bluuebunny/crossref_metadata_2025_split huggingface dataset:
Usefulness of Goldberger"s triad to select dilated cardiomyopathy
Authors: Chung I 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Background: In 1982, Goldberger described an electrocardiographic triad (SV1 or SV2 +RV5 or RV6 ≥3.5mV, total QRS amplitude in limb leads ≤0.8mV, and R/S ratio &lt; 1 in lead V4) that was 70% sensitive and &gt;90% specific for detecting severe left ventricular (LV) dysfunction. The pathophysiology of this highly specific ECG triad probably relates to a number of mechanical and vectorial factors associated with congestive heart failure of a variety of etiologies. Left ventricular enlargement causes increased precordial voltage. The horizontal plane vector shifts posteriorly, orthogonal to the frontal plane, causing poor R wave progression and low limb lead voltage. Finally, increased extracellular fluid may preferentially attenuates QRS voltage in the limb leads.

Objective
To test the sensitivity of this triad in patients with non-ischaemic cardiomyopathy and severe left ventricular systolic dysfunction

Methods
Methods: 386 patients mean age 62.45 ± 13.96 years, male 72%, NYHA II-IV, with non-ischaemic cardiomyopathy, 70 had bundle branch block (18%) and mean left ventricular ejection fraction(EF) 22.57 ± 8.62%. 76% hypertension, 39% diabetes mellitus, 32% atrial fibrillation. The electrocardiographic triad was sought in the ECG recorded at time of the echocardiographic study. The mean LV end-diastolic diameter was 5.81 ± 1.53 cm.

Result
Results: 56% patients had SV1 or SV2 +RV5 or RV6 ≥3.5mV, 85% patients had R/S ratio &lt; 1 in lead V4, 19% had total QRS amplitude in limb leads ≤0.8mV. 50% patients had SV1 or SV2 +RV5 or RV6 ≥3.5mV and R/S ratio &lt; 1 in lead V4. Only 6% patients fulfilled the triad.

Conclusions
Conclusion: Goldberger"s triad is an insensitive marker for severe LV dysfunction. Using SV1 or SV2 +RV5 or RV6 ≥3.5mV and R/S ratio &lt; 1 in lead V4 had a sensitivity of 50%. 85% patients had R/S ratio &lt; 1 in lead V4. R/S ratio &lt; 1 in lead V4 is a simple way to select dilated LV.
Prevalence and clinical characteristics of patients presenting with phase 4 atrioventricular block
Authors: Bun S-S , Heme N , Asarisi F , Squara F , Scarlatti D , Ferrari E 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The prevalence of phase 4 atrioventricular block (4AVB) is not known.

Objective
To assess the exact prevalence of 4AVB in a population of patients with high-degree AVB.

Methods
All the ECG from patients admitted for high-degree AVB (2 to 1 and complete) were collected at the University Hospital of Nice. The ECG tracings (12-lead surface and telemonitoring during hospitalization) were reviewed by an electrophysiologist.

Results
From Sept 2019 to Sept 2020, 65 patients were admitted for high-degree AVB. 8 patients (12 %) with 4AVB were identified (3 men; 88 ± 5 years). Arterial hypertension was present in 7/8 (87 %), and a syncopal episode - 4AVB-related - was noticed in 6/8 patients (75 %), mean left ventricular ejection fraction 54 ± 13 %. Baseline QRS width and corrected QT intervals were respectively 131 ± 30 ms and 469 ± 34 ms). 4AVB sequence was induced by a: premature atrial contraction (5/8), premature ventricular contraction (1/8), conduction block in a branch (1/8), sinus rhythm acceleration (1/8). All patients received a dual-chamber pacemaker during hospitalization.

Conclusion
The exact prevalence of 4AVB is not rare (12 %), and may be underestimated. 4AVB is usually observed in an elderly population, treated for arterial hypertension, and with baseline conduction disorders. Abstract Figure. Phase 4 AVB induced by PAC
Development and validation of an algorithm to assist in the interpretation of the electrocardiogram
Authors: Pallikadavath S , Watts J , Gay S , Sandilands A 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background and Purpose
Interpretation of the electrocardiogram (ECG) is often poorly performed, affecting time critical patient care. There are no reliable methods that consistently bridge the gap between novices and competency. However, the development of a framework allowing a step-wise approach to interpret the ECG based on relevant signals might help. Indeed, in addition to expert teaching, a pilot study of this algorithm significantly improves sustained ECG interpretation in medical students. This study aimed to validate the ECG algorithm tool by confirming the appropriateness of its step-wise components through expert cardiologists.

Methods
A Modified Delphi Exercise protocol was used. Cardiologists were invited to participate in a questionnaire through an online survey tool. Expert participants evaluated each stage of the ECG algorithm through multiple levels of agreement and explained their decision making with the option of free-text comments. These were collated and analysed by the four authors and changes subsequently made. The process was repeated, with evaluation of the changes from each round until a predetermined level of agreement was achieved.

Results
This Modified Delphi Exercise produced two rounds. Overall, 55 responses from experts was achieved (first round = 33, round two = 22). The average agreement in round one was 85.8% with 25 changes from 124 comments. Round two achieved 93.4% agreement with 12 changes from 57 comments. After discussion by four authors, a consensus was reached and a final algorithm was achieved. Figure 1 shows the bradycardia section of the final algorithm (tachycardia and ST/T-wave/ischaemia sections not shown).

Conclusions
We have validated an ECG algorithm through a rigorous development and review process in a multi-institutional and multi-national Modified Delphi study. The completed expert reviewed algorithm may be a safe, informative tool for novice users to improve ECG interpretation. However, further validation in user groups is now mandated to refine the tool. Abstract Figure 1- Algorithm one of three
Incidence and type of arrhythmias recorded by one-month continuous ECG monitoring in stroke patients
Authors: Castrejon Castrejon S , Ruiz-Ares G , Martinez Cossiani M , Rigual R , Gutierrez Zuniga R , Alonso De Lecinana M , Tebar D , Fernandez Gasso L , Fuentes B , Merino JL 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
BACKGROUND
The incidence of atrial fibrillation (AF) following stroke has been studied with implantable loop recorders. However, these devices do not record short lasting AF episodes (&lt;30-120 seconds [s]). In addition, the incidence and type of other clinically relevant arrhythmias is poorly understood in this clinical setting.
PURPOSE
To evaluate the incidence, type and clinical relevance of arrhythmias detected by one-month continuous ECG monitoring in patients after cryptogenic stroke.
MATERIAL AND METHODS
Consecutive patients (p) with stroke and no previous AF or other cardioembolic or atheroembolic causes were prospectively enrolled in the study. An external wearable 2-lead ECG monitoring system (NUUBO) was used for 30 days (d) in all of them after the acute phase of the stroke. In the absence of documented AF, a parafibrillatory status was defined as &gt;3000 atrial ectopic beats/d or &gt;2 "micro AF" episodes (fibrillatory burst &lt;30 s)/d or ≥1 episode of "micro AF" &gt;14 s.
RESULTS
130 p. were included in the study (age 73 ± 12, 57% males, 19% previous stroke, 7% ischemic cardiopathy, CHA2DSVA2Sc pre-stroke 3.1 ± 1.7). 3 were withdrawn from the study due to inadequate use (recording time &lt;14 d) and 1 due to stroke during SARS-CoV2 infection. Total recording time was 28 ± 3 d, total analyzable ECG time was 23 ± 5 d. ECG monitoring was repeated in 12 (9.5%) p due to poor ECG quality in 6 p or high suspicion of AF despite an initial negative result in 6 p. AF &gt;30 s was detected in a total of 27 (21.4%) p, average AF duration was 52 hours (range 30 s-22 d). AF &gt;30s was detected in 2 (17%) p with repeated monitoring. All these patients were placed on anticoagulation. Sustained paroxysmal supraventricular tachycardia (SVT) was documented in 4 (4.4%) p without AF. All episodes of AF and SVT were asymptomatic. Mobitz I second degree AV block in 4 (3.2%) p. 3 (2.4%) p had a pacemaker implanted: 2 for severe sinus dysfunction and 1 for AV block. High-density ventricular ectopy (&gt;3000/d) was present in 7 (6%) p and ≥1 episode of non-sustained ventricular tachycardia was detected in 26 (21%) p. A parafibrillatory status was identified in 27 (21%) p with no AF &gt;30 s. At 1-year follow up 4/22 (18%) of patients with parafibrillatory status and 3/59 (5%) without parafibrillatory status suffered a new stroke (p = 0.08).

CONCLUSIONS
AF and other potentially relevant arrhythmias are frequent after stroke and easily detectable with one-month non-invasive continuous ECG monitoring. Patients with a parafibrillatory status could benefit from longer monitoring time to detect AF.
Cardiac Magnetic Resonance as a diagnostic tool in arrhythmias
Authors: Caldeira Da Rocha R , Picarra B , Pais J , Santos AR , Carrington M , Dias Claudio F , Fernandes R , Trinca M 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Etiology of cardiac arrhythmias is often difficult to determine.As the gold standard to anatomical and functional cardiac evaluation,Cardiac Magnetic Resonance(CMR)can be a fundamental technique for accurate assessment of myocardial arrhythmic substrates or for arrhythmias management.

Purpose
The aim of this study is to determine diagnostic and arrhythmic risk stratification impact of CMR performed in patients with suspected or confirmed arrhythmias.

Methods
We performed a six-years prospective study of patients with suspected or confirmed arrhythmias which evaluation with other techniques did not provide a definitive diagnosis.These patients underwent CMR for diagnostic and risk stratification assessment.We applied a protocol to evaluate both ventricles’ morphology and functional and late gadolinium enhancement (LGE) presence.

Results
A total of 93 patients were included,of which 66% were male, with a mean age of 45 ± 17 years old. The indications for patients with suspected or confirmed arrhythmias performing CMR evaluation were the following: 33% (n = 31) of the patients had very frequent premature ventricular complexes, 23% (n = 21) had sustained ventricular tachycardia (VT), 5%(n = 5) non-sustained VT, 17%(n = 16) suspected structural heart disease with high arrhythmic potential,10%(n = 9) unexplained recurrent syncope,9 %(n = 8) supraventricular tachycardia and 3% (n = 3) aborted sudden cardiac death. Depressed ejection fraction (EF)(&lt;50%) was present in 10% (n = 9) for LV(mean EF 38 ± 9%) and 15%(n = 14) for RV (mean EF 42 ± 7%). Dilation of LV was found in 25% of patients (n = 23, mean LV volume: 115 ± 7ml/m²), with RV dilation being present in only 1 patient, who had right ventricle arrhythmogenic dysplasia (RVAD) (RV volume: 152ml/m²). In total, 16%had interventricular septum hypertrophy (mean 15 ± 4mm/m2).We found slight anterior leaflet prolapse of mitral valve in 10% (n = 9) of the cases and mild mitral regurgitation in 15% (n = 14). Left atrium dilation was observed in 17% (n = 16) of patients (mean area of 18 ± 2cm2/m2), as right atrium was dilated in only two. In 20% of the patients, CMR contributed to establish a previously unknown diagnosis: 6% (n = 5) have hypertrophic cardiomyopathy,4%(n = 4)a myocarditis sequelae and 2%(n = 2)had RVAD. LV non-compaction,a silent myocardial infarction scar and non-ischemic dilated cardiomyopathy were diagnosed in 3%of the cases each. In 15%(n = 14)we found nonspecific variations, which deserve follow-up. On the remaining patients, CMR was considered normal.

Conclusion
As a high reproducible, accurate and versatile technique, CMR allowed an increase on diagnosis in 20% of the patients with suspected or confirmed arrhythmias. Consequently, it contributed to the risk stratification of our study population with suspected high arrhythmic potential when the first-line complementary exams were inconclusive.
Noninvasive unipolar electrogram T-wave upslope is an accurate marker of local refractoriness in explanted hearts with drug-induced repolarization dispersion
Authors: Stoks J , Bear L , Volders PGA , Cluitmans MJM 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): French National Research Agency Matthijs Cluitmans is supported by a Veni grant from the Netherlands Organization for Scientific Research

Background
The relationship between T-wave morphology in local unipolar electrograms (UEGs) as mapped with noninvasive electrocardiographic imaging (ECGI) and local repolarization time (RT) has not been validated in pronounced RT dispersion.

Purpose
To study the time of upslope of the T-wave (Tup) in epicardial UEGs mapped with ECGI as a marker of time of local refractoriness (trefr, a surrogate for RT) in intact hearts with RT dispersion.

Methods
Six pig hearts were Langendorff-perfused with selective perfusion of the LAD artery and submersed in a torso-shaped tank containing 256 electrodes on the torso surface (panel A). RT was prolonged in the non-LAD regions by infusing dofetilide (‘Dof’) and shortened in the LAD region using pinacidil (‘Pin’). Tup was determined in both invasive UEGs (recorded with epicardial electrodes) and in noninvasive UEGs (reconstructed with ECGI). Programmed stimulation was used to determine trefr, defined as the shortest coupling interval with capture. Both metrics were determined relative to the common pacing spike.

Results
In all six hearts, selective dofetilide and pinacidil infusion resulted in delayed trefr and Tup in the non-LAD region, and shortened invasive trefr and noninvasive Tup in the LAD region, respectively (panel B and C). Over all 59 observations, Tup showed high agreement with trefr (values close to line of identity, panel D) with strong correlation (r = 0.91). This finding was independent of T-wave polarity (positive, negative or biphasic).

Conclusion
The moment of steepest upslope of the T-wave in a noninvasively reconstructed UEG accurately reflects end of local refractoriness in intact hearts, in case of pronounced RT dispersion. Under these circumstances, when local RT is defined by moment of re-excitability (allowing to link it to conduction block and re-entry), ECGI T-wave upslope can be taken as a truthful marker for local RT. Abstract Figure. Results
Non-invasive predictors for infranodal conduction delay in patients with left bundle branch block after transcatheter aortic valve replacement
Authors: Auberson C , Badertscher P , Madaffari A , Malushi M , Bourquin L , Spies F , Aeschbacher S , Fahrni G , Kaiser C , Jeger R , Osswald S , Sticherling C , Kuehne M , Knecht S 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Left bundle branch block (LBBB) is the most common conduction disorder after transcatheter aortic valve replacement (TAVR) with an increased risk of atrioventricular (AV) block. The aim of the current study was to identify non-invasive predictors for infranodal conduction delay in patients with LBBB.

Methods
We analyzed consecutive patients undergoing TAVR with pre-existing or new-onset LBBB between August 2014 and August 2020. His ventricular (HV) interval measurement was performed on day 1 after TAVR. Baseline, procedural, as well as surface and intracardiac electrocardiographic parameters were included. Infranodal conduction delay was defined as HV interval &gt;55 ms.

Results
Of 825 patients screened after TAVR, 151 patients (82 ± 6 years, 39% male) with LBBB were included. Among these, infranodal conduction delay was observed in 25%. ΔPR (difference in PR interval after and before TAVR), PR and QRS duration after TAVR were significantly longer in the group with HV prolongation. In a multivariate analysis in patients with sinus rhythm (n = 131), ΔPR (OR per 10 ms increase: 1.52; 95% CI: 1.19-2.01; p = 0.002) was the only independent factor associated with infranodal conduction delay. The AUC of the ROC curve was 0.724 (95% CI) for ΔPR. A change in PR interval by 20 ms yielded a sensitivity of 26% and specificity of 83% with a positive predictive value of 45% and a negative predictive value of 84% to predict HV prolongation.

Conclusions
Simple analysis of surface ECG and a calculated ΔPR &lt;20ms can be used as predictor for the absence of infranodal conduction delay in post-TAVR patients with LBBB. Abstract Figure HV
ECG wearable rhythm monitoring in covid-19 patients
Authors: Garkina S , Orshanskaya V , Simonova K , Arzhelas S , Mineeva E , Lebedev D 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Wearable monitors and external smart-phone enabled devices represent the new era in remote patient management during covid-19 pandemy. There is growing evidence showing that arrhythmias are one of the major complications of SARS-CoV-2 infection especially in high risk group of patients.

Methods
We enrolled 34consecutive patients with confirmed diagnosis of SARS-CoV-2 (mean age62.45 ± 5.25years, 16male). Remote wireless rhythm monitoring was performed using portative ECG sensor.Average follow-up period was 21 days during in-hospital stage and 2 months after discharge.

Results
Among hospitalized patients with verified SARS-CoV-2 some presented different arrhytmias before admission (9 patients had atrial fibrillation and 11 patients had history of ventricular extrasystoles and non-sustained ventricular tachycardia). One patient underwent cardiac transplantation 1.5 years ago (female 38 years old with a history of dilated cardiomyopathy) and one patient had implanted CRTD device as primary prevention (male 54 years old with a history of myocardial infarction and low LVEF 28%). Other 12 patients did not experience any cardiac arrhythmias before admission. During monitoring period one patient demonstrated asymptomatic pauses longer than 6 seconds (Figure 1) revealed by portative device. After 2 months of follow up he continued to have hemodinamycally significant rhythm pauses and underwent pacemaker implantation. One patient had spontaneus AF conversion into sinus rhythm (Figure 2) also confirmed by wireless monitoring. Other patients did not demonstrate clinically significant arrhythmias. The duration of QT interval was also monitored during in-hospital period in all patients, average score was 451 ± 12 msec.

Conclusions
Using of wearable electronic devices may contribute to better monitoring of the state of patients and control of symptoms. Abstract Figure. Hemodynamically significant rhythm pause
Antiarrhythmic effect of 9-week hybrid cardiac telerehabilitation - subanalysis of the TELEREHabilitation in Heart Failure patients - TELEREH-HF randomized clinical trial
Authors: Orzechowski P , Piotrowicz R , Zareba W , Pencina MJ , Kowalik I , Komar E , Opolski G , Banach M , Glowczynska R , Szalewska D , Pluta S , Irzmanski R , Karalus Z , Piotrowicz E 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The National Centre for Research and Development, Warsaw, Poland.
Background. Cardiac rehabilitation is a component of heart failure (HF) management but its effect on ventricular arrhythmias is not well recognized.
Purpose. We analyzed the antiarrhythmic effect of a 9-week hybrid cardiac telerehabilitation (HCTR) and its influence on long term cardiovascular mortality in HF patients taken from the TELEREH-HF trial.
Methods. We evaluated the presence of non-sustained ventricular tachycardia (nsVT) and frequent premature ventricular complexes ≥10 beats/hour (PVCs ≥10) with 24-hour ECG monitoring at the baseline and after 9-week HCTR or usual care (UC) of 773 HF patients (NYHA I-III, LVEF ≤ 40%).
Results. Among 143 patients with nsVT, arrhythmia subsided in 30.8% after HCTR, similarly among 165 patients randomized to UC who had nsVT 34.5% did not show them after 9 weeks (p = 0.481). There was no significant difference in the decrease in PVC ≥10 over 9 weeks between randomization arms (14.9% vs. 17.8%, respectively p = 0.410). Functional response for HCTR (Δ peak oxygen consumption [pVO2] in cardiopulmonary exercise test &gt;2.0 ml/kg/min) did not affect occurrence of arrhythmias. The multivariable analysis of the entire population did not identify HCTR as an independent factor determining improvement in terms of nsVT or PVCs &gt;10. However, only in the HCTR group, the achievement of the antiarrhythmic effect significantly reduced the cardiovascular mortality in 2 years follow-up (Logrank p = 0.0009) (Figure).
Conclusions. Significant improvement in physical capacity after 9 weeks of HCTR did not correlate with the antiarrhythmic effect in terms of incidence of nsVT or PVCs ≥10. An antiarrhythmic effect after the 9-week HCTR affected long term cardiovascular mortality in HF patients. Abstract Figure
Oral procainamide as pharmacological treatment of recurrent and refractory ventricular tachyarrhythmias
Authors: Toniolo M , Grilli G , Proclemer A , Rebellato L , Muser D , Daleffe E , Facchin D 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The antiarrhythmic therapy of recurrent ventricular arrhythmias in patients having undergone catheter ablation and in whom amiodarone and/or beta blockers were ineffective or contraindicated, is a controversial issue.

Purpose
The present study sought to evaluate the efficacy and tolerability of oral procainamide in patients with recurrent ventricular arrhythmias, when the standard therapy strategy failed.

Methods
All patients with an implantable cardioverter defibrillator (ICD) treated with oral procainamide for recurrent ventricular tachycardia (VT) or ventricular fibrillation (VF) in our institution between January 2010 and May 2019 were enrolled. The primary endpoint was the total number of ICD interventions after the beginning of procainamide therapy. Secondary endpoints were total number of VTs and VFs recorded on the ICDs controls, and discontinuation of therapy. The events occurring during procainamide treatment were compared with a matched duration period before the initiation of therapy with procainamide. Patients therefore served as self-controls.

Results
A total of 33 consecutive patients (31 males, 93.3%; mean age 73.3 ± 10 years) were included in the retrospective analysis. The mean time of procainamide treatment was 12.5 ± 13.5 months. The mean dose of procainamide was 1194 ± 495 mg/die. Procainamide therapy significantly decreased ICD interventions (DC shock: 102 vs 132; anti-tachycardia pacing: 418 vs 603; 12 patients manifested DC shock after the beginning of treatment vs 25 patients before treatment). Procainamide also decreased the total number of VT/VF episodes (514 vs 1078 episodes) [p &lt; 0,01]. Only 2 patients (6%) presented severe side effects (hypothension) requiring discontinuation of therapy.

Conclusions
Procainamide was associated with a significant decrease of ICD therapies and ventricular arrhythmias showing an optimal profile of tolerability.