bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long‐term seizure outcome of surgery versus no surgery for drug‐resistant partial epilepsy: A review of controlled studies
Authors: Schmidt Dieter , Stavem Knut 
Published: February 2009

SummaryA majority of patients with formerly drug‐resistant temporal lobe epilepsy become seizure‐free after surgery. However, apart from one 12‐month randomized trial, it is unclear how many become seizure‐free because of surgery. To determine the net benefit of surgery, we performed a systematic review and meta‐analysis of the published evidence of how many patients in similar studies become seizure‐free without surgery. Of 155 potentially eligible articles reviewed in full text, 29 (19%) fulfilled eligibility criteria. After excluding 9 publications, 20 studies form the base of evidence. Overall, 719 of 1,621 (44%) of patients with mostly temporal lobe surgery were seizure‐free compared to 139 of 1113 (12%) of nonoperated controls [pooled random effects relative risk (RR) 4.26, 95% confidence interval (CI) 3.03–5.98]. The pooled risk difference in favor of surgery was 42% (95% CI 32–51%). We found no comparative outcome data in patients with extratemporal lobe epilepsy only. The available evidence from mostly nonrandomized observational studies indicates that in appropriately selected patients with drug‐resistant temporal lobe epilepsy, the combination of surgery with medical treatment is 4 times as likely as medical treatment alone to achieve freedom from seizures.
Atypical language lateralization in epilepsy patients
Authors: Möddel Gabriel , Lineweaver Tara , Schuele Stephan U. , Reinholz Julia , Loddenkemper Tobias 
Published: February 2009

SummaryPurpose:  To investigate whether atypical language dominance in epilepsy patients is related to localization and type of lesions.Methods:  Four hundred and forty‐five epilepsy patients received bilateral Wada testing. Language was classified as left (L), right (R), bilateral‐dependent (BD, speech arrest after left and right injections), or bilateral‐independent (BI, no speech arrest after either injection). Groups were compared regarding handedness and magnetic resonance imaging (MRI) lesions. Lesions were classified as “early” (congenital), “late” neocortical (acquired after birth), and hippocampal sclerosis (HS).Results:  Of all patients, 78% were L, 6% R, 7% BD, and 9% BI. Right‐handers with left lesions did not differ from those without lesions. Left‐handers with normal MRI did not differ from right‐handers. Left‐handers with early left lesions were most likely R (46%). Left‐handers with late neocortical left lesions were most likely BD (37%); those with left HS were most likely BD (33%) or L (33%). In both latter groups, R language was rare (13% and 11%, respectively).Discussion:  The data support the notion that R dominance may indicate development of functional language areas in the right hemisphere following an early insult. BD language may signal defective maintenance of right hemispheric language caused by a late left hemispheric insult at a time when left dominance has already started to develop. In contrast, BI language may represent a variant with functional language representation in both hemispheres.
EEG features of absence seizures in idiopathic generalized epilepsy: Impact of syndrome, age, and state
Authors: Sadleir Lynette Grant , Scheffer Ingrid E. , Smith Sherry , Carstensen Bendix , Farrell Kevin , Connolly Mary B. 
Published: February 2009

SummaryPurpose:  Factors influencing the electroencephalography (EEG) features of absence seizures in newly presenting children with idiopathic generalized epilepsy (IGE) have not been rigorously studied. We examined how specific factors such as state, provocation, age, and epilepsy syndrome affect the EEG features of absence seizures.Methods:  Children with untreated absence seizures were studied using video‐EEG recording. The influence of state of arousal, provocation (hyperventilation, photic stimulation), age, and epilepsy syndrome on specific EEG features was analyzed.Results:  Five hundred nine seizures were evaluated in 70 children with the following syndromes: childhood absence epilepsy (CAE) 37, CAE+ photoparoxysmal response (PPR) 10, juvenile absence epilepsy (JAE) 8, juvenile myoclonic epilepsy (JME) 6, and unclassified 9. Polyspikes occurred in all syndromes but were more common in JME. They were brought out by drowsiness and sleep in fragments of generalized spike and wave (GSW). Polyspikes were more likely to occur during photic stimulation, but were not influenced by age independently. GSW was more likely to be disorganized in JME than JAE, and in JAE than CAE. Increasing age and levels of arousal were more likely to result in organized GSW. Factors specific to each child independently influenced EEG features; the nature of these factors has not been identified.Discussion:  The EEG features of absence seizures are influenced by a complex interaction of age, epilepsy syndrome, level of arousal, provoking factors, and other intrinsic factors. Epilepsy syndrome alone cannot predict specific features of GSW; however, JME is more frequently associated with polyspikes and disorganization of the paroxysm.
Electrocardiogram‐Based Algorithm to Predict the Left Ventricular Lead Position in Recipients of Cardiac Resynchronization Systems
Authors: PLOUX SYLVAIN , BORDACHAR PIERRE , DEPLAGNE ANTOINE , MOKRANI BILEL , REUTER SYLVAIN , LABORDERIE JULIEN , GARRIGUE STEPHANE , DELARCHE NICOLAS , JAIS PIERRE , HAISSAGUERRE MICHEL , CLEMENTY JACQUES 
Published: February 2009

Introduction: Biventricular pacing is associated with various electrocardiographic patterns depending on the position of the left ventricular (LV) lead. We aimed to develop an electrocardiogram‐based algorithm to predict the position of the LV lead.
Methods: The algorithm was developed in 100 consecutive recipients of cardiac resynchronization therapy (CRT) systems. QRS axis, morphology, and polarity were analyzed with a view to define the specific electrocardiographic characteristics associated with the various LV lead positions
. The algorithm was prospectively validated in 50 consecutive CRT device recipients.
Results: The first analysis of the algorithm was the QRS morphology in V1. A positive R wave in V1 suggested LV lateral or posterior wall stimulation. A QS pattern was specific of anterior LV leads. In the presence of an R wave in V1, V6 was analyzed to distinguish between an inferior and anterior LV lead. Inferior leads were never associated with a positive V6. To differentiate between lateral and posterior positions, we analyzed the pattern in V2. Lateral leads were associated with an R morphology in V1 and a negative V2. Posterior leads were associated with an R morphology in V1 and V2. The algorithm allowed a reliable distinction between an inferior or anterior and a lateral or posterior lead position in 90% of patients. Inferior, anterior, lateral, and posterior positions were reliably distinguished in 80% of patients.
Conclusion: This algorithm predicted the position of the LV lead with a high sensitivity and predictive value.
Evolution of Cardiac Autonomic Nervous Activity Indices in Patients Presenting with Transient Left Ventricular Apical Ballooning
Authors: ORTAK JASMIN , KHATTAB KERSTIN , BARANTKE MELANIE , WIEGAND UWE K.H. , BÄNSCH DIETMAR , INCE HÜSEYIN , NIENABER CHRISTOPH A. , BONNEMEIER HENDRIK 
Published: February 2009

Backround: Transient left ventricular (LV) apical ballooning (AB) is characterized by a rapidly reversible, acute LV systolic dysfunction, triggered by physical or emotional stress. Despite observations strongly suggesting catecholamine‐mediated myocardial stunning due to enhanced sympathetic activity, the early time course of heart rate variability (HRV) has not been described.
Methods: We prospectively enrolled 39 consecutive patients (median age = 68 years, range 35–85 years, 38 women) with LV AB. Indices of HRV were extracted from 24‐hour ambulatory electrocardiograms on the day of hospital admission, on days 2 and 3, and 3 months after the hospitalization.
Results: Within 48 hours after hospital admission, the indices of HRV were markedly depressed (standard deviation of normal‐to‐normal [NN] intervals [SDNN] 89.6 ± 19.9 ms; mean standard deviation of NN intervals for 5‐minute segments [SDNNi] 37.8 ± 6.2 ms; root mean square of consecutive difference of normal‐to‐normal intervals [rMSSD] 23.0 ± 9 ms; standard deviation of the averages of NN intervals for all 5‐minute segments [SDANN] 70.1 ± 18.0 ms; geometric triangular index [TI] 23.7 ± 5.9 ms), recovered in the subacute phase and had normalized at 3 months follow‐up (SDNN 124.7 ± 24 ms; SDNNi 47.1 ± 5.7 ms; rMSSD 31.1 ± 10.5 ms; SDANN 118.5 ± 27 ms; TI 31.2 ± 8 ms; all P < 0.05). Mean RR‐interval increased from 845 ± 121 ms on day 1, to 929 ± 84 ms at 3 months (P=0.06).
Conclusions: A marked depression of cardiac parasympathetic activity was observed in the acute phase of LV AB, followed by recovery of autonomic modulation between the subacute and the chronic phases. The rapid return of parasympathetic function may partially explain the favorable outcomes of patients presenting with LV AB.
Survival and Appropriate Device Interventions in Recipients of Cardioverter Defibrillators Implanted for the Primary Versus Secondary Prevention of Sudden Cardiac Death
Authors: STOCKBURGER MARTIN , KREBS ALICE , NITARDY AISCHA , HABEDANK DIRK , CELEBI ÖZLEM , KNAUS THOMAS , DIETZ RAINER 
Published: February 2009

Background: Implantable cardioverter‐defibrillators (ICD) implanted after an episode of ventricular tachyarrhythmia (VTA) or in patients at high risk of VTA lower the long‐term mortality. Comparisons of the clinical outcomes of the two indications are scarce.
Methods: The study enrolled 360 consecutive ICD recipients. The device was implanted for secondary prevention in 150 patients, whose mean age was 60 ± 14 years, and mean left ventricular ejection fraction (LVEF) was 40 ± 16%, and for primary prevention in 210 patients, whose mean age was 61 ± 11 years, and mean LVEF was 31 ± 13%. All‐cause mortality and time to first appropriate ICD therapy were measured.
Results: The two study groups were similar with respect to age and prevalence of coronary artery disease. Mean LVEF was higher in the secondary prevention group (P = 0.001). Cox regression analysis revealed a significantly shorter time to first appropriate ICD therapy in the secondary prevention group (HR = 0.51, 95% CI = 0.30 – 0.87, P = 0.01). Over a mean follow‐up of 37 ± 19 months, the all‐cause mortality in the overall population was 12.7%, and was similar in both subgroups (HR = 0.99, 95% CI = 0.55–1.77, P = 0.97).
Conclusions: The long‐term mortality in this unselected population of ICD recipients was low. Patients treated for secondary prevention received earlier appropriate ICD therapy than patients treated for primary prevention. Long‐term mortality was similar in both groups. The higher VT incidence of VTA was effectively treated by the ICD and was not associated with a higher mortality.
Depression of Heart Rate Variability in Patients with Increased Ventricular Wall Stress
Authors: ALTER PETER , RUPP HEINZ , ROMINGER MARGA B. , CZERNY FRIEDERIKE , VOLLRATH ANNA , KLOSE KLAUS J. , MAISCH BERNHARD 
Published: February 2009

Background: Heart failure is characterized by neurohumoral dysfunction that can be assessed by measurement of heart rate variability (HRV). Depression of HRV is related to several hemodynamic parameters. We hypothesized that an increased left ventricular (LV) wall stress is related to a depressed HRV in patients with LV dilatation or dysfunction.
Methods: Cardiac function and mass were measured in 31 patients with LV dilatation or dysfunction and 21 controls using cardiac magnetic resonance (CMR) imaging. LV wall stress was calculated using a CMR‐based thick‐walled sphere model. Standard deviation of normal‐to‐normal (NN) intervals (SDNN) and average NN intervals over 5 minutes (SDANN‐i) were calculated.
Results: LV end‐diastolic (ED) and end‐systolic (ES) wall stress were significantly increased in patients with SDNN < 75 ms (P < 0.05). SDNN and SDANN‐i were decreased (P = 0.001, P < 0.001) in patients with LVED wall stress >8 kPa and LVES wall stress >30 kPa (P < 0.05). To examine potential effects of LVEF, LVED and LVES volume, and wall stress on HRV, a multiple linear regression analysis was performed, which revealed LVED wall stress as the only independent parameter influencing SDNN (P = 0.039). LV ejection fraction, LV mass, and volumes were not significantly related to HRV.
Conclusions: LV wall stress was independently related with depression of HRV. Therefore, LV wall stress might be prognostically important and a therapeutic target in heart failure.
Magnetic Resonance Imaging is Superior to Cardiac Scintigraphy to Identify Nonresponders to Cardiac Resynchronization Therapy
Authors: YOKOKAWA MIKI , TADA HIROSHI , TOYAMA TAKUJI , KOYAMA KEIKO , NAITO SHIGETO , OSHIMA SHIGERU , TANIGUCHI KOICHI 
Published: February 2009

Background: Left ventricular (LV) postero‐lateral scar and total scar burden are factors responsible for a poor response to cardiac resynchronization therapy (CRT). Contrast‐enhanced magnetic resonance imaging (CMR) and 99mTc‐2‐methoxy isobutyl isonitrile single photon emission computed tomography (SPECT) perfusion imaging are widely used to detect myocardial scar tissue; however, their ability to detect regional scars and predict a positive response to CRT has not been fully evaluated.
Methods: CMR and SPECT were performed in 17 patients with dilated cardiomyopathy (DCM) and seven patients with ischemic cardiomyopathy (ICM) before CRT. All images were scored, using a 17‐segment model. To analyze the LV scar regions by CMR, we assessed the transmural delayed enhancement extent as the transmural score in each segment (0 = no scar, 4 = transmural scar). Similarly, a perfusion defect score was assigned to each segment by SPECT (0 = normal uptake, 4 = defect).
Results: By both SPECT and CMR imaging, the total scar score was significantly higher in the ICM than in the DCM group. An LV postero‐lateral wall scar region was detected using both imaging modes. By SPECT imaging, the percentage of regional scar score in the LV inferior wall was significantly higher in the DCM than in the ICM group.
Conclusions: By SPECT imaging in the DCM group, severe perfusion defects, due to attenuation artifacts, were frequently observed in the LV inferior wall, resulting in the overestimation of scar tissue. CMR identified nonresponders to CRT more reliably than SPECT in patients with DCM.
Analysis of 57,148 Transmissions by Remote Monitoring of Implantable Cardioverter Defibrillators
Authors: THEUNS DOMINIC A.M.J. , RIVERO‐AYERZA MAXIMO , KNOPS PAUL , RES JAN C.J. , JORDAENS LUC 
Published: February 2009

Introduction: Remote monitoring of implantable cardioverter defibrillators (ICD) is designed to decrease the number of ambulatory visits and facilitate the early detection of adverse events. We examined the impact of remote monitoring on clinical workload by a comprehensive analysis of transmitted events.
Methods: The study population consisted of 146 recipients of ICD capable of remote monitoring. Data were transmitted daily or in case of pre‐specified events (e.g., arrhythmia, out‐of‐range lead and/or shock impedance). Transmitted events were classified as clinical (disease‐related) or system‐related. Event rates/patient/month were calculated and compared according to events classification and clinical groups.
Results: During a mean follow‐up of 22 ± 16 months, a total of 57,148 remote transmissions were recorded. Of these transmissions, 1009 (1.8%) were triggered by a pre‐specified event, including induced ventricular fibrillation (VF) episodes during defibrillation threshold testing. The median number of events/patient/month was 0.14. Event rates were similar in patients with primary and secondary prevention indications for ICD (0.15 vs. 0.11). After exclusion of the induced VF episodes, 5.6% of transmitted events were classified as system‐related and 94.4% as clinical. The median number of clinical events/patient/month was 0.023. The clinical event‐free rates were 62% and 45%, at 1 and 4 years, respectively.
Conclusion: Remote monitoring of ICD patients is feasible. Despite the large number of data transmissions, remote monitoring imposed a minimal additional burden on the clinical workload. The rate of triggered data transmissions by critical events was, relatively, very low.
Predictive Value of Repeated Versus Single N‐Terminal Pro B‐Type Natriuretic Peptide Measurements Early After‐Myocardial Infarction
Authors: SANDHU SABRINA , HAR BRYAN J. , AGGARWAL SANDEEP G. , KAVANAGH KATHERINE M. , RAMADAN DARLENE , EXNER DEREK V. ,   for the REFINE Investigators
Published: February 2009

Background: A single, markedly elevated B‐type natriuretic peptide (BNP) serum concentration predicts an increased risk of death after myocardial infarction (MI), though its sensitivity and predictive accuracy are low. We compared the predictive value of a modestly and persistently elevated, versus a single, markedly elevated measurement of N terminal pro‐BNP (NT‐BNP) early after MI.
Methods and Results: NT‐BNP was measured 2–4, 6–10, and 14–18 weeks after MI. The median age of the 100 patients was 61 years, median left ventricular ejection fraction (LVEF) was 0.40, and 88% were males. Over a median follow‐up of 39 months, 10 patients died. The initial median NT‐BNP was 802 pg/mL and declined over time (P = 0.002). An initial NT‐BNP ≥2,300 pg/mL (upper quintile) was observed in 19 patients and predicted a 3.4‐fold higher independent risk of death (P = 0.05), with modest sensitivity (30%) and positive predictive accuracy (16%). A NT‐BNP consistently ≥1,200 pg/mL (upper tertile) was observed in 19 patients, and was associated with a 5.7‐fold higher independent risk of death (P = 0.01), with a higher sensitivity (50%) and positive predictive accuracy (26%) than a single, markedly elevated NT‐BNP measurement.
Conclusions: A moderately and persistently elevated NT‐BNP in the early post‐MI period was associated with a 5.7‐fold higher risk of death, independent of age, LVEF, and functional class. Compared with a single measurement, serial NT‐BNP measurements early after MI were more accurate predictors of risk of death.
Effects of Cardiac Resynchronization Therapy on Heart Rate Turbulence
Authors: SREDNIAWA BEATA , LENARCZYK RADOSLAW , MUSIALIK‐LYDKA AGATA , KOWALSKI OSKAR , KOWALCZYK JACEK , CEBULA SYLWIA , SLIWINSKA ANNA , SZULIK MARIOLA , KALARUS ZBIGNIEW 
Published: February 2009

Background: Cardiac resynchronization therapy (CRT) improves the clinical status of patients with heart failure (HF), though its effects on heart rate turbulence (HRT) are unknown.
Methods: We measured HRT indices in 58 recipients of CRT systems (mean age = 56 ± 9 years, 41 men) in New York Heart Association HF functional class III–IV, and with a left ventricular (LV) ejection fraction ≤35%. At 6 months of follow‐up, 42 patients were responders and 13 nonresponders to CRT, and three patients died suddenly. The HRT indices turbulence onset (TO%) and turbulence slope (TS ms/RR interval) were calculated from digital 24‐hour electrocardiogram before and after 6 months of CRT. TO ≥ 0% and TS ≤ 2.5 ms/RR interval were considered abnormal.
Results: Mean TO in the entire population was 0.4 ± 1.5 before CRT, and decreased to −0.8 ± 7.0 during the 6 months of CRT (ns). TS increased significantly from 2.0 ± 1.7 at baseline, to 3.9 ± 3.1 (P < 0.05), and a significantly lower proportion of patients had abnormal HRT indices at 6 months. In contrast to the significant increase observed in responders, not significant change in TS was observed among the nonresponders.
Conclusions: During 6 months of CRT, improvements in HRT indices and a decrease in the proportion of patients with abnormal HRT were observed. CRT may have beneficial effects on baroreflex sensitivity.
Timing of the Left Ventricular Electrogram and Acute Hemodynamic Changes During Implant of Cardiac Resynchronization Therapy Devices
Authors: VAN GELDER BERRY M. , MEIJER ALBERT , BRACKE FRANK A. 
Published: February 2009

Study Objective: To examine the relationship between timing of the left ventricular (LV) electrogram (EGM) and its acute hemodynamic effect on instantaneous change in LV pressure (LVdP/dtMAX).
Patients and Methods: In 30 patients (mean = age 67 ± 7.9 years) who underwent implant of cardiac resynchronization therapy systems, the right ventricular (RV) lead was implanted at the RV apex (n = 23) or RV septum (n = 7). The LV lead was placed in a posterior (n = 14) or posterolateral (n = 16) coronary sinus tributary. QRS duration, interval from Q wave to intrinsic deflection of the LV EGM (Q‐LV), and interval between intrinsic deflection of RV EGM and LV EGM (RV‐LV interval) were measured. The measurements were correlated with the hemodynamic effects of optimized biventricular (BiV) stimulation, using the Pearson correlation coefficient.
Results: The mean LVdP/dtMAX at baseline was 734 ± 180 mmHg/s, and increased to 905 ± 165 mmHg/s during simultaneous BiV pacing, and to 933 ± 172 mmHg/s after V‐V interval optimization. The Pearson correlation coefficient R between QRS duration, the Q‐LV interval, and the RV‐LV interval at the respective LVdP/dtMAX was 0.291 (P = 0.66), 0.348 (P = 0.030), and 0.340 (P = 0.033).
Conclusions: Similar significant correlations were observed between the acute hemodynamic effect of optimized BiV stimulation and the Q‐LV and the RV‐LV intervals. However, individual measurements showed an 80‐ms cut‐off for the Q‐LV interval, beyond which the increase in LVdP/dtMAX was <10%..
U22, a Protocol to Quantify Symptoms Associated with Supraventricular Tachycardia
Authors: KESEK MILOS , TOLLEFSEN TITTI , HÖGLUND NIKLAS , RÖNN FOLKE , NÄSLUND ULF , JENSEN STEEN M. 
Published: February 2009

Background: The main indication for ablation of supraventricular tachyarrhythmias (SVTA) is symptomatic relief. Specific paroxysmal symptoms cannot be quantified with general measures of quality of life, such as with the SF‐36 questionnaire. U22 is a new protocol which measures the effects of arrhythmia on well‐being, the intensity of discomfort during an episode, the type and temporal characteristics of dominant symptoms, and the duration and frequency of episodes. Discrete 0–10 scales are used. Unlike SF‐36, U22 can be used in individual patients.
Methods: U22 and SF‐36 protocols were used in the symptomatic evaluation of 88 patients (mean age = 49.6 ± 16.4 years; 43 men), who underwent catheter ablation of SVTA.
Results: The U22 scores (SD) for (a) well‐being (10 being best), (b) effects of arrhythmia on well‐being (10 being worst), and (c) discomfort during arrhythmia (10 being worst) were 5.6 (2.7), 7.5 (2.8), and 8.0 (2.4), respectively. For comparison, the physical and mental component summaries of SF‐36 were 45.3 (11.0) and 45.2 (12.1), respectively, slightly lower than the expected normal of 50. The intensity of dominant symptom scored by U22 was 9.7 (1.2), 10 being worst. In 29% of patients ≥4 symptoms were equally dominant. Multiple dominant symptoms in U22 were associated with a low general well‐being in SF‐36.
Conclusion: We found U22 useful to quantify symptoms associated with SVTA.