bluuebunny/crossref_metadata_2025_split huggingface dataset:
Drug interactions in incident NOACs users and risk of bleeding
Authors: Amadori M , Massaro G , De Angelis V , Ingrasciotta Y , Trifiro G , Diemberger I 
Published: October 2024

Abstract

Introduction
Oral anticoagulants (NOACs) are known to have a better safety profile than Vitamin K antagonists, but their metabolism largely depends on the P-glycoprotein and CYP3A4. All drugs inhibiting those proteins may affect NOACs’ bioavailability, by increasing the risk of drug interactions, particularly the risk of bleeding.

Purpose
The objective was to describe the pattern of polypharmacy in a large cohort of NOAC users, at baseline and within one year after starting anticoagulant treatment.

Materials and Methods
All persons residing in the catchment areas of Caserta LHU during the years 2012–2020 were considered. From the source population, all patients with at least 1 year of database history and receiving at least one NOAC dispensing during the observation period were identified. Of these, incident (i.e. no NOAC dispensing within one year prior to the first dispensing date, Index Date) NOAC users were included into the cohort and represented the majority of the patients enrolled (97,4%). The comparison of the distribution of interacting drugs number dispensed Pre-ID (within three months before the Index date) and Post-ID (within 12 months after Index date) was explored stratified by high/low dose of anticoagulant. 20.491 incident NOAC users were identified from Caserta LHU and 16,367 (79.9%) NOAC incident users with at least one year of follow-up after ID were included in the analysis. NVAF was the main indication for use of the study cohort (64.3%) and almost 60% of incident NOAC users treated for NVAF received high-dose NOAC. The frequency of incident NOAC users with at least one hospitalization for major bleeding within one year after ID was calculated and stratified by high/low dose of NOACs and the number of drug interactions. A statistically significant test result was considered if p ≤ 0.05.

Results
The number of interacting drugs dispensed within one year after ID increased from pre-ID to post-ID. 2,077 (12.7%) incident NOAC users without any interacting drugs within 3 months pre-ID received 1 interacting drug within one year after ID. 11.3% and 8.4% of incident NOAC users increased from 1 interacting drug (Pre-ID) to 2 interacting drugs (Post-ID) and from 2 interacting drugs (Pre-ID) to 3-5 interacting drugs (Post-ID) (Table 1). The proportion of NOAC users with a major bleeding increased with the increasing number of interacting drugs, reaching 2.9% and 2.1% among low-dose and high-dose NOAC users with more than 9 interacting drugs (Table 2).

Conclusions
The results of the current analysis suggest that independently from the type and the dose of NOAC, the number of interacting drugs prescribed with NOACs tends to increase after the first administration of NOACs. Hemorrhagic events are more related to the number of interacting drugs instead of dose of anticoagulant.Table 1 Table 2
HV interval measure immediately before TAVI with SEV for predicting pacemaker implantation
Authors: Olivas Medina D , Juan-Salvadores P , Salgado-Barreira A , Garcia-Campo E , Teijeira-Fernandez E , Cabanas-Grandio P , Pardo-Fresno M , Fernadez-Obanza E , Lopez-De La Garza H , Baz-Alonso J A , Jimenez-Diaz V A , Iniguez-Romo A 
Published: October 2024

Abstract

Introduction
Although improvements, new onset persistent disturbances in electrocardiogram (ECG) after transcatheter aortic valve implantation (TAVI) remains up to 34% at hospital discharge (1), needing permanent pacemaker implantation (PPM) in self-expanding valves (SEV) as high as 15-27% (2,3). In post TAVI scenario, European Society of Cardiology guidelines recommend an electrophyisiologic study centered in His-ventricular electrogram (HV) interval measure for assessing risk of progression to high auriculoventricular block (AVB), if abnormal a PPM is indicated (4,5). We aim to predict PPM through basal HV interval measurement prior TAVI with SEV. Furthermore, we aim to compare different current SEV with basal HV interval and the distinct rate of PPM before discharge.

Methods and Results
Single-center prospective cohort study, patients with severe aortic stenosis scheduled for TAVI, sinus rhythm at intervention day, without PPM or history of PPM indication were included. At time of TAVI, contralateral venous puncture to femoral arterial access was made, a tetrapolar catheter was advanced and placed at the septal aspect of tricuspid valve searching for His electrogram. A mobile polygraph was used to measure ECG parameters and HV interval before TAVI. Then, a tetrapolar catheter was advanced to ventricle to perform rapid stimulation as part of habitual valve implantation protocol. After procedure, we performed rhythm surveillance for at least &gt;48-72 hours and based in electrical evolution one of three decisions was made: 1)PPM implant, 2)late post TAVI HV interval re-measure or 3)clinical daily ECG vigilance, if this last was normal, unchanged from basal or with new but stable conduction disturbances, discharge were indicated following ESC guidelines.
A total of 41 patients were enrolled, median age 84±4 years, 24 females (54.5%), PR mean 198±42ms, QRS mean 112±30ms. 18 had a 1st degree AVB (40.9%) of whom 13 (72.5%) had a PR ˂240ms. EPS data showed prior HV interval mean of 55±9ms. A Mild abnormal HV interval (56-69ms) were seen in 21 patients (51.2%), of whom 12 had a narrow QRS. SEV implanted were 11 (25%) Medtronic CoreValve Evolut+, 5 (11.4%) Biosensors Allegra, 25 (56.8%) Abbott Navitor. Post TAVI procedure, 5 (12.2%) women and 8 (19.5%) men met criteria for PPM implantation before discharge. One woman was implanted 6 days after discharge due to high AVB (66ms HV interval prior TAVR). In a multivariate analysis including sex, age, PR, QRS and HV interval &gt;55ms, valve type the RR (IC 95% 1.37-30.99) risk of PPM was 6.52 folds higher (p=0.019).

Conclusions
An HV interval &gt;55ms before TAVI with SEV increases risk of PPM after TAVI and before hospital discharge. There was no difference in PPM implantation after TAVI between different SEV types in our center.
Patients on the ledge; ablation of incessant tachycardia. A single centre registry
Authors: Kamel O , Nasr A N , Abdelfattah M A , Ahmed E A , Wanees M W , Hammouda T H 
Published: October 2024

Abstract

Background
Incessant tachycardia was first described by Cassidy (1). in 1924, it is strongly associated with tachycardia induced cardiomyopathy. There is no data about its true incidence however, it seems to be more common during infancy and childhood.

Objectives
To present 5-year single centre experience in ablating incessant tachycardia in a cohort of pediatric and adult patients.

Methods
From 2018 to 2023, We reviewed patients presented to our centre with incessant tachycardia, their clinical data, ECGs, imaging modalities, procedures details & outcomes were examined thoroughly.

Results
Over 5 years, 900 patients were referred to our centre for ablation, among them 25 patients (2.7%) presented with incessant tachycardia. Of them: 10 patients were pediatrics (40%), the youngest was 40 days old, 3.4 Kg, 6 patients were haemdynamically unstable necessitating ventilation& IV supports, 14 patients had impaired EF, with the lowest EF of 20%.(A) Regarding the diagnosis, 14 patients had AT (4 CS ostium, 3 LAA, 2 parahisian, 2 Crista, 1 LSPV, 1 TA, 1RAA), 4 AVRT (2 concealed parahisian accessory pathways & 2 PJRT), 3 VT (2 scar related VT, 1 anterior papillary muscle), 4 AFL (3 CTI flutter & 1 mitral isthmus flutter). All patients were ablated using 3D mapping system except 4 pediatric patients (2 AT from CS, 2 concealed parahisian accessory pathways) due to accesses limitations or unavailability of 3D mapping, single catheter technique was used in one patient weighing 3.4kg with AT from CS (only one venous access accommodating 5F catheter could be obtained)(B), Rt & Lt jugular accesses were used for ablation of RAA AT in a pediatric patient with bilaterally occluded femoral veins.(C) NCC was used as a safe access for ablating parahsisan AT & accessory pathways in our cohort.(D) All patients had successful ablation with full recovery for those with impaired function except 2 patients of scar related VT as their EF was impaired previously. Regarding the complications, one patient had DVT and another patient had retroperitoneal hematoma, both were managed conservatively.

Conclusion
Incessant tachycardia ablation is quite challenging but carries good results. Careful planning, experienced team & selection of the appropriate approach are the keys for successful safe procedures.
Ventricular parasystole as a new indicator suggesting ventricular arrhythmias in cardiac sarcoidosis
Authors: Ikee T , Nakajima K , Nakamura T , Oka S , Miyazaki Y , Wakamiya A , Ueda N , Kamakura T , Wada M , Ishibashi K , Inoue Y , Miyamoto K , Nagase S , Aiba T , Kusano K 
Published: October 2024

Abstract

Background
In cardiac sarcoidosis (CS), it is considered that inflammation occurs in localized areas such as the basal septum. Inflammation has been suggested to be associated with ventricular fibrillation (VF). Meanwhile, ventricular parasystole is strongly associated with VF in non-ischemic cardiomyopathy. However, the relationship between CS and ventricular parasystole remains unclear.

Purpose
The purpose is to examine the frequency of parasystole in cases of VF and ventricular tachycardia (VT) in CS, and whether there is a correlation between the inflammatory activity of sarcoidosis and the origin of ventricular parasystole.

Methods
We evaluated ventricular arrhythmias (VA) in a cohort of 213 consecutive cases diagnosed with CS from 1989 to 2021 (median age 69 years, 104 males, median LVEF 36%) in our center. We investigated parasystole in cases that developed VA, using 5,313 electrocardiograms, 94 Holter electrocardiograms, and 3,174 ICD interrogation records. Classic parasystole is defined as three ventricular ectopic beats with the same morphology at a fixed interval but different coupling intervals (CI) in a 10-second continuous ECG. A new definition of parasystole requires two ventricular ectopic beats with a CI difference of more than 120ms. We also investigated the correlation of the inflammation site with ECG morphology.

Results
VAs were observed in 95 individuals (33.7%), and 22 developed VF (23.2%). In the VF group, parasystole was observed in 12 of 22 individuals (classic: 5, new: 7), and in the VT group observed in 20 of 73 individuals (classic: 5, new: 15), with parasystole being significantly more frequent in the VF group (P=0.018) and classic parasystole (P=0.033). In VF patients with recorded 12-lead ECGs of parasystole, the inflammation site on PET within 3 months of the VA and PVC origin matched in all 4 out of 4 cases, but no VF starting from ventricular parasystole ectopic beats was recorded.

Conclusion
Ventricular parasystole was detected in 54.5% of CS patients with VF. There is a possibility that the presence of parasystole and the inflammatory activity in the CS can predict the occurrence of VF.
Predictor of wasted implantable cardioverter defibrillator for secondary prevention
Authors: Akagawa R , Otsuki S , Wada R , Suzuki N , Ikami Y , Hasegawa Y , Chinushi M , Inomata T 
Published: October 2024

Abstract

Background
ICD is the ﬁrst line treatment to prevent sudden cardiac death from recurrence of VT/VF. However, patients with organic heart disease have many comorbidities, and some patients die without history of appropriate ICD therapy in lifetime.

Purpose
The aim of this study is to examine the predictors of death without appropriate ICD therapy in lifetime, among ICD patients for secondary prevention with organic heart disease.

Methods
We enrolled consecutive patients implanted with ICD/CRT-D for secondary prevention between 2000 and 2022. We excluded patients without organic heart disease, and alive patients without history of appropriate ICD therapy. Inappropriate candidate (Wasted-group) for defibrillator was defined as the patient who died without history of appropriate ICD therapy or died within one year from appropriate ICD therapy. Appropriate candidate (Appropriate-group) was defined as the patient who had been alive over one year from appropriate ICD therapy (Wasted-group:36, Appropriate-group:131).

Results
During a follow-up of 8.3 ± 5.3 years, a total of 93 (56%) patients died, including 6 (4%) patients died within one year from ICD/CRT-D implantation. Among the 36 patients of Wasted-group, 28 patients died without history of appropriate ICD therapy. Higher age, ischemic cardiomyopathy, non-ARVC, a past history of VF, diabetes mellitus, and higher serum creatinine was the predictor of Wasted-group (P&lt;0.05). Wasted ICD risk score was constructed with the summation of these predictors for predicting candidates of Wasted-group. When the Wasted ICD risk score was ≥3, positive predictive value and negative predictive value were 39.7% and 89.4%, respectively (AUC=0.77, P&lt;0.001).

Conclusion
Patients with a Wasted ICD risk score &lt;3 is likely to receive appropriate ICD therapy in lifetime. Therefore, Wasted ICD risk score might be useful to decide to need for ICD therapy, regarding elderly patients who would be hesitant to have ICD implanted.Wasted ICD risk score
Resuscitation of people with a do-not-resuscitate order: when does it happen and what are the outcomes?
Authors: Paratz E , Nehme E , Burton S , Heriot N , Bissland K , Rowe S , Fahy L , Anderson D , Stub D , La Gerche A , Nehme Z 
Published: October 2024

Abstract

Background
Do-not-resuscitate (DNR) orders allow competent individuals to state their wishes to not receive resuscitation. Despite the existence of a DNR order, resuscitative efforts may still occur.

Purpose
To identify rates and outcomes of resuscitation attempts for people with DNR orders.

Methods
The statewide out-of-hospital cardiac arrest (OHCA) registry in Victoria, Australia (population 6.5 million) identified rates of DNR orders and resuscitative efforts in ≥60-year-olds from 2006-2021.

Results
Of 47,322 patients ≥60 years old with OHCA, 2,688 (5.7%) had a DNR order. DNR order was communicated to emergency call-takers in only 332 (12.4%) cases. Bystander resuscitation was commenced in 1,074 (40.0%) patients, with EMS terminating efforts in 346 (32.2%) patients on arrival but commencing resuscitation in 189 others. Strongest predictors of bystander resuscitation were shockable rhythm (OR 7.75, 95% CI 5.04-11.9) and OHCA in public location (OR 4.8, 95% CI 2.0-11.3). Predictors of EMS terminating resuscitation efforts were OHCA in residential aged care facility (OR 1.93, 95% CI 1.47-2.5) and older age (OR 1.02, 95% CI 1.00-1.04). Transfer to hospital was undertaken in 107 patients, with strongest predictors being return of spontaneous circulation (OR 91.1, 95% CI 51.7-160.7) and witnessed OHCA (OR 7.5, 95% CI 3.9-14.5). Only 7 (0.3%) transported patients survived to discharge, with 5 deceased at 12-month follow-up.

Conclusion
Approximately 5% of EMS-attended OHCAs in ≥60-year-olds involve a patient with a DNR order, with low rates of awareness of DNR orders. Resuscitation is commenced in 47% of patients, and 4% are transported to hospital with very poor outcomes. Strategies to communicate DNR status and respect patients’ autonomy are extremely important.
Prevalence and characteristics of the catecholamine induced QT prolongation syndrome
Authors: Bordet M , Mansourati J , Rajalu A , Cotard V , Thollet A , Probst V , Gourraud J B 
Published: October 2024

Abstract

Background
We have recently described large families of idiopathic ventricular fibrillation characterised by catecholamine-induced QT interval prolongation (CIQTP). The patient presented with a normal QT duration at rest but an abnormal QT prolongation during a mental stress test (MST).

Objective
The aim of this study was to investigate the role of this new syndrome in inherited arrhythmic diseases.

Methods
Consecutive patients and their relatives, identified after unexplained familial sudden cardiac death or sudden cardiac arrest, were enrolled in the study in the presence of:
- no other diagnosis after cardiac ultrasound, stress test, pharmacological test with adrenaline and ajmaline.
- positive MST defined by a prolongation of the QT interval (&gt;-11ms) during MST (as previously published).

Results
134 families with unexplained SCD were examined. CIQTP was diagnosed in 15 families, representing a prevalence of 11.2%.
Family screening of these 15 families identified a total of 43 individuals. Seven (16%) had symptoms prior to diagnosis, including sudden cardiac arrest in one.
At baseline, the QTc interval was measured at 440+/-23 ms.
MST increased the QTc interval by 49+/-33 ms. The identification of QT interval prolongation was less important in the exercise test (delta QTc 17+/-52 ms at 4 minutes after exercise) and the epinephrine test (delta QTc 19+/-36 at 1 minute according to the Krahn protocol).
Treatment with beta-blockers was initiated in 19 patients (44%) on the basis of symptoms and major prolongation of the QT interval during the MST.
After a mean follow-up of 7+/-2 years, only one patient developed ventricular fibrillation. This episode occurred during a short period when he was no observant for the treatment. Since then, there has been no recurrence of the arrhythmia on beta-blocker therapy. All other patients, including those who were previously symptomatic remained symptom-free on treatment.

Conclusion
CIQTP may explain a significant part of sudden cardiac arrest or syncope in young patients. Conventional screening using ECG, exercise test and epinephrine challenge may not be able to unmask CIQTP. Then MST may be systematically proposed for the screening of patient and their family. In CIQTP patients beta blocker therapy appears to be highly efficient to prevent symptoms.
Leadless pacemaker - lead parameters stability and battery longevity in the mid-term follow-up
Authors: Certo Pereira J , Amador R , Reis Santos R , Bello R , A Gomes D , Rodrigues G , Matos D , Carmos J , Santos I , Galvao Santos P , Carmo P , Moscoso Costa F , Cavaco D , Belo Morgado F , Adragao P 
Published: October 2024

Abstract

Background
A leadless pacemaker (L-PM) has been designed to avoid the need for a pacemaker pocket and transvenous lead. Long-term safety will largely depend on the need for replacements, mainly due to battery depletion (end-of-life). While the mean L-PM battery longevity predicted by the manufacturer is 12 years, real-world longevity data are still scarce. We aimed to describe L-PM parameters’ stability and battery longevity during the mid-term follow-up.

Methods
Single-center registry of consecutive patients undergoing L-PM implantation from May 2015 to November 2023. Procedural characteristics, lead parameters and battery longevity were collected immediately after implantation and during the most recent follow-up visit.

Results
Overall, 261 consecutive patients had a transcatheter L-PM implanted through a femoral vein (mean age 78±10 years; 66% male). Mean procedural duration was 44±28min and fluoroscopy time was 4,4±3,9min. The device was successfully implanted in all but one patient. The main indications for permanent pacing were high-degree atrioventricular block [N=130 (50%)], atrial fibrillation with pauses [N=78 (30%)], and sinus node disease [N=28 (11%)]. Immediately after implantation, three cases (1,2%) of pericardial effusion (one with tamponade) were reported. In one case (0,4%), a conventional pacemaker was implanted due to L-PM acute dysfunction. No other procedure-related complications, including dislodgment, were reported at discharge.
After a mean follow-up of 2,8±1,7years, the pacing threshold and R-wave amplitude remained stable [0,67mV vs. 0,62mV (p=0,9); and 10,3mV vs. 16,1mV (p&lt;0,001), respectively] and mean ventricular pacing was 54±38%. Expected battery longevity was &gt;8 years (maximum value) in 84% of the patients. In the subgroup of patients with &gt;5 years of follow-up (N=20; mean follow up of 6,3±1,8years), the expected battery longevity was &gt;8 years in 85% (N=17) of the patients. In three cases, the L-PM was upgraded to cardiac resynchronization therapy or left bundle branch area pacing due to pacing-induced left ventricular dysfunction. There was one case of L-PM end-of-life 6 years after implant (pacing threshold 0,5mV; ventricular pacing 100%), in which a second L-PM was successfully implanted. Overall, 78 (31%) patients died, a mean of 2,2±1,9 years after L-PM implantation, none related to the device.

Conclusion
In this real-world cohort, L-PM maintained stable pacing parameters and, in the mid-term follow-up, only one battery depletion was observed while expected longevity remained above 8 years in the large majority of patients. Longer follow up will allow better understanding of both technical and clinical aspects relevant to manage end-of-life devices.Table 1Figure 1
Half of implantable cardioverter-defibrillator patients remain at risk of painful shocks in the last moments of life
Authors: Yilmaz D , Al Jaff A A M , Egorova A , Van Erven L 
Published: October 2024

Abstract

Background
Patients with implantable cardioverter-defibrillators (ICDs) are at risk of receiving painful shocks near the end of life due to ongoing tachytherapy. Position papers of various international societies emphasize the need for advance care planning and timely deactivation of tachytherapy. This study aims to assess the real world practice of deactivating ICD tachytherapy prior to death over a consecutive 18-year period and strives to identify areas for improvement.

Methods
Medical records were reviewed of all patients who were carriers of an ICD or CRT-D and under follow-up at our university medical center. Those who deceased between 2006 and 2023 were identified from the municipal civil registry and their follow-up data were extracted from electronic patient records. The cause of death and status of ICD therapy at the time of death was analysed.

Results
During the study period, 1724 patients with an ICD expired (mean age 73 ± 10 years; 265 (15%) females; 1396 (81%) primary prevention; median time from initial ICD implantation 7.5 [interquartile range: 4 to 12] years. Baseline characteristics of patients who had tachytherapy deactivated prior to death did not differ significantly from those who did not. Overall, 769 (43%) devices were deactivated before death. The proportion of patients with deactivated tachytherapy prior to death gradually increased over time, surpassing to just &gt;50% in the past decade (p&lt;0.001), Figure 1. Causes of death differed between the two groups (p=0.022), Figure 2. The majority of patients with deactivated tachytherapy prior to death died due to: heart failure (38%); non-cardiac causes (23%) e.g. myocardial infarction or valvular disease; malignancy (23%) and other non-cardiac causes such as infectious diseases, stroke and trauma (31%). However, substantial proportions of patients dying from causes that could potentially be identified as an end-of-life phase, remained at risk of shocks in the last moments of life due to active tachytherapy (30% heart failure, 11% malignancy, 25% other non-cardiac causes).

Conclusions
The rate of patient with deactivated ICD tachytherapy before death doubled within the initial 4 years of the study period and more or less stabilized thereafter, thus leaving nearly half of ICD patients susceptible to painful shocks in their final moments of life. This underlines the necessity of timely advance care planning, including discussions regarding discontinuation of ICD therapy during the end-of-life phase.