bluuebunny/crossref_metadata_2025_split huggingface dataset:
Submuscular reburial as an alternative to lead extraction in high risk patients
Authors: Llewellyn J , Meda G , Wright DJ , Rao A 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The Heart Rhythm Society (HRS) and European Heart Rhythm Association (EHRA) consensus states complete extraction is recommended for all patients with definite cardiac implantable electronic device (CIED) infection. Although complete removal of hardware is the best way to manage infections, lead extraction is a complex procedure with significant risk. As age and complexity of patients increase so too does extraction risk. In very high risk cases conservative management is cited, though little is known on outcomes.

Purpose
We are a high volume tertiary centre which serves a population of 2 million. 2 experienced operators perform 65 extraction procedures per year for the past 10 years. We report our experience of device reburial as initial management of CIED pre-erosion and erosion in cases deemed too high risk for extraction.

Method
We retrospectively reviewed all reburial procedures undertaken over 9 years. Patient and lead factors influencing decisions were assessed. Information on number of leads, dwell time, prior procedure, infective status and comorbidity was collated. The outcomes included morbidity, defined by repeat procedure (revision and/or extraction) and mortality.

Results
86 patients underwent 96 procedures from March 2013 until August 2020. All patients undergoing device reburial were included. 55.8% of patients were male, mean age was 73. 21 patients died, 7 of these deaths occurred within 12 months of the index reburial procedure. The mean follow up period was 39 months (range 5–90). 65.1% of patients had a procedure (de novo implant, upgrade or replacement) within 12 months prior to revision.
We reviewed patients in 2 subgroups based on revision indication – erosion and pre-erosion. Erosion was defined as externalised lead/device. Pre-erosion was defined as superficial device with skin tethering but no exposure. The former is a definite indication for lead extraction, the latter a relative indication. All in the pre-erosion group were systemically well with no infection evident. One patient with erosion had a positive blood culture.
The mean age in the erosion group was 85 years with a Clinical Frailty Score (CFS) 4.98 and lead dwell time 17.87 years compared to age 68 years, CFS 3.98 and dwell time 8.14 years in the pre-erosion group. Patients in this cohort with an eroded device were deemed too high risk to undergo transvenous lead extraction.
A higher proportion of patients presenting with erosion died within 12 months of the index reburial procedure (16.67% vs 4.84%). 21% with an eroded device and 11% with a pre-eroding device undergoing reburial as first line management required future extraction.

Conclusion
Our 9 year data suggests less invasive intervention is a valid option in high risk groups such as older age, frailty, long lead dwell time, with an acceptable incidence of reintervention and/or extraction. This data can help guide informed consent in the future.
Treatment of symptomatic atrial tachycardia in complex anatomic conditions: use and outcome of ablation in patients after damus-kaye-stansel surgery
Authors: Fischer AJ , Ho SY , Ernst S 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial tachycardias (AT) are amongst the most frequent complications in adult patients with congenital heart disease (ACHD). Their incidence mainly depends on age and complexity of underlying defect. AT has a marked impact on morbidity and mortality and is associated with sudden cardiac death particularly in complex ACHD patients. The arrhythmic substrate can be variable from re-entry to multifocal resulting in demanding requirements for electrophysiologic ablation procedures (EP) and thus, relatively high rates of recurrence.

Methods and results
Retrospective analysis of ACHD patients with prior Damus-Kaye-Stansel (DKS) surgery treated at one of the largest specialized tertiary centers for ACHD patients worldwide. Analysis focussed on occurrence of AT, respective treatment and outcome of EP.
Over a median observation time of 15 years, 13 patients with prior DKS surgery and complex congenital heart defects of different types but uniformly Fontan circulation, were identified (median age 22.0 years (IQR 20.5 – 25.5), 76.9% male, 92.3% NYHA Class I, median systemic ventricular ejection fraction 58.5%, 69.2% extracardiac tunnel). Seven patients (53.8%) presented with symptomatic AT (median cyclic length 440 ms (IQR 360.0 – 517.5)). Of these, six patients underwent EP. Median procedure time was 180.5 min (IQR 160.8 – 274.5), median fluoroscopy time 1.56 min (IQR 0.51 – 4.73) and radiofrequency time 851 sec (265.0 -2005.0). Remote magnetic navigation was used to access ablation site through a retrograde access via the aortic as well as the neo-aortic valve. Three-dimensional image integration aided in mapping and ablation. Throughout the procedure as well as in follow-up visits, no reportable complications were observed. After a mean of 1.5 procedures, all analysed patients stayed complaint-free throughout a median time-interval of 13 months.

Conclusion
AT are frequent in complex univentricular situations after Damus-Kaye-Stansel surgery (53.8%). Although more than one procedure (mean 1.5) was necessary to achieve satisfactory results even in experienced hands, EP appears to be an appropriate treatment strategy in this young and otherwise healthy patient cohort. According to our analysis, EP is feasible and safe in centers with knowledge of specific anatomic characteristics of congenital heart disease and when the appropriate technical infrastructure is present. Access to ablation site was performed by remote magnetic navigation in the majority of procedures. The floppy catheter was navigated through the neo-aortic as well as through the aortic valve without observable peri- or postinterventional complications. Mapping with three-dimensional image integration facilitated EP and led to a relatively low radiation exposure with the known benefits for the patient as well as for the healthcare professionals involved in the procedure. Abstract Figure.
Incidence, risk factors and outcomes of atrial arrhythmias in adult patients with atrioventricular septal defect
Authors: Jacquemart E , Bessiere F , Combes N , Ladouceur M , Iserin L , Gardey K , Henaine R , Chevalier P , Legendre A , Petit J , Di Filippo S , Hascoet S , Marijon E , Waldmann V 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): French Federation of Cardiology

Background
The number of adults with atrioventricular septal defects (AVSD) is growing, with however, very few data regarding the natural history of atrial arrhythmias in this specific population. We aimed to assess the incidence, associated factors and outcomes of atrial arrhythmias among adult patients with AVSD.

Methods
Multicentric retrospective cohort of patients with AVSD from 3 referral centers specialized in adult congenital heart disease. Unbalanced AVSD, univentricular hearts, and Eisenmenger syndromes were excluded. Lifetime cumulative incidences of different types of atrial arrhythmia (&gt;30 seconds) were analyzed (atrial fibrillation [AF] and intra atrial reentrant tachycardia/focal atrial tachycardia [IART/FAT]). Multiple logistic regression models were used to identify risk factors for atrial arrhythmias.

Results
The cohort comprised of 391 patients (61.6% of women) with a mean age of 36.3 ± 16.3 years and 17.3 ± 14.2 years of follow-up after surgical repair in operated patients, including 333 (85.1%) partial/intermediate and 58 (1.0%) complete AVSD. Overall, atrial arrhythmias were documented in 98 patients (25.1%).
The lifetime risks for developing atrial arrhythmia to ages 20, 40, and 60 were 3.7%, 17.6%, and 54.8%. IART/FAT was the leading arrhythmia until the age of 45 then AF surpassed IART/FAT.
Age (OR = 1.4, 95%CI = 1.2-1.6 by 5 years increment), the number of cardiac surgeries (OR = 4.1, 95%CI = 2.5-6.9), left atrial dilatation (OR = 3.1, 95%CI = 1.4-6.8), right atrial dilatation (OR = 4.1, 95%CI = 1.7-10.3), and moderate or severe left AV valve regurgitation (OR = 3.7, 95%CI = 1.2-11.7) were independently associated with a higher risk of atrial arrhythmias. Patients with atrial arrhythmias more frequently had pacemaker implantation (41.8% vs. 8.5%, p &lt; 0.001), heart failure (24.5% vs 1.0%, p &lt; 0.001) and cerebrovascular accidents (11.2% vs 3.4%, p = 0.007).

Conclusions
The lifetime risk of atrial arrhythmias in patients with AVSD is considerable with more than half of patients who will develop an atrial arrhythmia by the age of 60. Atrial arrhythmias are associated with a significant morbidity in this population. Abstract Figure. Central Illustration AVSD
Use of a smartphone ECG to diagnose arrhythmias in athletes: a case series
Authors: Jewson J , Orchard J , Semsarian C , Fitzpatrick J , La Gerche A , Orchard J 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
While athletes are generally very fit, intense exercise can increase the risk of atrial fibrillation (AF), resulting in distressing symptoms during or after exercise. Moreover, other arrhythmias such as atrial flutter or supraventricular tachycardia (SVT) can also cause troublesome, exercise-related symptoms. Accurate diagnosis is essential to guide appropriate treatment. Given the symptoms are infrequent and/or occur in specific circumstances, traditional monitoring devices are often impractical to use during exercise or too invasive. Recently, smartphone ECGs such as the Alivecor KardiaMobile device (iECG) has been shown to be interpretable by a cardiologist in 95% of cases and may be the portable tool required to help identify arrhythmias in this challenging population.

Purpose
This case series was designed to highlight the use of iECG devices in aiding the diagnosis of arrhythmias in exercise-related symptoms.

Methods
Five cases are reported where the iECG was used to document at least one episode of exercise-related symptoms. Participants were eligible if they were over 18 years of age and had had an iECG trace taken during an episode of exercise-related symptoms (e.g. light-headedness, shortness of breath, palpitations). which could be associated with an arrhythmia All participants were identified by authors from previous clinical experiences (or from clinical colleagues) and provided written, informed consent.

Results
The cases included one amateur middle-distance runner in his 40s, two amateur ultra-endurance runners in their 30s and two young elite cricketers (Figure 1). In four of the cases, an accurate diagnosis of an arrhythmia (atrial flutter, AF and 2x SVT) was obtained using the iECG device, which helped to guide definitive treatment (e.g. medication or ablation). Two of these cases had been investigated using traditional methods such as stress ECG or Holter monitor over many months without achieving a diagnosis. The final case did not obtain a cardiac diagnosis using the iECG device despite using it on multiple occasions during symptomatic events. This reassured this athlete that the symptoms experienced were not cardiac related and she is now confident to exercise.

Conclusion
The iECG was able to accurately detect arrhythmias and provide a diagnosis in cases where traditional monitoring had not. The utility of detecting no arrhythmia during symptoms in one case was also highlighted, providing the athlete with the confidence to continue exercising. This reassurance and confidence across all cases is perhaps the most valuable aspect of this device, where clinicians and athletes can be more certain of reaching a diagnosis and undertaking appropriate management. Abstract Figure 1: iECG traces
Machine learning based major complication prediction for patients undergoing transvenous lead extraction
Authors: Mehta VS , O"brien H , Elliott MK , Sidhu BS , Gould J , Razavi R , Niederer S , Rinaldi CA 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Relative benefits of transvenous lead extraction (TLE) should be weighed against the risks on an individual basis. Observational studies have identified disparate risk factors for major adverse events (MAEs), however there are few available tools to aid the clinician risk-stratifying patients.

Purpose
The purpose of this study was to develop a machine learning (ML)-based risk stratification system to predict risk of MAEs following transvenous lead extraction (TLE).

Methods
Multiple ML models were derived from a training cohort of 3555 patients undergoing TLE to pre-procedurally identify patients at high and low risk of major adverse events (procedure-related major complication, including procedure-related death). The ML models were then tested on an independent, reference centre cohort of 1171 patients undergoing TLE. Clinical features were selected based on whether they were available in both datasets without large gaps. For model selection we compared the ML algorithms logistic regression, ridge regression, support vector machines (SVM), gradient boosting classifier and random forest. The best performing of these was then compared to a self-normalising network (SNN).

Results
In total 3122 cases with the required features were included from the training cohort with 53 MAEs (1.7%), and 998 cases in the test cohort with 24 MAEs (2.4%). SVM identified lead dwell time, left ventricular ejection fraction (LVEF), estimated glomerular filtration rate (eGFR), chronic respiratory disease, local infection, heart failure, sepsis and male gender as predictors of MAEs in order of decreasing importance (see figure). For the training data, the SVM provided a more sensitive result compared with SNN (0.83 vs 0.71) at the cost of specificity (0.63 vs 0.79). For the test data, the SVM identified MAEs in 12 out of 123 (9.8%) "high risk" patients, 10 out of 552 (1.8%) "medium risk" patients, and 2 out of 323 (0.006%) "low risk" patients.

Conclusion
Machine learning provided good discriminative capabilities for identifying patients in a "high risk" and "low risk" category for MAEs. Abstract Figure. 8 most important predictors of MAEs
What are patients reading? Assessing the quality of online resources on sudden cardiac arrest in athletes
Authors: Fanous Y , Dorian P 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Patients frequently use the internet as an educational resource and sometimes in complete substitution of an expert physician’s consultation. Sudden cardiac arrests (SCA) in athletes are often sensationalised and attract much online readership. No studies have explored the quality of online content relating to SCA in athletes.

Purpose
To assess the quality of online educational resources on SCA in athletes.

Methods
The first 200 hits of the search "sudden cardiac arrest in athletes" on Google were analyzed. For each website, reading difficulty was evaluated using 5 validated reading indices. Content quality was assessed with point-based scoring systems established by expert opinion.

Results
A total of 115 unique web domains met eligibility criteria, only 2 of which were within the limits of national recommended readability level (≤8th grade). 53.9% were from educational institutions. Mean content accuracy scored only 6.5 ± 3.9 out of 15 (43%), and mean school-grade reading level was 13.3 ± 2.9 years (equivalent to a post-secondary level of education). The majority of websites had poor lay appropriate explanations of concepts; 91.3% failed to adequately explain basic principles of treatment; 68.7% failed to mention over half of common etiologies associated with SCA; only 59.1% correctly cited incidence of SCA amongst young athletes; 24.3% did not explore management options and only 28.7% mentioned treatment options beyond immediate resuscitation. Higher reading difficulty correlated with higher accuracy scores (β 1.1, p &lt; 0.001).

Conclusion
There is a paucity of accurate, lay language appropriate online health information on SCA in athletes. Incomprehensible and incomplete information may lead to inappropriate decisions by patients. A collaborative approach between experts and patients may assist in the creation of resources related to athletes’ health.
The TeleCheck-AF project on remote app-based management of atrial fibrillation during the COVID-19 pandemic: Patient experiences
Authors: Linz D , Pluymaekers N , Duncker D , Manninger M , Van Der Velden R , Hermans A , Verhaert D , Hemels M , Sultan A , Gupta D , Heidbuchel H , Sohaib A , Svennberg E , Crijns H , Hendriks J 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

OnBehalf
TeleCheck-AF Investigators

Aims
TeleCheck-AF is a multicentre international project initiated to maintain care delivery for patients with atrial fibrillation (AF) during COVID-19 through teleconsultations supported by an on-demand photoplethysmography-based heart rate and rhythm monitoring app (FibriCheck®). We describe the characteristics and experiences from recruited patients.

Methods
Self-reported patient characteristics were obtained from the app. A survey exploring patient experiences completed by 826 patients.

Results
Within 28 weeks, 1930 AF patients were recruited by 38 centers in 14 countries, mainly for remote AF control (31% of patients) and AF ablation follow-up (42%). One-third of patients was in the age range 60-69 years. The most common comorbidity was hypertension (42% of all patients). More than 70% of patients were treated with oral anticoagulation. In total 59.858 heart rate and rhythm measurements were recorded. During the one-week FibriCheck® use, patient adherence was high. Patients performed between 2 and 5 recordings a day and the median number of measurements per patient was 21 [15-29]. The highest average number of measurements per patient was seen in patients older than 80years of age. Patients agreed that the FibriCheck® app was easy to use (94%) and easy to install (89%). The app gave patients a safe feeling (74%) due to being in constant heart rate and rhythm control. More than half of the patients (58%) agreed or strongly agreed that they would like to use the FibriCheck® app in the future. They also found the automated reminders useful (64%).

Conclusions
In the TeleCheck-AF project, mHealth adherence was high, particularly in older patients ≥80 years. The app FibriCheck® is easy to use for 7 days before a scheduled teleconsultation. Patients think that remote rate and rhythm monitoring around teleconsultation by the TeleCheck-AF approach may be an alternative to traditional face-to-face consultations in the future. Abstract Figure.
Does sponsorship of electrophysiology and devices presentations alter conflict of interest disclosures?
Authors: Camm CJF , Crawford W , Bello A , Raouf Z , Schaefer A , Prachee I , Olivarius-Mcallister J , Ginks M , Nicol E 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Interaction with industry is often required for the development of electrophysiology (EP) and devices research. Findings from industry-funded research are often presented at sponsored sessions during international conferences. However, industry interactions produce potential conflict of interests (COIs). Such COIs must be disclosed appropriately when presenting research findings to allow viewers to interpret the results correctly. This is particularly true during sponsored sessions.

Purpose
To assess whether session sponsorship affects the presentation of potential COIs in EP and devices presentations.

Methods
Recorded presentations from the Arrhythmia & Devices section of ESC Annual Congresses 2016-2020 were assessed. Presentations were excluded if the original presentation contained no slides, was a panel discussion, it was a non-scientific presentation, or part of the presentation was missing. Sponsorship information was gathered from presentation meta-data. Chi-squared and Mann-Whitney U tests were used to assess differences between groups for dichotomous and continuous data respectively.

Results
Of 1,153 presentations assessed, 1,017 were suitable for inclusion. Of these 14% (n = 142) were sponsored sessions. COI disclosure slides were more likely to be missing in sponsored sessions (13.4%, n = 19) compared with non-sponsored sessions (6.2%, n = 54), p = 0.002. In those with COI disclosure slides, sponsored presentations contained a greater median number of COIs (12, IQR 6-19) compared with non-sponsored sessions (1, IQR 0-5), p &lt; 0.0001. Conversely, the time-per-word spent on COI disclosures was approximately 50% lower in sponsored sessions (125ms, IQR 76-217ms) compared with non-sponsored sessions (250ms, IQR 125-375ms), p &lt; 0.0001. Furthermore, presenters at sponsored sessions were much less likely than those at non-sponsored sessions to provide sufficient verbal details of their conflicts (0% vs 8.5% respectively, p = 0.0008). These findings were not materially altered when limited to only those presentations with COIs.

Conclusions
Sponsored sessions make up about one seventh of all EP/devices presentations at the ESC annual congress. Presenters at sponsored sessions were less likely to present a COI disclosure slide. Sponsored presentations had a higher number or of potential COIs, yet they were displayed for a far shorter time. This suggests that sponsored sessions have a higher risk of potential bias which viewers are not provided sufficient opportunity to assess.