bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mobile ECG devices in pediatric cardiology: efficacy and accuracy of smart watch and hand-held device in healthy children
Authors: Kurath-Koller S , Manninger M , Will J , Scherr D , Sallmon H 
Published: May 2024

Abstract

Background and Aim
Pediatric arrhythmias require accurate electrocardiogram (ECG) assessment for diagnosis and management. Mobile ECG devices, such as smart watch based and hand-held devices, offer potential advantages in terms of portability and accessibility. This study aimed to compare the efficancy and diagnostic accuracy of ECG tracings obtained using a smart watch and a hand-held device with standard 12-lead ECG tracings in healthy children.

Methods
ECG data were acquired from healthy pediatric subjects (n=30) aged 4 to 18 years using the smart watch, hand-held device, and standard 12-lead ECG. Single leads were acquired sequentially. The time required for ECG acquisition was recorded for each device. Subsequently, ECG leads were analyzed for voltage, duration, and morphology of waves and intervals, as well as ST segments. Qualitative assessment of leads included morphology comparison of waves and complexes to standard 12-lead ECG and using a physician based quality rating scale. Assessment was performed by two blinded pediatric electrophysiologists.

Results
We found significant differences in the time required to acquire ECG tracings between the smart watch, standard 12-lead ECG, and hand-held device, with the smart watch being notably slower (median 15 min, 4 min, 1 min, respectively). ECG leads obtained with the smart watch and hand-held device demonstrated comparability to standard 12-lead ECG tracings in terms of quantitative key parameters, including voltage (mV) and duration (ms) of waves and intervals. Qualitative assessment revealed good correlation of the hand-held device with standard 12-lead ECG, while the smart watch performed less well.

Conclusions
This study suggests that mobile ECG devices offer a diagnostic accuracy comparable to that of standard 12-lead ECGs in healthy children. While the smart watch may be slower in ECG acquisition, acquisition of all 12 standard ECG leads is feasible in this population. The potential of both included mobile devices for pediatric usage in specific clinical scenarios, such as remote monitoring or emergencies, is promising.Graphical Abstract
Diagnostic yield of a smartphone-operated, 6-lead device in Brugada syndrome
Authors: Berne P , Lopez H , Rodriguez-Manero M , Villuendas R , Casu G , Bisbal F 
Published: May 2024

Abstract

Background
The spontaneous type 1 ECG pattern (ECG-T1) is diagnostic of Brugada syndrome (BrS) and implies an increased arrhythmic risk, while pharmacologically-induced ECG-T1 without other clinical features only makes the diagnosis possible, according to ESC guidelines. Given the dynamic nature of the ECG patterns in BrS, tools to increase the detection of ECG-T1 are needed to improve BrS diagnosis and adequately assess the arrhythmic risk.

Purpose
To assess the diagnostic yield of a smartphone-operated, 6-lead device (6L-mobile ECG) in BrS.

Methods
Eighteen patients with spontaneous or drug-induced ECG-T1 (Figure 1-a), 18 patients with type 2 ECG pattern (ECG-T2, figure 2-a) and 18 controls were included. A 12-lead ECG and a 6L-mobile ECG were obtained by placing leads V1 and V2 in 2nd, 3rd and 4th intercostal space (ICS). The 6L-mobile ECG was placed with the 2 frontal electrodes in contact with the patients’ chest. Each 12-lead ECG and 6L-mobile ECG recording was classified as ECG-T1, ECG-T2 or non-diagnostic (ND), by considering the lead/ICS with the most evident pattern for analysis.

Results
Sixteen 6L-mobile ECG recordings were diagnostic of ECG-T1 (figure 1-b), 18 of ECG-T2 (figure 2-b) and 20 were ND. Unipolar 6-L mobile ECG recordings at any ICS had a 77% sensitivity and 94% specificity for the diagnosis of ECG-T1 (NPV 89%, PPV 88%, p&lt;0.0001). For ECG-T2, the 6L-mobile ECG showed a 89% sensitivity and 94% specificity (NPV 94%; PPV 89%, p&lt;0.0001).

Conclusions
The 6-L mobile ECG device showed a high diagnostic yield for type 1 and type 2 ECG patterns and may emerge as a new diagnostic and monitoring tool in BrS.
Arrhythmia during gestation: from diagnosis to follow-up
Authors: Smagulova A , Ainabekova B , Albaev R , Abdrakhmanova Z H , Suleymen Z H , Abdrakhmanov A 
Published: May 2024

Abstract

Background
Although arrhythmia is common cardiac complication during gestation, data on perinatal and neonatal outcomes in pregnant women with different arrhythmia management is limited.

Purpose
To explore clinical characteristics and outcomes of different management strategies in pregnant women with arrhythmias.

Methods
In this single-center, prospectively study we consequently included 87 cases of arrhythmias in pregnant (mean age 26.7±3.5 years, mean gestation age 24.6 ±3.3 weeks). Clinical characteristics, obstetric and neonatal outcomes were compared due to different arrhythmia management strategies: dynamic observation (the 1st group), antiarrhythmic therapy (the 2nd group) and catheter ablation (the 3rd group) within 12 month follow-up.

Results
Supraventricular tachycardia (n=47; 54%) was the most common arrhythmia in pregnant. Premature contraction was detected in 34 cases (39%). Cases of ventricular tachycardia (n=6; 7%) was rare during gestation. Benign course of arrhythmia was in 15 cases (17.2%) and do not require drug therapy or intervention. Antiarrhythmic drug was used for symptomatic patients with haemodynamic instability (n=28, 32.2%). Catheter ablation performed in cases of drug refractory and severe arrhythmias (n=44, 50.5%). The procedure performed under the guidance of CARTO (n=21; 47.7%) and Ensite Precision systems (n=23; 52.3%) without fluoroscopy and were successful in all cases (100%). The further course of gestation characterized by occurring increased incidence of uterine contractile activity (n=2, 4.5%, p=0.464) and placental abruption (n=2, 4.5%, p=0.464) only after catheter ablation while other complications were in all groups: uterine blood flow violation (n=6, 40% vs. n=4, 14.3% vs. n=6, 13.6%, p=0.168) and preeclampsia (n=1, 6.7% vs. n=1, 3.6% vs. n=2, 4.5%, p=0.730). Obstetric outcomes characterized by prevalence of vaginal delivery in all groups (n=13, 86.7% vs. n=22, 78.6% vs. n=37, 84%, p=0.465). Neonatal outcomes characterized by normal range of fetal birth weight and 5 minute Apgar score in all groups (3140.7±321.2 vs. 3265,3±290,1 vs. 3312,3±209,8 grams, p=0.701 and 8,6±1,1 vs. 8,5±1,2 vs. 8,6±1,2, p=0.721 respectively). There was no incidence of maternal and fetal mortality and arrhythmia recurrence after ablation in follow-up.

Conclusions
Supraventricular tachycardia is common in pregnancy. Arrhythmias in pregnant characterized by benign gestation course and outcomes regardless different management.
Key influences of VDD (DX) ICD selection: results from a prospective, national survey
Authors: Vamos M , Nemeth M , Kesoi B , Papp R , Polgar B , Ruppert M , Mikler C S , Liptak A , Selley T , Balazs T , Szili-Torok T , Zima E , Duray G 
Published: May 2024

Abstract

Background
To preserve the benefit of atrial sensing without the implantation of an additional lead, a single-lead ICD system with a floating atrial dipole (VDD or DX ICD) has been developed.

Purpose
The purpose of this nationwide survey was to provide an overview of the current key influences of device selection focusing on DX ICD systems and to test the applicability of a previously published decision-making flowchart of ICD type selection in the daily clinical practice.

Methods
An online questionnaire was sent to all implanting centers in Hungary. In total, 10 centers participated in the survey and reported data from 361 DX ICD and 10 CRT-DX systems implantations between February 2021 and May 2023.

Results
The most important influencing clinical factors indicated by the participating doctors were elevated risk of atrial fibrillation/stroke (56%), risk of sinus/supraventricular tachycardias (42%), and a potential need for CRT upgrade in the future (36%). The DX ICD was considered in the majority of cases instead of the VVI system (87%), and only in a small proportion instead of a DDD ICD (13%). 60% of the patients with DX ICDs were also included into remote monitoring-based follow-up. In 83% of the cases, good (&gt;2 mV) or excellent (&gt;5) atrial signal amplitude was recorded within 6 weeks after the implantation.

Results
In the current nationwide survey, the most important influencing clinical factors indicated by the responding doctors for selecting a DX ICD were the elevated risk of stroke or sinus/supraventricular tachycardias and a potential need for CRT upgrade in the future. These findings support the use of a previously published decision-making flowchart.Graphical abstract
Clinical and electrophysiological characteristics and long term outcomes of catheter ablation for right and left atrial tachycardias
Authors: Kilic S , Coteli C , Yorgun H , Aytemir K 
Published: May 2024

Abstract

Background
Atrial tachycardias (AT) are complex supraventricular tachycardias which are refractory to antiarrhythmic drugs that require catheter ablation.

Purpose
In this trial, we aimed to evaulate the outcomes of catheter ablation in patients with symptomatic atrial tachycardia, define the acute procedural success and the recurrence rates in long-term follow-up and determine the clinical and electrophysiological features that affect these outcomes.

Methods
A total of 666 [mean age: 55 ±16, gender: 344 (51.7%) female] symptomatic patients with AT were enrolled. Prior catheter or surgical ablation history for ATa was present in 199 (29.9%) and 18 (2.7%) of these patients, respectively. Activation mapping was performed during tachycardia in all patients as well as entrainment mapping when needed. Voltage mapping were performed in sinus rhythm in both atriums, late potential mapping was also performed in some patients. Low voltage areas and signals with continuous-fragmented morphology were tagged.

Results
Macroreentry was the primary mechanism in right and left atrium (70.2% and 52.8%, respectively). Cavotricuspid isthmus (CTI) dependent macroreentry was the most frequent mechanism in right ATs and perimitral reentry and roof-dependent macroreentry were the most common mechanisms in left ATs. A total of 59 (7.5%) complications were observed in 780 procedures.(2.1% major and 5.5% minor) Acute procedural success was 95.9%. Freedom from ATa was 72.8 % during a mean follow-up of 39±23 months. Freedom from ATa after index procedure was 82.3% at 12 months and 75.9 % at 24 months. After multiple procedures, freedom from ATa was 90% at 12 months and 86% at 24 months during the follow-up. In multivariate Cox regression analysis, atrial fibrillation (AF) [(HR) 2.43, 95% c(CI) 1.78-3.30; p&lt;0.001] , history of cardiac surgery [(HR) 1.68, 95% c(CI) 1.22-2.30; p=0.001] and moderate to severe tricuspid regurgitation [(HR) 1.47, 95% c(CI) 1.08-2.01; p=0.014] were significant predictors of ATa recurrence.

Conclusion
Our findings demonstrated that tailored catheter ablation of ATs especially guided by high density mapping has a high acute success rate and favourable long-term outcomes in patients with symptomatic AT episodes.
Impact of different ablation strategies during very high power short duration ablation: insights from the multicentric AIR HPSD registry
Authors: Poggi S , Lepiliier A , Grimaldi M , Scaglione M , Zucchelli G , Iacopino S , Rossi L , Mantovan R , Pandozzi C , Giomi A , Strisciuglio T , Stabile G , Solimene F 
Published: May 2024

Abstract

Background
The very high power short duration ablation by mean of the QDOT Micro catheter was demonstrated to be safe and effective to achieve pulmonary vein isolation (PVI) in atrial fibrillation (AF) patients. Data from large multicentric registries are still lacking.

Purpose
We sought to investigate whether different ablation approaches may impact procedural outcomes. First, the hybrid approach (Qmode+, 90 W for 4 sec, at the posterior wall of the left atrium and Qmode modality AI-guided at the anterior wall) was compared to the ablation performed exclusively with the Qmode+ modality. Second, we investigated the impact of the type of anesthesia.

Methods
The AIR HPSD registry is a multicentric real world data registry including patients undergoing AF ablation by mean of the QDOT Micro catheter. The ablation modality (hybrid/ Qmode+) and the type of anesthesia were left to operators’ preference.

Results
Overall, 330 patients were enrolled, 67% males, 71% had paroxysmal AF, the mean age was 61±11. Pulmonary vein isolation was reached in 100% regardless of the ablation modality or the anesthesia used. As for the first pass isolation (FPI) there was a trend toward higher rates in the hybrid group compared to the Qmode+ group (85% vs 74%, p=0.1). No differences in FPI were found between the general anesthesia/deep sedation group and the conscious sedation group (83% vs 81%, p=0.8), however when considering the Qmode+ group solely, the FPI was significantly higher in the general anesthesia/deep sedation group (84% vs 56%, p=0.006). As for the procedural time, this was significantly shorter in the general anesthesia/deep sedation compared to conscious sedation (82±21 vs 97±35 min, p&lt;0.01), as well as in the Qmode+ group compared to the hybrid group (80±31 vs 102±30 min, p&lt;0.01). Minor complications were observed in 1% of patients with no significant differences between groups.

Conclusions
The PVI can be safely and effectively obtained with both approaches, hybrid or Qmode+ solely, however the rate of FPI seems higher with the hybrid one. When adopting solely the Qmode+ modality the general anesthesia increases the rate of FPI.
Organized patterns of excitation during persistent atrial fibrillation in humans relate to tissue structure and activation rate
Authors: Testa Alonso D , Martinez Camblor P , Goni L , Salgado M , Sanchez C , Alvarez Velasco R , Martinez Leon A , Garcia Iglesias D , Filgueiras Rama D , Salgado R , Quintanilla J , Redondo A , Perez Villacastin J , Perez Castellano N , Calvo D 
Published: May 2024

Abstract

Background
The contribution of organized patterns of excitation as mechanisms maintaining persistent atrial fibrillation (PAF) is questioned.

Purpose
We aim to analyze the relationship of focal and reentrant activities, identified with the CARTO-Finder system, with tissue structure and activation rate to explain potential link with mechanisms and outcomes.

Methods
33 patients with PAF of at least 6 months (24±4 months) were admitted for right and left atrial (RA & LA) mapping with the CARTO-Finder system. The biatrial geometry, bipolar Penta-Ray`s signals (30 sec long) and activation patterns were exported for off-line analysis (MatLab environment). A fast-Fourier transform was computed on 30 sec bipolar signal length segments to compute dominant frequency (DF) and represented on atrial shells. Focal and reentrant patterns of activation were superimposed, and correlation with DF and bipolar voltage analyzed.

Results
Biatrial mapping was performed obtaining 15.3±5 Finder maps from the RA and 15.9±5 Finder maps from the LA. Focal activities (182±151 at the RA & 270±21 at the LA) were documented in all patients at both atria. Rotational activities (more than 2 consecutive) were documented in the left atria in 4 patients (22.5±16.8 rotations) and in the right atria in 9 patients (35.5±32 rotations). 30 sec long activation rate was higher at places with focal activities compared with areas without organized patterns (DF: 6.11±0.09 Hz vs 5.7±0.09 Hz; p&lt;0.001). The higher the number of consecutive focal activities, the higher the tissue activation rate (DF no focal activities 5.7±0.09 Hz vs DF 1-5 focal activities 6.0±0.14 Hz vs DF&gt;5 focal activities 6.2±0.14 Hz; p&lt;0.001). In addition, DF at focal activities strongly correlates with DF at areas without organized patterns (Pearson 0.91; p&lt;0.001). The bipolar voltage was higher at places with focal activities compared with areas without organized patterns (1.0±0.04 mV vs 0.5±0.04 mV; p&lt;0.001). None of the previous were observed at places with rotational activities (DF: 5.9±0.16 Hz vs 5.7±0.09 Hz; p=0.204 & Volt: 0.6±0.08 mV vs 0.5±0.04 mV; p=0.364). During follow-up after ablation (24±7 months), a cox regression model including number of focal activities, number of rotations, mean tissue activation rate (mean DF) and bipolar voltage, identified bipolar voltage as a unique independent predictor of survival free of AF recurrence (p=0.04).

Conclusions
Focal activities identified with the CARTO Finder system during PAF in humans correlate with tissue structure and activation rate, suggesting a potential link with mechanisms.
Pulmonary vein isolation with the radiofrequency balloon catheter: long-term results and predictors of ablation success
Authors: Del Monte A , Almorad A , Della Rocca D G , Pannone L , Vetta G , Cespon Fernandez M , Doundoulakis I , Marcon L , Monaco C , Bala G , Stroker E , Sieira J , Sarkozy A , Chierchia G B , De Asmundis C 
Published: May 2024

Abstract

Background
The novel multielectrode radiofrequency balloon catheter (RFB) has been demonstrated to achieve safe and effective pulmonary vein isolation (PVI). However, data on long-term ablation outcomes is lacking.

Purpose
This single-centre study aimed to evaluate the efficacy of the RFB beyond 1-year follow-up and define predictors of arrhythmia recurrence.

Methods
All consecutive patients with symptomatic paroxysmal atrial fibrillation (AF) undergoing first-time PVI with the RFB between January 2021 and November 2022 were prospectively included. Post-ablation remapping was systematically employed to confirm PVI at the end of the procedure. Procedural failure was defined as any atrial tachyarrhythmias (ATas) lasting &gt;30 s occurring during the follow-up after a 3-month blanking period (BP). Patient characteristics, procedural parameters, and ATas recurrence during BP were analysed with respect to ablation outcome.

Results
A total of 120 consecutive patients (50 female, 42%; mean age 65±12 years) were enrolled. After a mean follow-up of 16.1±7.9 months, ATas recurrence occurred in 30 patients (25%). ATas were adjudicated as AF in 25 patients (83.3%) and as atrial tachycardia/atrial flutter in 5 patients (16.7%). The mean time from the index procedure to ATas recurrence was 203±130 days. A redo procedure was performed in 17 patients (56.7%) and at least one PV reconnection was observed in 12 patients (70.6%). Patients with ATas recurrence presented higher values of body mass index (31.0 ±5.7 vs. 28.1±4.9 kg/m2, p=0.048), larger left atria (43±11 vs. 35±9 ml/m2, p=0.003), and increased rates of ATas recurrence during the BP (53.3% vs. 2.2 %, p&lt;0.001) compared to patients with persistent sinus rhythm. At multivariable Cox regression analysis, left atrial end-systolic volume index and ATas recurrence during the BP were independently associated with procedural failure (HR 1.05, 95%CI 1.00-1.11, p=0.048 and HR 23.88, 95%CI 7.71-73.99, p&lt;0.001, respectively).

Conclusion
At 16 months follow-up, PVI with the RFB resulted in freedom from arrhythmia relapse in 75% of patients. Left atrial end-systolic volume index and ATas recurrence during the BP were independent predictors of arrhythmia recurrence.ATas-free survivalPredictors of ATas recurrence
Impact of early atrial arrhythmia recurrence on long-term CryoPVI success
Authors: Rothe M , Boehmer A A , Nussbaum E , Wiedenmann L , Schneider K , Spork P , Keim C , Dobre B C , Kaess B M , Ehrlich J R 
Published: May 2024

Abstract

Background
According to current guidelines, the occurrence of atrial fibrillation (AF) recurrence within the first 90 days after pulmonary vein isolation (PVI) should not indicate re-do procedures. Accordingly, a 90-day blanking period is usually accepted. However, data suggests that early atrial arrhythmia relapses during the blanking period have an impact on the efficacy. The optimal period for indicating a re-ablation therefore remains unclear.

Methods
We prospectively analyzed consecutive AF patients who underwent cryoballoon PVI (CryoPVI) in a single-center cohort between 2018 and 2023. We divided patients into four groups according to arrhythmia recurrence (recurrence between 0-30 days, recurrence between 30-60 days, recurrence between 60-90 days and no recurrence within the first 90 days). CryoPVI was performed in a standardized procedure. At 3, 6, 12, 18, 24 and 36 months after CryoPVI follow up was performed. Efficacy endpoint was the occurrence of symptomatic atrial arrhythmia relapse.

Results
During the study period 1179 patients underwent a first CryoPVI. Of these, 84 patients (7.1%) had atrial arrhythmia relapse between 0-30 days, 38 patients (3.2%) had atrial arrhythmia relapse between 30-60 days, and 38 patients (3.2%) had a relapse between 60-90 days. Overall, 1019 (86.4%) patients didn’t have an atrial arrhythmia relapse between 0-90 days after CryoPVI. Primary efficacy endpoint incidence after 36 months was significantly higher in patients who experienced atrial arrhythmia relapse within the first 90 days (between 0-30 days 62.5% vs. between 30-60 days 70.1% vs. between 60-90 days 77.9% vs. no recurrence ≤ 90 days 41.6%, p&lt;0.0001).

Conclusion
Atrial arrhythmia relapse within the first 90 days is associated with a reduced long-term efficacy of CryoPVI. Re-ablation should be indicated regardless of the time of recurrence.
Safety and efficacy of pulse field ablation of atrial fibrillation in patients aged over 75 years
Authors: Prevot A , Duthoit G , Badenco N , Waintraub X , Gandjbakhch E , Laredo M 
Published: May 2024

Abstract

Introduction
Pulse-field ablation (PFA) is an emerging atrial fibrillation (AF) ablation technology associated with a favorable safety profile and short procedural times. Elderly patients, in whom AF ablation indications are expanding, may be particularly suitable to PFA. However, in a recent large multicenter trial, patients older than 75 years were not included, so that data on PFA safety and efficacy in this population are scarce.

Methods
Consecutive patients who underwent PFA of AF at a single academic center were prospectively included in a local registry. Written informed consent was obtained. Clinical, imaging and procedural data was collected and routine care follow-up was performed locally.

Results
From 2022, out of 345 consecutive patients who underwent PFA of, 42 (13%) were aged ≥75 years. As compared to &lt;75 years-old patients (mean age 61±3 years), elderly patients (mean age 78±4 years) were more frequently females (21 [51%] vs 121 [40%], P=0.02), had more frequently non-paroxysmal AF (27 [65%] vs 164 [54%], P=0.01), significant cardiac comorbidities (9 [21%] vs 33 [11%], P=0.01), and larger indexed left atrial volumes (65 mL/m2 [interquartile range (IQR) 54-76] vs 61 [IQR 54-68], P=0.04). With regards to procedural parameters, the total procedural length was comparable, while elderly patients received more frequently PFA applications outside the pulmonary veins. The rate of major complications was comparable, but 3 cardiac tamponades occurred in patients aged over 75 years, while none occurred in younger patients. After a median follow-up time of 185 days (IQR 65 – 202), the cumulative freedom from sustained atrial arrhythmia recurrence was not statistically different between patients aged over 75 years (75%, 95% confidence interval (CI) [62-84%]) and under 75 years (75%, 95% CI [62-84%], P=0.11).

Conclusions
PFA appear as a safe and effective technique for AF ablation in elderly patients, although there was an excess of cardiac tamponades in this group