bluuebunny/crossref_metadata_2025_split huggingface dataset:
May Measurement Month 2019: an analysis of blood pressure screening results from Cape Verde
Authors: Azevedo Vanda , Dias Luis , Garcia Glenda , Soares Irenita , Silva Marlinda , Delgado Isaulina , Lima Florentina , Sanches Nilson , Beaney Thomas , Partington Giles , Poulter Neil R 
Published: May 2021

Abstract
The Cabo Verdean population is aging and, consequently, non-communicable diseases, namely cardiovascular diseases, are increasing, with hypertension being an important risk factor. Following Cabo Verde's engagement with the May Measurement Month (MMM) campaign, in 2019, it was possible to improve the screening capacity, at the same time that a major social mobilization campaign was carried out to improve the population's knowledge about raised blood pressure (BP) and its consequences. With activities on nine islands, telemedicine was used to train researchers and volunteers. The MMM app was used to collect participant data. Individuals aged ≥18 years were recruited through opportunistic sampling. Each participant completed a questionnaire on demographic, lifestyle and environmental factors and had three BP measurements and weight and height measurements. Hypertension was defined as a systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg (mean of the second and third readings), or when using antihypertensive medication. When respondents did not provide three BP readings, multiple imputation using chained equations was used to calculate the mean of the second and third readings. A total of 17 627 individuals [mean age of 42.7 (SD 16.2); 63.8% women] were screened. After multiple imputation, 5990 (34.0%) had hypertension, of which 68.4% knew the diagnosis previously and 51.3% used antihypertensive drugs. The reported use of antihypertensive medication and a previous diagnosis of hypertension were strong predictors of higher levels of systolic and diastolic BP. Corrective actions were taken with an updated national protocol for hypertension treatment in primary health care. The II Non-Communicable Diseases Survey corroborated MMM national data that we see as an ideal initiative to reach the public, raising awareness about this important cardiovascular risk factor and providing political decision instruments.
May Measurement Month 2019: an analysis of blood pressure screening results from Spain
Authors: Molinero Ana , Calvo Eva , Beaney Thomas , Day Emily , Prats-Mas Rosa , Fornos José A , Mera-Gallego Inés , Tous Salvador , de Andrés Nicanor F , Rodilla Enrique , Gijón Teresa , Pérez-Manchon David , Poulter Neil R , Ruiz-Hurtado Gema , Ruilope Luis Miguel 
Published: May 2021

Abstract
The aim of the May Measurement Month (MMM) is devoted to better understanding the awareness, treatment, and control rates of hypertension in Spain. Presented here are the data corresponding to 2019 campaign. In 2019, a total of 4433 patients (61.5% males) with a mean age of 54.8 years were included. Of all, 96.0% were Caucasian, and 3294 were recruited in pharmacies. The mean values of systolic blood pressure (BP) were 125.6 and of diastolic 76.7 mmHg in the whole population. The most recent previous BP measurement took place more than 1 year before in 27.6% of participants. A total of 1883 were hypertensive (systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg or taking antihypertensive medication), of whom 77.2%/were aware and 71.1% were on medication. Of all, 64.9% of those on medication and 46.1% of all hypertensive participants had a BP controlled to &lt;140/90 mmHg. These data from MMM 2019 continue to indicate the need for an improvement in the awareness, treatment, and control of hypertension in Spain.
May Measurement Month 2019: an analysis of blood pressure screening results in the Philippines
Authors: Diaz Alejandro Bimbo F , David-Ona Deborah Ignacia , Mercado-Asis Leilani B , Atilano Alberto A , Vilela Gilbert C , Bonzon Dolores D , Chua Carlos L , Balmores Benjamin A , Castillo Rafael R , Beaney Thomas , Clarke Jonathan M , Poulter Neil R ,   the Philippine MMM19 Investigators
Published: May 2021

Abstract
The Philippine Society of Hypertension (PSH) took part again in the annual May Measurement Month 2019 (MMM19) blood pressure (BP) measurement campaign to raise awareness of hypertension especially in those who are not aware of their condition. The MMM19 standard protocol designed by the International Society of Hypertension was used during screening. These included the collection of basic data on demography, lifestyle, and environmental factors. Standardized sitting BP measurements were taken two to three times, using an automated BP apparatus and were inputted either in the MMM19 app or data were recorded in paper form and manually transferred to Excel spreadsheets by encoders supervised by the PSH. A total of 89 941 participated through opportunistic convenience sampling. After multiple imputation, a total of 47 925 (53.3%) participants had hypertension (≥140/90 mmHg or on antihypertensive medication). Of this number, 31 151 (65%) were aware that they had high BP and 30 120 (62.8%) were on antihypertensive medications. Of the 30 120 participants on antihypertensive medications, only 18 373 (61.1%) had controlled BP (&lt;140/90 mmHg). Being overweight or obese were significant predictors of high BP. Other predictors of high systolic BP and diastolic BP were alcohol intake, smoking, and a previous history of hypertension in pregnancy, while pregnant participants had significantly lower BP. The MMM19 campaign succeeded in raising awareness of high BP in our country, and the opportunistic sampling enhanced a sense of people empowerment by their knowing how easy it is to detect high BP and thereby enabling the prevention of long-term health complications. The higher BP control in the MMM19 hypertensive individuals possibly attests to the success of the previous MMM17 and MMM18 campaigns.
A new electrocardiographic marker with higher sensitivity and specificity for epicardial location of posteroseptal accessory pathway
Authors: Badiul A , Iorgulescu C , Bogdan S , Radu A , Paja S , Ene E , Cojocaru C , Nastasa A , Vatasescu R 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Catheter ablation of accessory pathways (AP) located in the posterior pyramidal space are often challenging due to its anatomical complexity. Scarce of data are available about the ECG features that might indicate when an epicardial approach is required in the ablation of the posteroseptal AP.

Objective
The purpose of this retrospective study was to describe the electrocardiographic features of posteroseptal AP which have been successfully ablated with epicardial approach and identify electrocardiographic predictors for epicardial AP location.

Methods
The 12 leads ECG of 75 patients with posteroseptal accessory pathways who were successfully ablated were retrospectively analyzed. ECG features for epicardial location described already in published studies have been considered (negative delta wave in DII, positive delta wave in aVR, high amplitude S wave in V6). Additionally the characteristics of the initial 40 ms of the delta wave in lead V1 (measured from the earliest QRS deflection in 12 leads) during full pre-excitation have been investigated.

Results
Of 75 patients with posteroseptal AP that undergone catheter ablation, 40 (53.3%) had successful epicardial ablation. An initial isoelectric or biphasic delta wave in lead V1 proved the highest sensitivity (82.5 %) respectively positive predictive value (97 %) and specificity (97 %) for an epicardial location of the AP. Deep S wave in V6 proved lower sensitivity (37.5%) and positive predictive value (68%) but higher specificity (80%) for epicardial location of AP. The specificity and sensitivity for epicardial location of AP of negative delta wave in DII were lower, however it failed to reach statistical significance.

Conclusion
This study shows that an initially isoelectric or biphasic delta wave aspect in lead V1 has a higher specificity, sensitivity and positive predictive value than previously described ECG markers for epicardial location of posteroseptal accessory pathways.
Non-algorithmic approach to accessory pathway localization based on a mobile app
Authors: Jastrzebski M , Moskal P 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Polish Cardiac Society - Section of Non-invasive Electrocardiology and Telemonitoring (PTK SENIT)

Background.
Electrocardiographical localization of accessory pathways (AP) in WPW syndrome remains an elusive goal. Despite several, often very complex algorithms that were developed over the last three decades, none of them is very accurate - as demonstrated by several independent validation studies. Moreover, algorithms are difficult to remember, which further limits their usefulness. The accessory pathway regions are arbitrary and transitions between them are smooth, not binary. The same applies to ECG features such as QRS polarity – they are not binary. Moreover, even the most careful ECG lead placement cannot compensate for the variability in heart position within the chest. Therefore, it is unrealistic to expect that any ECG feature or feature set will precisely identify a particular location in a 0 vs. 1 fashion.
Aim
We intend to create a mobile app / web based localizing application, that would support a novel method for AP localization: a colour density map generator - based on actual distribution of a sizable number of accessory pathway with a particular QRS features.

Methods
A total of 881 consecutive AP ablation procedures were reviewed and patients with successful ablation of an overt accessory pathway were included. ECG with baseline and full preexcitation obtained during incremental atrial pacing were obtained. AP localization was based on stored fluoroscopic images in several projections and procedure description. Each AP localization, as well as QRS polarity in all 12 leads, separately for full and baseline preexcitation patterns, were coded and introduced into the application database. An application web-based, optimized for mobile devices was developed. This application enabled to graphically show changing localization of AP with regard to the introduced, at each step, QRS polarity in a particular ECG lead. User can choose his/her own steps or criteria; there is no need to adhere to the proposed steps.

Results
A total of 604 patients/ ECGs were available for density map generation. With each additional lead QRS information introduced into the application the user can appreciate more and more precise localization of the AP. This quickly enables to pinpoint the area of maximum probability, i.e. the most likely/frequent location, followed by the immediate adjacent locations. Representative screen shots of to typical inital steps for left- and right-sided APs are provided below (Figure 1 and Figure 2). Limited prospective assessment was very favourable.

Conclusions
A novel method, easy to use, not requiring to remember any algorithmic steps, and based on an analysis of by far the largest cohort of over accessory pathways (in comparison with published algorithms) was developed. Prospective validation of the localization application seems warranted. Abstract Figure.
Anatomical localization and classification of bundle branch blocks using novel CineECG
Authors: Boonstra MJ , Hilderink BN , Locati ET , Asselbergs FW , Loh P , Van Dam PM 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by the Dutch Heart Foundation

Background
Ventricular conduction disorders can induce arrhythmias and impair cardiac function. Bundle branch blocks are diagnosed by 12-lead ECG, but discrimination between complete bundle branch blocks, incomplete bundle branch blocks and normal tracings can be challenging. CineECG computes the mean temporo-spatial isochrone (mTSI) trajectory of activation waveforms in a 3D-heart model from 12-lead ECGs. This trajectory represents the mean trajectory of the ventricular electrical activation at any time interval directly related to ventricular anatomy. In Brugada patients, CineECG has localized the terminal components of ventricular depolarization to right ventricle outflow tract (RVOT). Also, for the localization of bundle branch blocks, the region of latest activation contains the most information. Using CineECG, subject specific anatomically related information about the location of bundle branch blocks is obtained.

Purpose
This study aimed at exploring whether CineECG can improve the discrimination between complete left/right bundle branch blocks (LBBB/RBBB), and incomplete RBBB (iRBBB).

Methods
We utilized 400 12-lead ECGs from the online Physionet-XL-PTB-Diagnostic ECG Database with a certified ECG diagnosis. The mTSI trajectory was calculated and projected into the anatomical 3D-heart model. Five CineECG classes were established: "Normal", "iRBBB", "RBBB", "LBBB" and "Undetermined", to which each tracing was allocated. We determined the accuracy of CineECG classification with the gold standard diagnosis.

Results
A total of 391 ECGs were analyzed (9 ECGs were excluded for noise) and 240/266 were correctly classified as "normal", 14/17 as "iRBBB", 55/55 as "RBBB", 51/51 as "LBBB" and 31 as "undetermined". Average mTSI trajectories were calculated according to ECG diagnosis (Figure). The terminal mTSI contained most information about the BBB localization, as that part directs to the site of latest activation (Figure, red arrow).

Conclusion
CineECG provided the anatomical localization of different BBBs and accurately differentiated between normal, LBBB and RBBB, and iRBBB. CineECG may aid clinical diagnostic work-up, potentially also contributing to the difficult discrimination between normal, iRBBB and Brugada patients. Abstract Figure. Average CineECG trajectories
Remote magnetic navigation shows superior long-term outcomes in pediatric atrioventricular (nodal) tachycardia ablation compared to manual radiofrequency and cryoablation
Authors: Noten AME , Kammeraad JAE , Wijchers S , Van Beynum IM , Balinghaus M , Krasemann TB , Yap SC , De Groot NMS , Szili-Torok T 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Introduction – Catheter ablation (CA) is a first-choice treatment for tachyarrhythmia in pediatric patients. The currently available CA techniques differ in manner of catheter steering technique and energy sources. There are no large studies comparing long-term outcomes between the available CA techniques in pediatric patients with atrioventricular reentry (also known as accessory pathway mediated) tachycardia (AVRT) or atrioventricular nodal reentry tachycardia (AVNRT) mechanisms.
Objective – The aim of this study was to compare procedural parameters and outcomes of remote magnetic navigation-guided radiofrequency (RF) ablation (RMN), manual-guided RF ablation (MAN) and manual-guided cryoablation (CRYO).
Methods – This single-center, retrospective study included all first consecutive CA procedures for AVRT or AVNRT mechanisms performed in pediatric patients with no structural heart disease from January 2008 until June 2019. Three study groups were defined by the ablation technique used: RMN, MAN or CRYO. Primary outcome was recurrence of tachyarrhythmia and/or pre-excitation on ECG. Baseline clinical parameters, procedure times and complication rates were also evaluated.
Results – In total, we included 223 patients, aged 13.8 ± 2.8 years, with a mean weight of 55.6 ± 14 kilograms. In total, 108 procedures were performed using RMN, 76 using MAN and 39 using Cryo. RMN had the lowest recurrence rates at a mean follow-up of 5.5 ± 2.9 years (AVRT ablation: 4% vs. 16% vs. 55%, P &lt; 0.001; AVNRT ablation: 8% vs. 8% vs. 36%, P = 0.008; for RMN vs. MAN vs. CRYO respectively). In AVRT ablation, procedure and fluor times were comparable between groups. However, in AVNRT ablation, RMN and MAN had significantly lower fluoroscopy times compared to Cryo (10 (IQR 7-14) vs. 9 (IQR 6-26) vs. 15 (IQR 10-22) minutes respectively, P = 0.040). Moreover, procedure times were shortest in MAN and second in RMN ablation (101 (IQR 87-121) vs. 88 (IQR 62-99) vs. 120 (IQR 88-143) minutes respectively, P = 0.018). We observed minor complications in 3 patients (1%), which were comparable between groups and no major complications. Conclusion – In pediatric patients with no structural heart disease who underwent their first AV(N)RT ablation, RMN has the most favorable long-term outcomes, in addition to favorable fluoroscopy and procedure times. Abstract Figure. AVRT and AVNRT ablation recurrence rates
Final results from the EU focal impulse and rotor modulation (E-FIRM) registry
Authors: Sommer P , Spitzer S , Brachmann J , Janssen G , Lenz C , Luik A , Sarver A , Szili-Torok T 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Abbott

Background
The exact pathophysiology of how pulmonary vein (PV) triggers initiate or maintain episodes of atrial fibrillation (AF) has been elusive. Catheter ablation at relatively circumscribed areas of rapidly spinning rotors or very rapid focal impulse formation can significantly affect AF. Targeted ablation of these sources using Focal Impulse and Rotor Modulation (FIRM™) shows promise.

Purpose
To assess the safety and effectiveness of FIRM-guided procedures for the treatment of any type of symptomatic atrial fibrillation (AF).

Methods
Two hundred and ninety-nine subjects were enrolled in the E-FIRM Registry at 9 clinical sites in Germany and the Netherlands. Subjects were eligible if they had reported incidence of at least 2 documented episodes of symptomatic AF during the preceding 3 months and had failed at least Class I or III anti-arrhythmia drug. Data was collected at enrollment/baseline, procedure, and at 3-, 6-, and 12-month follow-up visits.

Results
A majority (59.5%, 178/299) had a history of previous ablation, 81.1% (133/164) in the left side, with an average of 1.5 ± 0.8 [range 0, 5] prior ablations. The primary safety endpoint was defined as freedom from procedure related Serious Adverse Events (SAEs) through 7-days and at 12-months. At 7-days, freedom from procedure related SAEs was 94.8% (257/271). At 12-months, freedom from procedure related SAEs was 84.4% (184/218). There were no deaths. Acute effectiveness success, defined as the elimination of all identified rotors, occurred in 64.0% (165/258) of treated patients. All patients for which data was reported had at least 1 rotor identified. The most common regions to find rotors were the lateral wall of the right atrium, the anterior/septal wall of the left atrium, and the posterior inferior region of the left atrium. 75.2% (194/258) of patients had at least one rotor identified in the right atrium, and 84.1% (217/258) of patients had at least one rotor identified in the left atrium. Success was defined as two sequential endpoints: single procedure freedom from AF recurrence at 3-months and single procedure freedom from AF recurrence. At 12-months, success was achieved in 46.4% (13/28) Paroxysmal, 42.9% (87/203) Persistent, and 0% (0/9) Long Standing AF subjects. Conclusions: Since acute success was reported as being achieved in only ∼2/3 of the treated subjects, it is possible that the full potential benefit of the FIRM-guided ablation was hidden in this evaluation of the full cohort. Considering the previous ablation and disease history of subjects, a single-procedure success rate at 12-months over 40% was considered a positive result. Based on these results, FIRM-guided RF ablation in conjunction with conventional RF ablation practices is both a safe and effective treatment strategy for patients with symptomatic AF.
Pulmonary vein isolation by irreversible electroporation: an efficacy and safety study in 20 patients with atrial fibrillation
Authors: Loh P , Groen MHA , Taha K , Wittkampf FHM , Doevendans PA , Van Es R 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Abbott

Background
Irreversible electroporation (IRE) is a promising new non-thermal ablation technology for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). First in human studies demonstrated the feasibility and safety of IRE PVI.

Objective
Further investigate the safety of IRE PVI.

Methods
Twenty patients with symptomatic AF underwent IRE PVI under conscious sedation. Oral anticoagulation was uninterrupted and heparin was administered to maintain activated clotting time at 300-350 seconds. Non-arcing, non-barotraumatic 6 ms, 200 J IRE applications were delivered via a custom non-steerable 8 F, 14-polar circular IRE ablation catheter with a variable hoop diameter (16-27
mm). Voltage mapping of the left atrium and the PVs was performed before and after ablation with a conventional circular mapping catheter. For both catheters a single transseptal access (8 F introducer, Agilis NxTTM) was used. Adenosine testing was performed after a 30-minute waiting period. On day 1 after ablation, patients underwent esophagoscopy and brain MRI (DWI/FLAIR). If abnormalities
were detected, examinations were repeated in due time.

Results
In 20 patients, all 80 PVs could be successfully isolated with a mean of 11,8 ± 1,4 IRE applications per patient. Average time from first to last IRE application was 22 ± 5 minutes, total procedure duration was 107 ± 13 minutes and total fluoroscopy time was 23 ± 5 minutes. One PV reconnection occurred during adenosine testing, re-isolation was achieved with 2 additional IRE pulses. No periprocedural complications
were observed. Brain MRI on day 1 after ablation showed punctate asymptomatic lesions in 3/20 patients (15%). At follow-up MRI the lesion disappeared in 1 patient while in the other 2 patients 1 lesion persisted. Esophagoscopy on day 1 showed an asymptomatic esophageal lesion in 1/20 patients (5%), at repeat esophagoscopy on day 22 the lesion had resolved completely.

Conclusion
Acute electrical PV isolation could be achieved safely and rapidly by IRE ablation under conscious sedation in 20 patients with symptomatic AF. Acute silent cerebral lesions were detected in 3/20 patients (15%) and may be due to ablation or to changes of therapeutic and diagnostic catheters over a single transseptal access.