bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical cardiac sympathetic denervation in patients with VT storm: long term follow-up data
Authors: Barwad P , Lokhandwala Y.Y , Kumar B , Vyas A , Shah V , Vichare S , Bachani N 
Published: November 2020

Abstract

Background
Surgical Cardiac Sympathetic Denervation (CSD) is a procedure which involves surgical removal of terminal cervical and thoracic sympathetic ganglion for reducing sympathetic discharge to the heart. CSD is usually performed as a last desperate measure in treatment of ventricular tachycardia (VT). We report here the clinical profile and long-term follow-up of all our patients who underwent CSD (unilateral or bilateral) predominantly upfront prior to considering catheter ablation of VT for VT storm.

Material and methods
We retrospectively collected data of all patients who underwent CSD for VT storm between year 2010 till 2019. Success of CSD was defined as successful discharge of patient from the hospital after the procedure more than 75% decrease in the frequency of VT after two weeks of surgical procedure.

Results
A total of 65 patients underwent CSD in the above-mentioned period and the average duration of follow-up was 28 months. The clinical parameters, demographic data and outcome analysis is provided in details in table 1. Only 14 (21.5%) patients underwent attempt of catheter ablation of VT prior to considering CSD. CSD was successful in 53 (81.5%) of patients. There was a significant decline in the incidence of number of ICD or external shocks before and after CSD (25.2±39.4 vs 1.09±2.9) respectively. There was no significant effect of CSD on ejection fraction. None of the available clinical parameters predicted the success of CSD.

Discussion and conclusion
The current retrospective analysis reemphasize the role of surgical CSD in treatment of patients with VT storm. As in predominant patient's CSD was performed even before the attempting catheter-based ablation, it brings in a new dimension in the treatment of VT. Efficacy of CSD (81.5%) in experienced hand is equivalent or even better than catheter-based ablation in patients with VT storm.

Funding Acknowledgement
Type of funding source: None
First two MRI guided stereotactic body radiation therapy of recurrent sustained ventricular tachycardia
Authors: Kovacs B , Mayinger M , Tanadini-Lang S , Ehrbar S , Wilke L , Chamberlain M , Duru F , Steffel J , Garcia Schueler H.I , Manka R , Ruschitzka F , Guckenberger M , Andratschke N , Saguner A.M 
Published: November 2020

Abstract

Background
Stereotactic body radiation therapy (SBRT) is emerging as a bail-out treatment in patients suffering from therapy resistant ventricular tachyarrhythmias (VT).

Purpose
We report the worldwide first cases of real-time magnetic resonance image guided SBRT (MR-SBRT) in recurrent sustained VT and electrical storm (ES) due to dilated cardiomyopathy (DCM).

Methods
The patients were male, 71- (patient A) and 74-year-old (patients B) suffering from recurrent VT and ES with ICD shocks, despite guideline-directed medical therapy including maximal antiarrhythmic therapy. Patient A had two endocardial radiofrequency catheter ablation (RFA) and one epicardial surgical RFA and patient B had one endocardial RFA prior. An interdisciplinary decision was made to perform MR-SBRT in palliative intent to minimize repetitive ICD shocks.

Results
Areas of VT-substrate were identified to build a volumetric target using the performed EP studies as well as cardiac MRI and CT. A single fraction of 25Gy at isodose 80% was delivered to a planned target volume of 115.1ml and 73ml in the anterior/anteroseptal basal regions in patients A and B, respectively on a dedicated MR linac using real-time MRI tracking. Patient A developed a prolonged ES interpreted as acute radiation-induced inflammation following the treatment, which ceased two days after administration of high-dose dexamethasone. Patient B had no immediate adverse effects from the treatment. Left-ventricular ejection fraction remained stable in both patients at 25%. Both patients had significant improvement of their quality of life. Patient A died 222 days after MR-SBRT due to recurrent ES at another hospital. Patient B is free from VT over six months after treatment.

Conclusion
In these first two cases, we demonstrate feasibility, safety and short-term efficacy of MR-SBRT.
ICD therapies before and after MR-SBRT

Funding Acknowledgement
Type of funding source: None
High rate pacing guided by short-term variability of repolarization prevents imminent ventricular arrhythmias autonomically by an ICD
Authors: Smoczynska A , Loen V , Hernandez A.A , Beekman H.D.M , Meine M , Vos M.A 
Published: November 2020

Abstract

Background
The anesthetized, chronic complete atrioventricular block (CAVB) dog model allows reproducible inducibility of Torsade de Pointes (TdP) arrhythmias due to ventricular remodeling and after a challenge with an IKr-blocker. High rate pacing (HRP) prevents ventricular arrhythmias, but has long-term detrimental effects on cardiac function when applied continuously. Temporal dispersion of repolarization, quantified as short-term variability (STV), increases prior to ventricular arrhythmias and has been proposed as a marker to guide HRP.

Purpose
A proof-of-principle study to show STV determined automatically and in real-time by an ICD can guide HRP to prevent imminent ventricular arrhythmias.

Methods
Eight CAVB dogs were implanted with an ICD (Medtronic, lead in the right ventricular (RV) apex), with software to automatically determine STV online (STV-ICD). STV was determined from the activation recovery interval (ARI) of 31 consecutive beats with the formula: STV = Σ|ARI(n+1) − ARI(n)|/(N*√2). The CAVB dogs were challenged twice with dofetilide (0.025 mg/kg i.v. in 5 minutes or until the first TdP). In the first experiment, the individual STV-ICD threshold was determined prior to the first arrhythmic event and programmed into the ICD. In a serial experiment, HRP was initiated automatically once the STV-ICD threshold was reached, by gradually increasing the heart rate to 100 bpm. Occurrence of TdPs was monitored for 10 minutes from the start of dofetilide infusion in both experiments. During HRP, STV was measured offline from RV electrograms (EGM) and left ventricular (LV) monophasic action potential durations (MAPD) (STV-offline).

Results
During the inducibility experiment, 8/8 dogs had repetitive TdPs and STV-ICD increased from 0.96±0.42 to 2.10±1.26 ms* (*p&lt;0.05). During the prevention experiment, all dogs reached the STV threshold. HRP decreased STV-offline from 2.02±1.12 to 0.78±0.28 ms*, which was accompanied by prevention of TdPs in 7/8 dogs* (Figure 1).

Conclusion
Temporal dispersion of repolarization, quantified as STV, can guide HRP automatically by an ICD to prevent ventricular arrhythmias.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Dutch Heart Foundation Public Private Partnership
Remote monitoring can predict lethal arrhythmic events through time-domain analysis of heart rate variability in patients with implantable cardioverter defibrillator
Authors: Shirakawa Y , Niwano S , Oikawa J , Saito D , Sato T , Matsuura G , Arakawa Y , Kobayashi S , Nishinarita R , Horiguchi A , Ishizue N , Kishihara J , Fukaya H , Ako J 
Published: November 2020

Abstract

Background
We prospectively collected device and heart rate data, i.e. heart rate variability (HRV), through remote monitoring (RM) of patients with implantable cardioverter defibrillator (ICD). Several studies have demonstrated usefulness of RM in implanted device patients, however, reports concerning the predictors of lethal ventricular arrhythmias are limited.

Purpose
The objective was to identify the predictors of lethal arrhythmic events (VT/VF).

Methods
Thirty-three patients (mean age: 50 years) with ICDs [with functionality of HRV analysis] were divided into 2 groups [VT/VF(+), VT/VF(−)]. Clinical, device (ventricular lead impedance; amplitude of ventricular electrogram), and HRV data were compared between the 2 groups. As the index of time-domain HRV analysis, NN intervals-index (SDNNi) was calculated for every 5 minutes, and the mean, maximum, and minimum SDNNi during the 24-hour period were used.

Results
During the observation period (median 12 months), 10 patients experienced VT/VF events. In HRV data, the mean, max, and min SDNNi were higher in VT/VF(+) than VT/VF(−) group (132.9±9.3 v.s. 93.5±6.1, p=0.0013; 214.6±10.6 v.s. 167.0±7.0, p=0.0007; 71.2±7.5 v.s. 43.9±4.9, p=0.0047). The other parameters did not exhibit significant difference. On logistic regression analysis, the mean SDNNi of 100.1, max SDNNi of 185.0 and min SDNNi of 52.0 as cut-off values for prediction of VT/VF event demonstrated significant receiver operating characteristics (ROC) curves (AUC=0.86, p=0.0007; AUC=0.84, p=0.0005; AUC=0.78, p=0.0030). Furthermore, in cases of VT/VF(+) group, the max ΔSDNNi, i.e., difference from baseline SDNNi, and min ΔSDNNi in 7 and 28 days preceding VT/VF events exhibited time course changes in comparison with baseline values. They were significant predictors of VT/VF events (max ΔSDNNi cut-off: 46.8, AUC=0.91, p=0.0002; min ΔSDNNi cut-off: −42.4, AUC=0.88, p=0.0014).

Conclusion
Time-domain analysis of HRV through RM may help identify patients at high risk of lethal arrhythmic events, and predict occurrence of such arrhythmic events.

Funding Acknowledgement
Type of funding source: None
Low-temperature electrocautery reduces lead-related complications: insights from the WRAP-IT study
Authors: Mittal S , Wilkoff B , Poole J , Kennergren C , Wright D , Berman B , Riggio D , Sholevar S , Moubarak J , Schaller R , Love J , Pickett R , Philippon F , Lande J , Tarakji K 
Published: November 2020

Abstract

Background
Patients with an existing cardiovascular implantable electronic device (CIED) often require a generator replacement or system upgrade/revision, during which some degree of dissection is usually necessary to free the existing lead(s). Commonly used techniques include blunt dissection, standard surgical electrocautery, or newer forms of electrocautery such as the low-temperature electrosurgical device (PlasmaBlade Soft Tissue Dissection Device) designed to minimize inadvertent thermal injury to leads.

Objective
Determine whether the dissection technique impacts the likelihood of developing a lead-related complication.

Methods
The WRAP-IT trial enrolled patients undergoing CIED replacement, upgrade, revision or de novo CRT-D implant. This analysis excluded patients undergoing a de novo procedure. All adverse events were adjudicated by an independent physician committee. Data were analyzed using Cox proportional hazard regression modeling, controlling for capsulectomies and lead dissections.

Results
5639 patients (mean [±SD] age: 70.6±12.7 years; 28.8% female) underwent a replacement/upgrade/revision. Electrocautery was used in 5203 (92.3%) patients and among these, low-temperature electrocautery was used in 1866 (35.9%) patients. Compared to standard electrocautery, low-temperature electrocautery was used more often when leads were dissected or mobilized (P&lt;0.001) or when a partial or complete capsulectomy was performed (P&lt;0.001). Use of low-temperature electrocautery was associated with a 31% reduction in lead-related complications (HR: 0.69, 95% CI: 0.49–0.98, P=0.037) (Figure).

Conclusion
The low-temperature electrosurgical device (PlasmaBlade) uses precise pulses of radiofrequency energy to dissect tissue with only minimal thermal damage. In this large cohort of replacement, revision, and upgrade procedures, use of low-temperature electrocautery led to significantly fewer lead-related complications.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Medtronic
Off-label combination of leadless pacemakers and subcutaneous defibrillators in bilateral venous occlusion: a new reimplantation strategy after lead extraction
Authors: Di Cori A , Viani S , Tolve S , Zucchelli G , Barletta V , Giannotti Santoro M , Parollo M , Cellamaro T , Branchitta G , Carluccio M , Segreti L , Paperini L , De Lucia R , Soldati E , Bongiorni M.G 
Published: November 2020

Abstract

Background
Subcutaneous implantable cardioverter-defibrillator (S-ICD) and leadless pacemakers (LPM) provide an alternative to transvenous implantable devices. Sometimes, after transvenous (TV) lead extraction, patients show a bilateral venous occlusion, resulting not eligible for TV reimplantation.

Purpose
This analysis was designed to provide preliminary data on feasibility and short-term outcome of an hybrid combination (Hyb) of s-ICD plus LPM after TV-ICD explantation, in patients without anatomical transvenous reimplantation options.

Methods
Among 2684 consecutive extracted patients, 31 (1.1%) were reimplanted with a LPM, 66 (2.4%) with a s-ICD and 6 (0.2%) patients with an Hyb combination. Hyb strategy was considered in patients with a pacing plus defibrillating indication, and an anatomical barrier, as bilateral superior venous occlusion or massive bilateral skin erosion.

Results
Hyb patients were old (72±10 years), with a prevalent ischemic disease (4/6) and a reduced ejection fraction (43±16%). Extraction indication was infection in 4 and severe venous occlusion in 2, and included 2 single chamber, 2 dual chamber and 2 biventricular ICD. After extraction, reimplantation timing was 7±6 days, LPM was implanted before and sICD the day after.
LPM reimplantation indication was sinus node dysfunction in 2 and AV block in 4. Implantation duration was 68±23 and fluoroscopy time 9.4±2.3 min. ICD reimplantation indication was primary prevention in 4 and secondary prevention in 2. Implantation duration was 118±10 min. No complications were observed. At 1 year, no complications were observed, including device related cross-talks.

Conclusions
The Hyb strategy is a potential option after TV-ICD explantation in pacemaker dependent patients, when transvenous implantation is not available.
Extraction and Reimplantation Session

Funding Acknowledgement
Type of funding source: None
Comparison of various instantaneous pulmonary arterial wedge pressure measurements with prognostic validation
Authors: Nagy A.I , Johnson J , Lund L.H , Manouras A 
Published: November 2020

Abstract

Background
Current recommendations on the diagnosis of pulmonary hypertension due to left heart disease (PH-LHD) emphasize the need for standardization of pulmonary arterial wedge pressure (PAWP) measurement. Instead of mean PAWP values instantaneous mid-A wave pressures or, in case of atrial fibrillation (AF), measurement 130–160 ms after the QRS onset is recommended. Recently, PAWP at the QRS onset has also been proposed. Our aim was to compare the various instantaneous PAWP measurements and assess the prognostic value of the derived diastolic pressure gradients (DPG) in heart failure (HF) patients.

Methods and results
PAWP and pulmonary arterial pressure (PAP) tracings of 116 patients with PH-LHD were manually analyzed offline. PAWP was measured in 4 different ways: 1. mean value [PAWPM]; 2.mid-A wave value in sinus, and at 10 ms intervals 130–160 ms following QRS onset in AF [PAWPR]; 3. at the onset of the QRS complex [PAWPQRS]; 4. pre C-wave point value [PAWPC]. The pre C-wave point was chosen as a reference for truly end-diastolic pressures. The corresponding DPGM, DPGR, DPGQRS and DPGC were calculated. The patients were followed for 17 (8–27) months and the prognostic value of the various DPG measurements for predicting all-cause mortality was assessed. The pre C-wave point was identifiable in 35 patients (30%); on average it occurred 171 ms after the QRS-onset whereas the A wave-onset and A-wave peak happened on average 62 and 149 ms after the QRS-onset, respectively. All three instantaneous PAWP measurements gave significantly lower values than PAWPM [19.3 (15.4–25.0)]. PAWPR did not differ from PAWPC [18.1 mmHg (14–22) vs. 19.2 mmHg (13–22.8), p=0.9], whereas PAWPQRS was lower [15.8 mmHg (12.2–19.9), p&lt;0.001]. Accordingly, all instantaneous DPG measurements were higher than DPGM, yielding lower prevalence of negative DPG (29%, 17% and 45%, for DPGR, DPGQRS and DPGM, respectively). In AF (n=30), DPGR values at 130–140–150–160 ms demonstrated increasing scatter and progressively overestimated DPGQRS. For prognostic assessment, in case of both DPGQRS and DPGR, 6 mmHg was identified as a best cut-off value for predicting all-cause mortality, at which both indices provided superior prognostic information than DPGM [DPGR: HR 2.7; CI 1.1–6.9, p=0.029; DPGQRS: HR 2.6; CI 1.1–6.4, p=0.037, high-risk cases 17 for both; DPGM: HR 2.8; CI 1.0–7.6, p=0.045, high-risk cases 10].

Conclusions
PAWP measured at the mid-A wave provides a reliable assessment of the end-diastolic PAWP in sinus rhythm. On the other hand, ECG-gated measurements yield more robust evaluation of PAWP in AF. Finally, both approaches carry significant and similar prognostic information in PH-LHD.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): AIN was supported by the János Bolyai Scholarship of the Hungarian Academy of Sciences
Resting coronary blood flow velocity profile predicts coronary flow reserve in HFpEF
Authors: Svedlund S , Brodin T , Hage C , Saraste A , Tan R.S , Beussink-Nelson L , Faxen U.L , Lagerstrom Fermer M , Lam C.S.P , Shah S.J , Lund L , Gan L.M 
Published: November 2020

Abstract

Background
Coronary microvascular disease (CMD) is prevalent in patients with heart failure with preserved ejection fraction (HFpEF). CMD can be assessed by coronary flow reserve (CFR) using transthoracic echocardiography (TTE). We hypothesised that the coronary Doppler flow profile in LAD at rest could reveal information about the downstream resistance in the vessel, where increased resistance is a sign of CMD.

Purpose
We aimed to measure features of the acceleration and deceleration of the LAD Doppler flow profile to investigate association with coronary and cardiac function.

Methods
CFR was assessed in 202 patients by TTE in the PROMIS-HFpEF-study. Detailed flow profile measurements were possible in 169 patients (84%) who constituted the study population. The coronary Doppler flow profiles were analysed with respect to acceleration time (corAT) and slope (corAS) and deceleration pressure half time (corPHT) (figure 1).

Results
The average age was 75±9 years and 55% were female. Atrial fibrillation (AF) was present in 53% and 62% were current or previous smokers. There was no significant difference in gender, age, BMI, blood pressure or heart rate in the CMD vs non-CMD group, but AF as well as a history of smoking was more prevalent in the CMD group, p=0.022 and 0.003 respectively. Further, there were no significant differences in neither corAT nor corAS between the two groups. However, patients with CMD had shorter corPHT of 268±64 ms compared to 298±67 ms, p=0.01. A longer corPHT was associated with increased TAPSE (R=0.205, p=0.007) and higher CFR (R=0.231, p=0.002). In a multivariable analysis adjusted for age, sex, BMI, SBP, reactive hyperemia index, HR, AF, diabetes, CVD, smoking, LVM and study site*, corPHT independently predicted CFR (table 1, p=0.016).

Conclusion
Short pressure half time, indicating a steep deceleration of the coronary Doppler signal at rest, may provide useful information for prediction of CFR determined by transthoracic ultrasound by reflecting the increased resistance in the coronary microvasculature associated with CMD.

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Sahlgrenska University Hospital, Sponsor AstraZeneca
Sex-specific effect of obesity on exercise capacity and diastolic function
Authors: Jung M , Ihm S.H , Han S , Jung H.O , Youn H.J , Ryu K.H 
Published: November 2020

Abstract

Background
Obese women are overrepresented in heart failure with preserved ejection fraction (HFpEF). We sought to 1) characterize the sex-specific effect of obesity on exercise capacity and diastolic function and 2) identify the determinant of exercise intolerance and diastolic dysfunction in each sex.

Methods
A total of 736 healthy participants, who underwent comprehensive health check-ups, were included in this study. All individuals were divided into 4 groups according to sex and presence of obesity (BMI ≥23kg/m2).

Results
The exercise capacity (peak VO2) was greatly affected by sex, which was worse in women. In addition, exercise capacity significantly differed according to obesity in women (23.5±7.3 vs. 21.3±5.4ml/kg/min, p&lt;0.05), whereas there was no such difference in men (28.2±7.8 vs. 28.0±6.6ml/kg/min, p&gt;0.10). Overall, women had an elevated E/e' ratio. Even non-obese women had a similar E/e' ratio to obese men (8.2±1.8 vs. 8.4±2.1, p&gt;0.10) and obese women exhibited the highest E/e' ratio over any other group (Fig 1). Among 5 parameters (aging, obesity, elevated blood pressure, elevated heart rate, and elevated fasting glucose), obesity was a significant determinant of exercise intolerance for women, but not for men (women, HR 1.87 [95% CI 1.12–3.11], p=0.016; men, HR 1.22 [95% CI 0.63–2.38], p=0.558). Furthermore, obesity confers a greater risk of diastolic dysfunction in women than men (women, HR 4.03 [95% CI 2.24–7.25], p&lt;0.001; men, HR 2.82 [95% CI 1.37–5.79], p=0.005).

Conclusions
Women had a more deleterious effect on exercise capacity and diastolic function in response to obesity than men. These sex-specific effects might explain the female predominance of HFpEF, particularly for the obese phenotype.
Figure 1

Funding Acknowledgement
Type of funding source: None