bluuebunny/crossref_metadata_2025_split huggingface dataset:
Electrophysiological Anatomy of Typical Atrial Flutter: The Posterior Boundary and Causes for Difficulty with Ablation
Authors: GAMI APOOR S. , EDWARDS WILLIAM D. , LACHMAN NIRUSHA , FRIEDMAN PAUL A. , TALREJA DEEPAK , MUNGER THOMAS M. , HAMMILL STEPHEN C. , PACKER DOUGLAS L. , ASIRVATHAM SAMUEL J. 
Published: October 2009

Electrophysiological Anatomy of Typical Atrial Flutter.

Background:
The electrophysiological anatomy of cavotricuspid isthmus‐dependent atrial flutter (CVTI‐AFL) has not been fully elucidated.
Methods:
We studied 602 autopsied human hearts from individuals aged 0 to 103 years. We measured morphological features of the right atrium, including the crista terminalis (CT), pectinate muscles, sub‐Eustachian pouch, Thebesian valve (TV), and the coronary sinus (CS) ostium.
Results:
In adults, the mean right atrium dimensions were 4.7 cm × 4.5 cm × 4.4 cm. Pectinate muscles extended medial to the CT in 54% of hearts. In 19% of hearts, these ended in another ridge termed the second CT. Pectinate muscles extended into the CVTI in 70% of hearts. A sub‐Eustachian pouch was present in 16% of hearts, was always located on the septal CVTI, and was more likely when a prominent TV was also present. A TV, present in 62% of all hearts, covered the inferior quadrant of the CS ostium in 9% of these hearts.
Conclusion:
The posterior boundary of the reentrant circuit of CVTI‐AFL comprises the Eustachian ridge and CT, but in some patients may also include a second CT. Sub‐Eustachian pouches on the septal CVTI are strongly associated with a prominent TV. The lateral CVTI can have prominent pectinate muscles. This comprehensive characterization of the electrophysiological anatomy of the reentrant circuit of CVTI‐AFL may provide guidance and improve success during difficult ablations. (J Cardiovasc Electrophysiol, Vol. 21, pp. 144‐149, February 2010)
Are MADIT II Criteria for Implantable Cardioverter Defibrillator Implantation Appropriate for Chinese Patients?
Authors: SIU CHUNG‐WAH , PONG VINCENT , HO HEE‐HWA , LIU SHASHA , LAU CHU‐PAK , LI SHEUNG‐WAI , TSE HUNG‐FAT 
Published: October 2009

MADIT II Criteria for Implantable Cardioverter. Background: MADIT‐II demonstrated that prophylactic implantation of an implantable cardioverter‐defibrillator (ICD) device prevents sudden cardiac death (SCD) in patients with myocardial infarction (MI) and impaired left ventricular ejection fraction (LVEF). It remains unclear whether the MADIT‐II criteria for ICD implantation are appropriate for Chinese patients.
Methods and Results:
We compared the clinical characteristics and outcome for a cohort of consecutive Chinese patients who satisfied MADIT‐II criteria for ICD implantation with the original published MADIT‐II population. Seventy consecutive patients who satisfied MADIT‐II criteria but did not undergo ICD implantation (age: 67 years, male: 77%) were studied. Their baseline demographics were comparable with the original MADIT‐II cohort with the exception of a higher incidence of diabetes mellitus. After follow‐up of 35 months, most deaths (78%) were due to cardiac causes (72% due to SCD). The 2‐year SCD rate (10.0%) was comparable with that of the MADIT‐II conventional group (12.1%), but higher than the MADIT‐II defibrillator group (4.9%). Similarly, the 2‐year non‐SCD rate was 3.0%, also comparable with the MADIT‐II conventional group (4.6%), but lower than the MADIT‐II defibrillator group (7.0%). Cox regression analysis revealed that advance NYHA function class (Hazard Ratio [HR]: 3.5, 95% Confidence Interval [CI]: 1.48–8.24, P = 0.004) and the lack of statin therapy (HR: 3.7, 95%CI: 1.35–10.17, P = 0.011) were independent predictors for mortality in the MADIT‐II eligible patients.
Conclusion:
Chinese patients who satisfy MADIT‐II criteria for ICD implantation are at similar risk of SCD and non‐SCD as the original MADIT‐II subjects. Implantation of an ICD in Chinese patients is appropriate. (J Cardiovasc Electrophysiol, Vol. 21, pp. 231–235, March 2010)
Catheter‐Based Cryoablation of Postinfarction and Idiopathic Ventricular Tachycardia: Initial Experience in a Selected Population
Authors: TIMMERMANS CARL , MANUSAMA RANDY , ALZAND BECKER , RODRIGUEZ LUZ‐MARIA 
Published: October 2009

Cryoablation of Ventricular Tachycardia. Introduction: Transvenous cryoablation has proven to be safe and effective for the treatment of supraventricular arrhythmias. The aim of this prospective study was to report the feasibility and safety of catheter‐based cryoablation for the treatment of postinfarction and idiopathic ventricular tachycardia (VT).
Methods and Results:
Catheter‐based cryoablation was performed in 17 patients (15 men, 58 ± 18 years). VT occurred after a prior myocardial infarction in 10 and was idiopathic in 7 patients. Cryoablation was performed with a 10‐F, 6.5‐mm tipped catheter. The ablation site was selected using entrainment mapping techniques for postinfarction VT. The site of the earliest activation time with optimal pace mapping was used for ablation of idiopathic VT. All targeted VTs (12 postinfarction and 7 idiopathic) were acute successfully ablated after a median number of 2 applications of 5 minutes with an average temperature of –82 ± 4°C. Mean procedure and fluoroscopy times were 204 ± 52 and 52 ± 20 minutes for postinfarction VT and 203 ± 24 and 38 ± 15 minutes for idiopathic VT. No cryocatheter or cryoenergy complications were observed. After a follow‐up of 6 months, 4 of the 10 patients with postinfarction VT had a recurrence. In 1 of the 7 patients with idiopathic VT the index arrhythmia recurred.
Conclusion:
In this small patient population, catheter‐based cryoablation of VT was safe and effective. Future studies are needed to evaluate the effect of cryothermy in a larger group of patients, especially those with postinfarction VT. (J Cardiovasc Electrophysiol, Vol. 21, pp. 255–261, March 2010)
Image‐Integration of Intraprocedural Rotational Angiography‐Based 3D Reconstructions of Left Atrium and Pulmonary Veins into Electroanatomical Mapping: Accuracy of a Novel Modality in Atrial Fibrillation Ablation
Authors: NÖLKER GEORG , ASBACH STEFAN , GUTLEBEN KLAUS J. , RITTGER HARALD , RITSCHER GUIDO , BRACHMANN JOHANNES , SINHA ANIL. M. 
Published: October 2009

DynaCT Cardiac Integration into Electroanatomical Mapping.
Introduction: Exact visualization of complex left atrial (LA) anatomy is crucial for safety and success rates when performing catheter ablation of atrial fibrillation (AF). The aim of our study was to validate the accuracy of integrating rotational angiography‐based 3‐dimensional (3D) reconstructions of LA and pulmonary vein (PV) anatomy into an electroanatomical mapping (EAM) system. Methods and Results: In 38 patients (62 ± 8 years, 25 females) undergoing catheter ablation of paroxysmal (n = 19) or persistent (n = 19) AF, intraprocedural rotational angiography of LA and PVs was performed. The subsequent 3D reconstruction and segmentation of LA and PVs was transferred to the EAM system and registered to the EAM. The distances of all EAM points to corresponding points on the LA syngo® DynaCT Cardiac surface were calculated.Segmentation of LA with clear visualization of adjacent structures was possible in all patients. Also, the integrated segmentation of the LA was used to guide the encirclement of ipsilateral veins, which resulted in PV isolation in all patients. Integration into the 3D mapping system was achieved with a distance error of 2.2 ± 0.4 mm when compared with the EAM surface. Subgroups with paroxysmal and persistent AF showed distance errors of 2.3 ± 0.3 mm and 2.1 ± 0.4 mm, respectively (P = n.s.). Conclusion: Intraprocedural registration of LA and PV anatomy by contrast enhanced rotational angiography was feasible and accurate. There were no differences between patients with paroxysmal or persistent AF. Therefore, integration of rotational angiography‐based reconstructions into 3D EAM systems might be helpful to guide catheter ablation for AF. (J Cardiovasc Electrophysiol, Vol. 21, pp. 278–283, March 2010)
Canadian Registry of ICD Implant Testing Procedures (CREDIT): Current Practice, Risks, and Costs of Intraoperative Defibrillation Testing
Authors: HEALEY JEFF S. , DORIAN PAUL , MITCHELL L. BRENT , TALAJIC MARIO , PHILIPPON FRANCOIS , SIMPSON CHRIS , YEE RAYMOND , MORILLO CARLOS A. , LAMY ANDRE , BASTA MAGDY , BIRNIE DAVID H. , WANG XIAOYIN , NAIR GIRISH M. , CRYSTAL EUGENE , KERR CHARLES R. , CONNOLLY STUART J. ,   on Behalf of the CREDIT Investigators
Published: October 2009

Defibrillation Testing at ICD Implantation.
Background: There is uncertainty about the proper role of defibrillation testing (DT) at the time of implantable cardioverter defibrillator (ICD) insertion. Methods: A prospective registry was conducted at 13 sites in Canada between January 2006 and October 2007. Objectives: To document the details of DT, the reasons for not conducting DT, and the costs and complications associated with DT. Results: DT was conducted at implantation in 230 of 361 patients (64%). DT was more likely to be conducted for new implants compared with impulse generator replacements (71% vs 32%, P = 0.0001), but was similar for primary and secondary prevention indications (64% vs 63%, P = NS). Among patients not having DT, the reason(s) given were: considered unnecessary (44%); considered unsafe, mainly due to persistent atrial fibrillation (37%); lack of an anesthetist (20%); and, patient or physician preference (6%).When performed, DT consisted of a single successful shock ≥ 10J below maximum device output in 65% of cases. A 10J safety‐margin was met by 97% of patients, requiring system modification in 2.3%. Major perioperative complications occurred in 4.4% of patients having DT versus 6.6% of patients not having DT (P = NS). ICD insertion was $844 more expensive for patients having DT (P = 0.16), largely due to increased costs ($28,017 vs $24,545) among patients having impulse generator replacement (P = 0.02). Conclusions: DT was not performed in a third of ICD implants, usually due to a perceived lack of need or relative contraindication. (J Cardiovasc Electrophysiol, Vol. 21, pp. 177‐182, February 2010)
Fragmented QRS Complexes on 12‐Lead ECG: A Marker of Cardiac Sarcoidosis as Detected by Gadolinium Cardiac Magnetic Resonance Imaging
Authors: Homsi Mohamed , Alsayed Lamaan , Safadi Bilal , Mahenthiran Jo , Das Mithilesh K. 
Published: October 2009

Background: Fragmented QRS complexes (fQRS) on a 12‐lead ECG are a marker of myocardial scar in patients with coronary artery disease. Cardiac sarcoidosis is also associated with myocardial granuloma formation and scarring. We evaluated the significance of fQRS on a 12‐lead ECG compared to Gadolinium‐delayed enhancement images (GDE) in cardiac magnetic resonance imaging (CMR). Method and results: The ECGs of patients (n = 17, mean age: 52 ± 11 years, male: 53%) with established diagnosis of sarcoidosis who underwent a CMR for evaluation of cardiac involvement were studied. ECG abnormalities included bundle branch block, Q wave, and fQRS. fQRS, Q wave, and bundle branch block were present in 9 (53%), 1 (6%), and 4 (24%) patients, respectively. The sensitivity and specificity of fQRS for detecting abnormal GDE were 100% and 80%, respectively. Sensitivity and specificity of Q waves were 11% and 100%, respectively. Conclusions: fQRS on a 12‐lead ECG in patients with suspected cardiac sarcoidosis are associated with cardiac involvement as detected by GDE on CMR.
Impact of Preceding Ventricular Premature Beats on Heart Rate Turbulence
Authors: Chen Hung Yi 
Published: October 2009

Background: Heart rate turbulence (HRT) has recently been introduced as a noninvasive tool for studying autonomic dysfunction. It presented short time fluctuation of sinus cycle length following single ventricular premature contraction (VPC). However, HRT parameters may be influenced by different factors. This study aimed to evaluate the possible influence of VPC frequency on HRT. Methods: 24‐h Holter recording was performed in patients with VPCs initially detected by 12‐lead electrocardiography (ECG) in the outpatient department. The numbers of VPCs in 2‐ and 5‐minute durations preceding each VPC tachogram were calculated. The HRT parameters and the numbers of the VPCs preceding VPC tachograms were analyzed. Results: There were 23,122 available VPC tachograms from 107 healthy subjects included in the study. The turbulence onset (TO) value increased and the turbulence slope (TS) value decreased as VPC's frequency increased. The TO values rapidly increased when the number of VPCs was >15 beats in the 2‐minute and >35 beats in the 5‐minute durations. There was also a prominent decrease in TS values when the VPCs reached 14 and 30 beats in the 2‐ and 5‐minute durations, respectively. Conclusion: Physiologic baroreflex may be attenuated under intensive stimulation, which is evidenced by blunted HRT parameters by frequent VPCs. Physiologic response to VPC's frequency may be related to baroreflex fatigue and is demonstrated as a sigmoid curve.
Influence of Diabetes and/or Myocardial Infarction on Prevalence of Abnormal T‐Wave Alternans
Authors: Martin David T. , Shoraki Azadeh , Nesto Richard W. , Rutter Martin K. 
Published: October 2009

Background: Subjects with microvolt‐level T‐wave alternans (TWA) in association with structural heart disease have an increased risk for sudden cardiac death. The presence of diabetes (DM) is associated with an increased risk of sudden death but there is limited data on the impact of DM and previous myocardial infarction (MI) on TWA prevalence. Methods: We performed a case‐control cross‐sectional study in 140 patients referred for routine exercise testing within a large multispecialty clinic. All patients with a history of DM and MI status within the past year were eligible: group 1 (no DM or MI), group 2 (DM only), group 3 (MI only), group 4 (DM and MI). Patients performed a symptom‐limited Bruce protocol exercise test with assessment of TWA by the spectral method using commercially available equipment. We used published criteria for the blinded interpretation of TWA; all tests not unequivocally negative were considered abnormal. Results: Age and gender were similar in all groups. The prevalence of abnormal TWA in groups 1–4 was 24%, 20%, 48%, and 62%, respectively (between group P = 0.002). Logistic regression analysis in all patients showed that abnormal TWA was related to prior MI [OR (95% CI): 4.0 (1.8–8.9), P < 0.001] but not to prevalent DM [0.9 (0.4–1.8), P = 0.72]. In patients with DM, the prevalence of abnormal TWA was related to reduced ejection fraction (P = 0.034) but not to BMI, DM duration, glycemic control, insulin use, or the presence of microvascular complications. Conclusion: The presence of DM alone does not increase risk of abnormal TWA. Prospective studies are required to establish the prognostic value of TWA in patients with DM.
Assessment of Physiological Amplitude, Duration, and Magnitude of ECG T‐Wave Alternans
Authors: Burattini Laura , Zareba Wojciech , Burattini Roberto 
Published: October 2009

Background: An association between T‐wave alternans (TWA) and malignant ventricular arrhythmias is generally recognized. Because relatively low levels of TWA have also been observed in healthy (H) subjects, the question arises as to whether these are ascribable to noise and artifacts, or can be given the relevance of a physiological phenomenon characterizing a preclinical condition. Methods: To answer this question, in the present study 20‐minute not noisy, sinus ECG recordings, from 138 H‐subjects and 148 coronary artery diseased (CAD) patients, were submitted to our adaptive match filter (AMF) procedure to identify and parameterize TWA in terms of duration (TWAD), amplitude (TWAA), and magnitude (TWAM, defined as the product of TWAD times TWAA). The 99.5th percentiles of mean values of TWAA, TWAD, and TWAM over 20‐minute ECGs were used to define three threshold levels (THRD, THRA, and THRM), which allow discrimination of abnormal TWA levels. Results: Nonstationary TWA was found in all our H‐subjects and CAD‐patients. TWAD, TWAA, and TWAM levels were classified as being physiological in 99% of H‐subjects and 87% of CAD‐patients. A linear correlation (r =−0.52, P < 0.001) was found between TWAA and RR interval in the H‐population. Conclusions: Our results support the hypothesis of the existence of physiological TWA levels, which are to be considered in the effort to improve reliability of nonphysiological TWA levels discrimination.
Comparison between Contrast‐Enhanced Magnetic Resonance Imaging and Selvester QRS Scoring System in Estimating Changes in Infarct Size between the Acute and Chronic Phases of Myocardial Infarction
Authors: Geerse Daniël A. , Wu Katherine C. , Gorgels Anton P. , Zimmet Jeffrey , Wagner Galen S. , Miller Julie M. 
Published: October 2009

Background: The Selvester QRS score was developed as a method to estimate infarct size (IS) using the ECG and has been validated during the prereperfusion era. Few comparisons exist with contrast‐enhanced magnetic resonance imaging (ceMRI) in reperfused patients. This study evaluates the ability of the Selvester QRS score to estimate serial changes in IS during the acute and chronic phases of the infarct evolution in patients who have received reperfusion therapy. Methods: Thirteen patients with acute myocardial infarction underwent serial ceMRI studies in the acute (<1 week) and chronic phase (>2 months) after their initial myocardial infarction. QRS scoring was performed on the corresponding ECGs. The correlation between ceMRI measurement and QRS score estimation of IS was determined at both time points and for the difference between the two phases. Results: The mean IS was 20.1 ± 11.0% of total left ventricular mass (% LV) in the acute phase and 13.3 ± 6.4% LV in the chronic phase ceMRI. The mean IS estimated by Selvester QRS score in the acute and chronic phases were 18.7 ± 8.2% and 16.4 ± 8.5% LV, respectively. A modest correlation was found for the acute (r = 0.57) and chronic phase IS (r = 0.54). However, there was no correlation for the difference in IS between the acute and chronic phases. Conclusions: In this pilot study, the Selvester QRS score correlates modestly to IS by ceMRI during both the acute and chronic phases of the infarction process. The serial changes over time in the Selvester QRS score and IS by ceMRI show no correlation.
Amygdalae Calcifications Associated with Disease Duration in Lipoid Proteinosis
Authors: Appenzeller Simone , Chaloult Erik , Velho Paulo , Macedo de Souza Elemir , Zanardi Araújo Verônica , Cendes Fernando , Li Li Min 
Published: October 2009

ABSTRACT Objectives. To describe imaging findings of central nervous system involvement in patients with lipoid proteinosis. Methods. Patients with lipoid proteinosis followed in the dermatology and neurology departments of the State University of Campinas between 2002 and 2004 were evaluated using high‐resolution MRI and computerized tomography (CT). Results. We reviewed the charts of three patients (two women) with lipoid proteinosis with, ages ranging from 5 to 44 years. Symptomatic disease duration ranged from 2 to 39 years. MRI scans showed hypointense signal in FLAIR and T2 images in the amygdalae in two of three patients. Brain CT scans from two patients showed that MRI findings were calcifications. The calcification was more evident in patients with longer disease duration. Epilepsy was identified in one patient with longer disease duration. No other epileptogenic lesion was identified on MRI in this patient. Conclusion. Lipoid proteinosis is associated with bilateral amygdalae calcification. These findings were more evident in patients with longer disease duration. Epilepsy, when present, may be related to these calcifications. Patients with lipoid proteinosis should be followed with MRI/CT in order to identify these abnormalities.
Almost Perfect Concordance Between Simultaneous Transcranial Doppler and Transesophageal Echocardiography in the Quantification of Right‐to‐Left Shunts
Authors: Belvís Robert , Leta Ruben Gabriel , Martí‐Fàbregas Joan , Cocho Dolores , Carreras Francesc , Pons‐Lladó Guillem , Martí‐Vilalta Josep Lluis 
Published: October 2009

ABSTRACT Background and Purpose. Transesophageal echocardiography (TEE) and transcranial Doppler (TCD) are the methods of choice to study patent foramen ovale (PFO), but there are discrepancies between the 2 concerning PFO detection. No study has analyzed right‐to‐left shunt (RLS) quantification concordance. The 2 methods are carried out in different hemodynamic states, and the Valsalva maneuver (VM) required in each also differs. The authors compared PFO detection and concordance of RLS quantification classifications performing the 2 studies simultaneously. Methods. The authors prospectively included consecutive stroke patients undergoing TEE and applied the TCD protocol of the Consensus Conference. Echocardiographic PFO was diagnosed when at least 3 microbubbles (MBs) were detected in the left atrium within 3 heartbeats after opacification of the right atrium. RLS quantification was (1) TCD: minimum (1‐10 MBs), moderate (11‐25 MBs), and massive (>25 MBs) and (2) TEE: small (3‐10 MBs), moderate (11‐30 MBs), and large (>30 MBs). Statistics: contingency tables (χ2 and K test). Results. The authors studied 110 patients whose mean age was 56.7 ± 12.1 years, and 60.9% were men. PFO was detected at the first VM in 30% of patients with TCD and in 31.8% with TEE. At the second VM, both methods detected the same patients (32.7%). RLS was minimum (14), moderate (5), and massive (17) in TCD and small (13), moderate (3), and large (20) in TEE. There was an almost perfect concordance in RLS quantification (K = 0.928, P= .001), with only 4 discrepancies. Conclusions. Simultaneous study with TCD and TEE showed an almost perfect concordance in PFO detection and RLS quantification.
Thickening of Multiple Cranial Nerves in a Patient with Extranodal Peripheral T‐cell Lymphoma
Authors: Matano Sadaya , Shirasaki Hiroe , Terahata Shintarou , Nobata Koji , Sugimoto Tatsuho 
Published: October 2009

ABSTRACTA 57‐year‐old male became aware of a subcutaneous tumor in March 2001. Histopathological examination showed peripheral T‐cell lymphoma. He achieved complete remission after chemotherapy. Later the lymphoma relapsed in the subcutaneous lesion and chemotherapy was performed again. In April 2003, he developed diplopia, dysarthria, and dysphagia. Abnormal lymphoid cells were found in the cerebrospinal fluid. An immunophenotypical study disclosed that CD2, CD3, CD5, and CD8 were positive. Rearrangement of TCR was detected by Southern blotting. Cranial magnetic resonance imaging did not detect any intraparenchymal lesions, but thickening of multiple cranial nerves was detected. These nerves were homogenously enhanced by gadolinium‐DTPA. After intrathecal chemotherapy, atypical cells disappeared from the cerebrospinal fluid and thickening of the cranial nerves was resolved. Finally, lymphoma spread to the bone marrow, and the patient died in July 2003.
Neuroform Stent‐Assisted Coil Embolization of a Ruptured A1 Segment Anterior Cerebral Artery Aneurysm
Authors: Gupta Rishi , Horowitz Michael B. , Gilman Steven 
Published: October 2009

ABSTRACTWe report a case of a 71‐year‐old woman who presented with a ruptured wide‐necked proximal anterior cerebral artery (ACA) aneurysm that was successfully embolized using Neuroform stent‐assisted coiling.