bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of survival and ICD shocks in a population submitted to ventricular tachycardia ablation
Authors: Alves Da Silva P , Rodrigues T , Brito J , Silverio-Antonio P , Cunha N , Couto-Pereira S , Valente-Silva B , Carpinteiro L , Cortez-Dias N , Pinto F.J , De Sousa J 
Published: October 2021

Abstract

Introduction
Sustained monomorphic ventricular tachycardia (VT) is associated with an increased risk of mortality and morbidity in patients with ischemic heart disease (IHD). While implantable cardiac defibrillators (ICD) have been shown to reduce mortality in patients with IHD and are effective in terminating VT, they are unable to prevent recurrent VT. Also, recurrent ICD shocks have been associated with an increase in all-cause mortality, hospitalizations for heart failure and are painful, resulting in impaired quality of life. Therefore, strategies to prevent ICD shocks are needed.

Aim
To evaluate risk factors associated to all cause Mortality and ICD shocks

Methods
We conducted a prospective, observational, single-centre and single-arm study involving patients with IHD, referred for Radiofrequency catheter ablation (RCA) procedure for VT using high-density mapping catheters. Variables selected from the univariate analyses (p&lt;0.10) were entered into multivariable Cox proportional hazards regression models to estimate predictors of ICD shocks recurrence and overall mortality. All analyses were 2-sided and a P-value &lt;0.05 was considered statistically significant. Statistical analysis was performed by using IBM SPSS Statistics 26™.

Results
From June 2015 to June 2020, a total of 64 consecutive patients were referred to our centre for a first RCA procedure using high density mapping for VT. The mean age was 68±9 years, 95% were male. 83% of patients were in NYHA functional class II or I and mean LV ejection fraction was 33±11%. All-cause mortality was 23.4%, an age higher than 70 years (p=0.01) and chronic kidney disease (CKD) were associated with reduced survival on univariate analysis. On multivariate analysis, CKD shown a tendency to reduced survival (HR 0.22; CI95%: 0.41–1.22, p=0.08). No risk factors for ICD shocks were found (table 2).

Conclusions
In our population, age and chronic kidney disease were associated with reduced survival, however no risk factors were associated with ICD shocks.

Funding Acknowledgement
Type of funding sources: None.
Comparison of mortality prediction scores in elderly patients with ICD for heart failure with reduced ejection fraction
Authors: Hayiroglu M.I , Cinar T , Cinier G , Pay L , Yumurtas A.C , Tezen O , Eren S , Kolak Z , Cetin T , Ozcan K.S , Turkkan C , Ozbilgin N , Tekkesin A.I , Alper A.T , Gurkan K 
Published: October 2021

Abstract

Background
This investigation aimed to examine and compare the predictive value of MADIT-II, FADES, PACE and SHOCKED scores in predicting 1-year and long-term all-cause mortality in implantable cardioverter-defibrillator (ICD) implanted patients who were 75 years and over since there has been an area of uncertainty about the utility and usefulness of available risk scores in such cases.

Methods
In this observational, retrospective study, ICD implanted 189 geriatric patients are divided into two groups according to the presence of long-term mortality in follow-up. The baseline characteristics and laboratory variables were compared between the groups. MADIT-II, FADES, PACE and SHOCKED scores were calculated at the time of ICD implantation. 1-year and long-term predictive value of these scores were compared by a receiver operating curve (ROC) analysis.

Results
A ROC analysis showed that the best cut-off value of the MADIT-II score to predict 1-year mortality is 3 with 87% sensitivity and 74% specificity (AUC: 0.83; 95% CI: 0.73–0.94; p&lt;0.001) and long-term mortality is 2 with 83% sensitivity and 43% specificity (AUC: 0.68; 95% CI: 0.60–0.76; p&lt;0.001) The predictive value of MADIT-II was superior to FADES, PACE and SHOCKED scores in ICD implanted patients who are 75 years and over.

Conclusion
MADIT-II score has a significant prognostic value compared to FADES, PACE and SHOCKED scores for the prediction of 1-year and long-term follow-up in geriatric patients implanted ICD for heart failure with reduced ejection fraction.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
High incidence of inappropriate alarms in patients with wearable cardioverter-defibrillators: findings from the swiss WCD registry
Authors: Kovacs B , Burri H , Reek S , Sticherling C , Linka A , Ammann P , Mueller A.S , Kobza R , Haegeli L , Mayer K , Eriksson U , Reichlin T , Steffel J , Saguner A.M , Duru F ,   Swiss WCD Registry
Published: October 2021

Abstract

Introduction
The wearable cardioverter defibrillator (WCD) uses surface electrodes built into the vest to detect underlying arrhythmia before initiating a treatment sequence. However, it is also prone to inappropriate detection due to artefacts.

Purpose
The aim of this study was to assess the alarm burden in patients and its possible impact on clinical outcomes.

Methods
The Swiss WCD Registry is a nationwide, retrospective, observational registry. Patients were included from December 2011 until February 2018. Clinical characteristics and data from the WCDs, including alarm burden were analysed. Recordings ≥30 seconds of length were analysed and categorized as VT/VF, atrial fibrillation (AF), supraventricular tachycardia or artefact.

Results
A total of 10'653 device alarms were documented in 324 of 456 patients (71.1%) over a mean WCD wear-time of 2.0±1.6 months. Among these, the episode duration was 30 seconds or more in 2996 (28.2%). One hundred and eleven (3.7%) were VT/VF episodes. The remaining recordings were inappropriate arrhythmia detections (2736 (91%) due to artefacts; 117 (3.7%) AF; 48 (1.6%) supraventricular tachycardia). Two-hundred and seven patients (45.0%) had 3 or more alarms per month, whereas 49 patients (10.7%) had 1 or more alarms per day. Body mass index (BMI) was significantly higher in patients with 3 or more alarms per month (p=0.002, 25.6 vs. 27.3 kg/m2) High alarm burden was not associated with a lower average daily wear time (20.8 hours vs 20.7 hours, p=0.785) or a decreased implantable cardioverter defibrillator implantation rate after stopping WCD use (48% vs 47.3%, p=0.156).

Conclusions
In patients using WCDs, alarms emitted by the device and impending inappropriate shocks were frequent and most commonly caused by artefacts. A high alarm burden did not lead to a decreased adherence, as determined by average daily wear-times. Obesity was significantly associated with a higher alarm burden.

Funding Acknowledgement
Type of funding sources: None.
Stability of pacemaker parameters in cardiac amyloidosis patients
Authors: Wang J.Q , Yang D.Y , Fang Q 
Published: October 2021

Abstract

Cardiac amyloidosis is a rare disease due to the deposition of amyloid fibrils in the heart. Clinical manifestation of the heart includes restrictive heart failure and arrhythmia, when myocardium and conduction system are involved respectively. Arrhythmia can present as atrioventricular block (AVB), and sick sinus syndrome (SSS), therefore cardiac amyloidosis may require permanent pacemaker implantation. However, the stability of pacemaker parameters in cardiac amyloidosis patients remains unknown.
We conducted an observational retrospective study of patients diagnosed with cardiac amyloidosis who underwent permanent pacemaker implantation from January 1, 2011 to December 31, 2019. Base-line data were obtained via Medical Record System. Data of pacemaker parameters were obtained via pacemaker programming at the time of implantation and last follow-up at the clinic.
A total of 10 patients were included in our study, among which 5 patients underwent cardiac biopsy and showed positive result, 4 patients showed positive biopsy result of other tissue and characteristic echocardiography result of restrictive diastolic dysfunction, 1 patient was diagnosed with primary systematic amyloidosis (AL) involving kidney and advanced atrioventricular block. Amyloidosis type of the 10 patients were primary systemic amyloidosis (AL). Among the 10 patients, 3 were female (30.0%), and the mean age was 61.3±3.9. All patients met the indication for permanent pacemaker implantation, including 9 SSS and 1 advanced AVB. 9 patients were implanted with DDD, and 1 with VVI. The middle survival time was 446 (331, 728) days from the time of implantation to last follow-up (June 30, 2020). Two patients died due to disease progression. As for the 7 patients whose baseline and follow-up data were both obtained, pacemaker parameters at baseline were as followed: Atrial Impedance 477.8±115.0 Ω, Atrial P Wave 1.30±0.70 mV, Atrial Threshold 0.75±0.16 V@0.4ms, Ventricular Impedance 551.3±233.4 Ω, Ventricular R Wave 7.99±4.66 mV, Ventricular Threshold 0.76±0.15 V@0.4ms. Pacemaker parameters at follow-up were as followed: Atrial Impedance 426.2±93.2 Ω, Atrial P Wave 1.34±0.71 mV, Atrial Threshold 1.59±1.51 V@0.4ms, Ventricular Impedance 405.8±41.6 Ω, Ventricular R Wave 10.69±6.53 mV, Ventricular Threshold 1.80±1.88 V@0.4ms.
Most patients relieved from cardiac symptoms and severe cardiac complications. A relatively short-term follow-up indicated elevation of Ventricular Threshold (P=0.028), and analysis of other parameters showed insignificant results. Elevation of Ventricular Threshold may be explained by the progression of amyloid fibrils deposition in the heart. Ventricular Threshold of one patient significantly increased from 1.0 V to 6.0 V at 3-month follow-up. Since all patients underwent chemotherapy for the primary amyloidosis, stability of pacemaker parameters may be another way for evaluation. Long-term follow-up is needed for further evaluation.

Funding Acknowledgement
Type of funding sources: None.
Single- vs dual-chamber ICDs to prevent from inappropriate shocks: the debate is still alive
Authors: Briongos Figuero S , Estevez A , Perez M.L , Martinez Ferrer J.B , Garcia E , Vinolas X , Arenal A , Alzueta J , Munoz Aguilera R 
Published: October 2021

Abstract

Background
The efficacy of dual-chamber implantable cardioverter defibrillators (ICDs) in preventing from inappropriate shocks (IS) is still a matter of debate.

Purpose
To compare the risk of IS among single- and dual-chamber ICDs in a cohort of heart failure (HF) patients carrying a prophylactic device. We aimed to focus on the relationship between programming and discriminators, and the risk of IS in a large cohort.

Methods
All HF patients with left ventricle ejection fraction &lt;35% undergoing a prophylactic ICD-only implant were collected from the multicentre, prospective and nationwide UMBRELLA study. ICD programming was performed according to regular clinical practice at each site and. ICD setting and arrhythmic events occurring during the study period were automatically stored through the remote monitoring system. An experts committee analysed in a blinded manner all electrograms coming from the arrhythmic events.

Results
From 2006 to 2015, 782 patients implanted with an ICD were analysed (537 patients (68.7%) with single-chamber ICDs and 245 patients (31.3%) with dual-chamber ICDs). During a mean follow-up of 4.35±2 years, 109 IS were delivered in 49 patients. IS occurred in 7.8% (n=42) of patients carrying single-chamber ICDs and in 2.9% (n=7) of dual-chamber carriers (p=0.001). A propensity score matched analysis was performed. The matched cohort was composed by 110 well-balanced (regarding baseline characteristics and programming) patients. In the weighted sample, dual-chamber ICDs were related to lower rates of IS (Figure 1) as compared to single-chamber devices (0.9% vs. 11.8%, p≤0.001).
Among programming the following ICD settings correlated to lower risk of IS: ≥30 of 40 intervals detection within ventricular fibrillation (VF) zone (HR=0.47; p=0.018), a programmed ATP-capable zone enabled through VF zone (HR=0.54; p=0.038), morphology discriminator (Wavelet®) (HR=0.42; p=0.032), and the specific dual-chamber discriminator (PR Logic®) (HR=0.28; p=0.004). After multivariable Cox regression analysis including clinical variables and device settings, PR Logic® discriminator was the only programming parameter independently related to a lower risk of IS (HR=0.18, CI 0.06–0.48, p=0.001).

Conclusions
In our nationwide cohort of primary prevention ICD-only patients, dual-chamber devices were associated with a lower risk of IS. ICDs equipped with PR Logic® discriminator might be useful to prevent from IS.

Funding Acknowledgement
Type of funding sources: None. Programming in the matched populationFigure 1
New York Heart Association class change on heart failure patients with implantable devices: does it matters?
Authors: Duarte F , Barradas M.I , Oliveira L , Serena C , Dourado R , Fontes A , Monteiro A , Machado C , Santos E , Pelicano N , Tavares A , Pacheco M , Martins D 
Published: October 2021

Abstract

Background
Chronic heart failure (CHF) is a pathology with high prevalence and an important cause of morbidity and mortality. Benefits of implantable devices have been demonstrated in selected groups of patients with benefits on symptoms and heart failure hospitalization.

Purpose
To determine the clinical impact of New York Heart Association class change (NYHA) in patients with CHF and Cardiac Implantable Electric Devices (CIEDs).

Methods
We retrospectively enrolled 178 consecutive patients with CHF and CIEDs between November 2003 and January 2021, during a follow-up period of 51±43,9 months. Patients demographic characteristic and NYHA class change impact on occurrence of arrhythmic events, heart failure hospitalization (HFH) or long-term admission in an emergency department were assessed. Patients with NYHA class change were considered responders to therapy.

Results
Out of 178 patients enrolled in this study, sixty-seven (37,6%) had a reduction ≥1 in NYHA functional class and in this group, 61 patients (91,0%) had a cardiac resynchronization therapy (CRT) and 9% had an implantable cardioverter defibrillator. Mean age 68±11,3 years, 44 (65,7%) patients were male, 33 (49,2%) were in NYHA class II, 30 (44,8%) NYHA class III and 4 (6%) NYHA class IV. Mean QRS width 129,9±63,1 ms before CIEDs. Fifty-eight patients (86,6%) had an improvement in one NYHA functional class and 9 patients (13,4%) in two NYHA functional class.
Fourty NYHA responders patients (59,7%) had paroxistic or permanent atrial fibrillation and 31,9% had an epicardial coronary artery disease, that was a negative predictor of NYHA response (p=0,012).
A total of 35 (19,7%) enrolled patients experience non-sustained ventricular tachycardia (NSVT) and 74,3% were non-responders (p=0,019).
There was fifteen and twenty HFH at 2 and 5 years of follow-up, respectively, and we observed that an improvement in NYHA class was associated with a reduction in HFH at 2 years of follow-up (p=0,043; OR 0,029, 95% CI 0,050–1,06) and 5 years of follow-up (p 0,027, OR 0,252; 95% CI 0,069 – 0,915). Emergency department (ED) admission related to HF decompensations was significantly reduced at 2 years of follow-up (p=0,035, OR 0,22, 95% CI 0,048 – 1,0) and at 5 years of follow-up (p=0,001, OR 0,15, 95% CI 0,044 – 0,55).
There was no difference on cardiovascular or all-cause mortality.

Conclusion
CHF patients with CIEDs and improving on NYHA class have less NSVT episodes, HFH and HF decompensations with ED admission, both at 2 and 5 years of follow-up.

Funding Acknowledgement
Type of funding sources: None.
The effect of QRS area in predicting survival benefit following cardiac resynchronization therapy: a systematic review and meta-analysis
Authors: Tokavanich N , Prasitlumkum N , Mongkonsritragoon W , Cheungpasitporn W , Trongtorsak A , Chokesuwattanaskul R 
Published: October 2021

Abstract

Background
QRS area, three-dimensional QRS complex, is among novel vectorcardiographical methods of measuring the magnitude of electrical forces generated by the heart. Hypothetically, greater QRS area portrayed higher dyssynchronous electrical activation, possibly deriving significant cardiac resynchronization therapy (CRT) benefit. Previous studies suggested a positive correlation between QRS areas and the degree of CRT responses. Nevertheless, its clinical use has remained premature. We hence performed a systematic review and meta-analysis of QRS area in predicting survival benefit following CRT.

Method
We comprehensively searched the databases of MEDLINE, EMBASE, and Cochrane database from inception to March 2021. Included studies with prospective and retrospective cohort design. Studies those report QRS area before implantation of CRT and outcome of total mortality. Data of each study were combined with random effects model. The results were reported in hazard ration (HR) with 95% confidence intervals.

Result
Four observational studies, including 4,931 patients, were identified. The cut-off values between large and small QRS areas ranged from 102–116 μVs. Our analysis showed larger QRS area was statistically associated with survival benefit in patients implanted with CRT with follow up time up to 5 years (Pooled hazard ratio 0.46, 95% confident interval 0.38–0.55, I2=42%). More QRS areas changes (pre and post implantation) were associated with lower total mortality rate (Pooled hazard ratio 0.45, 95% confident interval 0.38–0.52, I2=0%).

Conclusion
Patients with pre-implantation larger QRS area were strongly associated with survival benefit after CRT implantation. QRS area may potentially become additional selection criteria for CRT implantation.

Funding Acknowledgement
Type of funding sources: None. Figure 1. Forest plot of pooled hazard ratioTable 1. Study characteristics
HeartLogic algorithm for heart failure monitoring in the era of CoViD-19 pandemic and remote monitoring/telemedicine
Authors: Ebrille E , Amellone C , Lucciola M.T , Suppo M , Antonacci G , Gotta F , Birolo M , Favro E , Orlando F , Giammaria M 
Published: October 2021

Abstract

Background
Due to the current CoViD-19 pandemic, the number of outpatient hospital visits has significantly decreased, creating a fundamental need for telemedicine. Remote monitoring of implantable cardiac devices has emerged as a powerful and well-validated tool to follow patients with heart failure (HF) and cardiac resynchronization therapy (CRTs) devices.

Purpose
The aim of our study was to evaluate the CRT HeartLogic algorithm performance in the detection of HF episodes in a real-life population followed with remote monitoring.

Methods
Fifty-four patient (mean age 73±7 years, 72% males) with HF and reduced left ventricular ejection fraction were implanted with a HeartLogic-enabled CRT device and were enrolled in the Boston Scientific Latitude remote monitoring platform. Remote data were reviewed every month and at the time of an alert. The HeartLogic nominal value of 16 was used to trigger an alert episode. Patients were then contacted by phone and actions were taken to manage the potential HF condition detected by the alert.

Results
During a median follow-up of 12 (6–18) months, the HeartLogic alert was triggered in 9 patients (9/54, 17%). The median time between threshold crossing and a HF clinical event was 11 (2–19) days. The maximum HeartLogic index value was 43 (mean 29±8). Three events occurred after inappropriate discontinuation of HF therapy. All the events required clinical action. Four out of 9 patients required diuretic dosage increase, 1/9 electrical cardioversion for new onset atrial fibrillation, 3/9 hospitalization for i.v. therapy. One patient showed only mild HF symptoms but was found to have concomitant CoViD-19 infection.

Conclusion
The HeartLogic algorithm is useful to detect HF worsening and undertake appropriate clinical actions. Telemedicine and device remote monitoring are very helpful tools allowing early detection of HF-related clinical conditions. This is of utmost importance in the era of CoViD-19 pandemic, when scheduled access to the hospital for routine follow-up appointments might be limited.

Funding Acknowledgement
Type of funding sources: None.
Patients with transthyretin amyloid cardiomyopathy may have preserved, mildly reduced, or reduced ejection fraction
Authors: Garcia-Pavia P , Fine N , Weissman N.J , Castano A , Gundapaneni B , Sultan M.B , Shah S.J 
Published: October 2021

Abstract

Background
Transthyretin amyloid cardiomyopathy (ATTR-CM) is an often-overlooked form of heart failure with preserved ejection fraction (HFpEF). Previous studies have demonstrated that relatively high proportions of older patients with HFpEF have underlying ATTR-CM. However, while ATTR-CM should not be overlooked as a cause of HFpEF, it also should not be assumed that all patients with ATTR-CM present with HFpEF.

Purpose
To categorise patients with ATTR-CM from a large clinical trial by left ventricular ejection fraction (LVEF) at enrolment in order to describe the prevalence of HFpEF, HF with mildly reduced EF (HFmrEF), and HF with reduced EF (HFrEF).

Methods
The Tafamidis in Transthyretin Cardiomyopathy Clinical Trial (ATTR-ACT) enrolled 441 patients with ATTR-CM, including both hereditary (ATTRv) and wild-type (ATTRwt) patients. In ATTR-ACT, all patients underwent echocardiography at enrolment using a standardised protocol, and all images were reviewed and analysed at an independent central laboratory. In this analysis of patient data at enrolment, all patients in ATTR-ACT were categorised by LVEF as: HFpEF (LVEF ≥50%), HFmrEF (LVEF 41–49%), or HFrEF (LVEF ≤40%). The proportions of patients in these LVEF categories in the sub-groups of race, sex, genotype, and disease severity (by NYHA class) were assessed, together with myocardial contraction fraction (MCF) in each category.

Results
In ATTR-ACT, there were 220 (50.5%) patients with HFpEF, 119 (27.3%) with HFmrEF, and 97 (22.3%) with HFrEF (Table). Five subjects with missing LVEF at enrolment were not categorized. Asian patients had the highest proportion with HFpEF, followed by White, then Black patients. The ATTRwt group had a higher proportion of patients with HFpEF than the ATTRv group. There were significant differences (as assessed by Chi-square test; P=0.0001) in the proportion of patients in each EF category between NYHA class I or II and NYHA class III patients. Median MCF was higher in NYHA class I/II (16.6%) than NYHA class III (14.8%) patients, and higher in patients with HFpEF compared with HFmrEF and HFrEF.

Conclusions
Not all patients with ATTR-CM have HFpEF. In this analysis of patients at enrolment in ATTR-ACT half had mildly reduced or reduced LVEF, with even higher proportions of reduced EF observed in Black patients, ATTRv patients, and patients with worse functional class (NYHA class III). These data demonstrate that ATTR-CM should be considered as a possible diagnosis in all patients with HF regardless of EF.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Pfizer Table 1