bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term outcomes in patients with non-valvular atrial fibrillation and left atrial appendage closure in a large UK tertiary centre: 10-year experience
Authors: Briosa E Gala A , Pope MTB , Monteiro C , Leo M , Betts TR 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Left atrial appendage occlusion (LAAO) is a well-established stroke prevention strategy in patients with non-valvular atrial fibrillation (AF) and high risk of bleeding or contra-indication to oral anticoagulation (OAC). Despite encouraging randomised control trial and international registry safety and efficacy data, long-term outcome data remains sparce.

Purpose
This study sought to evaluate the long-term outcomes in ‘real-world’ AF patients undergoing left atrial appendage occlusion in a large UK tertiary centre.

Methods
This retrospective study included all patients that had a LAAO device implanted in our institution from January 2010 to December 2020. Medical notes, electronic patient records, procedural and imaging reports were reviewed. Annual bleeding risk was extrapolated from the Swedish National Cohort study according to CHA2DS2-VASc and HASBLED score.

Results
During the study period a total of 225 patients underwent LAAO device implant. Seventy-two percent were male, age 74 ± 8 years, BMI 27 ± 6 kg/m2, CHA2DS2-VASc score 4.4 ± 1.2, HASBLED score 3.2 ± 0.8 and at high risk of stroke (98 ischaemic strokes and 129 haemorrhagic strokes) and bleeding (151 life-threatening bleeding episodes). Three different LAAO devices were used: 136 Watchman, 54 Watchman FLX and 35 Amplatzer Cardiac plugs. Three patients (1.3%) had fatal complications related to the procedure. At discharge, 10% were taking single antiplatelet (ATP), 79% dual-antiplatelet (DAPT), 1.4% OAC, 3.6% ATP and OAC, 3.1% DAPT and OAC, 1.3% were not taking any anti-thrombotic. Nine (4%) patients had device-related thrombus on follow-up transoesophageal echocardiography with no significant difference between devices (5.0%, 2.8% and 6.7% p = 0.8, respectively) and anticoagulation strategy (p = 0.7). Over a total follow-up of 889 patient-years (mean follow-up 3.9 ± 3.7 years), 24 (10.4%) patients died, 55 patients (6.2/100 patient-years) suffered an adverse event, 15 ischaemic strokes (1.7/100 patient-years) and 20 non-procedural major bleeding episodes (2.3/100 patient-years) occurred. Compared to estimated annual stroke and bleeding risk adjusted for CHA2DS2-VASc and HASBLED score, our cohort had a 79% and 65% relative risk reduction in ischaemic stroke and major bleeding, respectively.

Conclusion
In this cohort of "real-world" high-risk patients, major bleeding and thromboembolic rate remained low on long-term follow-up. Abstract Figure 1
A new inherited syndrome causing sudden cardiac death with specific ECG changes and idiopathic left ventricular hypertrophy
Authors: Swojanowsky P , Von Korn H , Basso C , Pilichou K , Stefan V , Muenzel T 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Introduction
Sudden cardiac death (SCD) is a serious threat. In individuals under the age of 35 years sudden arrhythmic death is the most frequent cause. In younger persons, genetically determined cardiac diseases (e.g., cardiomyopathies, ion-channel diseases) account for an important proportion of these cases.
Purpose
We discovered a unusual combination of ECG changes and left ventricular hypertrophy that lead to a cumulation of sudden cardiac death in a single family. We therefore did a scientific work-up of this finding.

Methods
We investigated the case of a 23 year-old male with SCD, specific ECG changes and left ventricular hypertrophy (Figure 1). Family history was significant for SCD in the paternal line. A precise analysis was performed by an international multidisciplinary expert panel including autopsy of the index patient’s heart, molecular autopsy, whole exome sequencing, analysis of the pedigree and examination of available family members (Figure 2).
Results
Three cases of SCD were reported in paternal relatives. The index patient exhibited specific ECG changes (ST-depression), which were also found in five paternal relatives and the brother of the index Patient (Figure 3). Post-mortem analysis of the heart yielded mild idiopathic concentric hypertrophy without myocardial disarray.
The genetic analysis of the index patient showed two nucleotide variations in two different genes (ANK2: c.11791G &gt; A , MYO18B: c.3761G &gt; A), which were also expressed in five relatives. Two family members had showed all indicators of the inherited syndrome including specific ECG changes, genetic changes and left ventricular hypertrophy.

Conclusions
We described a distinct inheritable syndrome causing SCD, characterized by specific ECG changes, idiopathic left ventricular hypertrophy and mutations of ANK2 and MYO18. As far as we know this is the first description of this syndrom. We hypothesize that if all features (ECG-changes, described genetic mutations, left ventricular hypertrophy) are positive, the risk for SCD may be considerably increased. Abstract Figure. ECG of index patient and pedigree
Heterogeneity of right ventricular refractory period: a novel prognostic predictor in type-1 Brugada
Authors: Teresi L , Rossi A , Giannoni A , Nesti M , Castiglione V , Solarino G , Mirizzi G , Russo V , Panchetti L , Startari U , Ripoli A , Santoro A , Casolo G , Emdin M , Piacenti M 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Risk stratification in Brugada syndrome (BrS) is needed especially for the choice of an Implantable Cardiac Defibrillator (ICD). To date the predictive value of either clinical or conventional electrophysiological indexes in type 1 electrocardiographic pattern BrS is rather low.
We aimed to evaluate the eventual prognostic significance of refractoriness heterogeneity of right ventricular outflow tract, an emergent relevant pathophysiological substrate, at electrophysiological study (EPS) in patients with BrS.
From 5 centers 348 patients were retrospectively selected (age 44 ± 15 years, males 68%). Eighty-five (24%) patients had an ICD. EPS was proposed in patients with spontaneous type-1 ECG pattern regardless of symptoms, or in patients with drug-induced type-1 ECG pattern with symptoms (n = 174). The difference in the refractory period between the right ventricular outflow tract and the apex (ΔRPRVOT-apex) at EPS was evaluated as a prognostic factor. The optimal ΔRPRVOT-apex cutpoint for prognosis prediction was calculated through a P-spline hazard ratio analysis. Thus, ΔRPRVOT-apex was compared through different statistical analyses to other other clinical or conventional electrophysiological prognostic indexes previosly described in literature.
During a 36-month median follow-up (range 6-228) 3 SCD and 10 appropriate ICD shocks (aborted SCD, aSCD) occurred. Fifty patients (29%) had a positive EPS (induction of sustained ventricular tachycardia, VT, or ventricular fibrillation, VF, during the procedure). At multivariable logistic analysis, only ΔRPRVOT-apex and late potentials remained independent predictors of a positive EPS. At Cox Proportional Hazard analysis, family history of SCD, history of syncope, VT/VF inducibility and a ΔRPRVOT-apex &gt;60 ms were all univariate predictors of SCD/aSCD. At bivariate analysis, a ΔRPRVOT-apex &gt;60 ms remained an independent predictor of SCD/aSCD even when adjusted the other univariate predictors. At C-Statistic analysis, the strongest predictive model was the one using ΔRPRVOT-apex &gt;60 ms as covariate with a C-statistics (95% CI) of 0.72 (0.51-0.93). At Kaplan-Meyer curves, ΔRPRVOT-apex &gt;60 ms was confirmed a strong predictor of SCD/aSCD and another very interesting observation was possible: patients with positive EPS, but a ΔRPRVOT-apex &lt; 60 ms, had a similar risk to SCD/aSCD compared to patients with a negative EPS, while those with a positive EPS and a ΔRPRVOT-apex &gt; 60 ms were found to be at a higher risk of events.
Refractory period heterogeneity of the right ventricle defined as ΔRPRVOT-apex &gt; 60 ms at EPS is a strong and independent predictor of SCD/aSCD in patients with BrS, beyond VT/VF inducibility at EPS and common clinical predictors. Abstract Figure.
Time-efficient three-dimensional transmural scar assessment provides relevant substrate characterization for ventricular tachycardia features and long-term recurrences in ischemic cardiomyopathy
Authors: K Gutierrez L , Merino-Caviedes S , Alfonso-Almazan JM , Sanz-Estebanez S , Cordero-Grande L , G Quintanilla J , Sanchez-Gonzalez J , Marina-Breysse M , Peinado R , Merino JL , Perez-Villacastin J , Martin-Fernandez M , Perez-Castellano N , Alberola-Lopez C , Filgueiras-Rama D 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): - Ministerio de Ciencia e Innovación and the ProCNIC Foundation - Grant TEC2017-82408-R

Background
We aimed to validate a 3D methodology for transmural scar assessment using time-efficient upsampled models from 2D delayed gadolinium-enhanced cardiac magnetic resonance (LGE-CMR) sequences and determine the clinical implications in ischemic cardiomyopathy-related ventricular tachycardia (VT) episodes.

Methods
Translational study including 10 pigs with myocardial infarction and 15 patients with spontaneous VT episodes and underlying infarct-related scar. Pigs underwent 3D LGE-CMR sequences to test 3D transmural-based scar assessment using several downsampled resolutions from the original images. Validation in patients included 3D and 2D LGE-CMR studies performed within the same protocol. Transmural-based scar areas were used for correlation analyses with the cycle length (CL) of VT episodes. Scar volumes were used as a benchmark comparison.

Results
In pigs, 3D transmural-based scar areas showed interclass correlation coefficients &gt;0.94 between original 3D high-resolution- and downsampled-derived models. In patients, scar area quantification in myocardial regions with 3D transmurality &lt;0.2 (for upsampled 2D-derived models) and &lt;0.1 (for 3D-derived models) showed direct correlation with the CL of spontaneous VT episodes (r = 0.69; p &lt; 0.01 and r = 0.79; p &lt; 0.01, respectively) (See Abstract Figure). After ablation, patients with VT recurrences showed lower scar areas on 3D and upsampled 2D models using &lt;0.1 and &lt;0.2 transmurality criteria, respectively, than patients without VT recurrences (48.5 [37.7, 67.5] vs. 91.5 [84.3, 117.3] cm2, respectively, for 3D-derived models; p = 0.004, and 64.0 [43.5, 69.5] vs. 83.0 [70.2, 99.7] cm2, respectively, for upsampled 2D models; p = 0.04). Conversely, time-consuming scar volume reconstructions from 2D or 3D LGE-CMR sequences did not show significant differences between patients with and without VT recurrences.

Conclusions
Three-dimensional transmural scar assessment in upsampled 2D-LGE-CMR-derived models provides time-efficient characterization of infarct-related myocardial substrates associated with the CL of spontaneous VT episodes and VT recurrences after ablation. Abstract Figure
Zero fluoroscopy PVC ablation
Authors: Pena Mellado J , Sanchez Millan P , Gutierrez Ballesteros G , Tercedor L , Alvarez Lopez M 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Premature ventricular complex(PVC) catheter ablation is required in a wide spectrum of the population.Ionizing radiation exposure in this procedure carries health risks,especially in young patients.
In this prospective observational study we included 18 patients,submitted to PVC ablation without fluoroscopy between October 2018 and December 2020.Baseline characteristics of the population,acute success and complications derived from the procedure were evaluated,as well as recurrence rate during follow-up.
Median age was 49.5 years. Most often cause of ablation were palpitations(77.8%),followed by reduced LVEF(16.7%) and dyspnoea(5.6%).33.3% had a cardiopathy,the most common was tachycardiomyopathy(66.7%).PVC burden pre-ablation was 25 ± 12.6%.The most frequent PVC origin was RVOT(66.7%)followed by LVOT(22.2%),mitral annulus(5.6%) and papillary muscles(5.6%).
We used a 3D electroanatomical navigation system in all cases,intracardiac echocardiography in 88.9% and a contact force catheter for mapping(61%) and ablation(88.9%).The mean maximum radiofrequency power applied was 35 ± 5.7W(236.5s median time).Median number of applications was 5.5 and mean total procedural time was 198.6 ± 67.5 minutes.Median best prematurity was 28ms.We used isoprenaline in order to induce PVC in 77.8% of cases and suppression of PVC was achieved in 88.9%.There was only one complication(pericardial effusion without the need for pericardiocentesis).Median follow-up of 5 months,17.6% of recurrences(&lt;80% reduction of PVC burden at 3 months),all them(3) from RVOT.
In conclusion, the PVC ablation without fluoroscopy is a safe procedure with no major complications and good rates of success and recurrence in our experience. Baseline characteristics of the patientsMale6(33.3%)Female12(66.7%)Median age-yr.(range)49.5 (23-71)HTA6(33.3%)DM2(11.1%)Dyslipidemia3(16.7%)Smoking6(33.3%)LVEF median-(%)56.5%Treatment pre-ablationBeta blockers11(61.1%)No treatment6(33.3%)BB + flecainide/propafenone1(5.6%)1st column: Characteristics /2nd column: Patients included (N = 18) Abstract Figure 1
Long-Term outcome of ventricular tachycardia catheter ablation in ischemic heart disease patients using a high-density mapping substrate-based approach: a prospective cohort study
Authors: Silverio Antonio P , Lima Da Silva G , Rodrigues T , Cunha N , Couto Pereira S , Brito J , Valente Silva B , Alves Da Silva P , Nunes-Ferreira A , Bernardes A , Cortez-Dias N , Carpinteiro L , J Pinto F , De Sousa J 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction and objective
Radiofrequency catheter ablation (RCA) for ventricular tachycardia (VT) in patients with ischemic heart disease (IHD) is associated with a reduced risk of VT storm and implantable cardioverter defibrillator (ICD) shocks. We aim to report the long-term outcome after a single RCA procedure for VT in patients with IHD using a high-density substrate-based approach.

Methods
We conducted a prospective, observational, single-centre and single-arm study involving patients with IHD, referred for RCA procedure for VT using high-density mapping catheters. Substrate mapping was performed in all patients. Procedural endpoints were VT noninducibility and local abnormal ventricular activities (LAVAs) elimination. The primary end point was survival free from appropriate ICD shocks and secondary end points included VT storm and all-cause mortality.

Results
Sixty-four consecutive patients were included (68 ± 9 years, 95% male, mean ejection fraction 33 ± 11% , 39% VT storms, and 69% appropriate ICD shocks). LAVAs were identified in all patients and VT inducibility was found in 83%. LAVAs elimination and noninducibility were achieved in 93.8% and 60%, respectively. After a mean follow-up of 25 ± 18 months, 90% and 85% of patients are free from appropriate ICD shocks at 1 and 2 years, respectively. The proportion of patients experiencing VT storm decreased from 39% to 1.6%. Overall survival was 89% and 84% at 1 and 2 years, respectively.

Conclusions
RCA of VT in IHD using a high-density mapping substrate-based approach resulted in a long-term steady freedom of ICD shocks and VT storm. Abstract Figure. Appropriate shock & all cause mortality
Left ventricular non-compaction cardiomyopathy: additional predictors of life-threatening events for selecting patients for cardioverter-defibrillator implantation
Authors: Rineiska N , Komissarova S , Krasko O , Haidzel I 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
The aim of the study is to determine predictors of life-threatening arrhythmic events in order to identify high-risk patients requiring ICD/CRT-D implantation.
Methods. The study included 155 patients with left ventricular non-compaction cardiomyopathy (NCСM), 59 (38.1%) women, 96 (61.9%) men, and a median age of 39 (28; 51) years. In addition to the standard examination, cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE) was performed. The median follow-up was 36 months (6; 152). Endpoints of the study included life-threatening arrhythmic events (sustained VT/VF) requiring device implantation (ICD/CRT-D).
Results. The most frequent types of arrhythmia were ventricular premature beats (VPB) &gt;500 per day – in 64 (41.3%) pts, nonsustained ventricular tachycardia (VT) was observed in 54 (34.8%) pts, sustained VT – in 15 (9.7%) pts and permanent atrial fibrillation (AF) with episodes of nonsustained VT – in 34 (21.9%) pts. Syncope was recorded in 17 (11%) pts. Symptoms of NYHA FC III CHF were found in 28 (18.1%) pts. According to EchoCG data, the median LV ejection fraction (LVEF) was 44% (34; 54). According to LGE-CMR, 72 (46.8%) pts showed areas of myocardial fibrosis; the median volume of myocardial fibrosis was 13.2% (0.6; 58.5).
During the follow-up period, life-threatening arrhythmic events (sustained VT/VF) developed in 15 pts, among which ICD – 8 and CRT-D – 7 were implanted as part of the secondary prevention of sudden cardiac death (SCD). The 3-year event-free survival rate was 88 ± 14%. In multivariate analysis, independent factors associated with the risk of life-threatening events requiring ICD/CRT-D implantation are the following characteristics: the presence of syncope (HR 12.5; 95% CI 3.9–39.7, p &lt; 0.001), the presence of nonsustained VT (HR 11.8; 95% CI 1.5–95.1, p &lt; 0.021) and the percentage of fibrosis volume ≥30% (HR 3.23; 95% CI 1.01–10.4, p &lt; 0.048). Risk groups of life-threatening events were stratified based on multi-factor analysis. The three-year event-free survival rate of the high-risk group was 77.8 ± 5.8%, the low-risk group had no adverse events during the entire follow-up period, and the three-year event-free survival rate was 100%.
Conclusion. The developed model of risk stratification of life-threatening events allows identifying high-risk patients for timely preventive measures.
Long-term outcome of patients with inflammatory cardiomyopathies implanted with cardiac defibrillators: a single centre experience
Authors: Domenichini G , Herrera-Siklody C , Le Bloa M , Teres Castillo C , Carroz P , Graf D , Pascale P , Pruvot E , Porretta AP 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Arrhythmia management remains a challenge in patients with inflammatory cardiomyopathies and little is known about the clinical characteristics affecting the arrhythmia burden on the long term.

Purpose
To identify clinical predictors of ICD therapies among patients with inflammatory cardiomyopathies.

Methods
We included all ICD patients implanted in our centre over the last 10 years in a context of inflammatory cardiomyopathy. For each patient, data from implant, device checks and clinical follow-ups were retrospectively collected.

Results
A total of 16 patients were identified (11 males, age at implant 50 ± 13 years). Based on the revised 2019 Japanese Circulation Society criteria, a diagnosis of cardiac sarcoidosis was established in all cases. Secondary prevention of sudden cardiac death was the indication for ICD implant in 50% of the patients. In 5 cases a CRT-D device was implanted because of concomitant left ventricular systolic dysfunction and a high grade AV block.
During a median follow-up of 5.0 (0.9-6.6) years, 9 patients (56%) received ≥ 1 appropriate ICD treatment for ventricular tachycardia (VT) episodes (ATP only in 3 cases, ATP and shocks in 6 cases) with a median time lag from implant of 65.5 (57.0-314.8) days. Of these 9 patients, 6 were initially implanted for secondary prevention of sudden cardiac death. At the time of ICD therapies, 8 patients were under immunosuppressive treatment and 3 under antiarrhythmic drugs. A cardiac 18F-FDG PET scan was performed in 7 patients and an abnormal FDG uptake, compatible with an active inflammatory status, was documented in all cases. After optimisation of antiarrhythmic drugs, a VT ablation procedure was performed in 3 patients during the first 6 months following the ICD treatment because of recurrent VT. In another 3 patients, a VT ablation was performed 2-5 years after the first ICD treatment and was associated to stereotactic radiotherapy to achieve VT control.

Conclusion
In our series, patients affected by inflammatory cardiomyopathy and implanted with an ICD for secondary prevention of sudden cardiac death appear to be at high risk of ICD treatment especially during the first months after implantation. This could be the consequence of a more aggressive underlying inflammatory substrate, especially during the first phases of the disease, whereas the occurrence of VT episodes at later stage appear to be more scar-related. However, further studies on larger populations are required to confirm these observations.
Left femoral venous access for leadless pacemaker implantation: patient characteristics and outcomes
Authors: Jelisejevas J , Breitenstein A , Hofer D , Winnik S , Steffel J , Saguner A 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Leadless pacing has become an alternative approach for patients requiring a single-chamber pacemaker. Conventionally, Leadless Micra Transcatheter Pacing System (TPS) pacemakers are implanted via a right femoral venous access. However, due to various reasons, a left sided femoral venous approach may benecessary. We hypothesized that a left sided femoral venous approach is as safe and effective as compared to a right sided approach.

Objective
We assessed indications, procedural characteristics, safety and mid-term outcomes of Micra TPS implantation via a left femoral venous approach as compared to the conventional right sided approach.
Methods and Results: In this retrospective single-center analysis, 143 consecutive patients undergoing Micra TPS implantation were included. 87% (125/143) underwent Micra TPS implantation via a right, and 13% (18/143) via a left femoral venous access. The mean age at implantation was 79.8 ± 7.5 years. Acute procedural success, mean procedure and fluoroscopy times as well as device parameters at implantation and follow-up (mean 15 ± 11.5 months) were similar between the two groups. Five major complications (3.5%) were encountered, all using a right-sided approach. After a transfemoral TAVI procedure, left femoral venous access was used in 42% of cases as compared to 8% in the remaining population (p = 0.003). Final leadless pacemaker position within the right ventricle was mid-septal in 82% (102/125) for right femoral access vs 72% (13/18) for left femoral access (p = 0.16). In the remaining cases (28 %, 5/18), the device was placed infero-septal following a left femoral venous access, as compared to 14% (18/125) for a right sided approach (p = 0.19). No repositioning was needed in 68% (85/125) using a right femoral access vs 72% (13/ 18) patients with a left femoral access (p = 0.84).

Conclusions
A left femoral venous access for Micra TPS implantation is safe and effective with an excellent implantation success rate similar to a conventional right femoral venous access without longer implantation and fluoroscopy times. The most frequent reason for choosing left- vs. right femoral venous access was a previous transfemoral TAVI procedure.