bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reproducible target transfer from electroanatomic mapping to radiotherapy planning systems for cardiac radioablation - cross-validation for the RAVENTA trial
Authors: Hohmann S , Xie J , Grehn M , Karfoul N , Mehrhof F , Merten R , Rudic B , Krug D , Lyan E , Duncker D , Dunst J , Tilz R , Schweikard A , Blanck O , Boda-Heggemann J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): RAVENTA is part of the EU-Horizon-2020 STOPSTORM project.

Background
Ventricular arrhythmias are a leading cause of morbidity and mortality in patients with structural heart disease. Non-invasive stereotactic single-fraction arrhythmia radioablation (STAR) with 25 Gy has been proposed as a bail-out strategy in patients where catheter-based ablation is either not feasible or has previously failed to control the arrhythmia. Defining the exact radiotherapy target, however, presents unique challenges, and manual transfer of locations from the electroanatomic map (EAM) into the cardiac CT results in a high degree of uncertainty.
Different workflows have been developed to register EAM with the cardiac CT and allow for target definition in EAM space with semi-automated transfer of the target structure to CT coordinates. Validation of these approaches is presently lacking. Here we report the initial cross-validation results of two conceptually different software solutions for target transfer quality assurance in STAR.

Methods
Clinical case data of patients treated with STAR (EAM data, cardiac CT and screenshots of the map with marked target region) were collected retrospectively from centres participating in the RAdiosurgery for VENtricular TAchycardia (RAVENTA) trial. Two blinded investigators independently created a target volume in the cardiac CT based on the marked target region using either a 3D-3D registration approach (3D Slicer / EAMapReader) or a 2D-3D registration (CARDIO-RT), as described previously. The resulting target structures were analysed in a core lab for overlap and similarity by means of surface distance metrics and conformity.

Results
Three clinical data sets were analysed, one for each mapping system in widespread clinical use. Agreement between structures created with both approaches was good, with DICE coefficients of 0.88, 0.69 and 0.506 and median surface distances of 0 mm, 1.2 mm and 2.2 mm, respectively. The least agreement was seen in a case where no additional structures were mapped besides the LV, whereas additional anchor points such as the ascending aorta seem to reduce registration ambiguity.

Conclusion
Using two conceptually different approaches for the target transfer from EAM to cardiac CT we were able to show good agreement between both methods. Both techniques thus can be used for quality assurance and analysis in STAR. Further study in a larger sample of patient data sets is warranted to elucidate differences between transfer methods and predictors for improved registration.
Prognosis of patients undergoing catheter ablation of arrhythmic storm in patients with and without history of previous ICD interventions
Authors: Telesca A , Bencardino G , Scacciavillani R , Perna F , Narducci M L , Comerci G , Pinnacchio G , Spera F R , Gabrielli F A , Pelargonio G , Massetti M , Crea F 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Catheter ablation (CA) improves prognosis in patients with electrical storm (ES). However, its effectiveness and timing in patients with ventricular tachycardia and appropriate ICD therapies remain a matter of debate.

Purpose
Our aim was to investigate whether patients with history of discrete ventricular tachycardia episodes had different clinical features and outcome compared to patients with ES as first arrhythmic occurrence.

Methods
We enrolled 57 consecutive patients undergoing CA for ES and collected clinical, echocardiographic and electroanatomic mapping data. The primary end point was a composite of death from any cause and recurrences of sustained VT or ventricular fibrillation, appropriate ICD therapy, or ES.

Results
During a median follow up of 39 months, 28 patients (49%) met the primary end point of arrhythmic recurrence or death from any cause. There were no significant differences between clinical, electrocardiographic and echocardiographic parameters in the two groups.
Regarding ICD therapies, patients with who met the primary end point had a higher number of ATP/shock episodes preceding the ES event: 15 (52%) vs 25 (89%), p=0.002. At Cox regression analysis, NIDCM, previous ATP and/or shock and ≥3 ATP were associated with arrhythmic recurrences and/or death.
At multivariate analysis, ≥3 ATP was the only predictor that met statistical significance for the primary end point: HR was 30.41, CI 4.42 – 209.12, p=0.001.
When dividing our population in patients and without ventricular arrhythmias (VAs) with appropriate device intervention before ES, thoses with VAs arrhythmias before ES had a higher percentage of presence of late potentials (80% vs 55%, p=0.041) and a greater unipolar scar (59.2±41.6 vs 30.2±21.6, p=0.001). At univariate analysis the presence of late potentials was associated with ventricular arrhythmias before ES (OR 3.33, CI 1.03-10.84, p=0.045).

Conclusions
CA in patients with a long arrhythmia history, recurrent ICD therapies and presence of late potentials at electroanatomic mapping, may yield worse outcomes and therefore our results support an early referral for CA of VT to improve prognosis in these subjects.
Effect of ventricular tachycardia ablation on symptoms and health-related quality of life: data from a single-center registry
Authors: Charitakis E , Valera Soria C , Almroth H , Karlsson L , Guidi C , Sandgren E , Liuba I , Balata D , Hassel Jonsson A , Walfridsson H , Walfridsson U 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): ALF grants (County Council of Östergotland).

Background
Ventricular tachycardia (VT) is a significant cause of morbidity and mortality (1). Implantable cardioverter-defibrillators can terminate the arrhythmia and reduce the risk of sudden cardiac death but do not lower the risk of recurrence (2). Thus, the use of VT ablation as a method of prevention of VT recurrence has increased (3). Most articles have focused on the procedure’s efficacy and complications as opposed to data concerning arrhythmia-related symptoms and health-related quality of life (HRQoL).

Purpose
We sought to examine the effect of VT ablation on patients’ symptoms and HRQoL during a one-year follow-up period.

Method
Patients referred for catheter ablation of VT to our university hospital between June 2012 and June 2020 were asked to fill in the validated ASTA (Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia) questionnaire for the assessment of symptoms and HRQoL before and one year after the index procedure.

Results
One hundred sixty-one patients filled out the ASTA questionnaire before the index procedure and 133 (83 %) at one-year follow-up. Four patients died during follow-up. Of the 133 patients eligible for analysis, 53 had ischemic VT, 45 had non-ischemic VT, and 35 had idiopathic VT. Sixty patients were also followed up in detail concerning arrhythmia recurrence by screening ICD interrogation reports, ECGs, and Holter registrations. Repeated measures analysis of variance showed a significant reduction of symptoms and improvement of HRQoL irrespective of patients’ background disease (ASTA-symptom score: whole population, as well as subpopulations p&lt;0.001, figure 1, ASTA-HRQoL score: whole population as well as subpopulations p&lt;0.001, figure 2) after 1.6 procedures, while 41 % of patients did not report any arrhythmia-related symptoms after one year. Sixty-eight percent of the patients did not suffer any recurrence during the first year after catheter ablation, and the major complication rate was 7%.

Conclusions
Catheter ablation of VT effectively reduces arrhythmia-related symptoms and improves HRQoL irrespective of patients' background disease during a follow-up period of one year.
Accuracy of a novel ECGi system in localising the critical isthmus exit site in scar-dependant re-entrant ventricular tachycardia
Authors: Al-Sheikhli J , Patchett I , Marshall L , Khan J , Dhanjal T 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Vision in ventricular onset (VIVO) is a novel, non-invasive, mapping system designed to locate the site of earliest activation in ventricular arrhythmia. VIVO utilises a mathematical algorithm, cross-sectional imaging data (CT or MRI), 3D images of the electrodes on the patient torso, and a 12-lead electrocardiogram (ECG) to identify the site of earliest ventricular activation.(1) The system has been shown to accurately predict earliest activation of focal premature ventricular contractions (PVCs), but its accuracy in scar dependant re-entrant ventricular tachycardia (VT) has not been investigated.(1-3)

Objective
To assess the accuracy of VIVO in localising the VT exit site for patients with ischaemic cardiomyopathy (ICM) and scar related re-entrant VT.

Methods
5 patients with ICM (age 56 ± 19 yrs, male n = 5) were investigated (table 1). All patients had an implantable cardioverter-defibrillator with standard indications for VT ablation. Invasive electro-anatomical mapping was performed with the Advisor HD Grid multipolar catheter and maps were generated using omnipolar electrograms (EGMs). The VT exit site was identified using activation ± pace-maps and the location defined by the primary operator using the American Heart Association (AHA) 17 segment model of the left ventricle.(4) Using the intra-procedural VT ECG recordings, VIVO maps were constructed post-procedure. The VIVO predicted VT exit site was identified using the AHA 17-segment model by a second operator, blinded to the results of the procedure. A "complete match" was defined as exact segment concordance between the two operators, "partial match" as adjacent segments, and "no match" if neither requirements satisfied.

Results
Mean left ventricular ejection fraction was 30.5 ± 9.0%. Mean procedure time was 233 ± 31 minutes, with a mean ablation time of 24 ± 18 minutes. A total of 11 re-entrant VTs were mapped. The VT exit site was identified in all cases (10 activation-map; 1 pace-map). A complete match was seen in 91% of VTs and partial match in 9% (table 2). None of the cases demonstrated a "no match" between the invasive and VIVO maps. There were no procedural complications.

Conclusion
The VIVO mapping system can accurately predict the VT exit site in scar dependant re-entrant VT. Further studies to assess the feasibility of VIVO-guided ablation in scar dependant VT are ongoing.
The importance of the right ventricular insertion area for the functional substrate of ventricular tachycardia after myocardial infarction
Authors: Takamiya T , Rademaker R , Riva Silva M , Kimura Y , Zeppenfeld K 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Conducting systematic annotation and ablation of evoked delayed potentials (EDP) in response to short coupled right ventricular extra-stimuli (RV-ES) has improved ablation outcome of post myocardial infarction (MI) ventricular tachycardia (VT). The reported short radiofrequency catheter ablation (RFCA) times suggests the presence of predilection areas for these functional substrates.

Purpose
To evaluate the electroanatomical characteristics and distribution of EDPs in post-MI patients referred for RFCA of VT.

Methods
Electroanatomical mapping (EAM) data of 48 post-MI patients (69 ± 9 years, 39 male, LV ejection fraction 36 ± 10%, anterior MI 20 [42%], inferior MI 28 [58%]), who underwent functional substrate mapping and ablation were analyzed. Pre-procedural cardiac CTs of 16 patients (8 anterior, 8 inferior MI) were integrated with EAM data. Infarct extension (defined as bipolar voltage [BV] &lt;3.0mV, dense scar &lt;0.5mV and scar borderzone [BZ] 0.5-3mV) and EDP location were determined based on the AHA 17-segment model of the left ventricle.

Results
RV-ES was performed during mapping at 2180 LV sites (median 46 per patient, range 8-81) and EDPs were observed at 631 (29%) sites. Patients had a median of 11 (range 1-37) EDP sites. Compared to no-EDP sites, EDP sites had lower BV (median 0.57 mV vs. 0.77 mV, P &lt;0.001), longer duration (median 79 ms vs. 66 ms, P &lt;0.001), and larger number of positive sharp deflections (median 6 vs. 5, P &lt;0.001) during sinus rhythm. Of all EDP sites, 278 (44%), 286 (45%), 64 (10%), and 3 (1%) had BV of &lt;0.5mV, ≥ 0.5mV and &lt;1.5 mV, a BV of ≥1.5 mV and &lt;3.0 mV, and a BV of &gt;3.0 mV, respectively. In the 16 patients with CT image integration, a total of 124/272 segments showed EA scar with a median (IQR, range) of 8 (6-9, 4-12) segments per patient. Any EDP was identified in 71/124 (57%) of segments with EA scar. Of note, 73% of all EDPs in inferior MIs and 64% of all EDPs in anterior MI were located in 4 AHA segments, namely 3,4, 9,10 and 7,8,13,14, respectively, close to the inferior or anterior RV insertion. Such a cluster of EDP sites around the RV insertion was found in 6 (75%) patients with inferior MI and in 7 (88%) patients with anterior MI.

Conclusion
About 10% of EDPs are identified at sites with BV of ≥1.5mV and &lt;3.0mV during sinus rhythm supporting the recently proposed BV threshold &lt;3.0mV for post-MI scars. EDPs are frequently located near the RV insertion in both inferior MI and anterior MI suggesting a role of the RV insertion in the functional substrate of post-MI VT.
Evolution of deceleration zones during VT ablation and relation with cardiac magnetic resonance
Authors: Vazquez-Calvo S , Garre P , Ferro E , Falzone P , Uribe L , Guichard J B , Ortiz-Perez J T , Guasch E , Arbelo E , Tolosana J M , Mont L , Porta-Sanchez A , Brugada J , Roca-Luque I 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
A new functional mapping strategy based on targeting deceleration zones (DZs) has become one of the most commonly used strategies within the armamentarium of substrate-based ablation methods for ventricular tachycardia (VT) in patients with structural heart disease. The classic conduction channels detected by voltage mapping can be accurately determined by cardiac magnetic resonance (CMR).

Objectives
To analyze the evolution of DZs during ablation and their correlation with CMR.

Methods
Forty-two consecutive patients with scar-related VT undergoing ablation after CMR (October 2018-December 2020) were included (medium age 65.3±11.8 years; 94.7% male; 73.7% ischemic heart disease). Baseline DZs and their evolution in isochronal late activation remaps were analyzed. A comparison between DZs and CMR conducting channels (CMR-CCs) was realized. Patients were prospectively followed for VT recurrence for one year.

Results
Overall, 95 DZs were analyzed, 93.68% of which were correlated with CMR-CCs: 44.8% located in the middle segment and 55.2% located in the entrance/exit of the channel. Remapping was performed in 91.7% of patients (1remap: 33.3%, 2remaps: 55.6% and 3remaps: 2.8%). Regarding the evolution of DZs, 72.2% disappeared after the first ablation set, with 14.13% not ablated at the end of the procedure. A total of 32.5% of DZs in remaps correlated with a CMR-CCs already detected, and 17.5% were associated with an unmasked CMR-CCs. One-year VT recurrence was 22.9%.

Conclusions
DZs are highly correlated with CMR-CCs. In addition, remapping can lead to the identification of hidden substrate initially not identified by electroanatomic mapping but detected by CMR.
Characteristics of recurrent ventricular tachycardias after stereotactic body radiotherapy
Authors: Peichl P , Wichterle D , Cvek J , Stojadinovic P , Cihak R , Kautzner J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Grant project AZV NU20-02-00244 from the Ministry of Health of the Czech Republic and European Union's Horizon 2020 research and innovation program under grant agreement No 945119.

Introduction
Stereotactic body radiotherapy (SBRT) is a novel treatment for otherwise resistant ventricular tachycardias (VTs). Different mechanisms of SBRT for VT suppression were proposed that include radiation-induced fibrosis but also SBRT-triggered increase in myocardial conduction velocities without significant fibrotic changes.

Purpose
The study compared the morphologies and cycle lengths (CLs) of inducible VTs during re-do catheter ablation after SBRT with VTs before SBRT.

Methods
We investigated patients that underwent SBRT (a single session of 25 Gy) for refractory VT and subsequent electrophysiology study / reablation for recurrences of VTs. All inducible VTs were analysed concerning morphology and CL.

Results
A total of 9 patients (2 women, aged 60 ± 13 years) were included. Two patients had ischemic heart disease, six patients had nonischemic cardiomyopathy, and one had a cardiac fibroma. All patients were on chronic amiodarone treatment. The mean ejection fraction of the left ventricle was 35 ± 12%. The mean planning target volume for SBRT was 39 ± 21 ml. Electrophysiology study/reablation was performed at a mean interval of 8 months (interquartile range: 2-10months) after SBRT. A total of 23 and 27 distinct VT morphologies were inducible before and after SBRT, respectively. Twelve pairs of VTs (44%) were identified that had identical morphology before and after SBRT. The mean CL of these VT pairs decreased from 399 ± 98 ms to 472 ± 74 ms (P = 0.01) after SBRT. Overall, 15/27 of all VT morphologies induced after SBRT originated from the irradiated region.

Conclusions
Recurrent VTs after SBRT had commonly origin in the irradiated region. In pairwise comparison, the CL of VTs has prolonged after the SBRT. This suggests that SBRT results in radiation-induced fibrosis rather than an increase in conduction velocity.
Subcutaneous implantable cardioverter-defibrillator generator removal: a multicenter analysis
Authors: Luker J , Strik M , Andrade J G , Raymond Paquin A , Elrefai M H , Cano Perez O , Kron J , Schmitt J , Pott A , Veltmann C , Srinivasan N T , Van Stipdonk A , Fluschnik N , Haeberlin A , Steven D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): University Hospital Cologne

Introduction
The subcutaneous implantable cardioverter-defibrillator (S-ICD) was a significant recent advance in sudden cardiac death prevention. Device-related complications, including infection or lead fracture, or changes in the medical status, such as necessity for cardiac pacing, may necessitate device removal. (1) Real-world multicenter data on S-ICD removal are sparse.

Purpose
This multicenter analysis sought to assess the incidence and indications for S-ICD generator removal.

Methods
Retrospective data and the most recent follow-up data on S-ICD devices implanted at 14 participating centers in Europe, the US and Canada, and information on subsequent device removal was submitted to an online database (2). Limited baseline patient information and the incidence of and reasons for S-ICD generator removal or failure were reported. Premature device removal was defined as device removal for any reason other than regular battery depletion (&gt;5 years of longevity).

Results
Data from 1106 devices was analyzed. Devices were implanted between 15.10.2009 and 16.04.2021 at the participating centers. The first-generation model 1010 generator was implanted in 55 (5%), the newer models A209 or A219 were implanted in 457 (41.3%) and 594 (53.7%) respectively.
Patients were aged 46.7±16.1 years and the indication for ICD therapy was primary prevention in 616 (55.7%) and secondary prevention in 484 (43.8%). During the follow-up period, 37 (3%) patients deceased, and 96 patients were excluded from the analysis due to lack of follow-up (&lt;4 weeks).
Premature device removal was performed in 103 (9.3%) during the follow-up period of 31.3±19.5 months. The most common reasons for removal were battery depletion (52%), of which premature, defined as &lt;5 years longevity, depletion accounted for 57%, upgrade to transvenous ICD or CRT (17%) and infection (11%). Other indications for removal included heart transplantation (4%) or ventricular assist device implantation (1.5%), noise detection or inappropriate shocks (6.5%), and patient discomfort (0.7%). (see figure 1)
Regular battery depletion occurred in 34 devices after 69.2±5.3 months. There was no difference in device longevity between the different generator models (1010, A209, and A219).
There were no significant differences between the different generator models with respect to indications for explanation.

Conclusions
In this real-world retrospective multicenter analysis, premature S-ICD generator removal was necessary in 9.3% of patients. Premature battery depletion, infections, and the need for pacing were the most common indications for unplanned generator removal.