bluuebunny/crossref_metadata_2025_split huggingface dataset:
Heart rate turbulence as potential adjuvant index for optimal treatment guidance in severe pulmonary artery hypertension
Authors: Simeonidou E , Triantafyllidi H , Varounis C , Ntai K , Katogiannis K , Apostolopoulou O , Orphanos S , Armaganidis A , Lekakis J 
Published: October 2021

Abstract

Purpose
Despite significant progress achieved in the management of pulmonary arterial hypertension (PAH), the prognosis remains poor. Sudden cardiac death is one main cause of death in advanced disease. It is already known that in pts with PAH there is an alteration in cardiac autonomic nervous activity. Heart rate turbulence (HRT) is an ECG–related autonomic marker, helpful in risk stratification of proarrhythmia and sudden cardiac death. Aim of the study was to examine HRT in patients with severe idiopathic PAH (IPAH) and its relation to disease's progress.

Methods
The study population consisted of 46 pts, (32 men and 14 women), mean age 50±9 years, Group A 20 pts: NYHA III, III–IV diagnosed as severe IPAH and Group B 26 pts: NYHA II, II–III diagnosed as moderately severe IPAH. They underwent 24h Holter monitoring-HRT analysis with calculation of 2 parameters, turbulence onset (TO) and turbulence slope (TS) (Abnormal values: TO&gt;0, TS&lt;2.5msec/RR). Pts were defined as HRT(+) when TO and/or TS were abnormal and as HRT(−) when both TO and TS were normal or when HRT could not be calculated because of none or too few suitable PVCs. Reassessment of HRT was undertaken in 6 mo and 1 year in case of change in clinical status. Six pts from group A and 7 pts from group B underwent HRT reassessment because of change in clinical status.

Results
Initially abnormal HRT was found in 12 out of 20 pts (n=12, 60%) in group A and in none out of 26 (n=0, 0%) in group B (p=0,001). In 5 pts out of 8 with clinical improvement and 4 pts with clinical deterioration who had HRT reassessed, significant positive correlation was found between TS and change of clinical status (r=0,64, p=0,04). There was a tendency to greater normal TS mean values with clinical improvement even in group where TS was already normal (6,95±4,5 vs 3±0,3 p=0.077).

Conclusion
In severe IPAH cardiac autonomic system impairment was demonstrated mainly as abnormal TS in HRT. Significant positive correlation between normalization of TS and clinical improvement was revealed and that raises promises for use of HRT optimization as adjuvant index to guide optimal IPAH therapy and efficacy.

Funding Acknowledgement
Type of funding sources: None.
Implantable loop recorder follow-up
Authors: Pena Mellado J , Macias R , Tercedor L , Alvarez Lopez M 
Published: October 2021

Abstract

Introduction
Long ambulatory ECG monitoring can be a useful component in the evaluation of the patient with unexplained syncope or syncope with suspected arrhythmic origin, as well as a sensitive tool for detecting asymptomatic spontaneous cardiac arrhythmias or conduction abnormalities in predisposed patients.

Purpose
To determine the diagnostic cost-effectiveness of the implantable loop recorder (ILR) in the origin of unexplained syncope in our center.

Methods
A retrospective observational study was carried out in a tertiary center, those patients with an ILR between August 2014 and March 2021 were included. Baseline characteristics of the population and their previous ECG, arrythmias detected during follow-up and pacemaker implant rate were evaluated.

Results
One hundred twenty-seven patients with a ILR were included (age 67 years, 49.6% males). Most often cause of ILR was unexplained syncope (90.6%) followed by monitoring after TAVI implant (3.9%). Normal LVEF (&gt;50%) was present in 85.6%,and 75.6% had NYHA I functional class. 118 patients (92.9%) presented sinus rhythm at implant time, and 8 (6.3%) presented AF. 12.6% presented first degree atrioventricular (AV) block, 2 patients (1.6%) had presented previously Mobitz Type I AV block and one patient 2:1 block. Left bundle branch block (LBBB) was present in 13.4%,RBBB in 3.1%,LAFB in 9.4%, RBBB+LAFB in 11% and RBBB+LPFB in 2.4%. Median time of follow-up was 21 months. 3rd degree AV block was the most frequent arrhythmia detected (12.1%), followed by &gt;3s pause (8%) and previously unknown AF (2.4%).The patients with syncope who suffered head trauma (33%) presented a higher rate of pacemaker (PCM) implant compared to those without head trauma: 31.6% vs 14.7%. In total,19.8% PCM rate implant during follow-up. No complications ILR related.

Conclusion
In conclusion, long home ECG monitoring with ILR is a powerful and helpful tool to find out or rule out potentially dangerous arrhythmias as cause of syncope, with no complications in our experience.

Funding Acknowledgement
Type of funding sources: None. Baseline characteristicsArrhythmias detected during follow-up
Role of LA strain assessed by speckle tracking echocardiography in predicting patients who develop POAF after a coronary artery bypass surgery
Authors: Rukmani Prabha V , Rajeshwari N , Jenifer J 
Published: October 2021

Abstract

Objectives
To evaluate the correlation between left atrial dysfunction assessed by speckle tracking echocardiography and development of postoperative atrial fibrillation (POAF) in patients undergoing coronary artery bypass grafting. To determine the role of coronary risk factors in development of POAF.

Method
Patients undergoing CABG from January 2019 till June 2020 in Apollo institute, fulfilling the inclusion and exclusion criteria were included.Total of 200 patients were followed.They were subjected to LA strain and strain rate analysis by speckle tracking.

Results
The incidence of POAF in our study was 24% (n=48). The mean age of this study population was 59.13 years. The patients who developed POAF were older (68.5±9.048 vs 58.39±9.74 years, p value=0.05) than those with no POAF. POAF occurred in 2 phases. the highest proportion of POAF occurrence noticed on postoperative day 2. Among the total POAF cases 79.% occurred within the first 48 hours and 20.8% occurred later (p=0.001). Among the 48 patients who developed POAF, 5 of them developed recurrence during their hospital stay. They had reverted to sinus rhythm following anti-arrhythmic medication for a duration of &gt;24 hours, but went on to develop recurrence of AF at a later. 4 among them reverted to sinus rhythm at discharge while 1 continued to remain in AF at discharge.The duration of hospital stay for patients with POAF group was 10.4 days compared with 10.04 days for those without POAF. Similarly the post-operative stay in the hospital was 7.4 days for the POAF group and 7.04 days for the NO POAF.There was no added economic impact secondary to AF.Comparing the values of left atrial volume index of both the groups it was derived that the mean LAVI value of the POAF group was 26.84+3.654 ml/m2 and that for the NO POAF group was 26.6+3.037ml/m2. Though the patients with POAF had larger LA volume, the chi square test analysis did not yield any clinically significant relationship between LAVI and POAF in our study (p=0.3). The mean LA global strain for the patients with POAF was 29.73+3.695%. And for the patients with no POAF was 36.3+4.854%. LA global strain was reduced in patients who developed POAF (P&lt;0.001) which indicated a strong correlation between LA strain and POAF.

Conclusion
There is significant correlation between Global Left Atrial Strain and POAF in patients undergoing CABG (P&lt;0.001).There is no significant correlation between patient factors like age, BMI, and the conventional coronary risk factors with POAFThere is no significant correlation between the conventional echocardiographic parameters like LA diameter, LAVI, LVDD, LVSD, LVEF and transmitral flow velocities with POAF.
To conclude, preoperative speckle tracking assessment of LA has a strong predictive role in determining the occurrence of POAF in patients undergoing Coronary artery bypass grafting surgery.

Funding Acknowledgement
Type of funding sources: None.
Electrograms from the coronary sinus as a predictor for the outcome of a re-do pulmonary vein isolation
Authors: Mohsen Y , Grossmann N , Draheim J , Horlitz M , Stoeckigt F 
Published: October 2021

Abstract

Background
Voltage signals in the coronary sinus (CS) have been associated with the presence of left atrial fibrosis. The aim of the present study was to evaluate the value of CS voltage signals as a predictor for atrial fibrillation (AF)-recurrence-free outcome of pulmonary vein isolationprocedures (PVI) in patients after a first unsuccessful cryo-balloon PVI.

Method
We collected recordings from a diagnostic catheter positioned in the CS from 282 consecutive atrial fibrillation patients undergoing a re-dopulmonary vein isolation using a 3D mapping system. The patients were followed-up (Holter ECG and telephone calls) for at least one year (median of 14 months).

Results
Of the 282 patients (male 72%, mean age 63±10.8 years, 61% persistent AF) AF recurrences were documented in 152 pts (54%)with a signal amplitude in the proximal CS position of 2.4 mV ± 1.5 mV. Patients free of AF-recurrence showed significantly higher signal amplitude of 2.9 mV ± 2.1 mV (P&lt;0,05).
A CS voltage &lt;0.53mV could predict recurrences of AF with a sensitivity of 94.7% (95% CI 89.3% – 97.8%) and specificity of 8.6% (95% CI 4.6% – 14.8%; PLR 1.04; AUC 0.55).

Conclusion
Voltage signals in the CS, as a marker for left atrial fibrosis, are associated with the outcome of PVI. A voltage threshold of &lt;0.53mV can predict AF recurrences with a high sensitivity. However, the predictive value for AF recurrences is not high due to the low specificity of this test.

Funding Acknowledgement
Type of funding sources: None.
Novel rhythm conversion approach in unsuccessful electric cardioversion of persistent atrial fibrillation
Authors: Pyataeva O V , Zenin S A , Kononenko O V , Felikov I M , Fedoseenko A V 
Published: October 2021

Abstract

The average effectiveness of electrical cardioversion in persistent atrial fibrillation (AF) is considered about 90%. The success is limited by arrhythmia longevity, essential heart pathology, excessive body mass, concomitant deceases. A novel developed in Russia class III intravenous medication “Refralon” (4-nitro-N-(1RS)-1(4-fluorophenyl)-2-(1-ethylpiperidin-4-ethyl) benzamide hydrochloride) seems to be promising in sinus rhythm restoration in such patients.
The aim of the study was to assess the effectiveness of a novel class III intravenous medication “Refralon” in conversion to sinus rhythm in patients with permanent AF in whom electrical cardioversion was unsuccessful.

Materials and methods
19 patients were included: 16 male and 3 female aged from 45 to 68 years old (59,9±5,84 (M±SD)). Left atrial size was 47±3,2 × 59±2,8 mm, BMI 38,5±7,0 kg/m2, arrhythmia duration from 2 to 21 months (6,7±4,99). Refralon was injected according to the approved manual in ICU; heart rhythm and rate, blood pressure, SpO2 were monitored. Dynamic assessment of QT and QRS duration was performed.

Results
In 17 of 19 patients (89,4%) sinus rhythm was restored. In 7 patients (41%) sinus rhythm was restored before 10 min, in 4 patients (24%) before one hour, in 4 patients (24%) before two hours, in 2 patients (11%) before six hours. In two patients sinus rhythm was not restored. In both target dose was not infused due to non-sustained ventricular tachycardia in one case, and QT prolongation in another.

Conclusion
In a small pilot study Refralon was highly effective in patients with persistent atrial fibrillation when electrical cardioversion was ineffective. All the patients had significantly increased BMI. The results may suggest the indication for Refralon usage in obese patients.

Funding Acknowledgement
Type of funding sources: None.
Long-term outcomes among a cohort of 4296 implantable cardioverter-defibrillator patients: insights from the UMBRELLA study
Authors: Briongos Figuero S , Garcia Alberola A , Rubio J , Segura J M , Rodriguez A , Peinado R , Alzueta J , Martinez Ferrer J B , Vinolas X , Munoz Aguilera R , Perez M L 
Published: October 2021

Abstract

Background
Large observational real-world studies describing modern implantable cardioverter-defibrillator (ICD) populations with long-term follow-up are lacking.

Purpose
To assess the incidence of arrhythmias in a cohort of contemporary patients undergoing ICD implant from 2005 and 2017 and to analyze the arrhythmic risk and mortality according to their clinical profiles.

Methods
UMBRELLA (NTC01561144) is a prospective, multicentre, nationwide study of ICD patients followed by remote monitoring. All device information was automatically stored through the remote monitoring system and a blinded review of all the stored arrhythmic episodes was performed. The study outcomes were first appropriate ICD therapy and all-cause death.

Results
The study population consisted of 4296 patients (61.9±12.9 years, ischaemic cardiomyopathy (ICM): n=2150, dilated cardiomyopathy (DCM): n=1166, valvular heart disease (VHD): n=119, hypertrophic cardiomyopathy (HCM): n=294, arrhythmogenic right ventricular cardiomyopathy (ARVC): n=71, Brugada syndrome (BS): n=143, long QT syndrome (LQTS): n=43, and adult congenital heart disease (ACHD): n=60)). Primary prevention (PP) was the main indication (n=2758).
During a mean follow-up of 46.6±27.3 months, 16,067 episodes of sustained ventricular arrhythmia (SVA) occurred in 1344 patients. Appropriate ICD therapy was delivered to 85.7% (n=13,767) episodes of SVA in 1173 patients (27.3% of population). A higher risk of first appropriate ICD therapy was observed in VHD (HR: 1.94, 95% CI: 1.43–2.62), ARVC (HR: 1.84, 95% CI: 1.28–2.66), ICM (HR: 1.51, 95% CI: 1.29–1.78), and DCM (HR: 1.28, 95% CI: 1.07–1.53) whereas patients with HCM (HR: 0.72, 95% CI: 0.54–0.96) and BS (HR: 0.25, 95% CI: 0.14–0.45) were at significantly lower risk (Figure 1A). In multivariate analysis (Table 1), age, gender, atrial fibrillation (AF), secondary prevention, LVEF ≤35%, and QRS width emerged as clinical predictors of appropriate ICD therapy, whereas CRT-D correlated with lower risk. An independently higher risk was found in DCM, VHD, and ARVC, and a lower risk in BS patients.
At follow-up, 590 deaths (13.4% of population) were reported. Patients with ICM (HR 3.90, 95% CI: 2.58–5.90), DCM (HR 3.33, CI 95%: 2.18–5.10), and VHD (HR 3.97, CI 95%: 2.25–6.99) had worse prognoses and it was significantly better in BS patients (HR 0.11, 95% CI: 0.01–0.67, p=0.017) (Figure 1B). In multivariate analysis, age, gender, AF, renal failure, diabetes and reduced LVEF, emerged as independent predictors of all-cause death (Table 1).

Conclusions
Irrespective of the aetiology, contemporary ICD patients with an arrhythmic substrate derived from left ventricular systolic dysfunction had a similar risk of ICD life-saving interventions and death.

Funding Acknowledgement
Type of funding sources: None. Table 1Figure 1
Defibrillation testing of subcutaneous versus transvenous defibrillators in the clinical practice: a nationwide survey in Italy
Authors: Migliore F , Viani S , Ziacchi M , Ottaviano L , Checchi L , Francia P , D'Onofrio A , Bisignani G , Dello Russo A , De Filippo P , Solimene F , Pisano E , Palmisano P , Manzo M , Botto G L ,   RHYTHM DETECT registry
Published: October 2021

Abstract

Aims
According to current guidelines, defibrillation testing (DT) for efficacy can be omitted in patients undergoing transvenous implantable cardioverter–defibrillator (T-ICD) implantation. DT is still recommended for patients at risk for a high defibrillation threshold (e.g. hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, right-sided implantations) and for ICD generator changes. Moreover, a class I recommendation remains to perform DT during the implantation of subcutaneous ICD (S-ICD). The aim of the present survey was to analyze the current practice of DT during T-ICD and S-ICD implantations in Italy.

Methods
In March 2021, an ad hoc questionnaire on the current performance of DT and the standard practice adopted during testing was completed by 72 operators at Italian centers implanting S-ICD and T-ICD.

Results
48 (67%) operators reported never performing DT during de-novo T-ICD implantations, while no operators perform it systematically. The remaining respondents perform it in specific cases: right sided implantations (54%), poor signal sensing (46%), secondary prevention patients (42%), arrhythmic syndromes (13%), hypertrophic cardiomyopathy (8%). DT is never performed at T-ICD generator change. At the time of de-novo S-ICD implantation, DT is never performed by 9 (13%) operators and performed systematically by 48 (66%). The remaining operators perform DT in cases of: secondary prevention patients (73%), sub-optimal S-ICD placement (33%), non-compromised ejection fraction (33%) or obese patients (7%). DT is not performed at S-ICD generator change by 92% of operators. DT is conducted by delivering a first shock energy of 65J by 60% of operators, while the remaining 40% test lower energy values. The most frequently reported conditions for revising the system at the end of de- novo implantation procedure is high shock impedance (54%) and sub-optimal S-ICD placement or high PRAETORIAN score (50%). With adequately low shock impedance and optimal system placement, 37% of operators would accept a defibrillation margin &lt;15J.

Conclusion
In current clinical practice, the vast majority of operators omit DT at T-ICD implantation, even when still recommended in the guidelines. DT is also frequently omitted at S-ICD implantation. We also report a wide variability among operators in the procedures followed during DT and in the criteria applied for defining the procedural success.

Funding Acknowledgement
Type of funding sources: None.
Acute change in parasympathetic cardiac innervation after pulmonary vein isolation by pulse-field and radiofrequency energy
Authors: Stojadinovic P , Wichterle D , Peichl P , Cihak R , Haskova J , Jansova H , Nejedlo V , Kautzner J 
Published: October 2021

Abstract

Background
In patients with atrial fibrillation (AF), pulmonary vein isolation (PVI) by radiofrequency (RF) energy is associated with a significant change of cardiac autonomic regulations due to collateral ganglionic plexi ablation. Pulse-field (PF) ablation energy presumably spares neural tissue.

Purpose
We compared the effect of PVI by PF and RF energy on cardiac autonomic function.

Methods
A study enrolled 23 patients who underwent PVI in general anaesthesia. In 12 patients, a novel lattice-tip catheter and PF energy were used for ablation while 11 patients were ablated using a conventional irrigated-tip catheter and RF energy. The response of the sinus node (SAN) and atrioventricular node (AVN) to extracardiac high-frequency vagal stimulation (ECVS) was tested before and after PVI (via right internal jugular vein; stimulation frequency of 50 Hz; pulse width of 0.05 ms; output of 1 V/kg (&lt;70V); train duration of 5 s).

Results
At baseline, physiological massive response to ECVS (sinus arrest and/or AV block) was demonstrated in the majority of patients. After PVI, complete loss of autonomic response of the SAN in 11/11 (100%) and 3/12 (25%) patients (p=0.003), and the AVN in 9/11 (82%) and 3/12 (25%) patients (p=0.01) was observed in RF and PF groups, respectively. The figure shows the maximum duration of the pause in sinus rhythm (maximum P-P interval) and AVN block (maximum R-R interval during atrial pacing) induced by ECVS after PVI.

Conclusion
Cardiac vagal response is preserved in a considerable proportion of AF patients after PF ablation which is in contrast with a significantly stronger effect of RF energy. This may influence the clinical outcome of AF ablation procedures.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Institute for Clinical and Experimental Medicine, Prague
Earliest pulmonary vein potential guided cryoballoon ablation is associated with better clinical outcomes than conventional cryoballoon ablation: a result from two randomized clinical studies
Authors: Yonekawa J , Mizutani Y , Yamashita D , Makino Y , Hiramatsu T , Ichimiya H , Uchida Y , Watanabe J , Kanashiro M 
Published: October 2021

Abstract

Background
With regards to short-term outcome in atrial fibrillation (AF), the benefit of cryoballoon ablation (CBA) by pressing a balloon against the earliest pulmonary vein (PV) potential site during pulmonary vein isolation, (earliest potential [EP]-guided CBA) has been previously demonstrated.

Objective
The present study aimed to evaluate the long-term outcome of the EP-guided CBA.

Methods
This study included 136 patients from two randomized studies, who underwent CBA for paroxysmal AF for the first time. Patients were randomly assigned to the EP-guided and conventional CBA groups in each study. In the EP-guided CBA group, we pressed a balloon against the EP site when the time to isolation (TTI) after cryoapplication exceeded 60 s and 45 s in the first and second studies, respectively. The patients were followed up for 1 year after procedure. We compared the clinical outcomes between the EP-guided CBA group (68 patients) and the conventional CBA group (68 patients).

Results
No significant differences in baseline characteristics were observed between the two groups. Compared with the conventional CBA group, the EP-guided CBA group had a significantly higher success rate at TTI ≤90 s (98.5% vs. 90.0%, P&lt;0.001); lower touch-up rate and total cryoapplication; and shorter procedure time, and fluoroscopy time. The recurrence at 1-year after ablation was significantly lower in the EP-guided CBA group than in the conventional CBA group (6.0% vs. 19.4%; P=0.019).

Conclusions
The EP-guided CBA approach can facilitate the ablation procedure and achieve low recurrence at 1-year after ablation.

Funding Acknowledgement
Type of funding sources: None. Earliest potential [EP]-guided CBAThe recurrence at 1-year after ablation
Long-term outcome of endocardial-only versus combined endocardial-epicardial homogenization of the scar for treatment of ventricular tachycardia in patients with ischemic cardiomyopathy
Authors: Mohanty S , Trivedi C , Della Rocca D G , Gianni C , MacDonald B , Mayedo A , Bassiouny M , Gallinghouse G J , Horton R , Al-Ahmad A , Di Biase L , Burkhardt J D , Natale A.N.D.R.E.A 
Published: October 2021

Abstract

Introduction
We investigated the ablation success of scar homogenization with combined (epicardial + endocardial) versus endocardial-only approach for ventricular tachycardia (VT) in patients with ischemic cardiomyopathy (ICM) at 5 years of follow-up.

Method
Consecutive ICM patients undergoing VT ablation at our center were classified into group 1: endocardial scar homogenization and group 2: endocardial +epicardial scar homogenization. Patients with previous open heart surgery were excluded.
All patients underwent bipolar substrate mapping with standard scar settings defined as normal tissue &gt;1.5 mV and severe scar &lt;0.5 mV. Non-inducibility of monomorphic VT was the procedural endpoint in both groups. Patients were followed up twice a year for 5 years with implantable device interrogations.

Results
A total of 361 (Group 1: 291 and group 2: 70) patients were included in the study (mean age: 67 years, male: 88.4%).
At 5 years, significantly higher number of patients from group 2 remained arrhythmia-free (figure 1). Of those patients, 87 (45%) and 51 (89%) from group 1 and 2 respectively were off-anti-arrhythmic drugs (AAD) (p&lt;0.001). After adjusting for age, gender, hypertension, diabetes, and obstructive sleep apnea, scar homogenization using endo-epicardial approach was associated with 51% less recurrence compared to the endocardial ablation strategy (Hazard Ratio: 0.49, 95% CI: 0.27–0.89, p: 0.02).

Conclusion
In this series of patients with ischemic cardiomyopathy and VT, endo-epicardial scar homogenization was associated with a lower need for AAD and a significantly lower recurrence rate at 5-years of follow-up compared to the endocardial ablation alone.

Funding Acknowledgement
Type of funding sources: None. Figure 1