bluuebunny/crossref_metadata_2025_split huggingface dataset:
P5640How to decide to implant an ICD in out-of-hospital cardiac arrest survivors with bad neurological outcome. CPC is an option?
Authors: Baldi E , Savastano S , Buratti S , Rordorf R , Vicentini A , Sanzo A , Petracci B , Demarchi A , Cornara S , Astuti M , Frigerio L , Marioni A , Oltrona Visconti L , De Ferrari G M 
Published: October 2019

Abstract

Background
According to the European Society of Cardiology guidelines secondary prevention ICD implantation is a class I indication only for those patients with an estimated survival >1 year with a good functional status. However, it is not specified how to assess the functional status and its evaluation could be quite difficult in the case of Out-of-Hospital Cardiac Arrest (OHCA) survivors. Cerebral Performance Category (CPC) scale is the most widespread scale to define the neurological and functional outcome, but it is not known if it can be used to guide ICD implantation.

Purpose
To evaluate whether the presence of a bad neurological outcome (CPC >2) in OHCA survivors at discharged could be used as a prognostic index in order to evaluate the implantation of an ICD.

Methods
We considered all the patients enrolled in the Cardiac Arrest Registry of our Province (55ehz746.0583 inhabitants in northern Italy) from the 1 October 2014 to the 31 January 2018 presenting a CPC >2 at discharge. We evaluated the survival and the neurological status variation at 1-year.

Results
In the study period CPR was attempted in 1565 confirmed OHCA (60.2% males, 73.4±15.8 years). Of these, 119 (7.6%) were discharged and 26 of them (21.8%) showed a CPC more than 2 (13 CPC = 3, 11 CPC = 4 and 2 CPC A). 1-year survival of CPC>2 patients was significantly lower than those with a CPC≤2 (46.1% vs 92.5% p<0.001). Only 12/26 patients discharged with a CPC >2 survived at 1 year; a good cerebral performance (CPC 1) was recovered in 2 of them, whilst a moderate cerebral disability (CPC 2) was present in 1 of them. A severe cerebral disability (CPC 3 or 4) persisted in the other 9 patients. The neurological prognosis of patients based on CPC at hospital discharge is presented in Figure 1.
Figure 1

Conclusions
Our results highlight that 1-year survival is quite low in patients with a CPC >2 at discharge and an improvement in cerebral performance occur in a minority of them. The prognosis of the patients was very variable and unpredictable for all the CPC scale values at hospital discharge. This evidence suggest that an ICD implantation should carefully evaluated in this kind of patients and a clinical and neurological re-evaluation can be reasonable some time after the event to decide if implant an ICD.
P5644Hypoglycemic episodes increase the risk of ventricular arrhythmias and sudden cardiac arrest in patients with type 2 diabetes - a nationwide cohort study
Authors: Hsieh Y C , Liao Y C , Li C H , Lin J C , Weng C J , Lin C C , Lo C P , Huang K C , Huang J L , Lin C H , Wu T J , Sheu W H 
Published: October 2019

Abstract

Background
Hypoglycemic episode (HE) increases the risk of cardiovascular mortality. The impact of HE on the risk of sudden death remains unclear. We hypothesized that HE increases the risks of ventricular arrhythmia (VA) and sudden cardiac arrest (SCA), and that anti-diabetic agents (ADAs) causing hypoglycemia also increase the risks of VA and SCA.

Methods
Patients aged ≥20 years with newly diagnosed diabetes were identified from the Taiwan National Insurance Database. HE was defined as the presentation of hypoglycemic coma or specified/unspecified hypoglycemia. For control group, we included diabetic patients without HE, and they were frequency-matched to the HE group at a 4:1 ratio. The primary outcome was the occurrence of any event of VA (including ventricular tachycardia and fibrillation) and SCA during the defined follow-up periods. Multivariate Cox hazards regression model was used to evaluate the hazard ratio (HR) for VA or SCA.

Results
A total of 54,303 diabetic patients were screened with 1,037 of them in the HE group, and 4,148 in the control group. During a mean follow-up period of 3.3±2.5 years, 29 VA/SCA events had occurred. Compared to the control group, the HE group had a higher incidence of VA/SCA (adjusted HR: 2.42, p=0.04). Diabetic patients medicated with insulin for glycemic control increased the risk of VA/SCA compared to those without insulin (adjusted HR: 3.05, p=0.01).
Kaplan-Meier survival curves

Conclusions
HEs in patients with diabetes increased the risks of VA and SCA compared to those without. Their use of insulin also independently increased the risk of VA/SCA.
P5647Temporal variability of T-wave morphology and risk of sudden cardiac death in patients with coronary artery disease
Authors: Rahola J T , Kiviniemi A M , Ukkola O H , Tulppo M P , Junttila M J , Huikuri H V , Kentta T V , Perkiomaki J S 
Published: October 2019

Abstract

Background
The possible relationship between temporal variability of electrocardiographic spatial heterogeneity of repolarisation and the risk of sudden cardiac death (SCD) in patients with coronary artery disease (CAD) is not completely understood.

Purpose
To investigate the prognostic value of temporal variability of T-wave spatial heterogeneity in SCD in patients with CAD.

Methods
The Innovation to reduce Cardiovascular Complications of Diabetes at the Intersection (ARTEMIS) study population consisted of 1,946 patients with angiographically verified CAD. T-wave morphology dispersion (TMD), which estimates the average angle between all reconstruction vector pairs in T-wave loop based on leads I-II and V2-V6, was analysed on beat-to-beat basis from 10 minutes period of the baseline electrocardiographic recording in 1,678 study subjects. The temporal variability of TMD was evaluated by standard deviation of TMD (TMD-SD).

Results
After on average of 7.4±2.0 years of follow-up, a total of 47 of the 1,678 study subjects (2.8%) had experienced SCD or were resuscitated from sudden cardiac arrest (SCA). TMD-SD was significantly higher in patients who had experienced SCD/SCA compared with those who remained alive (3.64±2.57 vs. 2.65±2.54, p<0.01, respectively), but did not differ significantly between the patients who had experienced non-sudden cardiac death (n=40, 2.4%) and those who remained alive (2.98±2.43 vs. 2.67±2.55, p=0.45, respectively) or between the patients who succumbed to non-cardiac death (n=88, 5,2%) and those who stayed alive (2.74±2.44 vs. 2.67±2.55, p=0.81). After adjustments with relevant clinical risk indicators of SCD/SCA, such as left ventricular ejection fraction, diabetes, left bundle branch block and Canadian Cardiac Society class, TMD-SD still predicted SCD/SCA (HR 1.113, 95% CIs 1.028–1.206, p<0.01). The discrimination and reclassification accuracy increased significantly (p=0.02, p=0.033) and the C-index increased from 0.733 to 0.741 when TMD-SD was added to the clinical risk model of SCD/SCA. The Kaplan-Meier survival curves show proportional probabilities of event-free survival for different modes of death for patients classified according to the optimised TMD-SD cut-off point (Figure).
Figure 1

Conclusions
Temporal variability of electrocardiographic spatial heterogeneity of repolarisation represented by TMD-SD independently predicts long-term risk of SCD/SCA in patients with CAD.

Acknowledgement/Funding
Sigrid Juselius Foundation and Finnish Foundation for Cardiovascular Research
P5649Impact of atrial fibrillation detected by implantable cardioverter-defibrillators on future stroke events in patients with heart failure
Authors: Nakano M , Kondo Y , Nakano M , Kajiyama T , Hayashi T , Ito R , Takahira H , Kobayashi Y 
Published: October 2019

Abstract

Background
Atrial fibrillation (AF) is the most common type of arrhythmia. AF-related stroke tends to be more severe, and the mortality rate is higher compared with stroke without AF. The definition of AF in patients with implanted cardioverter-defibrillators (ICDs) is not clear and the appropriate treatment guideline for patients with AF episode has not established yet. Recent ICDs have led to an improvement in the early detection of AF episodes, especially in patients who are asymptomatic. Previous studies showed that atrial high-rate episodes (AHREs) detected by cardiac implantable electronic devices are associated with embolic stroke events. However, little is known about the incidence of AF and stroke events in Japanese heart failure patients with an ICD.

Objective
The purpose of this study was to identify the incidence of embolic stroke events in heart failure patients with and without AF events detected by ICDs and examine the risk factors of embolic stroke events.

Methods
We retrospectively analyzed the database of our hospital. Every 6 months, AF events were checked by ICDs. AF30 was defined as AF episodes lasting for ≥30 seconds detected by ICDs. We examined the characteristics and incidence of embolic stroke events and investigated the relationship between AF30 and the incidence of embolic stroke events.

Results
We enrolled 215 consecutive patients who had no prior AF and took no anticoagulant in this study (follow-up period, 58±35 months; age, 62±15 years; male sex, 75%). The mean CHADS2 score and CHA2DS2-VASc score were 2.4±0.8 points and 3.8±1.2 points, respectively. The mean HAS-BLED score was 2.1±1.0 points. During the follow-up, 14 of 215 patients (6.5%) had embolic stroke events. Nine patients (5.8%/year) and 5 patients (0.65%/year) had embolic stroke events with and without AF30, respectively. The comparison of characteristics among patients with and without embolic stroke events was shown in Table. In multivariate logistic regression analysis, independent predictors for embolic stroke events were new-onset episode of AF30 (odd ratio [OR] 21, 95% confidence interval [CI] 4.8–120, P<0.0001) and an enlarged left atrium ≥40mm (OR 14, 95% CI 2.2–304, P=0.0029).

Conclusions
Embolic stroke events were common in Japanese heart failure patients with an ICD. AF30 and enlarged left atrium were the risk factors of embolic stroke events in this population. Therefore, when physicians detect new-onset AF in patients with an ICD, they should consider a comprehensive assessment of the risk and benefit of prescribing an anticoagulant.
P5669Clinical management of syncope patients guided by insertable cardiac monitors in Europe
Authors: Moyson W , Verma A , Natale A , Amin A , Beinart S , Kasner S , Diener H.-C , Cerkvenik J , Mittal S 
Published: October 2019

Abstract

Introduction
Current European guidelines recommend the use of insertable cardiac monitors (ICMs) in the early phase of evaluation for patients with recurrent, unexplained syncope and a likelihood of recurrence during the device battery life. The ongoing Reveal LINQ Registry collects real-world data on clinical actions guided by the insertable cardiac monitor (ICM) in these patients.

Purpose
To characterize ICM-guided diagnosis and treatment of syncope patients in Europe.

Methods
The Reveal LINQ Registry is a prospective, observational, multi-center study evaluating real-world performance of the ICM. Patients from European centres who had syncope indicated as the reason for ICM implant were included in the analysis. Kaplan-Meier methods were used to determine the percentage of patients receiving treatment.

Results
In total, 139 patients from 12 centres [Portugal (78); The Netherlands (30); Belgium (12); Italy (10); Germany (5); United Kingdom (4)] received an ICM to monitor for unexplained syncope and had at least one follow-up visit. The mean age was 61.2 and 51.1% were female. During a mean follow-up time of 11.2 months, 31 patients experienced at least one recurrent syncope event classified as: cardiac (9), vasovagal (4), idiopathic (8) and unknown (10). An arrhythmia was diagnosed in 14 (45.2%) patients with a recurrent event and clinical actions were taken in 12 (38.7%) patients (10 IPGs, and 2 AF ablations). Among patients without a recurrence, 25 (23.1%) had an arrhythmia diagnosed and 20 (18.5%) had a clinical action taken (13 therapeutic device implants, 4 ablations, and 3 medication changes). Overall, the rate of clinical actions was 32.6% after 18 months of ICM follow-up in the unexplained syncope population (Figure).
Time to treatment

Conclusion
Clinical actions are taken in approximately one third of unexplained syncope patients monitored with an ICM after 18 months of follow up.

Acknowledgement/Funding
Medtronic
P5677Ictal asystole and bradycardia patients with epilepsy
Authors: Teryan R A , Serdyuk S E , Davtyan K V , Drapkina O M 
Published: October 2019

Abstract

Background
Events of ictal bradycardia or asystole may be of importance in epilepsy patients showing with ictal falls and are a funder to SUDEP. With using implantable loop recorders, we can detect ictal bradycardia or asystole. And implantation of cardiac pacemakers may prevent life-threatening syncope, cardiac arrest, and disturbances.

Purpose
The purpose of this study is to look at how many ictal bradycardia or asystole and match with localization, types of seizure and antiepileptic drugs in a patient with hard to treat epilepsy.

Methods
Patients with hard to treat epilepsy were implanted loop recorders. Patients or their relations were activated loop recorder (with a special patient assistant) during or after seizure depending on the type of seizure.

Results
204 patients included in the study. The mean duration of loop recording 24 months. 1168 ECG seizure were reordered of 204 patients, 494 (42%) secondary generalized seizures and 674 (58%) partial seizures. Nine patients (4%) were recorded ictal bradycardia and ictal asystole. Only four patients with ictal asystole and bradycardia take AED (antiepileptic drug) inhibit sodium channels. During seizure were recorded only 14 (1, 1%) seizure with ictal asystole and bradycardia of nine patients, 6 (42%) – with ictal asystole (5 – SA-block, 1 – AV-block), 8 (57%) – ictal bradycardia. Ten (71%) events of 14 was secondary generalized seizures, 4 (28%) - partial seizures. Five ictal asystoles recorded during secondarily generalized seizures, and only 1 partial seizure. Five ictal bradycardias reordered during secondarily generalized seizures, 3 - partial seizure. Frontal-temporal localization only 4 patients, 1 – occipital-frontal, 1 – frontal, 3 – without consistent epilepsy localization. Three patients with bilateral lateralization, 2 – left lateralization, 1 – right lateralization, 3 – without consistent epilepsy lateralization.

Conclusions
Ictal asystole can be problematic to diagnose because of both its under-recognition and its appearance only during seizures. In this study, we showed the most life-threatening events occurred in patients with the secondarily generalized seizures. Bradyarrhythmias can one of possible sudden unexplained death in epilepsy patients (SUDEP). No clear association was seen between ictal bradycardia/asystole and lateralization or localization of seizure onset.
P5684Left ventricular wall thickness measured with computed tomography stratifies the response to cardiac resynchronization therapy in patients with non-ischemic cardiomyopathy
Authors: Galand V , Ghoshhajra B G , Szymonifka J , Das S , Orencole M , Leclercq C , Truong Q A , Singh J P 
Published: October 2019

Abstract

Background
Cardiac resynchronization therapy (CRT) has provided benefit in selected heart failure (HF) patients. Unfortunately, up to 30% of device recipients do not benefit clinically from CRT. Left ventricular (LV) wall geometry analyzed using computed tomography (CT) has not been evaluated in the response to CRT. The objective of this study was to examine the association of LV wall thickness (WT) and the ability for reverse LV remodeling after CRT in non ischemic cardiomyopathy (NICM) patients.

Methods
In this prospective study, a total 54 patients (33 NICM) scheduled for CRT, underwent pre procedural CT. Reduced LV WT was defined as WT≤6mm and was quantified as a percentage of total LV area. End points were 6-month clinical and echocardiographic response to CRT (NYHA functional class, LV ejection fraction (LVEF), LV end-diastolic volume (LVEDV) and LV end-systolic volume (LVEDV)) and 2-year major adverse cardiac events (MACE). Of note, positive reduction was defined as in reduction LVESV and LVEDV by ≥15% and ≥10% respectively and ≥5% absolute increase in LVEF.

Results
The 33 NICM enrolled patients were divided in 3 groups according to the percentage of LV WT<6mm area: ≤20% (low LV WT area); 20–50% (moderate LV WT area) and ≥50% (high LV WT area). At 6 months, 78%, 67% and 25% of the patients experienced NYHA class improvement by ≥1 in the ≤20%, 20–50% and ≥50% group respectively. Furthermore, majority of patients in the ≤20% and 20–50% groups (92% and 75% respectively) had a significant improvement of their global assessment compared to only 38% in the ≥50% group. Additionally, low LV WT area group presented a significant LVEF, LVEDV and LVESV positive response rate (92%, 69% and 85% respectively). Patients included in the moderate and high groups exhibited gradually lower LVEF, LVEDV and LVESV positive response rate (42% and 50%; 67% and 50%; 75% and 50%, respectively). Notably, patients with the least LV WT (i.e ≥50% group) experienced significantly lower 2-years MACE survival free probability than other groups.
Left ventriculat segmentation

Conclusion
LV WT evaluated using CT could help to stratify the response to CRT in NICM patients.
P5686Role of internal stretch fraction parameter in quantification of mechanical dyssynchrony and prediction of cardiac resynchronization therapy outcome
Authors: Riedlbauchova L , Lozek M , Adla T , Suchanek V , Tomis J , Huptych M , Hozman J , Tomek V , Veselka J , Janousek J 
Published: October 2019

Abstract

Background
Dyssynchronous activation of the heart is a prerequisite for cardiac resynchronization (CRT) efficacy. Although the main goal of CRT is to resynchronize ventricular contraction, our abilities to quantify mechanical dyssynchrony are still limited. However, so called “internal stretch fraction” (ISF) might serve as a marker of global discoordination of ventricular contraction.

Methods and aim of the study
Thirty-six CRT candidates and 7 healthy controls underwent MRI scanning. Feature tracking data (in short axis) were analysed using Segment software and cicrumferential strain (S)/ strainrate (SR) was obtained for each of the 16 left-ventricular (LV) segments. ISF was calculated as an extent of stretch (product of number of stretched regions and their mean amount of stretch, integrated over given time period; ie. area under the positive part of the global SR curve) in relation to the extent of shortening (area under the negative part of the global SR curve) in 6 basal LV segments during the ejection time (ET). The onset and end of ejection for ISF calculation were set from the global S curve (obtained by the averaging of S curves in 6 basal LV segments). For flow-derived ISF (FISF) parameter, ET was defined from the MRI-flow through pulmonic and aortic valve (Fig-1). Higher ISF and FISF marks more ineffective ventricular contraction.
Aim of our study was to assess the ability of ISF and FISF to distinguish healthy controls from CRT candidates and to predict CRT responders (↓LVESV>15% after 6 months of CRT).

Results
ISF and FISF were significantly higher in CRT candidates than in healthy controls, greater difference between the two groups exhibited FISF (Fig-2). There were 37% of nonresponders among CRT recipients. Both parameters (ISF and FISF) were higher in future CRT responders. Cut-off value discriminating CRT responders from CRT nonresponders was >0,045 for ISF and >0,174 for FISF, however FISF had higher sensitivity than ISF (Fig-3; sensitivity 71% (ISF) versus 79% (FISF) and specificity 70% for both ISF and FISF).

Conclusion
Internal stretch fraction might be a useful parameter for selection of patients with discoordinated ventricular contraction who might profit from CRT. Higher sensitivity of FISF compared to ISF may be explained by the fact that ET derived from global S curve reflects only part of the ejection phase whereas FISF describes presence of ventricular discoordination in the entire ejection phase.

Acknowledgement/Funding
Supported by Ministry of Health of the Czech Republic, grant nr. 15-31398A. All rights reserved.
P5698What predicts the inefficiency of stellate ganglion block in the treatment of electrical storm?
Authors: Spacek R , Jiravsky O , Hudec M , Fismol J , Sknouril L 
Published: October 2019

Abstract

Introduction
Electrical storm (ES) is an emergent condition which requires a sofisticated approach. Massive sympathetic surge almost always connected with ES precipitates recurrent ventricular arrhythmias. Performing stellate ganglion block (SGB) to alleviate the sympathetic activity on myocardium is becoming a standard of care in many centers. However, there is no clear data to predict in which patients the SGB will be ineffective.

Purpose
To identify predictors of SGB failure in patients with ES.

Methods
We analyzed our case series of SGB – the procedure was performed in 31 patients with ES in our center from March 2017 to December 2018.

Results
Mean left ventricular ejection fraction was 27% (±9%), 74% of patients had ischaemic cardiomyopathy. The most frequent type of arrhythmia was monomorphic ventricular tachycardia (VT), occurring in 71% of patients, followed by polymorphic VT in 13% of cases. After SGB, the burden of ventricular arrhythmias failed to decrease by at least 50% in 10% of cases - these patients were marked as non-responders. Slow monomorphic VT (under 160/min) was observed in all of these patients. On the other hand, fast monomorphic VT or polymorphic VT seemed to respond very well to SGB. We also observed, that patients with ES after acute coronary syndromes were good responders as well. The effect of SGB was not related to age, gender, EF LK or the etiology of cardiomyopathy.

Conclusions
According to our experience, the failure of SGB in the treatment of ES is not frequent. It typically occurs in patients with slow monomorphic VT. It is probable that such arrhythmias are sustained primarily due to the extensive myocardial substrate, and not because of the sympathetic surge. The situation is quite the opposite in patients with fast VT and acute ischemia.