikane E , Nasu K , Kinoshita Y , Terashima M , Matsubara T , Murata A , Suzuki Y , Kawase Y , Okubo M , Matsuo H , Suzuki T 
Published: October 2019

Abstract

Objectives
We sought to evaluate the efficacy of plaque debulking by directional coronary atherectomy (DCA) before 2nd generation drug-eluting stent (DES) implantation for bifurcated coronary lesions.

Background
Percutaneous coronary intervention (PCI) for bifurcated lesions still remains complex and challenging in terms of restenosis or stent thrombosis regardless of whether simple or complex stenting used.

Methods
Patients with bifurcated lesions were enrolled in this prospective multicenter registry. Pre-2nd generation DES plaque debulking with a novel DCA was conducted. All patients were scheduled to perform a follow up (9–12 months) angiography (coronary angiography or coronary computed tomography). The primary end point was the target vessel failure (TVF) at follow-up. Secondary end points were procedure-related events and major adverse cardiac events at 1 year.

Results
A total of 77 patients with bifurcated lesions were enrolled. PCI with DCA was performed successfully in all without any major procedure-related event and only 1 case needed complex stenting. TVF rate at 9–12 months follow up was 3.9% (3 of 77) and those were all associated with revascularization of the target vessel. Restenosis was only observed at ostial of main-branch in 3cases. No death, no coronary artery bypass grafting, and no myocardial infarction were reported in the patients within the first year.
Figure1

Conclusion
DCA before 2nd generation DES implantation can possibly avoid complex stenting and provide a good mid-term outcome in patients with bifurcated lesions.

Acknowledgement/Funding
None
P975Safety and clinical outcomes of rotational atherectomy: an eleven-year centre experience
Authors: Pereira A R , Cale R , Santos P , Almeida A R , Marques A , Alegria S , Briosa A , Sebaiti D , Vitorino S , Pereira E , Martins C , Pereira H 
Published: October 2019

Abstract

Introduction
Rotational atherectomy (RA) is an adjunctive tool for the management of heavily calcified coronary lesions during percutaneous coronary intervention (PCI), but the clinical outcomes remain unclear. Access site choice is also poorly defined and there is growing evidence that transradial approach (TRA) is associated with lower complications and lower mortality.

Objectives
To assess the safety and long-term outcomes of RA for calcified coronary lesions and to investigate the influence of vascular access site in the efficacy and safety of the procedure.

Methods
Retrospective single-centre study that included consecutive PCI with RA performed from January 2006 to December 2017. Endpoint was a composite of major adverse cardiac events (MACE), defined as cardiovascular death, nonfatal myocardial infarction, nonfatal stroke and target vessel revascularization, at 1- and 5-year.

Results
246 procedures were included in a total of 236 patients (pts): mean age 70.1±9.7 years, 73.6% male; 36.2% had previous PCI, 12.2% vascular peripheral disease (VPD), 24% reduced left ventricle ejection fraction (LVEF) and 6.9% were under hemodialysis. PCI with RA was mostly performed due to stable angina (48.9%) and via TRA (55.3%), with a total of 371 treated segments and a median number of 1 vessel treated per intervention. The left anterior descending artery was the most frequently treated artery (67.5%). Single burr was used in 76% of cases (mean number of burrs 1.23; mean burr size 1.5 mm). Procedural success rate was 94.7%. Complications were recorded in 9.3%, with no procedure related death. Clinical follow-up was complete in 98.8% of pts at 1-year and 81.3% at 5-year (mean time 62.3±41.8 months). Survival free of MACE at 1- and 5-year were 83.7% and 73.2%, respectively. Multivariate Cox regression identified 6 independent predictors (only 1 protector) for 1-year MACE (Fig. A) and 6 independent predictors (all of increased risk) for 5-year MACE (Fig. B). TRA was protector of 1-year MACE and Kaplan-Meier curves showed benefit for both 1- and 5-year MACE occurrence (Fig. C and D), without significant difference in procedural success (p=0.92) and complications (p=0.45) rate comparing to transfemoral approach.

Conclusions
RA followed by stenting was a safe procedure with a high immediate success rate but an increased number of long-term cardiovascular events. Some clinical conditions, such as previous PCI, VPD and reduced LVEF, seems to adversely influence the long-term outcome while TRA appears to be protective.
P1004Diagnosis and management of fetal cardiac arrhythmias: about 100 cases
Authors: Messaoudi Y , Msaad H , Hakim K , Ouarda F 
Published: October 2019

Abstract

Background
Fetal cardiac arrhythmia complicates 1–2% of pregnancies and presents a major risk of morbidity and mortality in 10% of the cases. Different questions raised by this pathology must be asked: Is it necessary to treat the rhythm disorder? What are the risks of an anti-arrhythmic treatment for the fetus and its mother? In case of failure, should the fetus be extracted at the cost of prematurity, or must the therapeutic escalation be attempted?

Purpose
To emphasize the primordial role of fetal echocardiography in the diagnosis and management of fetal cardiac arrhythmias through our own experience and a review of the literature.

Methods
We present a series of 100 cases of fetal rhythm disorders diagnosed and treated in our department of pediatric cardiology during the last 12 years.

Results
The diagnosis was made at an average gestational age of 30 weeks of amenorrhoea. Extra-systoles were by far the most frequent (50 cases), followed by hetero-topic tachycardia (28 cases) and complete atrio-ventricular blocks (22 cases). We have excluded bradycardia and sinus tachycardia from our study. Our attitude regarding extra-systoles was mostly a simple surveillance and the total post natal disappearance was the rule. The tachycardias were distributed as follows: 9 flutters, 16 junctional tachycardias and 3 chaotic atrial tachycardias. 10 patients were in feto-placental anasarca. The medical treatment resulted in a reduction of the in utero tachycardia in 14 cases, 9 were only post natally reduced and 6 died. Mono-therapy was the rule and dual therapy was indicated in case of resistance to medical treatment or in front of a table of foeto-placental anasarch. With a mean follow-up of 2 years, there was no recurrence. A complete atrio-ventricular block was diagnosed in 22 fetuses at an average gestational age of 26 amenorrhea weeks. 4 patients had associated heart disease. The ventricular rate varied from 35 to 70 beats per minute. 7 fetuses were in heart failure. An immunoassay was positive in 10 mothers. At birth, the presence of antibodies against SSA and/or SSB was detected in 8 newborns.15 patients were stimulated epicardially, including the neonatal period. Six patients died.

Conclusion
We conclude that if the prognosis of fetal tachycardia is generally satisfactory, the atrio-ventricular blocks are more reserved because the conduction disorder is irreversible, and even in the absence of associated congenital cardiopathy, complications related to Stimulation in the newborn doesn't remain risk-free.
P1008Increased incidence of supraventricular tachycardia during high influenza activity
Authors: Safavi Naeini P , Rasekh A , Razavi M , Madjid M 
Published: October 2019

Abstract

Background/Introduction
Influenza remains a major risk to human health, estimated to result in 290,000 to 650,000 annual deaths worldwide. The association of influenza with coronary events is well established but influenza's impact on cardiac arrhythmias has received less attention.

Purpose
We investigated the effect of influenza on triggering supraventricular tachycardia (SVT).

Methods
This retrospective observational study included de-identified data from patients who had a Zio patch continuous cardiac monitoring from October 2012 to September 2017. The “influenza activity” was defined as the percentage of positive respiratory specimens that tested for influenza virus during each influenza season per reports from the Centers for Disease Control and Prevention. We included all SVT events from the weeks with the highest and lowest influenza activity up to two consecutive weeks after them. A paired t-test was used to compare the incidence of SVT episodes in weeks with the highest and lowest influenza activity.

Results
We reviewed records of 825869 patients (mean age, 61.06±15.31 years; 48.75% male); of these patients, 49984 had Zio patch during highest and lowest influenza activity time frame. The overall average episodes of SVT per person was 25% higher in the highest influenzas activity period comparing to the lowest activity (59.05 vs 47.26) and the higher incidence of SVT episodes in the highest influenza activity was significant (P value <0.01). A similar significant trend was observed during each individual influenza season.
Figure 1. average number of SVT episodes

Conclusion
High seasonal influenza activity is associated with increased odds of supraventricular tachycardia. Prospective studies are needed to determine the clinical implications of this finding.
P1013Biannular atrial flutter: clinical and electrophysiological characterization by activation and entrainment
Authors: Martinez Cossiani M , Castrejon S , Escobar C , Ortega M , Batlle M , Gonzalez Davia R , Gutierrez Larraya F , Lopez-Sendon J L , Merino J L 
Published: October 2019

Abstract

Introduction
re-entry mechanisms around mitral and tricuspid annuli are frequent causes of left and right atrial flutter (AFt) respectively in patients with ipsilateral atrial pathology. However, clinical and electrophysiological characteristics of other types of atrial re-entries that could involve both AV annuli are less known.

Purpose
characterize biannular atrial flutters.

Methods
4 patients with AFt were submitted for ablation (aged 30, 31, 58 and 61 yo; 2 females). All had a cardiac congenital disease with a prior surgical procedure: 3 atrial septal defects (ASD) with surgical repair and 1 with transposition of the great arteries (TGA) with Senning repair. The AFt had a cycle length (CL) of 290, 315, 330 y 340 ms respectively and 1:1 AV conduction in 3 of them. For the electrophysiological study, a multipolar catheter (20 or 24 poles) was placed in the right atrium (RA) in every patient, showing counterclockwise and clockwise activation in 1 and 3 patients, respectively. Coronary sinus (CS) activation was proximal to distal in one patient and distal to proximal in the other 2. No CS activation could be obtained in the patient with Senning repair.

Results
each AFt was mapped by entrainment from different sites of the RA, showing post-pacing intervals (PPI) similar to the CL of the AFt around the tricuspid annulus in all of them and also from proximal and distal CS in the 3 patients with ASD. Access to the native left atrium (LA) was achieved in the patient with Senning repair, showing PPIs around the mitral annulus that were similar to the LC of the tachycardia. In 2 patients the attempt to get to the LA through the interatrial septum (IAS) could not be achieved and was unattempted in the other one. Recordings and PPIs of the LA roof were obtained from the right branch of the pulmonary artery in 2 patients. Counterclockwise AFt and clockwise AFt by single biannular perimitrotricuspid rotation in 1 and 3 patients respectively. The AFt was ended and no reinduction was possible after radiofrequency application that achieved cavotricuspid isthmus block in all of the patients.

Conclusions
reentry around both AV annuli is possible as a single loop, counterclockwise or clockwise, of simultaneous rotation as a clinical mechanism of Aft. This type of AFt seems to be associated to absence or severe damage in the IAS.
P1016Novel surgical ablation technique using ultrasonic scalpel for atrial fibrillation in mitral valve surgery
Authors: Tsukui H , Fujita K , Iwasa S , Yamazaki K 
Published: October 2019

Abstract

Objective
Radiofrequency, cryoablation and cut-and-sew technique have been used for surgical ablation to treat atrial fibrillation. Ultrasonicscalpel is a surgical instrument used to simultaneously cut and cauterize tissue by ultrasound vibration. This device causes minimal lateral thermal tissue damage and increases the tissue penetration depth linearly with time. These features are suitable for surgical ablation for atrial fibrillation. This study evaluated surgical ablation with ultrasonic scalpel for atrial fibrillation.

Methods
From October 2017 to February 2019, 46 patients (mean age: 71.8 years [46–86], 28 male) with mitral valve procedure underwent surgical ablation using ultrasonic scalpel for atrial fibrillation. The ablation lines were carried out with Cox maze procedure or pulmonary vein isolation (PVI) on cardiopulmonary bypass. Endocardial atrial wall was ablated by direct touch with blade in a few seconds at energy level 5. Pathological study of left atrial wall received ablation with ultrasonic scalpel was carried out.

Results
Type of preoperative atrial fibrillation was persistent in 33 and paroxysmal in 13 patients. Mean left atrial diameter was 49.0 mm (35–81). Surgical ablation using ultrasonic scalpel was carried out to left atrium only or PVI in 33 patients and both atria in 13 patients. Mean surgical ablation time was 4 minutes and 21 seconds. Mitral valve repair and replacement were performed in 33 and replacement in 13 patients, respectively. Simultaneous surgery included 43 tricuspid valve repairs, 11 aortic valve replacements, and 7 coronary artery bypass grafting. Cardiopulmonary bypass and aortic cross-clamp times were 142.6 (70–261) and 98.6 (47–202) minutes, respectively. No operative death or perioperative stroke were observed. Thirty-eight patients (82.6%) returned to sinus rhythm immediately after surgery. Sinus rhythm was maintained in 30 patients (65.2%) in the mid-term period with average 142.2 days after surgery (7–426 days). Pathological study showed the atrial walls were not ablated transmurally. No complications including bleeding and tissue injury were observed.

Conclusion
Surgical ablation with ultrasonic scalpel for atrial fibrillation was feasible and provided satisfactory outcomes immediately after surgery and at mid-term. This technique can be performed in a short time without complications. Interestingly, pathological study showed no transmural tissue ablation despite of successful outcomes. This may imply transmural ablation is not necessarily mandatory for surgical ablation. Long-term follow-up are required to evaluate this technique.
P1021Comparative efficacy of microfidelity technology vs standard ablation for atrioventricular nodal ablation
Authors: Levine J L , Xiang K , Su J , Hsu S , Kim R J , Elayi S , Catanzaro J N 
Published: October 2019

Abstract

Background
Microfidelity Cateter Technology has proven efficacy in ablating atrial arrhythmias in multiple pilot studies. Closely spaced radial microelectrodes render a focused near-field electrogram. Case series suggest that this catheter design facilitates accurate ablations with fewer radiofrequency (RF) lesions. Atrioventricular junction (AVJ) ablation is regarded as a straightforward procedure, but case records show wide variance in procedure times and number of RF lesions required.

Methods
Twenty-four patients scheduled for AVJ ablation were randomized to treatment with either the Microfidelity technology or standard 8mm/8 French ablation catheter. Both groups located the AVJ by fluoroscopic landmarks and His electrograms, and the MiFi group used electroanatomical mapping to create the location of his electrograms. The primary endpoints were development of Junctional Rhythm (JR) or Complete Heart Block (CHB), and time from first RF lesion until rhythm change. Secondary endpoints included number of RF applications.

Results
Patients were randomized one-to-one to the MiFi arm or standard ablation arm. JR or CHB was achieved in all patients. Time from first RF lesion until JR/CHB was: (Median/IQR) 325 sec/250–1270 sec. vs 287 sec/101–406 sec. Number of RF applications was 5/3–15 applications vs 4.5/1–5 applications. Total procedure time in the lab was 134 min/73.5–172.5 min vs 58 min/52–146 min.
Microfidelity Technology vs Standard

Conclusion
Analysis suggests that the MiFi catheter is efficacious in ablating the AVJ, but requires greater RF duration and number of lesions, with wider case-by-case variability to achieve JR or CHB. Microfidelity technology and electroanatomical mapping did not result in faster time to completion than using fluoroscopic landmarks and His electrograms alone. Preoperative choice of sheath for catheter stability and contact may also play a role in a more efficient timely successful ablation of the AV node.

Acknowledgement/Funding
Boston Scientific
P1025Clinical predictors for the improvement of left ventricular ejection fraction and prognosis after catheter ablation of atrial fibrillation in patients with systolic dysfunction
Authors: Nagaoka K , Mukai Y , Kawai S , Takase S , Sakamoto K , Inoue S , Ikeda S , Chishaki A , Tsutsui H 
Published: October 2019

Abstract

Background
Catheter ablation (CA) of atrial fibrillation (AF) improves left ventricular ejection fraction (LVEF) and clinical outcomes in patients with left ventricular systolic dysfunction (LVSD). However, predictors of the improvement of LV function and clinical outcomes by CA were poorly understood.

Purpose
We examined the efficacy of CA in AF patients with LVSD and predictive factors associated with clinical outcomes.

Method
Among consecutive 795 patients undergone initial RFCA at our hospital, we studied 51 patients with LVSD (LVEF ≤50%). Improved LVEF more then 5% at 1-year after CA was classified as “responder” to CA. We analyzed clinical variables and echocardiographic parameters before and after the CAs.

Results
In the responder group, LVEF was significantly improved 1-year after catheter ablation compared with the non-responder group. (ΔLVEF 22±12% vs. −1±4%, p<0.001). The responder group was significantly younger, had more non-paroxysmal AF, smaller LV systolic diameter and lower plasma BNP level before CA (Table). Late gadolinium enhancement (LGE)-positive rate in cardiovascular magnetic resonance imaging (CMR) before CA was higher in the non-responder group than in the responder group (100% [6/6] vs. 38% [5/13], p<0.005). After CAs of AF, event-free survival from hospitalization for heart failure was significantly higher in the responder group (Figure) with less AF recurrence (27% vs. 47%, p=0.04) than in the non-responder group.
Baseline characteristics Responder (N=35) Non-Responder (N=16) P value Age, y 62±11 69±8 p<0.01 Male, n (%) 26 (74) 13 (76) NS Non-pAF 26 (74) 4 (24) p<0.01 LAD, mm 48±7 48±8 NS LAVI, ml/m2 54±17 58±20 NS LVDd, mm 54±7 58±10 NS LVDs, mm 43±7 48±10 p=0.05 EF, % 37±8 38±8 NS BNP (pg/ml) 278±225 684±848 p<0.05

Conclusion
Younger age, absence of LV dilatation, lower plasma BNP, or absence of LGE may well predict favorable clinical outcomes after CA in patients with LVSD.
1136Prognostic impact of mineralocorticoid receptor antagonists in patients hospitalized for acute heart failure
Authors: Yaku H , Kato T , Morimoto T , Inuzuka Y , Tamaki Y , Yamamoto E , Yoshikawa Y , Ozasa N , Kuwahara K , Kimura T 
Published: October 2019

Abstract

Background
The favourable effect of mineralocorticoid receptor antagonists (MRAs) on mortality was established in patients with stable heart failure (HF) with reduced ejection fraction (EF). However, its prognostic effect of MRAs in acute decompensated heart failure (ADHF) including HF with preserved EF (HFpEF) was unclear.

Purpose
This study sought to investigate the long-term impact of MRA on the post-discharge outcomes in patients with ADHF.

Methods
From the consecutive 3717 patients hospitalized for ADHF and discharged alive in the KCHF registry, we developed the propensity score (PS) for MRA use and constructed the PS-matched cohort. We compared the effect of MRA use on the primary outcome measure of all-cause death or HF hospitalization.

Results
A total of 1678 patients (45%) received MRA at discharge from the index hospitalization. Median follow-up was 470 days with 96% 1-year follow-up rate. In the PS-matched cohort (N=1034 in each group), the cumulative 1-year incidence of the primary outcome measure was significantly lower in the MRA group than in the no MRA group (28.4% vs. 33.9%, P=0.003) (Figure 1). The cumulative 1-year incidence of HF hospitalization was significantly lower in the MRA group than in the no MRA group (18.7% vs. 24.8%, P<0.001), while there was no difference in mortality between the 2 groups (15.6% vs. 15.8%, P=0.85). There was no interaction between the effect of MRA and the 3 subgroups stratified by EF (EF <40%, EF 40–49%, EF ≥50%) (interaction P=0.12).
Figure 1

Conclusion
The use of MRA was associated with lower risk for the primary composite outcome of all-cause death or HF hospitalization in patients hospitalized for ADHF including HFpEF, which was mainly driven by the lower risk for HF hospitalization.
1137A life support based comprehensive treatment regimen dramatically lowers the in-hospital mortality of patients with fulminant myocarditis —- a multiple center study
Authors: Chen C , Li S , Cui G L , Zhou N , Jiang J G , Wang D W 
Published: October 2019

Abstract

Background
Fulminant myocarditis (FM) is characterized by rapid onset and progression to cardiac and circulatory failure. It has high mortality; however, patients may benefit from short-term circulatory support. This study evaluated the therapeutic efficacy of a life support–based comprehensive treatment regimen (LSBCTR) for FM and demonstrated that it saved the lives of FM patients.

Methods
One hundred and fourteen FM patients were recruited from January 2007 to October 2017 were divided into two groups: those who received LSBCTR (65 cases), including management of fluids and nutrients, use of antiviral drugs and large doses of glucocorticoids (methylprednisolone over 200 mg) and immunoglobulins, continuous renal replacement therapy (CRRT), and life support (artificial positive pressure respiration, intra-aortic balloon pump [IABP] with or without extracorporeal membrane oxygenation [ECMO]), and those who received traditional methods (74 cases). The primary endpoints were in-hospital death and length of hospital stay for survivors.

Results
Of the population, 41 patients (36.0%) died in the hospital. In-hospital mortality rates were 3.0% (2/65) for the LSBCTR group and 52.7% (39/74) for the traditional treatment group (P<0.001). Early life support (IABP with or without ECMO and a respirator) and early applications of CRRT, antiviral therapy, and sufficient doses of glucocorticoids and immunoglobulins individually contribute to the efficiency of reducing in-hospital mortality. Vasoactive agents did not improve prognosis, especially noradrenaline, which dramatically increased the incidence of death.

Conclusion
Our data described comprehensive treatment for patients with FM that can dramatically reduce in-hospital mortality. Its generalization and application in clinical practice will efficiently save lives.
Clinical Trial: NCT03268642.