bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of right ventricular lead position on the outcomes of transvenous lead extraction
Authors: Miklos M , Zsigmond E J , Benak A , Makai A , Saghy L , Vamos M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Transvenous lead extraction of apically positioned right ventricular (RV) leads could be more challenging compared to septal leads, however there is no scientific evidence regarding this issue. The aim of this study was to evaluate the impact of the RV lead position on extraction outcomes.

Methods
Data from consecutive patients undergoing transvenous lead extraction between 2014 and 2022 were retrospectively analysed. Extracted RV leads were divided into apical and non-apical groups, according to the preoperative chest X-ray images. Complete success rate of lead extraction was compared between the two groups.

Results
A total of 197 patients (mean age 65±14 years, 73,6% male, mean EF 50%) underwent transvenous lead extraction of 408 leads due to pocket infection (n=132, 67%), endocarditis (n=40, 20%), or non-infectious indications (n=25, 13%). 218/408 (53%) leads were right ventricular, of which 142 (65%) were extracted from an apical and 42 (19%) from a non-apical position, respectively. 34 cases (16%) with RV leads in both locations or RV leads previously pulled back from the right ventricle were excluded. There was no significant difference in the ratio of ICD leads or dual-coils between the two groups, however apical electrodes were older and had more frequently passive fixation compared to non-apical RV leads. Locking stylets, powered sheaths or snare technique were used in 88%, 82% and 30%, respectively, without any significant difference between the two groups.
The complete success rate of lead extraction was higher in the non-apical group compared to apical leads (97,7% vs. 83,2%) (Odds Ratio (OR) 0,12; 95% CI 0,16-0,92; p=0,04). After adjustment for typical risk factors of extraction failure (i.e. age of leads, ICD leads, dual-coils, passive fixation) the difference become non-significant (adjusted OR 0,24; 95% CI 0,03-2,08; p=0,19).

Conclusion
In this single-centre, high-risk patient cohort we found better success rate of RV lead extraction from non-apical positions compared to apical leads, without statistically significant difference on multivariate analysis. Our results are hypothesis generating, and call for further research evaluating the impact of the RV lead position on extraction outcomes with larger patient populations.
Complicated pocket infection in patients undergoing lead extraction - a new entity?
Authors: Milman A , Wieder-Finesod A , Zahavi G , Meitus A , Kariv S , Shafir Y , Glikson M , Luria D , Beinart R , Yahav D , Nof E 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Cardiac implantable electronic device (CIED) infection can present with either pocket or systemic manifestations, both necessitating complete device removal and pathogen-directed antimicrobial therapy. However, some may present with both pocket and systemic infection. We aim to characterize those with complicated pocket infection.

Methods
A retrospective analysis of all CIED extraction procedures at our medical center from 07/2010 to 12/2018 was performed. Patients were divided to simple pocket infection, complicated pocket infection and systemic infection groups.

Results
A total of 300 patients were included; 104 (34.7%) had a simple pocket infection, 142 (47.3%) had a systemic infection alone and 54 (18%) presented with a complicated pocket infection. Most were males, with a similar mean age at time of extraction. No differences in comorbidities were observed, except for higher prevalence of diabetes (54.2%) in the systemic infection group (p=0.002).
Patients with a systemic and complicated pocket infection presented more frequently with leukocytosis and fever &gt; 37.8, as opposed to the simple pocket infection group. Staph Aureus was the most common pathogen in the systemic and complicated pocket infection groups (43.7% and 31.5% respectively) while CONS predominated (31.7%) for the simple pocket infection group (10.6%, p&lt;0.001). No differences were observed in procedural success rates or complications of the extraction procedure.
Kaplan Meier survival analysis showed that at 3 years of follow-up the rate of all-cause mortality was significantly higher among patients with systemic infection compared to both pocket infection groups which were similar (p&lt;0.001), with the curves diverging at 30 days. Multivariate analysis demonstrated high creatinine and lower albumin were predictors of 30 days and 1 year mortality while age and the presence of atrial fibrillation were predictors of 1 year mortality only.

Conclusions
We characterize a new entity of a complicated pocket infection. Albeit the similarity to the systemic infection group regarding clinical manifestation, those with complicated pocket infection carry a better prognosis than those with systemic infection alone.
Appropriate therapy for implantable cardioverter defibrillators used as primary versus secondary prophylaxis
Authors: Thuraiaiyah J , Jensen A S , Philbert B T , Sondergaard L , Jons C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Implantable cardioverter defibrillators (ICD) are used for primary prevention in children highly suspicious of life-threatening arrhythmias due to family history and malignant syncope. This practice might potentially result in a lower incidence of appropriate therapy compared with ICDs implanted for secondary prevention following documented ventricular arrhythmias.

Purpose
We aimed to compare the rate of appropriate therapy after ICD implantation for primary versus secondary prevention in young children.

Method
Using national ICD registry, this retrospective nationawide cohort study included children aged ≤15 years who received their first ICD between 1988 and 2020. Patient characteristics, medical history including mortality, device indication, therapy and complications were retrieved from electronic medical files. The primary endpoint was time to appropriate therapy, defined as shock or anti-tachycardia pacing for ventricular tachycardia or fibrillation.

Results
During the study period, a total of 81 ICDs (39 ICDs pr. million live births) were implanted. Among these, 79 were included in the outcome analysis due to retrievable follow-up data. At baseline, the majority had channelopathies (44%) or structural heart diseases (42%), whereas 25 (32%) and 54 (68%) devices were implanted as primary and secondary prophylaxis, respectively. The median age at primary implantation was 13.9 and 11.6 years (p&lt;0.05), respectively. During a median follow-up of 9.0 (IQR: 4.8–13.9) years, 44 patients experienced appropriate device therapy and 6 died, with no difference for primary and secondary prevention recipients (p=0.34 and p=0.83). The 10-year cumulative incidence of appropriate therapy was 56% for primary prevention recipients and 68% for secondary prevention recipients, whereas 10-year survival probability was 90% (95% CI: 76-100%) and 81 % (95% CI: 63%-99%), respectively. All deaths were of cardiovascular cause. Bleeding occurred in 0 versus 2, infection in 5 versus 4, and inappropriate shock therapy in 2 versus 11 patients, with an overall combined trend towards more events for ICDs implanted as secondary prophylaxis (p=0.08).

Conclusions
ICD implantation in young children was relatively rare. The rate of appropriate therapy was similar among primary and secondary ICD recipients, indicating too restrictive primary prophylaxis implantation, which should be investigated in future studies. The incidence of complications was highest among secondary ICD recipients.
PCSK9 inhibitors and incidence of arrhythmias in clinical practice: a phase IV multicentric study
Authors: Stronati G , Parente E , Nazziconi M , Brugiatelli L , Bastianoni G , Rago A , Comune A , Sfredda S , Costamagna M , Gironella P , Maurizi K , Finori L , Dello Russo A , Russo V , Guerra F 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
PCSK9 inhibitors (PCSK9i) are a novel drug class indicated for the treatment of dyslipidaemia. PCSK9i have been shown to remarkably reduce cardiovascular events in patients at high risk, but little data is currently available regarding the incidence of atrial fibrillation, no reports exist on ventricular events or other cardiac arrhythmias, and is not documented if this drug class is safe regarding arrhythmias as a potential side effect.

Purpose
To study the incidence of arrhythmias in patients before and after treatment with PCSK9i.

Methods
All consecutive patients starting treatment with PCSK9 inhibitors, either evolocumab or alirocumab, were consecutively enrolled in two high-volume Italian arrhythmia centres. All patients were treated according to ESC guidelines for primary and secondary prevention. All patients failed to achieve the recommended LDL goals with standard treatment before the introduction of PCSK9i. Patients with familial hypercholesterolemia were excluded. All arrhythmic endpoints were collected in a one-year time frame before and after the first dose of PCSK9i.

Results
191 patients were enrolled (mean age 63±15 years, 76.6% males) and followed up for one year. 13.2% were labelled as "statin-intolerant" and were treated only with ezetimibe, all the others had PCSK9i prescription on top of both statin and ezetimibe. The recommended LDL threshold was reached in 45.1% of patients at very high-risk and 76.7% at high-risk. 14.9% of all patients had a history of PACs and 15.6% had a history of PVCs. 7.8% had a previous diagnosis of atrial fibrillation, 2.1% of TRNAV and 6.4% of sustained ventricular arrhythmias. These 6.4% all had an ICD implanted for secondary prevention, while another 0.9% had a primary prevention indication. The total number of PACs in 24 hours decreased from 1260 to 800, although the difference was not statistically significant (p=0.058). Similar results were noted for PVCs (from 271 to 195 in 24 hours; p=0.089). The one-year incidence was 6.1% for atrial fibrillation, 2.3% for TRNAV and 3.8% for sustained ventricular arrhythmias, with no difference between the year before (all p=NS). Of all patients with an ICD and a history of appropriate ICD therapies (n=11, 5.7%) only one experienced appropriate therapies in the year after PCSK9i started.

Conclusions
The treatment with PCSK9 inhibitors does not significantly modify the risk of supraventricular or ventricular arrhythmias in patients with non-familial hypercholesterolemia. Preliminary data support the safety of this class of drug also regarding arrhythmic events.
Sudden death in sports. 2018-2020. Argentine Registry
Authors: Gant Lopez J , Cueto A F , Peidro R M , Colque F , Fitz Maurice M D , Cilio M , Sansalone R A , Speranza R , Meiller F , Guillen R H , Medesani L A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The prevalence of Sudden Death in Sports (SDS) is low in relation to other forms of death in the general population. There is little current data about this problem in Argentina.

Objectives
Obtain information about the characteristics of these events in order to recommend effective prevention measures.

Methods
A specific mailbox was created to receive SDS case reports. The study was presented in academic, health and social media institutions. The information received was analyzed and investigated with direct contact with professionals or people related to the event.

Results
From January 2018 to February 2020, 26 months, 35 cases of SDS were surveyed. 89% of the male sex pts, 68% over 35 years. SDS occurred mainly in: Football, 11 pts, Gymnastics, 10 pts and marathon 9 pts. 68% of the athletes were amateurs and 52% during high performance practices. Assistance received: 29 athletes received assistance, 19 pts Basic Cardiopulmonary Resuscitation (CPR) and 10 pts advanced CPR with automatic or manual defibrillation in 9 cases. Of the 21 pts that were transferred, 9 pts entered and 8 exited alive. The survival rate was 23% and all graduated in functional class I. A forensic autopsy was performed in only 8 cases. Associated pathologies: 8 pts with coronary heart disease, 7 pts dilated cardiomyopathy, 3 pts, unspecified heart disease, 1 pt with toxic medication, 1 pt died from commotio cordis and 15 pts without diagnosis.

Conclusions
The number of reported cases of SDS was low, with an approximate incidence of 0.25% / 100,000.hab / year, 1 to 2 cases per month. SDS episodes occurred mainly in football, gymnasia and marathon, with an adequate level of on-site assistance and greater use of defibrillation therapy compared to previous reports. High mortality persists (77%). The use of autopsy is low showing cardiomyopathy or unknown origin in young people and coronary disease in adults
Atrial fibrillation detection using the ECG signal in the left in ear region: validation study on patients electively admitted for DC cardioversion
Authors: De Lucia R , Parollo M , Barletta V , Di Cori A , Segreti L , Viani S , Canu A , Mazzocchetti L , Zucchelli G 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.
Early detection of atrial fibrillation is a major opportunity for mobile health, as portable devices nowadays available can detect multiple-lead electrocardiogram (ECG). The study aims to validate the in-ear region as a new anatomical site for ECG signal detection in patients (pts) affected by atrial fibrillation (AF).

Methods
We performed the ECG using KardiaMobile 6L device on 40 patients affected by AF and admitted to our hospital for elective electrical cardioversion. All the digital ECGs were detected in a modified modality or using the left in-ear region instead of the right hand. All the recorded ECGs were analyzed by the device and the results checked by two cardiologists.

Results
We successfully collected all 40 modified digital ECGs performed on the group of 40 pts: age 69.4 ± 9.4 years; male 28 (70)%; medium HR 95±25.4bpm; 26 (65%) affected by hypertension; 2 (5%) affected by diabetes mellitus; 37 (92,5%) in NOACs. In all cases, the KardiaMobile 6L automatic diagnosis of the ECG detected by this modified modality was correct in 100% of cases.

Conclusion
The in-ear region could be a reliable novel anatomical site for ECG signal detection in patients affected by atrial fibrillation. These data could support the development of new portable mobile ECG devices using the left in ear region and so leaving at least one hand free.
Deep learning to diagnose left ventricular hypertrophy from standard, 12-lead ECG signals: a proof-of-concept study
Authors: Pantelidis P , Oikonomou E , Souvaliotis N , Spartalis M , Lampsas S , Bampa M , Bakogiannis C , Antonopoulos A , Siasos G , Vavuranakis M , Papapetrou P 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Although several sets of voltage and non-voltage criteria have been employed to detect left ventricular hypertrophy (LVH) in 12-lead electrocardiogram (ECG) signals, their accuracy has been proven suboptimal, while their use is limited by the lack of expertise of most non-specialised caregivers. Deep learning (DL) can be employed as an integrated, automated solution, yielding high predictive power for this task.

Purpose
To train a DL model to diagnose LVH from 12-lead ECG signals and evaluate its diagnostic performance.

Methods
A total of 21,837 previously annotated ECG samples were retrieved from the PTB-XL database. Of them, 2,137 (9.8%) had a diagnosis of LVH, while the remaining 90.2% presented with other abnormalities, including non-specific ST changes and conduction disturbances. After applying discrete wavelet transformation to denoise signals (remove the baseline drift and fine noise), we applied a dedicated convolutional, time-series-dedicated neural network (InceptionTime), which we trained on 90% of the data. We reserved the remaining 10% of "unseen" samples for testing its performance and quantifying its recall (sensitivity), precision, F1-score (harmonic mean of recall and precision) and area under the curve (AUC). We employed k-fold cross-validation and repeated the same procedure 10 times, to obtain distributions for each metric score.

Results
The 10 training/testing iterations yielded a median recall of 0.78 (interquartile range, IQR: 0.70-0.91) and a median precision of 0.78 (IQR: 0.75-0.87), indicating the predictive power of the model to both correctly detect LVH when it exists and also not falsely overdiagnose it, missing less than 1 out of 4 cases, in both scenarios. The obtained F1-score was 0.8 (IQR: 0.76-0.83) and the median AUC was 0.86 (IQR: 0.83-0.91).

Conclusions
Although a proof-of-concept study, this attempt demonstrates the potential of DL approaches to accurately detect heart abnormalities, such as LVH, from standard ECG recordings. Such strategies can not only support non-specialist physicians in picking diagnoses hidden "in plain sight", but they can also offer high diagnostic performance, given that attempts are made to optimize them. Toward this direction, our concept work shows that even a simple DL approach, without rigorous optimization, can display high predictive power, misdiagnosing less than 22% of the cases, paving the way for the improvement of such techniques and their integration in clinical practice.
Improved patient selection for primary prevention ICD implantation by predicting ICD non-benefit using artificial intelligence
Authors: Kolk M Z H , Ruiperez-Campillo S , Deb B , Bekkers E J , De Vos B D , Van Der Lingen A C J , Allaart C P , Isgum I , Rogers A J , Clopton P , Wilde A A M , Knops R E , Narayan S M , Tjong F V Y 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NWO Rubicon (452019308)
Amsterdam Cardiovascular Sciences

Background
Left Ventricular Ejection Fraction (LVEF) is suboptimal as a sole marker for predicting sudden cardiac death (SCD) or benefit from an ICD. Machine (ML) and deep (DL) learning provide new opportunities for personalised predictions using complex, multi-modal physiological data.

Objective
We hypothesise that risk stratification for ICD implantation can be improved by ML and DL models that combine clinical variables with time series features from 12-lead electrocardiograms (ECG).

Methods
We present a multicentre study of 1010 patients with an ischaemic, dilated or non-ischaemic cardiomyopathy and LVEF≤35% implanted with an ICD between 2007 and 2021 for primary prevention of SCD (64.9 ±10.8 years, 73.2% male) in two academic hospitals. For each patient, raw 12-lead, 10-second ECG-recordings obtained &lt;90 days before ICD implantation and clinical details were collected. Supervised ML and DL models were trained and validated using stratified k-fold cross-validation (5 repeats, k=10) on a development cohort (n=550) from Hospital A. We used this model to predict ICD non-benefit defined as mortality without prior appropriate ICD-therapy on an external dataset from Hospital B (n=460). Kaplan-Meier survival analysis stratified by high vs. low predicted probability using Youden's J statistic as cut-off was performed.

Results
At 3-year follow-up, 16.0% of patients had died of whom 72.8% met the criteria for ICD non-benefit. Extreme gradient boosting models identified subjects with ICD non-benefit with an area under the receiver operator curve (AUROC) of 0.897 ±0.05 during internal validation (Figure 1, solid line). In the external cohort, the AUROC was 0.793 (95% CI 0.75-0.84) (Figure 1, dashed line). Survival analysis for low vs. high predicted risk indicated ICD non-benefit rates of 6.0% versus 30.3% at 3-year follow-up, respectively (Figure 2).

Conclusion
A ML model that combined clinical with ECG features better predicted ICD non-benefit at 3-years in a primary prevention population than currently available risk scores such as the MADIT-ICD score. This approach may provide new tools to support personalized decision making for ICD therapy. Prospective validation is needed to assess the real-world clinical performance of the model.
The European TeleCheck-AF project on remote app-based management of atrial fibrillation: ablation outpatient clinic experience
Authors: Hermans A N L , Gawalko M , Verhaert D V M , Duncker D , Manninger M , Scherr D , Sultan A , Steven D , Lodzinski P , Gupta D , Vernooy K , Sohaib A , Pluymaekers N A H A , Hendriks J M , Linz D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
TeleCheck-AF is a multicentre international project initiated to implement remote care delivery for patients with atrial fibrillation (AF) through teleconsultations supported by an on-demand photoplethysmography (PPG)-based heart rate/rhythm monitoring app.

Purpose
The current sub-study of the TeleCheck-AF project aimed to provide the first real-world dataset on feasibility and patient experience of this standardized mobile health (mHealth) infrastructure in the clinical setting of follow-up after catheter ablation.

Methods
This sub-study included consecutive patients in each centre who have undergone catheter ablation. In the post-ablation period, at the 3-, 6- or 12-month visit, patients were provided with the app and were instructed to perform 60-second heart rate/rhythm recordings three times daily and in case of symptoms for seven consecutive days prior to teleconsultation. Recurrences of AF were documented by PPG-based app (FibriCheck®). Motivation was defined as number of days in which the expected number of measurements (≥three/day) were performed per number of days over the entire prescription period. Adherence was defined as number of performed measurements per number of expected measurements over the entire prescription period. Patients’ experience was based on a survey sent to each patient via e-mail.

Results
Data from 588 patients (median age 63 [56-70] years, 39% female) from eight centres from six European countries were analysed. Patients with both optimal motivation (100%) and adherence (≥100%) constituted 158 (29%) of the study population and had more often previously undergone an ablation for AF (77% vs 62%), P=0.005) and had a higher number of AF PPG recordings (mean 1.9 vs 0.8, P=0.017). The app gave patients a safe feeling (70%) and automated reminders were useful (68%). Patients agreed that the app was easy to use (97%), easy to install (89%) and that they would like to use the app in the future (70%).
In 95 (16%) patients, AF was detected by the app. There was no statistically significant difference between patients with (vs without) app-based detected AF, except a higher prevalence of prescribed three or more cardiovascular drugs (65% vs 53%, P=0.032) and beta-blockers (64% vs 52%, P=0.033). Patients with (vs without) app-based detected AF had higher optimal adherence (66% vs 41%, P&lt;0.001).

Conclusion
The TeleCheck-AF approach is feasible and associated with high adherence as well as motivation to use the app and with optimal patient experience. Whether this approach can replace conventional rhythm follow-up after catheter ablation required further study.