bluuebunny/crossref_metadata_2025_split huggingface dataset:
CineECG analysis of body surface potential mapping performed in preclinical and clinical plakophilin-2-variant carriers
Authors: Van Der Schaaf I , Kloosterman M , Loh P , Van Dam P M 
Published: May 2024

Abstract

Background/introduction
Pathogenic variation of the plakophilin-2 (PKP2) gene is associated with arrhythmogenic cardiomyopathy (ACM). Disease manifestation in PKP2-pathogenic variant (PV) carriers differs greatly. Early detection of disease is crucial and could be of benefit in the risk stratification of this population. 67-lead body surface potential mapping (BSPM) could offer more insight into subtle electrical abnormalities. CineECG is a novel tool which can provide an estimation of the average pathway of ventricular activation based on the BSPM-signals, and could be of added value in the detection of electrical abnormalities.

Purpose
This study aimed to analyze 67-lead BSPM data with CineECG to ascertain the electrical activation pathway in PKP2-PV carriers and to compare these to the normal CineECG.

Methods
Ten PKP2-PV carriers underwent 67-lead BSPM. Six carriers were without definite ACM diagnosis (preclinical); no Task Force Criteria (TFC) were met apart from the identification of the pathogenic PKP2-variant. The other four carriers were all diagnosed with definite ACM (symptomatic). The average location and direction of ventricular activation was determined with CineECG, resulting in a CineECG trajectory throughout the ventricles. These results were compared to the normal CineECG trajectory, which was established in a previous study with normal ECG’s from the PTB-XL database. A CineECG trajectory that deviated more than 15% from the normal trajectory was considered abnormal. Additionally, to further determine the added diagnostic value of BSPM and CineECG beyond the standard 12-lead ECG, the 12-lead ECG’s were evaluated for abnormalities by three different ECG-experts.

Results
Expert evaluation of the 12-lead ECG showed that all preclinical PKP2-PV carriers had a normal ECG (no TFC and no other abnormalities such as abnormal electrical heart axis, pathological Q-waves or low voltage). In the symptomatic carriers, all ECG’s showed either presence of TFC or conduction abnormalities.
Of the ten PKP2-PV carriers, eight exhibited an abnormal CineECG trajectory. In the preclinical group, four out of six carriers had an abnormal activation trajectory, while all symptomatic carriers had an abnormal CineECG trajectory.

Conclusions
Through CineECG analysis of 67-lead BSPM, abnormal ventricular activation was identified in the majority of PKP2-PV carriers. Notably, abnormal activation was observed in four out of six preclinical PKP2-PV carriers while the standard 12-lead ECG showed no abnormalities. Future research in a larger group, which also includes follow-up data, is warranted to determine whether these results are an indication of early signs of disease.Figure 1
Diagnostic yield of cardiac monitors in patients with suspected arrhythmias: systematic literature review and network meta-analysis
Authors: Parikh P , Lukyanov V , Medic G , Wadhwa M 
Published: May 2024

Abstract

Objective
To demonstrate the diagnostic yield (DY) across cardiac rhythm monitors stratified by monitoring duration for symptomatic patients with suspected cardiac arrhythmias (palpitations, dizziness, syncope, presyncope, lightheadedness).

Methods
PubMed, Embase, and Scopus were searched to identify published randomized and observational studies between January 1, 2000, and November 28th, 2021. DY data were extracted for comparative studies. The DY of cardiac monitors in these patients was reviewed for Any Arrhythmia, Clinically Relevant Arrhythmia, Explained Episodes (symptomatic and clinically relevant), New Onset Atrial Fibrillation, and Symptomatic Events. Clinically Relevant Arrhythmia was defined by the study and included atrial fibrillation, atrial flutter, atrial tachycardia, other SVT, VT, pause, and bradycardia. Patients who had a history of prior stroke or transient ischemic attack were excluded. Network meta-analysis (NMA) was used to pool estimates. Cardiac monitoring duration was categorized into the following 3 timeframes: 3 days or less (≤3 d), greater than 3 days to less than 30 days (&gt;3 d), and 30 days or greater (≥ 30 d).

Results
Inclusion and exclusion criteria identified a pooled population of 1696 patients in 6 comparative studies, 2 Randomized Controlled Trials (RCTs) and 4 non-RCTs (Figure 1). NMA results for comparative studies show that monitoring durations of &gt;3 d and ≥30 d provided significant better DY than ≤3 d (Table 1). The odds ratio for DY of &gt;3 d as compared to ≤3 d was 5.75 (95% CI 2.05-19.38) in patients with Any Arrhythmias, 5.99 (95% CI 2.10 - 7.79) in patients with Clinically Relevant Arrhythmias, 10.22 (95% CI 0.61 - 4343.00) in patients with Explained Episodes, and 2.74 (95% CI 1.12 - 7.53) in patients with New Onset Atrial Fibrillation. As only a single study provided results on Symptomatic Events, NMA was not possible for this measure. The odds ratio for DY of &gt;3 d as compared to ≥30 d was 0.02 (95% CI 0.00 - 0.15) in patients with Any Arrhythmias, 0.03 (95% CI 0.00 - 0.10) in patients with Clinically Relevant Arrhythmias, 0.04 (95% CI 0.01 - 0.13) in patients with Explained Episodes, and 0.17 (95% CI 0.03 - 0.66) in patients with diagnosis of New Onset Atrial Fibrillation.

Conclusion
NMA indicates that &gt;3 d and ≥30 d provide significantly better DY than ≤3 d for identifying Any Arrhythmia, Clinically Relevant Arrhythmia, and New Onset AF. Despite favorable odds ratios for ≥30 d over &gt;3 d, these values were associated with uncertainty due to the limited studies available for monitoring durations of ≥30 d. Overall, in patients experiencing symptoms of palpitations, dizziness, syncope, and without prior stroke or transient ischemic arrest, &gt;3 d of monitoring improved DY compared with shorter monitoring durations.Figure 1.Prisma Flow DiagramTable 1.Diagnostic Yield Comparison.
Continuing evaluation of atrial fibrillation detection after cryptogenic stroke: one-year findings from a multi-center study with confirm Rx ICM
Authors: Quartieri F Q , Baek Y S , Kim T H , Honma K , Shin S Y , Feng L , Lee K , Grammatico A , Morimoto M 
Published: May 2024

Abstract

Background
The detection of atrial fibrillation (AF) after a cryptogenic stroke (CS) carries crucial therapeutic implications. While clinical trials have meticulously explored the incidence of AF in CS patients, real-world data on this topic remain relatively sparse. In this study, we aimed to assess the incidence of AF among patients with cryptogenic stroke, who underwent the implantation of an insertable cardiac monitor (ICM). The abstract reports the interim results from the CS sub-study of the Smart Registry.

Methods
A prospective, single-arm, multi-center registry was conducted to identify AF in patients with cryptogenic stroke using the Confirm R ICM. Inclusion criteria comprised participants aged 40 years or older who had experienced cryptogenic strokes within a 90-day window. Prior to enrollment, comprehensive diagnostic assessments were performed to meticulously rule out all potential sources of embolism, in accordance with the minimal standards of the American and European Guidelines. At each follow-up visit, expert electrophysiologists reviewed and adjudicated ICM detected AF episodes. The primary endpoint was the cumulative incidence of true device-detected AF (lasting more than 30 seconds) at 6 months. Kaplan-Meier curves were employed to assess the cumulative incidence of true device-detected AF through 12 months.

Results
In our study, 117 patients were enrolled across 19 global sites from September 2021 to August 31, 2023. Kaplan-Meier analysis revealed a 21.3% probability (confidence interval (CI): 14.5%, 30.7%) of true AF episodes lasting more than 30 seconds at 6 months, increasing to 31.0% (CI: 22.0%, 42.5%) at 12 months. Similar results were observed in episodes lasting over 120 seconds at both 6 months (20.7%) and 12 months (30.5%). In average, 14.4 true AF episodes per patient were detected per year. The median time from implantation to AF detection (&gt; 30 seconds) was 31.5 days (interquartile range, 7 to 191).

Conclusion
Our ongoing study illustrates the effectiveness of the Confirm Rx ICM in detecting atrial fibrillation after cryptogenic stroke. These results confirm the diagnostics value of long-term continuous AF monitoring in cryptogenic stroke patients.
Photoplethysmography recordings preceding onset atrial fibrillation show a higher heart rate variability - a TeleCheck-AF subanalysis
Authors: Hillmann H , Hermans A , Gawalko M , Mueller-Leisse J , Betz K , Van Der Velden R , Pluymaekers N , Evens S , De Cooman T , Sultan A , Gruwez H , Hendriks J , Manninger M , Linz D , Duncker D 
Published: May 2024

Abstract

Background
An increased heart rate variability (HRV), mostly assessed by 12-lead electrocardiogram (ECG) or long-term Holter monitoring, can be associated with the onset of atrial fibrillation (AF). Data evaluating HRV measurements using digital devices, especially those using photoplethysmography (PPG), in patients at risk for AF are sparse. In this analysis, we aimed to assess if hand-held-based non-continuous PPG measurements can provide short-term HRV to predict AF.

Methods
Patients from the TeleCheck-AF project with at least one PPG measurement in AF and one measurement in sinus rhythm (SR) were analyzed. Briefly, patients were provided with a PPG-based heart rate/rhythm monitoring smartphone app. They were instructed to record a PPG measurements three times daily and in case of symptoms for seven consecutive days. Short-term HRV using root mean square of successive normal-to-normal interval differences (RMSSD) was calculated in recordings in SR and compared between those not preceding and preceding an episode of AF (figure 1).

Results
Overall, 136 patients [56.3% men, median age 66 (59; 72) years] were included in the analysis. Median total number of recordings per patient was 24 (19; 30) including 4 (2;7) AF episodes per 1 week recording period. RMSSD was significantly higher in PPG measurements preceding an AF episode than in PPG measurements not preceding an AF episode [42.5 (33.2;70.7)ms vs. 41.1 (32.4;54.7)ms; p&lt;0.001]. Between-group comparison revealed no significant difference for gender, age, previous ablation or betablocker therapy (p=0.824; p=0.484; p=0.519 and p=0.624, respectively).

Conclusion
Short-term HRV based on RMSSD, assessed by digital hand-held devices is significantly higher in PPG recordings preceding an AF episode than in measurements not preceding a consecutive AF episode. Whether PPG-recording derived short-term HRV can help to predict onset-AF warrants further study in larger populations.
Figure 1: Patient example and exemplary analysis scheme, depicting the total number of recordings (n=14). HRV of recordings in sinus rhythm (SR) not preceding an episode of atrial fibrillation (AF) (A; grey circles) were compared to recordings preceding a consecutive AF episode (B; blue circles).Figure 1
Efficacy of smart device heart rhythm monitoring to detect spontaneous conversion to sinus rhythm in patients scheduled for electric cardioversion of atrial fibrillation. Kardiover Study
Authors: Benezet Mazuecos J , Alonso P , Lozano J M , Salas J , Gonzalez O , Rodriguez-Manero M , Narvaez I , Barrio I , Iglesias J A 
Published: May 2024

Abstract

Introduction
the management of patients with recent-onset atrial fibrillation (AF) is to achieve sinus rhythm (SR) by electrical or pharmacological cardioversion (CV). However, frequently SR is spontaneously restored, making scheduled admission and/or transesophageal echocardiogram (TEE) unnecessary and therefore causing misutilization of healthcare resources. Emerging medical technology has allowed for monitoring of heart rhythm abnormalities.

Objective
A prospective multicenter study was designed to evaluate the diagnostic ability of a smart device ECG monitor to detect spontaneous conversion to SR in AF patients, preventing unnecessary admission and providing an earlier management.

Methods
A prospective multicenter study was designed including patients with first diagnosed, paroxysmal or persistent AF scheduled for ambulatory electrical cardioversion in cardiology departments of 7 hospitals of Spain. Patients were asked to submit ECG recordings to a central Corelab daily, twice a day and whenever they present symptoms, until cardioversion (spontaneous or scheduled) and a week afterwards. Whenever a spontaneous conversion to SR was detected, investigators were contacted to confirm SR and abort admission, likewise when AF recurrence after cardioversion was detected. Patients’ satisfaction was evaluated using a test for perceived utility and value, convenience, and accessibility.

Results
A total of 62 patients were enrolled (age 62±10 years). Baseline characteristics of the study population are described in the Table. Fifteen patients (24%) did not undergo CV as they showed spontaneous conversion to SR. Among 47 patients admitted for CV, it was successful in 41 (87%). One patient aborted CV because of atrial thrombus on TEE. During follow up after conversion to SR (spontaneous or electrical), recurrences of AF occurred in 20 of 56 patients (36%) correctly detected by the devices. At the end of the follow-up 41 of 56 patients (73%) remained in SR. Due to the early detection of spontaneous conversion to SR, a total of 15 admissions and 9 TEE were prevented and these resources used for other patients. Adherence was high with a rate of ECG transmission over 80% in 56 patients (90%). Perceived satisfaction was also high with an overall punctuation of 9 over 10 in the patient’s feedback test.

Conclusion
Digital devices for heart rhythm monitoring can optimize the management of AF patients scheduled for CV, avoiding unnecessary admissions and providing a more rational use of healthcare resources.Table
Non-invasive assessment of the ventricular tachycardia isthmus during sinus rhythm
Authors: Reventos-Presmanes J , Pellicer B , Serrano J , Invers-Rubio E , Regany M , Borras R , Tolosana J M , Guasch E , Guichard J B , Vazquez S , Guillem M S , Porta-Sanchez A , Mont L , Climent A M , Roca-Luque I 
Published: May 2024

Abstract

Background
The ablation of ventricular tachycardias (VT) presents significant challenges due to the complex and time-consuming approaches involved in identifying arrhythmogenic regions. Combining non-invasive electrocardiographic imaging (ECGI) with endocardial mapping could potentially enhance the efficacy of interventions.

Objective
To evaluate the capability of ECGI in guiding operators towards areas of VT isthmuses during sinus rhythm.

Methods
Patients with scar-related VT, confirmed by late gadolinium enhancement cardiac magnetic resonance, were prospectively enrolled. We compared the areas of slowed conduction identified by ECGI with the VT sustaining regions identified endocardially. Simultaneous Electroanatomical Mapping (EAM) and ECGI mapping were performed during VT ablation procedures. In patients in whom a hemodynamically stable VT was maintained, the reentry circuit was mapped endocardially, and the ablation target was identified. The left ventricle was segmented into 9 regions, categorized as either VT-isthmus or non-VT isthmus based on EAM findings. Prior to ablation, local activation times (LAT) and conduction velocity (CV) ECGI sinus maps were computed. Slow conduction was quantified non-invasively by computing different ECGI metrics per region, including the mean and the standard deviation (SD) of LAT and CV, the regional Total Activation Time (rTAT) – time span between the earliest and latest activated nodes–, and the Slow Conduction Velocity (SCV) – the percentage of nodes where velocity falls below 60 cm/s -.

Results
The study included 20 consecutive patients with ischemic cardiomyopathy who were referred for VT ablation. A total of 21 regions linked to the VT isthmus were identified endocardially in 17 patients (age: 66.1±8.8 years, 94.1% male, left ventricular ejection fraction: 26.4±7.3%). Figure 1 illustrates the correlation between the VT circuit and the ECGI sinus map in two patients with extensive left ventricular fibrosis. ECGI metrics related to VT isthmuses exhibited a higher standard deviation in both LAT (18.1±2.0 vs 9.8±1.2 ms; p=0.001), and CV (50.4±4.7 vs 37.1±2.8 cm/s; p=0.011), and a greater percentage of nodes with slowed conduction (13.7±2.7 vs 7.4±1.6 %; p=0.029), compared to non-VT isthmus regions, Figure 2. Multivariate logistic regression analysis revealed that SD-LAT was the strongest predictor of VT isthmus localization.

Conclusion
ECGI has demonstrated the capability to pinpoint slowed conduction areas responsible for VT in sinus rhythm, showing promise in planning and guiding VT ablation strategies. This advancement paves the way for further research into using this non-invasive tool to improve risk stratification methods for ventricular arrhythmias.
Comparative analysis of antiarrhythmic drugs following atrial fibrillation ablation
Authors: Rocha De Almeida A , Carias De Sousa M , Congo K , Trinca M 
Published: May 2024

Abstract

Background
Atrial fibrillation (AF) ablation has become an established therapeutic modality for rhythm control. However, the optimal post-ablation pharmacological strategy remains uncertain. The present study addresses this gap by conducting a comparative analysis of four commonly used antiarrhythmic drugs (amiodarone, propafenone, sotalol, and flecainide), both as standalone treatments and in combination with beta blockers, to determine their impact on mortality, hospitalization rates, and AF recurrence.

Methods
A multi-center, retrospective cohort study was conducted, including patients who underwent successful AF ablation between 20010 to 2020. The study population was divided into groups based on the prescribed antiarrhythmic drug regimen: amiodarone, propafenone, sotalol, flecainide, and respective combinations with beta blockers. Patient demographics, comorbidities, and procedural details were collected. Endpoints included all-cause mortality, hospitalization due to cardiovascular events, MACE and AF recurrence.

Results
A total of 908 patients were included in this study. The mean age was 66 years old, and 33% (n=297) were female patients. Of 908 patients, 35% (n=316) were prescribed amiodarone, 34% (n=305) propafenone, 8% (n=76) sotalol, and 6%% (n=51) flecainide post AF ablation. Association with beta blockers were observed in 55% (n=496) of cases. Amiodarone group had a 0,3% (n=1) mortality, 9% (n=27) of hospitalizations, 2% (n=5) of major cardiovascular events (MACE) and 32% (n=101) of AF recurrence. Propafenone group had a 1,3% (n=4) mortality, 4% (n=12) hospitalizations, 2% (n=5) of MACE and 27% (n=81) of AF recurrence. Sotalol group had a 4% (n=3) mortality, 6% (n=4) of hospitalizations, 3% (n=2) of MACE and 44% (n=32) of AF recurrence. Flecainide group had 0 cases of death, 2% (n=1) of hospitalization, 0 cases of MACE and 35% of recurrence. Amiodarone is associated with a lower risk of death (p=0,018 OR 0,13). The presence of betablockers did not affect the endpoints, namely, death, hospitalization, MACE or AF recurrence. There were no other statistically significant associations between variables.

Conclusion
This study evaluated the effectiveness of common antiarrhythmics, such as amiodarone, propafenone, sotalol, and flecainide, with and without beta blockers, in the post-AF ablation setting. In this study, amiodarone showed a lower risk of death. There were no other statistically significant associations between either antiarrhythmic drug and each endpoint. The presence of betablocker therapy did not interfere with the endpoints.
The findings contribute to the ongoing discourse on the optimal pharmacological strategy for AF management post-ablation. Further prospective studies with larger sample sizes are warranted to validate and refine these observations, paving the way for evidence-based guidelines in tailoring antiarrhythmic drug regimens for improved patient outcomes
Real-world single center experience with the wearable cardioverter defibrillator: sex differences in risk stratification for sudden cardiac death
Authors: Rossi L , Bolognesi M G , Biagi A , Bricoli S , Aschieri D 
Published: May 2024

Abstract

Background
Wearable cardioverter defibrillator (WCD) demonstrated an important role for prevention of sudden cardiac death in patients with advanced heart failure and reduced left ventricular ejection fraction. Although in randomized trial there are no gender difference in WCD use and defibrillator (ICD) implantation rate, real world data in female patients is lacking.
Purposes: We aimed to describe the sex differences in WCD use, the rate of cardiac events detected with WCD and the rate of ICD implantation after WCD use in women in a real-world single center experience. nd reduced left ventricular ejection fraction or prior ventricular tachyarrhythmia.

Methods and results
According with the current guidelines indications, between August 2017 and June 2023 ninety-six consecutive patients (mean age 66.0±11.1 years) received a WCD at Piacenza Hospitals and were retrospectively included in this analysis. There were no differences in clinical characteristics between female (18 patients, 18,8%) and male: in particular baseline left ventricular ejection fraction (LV EF) were similar between the two groups (29.5±5.2 vs 27.9±7.9, p=0.23) and no differences were found in the rate of ischaemic cardiopathy (66,6% vs 69,2% p=0.51).
After 3-months follow up with WCD use, a similar rate of ventricular arrhythmias were found in the two groups (5.5% vs 3.8%, p=0.48) and no ventricular fibrillation was detected. The WCD usage period and median daily wear time were not different between female and male (55.2±50.6 vs 56.2±34.8 days p=0.53, 21.0±6.4 vs 23.1±1.5 hours p=0.48, respectively). However women presented a better LV EF improvement (12.2±9.7 vs 7.2±6.8, p=0.01), with a significant lower ICD implantation rate at the end of WCD use (55.5% vs 43.8%; p&lt; 0.01)

Conclusions
In this real word analysis women presented a nice compliance using WCD. In spite of a similar burden of ventricular arrhythmic events, women presented a better LV EF improvement with a significant lower ICD implantation rate.