bluuebunny/crossref_metadata_2025_split huggingface dataset:
Removal of spontaneously fractured leads with their proximal ends in the heart and vasculature -experience among 3847 lead extraction procedures
Authors: Kutarski A , Jachec W , Pietura R , Stefanczyk P , Czajkowski M , Sawonik S , Nowosielecka D , Tulecki L 
Published: May 2024

Abstract

Background
Spontaneous fractures and insulation breaks of the intracardiac leads near their entry into the venous system cause the proximal end of the fractured lead slide into the veins, with potential subsequent looping in the heart and secondary complications. So far, this topic has not been extensively studied. As it is a relatively uncommon finding, it has been described in a few number of case studies only.
The aim of the study was to describe the phenomenon of leads migrated proximal end (LMPEs) into the cardiovascular system and techniques for such leads removal.

Methods
Retrospective analysis of 3847 transvenous lead extractions (TLE).

Results
Over a 17-year period 72 (1.87%) leads with migrated proximal ends (LMPEs) (mean dwell time 148.0 months) were extracted, mainly ventricular leads (56.94%). Overall, 68.06% of MPLEs had their cut proximal ends located in the venous system. Most of them were pacing (95.83%) and passive fixation (98.61%) leads. Independent risk factors for LMPEs included abandoned leads (OR=8.473; p&lt;0.001) and leads on both sides of the chest (2.981; p=0.045). Higher NYHA class lowered the probability of leads with migrated proximal ends (LMPEs) (OR=0.380; p&lt;0.001). Extraction complexity was higher in the MPLE group than in remained patients. Femoral approach was most often used (62.50%), contrary to superior (23.61%) and combined approach (11.11%). Lead dilatation was necessary in 80.56%, and grasping and traction was effective in 18.06%. In 66.7%, the proximal end was strongly attached to the wall and a pulling loop had to be applied. In 15.28% of procedures the lead was wrapped around a pig-tail catheter ("spaghetti twisting technique"), which was sometimes sufficient to free the lead end. This manoeuvre was especially helpful in releasing the leads with their tip in the distal branch of the pulmonary artery. All these manoeuvres were performed from the femoral or superior approach, depending on the anatomical conditions. Extraction of MPLEs did not influence long-term survival. The rate of major complications was 2.78% but it may be attributed to long implant duration (152.2 months) and were not the result of extraction of LMPEs.

Conclusions
1. Extraction of leads with migrated proximal ends (LMPEs) is rare among other TLE procedures (1.9%), 2. Risk factors include abandoned leads and presence of leads on both sides of the chest. 3. Complexity of LMPEs extraction is higher as regards procedure duration, unexpected procedure difficulties, use of advanced tools and techniques but rates of major complications are comparable to other leads but in spite of a high level of procedure complexity its effectiveness is also high (procedural success rate 93.06%) with an acceptable rate of major complications. 4. Extraction of LMPEs did not influence long-term survival.
Severe lead induced tricuspid regurgitation - clinical impact of repair or replacement of tricuspid valve
Authors: Santos A R , Albuquerque F , Castelo A , Ferreira V , Rio P , Timoteo A T , Galrinho A , Branco L , Varela F , Leal A , Santos H , Valente B , Osorio P , Oliveira M , Ferreira R 
Published: May 2024

Abstract

The prevalence of lead-induced tricuspid regurgitation (LITR) ranges between 7 to 45%. The most frequent mechanism of LITR is the impingement of the leaflets, but right ventricle remodelling, pacing-induced cardiomyopathy and tricuspid annular dilatation also can contribute to the severity of tricuspid regurgitation (TR). Different studies concluded that LITR was associated with an increased risk of all-cause mortality and heart failure hospitalizations. Beyond diuretics, patients (P) may be candidates for interventional treatment, including lead extraction, surgery, or percutaneous tricuspid trans-catheter ‘edge-to-edge’ repair (TEER) and heterotopic bicaval devices (HBD). Despite its importance, there is a scarcity of data concerning the management and clinical impact of severe LITR. The purpose of the current analysis is to improve the knowledge regarding the impact of interventional treatment on the outcomes in this population.

Methods
A retrospective, single-centre analysis was made including P with severe LITR referred to evaluation regarding eligibility for tricuspid percutaneous intervention in a tertiary hospital. All P were evaluated using both transthoracic echocardiography (TTE) and transoesophageal echocardiography (TEE). Data were collected regarding clinical characterization, management, intervention and follow-up.

Results
From January 2020 to September 2023, of the 97 P referred for tricuspid intervention eligibility, 36 (37%) had LITR, with 14 cases (39%) presenting lead impingement as the TR mechanism. The majority of P were female (58%), with a median age of 78 [IQR 72-83] years. Median Euroscore II was 6 % [IQR 3-9]), with 51% of the P having a previous heart surgery, and 97% presenting atrial fibrillation. Prior to cardiac electronic device (CIED) implantation, 14% already presented TR. When analysing post-CIED TR, 30% increased 1 grade of TR at 1-year follow-up, and 68% increased 2 grades of TR at 5 years. According to TTE, ventricular desynchrony was present in 30% of the P. After evaluation of TR, 30% underwent intervention (22% percutaneous - TEER or HBD - and 8% surgical). All P remained with the previous electrodes. Mortality was 21.1% in the intervention population and 78.9% on the remaining pts (p=0.027). The type of intervention had no statistically significant differences in outcome.

Conclusions
In our study, more than 1/3 of the cases referred due to severe TR presented lead impingement as the mechanism underlying TR. As previously reported, the intervened population had better outcomes than the remaining pts.
Explainable AI for myocardial infarction using the vectorcardiogram
Authors: Ramirez E , Ruiperez S , Castells F , Millet J 
Published: May 2024

Abstract

Background and purpose
Myocardial infarction (MI), a widespread cardiovascular ailment, often lacks immediate patient awareness being early and accurate MI diagnosis crucial for lifesaving interventions. In artificial intelligence studies, ECG signals are extensively explored, while fewer examine the potential of vectorcardiogram (VCG) which offers a three-dimensional cardiac dipole representation. Traditional Machine Learning methods manually extract features; some studies advocate VCG features. Deep Learning, especially Convolutional Neural Networks (CNN), automates feature extraction. Although ECG contains redundant information from the VCG's 12 projections, no studies directly apply CNNs to VCG, nor assess the impact of redundancy on predictive ability. This study aims to bridge this gap by investigating CNNs' diagnostic capabilities with VCG inputs, specifically focusing on improving MI classification.

Methods
The PTB-XL database was used for this study, containing 10-seconds ECG data from various pathologies, including MI. The database encompasses 9,481 records from healthy patients and 4,129 records from patients with MI. Data was divided into 80% for training and 20% for testing. Consequently, the dataset was expanded to have 52% representing MI and 48% representing healthy cases. We designed a 1D-CNN classifier (Figure 1.A) with three convolutional layers. The network was trained using both ECG and VCG reconstruction through the Inverse Dower Transform.

Results
The trained model achieved accuracy values of 0.895 and 0.914 for the test set when utilizing ECG and VCG, respectively. These results underscore how the information condensation in the VCG contributes to an enhanced predictive capacity of the model. In a qualitative analysis, activation maps extracted from the CNN illustrate heightened activation in the QRS complex when the disease is present, contrasting with diminished activation in its absence. These maps depict the weight assigned to each signal segment, enabling the classification of signals into healthy and diseased categories. The presented figure exemplifies a notable activation in the QRS loop in the case of myocardial infarction (MI), aligning with the observed alteration in the cardiac signal associated with this pathology (Figure 1.B).

Conclusion
In this study, an interpretable CNN has been designed for MI detection, with the VCG yielding better results than the ECG for this task due to information compression. This provides a new insight for enhancing classification capability in Deep Learning models, allowing for advancements in the MI detection.
A polygenic risk score predicts future atrial fibrillation-related stroke/systemic embolism
Authors: Park H , Yang P S , Kim D H , Jang E S , Yu H T , Kim T H , Sung J H , Pak H N , Lee M H , Joung B Y 
Published: May 2024

Abstract

Background
Novel strategies to identify patients at risk of stroke/systemic embolism (SSE) earlier before development of clinical atrial fibrillation (AF) might be useful. We examined whether the AF polygenic risk score (PRS) added to a clinical risk model would improve prediction of AF-related SSE in people without prevalent AF.

Methods
A total of 62,145 individuals (≥65 years) without prevalent AF who had additional risk factors for stroke (hypertension, diabetes, heart failure, myocardial infarction, stroke or transient ischemic attack, and peripheral artery disease) were included from the UK Biobank. The primary endpoint was AF-related SSE and the secondary endpoint was incident AF. SSE event was considered AF-related when previously undiagnosed AF was identified at the time of SSE or up to 1-year after the SSE.

Results
For a median of 11.5 (10.6-12.4) years, 334 AF-related SSE and 7,428 incident AF events developed. After adjusting for the clinical risk model, AF-PRS identified a significant gradient for AF-related SSE and incident AF with a 4.59-fold (HR 4.59, 95% CI 3.12-6.75, p&lt;0.001) and 3.14-fold (HR 3.14, 95% CI 2.90-3.40, p&lt;0.001) higher risk in the top quintile of the AF-PRS. The number needed for 5-years of AF screening at the index age of 75 years to find 1 AF-related SSE and incident AF was 91 and 10 for high AF-PRS and 500 and 22 for low AF-PRS, respectively. AF-PRS added to a clinical risk model resulted in a significant improvement in C-statistics for AF-related SSE (C-index; 0.66 to 0.72, p for difference in C-index &lt;0.001) and incident AF (C-index; 0.65 to 0.68, p for difference in C-index &lt;0.001).

Conclusions
AF screening strategy based on AF-PRS added to a clinical risk model might detect and potentially prevent more cases of AF-related SSE.
Results of external validation for anatomical site recognition of ablation sites in atrial fibrillation using the CARTONET R12 model
Authors: Sasaki W , Kudou D , Tanaka N , Naganuma T , Narita M , Matsumoto K , Mori H , Tsutsui K , Ikeda Y , Kato R 
Published: May 2024

Abstract

Background
CARTONET® is a cloud-based management system designed for retrospective analysis of ablation procedures using the CARTO system. Leveraging a proprietary machine learning model, it automates procedural information analysis. However, the efficacy and accuracy of the CARTONET R12 model's automated location identification remain unverified.

Methods
This study involved a total of 396 cases. Pulmonary vein isolation (PVI), including cavo-tricuspid isthmus (CTI) ablation, was performed in 313 patients (PVI group). PVI and additional ablation, such as a Box isolation and superior vena cava isolation (SVCI), was performed in 83 patients (PVI+ group). We compared the automated location identification of R12 model and the location identification of arrhythmia experts.

Results
In this study, 29,422 points were analyzed. The sensitivity of the pulmonary vein carina was low in both PVI group and PVI+ group. Excluding the inferior, anterior, and ridge segmentations, PVI group demonstrated significantly higher sensitivity compared to PVI + group. Regarding the ablation lines for box isolation, both the roof line and post line showed results below 30%. The pulmonary vein carina showed a low PPV in both PVI group and PVI+ group. In segmentations excluding the anterior, PVI group demonstrated significantly higher PPV compared to the group PVI+. Regarding the ablation lines for box isolation, both the roof line and post line showed results below 50%.The R12 model couldn't auto-identify CTI and SVC.

Conclusion
Excluding the carina, it can be said that in cases where PVI was performed, both PPV and sensitivity demonstrate high accuracy. Conversely, in cases where Box isolation was performed, accuracy decreases due to the low discrimination ability between ablation information near the roof, posterior wall, and inferior wall of the pulmonary veins and the ablation lines of Box isolation. Regarding the right atrium, it was found that the R12 model is entirely incapable of discriminating SVC and CTI, indicating a need for revisions in the current model.The segmentation of anatomyResults of the positive predict value
Performance of a vectorcardiographic deep learning algorithm compared to single-lead and 12-lead ECG for atrial flutter detection: implications for wearable devices
Authors: Lampert J , Vajdic B , Shvilkin A , Zimetbaum P , Oguz A , Vaid A , Nadkarni G , Reddy V Y 
Published: May 2024

Abstract

Background
Wearable devices have developed the capacity to offer single-lead ECG analysis and are already widespread in use, particularly for detection of atrial fibrillation (1,2). Vectorcardiography entails the transformation of electrical vectors into X, Y, and Z axes to constitute a vectorcardiogram (VCG) (3). The VCG has diagnostic promise given the capacity to generate it without requiring clinical presentation for standard 12-lead ECG acquisition. Furthermore, a novel credit-card sized device capable of acquiring a VCG has recently been developed – raising the potential for arrhythmia detection and discrimination beyond wearable single-lead ECG systems.

Objective
To assess the performance of a deep learning algorithm trained on single lead and 12-lead ECGs and VCGs for detecting atrial flutter.

Methods
A convolutional neural network (AFL-CNN) was developed on a dataset of 4,000 ECGs and VCGs from a single US academic medical institution (80% training and 20% for testing). Validation was performed on a separate publicly available dataset (2223 ECGs). Model performance was assessed on single lead ECG analysis (lead I, obtained by removing the other leads) and standard 12-lead ECG. The gold standard for AFL diagnosis was physician-confirmed 12-lead ECG diagnoses in the dataset. The VCG was generated from the 12-lead ECG via Kors transformation matrix to which AFL-CNN was also applied. Model performance was assessed with sensitivity, specificity, positive and negative predictive values, accuracy, and F1 statistic.

Results
On single lead ECG analysis, AFL-CNN achieved 71.2% sensitivity and 96.9% specificity with PPV 84.0% and NPV 93.7% and 92.2% accuracy with F1 83.2%. When AFL-CNN was applied to the VCG, performance improved: 91.0% sensitivity and 98.7% specificity, PPV 94.24%, NPV 98.0%, 97.3% accuracy, and F1 95.31%. Lastly, the performance remained high when AFL-CNN was applied to the 12-lead ECG: 95.4% sensitivity, 98.63% specificity, PPV 94.0%, NPV 99.0%, and accuracy of 98.0%, with F1 97.2%.

Conclusion
A deep learning algorithm applied to vectorcardiography for the detection of atrial flutter showed improved performance over single lead analysis and comparable performance to standard 12-lead applications. The finding of improved model performance beyond single lead ECG tracings underscores both the limitations of current wearable technologies in arrhythmia detection beyond atrial fibrillation and the potential for VCG-based algorithm prediction to fill gaps in healthcare inequality when standard 12-lead acquisition is challenging to obtain.
Spatiotemporal stability of digital twin-guided atrial fibrillation dominant frequency sites and the clinical outcome of catheter ablation
Authors: Hwang T , Kwon O , Lim B , Yang S , Kim M , Kim D , Park J , Yu H , Kim T , Uhm J , Joung B , Lee M , Pak H 
Published: May 2024

Abstract

Background
Although the dominant frequency (DF) may localize the reentrant drivers of atrial fibrillation (AF), its meandering nature makes it difficult to localize as an extra-pulmonary vein (extra-PV) target.

Purpose
We explored and quantified the spatiotemporal stability of DF by sophisticated digital-twin maps and the association with the rhythm outcome of clinical AF catheter ablation (AFCA).

Methods
We retrospectively examined the DF sites in the digital twin integrated by high-density electroanatomical maps (EAM) of 170 patients previously included in the CUVIA-AF2 trial (male 70.6%, 59.2±11.3 years old, 100% persistent AF). We monitored 34 seconds of virtual AF and analyzed DF sites in 10 different left atrial (LA) regions at 3 consecutive periods (6 seconds each after 16sec induction and blanking periods). The spatiotemporal stability index (STSI) was calculated to quantify mean DF's spatial and temporal variability. During protocol-based rhythm follow-up, we assessed the atrial arrhythmia recurrence rate by dividing patients into two groups based on STSI 0.75.

Results
During the simulation, 108 out of 170 (63.5%) patients obtained mean DF values in all three consecutive periods. There were 26 (24.1%) patients in the stable DF group (STSI ≥0.75, Stable group) and 82 (75.9%) patients in the unstable DF group (STSI &lt;0.75, Unstable group). Although the proportion of patients with hypertension (73.1 vs. 47.6%, p=0.041) was higher and left ventricular end-diastole diameter (51.3±3.9 vs. 49.0±4.4 mm, p=0.020) was larger in the stable DF group than in the unstable DF group, other parameters, including LA size, LA voltage, or AF ablation targets, did not differ between two groups. During the median 19 [15-22] months follow-up, the atrial arrhythmia recurrence rate of the Stable group is higher than that of the Unstable group (log-rank p=0.031, HR = 2.06, CI [1.06-4.01])

Conclusions
We found that the temporally stable DF in EAM-integrated virtual AF, the potential extra-PV AF drivers, is a surrogate marker of the adverse rhythm outcome of AFCA. A prospective clinical trial targeting the spatiotemporally stable DF will be warranted.
Initial experience with a virtual atrial fibrillation clinic after pulmonary vein isolation
Authors: Reijrink-De Boer M , Wolsink I , Frenaij I , Beukema K F , Brouns B , Van Dijk V F , Liebregts M , Wijffels M C E F , Boersma L V A , Balt J C 
Published: May 2024

Abstract

Introduction
To detect recurrent atrial fibrillation (AF), a variety of methods are used, ranging from incidental electrocardiogram to rhythm monitoring with implantable loop recorders (ILRs). In clinical practice, routine use of ILRs is not feasible due to cost. Repeated (week)-Holters cause a considerable burden, both on patients and hospitals, and moreover are inadequate for detecting recurrent AF.

Purpose
To investigate whether remote monitoring (RM) is feasible in patients with AF after pulmonary vein isolation.

Methods
We set up a virtual AF clinic. Patients were equipped with a photopletysmography (PPG) application and asked to perform a recording when symptomatic. Recordings uploaded to the Hospital Electronic Patient Dossier and monitored by dedicated eNurses. The number of hospital contacts, hospital visits, electrocardiograms and Holter recordings were noted. Patient satisfaction and quality of life was measured by (validated) questionnaires. Comparisons were made with a historic control group from Jan-March 2019 with a traditional follow up of outpatient visits, electrocardiograms and Holters.

Results
157 patients were studied, 78 in the RM group and 79 in the control group. Mean age was 63 ± 10 years, 64% male. AF was paroxysmal in 68% of patients. Follow-up was 1 year and completed in all patients. In the RM group, patients performed 16±29 recordings/year. AF was detected in 37 (47%) patients on RM. While more planned remote contacts were performed in the RM group, significantly less planned and unplanned outpatient clinic visits, AF-related hospital admissions, and Holters took place. Patients report a high satisfaction with this form of remote monitoring.

Conclusions
A virtual AF clinic is feasible. When asked to record when symptomatic, patients perform few measurements. Compared to patients with a traditional follow-up, patients on PPG-based RM need fewer hospital visits and admissions, and undergo fewer Holters. Patient satisfaction with RM is high.
Digital patient care program following successful ablation or cardioversion of patients with atrial fibrillation
Authors: Von Degenfeld G , Langbein A , Boscheri A , Weyh P , Ziegler M O , Leber A , Schreier S , Spitzer S 
Published: May 2024

Abstract

Background
The current ESC guidelines on atrial fibrillation recommend the assessment of disease burden and the rigorous management of cardiovascular risk factors. A digital patient care program (Digital Health Program Atrial Fibrillation) was offered to patients following pulmonary vein isolation or cardioversion in cooperation with a major German statutory health insurer and a leading cardiology clinic. The 12 month program consists of the following functions: (1) self-recording of 1-channel-ECGs by patients with the possibility to receive short-term assessment by a teledoctor; (2) Patient education on health literacy, management of risk factors and lifestyle optimization via an App; (3) Monitoring of blood pressure and body weight; (4) Medication management via the App; und (5) videoconsultations on demand. When needed, medication was optimized by the teledoctors, or patients were referred to their family practice or cardiologists.

Results
an interim analysis of 72 patients that have participated in the first 6 months of the program showed:
1.) Over 20,000 ECGs were written, or a mean of approx. 1.5 ECGs/patient/day. Based on the teledoctor assessment of the ECGs and the videoconsultation over the platform recurring atrial fibrillation could be detected early and with high reliability, and patients could be advised.
2.) Figure A.: In patients with known, but insufficiently controlled arterial blood pressure at baseline (systolic blood pressure &gt; 130 mmHg), blood pressure was reduced by 7.2 ±7.8 mmHg (mean ± std); n = 20.
3.) Figure B.: In obese patients at baseline (BMI ≥ 30) the body weight was reduced by 3.03 ±4.71 KG (mean ± std); n = 26.
Summary: The combination self-recorded ECGs with high adherence, the feedback by the App and the possibility to book a short-term teledoctor appointment made it possible to perform quick and reliable assessment and give concrete recommendations to the patient. Furthermore, the accompanying education program led to reduced blood pressure and body weight.
This systematic analysis of a real world digital patient care program indicates that the program is feasible and effective. These results need to be confirmed in a controlled study.Figure 1