bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardioneuroablation for asystolic reflex syncope-left or right atrial approach? A randomized prospective Roman II study-preliminary results
Authors: Piotrowski R , Zuk A , Baran J , Sikorska A , Niedzwiedz M , Krynski T , Kulakowski P 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Centre of Postgraduate Medical Education

Background
Cardioneuroablation (CNA) by means of radiofrequency ablation of ganglionated plexi (GP) has emerged as a new promising therapeutic tool in patients with asystolic reflex syncope, however, optimal procedural strategy has not yet been established.

Purpose
To compare acute efficacy of CNA using right atrial (RA) versus left atrial (LA) approach.

Methods
This prospective randomized study included 36 patients (age: 40±13 years, 14 males) who were randomized to the RA group (n=19) or LA group (n=17). Intra-procedural efficacy of CNA was measured using extracardiac vagal stimulation [(ECVS) [50 Hz, 0.05 ms, 1 V/kg (&lt;70V), 5 s)]. If RF applications in the RA group occurred ineffective (firstly, paraseptal GPs - RAGP and PMLGP, followed by Ao-SVC GP and PMLGP from coronary sinus) there was a crossover to the LA where further applications were performed. Similarly, if RF applications in the LA group (paraseptal GPs, followed by LSGP and LIGP) did not cause complete vagal denervation on ECVS, there was a crossover to the RA.

Results
Both groups were comparable concerning clinical and demographic parameters. In the RA group complete vagal denervation confirmed by ECVS was achieved in 7 (37%) patients versus 14 (82%) patients from the LA group (p=0.008). Of 12 crossovers from RA to LA, 7 (58%) were due to ineffective CNA, 2 (17%) due to permanent nodal rhythm precluding accurate localization of sinus node, and 3 (25%) due to earliest sinus node activation and/or phrenic nerve course at the site of potential RF applications. In the LA group, all 3 crossovers were due to lack of complete vagal denervation on ECVS. Finally, after all crossovers, in all patients lack of response to ECVS was achieved. Procedural time (107±24 vs 106±24 min), x-ray dose (2,12±2,72 vs 2,08±2,64 Gycm2 and 17,43±20,38 vs 17,22±40,08 mGy), and electrophysiological parameters measured before and after CNA were similar in both groups. No complications were noted.

Conclusions
CNA in the LA is more often associated with complete vagal denervation compared with the RA approach only. CNA performed in both atria (after crossovers) resulted in unresponsiveness to ECVS in all patients. Thus, biatrial CNA may be a preferable approach. Whether these results translate to long-term efficacy of CNA needs to be established.
Anatomy of the isthmus: unraveling tissue composition of ventricular tachycardia diastolic pathway
Authors: Bisbal F , Aranyo J , Sanchez-Quintana D , Martinez-Falguera D , Rodriguez-Leor O , Fadeuihle E , Bazan V , Sarrias A , Villuendas R , Bayes-Genis A , Galvez-Monton C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Spanish Ministry of Science and Innovation

Background
Unequal tissue composition of post-myocardial infarction (MI) scar (viable myocardium, fibrosis, fatty infiltration) leads to heterogeneous conduction properties and excitability. The presence of a protected diastolic, slow-conducting pathway (isthmus) is the electrophysiological landmark of post-MI reentrant ventricular tachycardia (VT). Contemporary histological studies evaluating the tissue features needed for slow, protected conduction during VT are lacking.

Purpose
To characterize tissue composition singularities of confirmed VT isthmuses (VTI) in a chronic MI swine model, and to compare it to non-isthmus scar (NIS).

Methods
One-month after a non-reperfused anterior MI, 9 Landrace X Large White pigs (4 female; 33.6±2.2 Kg) with inducible VT underwent high-density activation mapping to define the diastolic corridor. VTI was defined as part of the diastolic pathway exhibiting mid-diastolic potentials. Discrete radiofrequency applications were delivered in the vicinity of the VTI and used as tissue landmarks to guide the ex vivo isthmus localization. Tissue transverse samples (5 mm) from the labelled VTI and NIS were obtained for further histological and immunohistochemical analysis. Dense scar and border zones were analyzed.

Results
Compared to NIS, border zone of VTI showed significantly higher fatty infiltration (p=0.016) and dense scar displayed less Collagen I (p=0.053), Collagen III (p=0.043), and Collagen Volume Fraction (p=0.027), without differences in the overall fibrotic deposition (P=0.119). Immunohistochemical studies revealed greater vascular density (Isolectin B4-positive vessels) at VTI, compared to NIS (p=0.018). Arteries and veins at the VTI were mostly surrounded by preserved cardiomyocytes (figure 1). Viable cardiomyocytes and fibroblasts at VTI displayed higher density of Cx43 and Cx40, respectively, compared to those at NIS (p=0.022 and p=0.004, respectively), despite no differences in cTnI, SERCA2 and Vimentin expression (figure 2).

Conclusion
The VTI exhibits distinctive tissue features compared to NIS. Unique electrophysiological properties of the VTI may be driven by increased adipocytic deposition, vascular density and Cx43/Cx40 expression, as well as lower presence of Collagen III and Collagen Volume Fraction.
Sepsis is the most frequent trigger for electrical storm in structural heart disease: results from a tertiary referral centre prospective registry
Authors: Parollo M , Mazzocchetti L , Sbragi S , Barletta V , Di Cori A , Segreti L , De Lucia R , Grifoni G , Soldati E , Viani S , Cellamaro T , Zucchelli G 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Electrical storm is a specific clinical presentation yielding to high morbidity and mortality. Acute development of electrical storms results from the underlying myocardial substrate, autonomic activation, and trigger factors. Main therapeutic approaches range from pharmacological to interventional treatment.

Methods
We enrolled in a prospective single center registry all patients admitted from March 2018 to March 2022 at our Centre who satisfied diagnostic criteria for electrical storm. Demographic, instrumental, and interventional data were obtained from local electronic health record.

Results
A total of 87 patients (79% male sex, mean age 72,21±10,49 years) were enrolled. Mean left ventricular ejection fraction was 37,27±11,62%. Underlying cardiomyopathy was ischemic in 57,47%; dilated cardiomyopathy in 20,69%, arrhythmogenic cardiomyopathy in 8%, other in 13,84%. A definite trigger was identified in 34 cases (39%), most frequent ones were sepsis (11 events, 32,4%), acute heart failure (6 events, 17,6%), myocardial ischemia (5 events, 14,7%), thyrotoxicosis (5 events, 14,7%), ionic disorder (4 events, 11,8%). An ICD was already implanted in 89,66% of patients, all remaining patients were implanted during index hospitalization. An ablation strategy was pursued in 65,52% of cases. Mean days from hospitalization to ablation were 7±5. Median hospital stay was 11 days (IQR 8-18).

Conclusion
In our single referral centre experience, in patients with electrical storm, ischemic cardiomyopathy was the dominant underlying heart disease. An identifiable trigger was found in a large cohort of patients, with sepsis being the most frequent. An ablation strategy was pursued in most cases.
Incidence and predictors of new-onset sustained ventricular tachycardia in patients with cardiac sarcoidosis and high-grade AV block as first cardiac symptom
Authors: Dinov B , Henftling C H , Ebbinghaus H E , Latuscynski K S , Kluge T K , Hindricks G H , Laufs U L , Ueberham L U 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiac sarcoidosis (CS) is infrequently affecting the heart and may cause heart failure and dangerous arrhythmias. If left untreated, it usually progresses to end-stage heart failure or can cause sudden cardiac death. A frequent initial presentation is AV block, but malignant ventricular arrhythmias can occur in the course of the disease, as well. Ventricular tachycardia or fibrillation (VT/VF) can occur even in patients with normal or nearly normal ejection fraction. Therefore, the current guidelines recommend implantation of ICD devices whenever a pacemaker implantation is needed, such as in case of AV block, although there are little data supporting this opinion.

Purpose
The purpose of this study was to establish the risk for occurrence of VT/VF in patients with CS, initially presenting with AV block. Furthermore, we sought to establish possible predictors for occurrence of VT/VF.

Methods
We analyzed 128 patients diagnosed with CS according to the latest JCS criteria. Patients with AV block as initial cardiac presentation were selected and were followed for occurrence of VT/VF or death. We analyzed the differences between the baseline characteristics and the cardiac imaging between those with and without VT/VF.

Results
Out of 128 patients with CS, 30 (23%) patients (13 female, age 50 ± 10 y; EF 48 ± 12%) with high-grade AV Block as initial cardiac symptom were identified. In 7 of them, a permanent pacemaker had already been implanted. In 15 (50%) patients the diagnosis was confirmed histologically. Cardiac MRI showed presence of LGE in 10 patients with mean LGE volume of 14±8%, and RV involvement in 5 cases. 18FDG-PET showed abnormal tracer enhancement in 12 (40%) patients with SUVmax 9 ± 5.
A new sustained VT/VF occurred during the follow up in 10 (30%) patients; and non-sustained VT in other 4. Death occurred suddenly in 2 patients, both without an ICD device. In the univariate analysis, the following baseline characteristics were not associated with occurrence of VT: age, LVEF, amount of LGE, SUVmax, ACE and sIL2-R. Patients with new VT/VF during FU had more frequently RV involvement ( 50% vs. 0 %); LGE in CMR (100% vs 50%) and positive PET ( 100% vs. 57%).

Conclusions
Patients with cardiac sarcoidosis and AV block as initial presentation have a very high risk of developing sustained VT/VF. Death occurred only in patients without an ICD. ICD implantation, instead of pacemaker, should be considered in all patients with AV block, especially in presence of LGE in CMR, abnormal 18FDG PET and RV involvement.
Ventricular tachycardia substrate ablation in patients with slightly depressed left ventricular ejection fraction. Predictors of VT-free survival in a prospective multicentre registry
Authors: Falasconi G , Penela D , Fernandez-Armenta J , Soto-Iglesias D , Acosta J , Linhart M , Bisbal F , Marti-Almor J , Alderete J , Ordonez A , Viveros D , Bellido A , Francia P , Mont L , Berruezo A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
There is no consensus about the need for ICD implantation in patients with slightly depressed left ventricle ejection fraction (LVEF) after catheter ablation for hemodynamically tolerated ventricular tachycardia (VT).

Purpose
This study aims to investigate predictors of mortality VT-free survival in this population.

Methods
We evaluated predictors of VT-free survival in patients with LVEF&gt;40% from a prospective multicenter register of patients undergoing VT substrate ablation for hemodynamically tolerated VT. Decision to protect with ICD implantation at hospital discharge was performed according to the judgment of the treating cardiologist. The patients included in the study were followed every six months. Ventricular arrhythmia-free survival was the primary endpoint. Any episode of sustained VT (&gt; 30 s) or appropriate ICD therapy was considered VT recurrence.

Results
One-hundred thirty-two patients [67±13 years, 91% male, 50±8% mean LVEF, 85 (65%) with ischemic heart disease] with a LVEF&gt;40% were identified. Twenty-one (16%) of them were non-inducible at the end of the procedure and were discharged without ICD implantation as they were considered to have a low risk of recurrences. After a mean follow-up of 26±23 months, 32 (24%) patients had VT recurrences. A complete arrhythmogenic substrate elimination [HR: 0.34 (0.16-0.7), p&lt;0.01] and the use multiple ventricular extrastimuli for hidden slow conduction (HSC) identification and ablation [HR: 0.51 (0.27-1.1), p=0.09] were related with VT-free survival (Figure 1). 53 (40%) patients fulfilled both criteria, having a 8% recurrence rate during the follow-up. Compared with the clinical decision making of ICD implantation at hospital discharge, the use of these two variables better identify patients at risk for VT recurrences, with a net reclassification improvement of 23% (Figure 2).

Conclusions
VT recurrence after VT substrate ablation in patients with slightly depressed LVEF remains high. However, complete substrate elimination and HSC analysis and ablation are related with higher VT-free survival and identify a subgroup of patients in whom ICD might be not beneficial.
Electrocardiographic characteristics of definite drug induced Brugada patients
Authors: Ensam B , Scrocco C , Batchvarov V , Behr E 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The Robert Lancaster Memorial Fund sponsored by McColl’s Research Group British Heart Foundation.

Background
Clinical, electrocardiographic, and genomic factors associated with the development of the drug induced type 1 Brugada pattern (DI-T1BP), in response to sodium channel blocker provocation (SCBP) have been investigated. However, these prior analyses have mostly been concerned with the prediction of the DI-T1BP rather than the strength or validity of the diagnosis of Brugada syndrome (BrS). We sought to analyse and compare the ECG response to SCBP with Ajmaline in a cohort of healthy subjects (Healthy Controls) and clinical patients with a DI-T1BP and a Shanghai Score (ShS) &gt;3.5 (Definite-BrS group).

Methods
From an existing clinical cohort of consecutive patients investigated at our centre between 2010 - 2022, we identified those with a DI-T1BP and a ShS &gt;3.5. Respondents to a national advertisement, completed an online medical questionnaire. Those fulfilling the inclusion criteria were invited to undergo further evaluation with eligible subjects being recruited to the healthy control group.
All subjects received a diagnostic AP (1mg/kg max. 100mg over 5 minutes). A continuous ECG was recorded in the standard and high right precordial lead (HRPL) position. Automated analysis of conventional and novel ECG measurements were made at baseline and at peak drug effect, which was defined as the point of maximum QRS duration (excluding precordial leads).

Results
One hundred healthy controls and 166 patients with definite BrS were recruited, Table 1.0. This included 51 (31%) BrS probands. In the definite BrS group, the mean pre-ajmaline ShS was 2.1 (± 0.80) and mean final ShS was 4.3 (± 0.75). In comparison to healthy controls, the time to peak drug effect was significantly earlier in definite BrS patients, 05:18 (±02:05) vs. 05:59 (± 01:20).
Whilst the increase in global QRS duration was greater in the definite BrS group, ∆37.78ms (± 18.16ms) vs. ∆25.66ms (±11.98) P&lt;0.01, the increase in PR interval was greater in the healthy control group, ∆43.36ms (±17.27ms) vs. ∆20.77ms (±31.64ms), P&lt;0.01. Compared to the healthy controls, the definite BrS group experienced a pronounced increase in anterior ST-J point amplitude ∆27.58µV (±27.70) vs. 115.37µV(±106.41), P&lt;0.01, respectively. In contrast, whilst there was a reduction in inferior and lateral ST-J point amplitude in the definite BrS group, healthy controls demonstrated an increase in amplitude in these regions, Table 2.0.
Mean QRS area was significantly greater at peak drug effect in the definite BrS group, ∆0.14V/s (±0.31) vs. ∆-0.20 (±0.18), P &lt;0.01, whilst T wave area showed a reduction.

Conclusion
In addition to the DI-T1BP patients with definite BrS experience a number of ECG characteristics that might allow for a quantitative refinement of the diagnosis.
Machine learning based prediction of 1-year arrhythmia recurrence after ventricular tachycardia ablation in patients with structural heart disease
Authors: Komlosi F , Toth P , Bohus G Y , Tokodi M , Vamosi P , Szegedi N , Sallo Z , Piros K , Perge P , Osztheimer I , Abraham P , Szeplaki G , Merkely B , Geller L , Nagy K V 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Project no. NVKP_16-1–2016-0017 (’National Heart Program’) - National Research, Development and Innovation Fund of Hungary
Thematic Excellence Programme (2020-4.1.1.-TKP2020) of the Ministry for Innovation and Technology in Hungary

Background
Ventricular tachycardia (VT) is a life-threatening condition. Catheter ablation treatment is often successful, however post procedural VT recurrence still remains an issue. Therefore, there is a demand for an accurate risk stratification system to assess the probability of arrhythmia recurrence after the procedure.

Objective
We aimed to implement a machine learning (ML) pipeline to predict 1-year VT recurrence in patients with structural heart disease (SHD) undergoing VT ablation.

Methods
For 297 patients who underwent VT ablation, we collected medical history, laboratory, echocardiography, and procedural data. Following manual and ML-based feature selection, we trained several supervised machine learning models to predict 1-month and 1-year recurrence. The area under the receiver operating characteristic curve (AUC) was calculated to quantify the models’ performance.

Results
1-year VT recurrence was observed in 107 (36%) cases. The best predictions of VT recurrence were demonstrated by random forest models utilizing 7 input features [1-month AUC: 0.74; 1-year AUC: 0.76]. These models significantly outperformed a previously published risk score, the I-VT score [AUC: 0.63, p=0.024] on our data. The most important predictors of recurrence were the number of VT morphologies during the procedure, electrical storm, left ventricular ejection fraction, left ventricular end systolic diameter, and the severity of mitral regurgitation.

Conclusion
Our machine learning model can efficiently predict VT recurrence in SHD patients undergoing VT ablation. Thus, it could facilitate the prompt identification of high-risk patients and the personalization of treatment and follow-up strategies, ultimately leading to improved outcomes.
Stereotactic Arrhythmia Radioablation (STAR) for refractory ventricular tachycardia (VT) - A preliminary report from the German multicenter RAVENTA study
Authors: Krug D , Hohmann S , Boda-Heggemann J , Mehrhof F , Grehn M , Lyan E , Merten R , Rudic B , Boldt L H , Kirstein B , Rades D , Bonnemeier H , Dunst J , Tilz R , Blanck O 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): The multicenter RAdiosurgery for VENtricular TAchycardia (RAVENTA) study (NCT03867747) is part of the STOPSTORM.eu consortium project

Background
Stereotactic Arrhythmia Radioablation (STAR) has been shown to be a promising treatment option for refractory ventricular tachycardia (VT) in initial reports of monocentric clinical studies and case series.

Methodology
The multicenter RAdiosurgery for VENtricular TAchycardia (RAVENTA) study is part of the STOPSTORM.eu consortium project and investigates STAR with 25 Gy in one session for patients with refractory VT without further treatment options. The primary endpoint is to evaluate the feasibility and safety of the procedure with an incidence of ≤ 5% of severe (grade ≥ 3) treatment-related side effects within 30 days after therapy. We now present an analysis after enrolment of 10 of the 20 planned patients.

Results
Ten patients were included in the RAVENTA study at four treatment centers between 10/2019 and 10/2022. STAR was performed without complications in all patients. To date, there were no acute (≤ 30 days) or late (&gt; 30 days up to one year) grade ≥ 3 side effects which were possibly treatment-associated. Significant reduction in VT burden and ICD interventions was observed in most patients. In 7/10 (70%) of the patients, sustained freedom from VT was achieved up until last follow-up.

Conclusion
RAVENTA is the world's first multicenter study for STAR of refractory VT. We did not observe any treatment-related severe side effects in the current analysis. Most patients benefited from significant reductions in VT burden.
Testing radiofrequency energy delivery and catheter entrapment in three left ventricular assist device models in mock circulation
Authors: Simsek E , Yagmur B , Kahraman U , Candemir A , Engin C , Yagdi T , Nalbantgil S , Ozbaran M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The use of Left Ventricular Assist Devices (LVAD) as a bridge to heart transplantation (HTx) or as a destination therapy is increasing. Near half of the patients had ventricular arrhythmias (VA) in the first year of LVAD support. Ablation is common method for recurrent ventricular tachycardias in LVAD patients. Even there are many case reports about successful VT ablations in LVAD patients there is no report about consequences of RF energy delivery inside LVAD or ablation catheter contact – entrapment to the rotor of the LVAD.

Method
Mock circulation models were created for three mostly used LVAD models ( Figure 1) (HeartMate3, HeartMate2, HVAD) Sheep heart was located inside the mock circulation model and 4mm non-irrigated RF ablation catheter and RF generator used for RF energy delivery tissue ( sheep heart) , ostium, mid and rotor of the LVAD)(Figure 1). During RF delivery flow parameters of the LVAD systems were noted also external noncontact flow monitor located out flow canula of the LVAD. All LVADs out flows were tested for 24 hours after RF energy delivery for long term malfunction. Also RF ablation catheters were tested for mechanical and functional disfunctions after contact of the LVAD rotors.

Results
No malfunctions were observed during and after RF energy delivery inside the LVADs. Only LVAD flow parameters temporary decreased in HeartMate 3 when the catheters had a contact to the rotor of the LVAD. This phenomenon occurred irrespective of RF energy delivery status. There were no changes in HVAD and Heartmate 2. After 24 hours continuous testing of the flow of the LVADs any changes were not observed . Impedance changes were noticed during RF energy delivery. Impedance values were dropped when RF catheter moved from tissue to the ostium of the LVAD in all models. Small increases observed during contact to the rotor of the LVAD in HeartMate 3 ( Figure 2). No mechanical damage were observed on the tip of the catheters after contact to the rotors also RF lesion dimensions were compared before and after the contact and there were no differences.

Conclusion
RF energy delivery and catheter entrapment of the RF catheters to the rotors of the LVADs caused no changes in LVAD functioning in ex-vivo conditions in a mock circulation.