bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1129Bipolar voltage cut-off validation in electroanatomical voltage mapping to identify scar and conduction channels in ventricular tachycardia ablation: need for new cut-off in NICM
Authors: Zaraket F , Sanchez Somonte P , Quinto L , Garre P , Alarcon F , Tolosana J M , Guasch E , Arbelo E , Doltra A , Ortiz J M , Prat S , Brugada J , Sitges M , Mont L , Roca Luque I 
Published: June 2020

Abstract

Background/Introduction
Substrate-guided techniques have changed the approach and results of ventricular tachycardia (VT) ablation and electroanatomical voltage mapping (EAVM) constitutes a diagnostic and therapeutic cornerstone in this field. In current practice normal myocardium is typically characterized by bipolar voltage &gt; 1.5 mV, dense scar &lt; 0.5 mV, and border zone (BZ) tissue by the range between 0.5 to 1.5 mV. Of note, evidence for these cut-off values has been derived in humans from small observational studies and in animals. Furthermore, some studies suggest that only the 60% of not transmural endocardial scars and the 35% of not endocardial scars are detected without any adjustment of these values. New voltage cut-off values are needed.

Purpose
The purpose of this study is to adjust voltage cut off in order to establish the threshold that more accurately define the pathological substrate in VT ablation. Additionally, predictors of usefulness of current thresholds are analyzed.

Methods
EAVM were created with CARTO3 System and Sensor-Force catheter (Navistar Smart-Touch and Pentaray). We delineated the conducting channels by analyzing the late potentials activation. Based on these channels we looked for the best cut-off values to detect these channels. We describe the baseline characteristics, the best cut-off values for border zone and scar core in our series and we analyzed the accuracy of the current established values to detect the arrhythmogenic VT substrate

Results
We investigated 51 patients (74,5% males; 41,2% ischemic cardiomyopathy, mean LVEF 38,6% +/-13,6) with sustained monomorphic VT submitted to ablation during 2016 and 2017. The range of the voltage adjustment was from 0,01-1 mV for core area and 0,2-6mV as maximum, with an average of 0,31-1,42mV. Using currently accepted bipolar voltage cut-off &lt;0.5 mV the core scar was correctly identified in 80,4% of patients: 90,4% in ischemic and 73,3% in NICM. Regarding BZ, using classical cut off (0.5-1.5mV) only 56,9 % of the cases were well identified: interestingly, accuracy was worse in NICM (46,6%) than in ischemic patients (71,4%) (p = 0,07).
Conclusions EAVM is very important to detect scar and channels in VT ablation, but several elements can affect it and recently the traditional voltage values have been questioned. Our study suggests how the threshold as currently applied in daily practice could be acceptable to detect the core scar area, but it has to be reconsidered in NICM, especially regarding the border zone. An evident trend (p = 0,07) suggests a better accuracy of current values to define VT substrate in ischemic patients than in NICM.
Abstract Figure. Channel Identification
915ATP efficacy on terminating ventricular tachycardia by device type, indication, and ventricular median cycle length
Authors: Brown M , Kurita T , Sterns L D , Schloss E J , Auricchio A , Zhang Y , Li S , Meijer A , Lexcen D R 
Published: June 2020

Abstract

Funding Acknowledgements
Medtronic

OnBehalf
PainFree SST

Background
Anti-tachycardia Pacing (ATP) is an established therapy that terminates VT without the need for painful ICD shocks. Here we use the data from PainFree SST clinical trial to evaluate the ATP success rate by device type, indication and MCL.

Methods
Spontaneous episodes that were detected by ICD or CRT-D devices in the VT, fast VT and VF zones were included in the analysis. Episodes successfully terminated by ATP were deemed as having ATP success. Using the GEE method, ATP success rate and its 95% CI were calculated for device types, indications and ventricular MCL.

Results
Of the 2770 enrolled patients (79% male, average age 65 years), 1699 (61%) were implanted with an ICD and 1071 (39%) with a CRT-D system; 1917 (69%) were reported as primary prevention and 847 (31%) were secondary prevention patients. For all MVT episodes, the ATP success rate was similar between ICD and CRT-D devices (82.3% vs 80.3%, p = 0.74). Patients with secondary prevention had a higher ATP success rate compared to those with primary prevention but the difference was not statistically significant (84.4% vs 76.8%, p = 0.16). Regardless of device type and indication, ATP success rate was significantly higher in the slower VTs (MCL ≥ 320 ms) compared to the faster VTs (MCL ≥ 240 to &lt; 320 ms) (89.2% vs 73.7%, p &lt; 0.0001).

Conclusion
We found that ATP had a greater than 80% rate of success for terminating ventricular tachycardias overall. Slower VTs was significantly associated with a higher ATP success rate regardless of device type and indication compared to faster VTs. For faster VTs with a MCL ≥ 240 to &lt; 320 ms, the ATP success rate was still successful at terminating VT more than 70% of the time.
Table 1. ATP Success Rates - No. of Enrolled Subjects (% of total) No. of Episodes Analyzed for ATP Success (No. of Subjects) GEE-estimated ATP Success Rate (95% CI) P-value* Overall 2770 (100%) 2277 (376) 81.5% (78.4%, 84.2%) - Device Type - - - 0.7440 ICD 1699 (61.3%) 1484 (229) 82.3% (78.3%, 85.6%) - CRT-D 1071 (38.7%) 793 (147) 80.3% (75.0%, 84.6%) - Indication - - - 0.1609 Primary Prevention 1917 (69.2%) 631 (160) 76.8% (71.2%, 81.6%) - Secondary Prevention 847 (30.6%) 1615 (212) 84.4% (80.7%, 87.6%) - Median Cycle Length - - - &lt;0.0001 (&gt;/=) 240 ms and &lt; 320 ms - 861 (257) 73.7% (69.2%, 77.7%) - (&gt;/=) 320 ms - 1416 (209) 89.2% (85.7%, 91.9%) - * Per a GEE main effect model for all episodes where device type, indication and median cycle length were considered.
221Evaluating the ability of different substrate mapping techniques to identify scar-related ventricular tachycardia circuits using computational modelling
Authors: Campos F , Orini M , Whitaker J , O"neill M , Razavi R , Porter B , Hanson B , Aldo Rinaldi C , Gill J , Lambiase P D , Taggart P , Bishop M J 
Published: June 2020

Abstract

Funding Acknowledgements
National Institute for Health Research; British Heart Foundation; and The Wellcome Trust and Engineering and Physical Sciences Research Council.

Background
Accurate identification of targets for catheter ablation therapy of ventricular tachycardias (VTs) in the postinfarction heart remains a significant challenge. Identification of such targets often requires VT-induction to delineate the entry/exit points of the reentrant circuit sustaining the VT. However, inducibility may not be possible due to hemodynamic instability. In this scenario, substrate ablation strategies can still be performed to uncover the arrhythmogenic substrate during sinus or paced rhythm. However, substrate mapping may fail to accurately delineate the reentrant circuit resulting in VT recurrence after the procedure.

Purpose
To use computer simulations to compare the ability of different electroanatomical maps constructed following typical substrate ablation strategies to identify the VT exit site.

Methods
An image-based computational model of the porcine post-infarction left ventricle was constructed to simulate VT and paced rhythm. Electroanatomical maps were constructed based on the following features extracted from electrograms computed on the endocardial surface: activation time (AT), bipolar electrogram amplitude, signal fractionation and the reentry vulnerability index (RVI - a metric combining activation and repolarization timings to identify tissue susceptibility to reentry). Potential ablation targets during substrate mapping were compared for: highest 5% AT gradient; lowest 5% bipolar signal amplitudes; areas with fragmented signals (more than one peak); and lowest 5% RVI. The minimum distance, d, between the manually identified VT exit site and the targets was measured.

Results
The RVI performed better than the other metrics at detecting the VT exit site (see Figure). The minimum distance between sites of lowest RVI and the exit site was 3.2mm compared to 13.1mm and 15.9mm in traditional AT and voltage maps, respectively. As the scar was not transmural, parameters derived from all electrograms (including those located on dense scar regions) were used to construct the electroanatomical maps. This improved the performance of the RVI significantly, making it more specific than the other metrics as can be seen in the Figure.

Conclusions
Among all metrics investigated here, the RVI identified the vulnerable region closest to VT exit site. This finding suggests that activation-repolarization metrics may improve the detection of pro-arrhythmic regions without having to induce VT. Moreover, the RVI may be particularly well suited for detecting vulnerable regions within non-transmural scars.
Abstract Figure. VT and Substrate Mapping
1261Geographical variations in the incidence of CIED infection and infection prevention strategies: Update from the global WRAP-IT study
Authors: Kennergren C , Poole J E , Wilkoff B L , Mittal S , Corey G R , Mccomb J , Diemberger I , Wright D J , Philbert B T , Simmers T A , Boersma L V A , Debus B , Krueger J , Vandersteegen K , Tarakji K G 
Published: June 2020

Abstract

Funding Acknowledgements
Medtronic, Inc.

Introduction
Cardiac Implantable Electronic Device (CIED) infections lead to significant morbidity, mortality, and use of health care resources. There is variation in infection prevention strategies among centers, and it is not clear whether there is also variation in infection rates across different geographies. Recently, WRAP-IT, the largest global randomized trial to evaluate an infection reduction strategy, randomized 6,983 patients to receive an antibacterial envelope (treatment) vs. no envelope (control). The results demonstrated a significant reduction in major CIED infection with the TYRX antibiotic envelope (12-mo infection rate for envelope vs. control 0.7% and 1.2%, respectively; HR, 0.60; 95% [CI], 0.36 to 0.98; P = 0.04). The purpose of this analysis is to assess geographical variations in patient characteristics, procedural routines, and infection rates.

Methods
The WRAP-IT study enrolled patients undergoing a CIED pocket revision, generator replacement, or system upgrade or an initial implantation of a cardiac resynchronization therapy defibrillator and randomized them to receive the envelope or not, in addition to mandated pre-procedure intravenous antibiotic prophylaxis. To assess geographical variations in infection rates, the control group (per protocol) baseline demographics and procedural characteristics were identified. Major infection was defined as CIED infections resulting in system extraction or revision, long-term antibiotic therapy with infection recurrence, or death.

Results
A total of 3429 control patients were evaluated and followed for a mean of 20.9 ± 8.3 months; 2530 patients from 123 centers in North America, 777 patients from 46 centers in Europe, and 122 patients from 11 centers in Asia/South America. The 24-month Kaplan-Meier major infection rates were 1.2% in North America (30 pts), 2.5% in Europe (16 pts), and 4.3% Asia/South America (5 pts) (see Figure). These geographical variations in the incidence of major CIED infections were significant (overall P = 0.008, univariate). There were differences in baseline patient characteristics, including age, sex, medication use, NYHA Class, and number of previous devices across geographies. Differences also included procedural characteristics, such as device type, use of pocket wash, skin preparation, pre-operative antibiotic drug use, and procedure time.

Conclusion
Major CIED infection rates vary significantly across geographies. The effect of patient demographics and procedural characteristics on these findings will be assessed and presented at EHRA. Insights into geographical variability of CIED infections is important to mitigate infection risk, reduce morbidity and cost.
Abstract Figure. Major CIED Infection Rate by Geography
P1174Impact of sex-differences in long-term outcomes with cardiac resynchronization therapy: are women different?
Authors: Moreno Weidmann Z L , Alonso-Martin C , Mendez-Zurita F , Rodriguez-Font E , Guerra-Ramos J , Campos-Garcia B , Brossa V , Vinolas-Prat X 
Published: June 2020

Abstract

Introduction
Women are frequently underrepresented in clinical trials for heart failure. Differences on cardiovascular background may imply differences on indications, device election and outcomes in patients receiving cardiac devices (CRT and ICD). We sought to compare sex-related differences in a real-life cohort.

Methods
We analyzed all subjects who underwent a cardiac resynchronization therapy (CRT) implantation (with or without ICD) between 2016 and 2019 in a single center, all of them followed by remote monitoring. Baseline characteristics and outcomes were compared according to gender. Response to resynchronization was defined as clinical improvement in NYHA class or an increase of &gt; =10% in LVEF.

Results
A total of 430 devices (ICD or CRT) were implanted. 149 (35%) of them were CRTs: 116 (88%) CRT-D and 33 (22%) CRT-P. Of the whole cohort, 43 (29%) were women and the mean age was similar in both sex (70+/-9 years). Women had more likely non-ischemic cardiomyopathy (86% vs 49%, p &lt; 0.01), higher proportion of NYHA class III-IV (26% vs 40%, p 0.04) and worse renal function (mean glomerular filtration 61ml/min vs 75ml/min, p 0.04), but tend to be less affected by atrial fibrillation (21% vs 40%, p 0.05). Left ventricular ejection fraction was similar at the moment of implantation among both sex (30+/-7%, p &gt; 0.05) and no difference on optimal medical treatment was observed. Women trend to receive more frequently CRT-P than men (33% vs 18%, p 0.054). After a mean follow-up of 3 years, a four-fold higher response to CRT was observed in women (OR 4.0, 95% CI 2.0-10.7, p 0.002), after adjustment by the etiology of the myocardiopathy. No differences on all-cause mortality (6% in men vs 1% in women, p 0.2) or ventricular arrhythmias (10% in men vs 2% in women, p 0.3) were observed.

Conclusions
in a real-life cohort, CRT implantation showed a sex-disparity: the proportion of women receiving a CRT was lower than in men, but a CRT without defibrillation was more frequently implanted in women, reflecting a higher prevalence of ischemic cardiomyopathy in men. The underlying myocardial substrate in women and a lower prevalence of AF may explain a more favorable response to CRT, despite more pronounced symptoms of heart failure at the moment of implantation.
P508Biventricular pacing versus His bundle pacing after atrioventricular node ablation in heart failure patients with permanent atrial fibrillation and narrow QRS
Authors: Zizek D , Antolic B , Zavrl-Dzananovic D , Klemen L , Jan M , Zupan Meznar A , Breskvar Kac U D , Stublar J , Zupan I , Sinkovec M 
Published: June 2020

Abstract

Background
Atrioventricular (AV) node ablation with biventricular (BiV) pacemaker implantation is a feasible rate control strategy for symptomatic permanent atrial fibrillation (AF) with rapid ventricular response and tachycardia-induced heart failure (HF). However, certain controversy exists since BiV pacing delivers non-physiological ventricular resynchronization and does not return left ventricular (LV) activation times to those seen in individuals with intrinsically narrow QRS. Permanent His bundle pacing (HBP) is a physiological alternative to conventional and BiV pacing. By capturing the native conduction system, depolarization of the ventricles through the His-Purkinje system induces normal synchronous ventricular activation.

Purpose
The aim of the study was to compare short-term outcomes between BiV pacing and HBP after AV node ablation in HF patients with symptomatic permanent AF and narrow QRS.

Methods
A total of 25 consecutive HF patients with permanent AF and narrow QRS (≤110 ms) who underwent AV node ablation in conjunction with BiV pacing or HBP in our centre were enrolled. Post-implant QRS duration, echocardiographic data, and New York Heart Association (NYHA) functional class were assessed in short-term follow-up.

Results
Among 25 HF patients (aged 68 ± 7 years, 52% female, QRS 96 ± 9 ms, LVEF 37 ± 7%, NYHA II-IV), 13 received BiV pacing and 12 HBP. Implant and ablation procedures were acutely successful in both groups. In BiV group 1 patient had a LV lead dislodgement and 1 patient in the HBP group had an acute HB lead threshold increase after AV node ablation. In HBP group post-implant QRS duration was shorter compared to BiV (103 ± 15 ms vs. 177 ± 13 ms, p &lt; 0.001). At a median follow-up of 6 months, patients treated with HBP had greater increase in LV ejection fraction compared to BiV (44 ± 10 vs. 37 ± 6, p = 0.045). A trend toward greater reduction of LV volumes (EDV 119 ± 54 ml vs. 153 ± 33 ml, p = 0.07; ESV 75 ± 34 ml vs. 97 ± 26 ml, p = 0.09) and improvement of NYHA class (2.1 ± 0.7 vs. 2.7 ± 0.8, p = 0.08) was also observed in HBP group compared to BiV group.

Conclusion
In rate control refractory HF patients with permanent AF and narrow QRS atrioventricular node ablation in conjunction with HBP demonstrated superior electrical resynchronization and greater increase in LV ejection fraction compared to BiV pacing. Larger prospective studies are warranted to address clinical outcomes between both pace and ablate strategies.
Far from acceptable: youth-reported risk behaviour screening by primary care physicians
Authors: Eisner-Fellay Taslina , Akre Christina , Auderset Diane , Barrense-Dias Yara , Suris Joan-Carles 
Published: June 2020

Abstract

Background
Adolescence and early adulthood are periods of experimentation during which health detrimental behaviours might be acquired.

Objective
This study’s purpose is to evaluate physicians’ likelihood of addressing health risk behaviours with youths depending on the youths’ wishes, risk behaviours and personal characteristics.

Methods
Data were drawn from the third wave (2017–18) of the GenerationFRee longitudinal study carried out on a sample of 1970 youths aged 17–26 in Switzerland. Analysed risk behaviours were: eating disorders, substance use, emotional wellbeing, problematic Internet use and gambling. Bivariate and multivariate analyses were performed, results are presented as adjusted odds ratios (aORs).

Results
Physicians discussed most risk behaviours with less than half of the youths. The odds of addressing risk behaviours were seldom raised when the risk behaviour was present, or when the youth wished to discuss it. Emotional wellbeing was addressed with half as many males as females (aOR 0.47), and drugs were found to be addressed more frequently with youths reporting a low family socio-economic status (aOR 6.18). When a risk behaviour is addressed it is mostly alongside an extended screening.

Conclusions
This study confirmed the low levels of health risk behaviours screening, regardless of the youths’ wish to discuss the topic with their physician. Despite the low levels, physicians do tend to screen systematically, especially when discussing substance use. There is a need to improve physicians training in risk behaviour screening and counselling in order to increase this practice.
Restoring trust into the NHS: promoting data protection as an ‘architecture of custody’ for the sharing of data in direct care
Authors: Basu Subhajit , Guinchard Audrey 
Published: June 2020

Abstract
Aiming to provide better, more personalized care, by harnessing the power of digitalization, the National Health Service (NHS) has employed a strategy of sharing its patients’ information with the private sector, raising questions as to whether it can be trusted as a custodian of its patients’ data. The development of the Streams application by DeepMind, a subsidiary of Google Health UK, illustrates the dichotomy between, on the one hand, the need to use innovative technologies to provide effective direct care and, on the other hand, the obligation to protect patients’ rights and interests in their health data. This article focuses on an under-explored aspect of the Streams debate: the NHS’s processing of health data in direct care. It argues that the data protection framework is best viewed as an architecture of custody, where all participants in the framework have a custodial role to play and should collaborate to ensure the balance between the free flow of data and the data subjects’ rights and interests.
Pharmacokinetics of fosfomycin in patients with prophylactic treatment for recurrent Escherichia coli urinary tract infection
Authors: Kuiper Sander G , Dijkmans Anneke C , Wilms Erik B , Kamerling Ingrid M C , Burggraaf Jacobus , Stevens Jasper , van Nieuwkoop Cees 
Published: June 2020

Abstract

Objectives
To evaluate the pharmacokinetics and clinical effectiveness of IV and oral fosfomycin treatment in patients with recurrent urinary tract infection (rUTI) with Escherichia coli.

Patients and methods
Patients with rUTI treated with 3 g of oral fosfomycin every 72 h for at least 14 days were included in a prospective open-label single-centre study. Serum samples were taken after oral and IV administration of fosfomycin. Urine was collected for 24 h on 3 consecutive days. Fosfomycin concentrations in serum and urine were analysed using validated LC–MS/MS. Pharmacokinetics were evaluated using a population model. EudraCT number 2018-000616-25.

Results
Twelve patients were included, of whom nine were also administered IV fosfomycin. Data were best described by a two-compartment model with linear elimination and a transit-absorption compartment. Median values for absolute bioavailability and serum half-life were 18% and 2.13 h, respectively. Geometric mean urine concentrations on Days 1, 2 and 3 were above an MIC of 8 mg/L after both oral and IV administration. Quality of life reported on a scale of 1–10 increased from 5.1 to 7.4 (P = 0.001). The average score of UTI symptoms decreased after fosfomycin dosing (by 3.1 points, 95% CI = −0.7 to 7.0, P = 0.10).

Conclusions
Oral fosfomycin at 3 g every 72 h provides plasma and urine concentrations of fosfomycin above the MIC for E. coli. This pharmacokinetic model can be used to develop optimal dosing regimens of fosfomycin in patients with UTI.
Hilary Putnam’s Liberal Naturalism about Language Use, Reference, and Truth
Authors: Ebbs Gary 
Published: June 2020

AbstractHilary Putnam observes that a typical competent English speaker who cannot tell an elm tree from a beech tree may nevertheless use the word “elm” to make assertions and ask questions about elm trees. Putnam also observes that scientists may be wrong about the phenomena they investigate, while still being able to use their words to identify and raise research questions about it. This prompts him to ask what “language use” means in these contexts. He proposes two closely related methods for answering this question. The first method is to investigate and clarify the uses of sentences and words in a given linguistic practice from the point of view of a participant in the practice. The second is to explain our applications of ‘is true’ and ‘refers’ to sentences and words whose uses are described in accord with the first method. In this paper I raise several problems for Putnam’s applications of these methods and sketch a different way of applying the methods that avoids the problems.