bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of corrected QT dispersion, tp-e values in small heart syndrome patients
Authors: Ibisoglu E 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background and objectives
We aimed to evaluate the marker of ventricular arrhythmias such as Tp-e/QT, Tp-e/QTc, Tp-e/JT and Tp-e/JTc ratios in ‘Small Heart Syndrome’ female patients and also aimed to evaluate the association between ‘small heart syndrome’ and fibromyalgia in female patients.

Methods
A total of 94 female, including 47 small-heart and 47 normal-heart patients, who applied from March 2018 to February 2020 and who were examined by a physical therapy and rehabilitation specialist, were included in the study by calculating their cardiothoracic ratios (CTR) from the chest x-ray. QTmax, QTmin,QRS, JT and Tp-e intervals were measured. In addition, Tp-e/QTmax, Tp-e/QTc max, Tp-e/JT and Tp-e/JTc rates and QTc max, QTc min, cQTd and JTc intervals were calculated.

Results
cQTd (24,246 ± 9,046 ms vs. 35,495 ± 14,358 ms, p &lt; 0.001), Tp-e (67,32 ± 11,661 ms vs. 72,67 ± 11,028 ms, p = 0.04), Tp-e/QTc max (0,166 ± 0.028 vs. 0.181 ± 0.027, p = 0,012), Tp-e/JTc (0,214 ± 0.038 vs. 0.232 ± 0.034, p = 0,022) values were significantly higher in small heart patient group. QT min (330,68 ± 26,611 ms vs. 323,04 ± 30,829 ms, p = 0,202) values were significantly lower in patient group.

Conclusion
Compared to control group potential ECG repolarization predictors were signiﬁcantly increased in ‘Small Heart Syndrome’ patients. TableElectrocardiographic findings o Control group(n = 47) Patient group(n = 47) P value Heart rate, bpm 87,81 + 15,532 83,81 + 14,372 0,223 QRS; ms 83,23 + 6,948 81,91 + 10,052 0,206 QT max; ms 354,93 + 26,796 358,54 + 28,434 0,528 QT min; ms 330,68 + 26,611 323,04 + 30,829 0,202 JT; ms 265,7 + 25,16 271,88 + 23,104 0,218 QTc max; ms 403,59 + 18,208 400,20 + 18,336 0,371 QTc min; ms 379,34 + 20,064 364,71 + 23,149 0,004* JTc; ms 314,37 + 21,325 313,55 + 22,526 0,856 cQTd; ms 24,246 + 9,046 35,495 + 14,358 &lt;0,001* Tp-e; ms 67,32 + 11,661 72,67 + 11,028 0,040* Tp-e/QT max 0,190 + 0,034 0,203 + 0,031 0,063 Tp-e/QTc max 0,166 + 0,028 0,181 + 0,027 0,012* Tp-e/JT 0,255 + 0,047 0,267 + 0,036 0,295 Tp-e/JTc 0,214 + 0,038 0,232 + 0,034 0,022*
Direct capture of the left bundle branch compared to left bundle branch area pacing deteriorates interventricular synchrony but improves left ventricular lateral wall depolarization duration
Authors: Curila K , Jurak P , Waldauf P , Halamek J , Karch J , Plesinger F , Susankova M , Znojilova L , Viscor I , Vondra V , Smisek R , Leinveber P , Osmancik P 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): This paper was supported by the Charles University Research Centre program No. UNCE/MED/002 and 260530/SVV/2020

Background
Direct and indirect pacing of the left bundle branch are novel pacing techniques preserving LV synchrony. Aim of the study was to compare differences in ventricular activation between them using an UHF-ECG.

Methods
The left septal lead placement was done in 68 patients with bradycardia. Four distinct ventricular captures were described; nonselective LBBp (nsLBBp), selective LBBp (sLBBp), paraLBBp and left bundle branch area capture (LBBap). The timings of local ventricular activations and local depolarization durations were displayed by the UHF-ECG. e-DYS was calculated as a difference between the first and last activation.

Results
There were 35 nsLBBp, 21 paraLBBp, 12 sLBBp and 96 LBBap obtained in 68 patients. The nsLBBp compared to LBBap caused worse interventricular synchrony (e-DYS -23 ms (-28;-18) vs -12 ms (-17;-8), p &lt; 0.001), but improved LV lateral wall depolarization duration. The sLBBp, nsLBBp and paraLBBp differed in e-DYS; -31 ms (-38;-24) vs -23 ms (-28;-17) vs -13 ms (-20;-7), p &lt; 0.01 between each of them. Their left ventricular depolarization durations were the same, but they were longer when pacing resulted in the left axis deviation. If the direct capture of the LBB was not confirmed (LBBap), LV depolarization duration was deteriorated irrespective of the QSR morphology in the V1 or RWPT in the V5. Examples of UHF-ECG maps during LBBap, paraLBBp and nsLBBp are shown in Figure 1.

Conclusions
The direct capture of the left bundle branch deteriorates interventriclar synchrony but improves the depolarization duration of the left ventricular lateral wall compared to left ventricular myocardial septal pacing. Abstract Figure 1
Predictors of all-cause mortality among patients with implantable cardiac defibrillators for nonischemic heart failure with reduced ejection fraction
Authors: Cinier G , Hayiroglu MI , Yumurtas AC , Kolak Z , Cetin T , Tezen O , Eren S , Pay L , Turkkan C , Ozcan KS , Ozbilgin N , Tekkesin AI , Alper AT , Gurkan K 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Implantable cardiac defibrillators (ICD’s) are recommended in patients with heart failure with reduced ejection fraction (HFrEF) of nonischemic etiology. Determining patients who are at high risk despite ICD implantation is of clinical value.

Methods
Between 2009-2019 patients who were implanted ICD due to nonischemic HFrEF were included to the present analysis. Baseline characteristics, laboratory parameters and echocardiographic findings were obtained from the electronic database. The primary outcome was all-cause mortality. Appropriate and inappropriate device therapies were also extracted from the database and was confirmed with patients’ reports. Predictors for long term all-cause mortality was determined by using Cox regression analysis.

Results
Overall, 1199 patients were screened and 238 were eligible for the analysis. ICD’s were implanted for primary and secondary prevention in 68 (28.6%) and 170 (71.4%) of patients respectively. Multivariate analysis revealed that increased pro-BNP [Hazard ratio (HR): 1.001, 95% Confidence interval (CI): 1.000 – 1.001, p = 0.024] and reduced left ventricle ejection fraction (HR: 0.950, 95% CI: 0.907 – 0.994, p: 0.026) predicted all-cause mortality during long term follow up. Pro-BNP &gt; 425 pg/ml has sensitivity and specificity of 74% for each in predicting all-cause mortality.

Conclusion
Among patients who were implanted ICD for HFrEF of nonischemic etiology, higher pro-BNP prior to the implantation and lower LVEF predicted all-cause mortality during long term follow up. Table 1Univariate analysisP valueHR (95% CI)Multivariate analysisP valueHR (95% CI)Diabetes mellitus0.0062.587 (1.315 - 5.090)Diabetes mellitus0.1441.837 (0.812 - 4.153)Atrial fibrillation0.0023.080 (1.531 - 6.195)Atrial fibrillation0.1811.738 (0.774 - 3.903)NYHA &gt; 20.0172.394 (1.168 - 4.908)NYHA &gt; 20.2531.642 (0.701 - 3.847)RDW0.0441.191 (1.005 - 1.412)RDW0.6461.046 (0.862 - 1.270)Lymphocytes0.0220.616 (0.408- 0.932)Lymphocytes0.1650.683 (0.399 - 1.170)Blood urea nitrogen0.0381.015 (1.001- 1.030)Blood urea nitrogen0.1521.015 (0.995 - 1.036)Pro-BNP&lt;0.0011.001 (1.000 - 1.001)Pro-BNP0.0241.001 (1.000 - 1.001)Albumin&lt;0.0010.252 (0.143 - 0.444)Albumin0.0790.525 (0.256 - 1.079)Ejection fraction&lt;0.0010.921 (0.885 - 0.959)Ejection fraction0.0260.950 (0.907 - 0.994)LVEDD0.0011.408 (1.017 - 1.079)LVEDD0.1521.078 (0.973 - 1.194)LVESD0.0041.038 (1.012 - 1.065)LVESD0.2890.957 (0.883 - 1.038)Appropriate shock in follow-up0.0102.407 (1.237 - 4.684)Appropriate shock in follow-up0.1561.768 (0.805 - 3.883)Univariate and multivariate Cox regression analyses for long-term mortality after ICD implantation Abstract Figure 1
Echocardiographic but not clinical response to CRT is an independent predictor of a better survival free from arrhythmic events
Authors: Valbom Mesquita D , Parreira L , Esteves A , Farinha J , Marinheiro R , Amador P , Fonseca M , Lopes C , Chambel D , Goncalves A , Caria R 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiac resynchronization therapy (CRT) is of proven benefit in heart failure patients, improving mortality and reducing hospital admissions. There is however uncertainty if the arrhythmic risk is reduced in responders.

Purpose
We aimed to assess if patients with a CRT implanted for primary prevention had less arrhythmic episodes if they responded to this therapy and if echocardiographic and clinical responses to CRT differ regarding the occurrence of ventricular arrhythmias.

Methods
We prospectively enrolled patients that underwent CRT implant for primary prevention according to ESC guidelines. Patients were classified as responders if they fulfilled one of four criteria (echocardiographic or clinical) at six months after implant: a 5% absolute improvement in LV ejection fraction (LVEF), a 15% improvement in LVEF, a 15% decrease in LV end-diastolic volume or a decrease in NYHA class. During follow-up with device interrogation, arrhythmic ventricular events (AVE) were classified as appropriate ICD therapies or sustained ventricular tachycardia either occurring in ICD monitoring zones or undetected by the device due to a slower rare, but clinically documented. All patients were further classified according to type of pacing, biventricular or LV only. Demographic characteristics of patients were also assessed.

Results
We enrolled 73 patients, 58 (79.5%) male, median age of 72 (65-77) years. Median LVEF was 28 (22-35) % (p = 0.95 between groups), ischemic etiology in 36 (46.6%, p = 1.00). The two groups with and without AVE did not differ significantly regarding clinical, echocardiographic, and electrocardiographic characteristics (table). CRT echocardiographic response criteria were met by 50 (68.5%) of patients and clinical criteria by 53 (72.6%) patients. AVE occurred in 15 (20.5%) patients. In univariate regression analysis, echocardiographic response was associated with reduced AVE (OR 0,14; p = 0,005). Clinical response to CRT was not associated with AVE (p = 0.07). LV only pacing was associated with a higher probability of AVE (OR 5.1; p = 0.038). In Cox regression multivariate analysis, response to CRT was the only independent predictor of better survival free from AVE (HR 0.28;CI 95%, p = 0.044) and LV only pacing was not associated with more episodes of ventricular arrhythmias (p = 0.17). Conclusions: Echocardiographic, but not clinical response to CRT therapy, is the only independent predictor of a higher survival free from arrhythmic events. In spite controversies regarding the arrhythmogenic role of LV pacing, this was not associated with higher ventricular arrhythmic events. Abstract Figure.
Impact of COVID-19 lockdown in patients with implantable cardioverter and cardiac resynchronization therapy defibrillators: insights from daily remote monitoring transmissions
Authors: Mascioli G , Lucca E , Napoli P , Giacopelli D 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
In Italy, a strict lockdown was imposed from 8 March 2020 to stop the spread of the Coronavirus Disease 2019 (COVID-19).

Purpose
To explore the effect of this lockdown on data transmitted by remote monitoring (RM) of implantable cardioverter and cardiac resynchronization therapy defibrillators (ICDs/CRT-Ds).

Methods
RM daily transmissions from ICDs and CRT-Ds were analyzed and compared in two consecutive 1-month frames pre- and post-lockdown: Period I (7 February–7 March 2020) and Period II (8 March–7 April 2020).

Results
The study cohort included 180 patients (81.1% male, 63.3% ICDs and 36.7% CRT-Ds) with a median age of 70 (interquartile range 62-78) years. The median value of physical activity provided by accelerometric sensors showed a significant reduction between Period I and II (13.1% [8.2-18.1%] versus 9.4% [6.3-13.8%], p &lt; 0.001]. Eighty-nine percent of patients decreased their activity, for 43.3% the relative reduction was ≥25%. The mean heart rate decreased significantly (69.2 [63.8-75.6] bpm vs 67.9 [62.7- 75.3] bpm, p &lt; 0.001), but with greater reduction (≈3 beats/minute) in patients aged &lt; 70 years. Resting heart rate and thoracic impedance showed minor variations. No differences were observed in device pacing percentages and arrhythmias.

Conclusions
In cardiac patients, the lockdown imposed to contain COVID-19 outbreak significantly reduced the amount of physical activity and the mean heart rate. These side effects of in-home confinement quarantine should be taken in consideration for frail patients. Abstract Figure. Activity and mean heart rate trends
Long-term survival following transvenous lead extraction: importance of indication and comorbidities
Authors: Mehta VS , Elliott MK , Sidhu BS , Gould J , Vergani V , Kadiwar S , Niederer S , Razavi R , Rinaldi CA 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background/Introduction:
The significant rise in cardiac implantable electronic devices (CIED) has been paralleled by an increase in the number of procedures required for the removal of such devices and their associated leads. High procedural success rates with low rates of major in hospital complications is well recognised. Longer term mortality following transvenous lead extraction (TLE) is less well characterised. Long term outcomes are important as they should inform the decision making and consent process, especially in non-infected cases where there may not be a class I indication for lead removal.

Purpose
The purpose of this study was to evaluate the factors influencing survival in patients undergoing TLE depending on extraction indication.

Methods
Clinical data from consecutive patients undergoing TLE in the reference centre between the years 2000 to 2019 were prospectively collected. Only patients surviving to discharge were included. The total cohort was divided into groups depending on whether there was an infective or non-infective indication for TLE. We evaluated the association of demographic, clinical, device related and procedure-related factors on mortality.

Results
A total of 1151 patients were included in the analysis. 632 (54.9%) and 519 patients (45.1%) were for infective and non-infective indications respectively. Analysis of long-term outcomes on the total cohort (mean 66-month follow-up) revealed a mortality of 34.1% (392 deaths). A higher proportion of patients died in the infection vs the non-infection group (38.6% vs 28.5%, p &lt; 0.001). Local infection (hazard ratio [HR] = 1.4, 95% confidence interval [CI] [1.12-1.75]) was associated with similar long-term mortality risk as systemic infection (HR = 1.3, CI[0.99-1.72]). Multivariate analysis demonstrated increased risk of mortality with higher age (HR = 1.05, CI[1.04-1.07]), eGFR &lt; 60ml/min/1.73m2 (HR = 1.55, CI[11.22-1.97]), higher cumulative co-morbidity burden (HR = 1.15, CI [1.06-1.23], and reduced risk per percentage increase in LVEF (HR = 0.98, CI[0.96-1.00]). Kaplan-Meier survival analysis demonstrated statistically worse prognosis in patients with a higher number of leads extracted and increasing co-morbidities.

Conclusion
Long-term mortality for patients undergoing TLE remains high. Consensus guidelines recommend evaluating risk for major complications when determining whether to proceed with TLE. This study suggests assessing longer-term outcomes when considering TLE, particularly for non-infective indications. Abstract Figure.
Transvenous lead revision for cardiac perforation: a single centre experience
Authors: Elbatran A , Akhtar Z , Bajpai A , Leung L WM , Li A , Pearse S , Zuberi Z , Kaba R , Saba M , Norman M , Grimster A , Gallagher MM , Sohal M 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiac perforation is an uncommon but life-threatening complication of cardiac implantable electronic device (CIED) implantation. Management strategy commonly relies on diagnostic Computed Tomography (CT) imaging and cardiac surgery. Emerging evidence has indicated a diversion from this approach. Transvenous culprit lead revision has been shown to be safe and efficacious in limited series.
We sought to evaluate the outcomes of transvenous lead revision in patients with cardiac perforation.

Method
Data was collected retrospectively of patients admitted to a single tertiary centre with CIED-related cardiac perforation between December 2013 – October 2019. Transvenous lead revision was performed as standard with cardiac surgery on standby. Patient demographics, use of CT imaging, method of removal and 30-day outcomes were recorded.

Results
Of the 46 recorded CIED-related cardiac perforations, the majority occurred in female patients (63%) and hypertensives (61%), whilst a proportion had cancer (20%) and ischaemic heart disease (30%). The culprit in most cases was a standard pacing lead (92%) of an active fixation (98%) in the right ventricle (80%) positioned at the ventricular apex (65%). The median time to presentation from implant was 14 days [IQR 4-50 days] with chest pain (44%); abnormal pacing indices was highly prevalent (95%) whilst a pericardial effusion was noted in the majority of cases (57%). CT scanning was performed in 19 cases (41%) for various indications but deemed essential in only 4, all of which had non-diagnostic pacing indices and imaging. Chest X-ray (CXR) found clear perforation, lead displacement or pleural effusion in 74% of cases, whilst an echocardiogram found these in 64% of cases. The culprit lead was replaced in the majority of cases (87%) under local anaesthesia (76%) with surgical backup. The median hospital stay was 7 days [IQR 3-10 days] with zero procedural and 30-day mortality.

Conclusion
Transvenous lead revision for CIED-related cardiac perforation is safe and efficacious. CT modality for diagnostic purposes is useful in providing incremental value in a minority of cases; patients with non-diagnostic pacing parameters and non-CT imaging benefit most from this.
Telemedicine-based early rule out and followup ECG algorithm for COVID-19 patients
Authors: Turan OE , Yilancioglu RY , Alak C , Baskurt AA , Hunuk B , Dugral E , Yilmaz MB , Ergene AO , Ozcan EE 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Drugs with the potential to prolong QT are used in the treatment of coronavirus 19 (COVID-19) pneumonia. We have developed a telemedicine-based corrected QT (QTc) follow-up algorithm that allows early rule out for follow up.

Aims
In this study, we investigated the availability and safety of the algorithm.

Study design
Retrospective cohort

Methods
Consecutive patients; administered hydroxychloroquine (HCQ) for COVID-19 pneumonia were enrolled into digital ECG recording program which includes QTc follow-up algorithm.

Results
Patients were classified into three groups as those, excluded promptly from the QTc follow-up based on two consecutive ECG findings (early rule out, n = 92) and those, for whom the follow-up was continued (n = 12) and usual care group (n = 68). Of note, 237 ECG tracings were performed in our algorithm population contrary to standard practice of daily recommended ECG monitoring which could have yielded 975 ECG tracings along with accompanied risks of exposure. This way; we ended in 738 (75.7%) fewer ECG tracings. Sustained ventricular arrhythmia or sudden cardiac death was not observed in the entire patient population.

Conclusions
It is safe to rely on telemedicine-based early rule out algorithm in COVID-19 patients, receiving hydroxychloroquine treatment. This algorithm abolished the need for further ECG in majority of patients without increased risk during follow up. These algorithms can significantly reduce the healthcare worker exposures by eliminating the need for ECG follow-up promptly. Abstract Figure. Covid-19 Follow up Algorithm
Cardiac reparative therapy with adipose graft transposition procedure reduces slow conduction areas in a chronic myocardial infarction swine model
Authors: Adelino Recasens R , Galvez-Monton C , Martinez-Falguera D , Curiel C , Marsal R , Teis A , Rodriguez-Leor O , Fadeuilhe E , Sarrias A , Bazan V , Villuendas R , Aranyo J , Bayes-Genis A , Lupon J , Bisbal F 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Insituto de Salud Carlos III

BACKGROUND
Cardiac regenerative therapy is a promising treatment for patients with ischemic heart disease, but there are some concerns on the potential increased risk of arrhythmic events following specific cell therapies. Adipose graft transposition procedure (AGTP) is a cardiac reparative therapy consisting in transposing a vascularized adipose flap from the autologous pericardium and placing it over the epicardial scar area and has demonstrated to reduce infarct size and improve the left ventricular ejection fraction in preclinical and human studies. Specific electrophysiological properties of the scar, (i.e. slow conduction velocity (CV)) have been identified as key features of ventricular tachycardia (VT) isthmuses.

PURPOSE
To assess the effect of the AGTP on VT inducibility and the electrophysiological properties of the post-MI scar with ultra-high density (UHD) mapping.

METHODS
A left circumflex artery (first marginal branch) MI was induced in 10 Landrace X Large White pigs by delivering 1-3 coils. Two weeks post-MI, all subjects underwent baseline left ventricular endocardial UHD mapping during right ventricular pacing with 64-electrode basket mapping catheter, as well as electrophysiological study (EPS) to test for VT inducibility. Following the mapping, subjects were allocated 1:1 to AGTP or sham group. UHD mapping and EPS were repeated 30 days post-treatment (6 weeks after MI). Voltage and activation maps were analyzed off-line with self-customized Paraview-based software. Voltage cut-offs of 1.5 and 0.5mV (bipolar) defined normal tissue, border zone (BZ) and dense scar, respectively, and 6.7mV for unipolar. Conduction velocity (CV) was determined for every pair of contiguous points and areas of similar CV were quantified for every 0.2m/s steps (for up to 4 m/s).

RESULTS
There were no differences between groups with regard of dense scar, BZ an low unipolar voltage areas. The AGTP group had a significant reduction of the size of slow CV (&lt;0.2 m/s) areas, compared to the sham group in whom it increased (-4.1 ± 1.7 vs. +2.4 ± 1.6 mm2, p = 0.028)(Figure). There were no differences in the size of other ranges of CV. EPS did not induce VT in any subject at baseline, and only in 1 of the sham group at the follow-up EPS.

CONCLUSIONS
Cardiac reparative therapy with AGTP of post-MI scar reduced the size of slow conduction areas and could provide a protective effect against arrhythmic events in ischemic heart disease. Abstract Figure.