bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does ChatGPT-4 succeed in the ECG interpretation: friend or foe to cardiologists?
Authors: Lisicic A , Serman A , Jordan A , Jurin I , Novak A , Benko I , Pavlovic N , Manola S , Zeljkovic I 
Published: May 2024

Abstract

Background/Introduction
Artificial intelligence (AI) and large language models (LLMs) are increasingly being tested for medical purposes, especially in clinical settings and one of the most well-known LLMs is OpenAI’s ChatGPT-4. Recent explorations have considered using ChatGPT to answer medical questions, and the new ChatGPT-4 also allows graphical inputs, which could aid medical doctors in interpreting electrocardiograms (ECGs) in everyday practice. AI-powered ECG interpretation has shown promising results, improving the detection of arrhythmias, ST-segment changes, QT prolongation, and other ECG abnormalities. However, whether ChatGPT4’s interpretation of ECGs is comparable to that of experienced cardiologists has yet to be established.

Purpose
We sought to test whether ChatGPT-4 could analyze and interpret ECGs similarly to experienced cardiologists.

Methods
We tasked ChatGPT-4 with interpreting, for scientific purposes, 12-lead ECGs, from 150 patients included in our prospective CaRD registry, presenting with various cardiac pathologies, including acute coronary syndrome, arrhythmias (primarily atrial fibrillation), conduction abnormalities, pacemaker rhythms and normal ECGs. Four experienced cardiologists reviewed the ECG interpretations provided by ChatGPT-4. The model provided information on rate, rhythm, axis, P-wave, PR interval, QRS complex, ST segment, T wave, differential diagnoses, most likely diagnosis and further diagnostic step.

Results
In this observational study, ChatGPT-4 demonstrated low overall accuracy in interpreting ECGs, with only 24% of the most likely diagnosis being correct. ChatGPT-4 performed the best when interpreting normal ECGs with sinus rhythm, achieving 62% accuracy rate, followed by 17%, 10% and 7.3% for ECGs with arrhythmias, acute ischemic changes, and conduction abnormalities or pacing rhythms, respectively.

Conclusion
ChatGPT-4 exhibited very low accuracy in interpreting different categories of pathology in 12-lead ECG, yielding less than 20% success rate. While the use of AI in medical diagnostics is an appealing concept in theory, the results suggest that, in its current state, ChatGPT-4 would not provide significant aid to experienced cardiologists in clinical settings.
PET-MRI Imaging to assess severity and distribution of atrial fibrosis in atrial fibrillation
Authors: Wang H , Po S , Zhang Y 
Published: May 2024

Abstract

Background
Atrial fibrosis is a major determinant of atrial fibrillation (AF) susceptibility and ablation targeting fibrotic areas to suppress AF revealed by magnetic resonance imaging (MRI) was considered a promising approach to treat persistent AF; however, its outcome has been disappointing. We sought to develop a new imaging modality to detect the severity and distribution of atrial fibrosis.

Methods
This study enrolled 19 healthy volunteers and 85 patients with various cardiovascular (CV) diseases of whom 22 had persistent AF. Each patient underwent 18F-labeled aluminum fluoride targeting fibroblast activation protein inhibitor (18F-AlF-FAPI)-positron emission tomography - magnetic resonance imaging (PET-MRI). Left atrial appendage tissue biopsied at 18F-FAPI-uptake positive and negative sites was stained with Masson trichome to detect fibrosis (N=10). We compared cardiac atrial 18F-AlF-FAPI-PET-MRI imaging among healthy individuals, patients without AF and patients with persistent AF as well as patients developing and not developing postoperative AF (POAF).

Results
Degree of fibrosis based on Masson staining was consistent with 18F-FAPI-uptake (P&lt;0.05). Whereas 18F-FAPI uptake was essentially undetectable in healthy volunteers, in patients with CV diseases, 18F-FAPI uptake was present in all atrial chambers. Patients with persistent AF had the greatest and most widespread uptake (P&lt;0.001), including left atrium (P=0.001), right atrium (P&lt;0.001), left atrial appendage (P=0.007), right atrial appendage (P&lt;0.001), and left atrial posterior wall (P=0.004). 18F-FAPI-uptake did not differ between those with versus without POAF.

Conclusions
18F-AlF-FAPI-PET-MRI imaging detected atrial fibrosis in patients with various CV diseases; patients with persistent AF exhibit severe and widespread fibrosis, while POAF is not associated with increased 18F-FAPI uptake.
Use of class IC antiarrhythmic drugs in patients with structural heart disease and implantable cardioverter defibrillator
Authors: Zylla M M , Wolfes J , Schleberger R , Lawin D , Kieser M , Reinke F , Eckardt L , Rillig A , Stellbrink C , Thomas D , Frey N , Lugenbiel P 
Published: May 2024

Abstract

Background
Due to suspected pro-arrhythmic effects and increased mortality associated with class-IC antiarrhythmic drugs (AADs) in previous trials, AAD-therapy in structural heart disease (SHD) is mainly restricted to amiodarone. In the presence of diagnostic and therapeutic advancements in cardiovascular medicine, it remains unclear if previous studies adequately reflect contemporary patients. In clinical practice, class-IC-AADs are occasionally used in individual cases, particularly in patients with an implantable cardioverter defibrillator (ICD).

Methods
This study retrospectively investigated outcome in ICD-carriers with SHD in whom class-IC-AADs were used as an individualized therapy due to failure, side effects, or unacceptable risk of alternative therapeutic options.

Results
Fifty patients from four tertiary centers were included (median age 48.5 years; 52% female). The most common underlying SHD were dilated (42%) or ischemic cardiomyopathy (26%) (median LVEF=45%). Indications for AAD were sustained ventricular arrhythmias (VA) (58%), symptomatic premature ventricular contractions (26%), or atrial arrhythmias (16%). Median follow-up was 27.8 months. Freedom from sustained VA was 72%, freedom from ICD-therapy was 80%. In 19 patients (38%) AAD-therapy was terminated. The most common reason was insufficient efficacy (n=8). Pro-arrhythmia was suspected in three patients. Five patients died during follow-up (10.0%), two of cardiovascular cause (4.0%).

Conclusion
In a multicenter cohort of ICD-carriers with SHD, class-IC-AADs were associated with a low rate of pro-arrhythmic effects or cardiovascular mortality. The majority of patients remained free from sustained VA during a follow-up of &gt;2 years. Further efforts should be made to evaluate the safety of class-IC-AADs in SHD-patients receiving contemporary cardiovascular therapy.
Staged hybrid convergent procedure versus pulsed field ablation for pulmonary veins and posterior wall isolation in the treatment of atrial fibrillation
Authors: Zito E , Bianchini L , Schiavone M , Vettor G , Tondo C 
Published: May 2024

Abstract

Background
There are limited effective treatment options for persistent atrial fibrillation (AF) patients, with pulmonary veins (PV) isolation alone being considered suboptimal for many patients. Hybrid convergent ablation has been shown to improve clinical outcomes when compared to an endocardial-only radiofrequency (RF) strategy. Pulsed field ablation (PFA) has recently gained growing interest for its efficacy and safety profile in PV and posterior wall (PW) ablation.

Objectives
To compare clinical outcomes of hybrid convergent RF ablation versus endocardial PFA for PV and PW isolation in patients with persistent AF.

Methods
From July 2022, 86 persistent AF consecutive patients, receiving endocardial PFA of PV and PW (PFA group, N = 44) or receiving hybrid convergent RF ablation (Hybrid group, N = 42) at our institution were enrolled. Recurrence was defined as any atrial tachyarrhythmia following the 3-month blanking period.

Results
No differences were found between PFA and Hybrid groups regarding age (PFA 66.0±7.4 years vs Hybrid 63.9±10.6 years; p=0.193) and left atrial volume index (PFA 45.5 [36.7-57.2] ml/m² vs Hybrid 45.0 [39.2-59.7] ml/m²; p=0.920). Differences regarding left ventricular ejection fraction were borderline significant among groups (PFA 55.0 [49.5-62.0]% vs Hybrid 60.5 [52.3-65.0]%; p=0.048), both showing an overall normal LV function. There were no significant differences regarding AF duration (PFA 38.0 months [IQR: 19.2 to 99.0 months] vs Hybrid 70.0 months [IQR: 46.0 to 118.0 months]; p = 0.063). Redo ablation patients’ rate was higher in the hybrid group (PFA n=16, 36.4% vs Hybrid n=28, 66.6%; p&lt;0.001). Procedure duration was Ionger in the hybrid group (179.9±60.1 minutes) compared to PFA endocardial ablation (PFA 106.2±30.7 minute; p&lt;0.01). After a median follow-up of 233.0 [179.0–331.8] days, there was no difference in atrial tachyarrhythmias recurrence rate (PFA n=11, 25.0% vs Hybrid n=10, 23.8%; p=0.897); no difference in the antiarrhythmic drug use rate was found (PFA n=24, 54.5% vs Hybrid n=19, 45.2%; p=0.388).

Conclusions
PFA of PV and PW, compared with the hybrid convergent ablation strategy, is an endocardial-only, less invasive, and faster procedure. 6-month rhythm outcomes were similar in both groups.
Predictors of neuromodulation during single-shot thermal atrial fibrillation ablation: a computed tomography imaging analysis
Authors: Nakasone K , Del Monte A , Della Rocca D G , Pannone L , Gauthey A , Overeinder I , Bala G , Sorgente A , Sieira J , Almorad A , Sarkozy A , Chierchia G B , De Asmundis C , Tanaka K , Stroker E 
Published: May 2024

Abstract

Background
Ganglionated plexi (GPs) are part of the cardiac autonomic nervous system (CANS), which play an important role in the induction and maintenance of atrial fibrillation (AF). Because of the anatomic proximity of the pulmonary veins with GPs, pulmonary vein isolation (PVI) using thermal (radiofrequency (RF) or cryo) ablation, has been shown to concomitantly affect the GPs, as suggested by increased heart rate (HR) after ablation. Right superior pulmonary vein (RSPV) isolation has been reported to have the most evident inhibitory responses to the CANS via modulation of the anterior right ganglionated plexus. Nonetheless, there are also cases with little to no effect on neuromodulation post-ablation.

Purpose
To assess the clinical and anatomical predictors of thermal ablation-induced CANS changes, as assessed via variations in resting HR post-ablation.

Methods
We retrospectively analyzed consecutive patients with symptomatic paroxysmal AF who underwent first-time PVI by cryoballoon (CB) or RF balloon (RFB) between January 2022 to November 2022. Patients who were not in sinus rhythm, had cardiac implantable electronic devices, or did not have a contrast-enhanced computed tomography before the ablation were excluded. Pre-ablation and 24-hour post-ablation ECGs in sinus rhythm were collected and analyzed to assess HR.

Results
A total of 83 patients (CB group, n = 43 vs RFB group, n = 40) were included in the analysis. Baseline patients’ characteristics were similar between the two groups (Table 1). A significant HR increase (ΔHR ≥ 15 bpm) at 24h post-ablation occurred in 31 patients [CB group 16 (52 %), RFB group 15 (48 %)]. Predictors of increased HR were the distance between superior vena cava (SVC) and RSPV (OR 0.51, CI 0.35 - 0.75, p value &lt; 0.01) and age (OR 0.94, CI 0.89 - 0.99, p value &lt; 0.01) (Table 2).

Conclusions
Single-shot thermal PVI influences the CANS, especially in patients with a shorter SVC - RSPV distance and in younger patients.Table 1Table 2
Evaluation of left atrial function and tissue after pulmonary vein isolation - initial results of The EVALUATE-PVI STUDY
Authors: Van Pouderoijen N , Hopman L , De Groot J R , Tahapary G J M , Kemme M J B , Gotte M J W , Allaart C P 
Published: May 2024

Abstract

Background
Pulmonary vein (PV) isolation (PVI) by catheter ablation is a well-established treatment for atrial fibrillation (AF). Currently, the direct and long-term impact of ablation injury on left atrial (LA) function and tissue is poorly understood.

Purpose
The aim of this study is to evaluate the acute and long-term impact of radiofrequency (RF) PVI ablation on LA function and corresponding tissue changes as assessed with cardiac magnetic resonance imaging (CMR).

Methods
Seventeen patients (76.5% male, 60.8±9.7 years) with AF who underwent primo RF PVI as part of the EVALUATE-PVI STUDY underwent three sequential CMR scans prior to PVI, and &lt;72 hours and 3 months after PVI ablation. T2-weighted turbo spin echo imaging was applied to assess post-ablation edema. High-resolution three-dimensional (3D) late gadolinium-enhancement (LGE) images were acquired to study acute LA wall injury and chronic fibrosis formation. LA volume and function were derived from two-chamber and four-chamber SSFP cine images. Maximum and minimal LA volume was indexed to body surface area to compute LAVimax and LAVimin. Longitudinal LA strain was calculated using feature tracking, and subdivided into reservoir, conduit, and contractile strain.

Results
Acutely post-PVI, T2w images showed increased signal intensity and thickening throughout the entire LA wall. LGE images showed diffuse increased signal intensity, without distinct focal high signal intensity areas (Fig. 1). Functional assessment at this stage showed significantly reduced LA emptying fraction (EF), LA reservoir, and contractile strain compared to pre-PVI (54.8±11.1% vs. 48.5±7.9%, p=0.01; 18.6±5.6% vs. 14.6±2.0%, p&lt;0.01; 8.5±3.5% vs. 5.2±1.8%, p&lt;0.001, respectively), while LA conduit strain, LAVimin, and LAVimax did not differ significantly (Fig. 2).
The LGE images acquired at 3 months, displayed clear, focal, high signal intensity areas surrounding the PVs. At this stage post-PVI, a significant increase in LA strain was observed (LA reservoir strain 14.6±2.0% vs. 16.9±3.5%, p&lt;0.01; and contractile strain 5.2±1.8% vs. 6.7±2.9%, p&lt;0.01; respectively). LAVimax was significantly reduced at 3 months compared to acutely post-PVI (Fig. 2).
LAVimin and LA conduit strain did not differ between the pre- and post-PVI stages.

Conclusion
PVI ablation resulted in temporary reduced LA function acutely post-PVI, likely due to edema and thickening of the LA wall. At three months, LGE images revealed clearly visible increased signal intensity in the ablated segments. At this stage, LA function improved, though full recovery did not occur as evidenced by the persistent slightly reduced contractile strain, possibly due to the ablation-induced loss of LA myocardium and formation of fibrosis. The decrease in LAVimax indicates reverse remodeling as a result of the ablation.
The new "olive strategy" for pulsed field ablation of atrial fibrillation: procedural data and early follow-up
Authors: Plank K , Schaack D , Tohoku S , Chen S , Urbanek L , Ebrahimi R , Hirokami J , Bordignon S , Schmidt B , Chun K R J 
Published: May 2024

Abstract

Background
Pulsed field ablation (PFA) is a new myocardial-specific ablation technology for atrial fibrillation (AF). Direct current electric energy is applied to cells and disrupts cell membranes by creating pores.

Purpose
The aim of this single-center study was to report procedural data and early recurrence of atrial tachyarrhythmia (ERAT) following a new PFA-based ablation strategy for pulmonary vein isolation (PVI).

Methods
Consecutive patients with symptomatic AF were enrolled to undergo PFA-PVI using the pentaspline catheter. A new ablation strategy was performed: In total 10 applications per pulmonary vein (PV) were delivered. In addition to the conventional four applications in flower- and four applications in basket-configuration, two applications were delivered in a smaller "olive"-configuration. ERAT was defined as any documented AF/atrial tachycardia (AT) lasting more than 30 seconds during a 90-days blanking period. Procedural and demographic data were analysed.

Results
60 patients (37% female, age 67±12, 43% paroxysmal atrial fibrillation [PAF]) were included in this preliminary analysis. 239 PVs were identified, and all PVs could be isolated using solely the PFA device. All PVs were isolated with the first application. 40 applications per patient were delivered. No complications occurred. Procedure time was 30±11 min, fluoroscopy time was 6±3 min. Median follow-up time was 100 days. 20% of patients experienced an early recurrence after a median of 2 days (IQR 1-7.25; 92% AF, 8% AT). Kaplan Meier estimated freedom of AF/AT was 83.3 % at 3 months, 92.3% for PAF and 76.5% for persistent atrial fibrillation (p=0.11).

Conclusions
Our data show feasibility of a new ablation strategy with the pentaspline PFA-catheter. This study indicates high acute efficacy and safety. 83.3% of patients are free of AF/AT at 3 months. Longer follow-up times are needed to assess the clinical outcome and will be available at the time of presentation.
Pulsed field ablation of atrial fibrillation using a large area focal catheter with a novel contact detection algorithm. A first-in-human experience using the QuickShot catheter
Authors: Anic A , Breskovic T , Jurisic Z , Sikiric I , Katic J , Lisica L , Doshi S 
Published: May 2024

Abstract

Background/Introduction
Pulsed field ablation (PFA) is emerging as a safe and effective alternative energy modality for cardiac ablation. Data have shown that while tissue contact is critical for PFA, the amount of contact force is less important. Single-shot catheters have shown comparable results to current thermal methods for pulmonary vein isolation (PVI), however, are limited to anatomical-based ablation strategies and have limited ability to detect tissue contact. The investigational QuickShot™ large-area focal catheter (Galvanize Therapeutics, Redwood City, CA) combines high-density mapping with large-area focal ablation guided by contact detection.

Purpose
The QuickShot PEF-AF study was a prospective, single-arm, first-in-human study performed at a single European center to evaluate the safety and performance of the QuickShot catheter (see Figure 1, panel A) combined with the CE-marked CENTAURI™ System (Galvanize Therapeutics, Figure 1, panel B) for catheter ablation of atrial fibrillation (AF).

Methods
Subjects with paroxysmal or persistent AF underwent a PVI procedure under deep sedation (fentanyl, midazolam, propofol) guided by Rhythmia™ HDx (Boston Scientific, Marlborough, MA, Figure 1, panel D). Irrigation was set to a constant 6 mL/min during the procedure. Focal, monopolar, biphasic PFA lesions were delivered asynchronously at 33 Amps and a 10 mm inter-lesion spacing (center to center with 10 mm lesion tag size). Catheter-tissue contact was confirmed by ICE/fluoroscopy and a novel impedance-based contact detection system (Figure 1, panel C). The acute performance endpoint was PVI, assessed by entrance and exit block using high-density mapping. Procedural safety assessments included microbubble detection via ICE, induction of VT/VF, muscle stimulation, phrenic nerve function, and NIHSS post-procedure.

Results
Twenty (20) subjects (60% PAF, 60 ± 12 years, 75% male, 4.3 ± 0.52 cm LA AP diameter) were enrolled and treated. Acute PVI was achieved in 100% of patients and targeted PVs (82/82), with first-pass isolation in 88% of targeted PVs. The PVI time was 31 ± 10 min with 46.7 ± 11.4 PFA applications. There were no device- or procedure-related adverse events, and no documented incidence of microbubble formation, arrhythmia induction, muscle stimulation, phrenic nerve dysfunction, esophageal injury, or change in NIHSS post-procedure.

Conclusion
The QuickShot catheter enables safe and effective large-area focal PFA for subjects requiring PVI. The catheter design enables efficient and flexible focal lesion placement with the ability to ensure adequate apposition to targeted tissues using its novel contact detection algorithm. Future studies will investigate the use of this novel catheter for PFA strategies beyond PVI.
Electrocardiographic characteristics and catheter ablation of premature ventricular complex- mediated ventricular fibrillation
Authors: Maan A , Iwanari Kawamura I K , Musikantow D M , Stanton E S , Koruth J K , Miller M M , Lampert J L , Whang W W , Dukkipati S D , Reddy V R 
Published: May 2024

Abstract

Background
Premature ventricular contractions (PVCs) can trigger ventricular fibrillation (VF) in patients with/or without structural heart disease. There are limited data on coexisting electrocardiographic (ECG) features and catheter ablation outcomes in these patients which could suggest the concomitant presence of an abnormal electrical and structural substrate.

Purpose
We investigated ECG and electroanatomic characteristics and clinical outcomes in patents who underwent catheter ablation of PVCs triggering VF.

Methods
We analyzed data from a consecutive series of patients who underwent catheter ablation between 08/2019 and 04/2023 for PVCs triggering VF. On the 12-lead ECG, we assessed the following abnormalities: (a) Early repolarization (ER) pattern in either inferior or lateral leads (Figure 1), or (b) QRS Notching of either the native sinus beat or PVC (Figure 2). Post-ablation follow up outcomes were collected using a combination of ICD interrogation, remote transmission and clinical follow up.

Results
The cohort included 15 patients: age 52.1±16.8 years, 46.7% females, and 26.7% presenting with VF storm. On average, there were 3.8 HV shocks/per patient from an ICD prior to the index ablation procedure (range: 0-19 shocks). On the 12-lead ECG, the mean coupling interval of the PVC leading to VF was 204±82 ms, and an overall narrow PVC morphology with a mean QRS duration of 107±17 ms. We observed early repolarization (ER) in 6 (40%) of the cohort. In most patients (n=11; 73.3%), at least one of the 2 ECG abnormalities were present. An endocardial-only approach was adequate in all patients, and during catheter ablation, Purkinje potentials were targeted in 10 (66%) of the patients.
Based on activation and pace-mapping, the PVCs were localized to the following sites: (a) left ventricular (LV) septum in 11 (73.3%), (b) papillary muscles in 2 (13.3%), and (c) other sites such as the Moderator band and right ventricular outflow tract in the remaining 2 (13.3%) patients. The ablation locations on the LV septum extended from basal to mid-septum. After an average of 1.7 ablation procedures targeting PVC-triggering VF, 12 (80%) patients remained free of sustained ventricular arrhythmias and ICD shocks, over a mean follow up of 479±395 days.

Conclusion
In most patients with PVCs-triggering VF, there was an evidence of an ECG abnormality either in the form of an ER pattern or notching of either the Sinus QRS or the PVC complex on pre-ablation ECG. During ablation, Purkinje potentials and PVCs were mapped to and ablated in the region of the LV interventricular septum and papillary muscles. Over long-term follow up, catheter ablation seemed durable and effective in reducing VF episodes and ICD shocks.Presence of Early Repolarization patternPresence of a notching pattern in the Si