bluuebunny/crossref_metadata_2025_split huggingface dataset:
P2791Method for detection of blood clots in ventricular assist devices
Authors: Fuchs G , Berg N , Broman L M , Prahl Wittberg L 
Published: October 2019

Abstract

Background
The technical development of modern ventricular assist devices (VAD) shows continued improvement in patient outcome. VADs continue to gain increased use not only as bridge to transplant but also as a destination therapy. However, VAD therapy is associated with complications, among which thromboembolic complications are common. Better management for early detection is paramount to improve patient outcome.

Purpose
The aims of this study were to determine if the VADs under consideration may retain clots, and to assess the feasibility of early clot detection using a non-invasive technique.

Methods
Two different VADs, the HeartMate II (HMII) and HeartMate 3 (HM3) were tested in a mock loop. Clot analogs (2 cm yarn fragments) were introduced into the loop upstream to the pump. Sound and vibration of the pump was measured using two hydrophones and at the inflow and outflow of the VAD (frequency range: 0.1Hz to 180kHz). The acoustic/vibration data was analyzed concerning the spectral content.

Results
The flow at the outflow section contained a low frequency swirling component. This appeared to be the basic flow feature. However, in the presence of clot analogs, the frequency signal was amplified. For the HMII this occurred below 10Hz. Concerning the HM3 this signal was more difficult to analyze due to HM3's non-constant rotational speed. However, by using wavelet filtering, it was possible to detect the low frequency signal in the presence of clot analogs. It was also observed that clot analogs tended to accumulate at certain regions in the respective VAD. In the HM3, clot fragments remained in a stagnation region at the bottom pump. This experimental finding contradicts published washout results based on a passive scalar model.

Conclusions
These mock loop results indicated the feasibility of early detection of blood clots in VADs by analysis of the sound/vibration induced by the clot. The signal “finger-print” needed for detection may also be possible to recover under non-continuous operational rotational speed as in the HM 3.
P2802Second-generation drug-eluting stents versus coronary artery bypass surgery in patients with stable angina and an isolated lesion in the proximal left anterior descending artery
Authors: Matsoukis I , Toutouzas K , Patsa C , Anousakis-Vlachochristou N , Triantafyllou K , Kantzanou M , Drakopoulou M , Tsiamis E , Latsios G , Synetos A , Karanasos A , Petridou E , Tousoulis D 
Published: October 2019

Abstract

Background/Introduction
Both coronary artery bypass grafting surgery (CABG) and percutaneous coronary intervention (PCI), especially with the use of new-generation drug-eluting stents (DES), remain the most common therapeutic options of coronary artery disease, especially when the proximal segment of left anterior descending artery (pLAD) is involved. There are only a small number of studies comparing these approaches in patients with isolated lesions in LAD.

Purpose
We aim to compare the long-term outcomes of PCI with second-generation DES versus CABG surgery with left internal mammary artery, in patients with stable angina and an isolated single vessel pLAD disease.

Methods
The study population consisted of 1010 consecutive patients with stable angina and an isolated pLAD that were treated either with PCI with second generation (zotarolimus or everolimus) DES (631 patients) or with CABG surgery (379 patients). The primary endpoint was the occurrence of any major adverse cardiac event (MACE) namely cardiac death, non-fatal myocardial infarction and target lesion revascularization (using either percutaneous or surgical technique) as a composite index. Other evaluated main clinical outcomes were the components of MACE, patient-related outcome (PRO-a composite index of all-cause mortality, any myocardial infarction, any revascularization), recurrence of stable angina and arrhythmias occurrence.

Results
Lower rates of in-hospital complications (0.3% versus 12.1%, p<0.001) and shorter hospitalization [median, 1 (interquartile-range: 1–4) versus 8 (interquartile-range: 7–11), p<0.001] were recorded in the PCI group compared with the surgery arm. During the follow-up period (mean, 4.6±2.5 years), no statistical difference was observed in respect to MACE between the two study groups (10.1% versus 7.4%, p=0.14). Higher rates of repeat revascularization were detected in patients treated with PCI than those treated with CABG (5.5% versus 2.9%, p=0.05). Concerning other secondary endpoints, cardiac death (2.9% versus 3.2%, p=0.78), myocardial infarction (1.7% versus 1.3%, p=0.60), and PRO (18.9% versus 17.7%, p=0.64) did not differ in a statistically significant manner between the two techniques. Recurrence of stable angina was significantly increased in PCI (15.6% versus 8.4%, p=0.001), whereas arrhythmias occurrence was most common in the surgery group (6.3% versus 11.9%, p=0.002).

Conclusion
PCI with second-generation DES seem to have similar long-term clinical outcomes compared with CABG in patients with isolated LAD disease, highlighting the excellent long-term outcomes of both therapeutic approaches
P2810Clinical outcomes 1 year after filter protection during percutaneous coronary intervention in patients with attenuated plaque identified by intravascular ultrasound
Authors: Hibi K , Kozuma K , Sonoda S , Endo T , Tanaka H , Koshida R , Ishihara T , Kume T , Tanabe K , Morino Y , Ikari Y , Fujii K , Yamanaka T , Kimura K , Isshiki T 
Published: October 2019

Abstract

Background
In the VAMPIRE 3 (VAcuuM asPIration thrombus REemoval 3) trial, we have previously shown that selective use of distal filter protection during percutaneous coronary intervention (PCI) decreased the incidence of no-reflow phenomenon and was associated with fewer in-hospital serious adverse cardiac events than conventional PCI in patients with attenuated plaque ≥5mm. However, whether the early efficacy of distal embolic protection translate into long term clinical benefit is unknown.

Methods
Patients with acute coronary syndrome (ACS) with attenuated plaque ≥5mm were assigned to distal protection (DP) (n=98) or conventional treatment (CT) (n=96). The primary end point of the incidence of no-reflow phenomenon during PCI and the secondary end point of in-hospital serious adverse cardiac events has been reported previously. The rate of a major adverse events, a composite of death from any cause, non-fatal myocardial infarction, or unplanned target vessel revascularization (TVR) at 1 year was the prespecified secondary end point of the trial. All clinical endpoint events were adjudicated by an independent Clinical Event Committee.

Results
Major adverse events at 1 year occurred in 12 patients (12.2%) in the DP group and in 3 patients (3.1%) in the CT group (P=0.029). The difference was driven by a higher risk of TVR (11 [11.2%] vs. 2 [2.1%], p=0.018) in the DP group compared with the CT group. In patients treated with bare metal stents (n=42), major adverse events occurred in 25.0% of the patients in the DP group and in none of the patients in the CT group (P=0.029), whereas in patients treated with drug eluting stents (n=152), rates of major adverse events were similar between the groups (8.1% vs. 3.9%, p=0.32). Rates of cardiac death were not significantly different (1.0% vs. 1.0%, p=1.00). No definite stent thrombosis was observed in either group.

Conclusions
In the VAMPIRE 3 trial of patients with ACS with attenuated plaque ≥5mm, the 1-year rates of major adverse events in the distal protection group were higher than in the conventional treatment group. This effect could be mitigated by the use of drug eluting stents.

Acknowledgement/Funding
This work was supported in part by a grant from Nipro, Boston Scientific Corporation, and Japan Lifeline.
P2825ICD implantation in secondary prevention after an out-of-hospital cardiac arrest. Does age really matter?
Authors: Baldi E , Buratti S , Rordorf R , Vicentini A , Sanzo A , Petracci B , Demarchi A , Cornara S , Astuti M , Frigerio L , Oltrona Visconti L , De Ferrari G M , Savastano S 
Published: October 2019

Abstract

Background
The implantation of an implantable cardioverter defibrillator (ICD) in secondary prevention is a class I indication for patients with an estimated survival more than 1 year with a good functional status. However, in the elderly population, it is often difficult to estimate the expected survival, especially after an acute event such as an out-of-hospital cardiac arrest (OHCA).

Purpose
To evaluate 1-year survival after OHCA of patients older than 80 compared to those younger than 80.

Methods
We considered all the patients who suffered an OHCA in our Province (55ehz748.1135 inhabitants in northern Italy) from October 1st 2014 to November 30th 2017 stratified in two groups accordingly to their age at the moment of OHCA: elderly group (≥80 years old) and non-elderly group (<80 years old).

Results
In the period analysis resuscitation was attempted in 1464 OHCA patients: 632 of the elderly group (mean age of 86.4±4.4 years) and 832 of the non-elderly group (mean age of 63.4±13.8 years). The two groups were different at baseline. In the non-elderly group there were more males (74.5% vs 42.4%, p<0.001), more cases of medical etiology (95.9% vs 91.2%, p<0.001), a higher rate of bystander CPR (39.4% vs 23.4%, p<0.001) and more shockable rhythms at presentation (25.5% vs 7.9%, p<0.001), whilst a home location of the event was more frequent in the elderly group (81.3% vs 77%, p=0.048). No differences were found regarding both the percentage of not witnessed cardiac arrest (27.5% in elderly and 26% in non-elderly, p=0.57) and the time of EMS arrival (11:36 mins in elderly and 11:23 mins in young, p=0.64). Non-elderly patients showed a significantly higher rate of survival both to hospital admission (25.2% vs 6.8%, p<0.001), to hospital discharge (12.1% vs 1.7%, p<0.001) and at 1 year after the event (10.2% vs 1.6%, p<0.001, Figure 1 - left) as compared to older ones. However, when considering only those patients discharged alive we found a non-significant difference in one-year survival (84.2% vs 90.9%, p=0.64, Figure 1 – right).

Conclusions
Elderly patients have a worst prognosis in the acute phase after an OHCA. However, after hospital discharge, older and younger patients showed a similar 1-year survival. This result highlights how age should not be considered alone to decide whether an ICD in secondary prevention could be indicated or not in older OHCA survivors.
P2835Feasibility and safety of same day discharge after radiofrequency catheter ablation for paroxysmal atrial fibrillation
Authors: Rajendra A , Hunter T , Morales G , Osorio J 
Published: October 2019

Abstract

Background
Atrial fibrillation catheter ablation (CA) is the most frequent arrhythmia ablation and accounts for a significant proportion of treatment cost. Same day discharge (SDD) after paroxysmal atrial fibrillation (PAF) ablation is an attractive strategy for both patients and hospitals.

Objective
To understand the eligibility criteria and outcomes for PAF patients who can safely undergo same day discharge after radiofrequency catheter ablation.

Methods
Patients undergoing CA for PAF were evaluated for SDD at a pre-procedure visit to assess the risk of groin, respiratory, cardiac or bleeding complications. Eligibility criteria for SDD were stable anticoagulation and absence of bleeding history, systolic/diastolic heart failure, or interventional procedures within 60 days, with recommended BMI <35. Patient proximity to the hospital was also considered. Anesthesia included propofol with endotracheal intubation and all patients were ablated with a porous tip contact force catheter (STSF). Patients were on bed rest for 6 hours post-procedure, then ambulated intermittently for 1–2 hours. Discharge followed if they were stable with no evidence of vascular access complications or bleeding. A dedicated RN telephoned patients the following morning to ask a series of standard questions designed to elicit evidence of any complications.

Results
52 procedures were identified for SDD, with 7 patients declining. 45 planned SDD procedures for 43 patients occurred 4/17–6/18. Average age was 57±11 years and CHA2DS2-VASc was 1.5±1.1 at procedure. Procedure time was 69±26 min (IQR: 49 - 84 min) with maximum fluoroscopy usage of 0.2 min and 508±149 mL of fluid infused through the catheter. Two patients stayed overnight due a groin bleed and atelectasis with fever, and one chose to stay for comfort. The remaining 42 discharges occurred after 7.2±1.0 hours in recovery, with no SDD-related complications and no required return visits after the follow-up call. There were 3 AF recurrences (6.7%) as of the 10 week visit.

Conclusion
Appropriate low risk patients identified by simple clinical criteria can be safely discharged the same day after CA of PAF. Further evaluation is required for higher risk patients.

Acknowledgement/Funding
The study was funded by Biosense Webster Inc.
P2839The golden age of ablation: results for atypical flutter ablation in the very elderly
Authors: Lozano-Granero C , Moreno J , Matia R , Hernandez-Madrid A , Sanchez-Perez I , Zamorano J L , Franco E 
Published: October 2019

Abstract

Introduction
Atypical flutter ablation (AFL) is a challenging procedure with limited long-term benefits and not exempt from significant risks.

Purpose
To compare the efficacy and safety of this procedure in a population of octogenarian patients over a population of younger patients.

Methods
From 2015 to 2018, all patients in which AFL ablation was attempted were included. Activation and voltage mapping were used to define AFL circuit. Radiofrequency lesions were performed to operator's discretion until AFL termination. Programmed atrial stimulation was repeated to test inducibility, and any sustained induced arrhythmia was ablated. Follow-up included visits with ECG and/or 24h Holter-ECG at 3 and 12 months.

Results
107 patients (55 females) were included, 26 (24%) aged 80 or older (table). Successful ablation of the original circuit was achieved in 96% in both groups (acute success rate, p=0.973), with induction of other AFL circuits in 43% (46% octogenarians, 42% younger, p=0.708), successfully ablated in 88% in both groups (total success rate, p=0.952). No significant difference was detected in the rate of adverse events (8% in octogenarians versus 7% in younger, p=0.962), with a case of cardiac tamponade in the former, successfully resolved. After a mean follow-up of 11±12 months, 52 patients (49%) were free from recurrence, 13 (50%) in the octogenarian group and 39 (48%) in the younger, with an estimated median survival free from atrial arrhythmias of 26 months (95% CI: 4–48) in the octogenarian group and 18 months (95% CI: 5–32) in the younger group (p=0.716). After multivariate analysis, history of prior AF and indexed left atrial volume, but not age, predicted recurrence.
Demographical and clinical variables All patients (n=107) Octogenarians (n=26) No octogenarians (n=81) p-value Age (years) 69±13 83±3 65±11 <0.0001* Cardiomyopathy (%) 54 (50%) 13 (26%) 41 (51%) 0.956 Left ventricular ejection fraction (%) 60±13 57±17 61±11 0.24 Indexed left atrial volume (ml/m2) 45±19 48±14 43±19 0.55 Prior AF history 49 (46%) 7 (27%) 42 (52%) 0.026* Prior ablation procedures 53 (50%) 8 (31%) 45 (56%) 0.028* Prior cardiac surgery 30 (28%) 2 (8%) 28 (35%) 0.008* Left AFL origin (%) 87 (81%) 24 (92%) 63 (78%) 0.098 *Statistically significant difference.
Survival function

Conclusion
AFL ablation was as effective and safe in octogenarian as in younger ones, with a median survival time free from atrial arrhythmias of more than 2 years.
P2843Impact of bipolar vector orientation and inter-electrode spacing on electrograms during human atrial fibrillation
Authors: Linz D , Saha S , Kutieleh R , Kadhim K , Lau D , Baumert M , Sanders P 
Published: October 2019

Abstract

Background
In patients with atrial fibrillation (AF), local atrial bipolar electrograms (EGM) are clinically used to determine peak-to-peak voltage (Vpp), dominant frequency (DF) and Shannon Entropy (ShEn) for electroanatomical substrate characterization and substrate-based ablation. The effect of bipolar vector orientation and inter-electrode spacing on these EGM-derived measures during AF is unclear.

Methods
To quantify the impact of bipolar vector orientation and inter-electrode spacing, bipolar EGM (10,496 and 20,968 atrial sites, respectively) were reconstructed from unipolar EGM recorded with an array of 18 electrodes in 14 patients with persistent AF. We compared Vpp, DF and ShEn between any two adjacent bipolar vectors with a difference of 45 degree. Vpp, DF and ShEn values were ranked into different classes from highest to lowest value. To quantify the effect of inter-electrode spacing, bipolar EGM were constructed from electrodes spaced 4mm, 8mm, and 12mm apart, respectively.

Results
First, bipolar vector orientation significantly impacts Vpp (maximal difference: 1.341±2.169 mV vs. 0.595±0.652 mV; p<0.01) and the percentage of atrial low voltage areas (Vpp<0.05mV) (maximal difference: 62.31% vs. 32.54%). Bipolar vector orientation also influences DF (maximal difference: 8.547±2.971 Hz vs. 6.360±1.077 Hz; p<0.01) and ShEn (maximal difference: 4.898±0.488 vs. 4.120±0.650; p<0.01) measurements. Second, inter-electrode spacing affects Vppincreasing from 0.854±1.299 mV to 1.013±1.302 mV for 4mm, and 12mm, respectively (p<0.01). The percentage of atrial low voltage areas differed between 53.77% and 42.03% for 4mm and 12mm, respectively. Furthermore, inter-electrode spacing alters DF (maximal difference: 7.316±2.239 Hz vs. 7.234±2.124 Hz; p<0.01) and ShEn (maximal difference: 4.364±0.714 vs. 4.514±0.624; p<0.01) measurements.

Conclusions
Bipolar vector orientation and inter-electrode spacing both significantly affect bipolar EGM-derived measures that may result in significant uncertainty around the electroanatomical substrate characterization in AF patients, which should be considered in the development of future mapping catheter tools and algorithms.
P2851Transvenous lead placement in the setting of venous obstruction: outcomes of tunneling technique versus venoplasty
Authors: Yasin O , Kella D , Isath A , Padmanabhan D , Hodge D , Cochuyt J , Mulpuru S , Cha Y , Friedman P 
Published: October 2019

Abstract

Background
Venous stenosis is a well-recognized complication of transvenous leads when patients require lead revisions or device upgrade. In these cases, balloon venoplasty or alternative venous access with subcutaneous tunneling can be performed.

Purpose
Compare the outcomes of venoplasty vs. tunneling in patients requiring additional transvenous lead implantation.

Methods
A single center retrospective cohort study of all patients undergoing lead implantation/revision requiring venoplasty or tunneling from 2005–2017. Chi-squared and Wilcoxon Rank-Sum tests were used to compare categorical and continuous variables.

Results
Ninety five patients met our inclusion criteria (60 venoplasty & 35 tunneling). There was no difference in procedure success rates (p-value=0.98). Tunneling was associated with less fluoroscopy time but higher incidence of acute complications (0% vs. 23%, p-value=0.002) most requiring invasive intervention and/or blood product transfusion. Long term outcomes were comparable and related to lead failure or infection.
Outcomes for tunneling vs. venoplasty Variable Tunneling (n=35) Venoplasty (n=60) p-value Age Y 67 (23–84) 70 (29–91) 0.25 Male (%) 24 (69%) 41 (68%) 0.98 Number of existing leads 2.1 (1–4) 2.4 (0–4) 0.1 Age of oldest lead 7.0 (0–21) 7.2 (0–33) 0.73 Number of new leads 1.2 (1–3) 1.4 (1–3) 0.26 Fluoroscopy time (SD) min 29.2 (21.3) 39.7 (21.5) 0.012 Procedure success (%) 35 (100%) 55 (92%) 0.9 Acute complications (%) 8 (23%)1 0 (0%) 0.0002   Pocket hematoma/bleed 4 (11%)2   Hemothorax 2 (6%)3   Pericarditis 1 (3%)   Lead compromise 1 (3%) Follow up M 18 (0–76) 28 (0–98) N/A Long term lead issues (%) 6 (17%) 10 (17%) 0.95 Long term complication requiring intervention 4 (11%) 8 (13%) N/A Procedure success: functional lead placed as a result of venoplasty or tunneling. 1Two patients required blood products. 2Two patients required invasive intervention. 3One patient required chest tube and the other ICU admission.

Conclusions
Balloon venoplasty is associated with similar rates of success and a less incidence of acute complications when compared subcutaneous tunneling.

Acknowledgement/Funding
NIH T32 Training Grant HL07111-40
P2872Remote management of heart failure patients with the multisensor ICD alert: preliminary results from the Italian pilot experience
Authors: De Ruvo E , Capucci A , Santini L , Pecora D , Favale S , Molon G , Petracci B , Bianchi V , Cipolletta L , Calo' L , Ammirati F , La Greca C , Santobuono V E , Campari M , D'Onofrio A 
Published: October 2019

Abstract

Background
The HeartLogic (Boston Scientific) 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.

Objective
To describe a preliminary experience of remote HF management of patients who received a HeartLogic-enabled ICD or cardiac resynchronization therapy ICD (CRT-D) in clinical practice.

Methods
The HeartLogic feature was activated in 101 patients (74 male, 71±10 years, ejection fraction 30±7%). From implantation to activation (blinded phase), the HeartLogic index trend was not available, thus no clinical actions were taken in response to it. After activation (active phase), remote data reviews and patient phone contacts were performed monthly and at the time of HeartLogic alerts (when the index crossed the nominal alert threshold value of 16), to assess the patient decompensation status. In-office visits were performed when deemed necessary.

Results
During the blinded phase, the HeartLogic index crossed the threshold value 24 times (over 24 person-years, 0.99 alerts/pt-year) in 16 patients. HeartLogic alerts preceded all hospitalizations and unplanned in-office visits for HF (sensitivity: 100%, median early warning: 38 days for hospitalizations, 12 days for HF visits). No clinical events were detected during or within 30 days of recovery of 10 HeartLogic alerts (unexplained alert rate: 0.41 per patient-year). Thus, the positive predictive value was 58% (14/24). During the active phase, 44 HeartLogic alerts were reported (over 46 person-years, 0.95 alerts/pt-year) in 30 patients. 26 (59%) HeartLogic alerts were judged clinically meaningful (i.e. associated with worsening of HF and/or influenced the clinician's decision to make changes to the subject's management).

Conclusions
In this first description of the use of HeartLogic in clinical practice, the algorithm demonstrated its ability to detect gradual worsening of HF. The results of the blinded phase of our experience favorably compare with those reported in the validation study. In the active phase, the HeartLogic index provided clinically meaningful information for the remote management of HF patients.