bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pacing of the interventricular septum with His bundle engagement, unlike myocardial pacings of the right ventricle, does not lead to ventricular dyssynchrony, as assessed by ultra-high frequency ECG
Authors: Curila K , Jurak P , Karch J , Halamek J , Prochazkova R , Stros P , Plesinger F , Smisek R , Waldauf P , Susankova M , Herman D , Osmancik P , Widimsky P 
Published: November 2020

Abstract

Background
Nonselective pacing of the distal His bundle is practically just another way of right ventricular septal pacing. It leads to the concomitant activation of the His bundle and septal myocytes with unknown impact on ventricular synchrony. Ultra-high frequency ECG (UHF-ECG) is a novel tool for ventricular depolarization imaging.

Purpose
To describe ventricular depolarization patterns during nonselective pacing of a ventricular aspect of His bundle and myocardial captures from different locations in the right ventricle by using the UHF-ECG.

Methods
Consecutive patients with an indication for permanent pacing due to bradycardia were included. During pacemaker implantation, the pacing lead was temporarily placed in prespecified locations of the right ventricle (mid-septum, anterior, lateral wall, and the para-hisian area of the RV). When pacing from mentioned locations, myocardial activation time under each specific lead (Vd), and ventricular dyssynchrony (e-DYS) indexes were calculated from UHF-ECG maps, for each particular type of pacing. The demonstration of UHF-ECG maps during pacing from different locations of the right ventricle is shown in the figure.

Results
Two hundred and fifty UHF ECG recordings were performed in forty-six patients. The calculated mean e-DYS parameter was significantly shorter during non-selective capture of the distal His bundle (14±8 ms) compared to each of myocardial captures of the right ventricle (pure myocardial para-hisian; 35±12 ms, mid-septal; 28±11 ms, anterior wall; 51±16 ms and lateral wall; 62±19 ms (p&lt;0.001). The Vd was also shortest during non-selective capture of the distal His bundle (39±5 ms) compared to each of the others (pure myocardial para-hisian; 52±11 ms, RV mid-septal; 57±11 ms, RV anterior wall; 68±12 ms and RV lateral wall pacing; 85±14 ms (p&lt;0.001).

Conclusion
Pacing of the basal interventricular septum with the engagement of the His bundle produced a superior depolarization pattern in both heart ventricles compared to other types of right ventricular myocardial capture, as assessed using UHF-ECG.
Figure 1. Examples of UHF-ECG depolarization maps of different types of ventricular activation in the same patient.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Charles University in Prague
Novel plasma biomarkers in arrhythmogenic cardiomyopathy: the role of ST2 and GDF-15 in predicting biventricular involvement
Authors: Akdis D , Chen L , Saguner A.M , Zhang N , Gawinecka J , Saleh L , Von Eckardstein A , Ren J , Matter C , Hu Z , Ruschitzka F , Chen X , Brunckhorst C , Song J , Duru F 
Published: November 2020

Abstract

Background
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited heart muscle disease characterized by fibrofatty replacement of the myocardium and ventricular arrhythmias. Biventricular (BiV) involvement in ARVC may lead to heart failure.

Purpose
This study aimed to investigate the role of novel plasma biomarkers soluble (s)ST2, Galectin-3 (Gal-3) and GDF-15 in predicting BiV involvement and adverse outcomes in ARVC patients.

Methods
ARVC patients from two independent cohorts were studied. 108 patients were included from the discovery cohort and 47 patients were included from a second validation cohort. All patients had a definite ARVC diagnosis at time of blood withdrawal. sST2, Gal-3 and GDF-15 were independently correlated with NT-proBNP, left ventricular (LV) ejection fraction, late gadolinium enhancement by cardiac magnetic resonance (CMR) imaging and clinical outcome.

Results
ARVC patients with LV involvement had higher levels of sST2 and GDF-15 as compared to controls and patients with isolated right ventricular involvement. sST2 and GDF-15 significantly correlated to late gadolinium enhancement on CMR and also correlated to adverse heart failure outcomes. Gal-3 was elevated in ARVC patients with and without LV involvement as compared to controls. The combined use of the three biomarkers (NT-proBNP, sST2 and GDF-15) showed the best performance in predicting LV involvement in both the discovery and the validation cohort. Plasma drawn from coronary arteries and coronary sinus showed a transmyocardial elevation of sST2.

Conclusion
Our study shows that sST2 and GDF-15 may predict BiV involvement and the combined use of NT-proBNP, sST2 and GDF-15 shows the best prediction of LV involvement in ARVC. Transmyocardial elevation of sST2 suggests that this biomarker is produced by myocardial tissue in ARVC.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Fuwai ARVC Program was supported by CAMS Innovation Fund for Medical Sciences and the National Natural Science Foundation of China, Zurich ARVC Program was supported by grants from the Schwyzer Foundation and Baugarten Foundation
Prognostic significance of negative T-waves and low amplitude T-waves in the general population
Authors: Holkeri A , Eranti A , Haukilahti M.A.E , Kerola T , Kentta T.V , Noponen K , Seppanen T , Rissanen H , Heliovaara M , Knekt P , Junttila M.J , Huikuri H.V , Aro A.L 
Published: November 2020

Abstract

Background
Negative T-waves are associated with sudden cardiac death (SCD) in the general population. Whether also low amplitude T-waves link to SCD risk in the general population is unknown.

Purpose
We investigated the prognostic significance of T-wave abnormalities in a general population cohort.

Methods
We evaluated the ECGs of 6584 Finnish general population subjects aged ≥30 years (mean age 51.2±13.9, 45.6% men) and classified them according to the T-wave morphology to 3 classes: 1) negative T-waves (negative T-wave with amplitude ≥0.1mV in ≥2 of the leads I, II, aVL, V4-V6), 2) low amplitude T-waves (negative or positive T-wave with amplitude &lt;0.1mV and amplitude ratio of T-wave and R-wave ≤10% in ≥2 of the leads I, II, aVL, V4-V6), and 3) normal T-waves (not meeting the criteria for negative or low amplitude T-waves). Subjects were followed for 10 years for the occurrence of SCD, cardiac death, or death from any cause.

Results
A total of 239 subjects (3.5%) had negative T-waves, 869 (12.7%) low amplitude T-waves, and 5746 (83.8%) normal T-waves. The Table shows the baseline characteristics. Subjects with T-wave abnormalities were older and had more often cardiovascular morbidities than subjects with normal T-waves. Cardiovascular morbidities were most common in subjects with negative T-waves. After adjusting for multiple clinical factors, negative T-waves (HR 3.91; 95% CI 2.30–6.64) and low amplitude T-waves (HR 1.80; 95% CI 1.13–2.86) were associated with SCD, when compared to normal T-waves. Furthermore, both negative T-waves and low amplitude T-waves associated with cardiac death (HR 2.34; 95% CI 1.75–3.13 and HR 1.49; 95% CI 1.17–1.91, respectively) and death from any cause (HR 1.85; 95% CI 1.50–2.27 and HR 1.45; 95% CI 1.24–1.70, respectively). The Figure displays the survival plots for SCD according to T-wave group.

Conclusion
In addition to negative T-waves, low amplitude T-waves also associate with SCD risk in the general population. Focus should be also placed on these minor T-wave abnormalities in the future.
Kaplan-Meier plot

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Finnish Medical Foundation, Aarne Koskelo Foundation
Association of acute resuscitation and post-resuscitation survival with overall risk-standardized survival to discharge for in-hospital cardiac arrest
Authors: Girotra S , Nallamothu B , Tang Y , Chan P 
Published: November 2020

Abstract

Background
Although survival for in-hospital cardiac arrest (IHCA) varies markedly across sites, it remains unknown whether high survival at top-performing hospitals is due to high rates of acute resuscitation survival (i.e., achievement of return of spontaneous circulation [ROSC]), post-resuscitation survival (i.e., survival to discharge among patients who achieved ROSC), or both.

Methods
Using 2015–2018 Get With The Guidelines (GWTG)-Resuscitation data, we identified 290 hospitals (86,426 patients) with IHCA. For each hospital, we calculated overall risk-standardized survival (RSSR) to discharge for IHCA using a previously validated hierarchical regression model and categorized hospitals into quartiles based on that metric. Risk-adjusted rates of acute resuscitation survival (defined as return of spontaneous circulation for &gt;20 minutes [ROSC]) and post-resuscitation survival (defined as the proportion of patients achieving ROSC who survived to hospital discharge) were also computed for each hospital. We examined the correlation between a hospital's overall RSSR with its risk-adjusted rate of acute resuscitation and post-resuscitation survival.

Results
Among study hospitals, the median RSSR was 25.1% (inter-quartile range [IQR]: 21.9%–27.7%). The median risk-adjusted rate of acute resuscitation survival was 72.4% (IQR: 67.9%–76.9%) and post-resuscitation survival was 34.0% (IQR: 31.5%–37.7%). Hospital rates of RSSR were less strongly correlated with risk-adjusted rates of acute resuscitation survival (rho=0.50, P&lt;0.001) than post-resuscitation survival (rho=0.90, P&lt;0.001). Compared with hospitals in the lowest quartile of RSSR, hospitals in the highest quartile had substantially higher rates of acute resuscitation survival (Q4: 75.4% vs. Q1: 66.8%; P&lt;0.001) and post-resuscitation survival (Q4: 40.3% vs. Q1: 28.7%; P&lt;0.001). Notably, there was no correlation between hospital risk-adjusted rates of acute resuscitation survival and post-resuscitation survival (rho=0.09, P=0.11).

Conclusion
Hospital that excel in overall IHCA survival in general excel in either acute resuscitation or post-resuscitation care. As most hospital-based quality improvement initiatives largely focus on acute resuscitation survival, our findings suggest that efforts to strengthen post-resuscitation care may offer additional opportunities to improve IHCA survival.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): NHLBI
Combined endocardial and epicardial ventricular tachycardia ablation for ischemic and nonischemic dilated cardiomyopathy
Authors: Nascimento Matos D , Adragao P , Pisani C , Hatanaka V , Freitas P , Costa F , Chokr M , Hardy C , Ferreira A.M , Carmo P , Laura S , Morgado F , Cavaco D , Mendes M , Scanavacca M 
Published: November 2020

Abstract

Background
Patients with ischemic (IHD) and nonischemic (NICM) dilated heart disease and reduced left ventricular ejection fraction are at increased risk of ventricular tachycardias (VTs) or sudden cardiac death. VT catheter ablation is an invasive treatment modality for antiarrhythmic drugs-resistant VT that reduces arrhythmic episodes, improves quality of life and improves survival in patients with electrical storm. Direct comparison of the outcomes from combined and non-combined endoepicardial ablations is limited by patient characteristics, follow-up durations, protocols heterogeneity and scarcity of randomized trials. We aim to investigate the long-term clinical outcomes of these 2 strategies in the IHD and NICM populations.

Methods
Multicentric observational registry including 316 consecutive patients who underwent combined (C-ABL) and non-combined (NC-ABL) endoepicardial ventricular tachycardia (VT) ablation for drug-resistant VT between January 2008 and July 2019. Chagas' disease patients were excluded. Primary and secondary efficacy endpoints were defined as VT-free survival and all-cause death after ablation. Safety outcomes were defined by 30-days mortality and procedure-related complications.

Results
Most of the patients were male (85%), with IHD (67%) and a mean age of 63±13 years. During a mean follow-up of 3±2 years, 117 (37%) patients had VT recurrence and 73 (23%) died. Multivariate survival analysis identified storm (ES) at presentation (HR=2.17; 95% CI 1.44–3.25), IHD (HR=0.53, 95% CI 0.36–0.78), left ventricular ejection fraction (LEVF) (HR=0.97, 95% CI 0.95–0.99), New York Heart Association (NYHA) functional class III or IV (HR=1.79, 95% CI 1.13–2.85) and C-ABL (HR=0.49, 95% CI 0.27–0.92) as independent predictors of VT recurrence. In 135 patients undergoing two or more ablation procedures only C-ABL (HR=0.36, 95% CI 0.17–0.80) and ES at presentation (HR=2.42, 95% CI 1.24–4.70) were independent predictors of arrhythmia recurrence. The independent predictors of all-cause mortality were ES (HR=2.17, 95% CI 1.33–3.54), LVEF (HR=0.95, 95% CI 0.92–0.98), age (HR=1.03, 95% CI 1.01–1.05), NYHA functional class III or IV (HR=2.04, 95% CI 1.12–3.73), and C-ABL (HR=0.22, 95% CI 0.05–0.91). The survival benefit was only seen in patients with a previous ablation (P for interaction=0.04) – Figure 1. Mortality at 30-days was similar between NC-ABL and C-ABL (4% vs. 2%, respectively, P=0.777), as was the complication rate (10.3% vs. 15.1% respectively, P=0.336).

Conclusion
A combined endo-epicardial approach appears to be associated with greater VT-free survival and overall survival in ischemic and nonischemic patients undergoing repeated VT catheter ablations. Both strategies seem equally safe.
Survival analysis for C-ABL vs NC-ABL

Funding Acknowledgement
Type of funding source: None
Electrograms guided his bundle pacing implant: moving from radiology to electrical signals
Authors: Zanon F , Marcantoni L , Pastore G , Baracca E , Picariello C , Lanza D , Maddalozzo A , Roncon L 
Published: November 2020

Abstract

Background
The standard technique to His Bundle Pacing (HBP) based on a fluoroscopic approach might be challenging and fluoro consuming. The electrical signals could lead to a precise and rapid lead implant, thus reducing the fluoroscopy time (FT) and X-ray dose.

Objective
To evaluate the feasibility, efficacy and safety of the electrogram-guided technique to obtain His Bundle pacing (HBP) with minimal or no fluoroscopy use.

Methods
Between October and December 2018, 41 consecutive patients with indication for pacing underwent HBP with the electrogram-guided approach.

Results
Successful HBP was obtained in 39/41 (95%) pts, which is the study population (mean age 78±10 years). S-HBP and NS-HBP were achieved in 23 (59%) and 16 (41%) pts, respectively. Final HBP lead position was achieved in 31/39 (79.4%) pts with zero fluoroscopy, only guided by the electrical signals. In the remaining 8 pts a minimal dose of fluoro (mean 8 sec) has been required to locate the His. Fluoroscopy has been routinely used to remove the sheath and to ensure the slack. The atrial lead has been implanted in a standard fashion. No difference was observed in the FT for HBP lead placement in patients with S-HBP and NS-HBP (mean 8.1±25 sec vs 7.5±20 sec, p=0.8; median value 0 sec vs 0 sec). Moreover, no significant differences were observed in the FT needed for the entire procedure, total Dose Area Product (DAP) and total procedural time among both S-HBP and NS-HBP. The His lead dislodgement occurred in 1 (2.6%) patient one day after the procedure.

Conclusion
HBP could be performed safely and efficiently using the electrograms, with minimal or no fluoroscopy. Fluoroscopy was required during sheath removal and atrial lead placement.

Funding Acknowledgement
Type of funding source: None
Development of machine learning models to predict response after cardiac resynchronization therapy
Authors: Liang Y , Ding R , Zhu S , Su Y , Ge J 
Published: November 2020

Abstract

Background
There have been few practical and precise tools to predict response after cardiac resynchronisation therapy (CRT).

Purpose
We intend to develop predictive models using machine learning (ML) approaches and easily available features prior to implantation.

Methods
The baseline features of 596 patients receiving CRT were retrospectively collected. Nine predictive models were established, including logistic regression (LR), Elastic Net (EN), lasso regression, ridge regression (Ridge), neural network, support vector machine (SVM), random forest, XGBoost and k-nearest neighbor. Sensitivity, specificity, precision, accuracy, F1, area under receiver operating characteristic curve (AU-ROC) and average precision of each model were evaluated, and AU-ROC was compared between each pair of ML models and further between ML models and the latest guidelines.

Results
Sensitivity was highest with SVM by 0.69, and specificity was highest with LR by 0.81. The models EN and Ridge showed the highest overall predictive power with an average AU-ROC of 0.77. Specifically, the Ridge model provided significant higher AU-ROC than any other model (all P&lt;0.05). All ML models showed significant higher AU-ROC than those derived from the latest guidelines (all P&lt;0.05). Additionally, the effect size analysis identified LBBB, LVESD, and history of PCI as the most crucial predictive features.

Conclusion
ML algorithms produced efficient predictive models for evaluation of response after CRT with features prior to implantation. Tools developed accordingly might improve selection of CRT candidates and reduce rate of non-response in the future.
ROC and PR curves of predictive models

Funding Acknowledgement
Type of funding source: None
Threshold stability using active fixation LV lead
Authors: Diaz Exposito A , Ruiz Salas A , Medina C , Barrera A , Alzueta J , Gomez Doblas J.J 
Published: November 2020

Abstract

Introduction
The proper functioning of the CRT devices depends on the correct positioning of the electrodes, sometimes being compromised by the absence of suitable epicardial veins, leads instability or unacceptable high thresholds, among other. In 2017, a novel quadripolar active fixation LV lead was released with an innovative helical mechanism that expands to attach the lead within the vessel.

Objectives
Study the impact of the active fixation LV lead on threshold stability and dislocations.

Methods
We included 127 consecutive patients undergoing CRT between September 2017 to December 2019 in one hospital. They were randomly assigned: 62p active fixation VI leads vs 65p standard VI leads. LV thresholds, capture losses and dislocations were collected at standard pacing checks (1 week, 2 months, 6 months).

Results
The mean age of the sample was 73,9±8,4 years. 75% patients were male and 48,4% suffered ischemic cardiomyopathy. The two groups were similar according to this variables. 5 (7.7%) dislocations were reported in the control group against 2 (3.2%) in the active fixation group (n.s). The mean threshold (V) at the moment of the implant was 1,4 in the active fixation vs 1,41 in the standard LV leads; at the first visit 1,55 vs 1,99; at two months 1,59 vs 2,13 and at six months 1,74 vs 2,48.
The threshold stability is shown in Figure 1.

Conclusions
– The active fixation LV lead provides higher threshold stability than the conventional one.
– There is a non-significant tendency to reduce dislocations.
Figure 1

Funding Acknowledgement
Type of funding source: None
Impact of chronic sequential LV-RV pacing with cardiac resynchronization therapy for patients with narrower (&lt;130 ms) QRS complexes following evaluation of acute myocardial strain characteristics
Authors: Kantharia B , Singh A , Karnik R , Shah A , Wu L , Narasimhan B 
Published: November 2020

Abstract

Background
Prior studies have shown acute improvement in myocardial strain patterns (SP) and strain rates (SR), left ventricular ejection fraction (LVEF), and long-term clinical improvement by Cardiac Resynchronization Therapy (CRT) preferential LV pacing. This relationship has not been studied in patients (pts) with narrower QRS.

Objectives
We aimed to evaluate myocardial speckle tracking SP and SR at different VV intervals in pts with narrow (&lt;130 ms) and wide (&gt;130 ms) QRS.

Methods
We assessed LVEF and speckle tracking myocardial SP and SR as per the American Society of Echocardiography (ASE) Dyssynchrony Writing Group methods in pts with CRT in acute settings at VV0, VV60 and LV-only pacing. For SP assessment, we used Bull's eye format display of the LV segments, and scores for SR, 2 = early stretch, late peak, 1= early stretch, early peak, and 0 = single peak at aortic closure.

Results
Total cohort of 271 pts; age 69.2±10.3 yrs (mean ± SD), male - 60%, divided into 2 groups; Gp A (QRS &lt;130 ms, n=69) and Gp B (QRS &gt;130 ms, n=202). QRS width and LVEF in Gp A and B were 120.1±12.3 ms and 152.1±12.9 ms, and 22.3±9.4% and 23.3±10.2% respectively. With VV0 increase in LVEF, 67±6.0% from baseline 22.3±9.4% was seen in Gp A compared to 43±6.5% from 23.3±10.2% in Gp B (p&lt;0.01). With VV60 and LV-only pacing further rise in LVEF to 100.0±7.1% and 112.0±7.2% in Gp A and 80.2±8.0% and 93±8.1% in Gp B was seen. (Figure 1). Strain scores at different VV timings in both groups are shown in Table 1.

Conclusions
In pts with CRT, different VV timings show differences in acute myocardial speckle tracking SP and SR, and LVEF. These changes are markedly favorable with LV-only and sequential LV-RV pacing even in pts with narrower QRS. Our findings support chronic sequential LV-RV pacing programming in CRT pts with narrow QRS.
Figure 1

Funding Acknowledgement
Type of funding source: None
Clinic time required to manage cardiac implantable electronic device patients: a time and motion workflow evaluation
Authors: Biundo E , Burke A , Rosemas S , Lanctin D , Nicolle E 
Published: November 2020

Abstract

Background
The population with cardiac implantable electronic devices (CIEDs) is growing, creating workload for device clinics to manage these patients. However, the CIED follow-up workflow is poorly understood. This study sought to characterize the workflow and staff time for CIED patient management.

Methods
A time and motion workflow evaluation was performed in 6 U.S. CIED clinics, which manage an average of 4,217 patients. Each task involved in CIED management was repeatedly timed, including all manufacturers, during 1 business week at each clinic. Mean staff time for a remote transmission and an in-person visit were calculated, including all clinical and administrative (e.g: scheduling, documentation) activities related to the encounter. Annual staff time for follow-up of 1 patient was modeled using CIED transmission data for the 6 clinics, guidelines for CIED follow-up, and published literature.

Results
124 clinic visits and 1,374 remote monitoring activities were observed. Staff time required per remote transmission ranged from 12.1–13.4 minutes (depending on the CIED type), and time per visit was 43.4–51.0 minutes. Including all remote and in-person follow-ups, the estimated total staff time per year to manage one pacemaker, ICD, CRT, and ICM patient was 2.3, 2.4, 2.4, and 9.3 hours, respectively (Table 1).

Conclusion
CIED clinic workflow is complex and requires significant staff time. Remote monitoring is an efficient complement to in-office visits, allowing for continuous follow-up of patients. Future research should examine heterogeneity in clinic processes to identify the most efficient workflow.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Medtronic