bluuebunny/crossref_metadata_2025_split huggingface dataset:
P526Are 40 joules enough for successfully defibrillate with subcutaneous implantable cardioverter-defirbrillator?
Authors: Biffi M , Bianchi V , Ziacchi M , Palmisano P , Pieragnoli P , Manzo M , Ottaviano L , Piro A , Nigro G , Bonfantino M V , Perego G B , Rapacciuolo A , Caroli E , Lovecchio M , Viani S 
Published: June 2020

Abstract

Funding Acknowledgements
NO FUNDING

OnBehalf
Rhythm Detect Registry

Background
The subcutaneous ICD (S-ICD) is an effective alternative to the traditional transvenous option. Due to its extracardiac design the S-ICD requires a higher shock output than the traditional ICD. Nonetheless, preliminary data suggest that acute defibrillation test may be successful even at energies lower than the usually tested value of 65J, and that optimization of implantation technique may increase the defibrillation safety margin among S-ICD recipients.

Purpose
To evaluate the efficacy of conversion test performed at 40J, and to investigate the association between shock efficacy, clinical characteristics and device position.

Methods
VF was induced and subsequently, conversion test was performed by delivering a 40J shock. Success was defined as termination of VF by the first shock. S-ICD system positioning was evaluated with the PRAETORIAN score using bidirectional chest X-rays. Cranial-caudal S-ICD placement was defined as superior if the entire generator was contained in the cardiac silhouette, inferior if partially or completely outside.

Results
233 consecutive patients (83% male, 49 ± 14 years, BMI 26 ± 4kg/m2, ejection fraction 46 ± 17%, 112 (48%) ischemic/non-ischemic dilated cardiomyopathy) were enrolled and underwent S-ICD implantation with conversion test at 40J. The generator was positioned in an intermuscular pocket in 228 patients (98%). The PRAETORIAN score was &lt;90 (low risk of conversion failure) in 218 (94%) patients. Cranial-caudal generator placement was superior in 188 (81%) patients. Overall, VF termination occurred in 191 (82%) patients with 40J. The BMI was similar in patients with successful and unsuccessful termination (26 ± 4kg/m2 versus 27 ± 6kg/m2, p = 0.195). The efficacy was comparable in patients with dilated cardiomyopathy (86%) versus other conditions (79%, p = 0.153). PRAETORIAN score was not associated with shock efficacy at 40J (82% with score &lt;90 versus 87% with score ≥90, p = 1.000), while a trend toward higher efficacy was seen with superior generator placement (84% versus 73%, p = 0.093).

Conclusions
We observed high S-ICD defibrillation success rate at 40J, suggesting that the safety margin is frequently higher than the usually accepted 15J. We found no difference in efficacy according to the cardiac disease and no association between test failure and body habitus. The intermuscular positioning of the generator resulted in low values of the PRAETORIAN score that however did not appear associated with test efficacy.
P1049Influence of body mass index on recurrence in atrial fibrillation patients after radiofrequency catheter ablation
Authors: Calero Nunez S , Hidalgo-Olivares V M , De Leon-Ruiz A , Diaz-Lancha S , Exposito-Calamardo L , Ramos-Martinez R , Garcia-Sacristan J F , Cordoba-Soriano J G , Enero-Navajo J 
Published: June 2020

Abstract

Funding Acknowledgements
No conflicts of interest

INTRODUCTION
Evidence has shown that obesity, expressed as high body mass index (BMI), is associated with the development of atrial fibrillation(AF). However, the relationship between BMI and recurrence of AF after catheter ablation(CA) remains controversial. Understanding this relationship, may help in regard to patient(p) counseling and management before and after CA.

Purpose
To evaluate single center AF recurrences after pulmonary vein isolation according to BMI status. Secondary endpoints were to compare the influence of other comorbilitys such as pulmonar disease or obstructive sleep apnea(OSA)

METHODS
We included 114p with AF(54,5 ± 9,6 years; male 75,4%; paroxysmal 70,2%; persistent 29,8%) treated with first time radiofrequency ablation between 2013 and 2018. On the basis of the baseline BMI, patients were categorized into 2 groups: normal/overweigth (BMI &lt; 30kg/m2) and obese(BMI≥30kg/m2).

RESULTS
There was no significant difference between the majority of baseline characteristics of the groups (table 1), however patients with BMI≥30 were more likely to sufferd OSA(34% vs 8,2%:p = 0,001), to have larger left atrial (diameter &gt; 40mm: 70,5% vs 46,3%;p = 0,004), and persistent AF (43,4% vs 18%; p 0,004). During 12 months of follow-up AF recurred in 34p (29,8%), the freedom from AF was significantly higher in the BMI &lt; 30 group (48p(80%) vs 31(58,5%), p = 0,015). Multivariate analysis including variables of type of AF, OSA, BMI, left atrial size, ejection fraction, and hypertension demonstrated that BMI was the strongest predictor of being freedom from recurrent AF (OR = 0.35, 95% CI: 0,11–0,81, P = 0.014). A serious complication occurred in 6p(5,3%), with no relationship to BMI.

CONCLUSION
This study suggest that tight association between obesity and AF recurrence after ablation may be partly due to other concomitant conditions which in turn are more frequent in obese patients like OSA, left atrial size and presence of persistent AF.
Abstract Table 1
855Performance of a multisensor icd algorithm in heart failure patient management
Authors: Santini L , Bianchi V , Dello Russo A , Calo L , Pecora D , Mahfouz K , Favale S , Petracci B , Costa A , Cipolletta L , De Ruvo E , La Greca C , Mangone G , Campari M , D Onofrio A 
Published: June 2020

Abstract

Funding Acknowledgements
No funding

Background
The HeartLogic index combines data from multiple implantable cardioverter-defibrillator (ICD)-based sensors and has proved to be a sensitive and timely predictor of impending heart failure (HF) decompensation.

Purpose
To describe a multicenter experience of remote HF management of patients who received a HeartLogic-enabled ICD or cardiac resynchronization therapy ICD (CRT-D).

Methods
The HeartLogic feature was activated in 104 patients (76 male, 71 ± 10 years, left ventricular ejection fraction 29 ± 7%). In accordance with a standardized follow-up protocol, remote data reviews and patient phone contacts were performed monthly and at the time of HeartLogic alerts (when the index crossed the nominal threshold value of 16), to assess the patient decompensation status. In-office visits were performed every 6 months or when deemed necessary.

Results
During a median follow-up of 13[11-18] months, 100 HeartLogic alerts were reported (0.82 alerts/pt-year) in 53 patients. 60 HeartLogic alerts were judged clinically meaningful (i.e. associated with worsening of HF or resulted in active clinical actions). Specifically, multiple associated conditions were reported: 45 (75%) symptoms or signs of clinical deterioration of HF, 13 (22%) discontinuations or reductions of prescribed HF therapy, 11 (18%) declines in CRT percentage (with or without new onset atrial fibrillation), 8 (13%) recurrences of previous HF events. For 48 out of 60 alerts the clinician was not previously aware of the condition. Of these, 43 alerts triggered multiple clinical actions. Alert-triggered actions were: 30 (70%) diuretic dosage increases, 15 (35%) other drug adjustments, 6 (14%) HF hospitalizations, 3 (7%) device reprogramming/revisions, 1 (2%) cardioversion, 1 (2%) patient education on therapy adherence. Out of 40 non-clinically meaningful alerts (0.33 alerts/pt-year), 8 (20%) were associated with non-HF therapy changes or interventions, 3 (8%) with pulmonary events, 29 (72%) remained unexplained. The overall number of HF hospitalizations was 16 (rate 0.13 hospitalizations/pt-year). Five HF hospitalizations were not preceded by HeartLogic alert (0.04 hospitalizations/pt-year).

Conclusions
The HeartLogic index provided clinically meaningful information and allowed to remotely identify relevant HF related clinical conditions, with a low rate of unexplained detections and undetected HF events. In this experience, remote monitoring using HeartLogic alerts allowed to drive HF care and take effective clinical actions.
P1492Comparison of the long-term performance of the quadripolar IS-4 and the bipolar IS-1 left ventricular lead for cardiac resynchronization therapy
Authors: Maurhofer J , Tanner H , Haeberlin A , Noti F , Seiler J , Baldinger S H , Roten L , Lam A , Asatryan B , Nozica N , Franzeck F , Kueffer T , Reichlin T , Servatius H 
Published: June 2020

Abstract

BACKGROUND
The implantation of left ventricular (LV) leads for cardiac resynchronization therapy (CRT) and the management of lead-related complications can be challenging. The introduction of the quadripolar IS-4 LV lead may have facilitated the implantation procedure and may have reduced lead-related complications. Data of long-term follow-up (FU) comparing the IS-4 lead with the IS-1 LV lead are rare and conflicting.

PURPOSE
Comparison of lead-related complications and all-cause mortality between CRT patients who received an IS-4 or an IS-1 LV lead in the long-term FU.

METHODS
Adults with an indication for a CRT-Defibrillator or CRT-Pacemaker, a successful endovascular IS-4 or IS-1 LV lead implantation, and a minimal FU of three years were included in this retrospective study. The combined primary endpoint was freedom from lead-related complications defined as (i) occurrence of persisting high pacing threshold (&gt;2.75V/0.4ms), (ii) unresolved phrenic nerve stimulation, (iii) LV lead dislodgement/disruption, (iv) the necessity of re-interventions affecting the LV lead, and (v) LV lead deactivation/explantation. Secondary endpoints were all singular complications and all-cause mortality.

RESULTS
Eligible for the study were 133 patients (IS-4 n = 66; IS-1 n = 67) with a mean FU of 4.03 ± 1.93 years. Baseline characteristics of both patient groups did not differ significantly. Freedom from lead-related complications was higher in patients with an IS-4 lead as compared to an IS-1 lead (Figure 1; 87.9% vs. 65.7%; p = 0.002). The secondary outcomes showed a higher rate of LV lead dislodgement/disruption (4.5% vs. 17.9%; p = 0.015) in the IS-1 patient group and more patients suffered from unresolved phrenic nerve stimulation with an IS-1 lead (3.0% vs. 13.4%; p = 0.029). LV lead deactivation/explantation during FU and LV lead-related re-interventions were fewer in case of an IS-4 lead (4.5% vs 22.4%; p = 0.003; 6.1% vs. 17.9%; p = 0.036, respectively). The rate of persisting high pacing thresholds and all-cause mortality did not differ (4.5% vs. 9.0%; p = 0.492; 22.7% vs 25.4%; p = 0.721, respectively).

CONCLUSION
The quadripolar IS-4 LV lead showed in this retrospective study a better long-term performance than the bipolar IS-1 lead.
Abstract Figure 1
P311Hypertrophic cardiomyopathy and other forms of left ventricular hypertrophy. The P wave can make the difference
Authors: Raab S , Roten L , Branca M , Nozica N , Wilhelm M , De Marchi S , Brugger N , Elchinova E , Seiler J , Asatryan B , Tanner H , Baldinger S H , Lam A , Reichlin T , Servatius H 
Published: June 2020

Abstract

Background
Structural disarray of hypertrophied myocytes and interstitial fibrosis characterize hypertrophic cardiomyopathy (HCM). These morphological changes also affect atrial myocytes and, together with hemodynamic alterations because of HCM, may lead to atrial cardiomyopathy.

Purpose
To investigate the incremental value of P-wave parameters to differentiate left ventricular hypertrophy (LVH) because of HCM from LVH in hypertensive heart disease (HHD) and athletes heart.

Methods
In a prospective study, we compared electrocardiographic (including signal-averaged ECG of the P wave) and echocardiographic data of patients with HCM, HHD and athletes heart. We developed a predictive model with a simple scoring system to identify HCM.

Results
We compared data of 27 patients with HCM (70% males, 49.8 ± 14.5 years), 324 patients with HHD (52% males, 74.8 ± 5.5 years), and 215 subjects with athletes heart (72% males, 42.3 ± 7.5). The table shows the significant differences among the 3 groups. We included the following parameters into a predictive score to differentiate HCM from other forms of LVH: QRS width (&gt;88ms = 1 point), P-wave integral (&gt;688µVs = 1 point) and septum thickness (&gt;12mm = 2 points). A score &gt;2 (Youden index 0.626) correctly classified HCM in 81% of the cases with a sensitivity and specificity of 82% an 81%, respectively.
Conclusion Differentiation of HCM from other forms of LVH is improved by including atrial parameters. A simple scoring system including septum thickness, QRS width and P wave integral allowed identification of patients with HCM with a sensitivity and specificity of &gt;80%. This score needs to be validated prospectively.
Table 1 HCM HHD Athletes P-value HCM vs HHD* HCM vs Athletes* 95%-CI P-value 95%-CI P-value P-wave duration [ms] 152.7 ± 25.8 143.9 ± 16.5 133.5 ± 14.2 &lt;0.001 -16.9 -24.6 to -9.1 &lt;0.001 -16.3 -22.7 to -9.9 &lt;0.001 P-wave integral [µVs] 850.4 ± 272.4 672.0 ± 235.4 773.1 ± 260.1 &lt;0.001 -198.6 -320.8 to -76.3 0.002 -68.2 -169.7 to 33.2 0.187 QRS [ms] 110.3 ± 27.3 96.9 ± 20.3 95.1 ± 9.8 &lt;0.001 -16.4 -24.7 to -8.1 &lt;0.001 -13.8 -20.8 to -6.9 &lt;0.001 QTc [ms] 447.9 ± 27.2 438.6 ± 24.5 414.0 ± 22.9 &lt;0.001 -21.1 -32.7 to -9.5 &lt;0.001 -30.8 -40.5 to -21.2 &lt;0.001 LVMMI [g/m2] 153.6 ± 55.5 133.5 ± 30.3 98.6 ± 19.7 &lt;0.001 -15.3 -29.7 to -0.9 0.038 -56.1 -67.7 to -44.6 &lt;0.001 IVS [ms] 16.8 ± 4.2 11.8 ± 2.2 10.3 ± 1.5 &lt;0.001 -5.2 -6.3 to -4.1 &lt;0.001 -6.4 -7.3 to -5.6 &lt;0.001 LAVI [ml/m2] 43.2 ± 13.9 30.5 ± 9.7 30.8 ± 9.5 &lt;0.001 -14.6 -20.0 to -9.3 &lt;0.001 -12.2 -16.6 to -7.9 &lt;0.001 The table shows the study result after univariate and multivariate (*; adjusting for age and sex) analysis.
Abstract Figure 1
P538Single- and Multi-Site Pacing Strategies for Optimal Cardiac Resynchronization Therapy: Impact on Device Longevity and Therapy Cost
Authors: D"onofrio A , Bertini M , Infusino T , D Arienzo G , Misiani A , Bianchi V , Licciardello G , Savarese G , Russo G , Ricciardi D , Manzo M , Santini L , Ospizio R , Valsecchi S , Forleo G B 
Published: June 2020

Abstract

Funding Acknowledgements
No funding

Introduction
Multiple left ventricular pacing strategies have been suggested for improving response to cardiac resynchronization therapy (CRT). However, these programming strategies can be obtained by accepting configurations with high pacing threshold and accelerated battery drain. We assessed the feasibility of predefined pacing programming protocols and we evaluated their impact on device longevity and their cost-impact.

Methods
We estimated battery longevity in 167 CRT-D (RESONATE, Boston Scientific) patients based on measured pacing parameters and according to multiple programming strategies: single-site pacing associated with lowest threshold, non-apical location, longest interventricular delay, pacing from two electrodes. To determine the economic impact of each programming strategy, we applied the results of a published model-based cost analysis to a 15-year time-horizon.

Results
Selecting the electrode with the lowest threshold resulted in a median device longevity of 11.5 years. Non-apical pacing and interventricular delay maximization were feasible in most patients (99% non-apical pacing, 65% RV-to-LV interval &gt;80ms), and were obtained at the price of a few months of battery life. Device longevity of &gt;10 years was preserved in 87% of cases of non-apical pacing and in 77% on pacing at the longest interventricular delay. The mean reduction in battery life when the second electrode was activated was 1.5 years. Single-site pacing strategies increased the therapy cost by 4-6%, and multi-site pacing by 12-13%, in comparison with the best-case scenario.

Conclusions
Modern CRT-D systems ensure effective pacing and allow multiple optimization strategies for maximizing service life or for enhancing effectiveness. Single- or multi-site pacing strategies can be implemented without compromising device service life and at an acceptable increase in therapy cost.
Abstract Figure. Image1
P377Zero-fluoroscopy ablation with ultrasound-guided sheath insertion
Authors: Kawakami T , Saitoh N , Asukai Y , Wada S , Sasaki H , Takahashi H , Hatori K , Itou N , Fukunaga H , Toubaru T 
Published: June 2020

Abstract

Background
Radiation exposure during catheter ablation procedures is a risk for both the patient and electrophysiology staff. Recently, the feasibility and effectiveness of zero-fluoroscopy ablation have been shown. However, ensuring a safe sheath insertion through the venous system toward the heart is a concern in catheter ablation using the zero-fluoroscopy technique.

Purpose
The objective of this study was to confirm feasibility and safety for zero-fluoroscopy ablation using ultrasound-guided sheath insertion.

Methods
Zero-fluoroscopy catheter ablation was performed in 220 patients (185 patients with atrial fibrillation (AF), 26 patients with supraventricular tachycardia (SVT), and nine patients with ventricular arrhythmias (VA)) using a 3-dimensional electro-anatomical mapping system, contact force monitoring, and intracardiac echocardiography (ICE) imaging. In all cases, ultrasound-guided sheath insertion was performed through the femoral vein. In 6 cases of VA, the retrograde approach through the femoral artery was performed with ICE imaging and contact-force monitoring. The endpoint of ablation for AF was pulmonary vein ablation in all cases and addition of left atrial posterior wall isolation in persistent AF cases. The endpoint of ablation for SVT and VA was noninducibility after ablation.

Results
The endpoints of ablation were achieved in all cases. The fluoroscopic time during ablation procedures was 0 seconds. There were two complications (one cardiac tamponade and one acute heart failure). There were no complications related to sheath insertion.

Conclusions
Zero-fluoroscopy catheter ablation with ultrasound-guided sheath insertion may be feasible and can be performed safely. This method eliminates exposure radiation safely, which is a concern of zero-fluoroscopy endocardial catheter ablation.
P1377Substrate-based ablation in patients with frequent appropriate ICD therapy and dilated cardiomyopathy: long-term experience with high-density mapping
Authors: Oliveira M M O , Cunha P S C , Valente B V , Portugal G , Lousinha A , Pereira M , Braz M , Delgado A S , Ferreira R C 
Published: June 2020

Abstract
Recurrent ventricular tachydisrhythmias (VT) episodes have a negative impact in the outcome of patients (P) already with an implantable cardioverter-defibrillator (ICD). Elimination of arrhythmic reentry circuits represents a difficult challenge, mainly due to the induction of intolerable VTs, with multiple ECG morphologies, requiring rapid interruption. Substrate guided ablation has been used as a promising approach strategy to treat recurrent VTs. Aim: to assess long-term results of a VT substrate-based ablation using high-density mapping in P with an ICD, severe left ventricular (LV) dysfunction and recurrent appropriate ICD therapy. Methods: 16P (12 men, non-ischemic cardiomyopathy 67%, 55 ± 13 years, LV ejection fraction 32 ± 6%) and recurrent appropriate shocks despite antiarrhythmic drug therapy and optimal heart failure medication. All P underwent a protocol of ventricular programmed stimulation (600 ms/S3) to obtain baseline VT documentation. A sinus rhythm (SR) voltage map was created using a 3D electroanatomic mapping system (CARTO) with a high-density mapping catheter (PentaRay) to delineate areas of scarred myocardium (ventricular bipolar voltage ≤0,5 mV – dense scar; 0,5-1,5 mV – border zone; ≥1,5 mV – healthy tissue) and provide high-resolution electrophysiological mapping. The substrate modification included catheter elimination of local abnormal ventricular activities (LAVA) - fractionated, splited, low-amplitude/long-lasting, late potentials, pre-systolic potentials - and linear ablation to obtain scars homogenization and scar dechanneling. Pace-mapping techniques were used when capture was possible. LV approach was retrograde in 6 cases, transeptal in 4 and endo-epicardial in 2 cases. In 2P the ablation was performed in the right ventricle. Results: VTs were induced and interrupted with bursts or external DC shocks. LAVA were identified and ablated in all P. Eleven P underwent modification of scar areas. The mean duration of the procedure was 153 mn (103-218 mn), with radiofrequency ranging from 18 to 60 mn (mean 33 min), and a mean fluoroscopy time of 16 mn. Non-inducibility was achieved in 75% of the cases. There was 1 pericardial tamponade drained successfully. During a follow-up of 48 ± 18 months, 75% had no VT recurrences, 2P underwent redo ablation, 1P died from stroke. Conclusion: Catheter ablation of VT based on substrate modification guided by high-density mapping is feasible and safe in P with LV dysfunction. This approach may be of clinical relevance, with potential benefits in reducing VT burden.
P1448Ablation of cti-dependent flutter using a novel advanced mini-electrodes technology: preliminary results from Leonardo registry
Authors: Maglia G , Pentimalli F , Solimene F , Infusino T , Calo" L , Perego G B , Stabile G , Matta M , La Greca C , Rago A , Tomasi C , Zingarini G , Bottoni G , Malacrida M , Verlato R 
Published: June 2020

Abstract

Funding Acknowledgements
NO FUNDING

OnBehalf
LEONARDO study group

Background
Ablation of cavotricuspid isthmus (CTI) represents the standard therapeutic approach for the creation of bidirectional conduction block (BDB) across the isthmus and the prevention of recurrences, yet recurrence of arrhythmia is common.

Objective
To evaluate the acute and long-term outcome of CTI ablation through a novel ablation catheter equipped with three radially distributed mini-electrodes (ME) compared with standard ablation catheter technology (ST).

Methods
Atrial Flutter Ablation in a Real World Population (LEONARDO) is a prospective, multicenter cohort study aimed at providing an estimate of acute to long-term outcome in a large population of pts indicated for AFL ablation from 2015 to 2017. The procedural endpoint was the creation of a BDB. Presence of widely split double potentials (DP) along the ablation line and assessment of the atrial activation sequence (AAS) were used as criteria for complete BDB. Recurrence of AFL and complications were assessed at 12-month follow-up.

Results
205 consecutive pts undergoing typical AFL ablation were included (74% male, 50.6% with history of AF, median of 7[4–11] ablation lesions, median ablation time of 20[10-30] min). Complete BDB was achieved in 175 (85.4%) pts (10 pts had DP only criterion, 19 pts had AAS only criterion whereas in 1 pt we failed to reach a BDB). 15 (7.3%) pts experienced AFL recurrence during follow-up. 102 pts (49.8%) underwent ablation procedure with ME catheters whereas 103 (50.2%) pts were treated by ST catheters. The median number of lesions/pt was significantly lower in the ME group compared to the ST one (4[3-6] vs 8.5[6-12], p &lt; 0.0001), whereas no differences were found in terms of fluoroscopy time (10.5[7-15] min vs 10[5.8 ± 15] min, p = NS) or ablation time (22.5[10-30.5] min vs 18[10-26] min, p = NS). No complications were reported. The acute procedural success was comparable between groups (81.4% vs 89.2%, p = NS) whereas the time to AFL recurrence was significantly longer among pts targeted with ME catheters (HR = 0.343; 0.12 to 0.97; log-rank p = 0.044).

Conclusions
In our preliminary experience, the use of the ME technology seemed safe and effective. It resulted in fewer lesions/pt and a lower AFL recurrence rate at 1-year follow-up compared with ST ablation catheters.