bluuebunny/crossref_metadata_2025_split huggingface dataset:
Home fitting of electrocardiogram (ECG) ambulatory monitors during covid-19
Authors: Muddassir Z , Padmadas H , Khan S , Krishnathasan K 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Interruption of health services during COVID-19 leading to increased risk to patients and a backlog for vital outpatient cardiac diagnostic services.

Purpose
To safely deliver ambulatory ECG monitors whilst reducing risk to patients and staff by providing monitors to be fitted at home.

Methods
A system was developed whereby monitors were set up for the patient/carer to collect a preassembled pack and fit at home using videos/written instructions. A retrospective evaluation was undertaken over four months (12/4/20 – 12/08/20) through feedback questionnaires containing closed and open-ended questions.

Results
Of a total of 726 ECG ambulatory monitors fitted in this period 60% were self-fitted. 97 patients gave feedback (13.3%). 84.4% of patients were satisfied with the process. 58.33% felt safer fitting it at home as 40% were fitted in-house due to limitations e.g. elderly/wheelchair/pregnant patients and/or those without access to view the videos. 6 monitors (&lt;1%) were refitted due to artefact/early disconnection. Improvement suggestions implemented included simplifying instructions and adding specific information for female electrode placement.

Conclusions
This project enabled vital cardiac diagnostics whilst maintaining social distancing - reducing infection risk and achieving high patient satisfaction. Implementing a locker system will decrease differing instructions and positively impact waiting times to further reduce viral transmission risks.
Implantable loop recorders in patients with a structural or electrical heart disease: comparison of the clinical value in patients with and without a history of syncope
Authors: Assaf A , Sakhi R , Michels M , Roos-Hesselink JW , Verhagen JMA , Baghwandien RE , Szili-Torok T , Theuns DAMJ , Yap SC 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background Patients with structural and electrical heart disease are at increased risk for sudden cardiac death. Guidelines recommend the use of an implantable loop recorder (ILR) in symptomatic patients when symptoms are sporadic and suspected to be related to arrhythmias. In clinical practice, an ILR is mainly used in patients with unexplained syncope.
Purpose To compare the clinical value of an ILR in patients with a heart disease and a history of syncope versus those with non-syncopal suspected arrhythmia-related symptoms.
Methods In this observational single-center study we included symptomatic patients with structural or electrical heart disease who received an ILR. The primary endpoint was an actionable event which was defined as an arrhythmic event leading to a change in clinical management. The secondary endpoint was an event leading to implantation of a pacemaker or implantable cardioverter-defibrillator (ICD).
Results A total of 120 patients (mean age 47 ± 17 years, 49% men) were included. Underlying disease substrate was inherited cardiomyopathy (31%), congenital heart disease (28%), channelopathy (23%), and other structural heart disease (18%).There were 43 patients with a history of syncope (group A) and 77 patients with non-syncopal symptoms (group B) such as palpitations, dizziness and/or near-syncope at baseline. During a median follow-up of 19 months (IQR 8-36), a primary endpoint was reached in 14 patients (33%) of group A, and in 28 patients (36%) of group B (logrank P = 0.54, Figure A). There was also no significant difference in the cumulative rate of cardiac device implantation between group A and B, 14% versus 10%, respectively (logrank P = 0.97, Figure B).
Conclusion Our results show no differences in ILR yield in patients with structural or electrical heart disease who present with any suspected arrhythmia-related symptom, including those with non-syncopal symptoms. Abstract Figure.
Late gadolinium enhancement as a predictor of arrhythmias in patients with hypertrophic cardiomyopathy
Authors: Castelo A , Rosa S , Fiarresga A , Marques M , Portugal G , Cunha P , Bras P , Ferreira V , Mendonca T , Oliveira M , Ferreira R 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Patients with hypertrophic cardiomyopathy (HCM) are at increased risk of arrhythmias and sudden cardiac death (SCD). The Late gadolinium enhancement (LGE) in cardiovascular magnetic resonance (CMR) has been associated with the occurrence of arrhythmic events.

Purpose
The aim was to analyze the association between LGE burden and location and arrhythmic events in HCM patients (P).

Methods
Retrospective analysis of P with HCM in a single tertiary center. Baseline clinical, echocardiographic and CMR characteristics were collected. On follow up arrhythmias (ventricular fibrillation (VF), sustained ventricular tachycardia (SVT), non-sustained ventricular tachycardia (NSVT), paroxysmal supraventricular tachycardia (PSVT), atrial fibrillation (AF) and atrial flutter (AFL)) were identified. LGE on CMR was compared between patients with and without arrhythmias.

Results
61P (59% male) were included, with a mean age of 58 ± 2 years. The HCM risk-SCD score was 3.35 ± 0.28%. On echocardiography mean left ventricle ejection fraction was 62.16 ± 1.36% and maximum wall thickness 20.59 ± 0.596mm. 31.1% had systolic anterior movement of mitral valve and 26.7% had left ventricle outflow tract obstruction. LGE was present in 88.5% P with a median number of 5 ± 7 segments involved. Interventricular septum (IVS) was involved in 78.7% P, anterior wall
in 57.4%, inferior wall in 54.1%, lateral wall in 52.5%, posterior wall in 9.8%, basal segments in 62.3%, median segments in 68.9% and apical segments in 63.9%. On follow up 3.3%P died, 45.8% had hospitalizations (22,2% because of an arrhythmia) and 75% had arrhythmias (1.6% VF, 6.6% SVT, 50% NSVT, 9.8% PSVT, 37.7% AF and 6.6% AFL). The number of segments with LGE correlated with arrhythmias (p = 0.05 for arrhythmias, p = 0.03 for SVT, p = 0.008 for NSVT and p = 0.042 for PSVT). A cut off of 5 segments involved was a good predictor of arrhythmias (p = 0.002), NSVT (p= 0.006), PSVT (p = 0.024) and AF (p = 0.0029). For SVT the best cut off was 9 (p = 0.003). Considering the LGE location, we found an association between the segments involved and the occurrence of different arrhythmias (table 1).

Conclusion
Supraventricular and ventricular Arrhythmias are frequent in patients with HCM, with the most frequents being NSVT and AF. The LGE burden (&gt;5 segments) and location (median inferior IVS, median anterior IVS, median anterior wall, basal anterior IVS, apical anterior wall, median inferior wall, apical anterior wall and basal inferior IVS) were correlated with arrhythmic events. Abstract Figure.
Buccal mucosa cells as a diagnostic tool in patients with arrhythmogenic cardiomyopathy
Authors: Van Der Voorn SM , Driessen HE , Van Lint FHM , Bourfiss M , Mirzad F , El Onsri L , Vos MA , Van Veen TAB 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Netherlands Cardio Vascular Research Initiative (CVON): the Dutch heart foundation

Background
Arrhythmogenic cardiomyopathy (ACM) is predominantly caused by mutations in genes encoding desmosomal proteins (most often multiple different mutations in plakophilin-2), however also mutations in non-desmosomal proteins like phospholamban (PLN, PLNR14Del) are found. Previous investigations showed that plakoglobin protein levels and localization in cardiac tissue of ACM patients is disturbed and this could be a valuable additional tool to discriminate between non-affected family members and those being at risk during progression of the disease. Information about cardiac plakoglobin status can only be obtained via endocardial biopsies, however, this technique has major draw-backs and risks, and therefore an alternative is needed. A promising new non-invasive tool is the use of buccal mucosa cells (BMC), as it has been reported that effects of mutations in desmosomal proteins are additionally reflected in non-cardiac tissues like buccal mucosa smears that do also express those desmosomal genes.

Purpose
To investigate the clinical usability of BMC as tool to classify patients at risk of developing ACM by comparing healthy controls with asymptomatic and symptomatic classical ACM patients, and patients carrying a PLNR14Del mutation.

Methods and results
BMC of 84 human subjects, 33 ACM patients (19 males, 28 with a PKP2 mutation), 17 PLN patients (6 males) and 34 healthy controls (14 males), were collected on glass slides, fixed and labelled with anti-plakoglobin antibodies diluted 1:5.000, 1:10.000, 1:20.000 and 1:40.000, and scored for their membrane labelling. Data revealed that for each applied dilution, plakoglobin protein levels at the membrane were significantly reduced in BMC obtained from ACM patients compared to healthy controls. This effect appeared independent from age and sex of the patients. Furthermore, dilutions 1:5.000 and 1:10.000 showed a moderate correlation with the revised 2010 Task Force Criteria Score (TFC) which are commonly used for ACM diagnosis (Rs -0.67, n = 64, p &lt;0.0001 and Rs -0.71, n = 64, p &lt; 0.0001 resp.) In contrast, plakoglobin scores of PLN patients were similar to controls.

Conclusion
On the population level, there is a significant reduction of plakoglobin protein in BMC membranes of ACM patients but not for patients bearing the PLNR14Del mutation when compared to healthy controls. However, for clinical diagnosis of the individual patient, this method is most likely not discriminative enough to distinguish patients from healthy controls, because of the high interindividual variability.
A novel non-invasive electrocardiographic imaging technique facilitates the preprocedural diagnostic workup of patients with infrequent ventricular arrhythmias
Authors: Lesina K , Hoogendijk MG , De Wit A , Peters E , Szili- Torok T 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Catheter ablation (CA) fails in considerable numbers of patients with ventricular arrhythmias (VAs). Possible reasons include absence and non-inducibility, multifocal origin and anatomically difficult locations of premature ventricular complexes (PVCs) and ventricular tachycardias (VTs). A novel non-invasive electrocardiographic imaging (ECGI) diagnostic tool may help to determine the best treatment strategy of these patients.

Purpose
To evaluate outpatient ECGI (VIVO, View Into Ventricular Onset, Catheter Precision, NJ) to tailor treatment of patients with infrequent ventricular arrhythmias referred for CA.

Methods
Thirteen patients in an outpatient setting with VAs were included in this pilot-study. All patients underwent ECGI mapping using VIVO. It is a novel technique that localize the origin of VAs using a combination of 12-lead ECG and a patient specific 3D anatomical reconstruction of the heart and thorax using cardiac magnetic resonance imaging (MRI) or cardiac computed tomography imaging (CT). The technique is based on virtual simulation of pace-mapping and has a unique feature that the imaging can be performed independently from recording of the arrhythmias. Suitability for ablation was based on the VIVO mapping in this cohort.

Results
Among the 13 patients enrolled (10 female, 3 male, age 39 ±15 years), a total of 16 PVC/VT morphologies were analyzed using VIVO. Ten of them had a low PVC burden (&lt;8%). Ten patients underwent pre-procedural cardiac MRI and 4 had CT imaging. Seven of the patients had structurally normal hearts, while the remaining 6 had non-ischemic cardiomyopathy. Based on the VIVO mapping findings the patients were divided in two groups. Group A: 7 patients in whom ablation was considered suitable. In this group a VIVO based anatomy CA was attempted in 3 patients for PVCs. Two out of these were successful. Three patients were offered CA but was declined by patient decision (suboptimal balance between burden, complaints and the offered success rates without procedural hard endpoint). Another patient is offered and is waiting for CA. The other group B: 6 patients in whom VIVO mapping was consistent with an unacceptable chance for treatment success were not offered CA. This included: 4 patients with a multifocal origin and a low burden of PVCs. One patient had different diagnosis (atrial fibrillation) and another had no PVC’s during 12-lead ECG monitoring.

Conclusions
Non-invasive ECGI pace-map is a unique tool that can identify the origin of infrequent VAs in an outpatient clinical setting in order to screen out patients not feasible for CA. Low burden PVCs maybe attempted to be ablated when the source is clearly associated of certain anatomical structures.
Impact of the COVID-19 pandemic on electrophysiological procedures at a national referral center
Authors: Cueva-Parra A , Munoz-Benavides G , Ortiz-Solis W , Gomez-Flores J , Marquez MF , Morales JL , Levinstein M , Nava S 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background - Introduction: The COVID-19 pandemic has generated serious repercussions on the health system, reducing the number of all cardiology procedures worldwide.

Objectives
Describe the impact of the COVID-19 pandemic on the procedures performed by the electrophysiology department in a national referral center.

Methods
We made a retrospective review of our data base and we compared procedures made in the last 3 years since 2017 to 2019 with the procedures made in the 2020. We divide the procedures into two large groups: Cardiac Implantable Electronic Devices (CIED) related procedures (which included implants, revisions, changes, upgrades and extractions) and electrophysiological studies and ablations (which included conventional and complex procedures). Other types of procedures were no included.

Results
There was a significant reduction in all procedures, the average of procedures performed in the last 3 previous years was 467 (there were 479 in 2017, 411 in 2018 and 511 in 2019), while in 2020 we performed only 319 (p = 0.01); this represents a reduction of 33.4% in the total number of procedures performed in our center. There was no statistical difference regarding the CIED related procedures, the average of procedures of the last 3 previous years was 174 (there were 186 in 2017, 148 in 2018 and 188 in 2019), and in 2020 we performed 189 procedures, this value is near to the average of the last 3 previous years and very close to the value of the 2019 (p = 0.46).
Regarding the electrophysiological studies and ablations, the average of procedures of the last 3 previous years was 293 (there were 293 in 2017, 263 in 2018 and 323 in 2019), while in 2020 we performed only 129 procedures, considerably decreasing compared to the previous years (p &lt; 0.01). The reduction in the electrophysiological studies and ablations was 55.97%. The most affected months were April, May and June.

Conclusions
The COVID-19 pandemic considerably affected the number of electrophysiological procedures in our center, reducing it by 33.4% compared to the previous years. The reduction of procedures fundamentally affected the electrophysiological studies and ablations, reducing them by 55.97%. The number of CIED related procedures were no affected. Electrophysiological procedures Procedures2017201820192017-2019 average2020CIED related procedures186148188174189Electrophysiological studies and ablations293263323293129Total479411511467319Comparative table of the electrophysiological procedures performed in our center in recent years.Abstract Figure. Comparison of the procedures.
The dose-dependent effect of chronic Verapamil treatment on cardiac function in isolated rat heart with Hypertension
Authors: Simovic S , Jeremic J , Davidovic G , Srejovic I , Zivkovic V , Ravic M , Nikolic M , Iric-Cupic V , Vucic R , Sreckovic M , Miloradovic V , Andjic M , Rankovic M , Draginic N , Jakovljevic V 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Verapamil, a calcium channel blocker, is used for treatment of hypertension, paroxysmal supraventricular tachycardia and angina pectoris. It primarily blocks L-type calcium channels preventing excessive influx of calcium into cardiomyocytes, leading to negative inotropic effect, and smooth muscle cells resulting in reduced relaxation of vasculature. With calcium antagonism it also causes negative chronotropic effect. However, there is no data on it’s dose-dependent effects on cardiac dynamic parameters and heart rate on isolated rat heart with hypertension.

Purpose
To investigate chronic, dose-dependent effects of Verapamil on cardiodynamic parameters in isolated rat heart with hypertension.

Methods
The present 4-week study was carried out on 24 spontaneously hypertensive Wistar Kyoto male rats (6 weeks old): Control (n = 6), rats treated with 0.5 mg/kg/day of Verapamil (n = 6), rats treated with 5 mg/kg/day of Verapamil (n = 6) and rats treated with 50 mg/kg/day of Verapamil (n = 6). Isolated rat hearts were perfused on Langendorff perfusion apparatus.

Results
Chronic, low-dose Verapamil treatment significantly depressed function of all cardiodynamic parameters of the hypertensive heart when compared to the rats treated with higher doses of Verapamil (p &lt; 0.001), except on the coronary flow and heart rate when compared to the Control (p= 0.137; p = 1.000, respectively). There was no significant differences between Verapamil in middle dose (5 mg/kg/day) and the Control group in inotropic (p = 0.415) and lusitropic (p = 1.000) effects, while it significantly lowered values of coronary flow (p = 0.002). It achieved significantly lower inotropic, lusitropic and chronotropic effects (p &lt; 0.001) than high Verapamil dose and significantly better inotropic (p = 0.017), lusitropic (p &lt; 0.001), but not chronotropic effects than low-dose Verapamil treatment (p = 0.179). High-dose, chronic treatment with Verapamil significantly intensified function of the isolated rat heart with hypertension when compared to Control and lower doses of Verapamil (p &lt; 0.001), without significant effects on coronary flow (p = 0.363).

Conclusions
Chronic treatment with Verapamil in high dose achieved better inotropic, chronotropic and lusitropic effects than treatment in low and middle doses of Verapamil, without significant effects on coronary flow. There is dose-depended effect of chronic Verapamil treatment on cardiac function of isolated rat heart with hypertension.
Second and fourth generation Cryoballoon based left atrial appendage isolation for the treatment of persistent atrial fibrillation
Authors: Heeger CH , Meyer-Saraei RMS , Fink TF , Sciacca VS , Vogler JV , Eitel CE , Kuck KHK , Ouyang FO , Tilz RRT 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Although pulmonary vein isolation (PVI) is an effective treatment strategy for patients with paroxysmal atrial fibrillation (AF), it is associated with limited success rates in patients with persistent AF (PersAF). In this context the left atrial appendage (LAA) was recently identified as a target of catheter ablation especially in PVI non-responders. Although effective, this strategy may cause electromechanical dissociation and was therefore assumed to be associated with an increased risk of thromboembolism despite oral anticoagulation (OAC). Since RF based LAAI showed increased rates of thromboembolism and stable LAAI is difficult to achieve in some cases, Cryoballoon-based LAAI might offer a valuable option to achieve safe and durable LAAI. Recently the fourth generation cryoballoon was introduced. Additionally, the 40% shorter tip potentially increases the safety profile as well as efficacy of CB-based LAAI.

Objective
To assess safety and efficacy on CB2 vs CB4 based LAAI.

Methods
Cryoballoon based PVI and LAAI was performed in 20 patients with PersAF and long-standing PersAF. The first 10 consecutive patients were treated by the second-generation cryoballoon (CB2) the last 10 patients were treated by the CB4. LAAI was performed by utilizing a bonus freeze protocol (freezing time 300 seconds + another 300 seconds after LAAI).

Results
Stable LAAI was achieved after a mean of 2.6+/- 1.7 cryoballoon applications with a mean minimal temperature of -52+/-6 °C. Unless one phrenic nerve palsy (5.6%) of the left phrenic nerve no further periprocedural complications occurred. Successful LAAI was performed in 19/20 (95%). TEE after 6 weeks detected LAA thrombus in 3/10 (30%) patients (CB2 group) and 3/10 patients (30%) (CB4 group), p = 0.99. Successful LAA-closure was performed in 16/20 patients (80%) after a mean of 75+/-59 days. The LAA was durable isolated in 8/9 patients (89%, CB2) and 6/8 patients (75%, CB4), p = 0.56). AF recurrence after 6 weeks was 1/10 (10%, CB2) and 3/9 (33%, CB4), p = 0.26.

Conclusions
Here we used – to our knowledge – for the first time a CB4 for LAAI, followed by a combined check for LAAI and LAA-closure after 6 weeks, compared to the CB2. LAAI was successfully isolated by both cryo-balloons in the majority of patients. Hence the use of newest cryo-balloon generation for LAAI seems a safe and successful procedure compared to earlier balloon generations. However, a relatively high rate of LAA-Thrombus was detected after LAAI. Therefore, LAA closure is mandatory in this population.
Predictive value of early AF recurrence after cryoballoon ablation
Authors: Boehmer AA , Rothe M , Soether CM , Abboud J , Dobre BC , Kaess B , Ehrlich JR 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Early recurrence of atrial fibrillation (ERAF) during a blanking period of 90 days after radiofrequency ablation has been associated with worse long-term outcome. However, the impact of ERAF after cryoballoon pulmonary vein isolation (cryoPVI) is less clear.

Objective
A prospective comparison of long-term ablation success after cryoPVI between patients who had ERAF during the blanking period and patients who remained free of AF recurrence during this period.

Methods
We analyzed consecutive patients who underwent cryoPVI in a single-center cohort between 2018 and 2020. Follow-up was performed at 3, 6, 12, 18 and 24 months after ablation. Primary endpoints were: symptomatic AF recurrence after a 90-day blanking period for efficacy and bleeding, phrenic nerve injury, stroke or death for safety.

Results
472 consecutive patients with paroxysmal or persistent AF who underwent cryoPVI in a single-center cohort were analyzed. Mean follow-up time was 15 months. 64 patients presented with ERAF during blanking period (age 70 ± 8 years, 52% male gender, CHA2DS2-VASc 2.9 ± 1.5) while 408 patients demonstrated freedom from AF within the first 90 days after cryoPVI (age 69 ± 10 years, 57% male gender, CHA2DS2-VASc 2.7 ± 1.4). At 24 months, Kaplan-Meier estimates showed a significantly higher AF recurrence in patients with ERAF compared to patients without ERAF (74.6 % vs. 33.3%, P &lt; 0.0001, Figure). Cox-regression analysis confirmed ERAF as independent predictor of impaired long-term ablation success after cryoPVI for both paroxysmal and persistent AF (P &lt; 0.0001). Primary safety endpoint occurred in form of pericardial effusion or transient phrenic nerve palsy in one patient with ERAF (1.5%) and five patients without ERAF (1.2%). No deaths or strokes were observed.

Conclusion
ERAF during blanking period predicts long-term sucess of patients undergoing cryoPVI. Prospective studies addressing outcome optimisation in this particular cohort of patients are needed. Abstract Figure.