bluuebunny/crossref_metadata_2025_split huggingface dataset:
P2834Diagnostic yield of holter recording after atrial fibrillation ablation - detection of asymptomatic recurrences during a one-year follow-up period
Authors: Van Vugt S P G , Volleberg R H J A , Westra S W , Thannhauser J , Evertz R , Hemels M E W , Beukema R J , De Asmundis C , Chierchia G B , Brouwer M A 
Published: October 2019

Abstract

Background
Strategies to detect recurrences after atrial fibrillation (AF) catheter ablation vary widely. Whereas a symptom-based approach may overestimate procedural success due to asymptomatic recurrences, continuous invasive monitoring with implantable devices may be refused by patients and is not routinely recommended. In trial settings, Holter monitoring is recommended at one year after ablation, though more frequent and intensive follow-up is encouraged for more accurate detection of arrhythmia recurrences.

Purpose
To study the diagnostic yield of Holter monitoring in the detection of asymptomatic recurrent arrhythmias after cryoballoon catheter ablation for AF.

Methods
Prospective registry on AF patients who underwent cryoballoon ablation with subsequent follow-up in our centre. Follow-up comprised routine (i.e. at 3, 6, and 12 months) and symptom-driven electrocardiographic (ECG) registrations after a three-month blanking period. In addition, patients were scheduled for six-day Holter monitoring shortly after the blanking period, at six months and at the end of the one-year follow-up period. For the current analysis, we studied the Holter recordings of the patients without previously detected arrhythmia recurrence and determined the proportion of asymptomatic recurrences at each respective monitoring period.

Results
We studied 364 patients with a median age of 60 years (IQR 54–66) and a median CHA2DS2-VASc score of 1 (IQR 1–2). One-year recurrences were documented in 119 (32.7%) patients, of which 90 were initially detected on Holter recording and 39 on ECG registrations (Table). A total of 34 patients did not report symptoms during the documentation of recurrent arrhythmia and comprised 28.6% (34/119) of all recurrences and 37.8% (34/90) of the Holter-detected recurrences. At the three-month Holter registration, 33.3% of the patients with recurrences did not report symptoms, which was 29.4% and 62.5% at the six- and twelve-month registrations, respectively (Figure).
Timing and detection of recurrences Time after ablation 3 months 3–6 months 6 months 6–12 months 12 months Patients with Holter-detected recurrences 57/119 (47.9%) 17/119 (14.3%) 16/119 (13.4%) Patients with ECG-documented recurrences 18/119 (15.1%) 11/119 (9.2%)
Proportions of asymptomatic recurrences

Conclusions
In this cohort of AF patients with serial six-day Holter monitoring after cryoballoon ablation, up to one-third of the patients had asymptomatic recurrences. Whereas Holter monitoring shortly after the blanking period detected nearly half of all one-year recurrences, the proportion of asymptomatic detected recurrences was higher in recordings at one year and seems therefore important in the detection of asymptomatic recurrences after catheter ablation.
P2838The impact of anesthesia depth on catheter ablation for atrial fibrillation: a systematic review and meta-analysis of observational studies
Authors: Li K H , Sang T , Chan C P , Gong M , Li G , Liu T , Wu W K K , Chan M , Tse G , Xia Y , Ho J 
Published: October 2019

Abstract

Objectives
This meta-analysis and systematic review seeks to compare both characteristic parameters and procedural outcomes of catheter ablation in patients under GA/deep sedation and mild/moderate sedation.

Background
Catheter ablation has become a widely applied intervention for treating symptomatic AF and arrhythmias that are refractory to medical therapy. It can be conducted through from mild sedation to general anesthesia.

Methods
PubMed and Embase were searched up to July 2018 for randomized controlled trials, cohort and observational studies that assessed the outcomes of catheter ablation under GA/deep sedation or mild/moderate sedation. 12 studies were included in this meta-analysis after screening with the inclusion and exclusion criteria. Heterogeneity between studies and publication bias was evaluated by I2 index and Egger's regression, respectively.

Results
Our meta-analysis found catheter AF ablation with GA/deep sedation to be associated with reduced risk of recurrence (RR: 0.79, 95% CI: 0.56 to 1.13, P=0.20) and complications (RR: 0.95, 95% CI: 0.64 to 1.42, P=0.82), though statistically insignificant. In terms of procedural parameters, there was non-significant difference between the two groups when both procedural time (SMD: −0.13, 95% CI: −0.90 to 0.63, P=0.74) and fluoroscopy time (SMD: −0.41, 95% CI: −1.40 to 0.58, P=0.41) were considered. Multivariate meta-regression demonstrated hypertension as an independent moderating factor for complication risk.
Complications Comparison

Conclusion
Apart from an increased likelihood of procedural success, ablation by GA/deep sedation was found to be non-significantly different from the mild/moderate sedation approach in both procedural parameters and outcome measures.
P2841Atrial fibrillation ablation using ablation index guided high power (50W) smart touch technology for quantifiable and efficient circumferential pulmonary vein lesions (the FAFA power-touch study)
Authors: Chen S , Schmidt B , Bordignon S , Chun K R J 
Published: October 2019

Abstract

Background
High-power short-duration ablation appears a promising concept. The so-called ablation index (AI) integrating power, contact force and time have demonstrated increased pulmonary vein isolation (PVI) durability. However, feasibility and safety of AI guided high-power ablation is unknown.

Methods and results
Symptomatic AF patients (n=50) underwent circumferential PVI using AI guided high-power point-by-point ablation (CARTO Smart-Touch). Ablation was set to 50W targeting AI values (550: anterior wall/roof, 400: posterior wall) with an inter-lesion distance of 6mm using a non-steerable sheath. An esophageal probe monitored luminal temperature rises (limit: 39°C).
Acute PVI was obtained in all patients; first-pass efficacy was 92%. Mean ablation time per procedure was 11.2±2.2 min, mean procedure time was 55.6±6.6 min.
A total of 2105 lesions were analyzed, comparing left anterior wall vs. left posterior wall and right anterior wall vs. right posterior wall, the mean ablation time (sec.) was 20.5±8.2 vs. 8.6±3.2, and 12.2±4 vs 9.3±3.4; the mean contact force (g): 17.1±12 vs 25.4±14.2 and 33.7±13.1 vs 21.0±10.5, the mean AI: 546.8±48.2 vs 444.6±55 and 554.8±56 vs. 439.8±47.1 (all P<0.0001). Audible steam pops were noted in in 4 (8%) patients. Esophageal temperature rise >39°C were noted in 25 (50%) patients. In 1/50 (2%) patient a minor esophageal lesion after ablation was observed without requiring specific therapy. No major complications such as death, stroke, tamponade or atria-esophageal -fistula occurred.

Conclusion
The novel AI guided high power ablation appears to be a feasible, safe, quantifiable and efficient strategy for PVI.
P2850Time to isolation guided hot balloon ablation for pulmonary vein isolation
Authors: Chikata A , Kato T , Usuda K , Fujita S , Maruyama M , Otowa K , Takashima S , Murai H , Usui S , Furusho H , Kaneko S , Takamura M 
Published: October 2019

Abstract

Background
One disadvantage of hot balloon ablation (HBA) system is that real time monitoring of pulmonary vein (PV) potential is technically impossible. Therefore, the optimal radiofrequency-generated thermal energy application duration and application number are not completely established.

Purpose
The aim of this study is to evaluate the utility of 2Fr 4-electrode unidirectional catheter inserted into PV along with HB for real time monitoring of PV potential and investigate the time to isolation (TTI) guided optimal application strategy for HB based PV isolation in the acute phase.

Methods
We evaluated 23 consecutive patients who performed PV isolation using HBA system. Real time monitoring of PV potential was performed by 2Fr 4-electrode unidirectional catheter inserted into PV along with HB (Figure1A). After HBA applications, PV isolation was validated by high-resolution mapping with the 20-pole steerable mapping (PENTARAY) catheter as a standard. PV potentials during HBA application were categorized into five patterns. PV potentials disappeared during HBA applications and not emerged again (acute isolation), disappeared but verified by PENTARAY catheter (pseudo isolation), once disappeared but emerged again during the same application (acute reconnection), visible but not disappeared (ineffective application) and Invisible (Figure1B).
TTI, difference between TTI and time to reach target temperature (TTRT), balloon temperature at isolation and ablation time after isolation were examined for each applications.

Results
Out of 92 PVs, 69/92 (75.0%) PVs were isolated using HBA and 23/92 (25.0%) PVs required touch up ablation. In total, 120 applications were performed. Real time monitoring of the PV activity was obtained in 114 of 120 applications (95.0%). The distribution of PV potential patterns were 64/120 (53.3%), 2/120 (1.7%), 27/120 (22.5%), 23/120 (19.2%), for acute isolation, pseudo isolation, acute reconnection, ineffective application, respectively.
TTI and difference between TTI and TTRT were significantly shorter in the acute isolation group. Balloon temperature at isolation was significantly lower, TTRT and ablation time after isolation was significantly longer in the acute isolation group. Among them, TTI and difference between TTI and TTRT were highly predictive by receiver operation characteristics curve analysis. TTI <36.5s predicted successful application with sensitivity 83.9% and specificity 79.3%. Difference between TTI and TTRT <6.5s predicted with sensitivity 82.3% and specificity 89.7%.
Figure 1

Conclusions
In HBA system, real time monitoring of PV potentials can be obtained using 2Fr 4-electrode unidirectional catheter and accuracy to confirm an ostial PV isolation is relatively high.
TTI <36.5s and difference between TTI and TTRT <6.5s could be a suitable target for effective application.
P2853Contemporary reporting of acute complications from implantable cardioverter defibrillator surgery
Authors: Hassan A , Birnie D , Nery P , Nair G , Davis D , Green M , Sadek M , Golian M , Redpath C 
Published: October 2019

Abstract

Background
Defibrillator placement carries an inherent risk to the patient. Traditionally, major adverse events defined as cardiac arrest, tamponnade, pneumothorax, infection requiring re-operation, MI and CVA within 30 days are reported to occur between 3 and 4%. Minor complications such as heamatomae or lead dislodgement are reported between 8 and 13%. Novel lead technologies, protocolised programming and reduced use of Heparin bridging have been reported to reduce adverse outcomes. However, patients are still typically monitored in hospital for 24 hours to mitigate these risks. There is little evidence that discharge delay is effective yet incurs significant additional costs.

Purpose
We sought to evaluate the frequency and timing of adverse events relating to defibrillator surgery (ICD and CRT-D) at a large Canadian tertiary care center (UOHI).

Methods
We retrospectively reviewed all patients who received a defibrillator placed from 1st April 2013 to 31st March 2018 inclusive. Patient comorbidities were extracted from the hospital electronic medical record (EMR) system. Device related information and complications were extracted from UOHI PaceartTM system and EMR and cross referenced with physician remuneration databases.

Results
A total of 2221 procedures were performed on 2153 patients (78% male, mean age 65 years). The majority (60%) of defibrillator implants were de novo, with 884 (40%) pulse generator replacements/ upgrades and 868 (39%) defibrillators had CRT capability. Patients were routinely discharged within 24 hours of ICD surgery. Post-operative follow up ≥30 days was complete in 97% patients. Major adverse events occurred within 30 days in 9 patients (0.4%); 9 (100%) were infection requiring re-operation. An additional 32 patients (1.5%) required repeat interventions or readmission within 30 days of implant, most commonly due to lead dislodgement. Only 2 patients required readmission within 24 hours of surgery (0.1%). All procedure-related adverse events during clinical follow up (≤5 years) were 131 (5.9%) occurring in 122 patients. There were no apparent predictors of adverse events in this cohort.

Conclusion(s)
Contemporary risks to patients undergoing defibrillator surgery are considerably lower than that reported in 2010. The risk of infection appears constant despite increased antibiosis. Patients receiving an ICD or CRT-D can safely be discharged within 24 hours if no complications are apparent.

Acknowledgement/Funding
None
P2854Floating connecting tissue scars ghosts after transvenous lead extraction
Authors: Polewczyk A , Nowosielecka D , Tomaszewski A , Brzozowski W , Szczesniak Stanczyk D , Tulecki L , Tomkow K , Jachec W , Kutarski A 
Published: October 2019

Abstract

Background
The phenomenon of appearance of connecting tissue remnants floating in vena cava (VC), right atrium (RA) tricuspid valve (TV), right ventricle (RV) or coronary sinus (CS) was described recently. Frequency of occurrence and their significance remain unknown. Till now, our knowledge is limited due lack exact description in the literature.

Purpose
The goal of this study was analysis of the appearance of this phenomenon using trans-esophageal echocardiography.

Methods
Between 2006 and January 2018 we performed 2408 TLE procedures using conventional mechanical sheaths. 3836 leads (mean implant duration 96,13 months) were extracted, mainly due to non-infective indications in 64,2%. Results of exact TEE before and after the procedure were available in 2034 patients. All patients with incomplete ECHO/TEE evaluation were excluded from the analysis.

Results
Results are presented in the table

Conclusions
In about 25% of patients after TLE floating connecting tissue scars can be observed. Most frequently they can be noted in VC (33%) RA (28%) and RV (10%). In 23% ghosts has numerous location in different combinations. Mean size of “ghosts” is about 20x4 mm. This phenomenon should be known for doctors who perform transesophageal echocardiography to avoid faulty diagnosis.
P2865Mutation specific clinical characteristics in long QT syndrome type 8; severe phenotype in Timothy syndrome patients
Authors: Ohno S , Yoshinaga M , Ozawa J , Fukuyama M , Seiichi S , Kashiwa A , Yasuda K , Kaneko S , Nakau K , Inukai S , Sakazaki H , Makiyama T , Aiba T , Suzuki H , Horie M 
Published: October 2019

Abstract

Background
Long QT syndrome type 8 (LQT8) caused by mutations in CACNA1C has been classified as a very rare and severe type of long QT syndrome accompanied with Timothy syndrome (TS) with extra-cardiac phenotype. Recently, various mutations in CACNA1C have been identified in non-TS patients. However, mutation specific severity in LQT8 has not been elucidated yet, especially for non-TS patients.

Purpose
We aimed to clarify the clinical characteristics of LQT8 patients.

Methods
The study consists of 26 LQT8 patients (21 probands and 5 family members). We evaluated their phenotype.

Results
Table summarizes the clinical characteristics of LQT8 patients. TS patients diagnosed in younger age than those of non-TS. Four TS and one non-TS patients were diagnosed at the age of 0, though the non-TS patient was a son of a patient and asymptomatic. Nine patients suffered symptoms including 7 with cardiac arrest. We identified three TS mutations; classical p.G406R in two and p.G402S in two, and a new TS mutation, p.412M in one. Four of TS patients were symptomatic and two died suddenly at the age of 4 and 5. In contrast, no one died in non-TS patients. Five non-TS patients suffered symptoms in the age of 4,9,15,54 and 64, and the mutations were p.S643F, p.R858H (2 patients), p.K1518E and p.K1591T.
Characteristics of TS and non-TS patient TS Non-TS P N (male) 5 (2) 21 (9) Age (range) 0 (0–7) 12 (0–64) 0.004 Symptom Syncope 4 5 0.034 CPA 3 4 0.101 ECG characteristics   QT interval 603±40 507±14 0.011   T wave alternans 5 2 <0.001   AV Block 4 1 0.002 Therapy (4 unknown)   Beta-blocker 4 7 0.311   Mexiletine 3 1 0.024   ICD implantation 2 2 0.21

Conclusions
Although TS patients showed severe phenotype, most of the non-TS patients were asymptomatic. The phenotype in LQT8 are diversely different depend on the mutations, especially between patients with TS and non-TS.
P2874Predictors of Electrical Strom among ICD patients: the importance of the burden of non-sustained VTs
Authors: Jimenez-Candil J , Castro J C , Hernandez J , Nunez J , Morinigo J L , Bravo L , Sanchez P L 
Published: October 2019

Abstract

Background
Among ICD patients, the burden of non-sustained ventricular tachycardias (NSVT) occurring during the first 6 months after implant is associated independently with an increase in cardiac death. It is unknown whether there are differences between the incidence of Electrical Storm (ES) and the cause of cardiac mortality (CM) according to the burden of NSVT.

Purpose
To determine the relationship between the burden of NSVT occurring early after ICD implant and the risk of ES in the long-term among ICD patients with left ventricular dysfunction.

Methods
In this prospective study, 416 patients (age: 65±11; LVEF: 30±8; ischemic etiology: 62%, primary prevention: 63%) with LVEF <45% and ICD without cardiac resynchronization therapy were followed-up for 41±27 after implant. ICD programming was standardized. NSVT was defined as any ventricular tachyarrhythmia with >5 beats at ≥150 bpm terminating spontaneously before therapy that occurred within the first six months after ICD implant.

Results
A total of 31 patients (7.5%) presenting with ES during the follow-up. After classifying the subjects into three groups according to the burden of NSVT (tertiles): no NSVT (N=166, group 1); 1–5 NSVT (n=130, group 2) and >5 NSVT (n=120, group 3), the cumulative incidence of ES was higher in group 3: 2.4% vs. 3.1% vs. 19.2%, with an average of time from implant to ES significantly shorter (mean [95% CI, months]): 97 (94–100) vs. 103 (99–106) vs. 86 (79–93); p<0.001 for groups 1–2 vs. 3 (log-rank test). Figure. All ESs were due to monomorphic VT in individuals with ≤5 NSVT; however, 19% of ESs were caused by polymorphic VT or VF among patients with >5 NSVT (p<0.05). By multivariate analysis (Cox-regression), LVEF, % (HR=1.06; p=0.026) and >5 TVNS (HR=4.66; p=0.001) were identified as independent predictors of ES. Cardiac mortality (CM) was independently higher in subjects with >5 NSVT (HR=1.7; p=0.03). The most frequent cause of CM was cardiac failure irrespective of NSVT burden (93% in patients with ≤5 NSVT and 79% in >5 NSVT); however CM due to ES was exclusive of individuals with >5 NSVT: 15% vs. 0% (p<0.05).
Figure 1

Conclusions
1. The burden of NSVT occurring during the first 6 months after an ICD implant is associated independently with a higher risk of ES in the long-term. 2. The adjusted risk of ES is 4-fold higher in individuals with >5 NSVT. 3. The most frequent etiology of CM is heart failure; CM due to ES is exclusive of patients with >5 NSVT causing the 15% of deaths in such population.
P2878Higher all-cause mortality in patients with implanted dual-chamber cardioverter-defibrillators for secondary prevention: an analysis from the Polish ICD Registry
Authors: Warchol I , Lubinski A , Sterlinski M , Kowalski O , Goscinska-Bis K , Pytkowski M , Mitkowski P , Kazmierczak J , Szwed H , Przybylski A , Trusz-Gruza M , Kempa M , Zienciuk A , Sielski S , Pazdyga A 
Published: October 2019

Abstract

Background
In the Polish ICD Registry population secondary prevention recipients account for over 27%. Despite the evolution of indications for secondary prevention implantable cardioverter defibrillators (ICDs), recommendations regarding the use of ICDs for secondary prevention of sudden cardiac death (SCD) rely on information from a small number of randomized controlled trials that were performed decades ago, with mixed results. Moreover, research on the outcomes after implantations for secondary prevention of ICDs is limited. While dual-chamber devices offer theoretical advantage over single-chamber devices, dual-chamber ICDs (DC-ICDs) were announced not superior to single-chamber (SC-ICDs) in some research.

Purpose
Therefore, the aim of the study was to evaluate the all-cause mortality among patients from the Polish ICD Registry receiving either a single- or a dual-chamber device for secondary prevention in contemporary clinical practice.

Methods
All patients enrolled in the Polish ICD Registry from 1995 to 2016 were identified. Patients were included in the study if they were designated as receiving an ICD for secondary prevention of SCD after documented tachycardic arrest, sustained ventricular tachycardia (VT), or syncope. Kaplan-Meier survival analysis was used to assess all-cause mortality.

Results
In the study population of 3596 ICD recipients (mean age 69±12 years, 81% male, SC-ICD 61%, DC-ICD 39%), during mean follow-up of 79±43 months all-cause mortality rate was higher in the dual-chamber group than in the single chamber group, with a significant difference between the two groups as depicted in Kaplan-Meier curve (p<0,05). The median survival time was 98 months versus 110 months for SC and DC-ICD, respectively.

Conclusions
This study is the first to describe the characteristics of a national cohort of patients receiving a secondary prevention ICD in such a long follow-up period in contemporary practice. Implantation of a dual-chamber ICD was associated with higher all-cause mortality compared with single chamber devices.