bluuebunny/crossref_metadata_2025_split huggingface dataset:
P426Routine use of transoesophageal echocardiography in patients with atrial fibrillation or atrial flutter undergoing cardioversion
Authors: Etsadashvili K , Kuridze N , Kavtiashvili T , Chaligava T S , Chumburidze V 
Published: June 2020

Abstract
Background. According to the recent guidelines, effective anticoagulation is recommended for a minimum of 3 weeks before the cardioversion of Atrial Fibrillation/Atrial Flutter. Transoesophageal echocardiography (TOE) could be considered, but is not mandatory to exclude/confirm the cardiac thrombus before the cardioversion in adequately anticoagulated patients.
Aim of the study was to reveal the incidence of thrombus or spontaneous echo contrasting (SEC) by TOE before cardioversion, despite effective anticoagulation.
Material and methods. Patients, where TOE was performed to evaluate the evidence of thrombus/SEC before the cardioversion of AF/Atrial flutter at our clinic in period of 2016-2018, were studied. Incidence of intracardiac thrombus and its relation to patients’ gender, age, hypertension, diabetes, atrial diameter, LVEF, duration of Atrial Fibrillation/Atrial flutter, as well as to anticoagulation regimen were evaluated. Results. All patients received recommended anticoagulation therapy, DOACs or VKAs, for a minimum of 3 weeks before the TOE. Finally 180 patients were divided in two groups: group 1 (121 patients) without evidence of thrombus and group 2 (59 patients) where TOE revealed the thrombus. Thrombus was found in 37 (20.5%) patients, and SEC was found in 22 (12.2%) patients. There were no difference between the two groups with respect to: gender (85 male (70%) in group 1 vs. 38 male (64%) in group 2, p = NS), age (62.8 ± 8.73 vs. 63.0 ± 9.04, p = NS), hypertension (78 (64.4%) vs. 44 (74.6%), p = NS), diabetes (17 (14%) vs. 7 (12%), p = NS), CHAD2DS2-VASc score (2.2 ± 1.8 vs. 2.4 ± 4.0, p = NS), LVEF (48.1 ± 7.1% vs. 46.4 ± 7.3%, p = NS), duration of arrhythmia (7.7 ± 11.6 months vs. 9.7 ± 14.0 months, p = NS), type on anticoagulation (DOACs 59 (48.3%) vs. 30 (50.8%), p = NS, VKA (Warfarin) 54 (44.6%) vs. 29 (49.1%), p = NS)) respectively. Only difference in atrial diameter was found statistically significant between the two groups: left atrial diameter (42.6 ± 3.3mm vs. 45.3 ± 3.6mm, p &lt; 0.001) and right atrial diameter (39.4 ± 3.3mm vs. 40.8 ± 2.3mm, p = 0.001) respectively. Conclusion. Thrombus/SEC could persist despite the effective anticoagulation therapy for ≥3 weeks. Therefore all patients should perform TOE before the cardioversion to avoid the incidence of stroke.
P953Smartphone monitor kardia: an effective diagnostic tool for paroxysmal palpitations
Authors: Frey P , Irles D , Dompnier A , Akret C , Delfanne C 
Published: June 2020

Abstract

Funding Acknowledgements
no grants to declare

OnBehalf
not applicable
Background : Paroxysmal palpitations are diagnostic challenge because the ECG and the 24-hour holter ECG monitoring without palpitations is usually normal. We report a 1 year experience of a new diagnostic tool for paroxysmal palpitations: the smartphone monitor Kardia®. Patients with paroxysmal palpitation and negative 24 hour holter ECG was ask to sent iECG during symptoms during the 1 month follow-up.

Results
Between January and December 2018, 20 patients have received Kardia®, mean age 40 years, the mean duration kardia-monitoring was 26 days. A total of 235 iECGs were sent by email, a median of 6 iECG/patients. 9 (45%) patients remained without rhythmic diagnosis (sinus rhythm, normal heart rate), 11 (55%) patients had at least one pathological iECG: 4 atrial fibrillation, 4 junctional tachycardia including 1 with paroxysmal pre-excitation, 2 atrial flutters. These diagnosis had therapeutic consequences: 2 AF ablations, 2 AF treated by antiarythmic drugs (AAD), 2 atrial flutters ablation, 1 ILR was implanted for absence of diagnosis with kardia®. The other patients without diagnosis at the time of palpitations were reassured on the absence of cardiac rhythm disturbance.

Conclusion
The purchase of 5 Kardia® as a new diagnostic tool for paroxtysmal palpitations is a reasonable investment for a cardiology derpartment, the diagnostic performance is higher than current standards (24 hours holters ECG monitoring), since it allows an arhythmic diagnosis in more than 50% of cases in 1 mounth. The main limitation is the selection of patients, most often young, who already have a smartphone and can send an email.
patient age (years) duration (days) i-ECG sent number diagnosis treatment patient 1 23 11 3 AF AF ablation patient 3 51 23 7 AF AA Drugs patient 10 65 20 5 AF AA Drugs patient 11 35 29 6 SVT : AVNRT no ablation patient 12 48 22 27 atrial flutter flutter ablation patient 13 34 1 13 SVT : AVNRT no ablation patient 14 56 7 18 atrial flutter flutter ablation patient 15 59 21 80 AF and PVC AF Ablation patient 16 50 1 3 SVT : AVRT no ablation patient 17 28 28 2 SVT : AVNRT no ablation patient 19 49 35 8 PVC AA Drugs 1 year kardia experience : diagnosis performance in the 11/20 patients with abnormal iECG
Abstract Figure. iECG : termination of SVT (patient 17)
P1443Accuracy of three algorithms in predicting accessory pathway localization in a pediatric population with ventricular pre-excitation
Authors: Ferrari P , Malanchini G , Leidi C , Gulletta S , De Filippo P 
Published: June 2020

Abstract

BACKGROUND
Prediction of accessory pathway location is extremely important before scheduling ablation, even more in paediatric patients. Given the absence in the literature of conclusive and recent studies that established the best algorithm to predict location in these patients, especially after the introduction of 3D mapping systems, we designed a study to compare three previously published algorithms.

AIM
The aim of this study is to assess and compare the accuracy in predicting accessory pathway location of the algorithm by Arruda, Boersma and Chiang.

METHODS
This is a multicenter, observational, retrospective clinical study based on the analysis of the resting 12-leads ECGs of children (aged 0-18 years) with ventricular pre-excitation pattern. The study lasts from January 2013 to June 2019. We analyzed the accuracy (defined as percentage of true positive values) of predicted location by each algorithm, which could include one or more than one of 13 regions around mitral and tricuspid annuli.

RESULTS
Study population was composed by 120 patients, mean age was 12.7 +/- 3.6 years (height 155.6 +/-19.3 cm and weight 48.3 +/- 17.1 kg). The algorithm by Boersma has the highest percentage of predicted pathway locations that are found to be concordant with the site of successful AP ablation (see table). When we corrected for pre-test probability, the algorithm by Arruda makes the possibility of one specific location 8 times higher, the one by Boersma 6.4 times higher and the one by Chiang 6.9 times higher than by chance.

CONCLUSIONS
The algorithm by Boersma showed the highest accuracy in accessory pathway location, on the other hand the one by Arruda seems to have the highest corrected accuracy in accessory pathway among children.
table 1 Arruda Boersma Chiang Number of locations 13 9 13 Total accuracy 0,617 0,717 0,533 Corrected accuracy per locations 8,0158 6,4494 6,929
Abstract Figure. picture 1
1320Effectiveness of atrial flutter ablation line selection using SOUNDSTAR catheter
Authors: Yada H , Ito K , Naganuma T , Yumita Y , Kagami K , Osaki A , Yasuda R , Toya T , Namba T , Nagatomo Y , Masaki N , Adachi T 
Published: June 2020

Abstract

Background
Cavotricuspid isthmus (CTI) ablation for atrial flutter (AFL) shows a high success rate and effective for patients. However, operators experience difficulties in CTI ablation in some cases and need additional ablation for repeated recurrence. We investigated whether the SOUNDSTAR® (Biosense. Webster, Diamond Barr, CA, USA) catheter would be effective to select a CTI line of high therapeutic effect.

Methods
We have investigated the anatomy of around CTI by SOUNDSTAR® catheter and decided the CTI line using the anatomical information in AFL ablation (Figure1). We assumed two CTI lines of medial and lateral line. Medial CTI (M-CTI) line was more common and shorter line. Lateral CTI (L-CTI) line was uncommon and slightly longer line. We use 3.5mm tip catheter with NxT steerable introducer. The target Ablation Index (AI) was 400, and the target VisTtag™ interval was 6 mm or less.

Results
A total 30 of AFL ablated cases were investigated retrospectively. We surveyed 15 cases in M-CTI group and 15 cases in L-CTI group. Comparing the length of CTI in all cases, the length of M-CTI line was shorter than L-CTI line (M-CTI 32.1 ± 6.6mm vs. L-CTI 38.4 ± 8.3mm, n = 30, p &lt;0.01). The atrial wall thickness of midsection and tricuspid valve (TV) side were thicker in M-CTI line (Midsection: M-CTI 4.0 ± 1.2mm vs. L-CTI 3.3 ± 0.8mm, n = 30, p &lt;0.05, TV side: M-CTI 5.4 ± 1.4mm vs. L-CTI 4.3 ± 1.1mm, n = 30, p &lt;0.05,). There was no difference in the required number of points to complete initial line (M-CTI 8.4 ± 1.6 vs. L-CTI 8.1 ± 1.7, n = 15, ns). Eustachian ridge in IVC side was thicker and higher in the M-CTI group (3.4 ± 3.3mm vs. 0.9 ± 1.9mm, n =30, p &lt;0.01) and ablation on the Eustachian ridge showed instability of catheter placement. A lot of RF delivery was required on Eustachian ridge in M-CTI (2.6 ± 0.6 vs. 2.1 ± 0.7, n =15, p &lt;0.05) and AI had resulted lower in M-CTI (351 ± 42.8 vs. 381 ± 27.1, n =15, p &lt;0.05). Recurrence is more common in M-CTI group (9/15, 60% vs. 3/15, 20%). Recurrence sites in M-CTI group were distributed ((IVC side 3/9 (33%), midsection 5/9 (56%), TV side 5/9 (56%)) and multiple recurrences occurred in 3/9 (33%). Recurrence sites in L-CTI were only midsection of CTI (3/3, 100%).

Conclusions
CTI ablation at the shorter distance M-CTI, which is commonly selected, resulted in more recurrences due to the unevenness including Eustachian ridge and the myocardium thickness. However, ablation at slightly longer L-CTI line showed lower recurrence and effective for CTI ablation.
Abstract Figure 1
P1470Outcome of leadless pacemaker implantation in a referral centre for lead extraction: a comparison with transvenous pacemaker
Authors: Tolve S , Zucchelli G , Barletta V , Parollo M , Di Cori A , Della Tommasina V , De Lucia R , Giannotti Santoro M , Mazzocchetti L , Cellamaro T , Viani S , Segreti L , Paperini L , Soldati E , Bongiorni M G 
Published: June 2020

Abstract

Background
Leadless cardiac pacing is a promising technology in terms of efficacy and safety.

Purpose
The aim of the study was to compare the long-term clinical and electrical performance of Micra leadless pacemaker with ventricular single-chamber transvenous pacemaker (VVI TV-PM) in a high-volume centre for transvenous lead extraction (TLE).

Methods
Between May 2014 and April 2019, 100 patients (group 1) underwent Micra implant at our centre. We identified 100 patients (group 2) who underwent VVI TV-PM implant in the same period for a 1:1 comparison matched by age, sex, left ventricular systolic ejection fraction and previous TLE.

Results
The implant procedure was successful in all patients. In group 1, the procedure duration was lower than in group 2 (43.86 ± 22.38 vs 58.38 ± 17.85 min, p &lt; 0.001), while the fluoroscopy time was longer (12.25 ± 6.84 vs 5.32 ± 4.42 min, p &lt; 0.001). There was no difference about the rate of septal deployment at the right ventricle (group 1 vs group 2: 76% vs 86%, p = 0.10). Patients were followed-up for a median of 12 months. We did not observe any acute and chronic procedure-related complications in group 1, while we reported acute complications in seven patients (0 vs 7%, p = 0.02) and long-term complications in three patients (0 vs 3%, p = 0.24), needing for a system revisions in 6 cases (0 vs 6%, p = 0.038) in group 2. One systemic infection occurred during follow-up in a patient with VVI TV-PM. Electrical measurements were stable during follow-up in both groups, with a longer estimated battery life in group 1 (mean delivered energy at implant group 1 vs group 2: 0.14 ± 0.21 vs 0.26 ± 0.22 μJ, p &lt; 0.001).

Conclusion
Micra pacemaker implant is a safe and effective procedure, with a lower rate of acute complications and system revisions and a longer estimated battery life compared to VVI TV-PM, even in a real life setting including patients who underwent TLE.
P1182Asymptomatic masses on the pacing leads - influence on long term survival
Authors: Polewczyk A , Nowosielecka D , Tomaszewski A , Brzozowski W , Szczesniak-Stanczyk D , Polewczyk M , Jachec W , Kutarski A 
Published: June 2020

Abstract

Background
Asymptomatic Masses on Endocardiac Leads (AMELs) are relatively often found in echocardiography in patients with cardiac implantable electronic devices (CIED) but their clinical significance is unknown.

Purpose
Aim of the study was to evaluate the incidence of AMELs and assesment of their influence on long term survival (mean follow up- 4,28 ± 3,13 years) of patients undergoing transvenous leads extraction (TLE).

Methods
We analyzed the clinical data of patients undergoing TLE in single center in years 2006-2019. Echocardiography before TLE was performed in 2558 patients (60,4% male). AMELs were detected in 426 (16,7%) cases. Classifications of AMELs included connective tissue surronding the leads, clots, alike vegetations masses. Additionally, real vegetations, thickening of the leads and strong connective tissue scars were distinguished. Long term survival was compared between individual types of AMELs and patients without any additional masses on the leads.
Results are presented in the table.

Conclusion
Poor long-term survival was observed in patients with AMELs on the pacing leads.
Abstract Table
P524Serratus anterior plane block in subcutaneous implantable cardioverter defibrillator implantation: a case-control analysis
Authors: Ziacchi M , Bisignani G , Palmisano P , Scalone A , Martignani C , Mocavero P E , Caravati F , Della Cioppa N , Mazzuero A , Pecora D , Vicentini A , Landolina M E , Lovecchio M , Valsecchi S , Droghetti A 
Published: June 2020

Abstract

Funding Acknowledgements
No Funding

OnBehalf
RHYTHM DETECT study group

Background
A two-incision technique, in association with inter-muscular positioning of the subcutaneous defibrillator (S-ICD), is now the most frequently adopted implantation approach in Europe. Ultrasound-guided serratus anterior plane block (SAPB) has been proposed in order to provide anesthesia/analgesia during S-ICD implantation.

Objective
We performed a case-control analysis in which a standardized SAPB approach was compared with the typical local anesthesia and sedation approach.

Methods
91 consecutive patients underwent implantation of an S-ICD with the SAPB approach for anesthesia/analgesia at 10 centers. The control group consisted of 55 consecutive patients who underwent S-ICD implantation with standard local approach.

Results
The mean procedure duration was 59 ± 15min in the SAPB group and 76 ± 23min in the control group (p &lt; 0.001). No operative complications were reported in either group. During the procedure, 79 (87%) patients in the SAPB group and 25 (46%) patients in the control group (p &lt; 0.001) remained awake. Lower values of pain intensity at the device pocket (p = 0.005) and the lateral tunneling site (p = 0.046) were reported in the SAPB group. The difference in static (p = 0.002) and dynamic (p = 0.007) pain intensity between the groups persisted at 1 hour, while no differences were observed 6 hours after the end of the procedure.

Conclusions
SAPB is feasible and effective in providing anesthesia/analgesia during S-ICD implantation. The procedures were successfully accomplished and no complications occurred in either group. However, SAPB was associated with lower pain levels, enabling the need for sedation to be reduced and more patients to remain awake. Moreover, it resulted in shorter procedure durations.
P1107First results of molecular autopsy examinations in sudden cardiac death drawn from nationwide multidisciplinary and multicentric collaboration in the Czech Republic
Authors: Krebsova A , Votypka P , Peldova P , Rucklova K , Pilin A , Kulvajtova M , Pohlova -Kucerova S , Blankova A , Tavacova T , Petrkova J , Tomasek P , Macek Sr M , Macek Jr M , Janousek J , Kautzner J 
Published: June 2020

Abstract

Funding Acknowledgements
Supported by Ministry of Health of the Czech Republic, grant nr. NV18-02-00237. All rights reserved."

Introduction
"Molecular autopsy" in sudden cardiac death (SCD) is an important diagnostic tool for primary prevention of cardiac arrest in victim´s relatives and requires multicentric and multidisciplinary collaboration.

Purpose
To establish a national network for SCD diagnostics, to assess the acceptance of genetic testing in at risk relatives and to elucidate the genetic etiology of SCD in a representative Czech cohort aged below 45 years.

Patients and Methods
Between 2016 and 2019 we ascertained 70 SCD (50 M / 20 F), with positive family history for cardiac arrest in 8/70 cases. Only one family did not agree with molecular autopsy. Genetic counselling and cardiological screening examination was carried out in first degree relatives of SCD survivors accompanied by custom-made targeted panel massively parallel DNA sequencing comprising 100 cardiac conditions-related genes. Presence of pathogenic variants was validated by Sanger DNA sequencing and through family segregation analyses.

Results
According to post-mortem diagnosis most victims died of HCM (17/70), ACM (16/70), no structural heart disease was found in 15/70 cases, DCM/LVNC in 9/70, 6/70 were SIDS cases, other rare diagnoses comprised aortic dissection, or myocarditis. Most of victims died at sleep, only 9/70 victims died during strenuous activities. About 50% of SCD victims did not have cardiac complaints before death. Very likely or certain molecular etiology (i.e. based on presence of ACMG.net Class 4 to 5 variants) was disclosed in 12/70 (17%) in RYR2, FLNC, TTN, KCNH2 and KCNQ1 genes, whilst potentially causative DNA variants (Classes 3-4) were observed in 13/70 (18%) cases. In SIDS we did not find any pathogenic variants. Interestingly, the KCNE1 p.Asp85Asn (LQT 5 lite) variant, was detected in 3/70 cases as a recognized risk factor for ventricular arrhythmias.

Conclusion
The multidisciplinary cooperation in Czech Republic has been established, family survivors are willing to receive genetic and cardiological care, while centralised molecular genetic analysis enables reliable results which are in accordance with other multicentric studies. The molecular autopsy should, especially in SIDS, be expanded to whole exome sequencing.
P333Left atrial function by echocardiography is independent of degree of left atrial electrical scar
Authors: Gallen R , Herczeg S , Mcgorrian C , Carron J , Walsh K , Keelan T , Galvin J , Szeplaki G , Keaney J 
Published: June 2020

Abstract

Introduction
Assessment of left atrial function via transthoracic echocardiography (TTE) is performed most commonly by measuring the transmitral A wave in sinus rhythm. Left atrial (LA) fibrosis plays an important role in the pathogenesis and perpetuation of Atrial Fibrillation (AF). It may be identified by bipolar voltage (BiV) mapping, which can easily be performed at the beginning of a Pulmonary Vein Isolation (PVI) procedure. The relationship between the degree of LA fibrosis, characterised with mapping, and LA function, determined by echocardiography, has not previously been elucidated.

Methods
Patients were enrolled in a project to evaluate the degree of fibrosis during PVI procedures. Pre-procedure TTEs of those presenting in sinus rhythm were assessed and the transmitral A wave was measured and compared to the degree of scarring seen. The high density electroanatomic maps (HD-EAMs) created during the PVIs were analysed using a novel VHA algorithm after the procedure. All points with voltages &lt; 0.5mV were defined to have electrical scar. Patients were classified into 4 quartiles based on the levels of scar seen (Figure 1).

Results
39 patients were included in the evaluation. Average age was 60.6 +/- 13.2 years. 32 (82.0%) of the patients were male. Mean CHADS2VASc score was 1.5. The mean percentage of scar was calculated as 19.6 +/- 15.9%. The average A wave was 0.62 +/- 0.18 ms-1. Pearson’s correlation coefficient showed no relationship between LA scar and either A wave velocities (r = 0.26, p = 0.11) or E:A ratio (r=-0.02, p = 0.91). A significant correlation between A wave velocity and CHADS2VASc was observed (r = 0.49, p = 0.001).

Conclusion
Our study demonstrates no relationship between degree of LA scarring and reduced LA function on TTE as assessed by the A wave. It has been established that structural remodelling in AF (such as atrial dilatation) may occur independently of the electrical remodelling. A potential explanation for our findings is that the electrical scarring in AF, which results in alterations in refractory periods, precedes the negative remodelling which ultimately results in reduced atrial function. This hypothesis would need to be further evaluated in larger studies.
Abstract Figure 1