bluuebunny/crossref_metadata_2025_split huggingface dataset:
High-intensity interval training in patients with an implantable cardioverter defibrillator: a randomized controlled study
Authors: Nyman M , Mjolstad O C , Dale A C , Amundsen B , Rossvoll O , Wisloff U , Loennechen J P 
Published: November 2023

Abstract

Background
Exercise is an effective treatment in a broad spectrum of cardiovascular diseases. High-intensity interval training (HIIT) has shown superior effect on cardiorespiratory fitness and equal or superior effect on morbidity and quality of life (QoL) compared to moderate continuous exercise training. However, evidence of the efficacy and risks of HIIT in patients with increased risk of ventricular arrhythmia remains limited.

Purpose
To evaluate the effects of HIIT on exercise capacity, QoL and burden of ventricular arrhythmias in patients with an implantable cardioverter defibrillator (ICD) with or without cardiac resynchronization therapy.

Methods
Patients with ischemic or dilated cardiomyopathy and ICD were randomized to a supervised 12-week HIIT program or to a control group continuing their usual exercise routines. HIIT consisted of four 4-minute intervals aiming at 85-95% of maximum heart rate (HRmax), and 3-minute active recovery aiming at 60-70 % of HRmax in between intervals, 3 times a week for 12 weeks. Primary outcomes were exercise capacity measured as peak oxygen uptake (VO2 peak) and QoL assessed with the Short Form 36 (SF-36) questionnaire. Main secondary outcome was the burden of ventricular arrhythmias analysed from remote patient monitoring data.

Results
Fifty-six patients were included (table 1). Three patients in the HIIT group did not complete the intervention. Two withdrew due to a knee injury and due to fear of SARS-CoV-2 exposure, respectively. One experienced an appropriate shock during exercise and was excluded from further training after clinical consideration. Fifty-three patients completed all follow-up examinations. HIIT significantly increased VO2 peak with 7.0 %, with no changes in the control group (p=0.001) (figure 1A). There was a significant increase in the SF-36 subscale scores on physical functioning (p&lt;0.05), general health (p&lt;0.05) and health change (p=0.001) in the HIIT group compared to the control group (figure 1B). There were no significant differences between groups in number of non-sustained or sustained ventricular tachycardias, anti-tachycardia pacing therapy or ICD shocks.

Conclusions
In patients with ICD due to ischemic or dilated cardiomyopathy, a supervised 12-week HIIT-program significantly increased VO2 peak and QoL without increasing the burden of ventricular arrhythmias.Table 1:Patient characteristicsFigure 1:Peak oxygen uptake and QoL
Incidence of sustained ventricular tachyarrhythmias in patients with non-ischemic cardiomyopathy in a multicenter multinational WCD cohort
Authors: Erath J W , Koepsel K K , Kovacs B K , Dreher T D , Blockhaus C B , Grotzmann M G , Klein N K , Hijazi M H , Saguner A S , Kowitz J K , Duru F D , Beiert T B , Aweimer A A , Akin I A , El-Battrawy I B 
Published: November 2023

Abstract

Background
Defibrillator use in patients with non-ischemic cardiomyopathy (NICM) and HFrEF remains controversial after the DANISH study. The new ESC guidelines recommend individualized risk stratification in these patients. The wearable cardioverter-defibrillator (WCD) seems to be appropriate to both protect and screen patients with HFrEF at risk for sudden cardiac death (SCD).
Puropose: To evaluate the rate of ventricular tachyarrhythmias (VT/VF) in NICM vs. ICM patients receiving a WCD for temporary SCD protection.

Methods
1157 patients were included in a multicenter registry from eight European centers. Among these patients, 602 patients received a WCD due to ischemic cardiomyopathy (ICM) and 555 patients for non-ischemic cardiomyopathy (NICM). Incidence of VT/VF and/or appropriate WCD shock discharge during WCD use were evaluated. The mean follow-up (FU) time of the whole cohort was 620.2±607.8 days.

Results
NICM patients were younger (mean 56.5±14.8a vs 63.9±11.6a; p&lt;0.001) and less often male (75% vs. 87.2%; p&lt;0.001) compared to ICM patients. Heart failure medication at hospital discharge did not differ between the two groups except for a higher prescription rate of aldosterone-antagonists in NICM compared to ICM patients (73.8% vs. 66.7%; p=0.02). The index left ventricular ejection fraction (LVEF) was significantly lower in NICM compared to ICM patients (mean 26.1±9.1% versus 29.5±9.2%; p&lt;0.001). A larger extent of LVEF recovery was detected in NICM patients compared to ICM patients up to the end of WCD use (mean LVEF post WCD: 45.7±35.4% vs. 40.2±11.8%; p=0.02). Average daily WCD wear-time was significantly lower in NICM patients compared to ICM patients (mean 20.7±4.9h vs. 21.6±3.7h; p=0.01). NICM patients had a significantly lower incidence of sustained ventricular tachyarrhythmia (VT/VF) compared to ICM patients (3.4% vs. 6.6%; p=0.02). Consistently, rate of appropriate WCD shock was significantly lower in NICM vs. ICM patients (0.7% vs. 3.7%; p&lt; 0.001), as was rate of re-hospitalization (30.2% vs. 46.1%; p&lt;0.001). Both groups showed a similar mortality rate during FU.

Conclusions
Patients at risk for SCD with NICM showed a more pronounced LVEF recovery, significantly lower incidence of VT/VF with concomitant shocks and hospitalization, while overall mortality was unchanged compared to ICM patients. These results indicate that WCD use might facilitate individual SCD risk stratification in NICM patients.
Integration of electro-anatomical maps in the planning phase of stereotactic arrhythmia radioablation for refractory ventricular tachycardia
Authors: Solana Munoz J , Luca A , Herrera-Siklody C , Van Der Ree M H , Postema P , Le Bloa M , Teres C , Porreta A P , Domenichini G , Pascale P , Schiappacasse L , Pruvot E 
Published: November 2023

Abstract

Introduction
Despite the efficacy of stereotactic arrhythmia radioablation (STAR) for the treatment of refractory ventricular tachycardia (VT), the planning phase to precisely delineate the arrhythmogenic substrate still suffers from limitations due to the incompatibility of data formats between 3D electro-anatomical mapping systems (EAM) and STAR planning software (CyberKnife).

Purpose
Within the STOPSTORM European consortium, we present a workflow to integrate all 3D EAM data (e.g. voltage, activation time, anatomical tags) into the STAR planning software using the open source software Slicer3D to improve targeting of the arrhythmogenic substrate.

Method
Two protocols were compared retrospectively.
Protocol 1 (STAR gold-standard) comprised the manual contouring of the clinical target volume (CTV) on planning 4D-CAT SCAN drawn side-by-side using EAM (Carto3, Biosense Webster) screen-shots and diagnostic reports.
Protocol 2 comprised semiautomatic segmentation of CTV on planning 4D-CAT SCAN using imported EAMs annotated with landmarks for VT target delimitation. The semiautomatic segmentation of CTVs included three steps: (1) semiautomatic segmentation of ventricular myocardium (VM), the blood-pool of the concerned ventricle and at least two additional cardiac cavities; (2) 3D alignment of EAM with the segmented cavities; and (3), 3D delineation of CTV identified as the transmural section of VM segment surrounding the EAM’s VT target delimited by the annotated landmarks.
The volume overlap (Dice coefficient) and the absolute difference of the CTVs obtained with the two protocols were compared. Both measurements were expressed in percentage as follows: Dice coefficient 0% means no overlap and 100% complete overlap; absolute difference of volumes 0% means no difference and 100% means that one CTV was twice the size of the CTV generated by the other protocol.

Results
Both protocols were applied to four patients (65.5 ± 8.5 yo) with refractory VT successfully treated with STAR. Figure 1 shows an example (Patient 1) of the CTV contouring using the CARTO EAMs aligned with the CT images in Slicer3D. Figure 2 illustrates significant mismatch between the segmented CTVs of the two protocols. The median volume overlap of the CTVs was 44%, while the median volume absolute difference was 35%. Table 1 reports detailed results.

Conclusion
Our study reveals a high variability of CTV delineation for STAR using two different protocols. The intraprocedural assignment of anatomical landmarks for VT target delimitation on EAM appears promising to improve CTV delineation. Further research is needed to evaluate the correlation between STAR outcome and CTV delineation accuracy.
Risk prediction of inappropriate implantable cardioverter-defibrillator therapy using machine learning
Authors: Tateishi R , Suzuki M , Shimizu M , Shimada H , Tsunoda T , Miyazaki H , Misu Y , Yamakami Y , Yamaguchi M , Kato N , Isshiki A , Kimura S , Fujii H , Nishizaki M , Sasano T 
Published: November 2023

Abstract

Background
Inappropriate shock from implantable cardioverter-defibrillators (ICDs) undermines quality of life and increases all-cause mortality risk. Various predictors of inappropriate ICD shock have also been indicated in previous studies. Nevertheless, no prediction model by machine learning has been reported.

Purpose
We developed ML models for evaluating the risk of inappropriate ICD therapy, and proposed easily calculable risk scoring.

Methods
In total, 182 consecutive cases implanted with ICD were enrolled. The predictive models were based on 16 statistically significant factors out of 189 items including electrocardiogram parameters and clinical features after ICD implantation. Statistical analysis and 14 ensemble learning methods were performed. Shapley additive explanation (SHAP) method was performed to extract important features in the best ML model, and easily calculable score was established from the features.

Results
Twenty-five patients (13.7%) underwent inappropriate therapy. The extra-trees classifier demonstrated the highest area under the receiver operating characteristic curve (AUROC; 0.839). The top six features were history of atrial arrhythmia, ischemic cardiomyopathy (ICM), no diabetes mellitus (DM), cardiac resynchronization therapy (CRT), and V4- and V5 R-wave amplitudes. From the six features, the Cardi45 score was developed (+6.5 points for history of atrial arrhythmia, -2.0 points for ICM, -1.0 points for DM, -0.5 points for CRT, and +0.5 points for V4 T-wave amplitude ≥1200 μV and V5 R-wave amplitude ≥1400 μV). The AUROC for the Cardi45 score was 0.886, which was higher than that of extra-trees classifier.

Conclusion
Our study demonstrates that the ML approach can provide a good prediction model and Cardi45 score was powerful predictors for inappropriate ICD therapy. Cardi45 score, derived from this model, may be used to judge whether an aggressive rhythm control strategy should be implemented or ICD implantation should be avoided in some patients.Picture 1Picture 2
Remote monitoring of cardiac implantable devices in children: characteristics and outcome in a retrospective single centre contemporary study. TelePaedia study
Authors: Jouen R , Delsarte L , Placide L , Favrot C , Di Giacomo G , Massin F , Granier M , Vicenti M , Pasquie J L 
Published: November 2023

Abstract

Introduction
Remote monitoring (RM) has revolutionized implantable cardiac device care in adults. It has demonstrated its safety on hard criteria, a reduction in the number of hospitalizations and emergency room visits, early detection of events and a reduction in inappropriate therapies. However, while pediatric population is becoming emerging, particularly considering congenital heart diseases, there is no contemporary study.

Objective
The aim of our study was to characterize in our cohort of RM patients the population of children (below 18 yo) implanted with a pacemaker or an ICD and under RM for more than 1 year.

Method
The data collection was carried out retrospectively within the cohort of RM patients at our university hospital. The outcome combined occurrence of ventricular (VT)/supraventricular (SVT) arrhythmias, appropriate or inappropriate therapies, lead dysfunction/fracture and ERI.

Results
The study population included 34 patients (17F/17M) with a mean age of 9.4+/-5.8 years (range 0-18 yo) and a mean remote follow-up of 4.6+/-3.9 years (range 1-13 y). The indications for pacing were postoperative atrioventricular block (AVB, n = 9) for operated congenital heart disease or hypertrophic cardiomyopathy (n=1), congenital AVB (n= 5), muscular dystrophy (n = 1) and genetic sinus node dysfunction (n = 1). Indications for an ICD were resuscitated sudden death in hypertrophic cardiomyopathy (n = 4), LQTS (n = 5), CPVT (n = 2), arrhythmogenic right ventricular dysplasia (n = 2), Brugada syndrome (n = 1) and congenital heart disease (n = 2). Pacing devices (n = 17) were mostly implanted with epicardial leads and abdominal box (n = 12). ICDs (n = 18) were implanted in primary (n = 4) or in secondary prevention with epicardial (n = 2)/ endovascular (n=9) /subcutaneous (n = 2) leads depending on children weight and anatomy. One 12 yo-boy had an S-ICD in addition to a previous pacemaker. There were a total of 13 patients with device-triggered alerts: VT in 8 including appropriate therapies in 6 and inappropriate shocks in 2, supraventricular tachycardia in 2, RV lead dysfunction in 2, RV lead fracture in 1 and no alert for ERI. All alerts were treated within 24h.

Conclusion
This is the first report of cardiac device remote monitoring in a pediatric population. In our population 13/34 patients experienced alerts necessitating intervention over a mean 4.6 year-follow-up. Remote monitoring through device-triggered alerts allowed efficient treatment of an arrhythmic event or a lead dysfunction. This is a preliminary study suggesting the need for further studies on a larger population. Remote monitoring should be considered in all eligible-device children and should be considered as standard of care.
Vascular access in cardiac implantable electronic devices: a systematic review and network meta-analysis
Authors: Castagno D , Saglietto A , Peddis M , Falasconi G , Millesimo M , Ferraris F , Anselmino M , Matta M , De Ferrari G M 
Published: November 2023

Abstract

Background
Despite the increasing number of cardiac implantable electronic devices (CIED) implantations worldwide, gaps in the evidence base on the optimal venous access to perform the procedure still exist and direct comparisons of different techniques are lacking.

Purpose
The aim of this study was to compare the acute and long-term safety and efficacy of the three main vascular access modalities (i.e. subclavian vein puncture [SVP], cephalic vein cut-down [CVC], axillary vein puncture [AVP]) used during CIEDs implantations.

Methods
A systematic review of the literature and network meta-analysis were performed searching Pubmed/MEDLINE databases for relevant articles using the following search strategy, without language restrictions: ((cardiac implantable device) OR (pacemaker) OR (ppm) OR (defibrillator) OR (icd) OR (resynchronization) OR (crt)) AND ((venous access) OR (subclavian) OR (axillary) OR (cephalic)). Randomized and non-randomized studies comparing one or more of the outcomes of interest, between at least two discernible groups (SVP, CVC and AVP), were included in the present analysis and SVP competitive arm was used as the reference group. The primary endpoints were safety outcomes, which included: 1) pneumothorax, 2) pocket haematoma, 3) lead failure, including both acute (dislodgment) and chronic (fracture, subclavian crush syndrome) events, 4) infective complications. Success rate, defined either by successful cannulation of the vein or by successful lead placement was a secondary outcome.

Results
Forty studies (33, 83% non-randomized) were selected and a total of 166782 patients (median age 69.2 years, 65.2% males) followed up for a median of 18 months (IQR 11-51) were included. Both AVP and CVC showed a significant reduction in the risk of pneumothorax compared to SVP (AVP: OR 0.12, 95% CI 0.05-0.28; CVC: OR 0.18, 95% CI 0.15-0.22) but no significant differences between treatment arms concerning bleedings (AVP: OR 1.11, 95% CI 0.52; 2.37; CVC OR 1.16, 95% CI 0.60; 1.88) or infective complications (AVP: OR 1.00, 95% CI 0.47- 2.14; CVC OR 0.67, 95% CI 0.31-1.44) were observed. Compared to SVP, AVP was significantly superior concerning the risk of lead failure (OR 0.42, 95% CI 0.27-0.67) while CVC showed a nearly statistically significant reduction in risk of lead complications (OR 0.73, 95% CI 0.52-1.02), see figure 1. Success rate did not differ significantly between treatments arms albeit CVC showed a trend towards a higher risk of need for alternate venous access compared to AVP (3.56, 95% CI 0.89-14.21).

Conclusions
Considering the lower risk of pneumothorax and lead failure, AVP and CVC should be preferred over SVP to achieve venous access during CIEDs implantation taking into account the higher success rates associated with AVP.Figure 1
Thoracic ultrasound versus chest X-ray for early detection of mechanical early complications of cardiac device implantation procedures
Authors: Floris R , Dell'era G , Pimpini L , Ghiglieno C , Fais L M , Cucco A , Faggioni A , Claretti C , Orru F , Demontis M V , Casella M , Dello Russo A , Delogu G , Guerra F 
Published: November 2023

Abstract

Background
In the immediate postoperative of cardiac implantable electronic devices (CIED) implantation, the use of chest radiography (CXR) is the gold standard diagnostic tool for early complications, accompanied by electrical parameters testing for diagnostic of early catheter dislodgement. However, the ability to detect thoracic complications using CXR is limited, and it requires radiation exposure. Thoracic ultrasound (TUS) is an easy and highly appropriate technique to detect thoracic pathologies, although its use in cardiac stimulation is not yet widespread.

Purpose
To compare the diagnostic power of the CXR and TUS alone and in association with electrical parameters testing in detecting early complications after CIED implantation.

Methods
397 patients who underwent CIED implantation or upgrade at four large arrhythmia referral centres were prospectively enrolled from November 1, 2021, to September 30, 2022. Following surgery, all patients underwent CXR and TUS at the bedside and the electrical parameters were tested with the device programmer. The primary endpoint was the rate of mechanical complications, defined as a composite or pneumothorax, haemothorax and pericardial effusion. The secondary endpoint was the composite of mechanical complications + electrical complications (lead macro- and micro-dislodgments).

Results
Total mechanical complications were 21 (5.3%), of which the most common were pneumothorax (3.3%) and pericardial effusion (2%). No cases of hemothorax were observed. The diagnosis of mechanical complication was made by TUS alone in 18 cases (86%), by CXR alone in 2 (9.5%) and in 1 case (4.8%) by both. TUS demonstrated a diagnostic sensitivity for mechanical complications of 90% and for total complications of 87% (associated with electrical control) compared to CXR which had a sensitivity of 20% and 57% respectively. Both methods did not differ in terms of specificity (100%).

Conclusions
In our experience, TUS has a diagnostic power superior to CXR to detect early mechanical complications. Our results suggest TUS may be used as the primary technique in association with standard electrical control to search for postoperative complications after CIED implantation.
Mutual effect modification between insulin-resistance and endothelial dysfunction in predicting incident heart failure in hypertensives
Authors: Toscani A F , Maio R , Sciacqua A , Gigliotti S , Fabiani G , Capomolla A , Perticone F , Perticone M 
Published: November 2023

Abstract
Both type-2 diabetes mellitus and endothelial dysfunction are associated with heart failure (HF); in addition, a strong interplay between endothelial dysfunction and insulin-resistance status that precedes of many years the clinical appearance of type-2 diabetes mellitus, has been well-demonstrated. Thus, the aim of this study was to investigate whether endothelial dysfunction and insulin-resistance are independent predictors of incident HF and if exists a possible interaction between them.
For this study we selected 705 white never-treated hypertensive outpatients free from HF, type-2 diabetes mellitus, chronic kidney disease, previous cardiovascular events and other chronic diseases potentially impacting on HF development. Endothelium-dependent vasodilation was investigated by intra-arterial infusion of acetylcholine, and laboratory determinations were obtained by standard procedures. Insulin-resistance was evaluated by the homeostasis model assessment (HOMA). During the follow-up [median 117 months (range 31–211)], there were 223 new cases of HF (3.3 events/100 patient-years). Stratifying the study population in progressors and non-progressors, we observed that progressors were older and had a higher prevalence of females, baseline glucose, insulin, HOMA, creatinine, and hs-CRP mean values, while estimated glomerular filtration rate and endothelium-dependent vasodilation were lower. In the multiple Cox regression analysis, serum hs-CRP (HR=1.362,(95% CI=1.208-1.536), HOMA (HR=1.293, 95% CI=1.142-1.465), maximal ACh-stimulated FBF (100% of increase, HR=0.807,(95% CI=0.697-0.934) and e-GFR (10 ml/min/1.73m2 increase, HR=0.552, 95% CI=0.483-0.603) maintained an independent association with incident HF. The subsequent analysis demonstrated that HOMA and endothelial dysfunction interact between them in a competitive manner (HR = 6.548, 95% CI = 4.034-10.629), showing also a mutual effect modification. These interaction analyses revealed that, in crude and adjusted models, HOMA significantly modified the effect of acetylcholine-stimulated FBF on incident HF and, given the mutualistic nature of the effect modification, also acetylcholine-stimulated FBF significantly modified the effect of HOMA on HF development.
Our findings demonstrate that both endothelial dysfunction and HOMA are independent and strong predictors of incident HF in hypertensives; we also demonstrated that these two risk factors interact between them with a competitive mechanism.Figure 1Figure 2