bluuebunny/crossref_metadata_2025_split huggingface dataset:
High success and safety of transvenous lead extraction using excimer laser sheaths in more than 1700 patients: a meta-analysis
Authors: Rinaldi C A , Biffi M , Diemberger I , Defaye P , Sizto E , Gao Y R , Epstein L M , Carrillo R 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Philips

Background
The excimer laser sheath is a commonly used advanced transvenous lead extraction (TLE) tool to aid the successful extraction of indwelling cardiac leads by ablating the tissues adhering to the leads. Many studies have reported favorable safety and efficacy results with leaser sheath assisted TLE in small patient groups. However, to date, there are no comprehensive large-scale studies using contemporary data to analyze the outcomes of excimer laser sheaths assisted TLE.

Purpose
To assess the performance and safety of excimer laser sheath assisted TLE using meta-analysis of contemporary data.

Methods
A systematic literature search was performed to identify articles relevant for the evaluation of the safety and performance of the SLS II and GlideLight excimer laser sheaths in TLE procedures from April 1, 2016 to March 31, 2021. Safety outcomes included procedure-related deaths and major and minor complications. Performance outcomes included procedural success and clinical success rates achieved in TLE procedures as defined by 2017 HRS and 2018 EHRA consensus guidelines. A random-effects, inverse-variance-weighting meta-analysis using arsine square root transformation was performed to obtain the weighted average of evaluated outcomes.

Results
A total of 17 articles were identified and included for evaluation and data extraction, among which 6 were prospective studies and 11 were retrospective studies. The evaluated studies included 1,729 patients with 2,887 leads, among which 311 leads were extracted with the SLS II device, 1,688 were extracted using GlideLight, and the rest (n=888) involved both devices. Overall, 38.5% of leads were extracted due to infection. The most common lead type targeted for extraction were ICDs (47.9%). On average, each patient had 2.3 ± 0.3 leads and the lead dwell time was 7.9 ± 3.0 years. The TLE procedure successes rate per patient was 96.8% (1,440/1,505; 95% CI: [94.9%-98.2%]) and per lead 96.6% (1,447/1,501; 95% CI: [95.1%-97.7%]). The clinical success rate per patient was 98.3% (989/1,010, 95% CI: [97.4%-99.0%]). The weighted average of the procedure-related death rate was 0.08% (7/1,729, 95% CI: [0.00%, 0.34%]), comparable to the mortality rate reported in other studies on lead extraction safety. The most common complications were pericardial effusion or tamponade (n=21), hematoma (n=20) and cardiovascular injuries (n=18).

Conclusion
TLE utilizing the excimer laser sheath has high success and low mortality rates and provides physicians with a valuable tool for safe and effective extraction of indwelling cardiac leads that require advanced extraction techniques.
Gradually increasing impedance in patients with pacemakers and implantable defibrillators: a watchful waiting strategy
Authors: Maass A , Klingenberg M , Groenveld H F , Mulder B A , Blaauw Y , Rienstra M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): hospital resources

Introduction
Pacing impedance measurements are important in the surveillance of pacemaker and implantable cardioverter/defibrillator (ICD) devices. Whereas sudden changes in impedances can reflect lead fracture or isolation defects, gradually increasing impedances are thought to occur because of calcifications at the endomyocardial interface. In many cases, these leads are replaced prophylactically but this has not been studied systematically.

Purpose
We aimed to identify the outcome of right ventricular (RV) electrodes with high impedances that were left active in this single center study.

Methods
All patients in the electronic patient database were screened for impedances &gt;1200Ohms. 41,201 individual recordings led to 219 individual patients. 161 patients were excluded from the analysis due to sudden impedance increase, temporarily high impedances or wrong entry. Of the remaining 58 patients, baseline characteristics as well as pacing impedance, sensing values, pacing thresholds, and shock impedance in case of ICDs were recorded.

Results
There were 17 pacemaker and 41 ICD patients, 68±15 years old, 69% were male. Glomerular filtration rate at baseline was 81±22 ml/min/1.73m2. Baseline RV impedance was 597±123Ohms. During follow-up impedances increased to 1875±682Ohms (p&lt;0,001). Pacing thresholds increased from 0,6±0,4V to 3,0±1,9V (p&lt;0,001). Sensing remained stable. The median time from implant to impedance rise &gt;1000Ohms was 5,5 (3,4-7)years and median follow-up thereafter 3,8 years (1,6-6,6). During follow-up, no intervention was performed for 45 leads (78%). No events occurred. 13 leads (22%) were replaced , 9 prophylactically (mostly because of ICD advisory leads), 3 because of high pacing thresholds and high percentage pacing and one lead because of noise oversensing, probably unrelated as it occurred 7 years after impedance increase.

Conclusions
A watchful waiting strategy appears to be a safe option for patients with ICDs and pacemakers with low percentage pacing. As impedance increase cannot be used for surveillance for imminent lead fracture, other means such as short interval counts and non-sustained oversensing have to be employed and should be combined with remote monitoring.
Transvenous vs. subcutaneous ICDs after transvenous device complication
Authors: Willy K , Frommeyer G , Wolfes J , Ellermann C , Wegner F K , Rath B , Koebe J , Reinke F , Eckardt L 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Boston Scientific

Background
During long-term follow-up of patients with implantable cardioverter defibrillators (ICD) numerous problems may occur. Apart from lead failure cardiac device related infectious endocarditis poses a serious threat to the patient. To date, there is no data on the question whether a re-implantation of a transvenous ICD (tv-ICD) or the implantation of a subcutaneous ICD (S-ICD) might be the better choice.

Methods and Results
The present study represents a single-center experience of matched patients with a complication of tv-ICDs which had to be revised. The patient either received a tv- or an S-ICD thereafter. 103 patients (53 patients in each group) were included, follow-up duration was about 3 years in both groups. Patients from the tv-ICD group were slightly older (58 vs 52 years). Infections as well as oversensing were equally responsible for revision in both groups (infection: tv 49%, S-ICD 45%, oversensing: tv 51%, S-ICD 45%). During follow-up unscheduled re-hospitalization (tv 60 %, S-ICD: 38%), re-infection (tv 9.4% vs. S-ICD 1.9%) and re-revision (tv: 18.9% vs S-ICD 5.7%) were all significantly more often in the tv-ICD group.

Conclusion
ICD patients who experienced a prior complication of a tv-ICD are at a considerable risk for a repeated complication if a new tv-ICD is implanted. Complication rates of S-ICDs in these patients seem to be lower so that S-ICD implantation might be preferred. Larger trials and prospective data is mandatory.
Regional patterns of activation during induced ventricular fibrillation in Brugada Syndrome
Authors: Sanchez Munoz J J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The activation pattern of induced ventricular fibrillation (VF) in Brugada Syndrome (BS) is not well known.

Objectives
The aim is to establish a hypothesis about temporal activation in the right ventricle (RV) during induced VF in BS patients.

Methods
We examined the sequence of electrical activation in RV during induced VF by programmed stimulation (PS) in 8 patients diagnosed with BS. The 12 ECG leads were analyzed and the electrograms (EGMs) were recorded from a quadripolar catheter placed in the RV apex or in the right ventricular outflow tract (RVOT), from which ventricular fibrillation was induced.

Results
ECG recordings and EGMs of VF were analyzed in 8 patients diagnosed with BS. VF was induced from the RV apex and the RVOT in 6 and 2 patients respectively. From the onset of induced VF to the appearance of sinusoidal waves, three activation areas were observed based on ECG morphology and the activation timing of the right ventricular EGM: apex, moderator band (MB), and RVOT. The first activated area coincided from where VF was induced. The second activated area was the MB in 6 patients. Following RV apex activation, a sinusoidal signal appeared in 2 patients with no activation area being distinguished. Activation was from the MB to RVOT and toward the RV apex in 3 and 2 patients respectively.

Conclusion
In ventricular fibrillation induced in Brugada Syndrome, the activation pattern is sequential from RVOT to RV apex and vice versa through the moderator band.
Measured and genetic LDL-C and the risk of incident atrial fibrillation
Authors: Park H , Kim D H , Jang E , Yu H T , Kim T H , Sung J H , Pak H N , Lee M H , Yang P S , Joung B Y 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Preventive therapy for atrial fibrillation (AF) is lacking, and association between hyperlipidemia and incident atrial fibrillation has been reported. We examined whether measured and genetically predicted low density lipoprotein cholesterol (LDL-C) can detect incident atrial fibrillation (AF) independent of clinical risk for AF.

Methods
A total of 339,023 individuals aged 39 to 73 without pre-existing ASCVD (coronary artery disease, ischemic stroke or transient ischemic attack, peripheral artery occlusive disease) and AF were included from the UK biobank. Clinical risk for AF was based on tertiles of CHARGE-AF (Cohorts for Heart and Aging Research in Genomic Epidemiology- Atrial Fibrillation) score. We calculated the risk of incident AF per SD increase in measured and genetic LDL, and its association with CHARGE-AF.

Results
Over a median 11.9 (11.2-12.6) years, the primary outcome occurred in 17,504 patients. Among those with low, moderate, and high CHARGE-AF, each SD increase in measured LDL-C was associated with hazard ratio of 1.09 (95% CI 0.85-1.38, p=0.502), 1.32 (95% CI 1.13-1.54, p&lt;0.001), and 1.23 (95% CI 1.12-1.37, p&lt;0.001). Among these same categories, each SD increase in genetic LDL-C was associated with hazard ratios of 1.10 (95% CI 1.04-1.16, p&lt;0.001), 1.07 (95% CI 1.03-1.11, p&lt;0.001), and 1.05 (95% CI 1.03-1.07, p&lt;0.001). Among those with normal LDL, untreated hyperlipidemia, and treated hyperlipidemia, each SD increase in genetic LDL-C was associated with hazard ratios of 1.11 (95% CI 1.04-1.18, p=0.001), 1.07 (95% CI 1.05-1.09, p&lt;0.001), and 1.02 (0.99-1.05, p=0.25).

Conclusion
LDL cholesterol polygenic risk score may augment identification of individuals at heightened AF risk, including those with low CHARGE-AF or normal LDL-C. Whether it may also guide antilipidemic initiation or intensification requires further study.
Is elevated calcium score alone or with the additional contribution of excess epicardial fat the trigger causing early inflammation leading to ECG abnormalities?
Authors: Sabatini A , El Shahawy M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Elevated EFV has been recently reported to be prevalent and a possible contributor to higher cardiovascular morbidity and mortality, particularly in the presence of elevated CACS.

Purpose
To assess whether elevated EFV in the presence of CACS has significant effects on the cardiac electrical activity as evidenced by 12-lead ECG abnormalities, in addition to triggering inflammation in the microvasculature (C2), altering the lipid profile and altering BP rise PME, in comparison to population without elevated EFV and the same demographic.

Methods
2932 asymptomatic subjects, 50 years +, underwent cardiovascular disease (CVD) risk assessment using the Early Cardiovascular Disease Risk Scoring System (ECVDRS), known as Rasmuessen Risk Score (RRS), which has been previously reported. The ECVDRS includes 10 cardiovascular tests, 7 of these tests are vascular and 3 are cardiac. 334 subjects underwent a cardiac CT for EFV and CACS determination. Out of these, 55 participants (43M + 12F) with significantly elevated CACS and elevated or normal EFV were further assessed regarding their exercise level, structural/functional abnormalities, presence of significant OCAD or INOCAD as assessed by cardiac catheterization, exercise stress test, and nuclear stress test.

Results
As shown in Table:

Conclusion
Increased CACS in the presence of normal EFV is not associated with significant inflammatory factors, obstructive CAD, and functional abnormalities.
We postulate that increased CACS in the presence of normal EFV may be associated with perivascular rather than intravascular calcium deposition.
Subjects with normal EFV have less structural and functional abnormalities even in the presence of elevated CACS in comparison to subjects with elevated EFV.
Subjects with elevated EFV are associated with significant prevalence of ECG abnormalities.
Based on our data, we recommend lifestyle modification with an emphasis on high levels of exercise along with novel treatment reported recently to decrease EFV aiming to reduce the risk of arrhythmia.
Assessment of the atrial fibrillation burden in Holter ECG recordings using artificial intelligence
Authors: Hennings E , Coslovsky M , Paladini R E , Aeschbacher S , Knecht S , Schlageter V , Krisai P , Badertscher P , Sticherling C , Osswald S , Kuehne M , Zuern C S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Swiss National Science Foundation, Swiss Heart Foundation

Background
Emerging evidence indicates that a high atrial fibrillation (AF) burden is associated with adverse outcome. However, AF burden is not routinely measured in clinical practice. An artificial intelligence (AI)-based tool could facilitate the assessment of AF burden.

Purpose
We aimed to compare the assessment of AF burden performed manually by physicians with that measured by an AI-based tool.

Methods
We analysed 7-day Holter ECG recordings of AF patients included in a prospective multicentre cohort study. AF burden was defined as percentage of time in AF, and was assessed manually by physicians and by an AI-based tool. We evaluated the agreement between both techniques by means of Pearson`s correlation coefficient, linear regression model, and Bland-Altman plot.

Results
We assessed the AF burden in 100 Holter ECG recordings of 82 patients. We identified 53 Holter ECGs with 0% or 100% AF burden, where we found a 100% correlation. For the remaining 47 Holter ECGs with an AF burden between 0.01% and 81,53%, Pearson’s correlation coefficient was 0.998. The calibration intercept was -0.001 (95% CI -0.008; 0.006), and the calibration slope was 0.975 (95% CI 0.954; 0.995; multiple R2 0.995, residual standard error 0.017). Bland-Altman analysis resulted in a bias of -0.006 (95% limits of agreement -0.042 to 0.030).

Conclusion
The assessment of AF burden with an AI-based tool provides very similar results compared to manual assessment. An AI-based tool may therefore be an accurate and efficient option for the assessment of AF burden.
Opportunistic screening for atrial fibrillation using a photoplethysmography technique in geriatric patients, a preliminary analysis of the Dutch-GERAF Study
Authors: Zwart L A R , Jansen R W M M , Spruit J R , Pisters R , Riezebos R K , De Groot J R , Hemels M E W 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Happitech. Provided the mobile photoplethysmography application

Background
Undiagnosed atrial fibrillation (AF) poses a great risk for stroke in high-risk patients. Different screening strategies have been developed to identify these patients. Geriatric patients often have multimorbidity, and are to be considered a population at very high risk for development of AF and cardiovascular events, but may have less access to wearable screening devices.

Purpose
The Dutch multicentre study into opportunistically screening of Geriatric patients for Atrial Fibrillation using a PPG smartphone App (the Dutch-GERAF Study) applies opportunistic screening to ambulatory geriatric patients, to identify new cases of AF and optimize stroke prevention. This preliminary analysis describes the feasibility and willingness to use of a smart phone photoplethysmography (PPG) application in an ambulatory cohort.

Method
Analysis of participation data and PPG use, of all included patients aged 70 years or older within the GERAF study. The GERAF study is a multicentre study on opportunistic screening for AF using a PPG application among patients visiting a geriatric outpatient clinic. All patients without a pacemaker/ICD, severe tremor, or severe dementia were invited to participate, during a 6 months screening period. Patients were stimulated to use the application at home on their own mobile device at least 3 times within 6 months following inclusion. If preferred by the patient, the application was installed on the mobile device of a spouse or other family member. The PPG signals were analysed using the commercially available algorithm.

Results
Data on PPG use for patients was available for 568 patients. Of these, 122 (21.5%) had a history of AF, and therefore not included in this analysis. Data on PPG use was analysed of 446 patients, 240 were female (54%), average age was 79 ± 5.5 years, the oldest patient was 95 years old. In total, patients performed 2232 PPG recordings within 6 months, in which a sufficient signal was acquired in 1874 (84%) recordings. The signal appeared sufficient at the first attempt in 79.3% of the recordings. In case of a failed first attempt, 60.5% of the patients immediately performed at least one extra recording until sufficient signal quality was achieved, and overall 61.2% of the patients performed at least 2 PPG recordings. Only 69 (15.5%) patients who consented to participation, did not perform any recordings.

Conclusion
This analysis of preliminary GERAF PPG data shows that very old subjects (with a mean age of almost 80 years) are willing and able to use eHealth applications on a mobile device. Most PPG recordings were of sufficient signal quality, and more than half of the patients were willing to perform repeated recordings.
Innovative primary care lead community palpitation management and investigation pathway
Authors: Khan M M , Childe S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Palpitations are a common reason for General Practitioner (GP) appointment in primary care and a frequent reason for cardiology referral. In the region where this project was performed, this translated to approximately 24,000 primary care and out of hours consultations in 2021 alone.

Purpose
The purpose of this pilot was to evaluate a pathway for palpitations diagnosis and management in primary care. The proposed pathway was designed to avoid unnecessary referrals to secondary care, to shorten the waiting time to diagnosis for patients and to cut down visits to A&E and out of hours service in primary care.

Method
The pathway, which was piloted at a federation for 30,000 patients, was based on a community cardiology approach, where a GP with Special interest in cardiology could offer the service for the wider community. The pathway began with an initial clinical evaluation comprising medical history, physical examination, and a standard 12-lead ECG. After ruling out of any red flags and otherwise deemed appropriate to continue to be assessed with the proposed diagnostic method, the patients were provided with a handheld ECG device for intermittent 30 seconds ECG registration at home. During a four-week investigation period the patients would record their ECG when experiencing symptoms.
The primary care team remotely monitored the traces which were received on a cloud-based system with AI capabilities, and if pathology was recorded, patient was contacted and informed of management plan. If after four weeks no pathology was found, patients received a discharge consultation for reassurance and final report was generated.

Results
During the 24-month pilot we screened the total of 191 patients. Out of the patients screened 24 (13%) were diagnosed with atrial fibrillation, 92 (48%) were diagnosed with benign ectopics as the cause of their palpitations. Two rare occurrences of a life threatening broad complex tachycardias were also detected, both of which ended up needing defib implantation. Table 1. further presents the results by diagnosis for rest of the patients.

Conclusions
The results from the pilot indicated a reduction in GP / out of hours consultations by 50% and over 90% reduction in referral to secondary care for Holter monitoring by implementing an easy-to-use handheld ECG as part of the community led palpitation pathway. The results further implied that a district-wide implementation could lead to at least 120 new AF diagnosis in our project district per year, having a knock-on benefit of stroke reduction and cost economic impact in the society by reducing anxiety, lost employment hours and increasing productivity.
Another key outcome seen is the reassurance value of conducting symptomatic palpitation monitoring to reassure patients, majority of whom had either normal sinus rhythm or benign ventricular ectopics and had failed to be satisfied with conventional Holter monitoring in the past.
Insertable cardiac monitors in high-risk post-infarction patients: a cost-effectiveness analysis
Authors: Villinger J , Cherrey L J , Schreinlechner M , Rizas K D , Bauer A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The randomised SMART-MI trial demonstrated that telemonitoring with insertable cardiac monitors (ICMs) for post-acute myocardial infarction patients with cardiac autonomic dysfunction and a left ventricular ejection fraction between 35-50% is highly effective in detecting serious arrhythmic events (SAE) compared to standard of care (SoC). In SMART-MI, SAE were also predictive of subsequent major adverse cardiac and cerebrovascular events (MACCE) which might be prevented by preemptive interventions. It is unknown whether such a monitoring strategy would be cost-effective.

Purpose
To evaluate the cost-effectiveness of ICM-based telemonitoring compared to SoC among a UK post-acute myocardial infarction population.

Methods
We created a Markov model to conduct a cost-effectiveness analysis comparing ICMs to SoC for the SMART-MI population. For the analyses, we hypothesized that the SAE-triggered interventions could prevent clinical complications with certain probabilities. A UK National Health System (NHS) perspective was employed with costs and health-related benefits discounted at 3.5%. We employed 6-months Markov cycles and calculated the model over a lifetime horizon. Patient characteristics and detection probabilities were based on the SMART-MI diagnostic study. UK-specific costs and risk-adjusted parameters were used to model the cardiovascular and cerebrovascular pathways. Scenario, deterministic and probabilistic sensitivity analyses were conducted to control for uncertainty.

Results
The base-case scenario found an incremental cost-effectiveness ratio (ICER) of the ICM to be £7,812.92 per QALY gained compared to SoC. There were 0.0646 less ischaemic strokes events per patient and 0.0168 less syncope events per patient in the ICM arm compared to SoC. Results were robust to sensitivity analysis.

Conclusion
Under the assumptions of the study, ICMs were a cost-effective diagnostic tool for detecting arrhythmias compared to SoC, preventing stroke and syncope events in post-acute myocardial infarction patients in the UK.