bluuebunny/crossref_metadata_2025_split huggingface dataset:
Non-revascularized chronic total occlusion is associated with worse outcomes in post-MI drug-refractory electrical storm patients treated by catheter ablation
Authors: Cojocaru C , Nastasa A , Iorgulescu C , Bogdan S , Popescu S , Gondos V , Vatasescu R 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
Outcomes in post-myocardial infarction (MI) patients which are referred for catheter ablation (CA) for drug-refractory electrical storm (ES) are influenced both by patient characteristics and procedural results. Previous data has shown higher risk for the first incident ES episode in the presence of non-revascularized chronic total occlusions (nCTOs). However, the prognostic effect of nCTOs in post-ES ablation patients is relatively unknown.

Purpose
We evaluated the impact of the presence of nCTO on all-cause mortality and sustained VT recurrence rate after CA for ES in post-MI patients.

Methods
In this single centre retrospective longitudinal study, we included consecutive post-MI patients referred for CA for drug-refractory ES. The median follow-up interval was 34.36 (7.25-63.65) months. CA outcome was defined by the absence or presence of residual sustained monomorphic VT at end-procedural programmed ventricular stimulation (PVS). Coronary angiography was performed prior to ablation in all patients.

Results
Sixty-four patients were included (85.9% (n = 55) males, age 62.64 ± 11.13 years). The mean left ventricular ejection fraction (LVEF) was 31.41 ± 10.99. There were 18.8% (n = 12) patients with nCTOs. Residual sustained monomorphic VT inducibility was documented in 28.1% (n = 18) cases. There were 29.7% (n = 19) deaths and sustained VT recurrences, respectively, during the monitored interval. Nine out of twelve (75%) nCTO patients died during follow-up. The presence of a nCTO induced a borderline significant higher risk of sustained VT recurrence during follow-up (HR 2.527, CI.95% 0.992 – 6.435, p = 0.052) in univariable Cox regression. In addition to age and residual sustained monomorphic VT at PVS, a multivariable Cox regression model identified the presence of nCTO as an independent predictor for all-cause mortality (HR 3.194, CI 95% 1.212-8.420, p = 0.019) (Figure 1).

Conclusion(s)
The presence of a nCTO in post-MI patients may be associated with higher all-cause mortality and sustained VT recurrences after ablation for drug-refractory electrical storm.
Ventricular conduction is a marker for arrhythmic risk in overlap sodium channel disease
Authors: Wijeyeratne Y , Tanck M W , Mckeown P P , Probst V , Crotti L , Page S , Galvin J , Petzer E , Horie M , Roden D , Veltmann C , Makita N , Aiba T , Ackerman M J , Behr E R 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): National Institute of Health Research
St George's, University of London

Background
SCN5A-E1784K (c.5350G&gt;A) is the most common variant associated with the LQT3 long QT syndrome (LQTS) and Brugada syndrome (BrS). It exhibits incomplete penetrance and can manifest variably as a mixed clinical phenotype of LQTS, BrS and/or conduction disorders (1-4). This presents a challenge for risk stratification and optimal management. We aimed to describe the clinical characteristics and risk markers in a large, well characterised international cohort of SCN5A-E1784K subjects and identify demographic and/or ECG parameters associated with event free survival.

Methods
Comprehensive clinical data, including initial presentation and follow-up data, were collected from SCN5A-E1784K subjects. Outcome ‘events’ included sudden death, aborted cardiac arrest, and documented VF or VT or arrhythmic syncope. ‘Lethal events’ included sudden death, aborted cardiac arrest or documented VF or VT. Associations between clinical characteristics and event free survival were investigated using Cox proportional hazard regression models.

Results
SCN5A-E1784K subjects (n=231) were recruited from 16 centres. Median follow up was 24.9 years (15.2 - 43.3) and 45 individuals (19%) experienced an event. Lethal events were observed in 14 subjects (6%). Figure 1 shows event (A) and lethal event (B) free survival in SCN5A-E1784K subjects. Higher QRS duration (corrected for age) was associated with shorter event-free interval. QRS duration was the only characteristic associated with increased risk with a hazard ratio (HR) of 1.04 or 1.05 per ms for events and lethal events, respectively. The observed survival for events and lethal events for QRS tertiles are shown in Figure 2.
Discussion
Ventricular myocardial conduction, as evidenced by QRS duration, appears to play a role in the risk of arrhythmic events in patients with SCN5A-E1784K. Corrected QT interval and BrS phenotype were, however, not associated with risk. This provides an important opportunity for the personalisation of risk stratification of these patients, whose management can otherwise be very challenging. Figures
Resting heart rate does not refine risk stratification of sudden cardiac death in the general population
Authors: Warming P E , Aagesen F N , Garcia R , Lynge T H , Jabbari R , Prescott E , Banner J , Tfelt-Hansen J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Horizon 2020

Background
Sudden cardiac death (SCD) is a major public health issue in which most events occur in the general population. Although resting heart rate is associated with SCD, its added value regarding prediction is unknown. Methods for risk stratification and prediction are needed to help prevent future SCD.

Purpose
The aim of this study was to assess the association between resting heart rate (RHR) and SCD in the general population.

Methods
Participants from the Copenhagen City Heart Study in sinus rhythm with baseline RHR between 40 and 120 bpm were followed from 1993 to 2016. Deaths were adjudicated, by two cardiologists, using death certificates and autopsy reports. Associations between RHR and SCD was investigated using cause specific cox models. The added value of RHR in predicting SCD was investigated by adding RHR to an already published prediction model (including age, sex, cholesterol, statin use, hypertension, systolic and diastolic blood pressure, current smoking status, diabetes, and body mass index (Bogle 2018)). RHR was evaluated as a continuous covariate with a linear effect. Prediction performance measures were evaluated using bootstrap cross validation.

Results
The study included 10,099 participants of which 8,986 fulfilled inclusion criteria (median age 60 (25%-75%: 47-70), 57% female). During 24 years of follow-up 4,668 deaths including 656 SCD were observed. Mean RHR was 73 bpm (SD 12.4). Increasing HR was associated with incidence of SCD (HR 1.18 (95% CI: 1.12-1.26) per 10 bmp), however, almost to the same extend with death from other causes (HR 1.14 (1.11-1.17). History of AMI and baseline hypertension were differentially associated with the two outcomes, but not RHR (figure 1). We find no added value when including RHR in a prediction model (AUC at 10 years 80.6 vs 80.4 (figure 2), Brier score 3.1 vs 3.1). Allowing for a more flexible RHR-fit (non-linear effect and interaction) did not improve predictions.
All results were consistent in sensitivity analyses (only individuals &lt;70 years at entry, censoring after 10 years of follow up, only the most certain SCD diagnoses).

Conclusion
In the general population, even if RHR was associated with SCD, it did not refine risk stratification when added to a model previously published.
Artificial intelligence predicts all-cause and cardiovascular mortalities using 12-lead electrocardiography in sinus rhythm
Authors: Park J W , Kwon O S , Kim D H , Yu H T , Kim T H , Uhm J S , Joung B Y , Lee M H , Hwang C , Pak H N 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Electrocardiography (ECG) can be easily obtained at a low cost and includes voltage and time interval representing heart conditions. We hypothesized that artificial intelligence (AI) detects a subtle abnormality in 12-lead ECG and may predict individual mortality.

Methods
Among 502,411 population in UK Biobank, 42,096 individuals had 12-lead ECG from 2013 to 2022. Among population with available ECG, 4,512 individuals were enrolled in this study adjusting the following inclusion criteria; age under 60 years, sinus rhythm, PR interval 120~200ms, QTc interval 350~460ms, and QRS duration 70~100ms. We developed and tested convolutional neural network (CNN) model to predict all cause death, cardiovascular (CV) death, or sudden cardiac arrest (SCA). The study population were divided into train (80%), validation (10%), and test (20%) set.

Results
Among 4,512 patients with median 3.7 years [IQR; 2.7-5.1] of follow-up, the rate of all-cause mortality was 11.6% (524). In overall study population, median age was 55.5 years and proportion of male sex was 42.2%. The patients with all-cause death were older (p&lt;0.001) and had more comorbidities (p&lt;0.001). In the train set, CNN model showed 0.93 in AUC for predicting all-cause death. In the test set, CNN model showed consistent good performance power (AUC 0.90) for all-cause death. In subgroup analysis, 102 of 4153 (2.46%) and 57 of 4065 (1.40%) patients experienced CV death and SCA, respectively. The performance power in test set were 0.90 in AUC for CV death and 0.87 in AUC for SCA.

Conclusions
AI detects and predicts future all-cause death, CV death, and SCA in median of 2.6 years by analyzing standard 12-lead ECG in generally looking normal sinus rhythm.
Association of ivabradin use with ventricular arrhythmias in heart failure patients
Authors: Pay L , Yumurtas A C Y , Tezen O T , Cetin T C , Keskin K K , Eren S E , Cinier G C , Hayiroglu M I H , Cinar T C , Tekkesin A I T 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
Heart failure patients with reduced left ventricular function are at high risk for ventricular arrhythmias and sudden cardiac death. Ivabradine, a specific inhibitor of the If current in the sinoatrial node, provides heart rate reduction in sinus rhythm and angina control in chronic coronary syndromes.

Purpose
The effect of ivabradine on ventricular arrhythmias in heart failure patients has not been fully elucidated. In this study, we aimed to investigate the effect of ivabradine use on life-threatening arrhythmias and long-term mortality in heart failure patients.

Methods
In this retrospective study, 1639 patients with heart failure were included. Patients were divided into two groups as ivabradine users and non-users. Patients presenting with ventricular tachycardia, presence of ventricular extra systole and ventricular tachycardia in 24-hour rhythm monitoring, appropriate ICD shocks and long-term mortality outcomes were evaluated according to ivabradine use.

Results
After adjustment for clinical variables, admission with ventricular tachycardia had 3.0 higher rates in ivabradine non-users (95% CI: 1.5 – 10.2). According to the adjusted model for all variables, approximately 4.1 times more appropriate ICD shocks were observed in the ivabradine non-users than the users (95% CI: 1.8 – 9.6). Long-term mortality did not differ between these groups after adjustment for all covariates.

Conclusion
The use of ivabradine reduced the appropriate ICD discharge in heart failure patients with low ejection fraction. Ivabradine has a potential in the treatment of ventricular arrhythmias in heart failure patients.
Ablation of left ventricle summit PVCs using guidewire and 2F octapolar microcatheter mapping
Authors: Constan De La Revilla E , Sanchez Millan P , Cabrera Borrego E 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Ventricular arrhythmias originating in the left ventricular summit region are especially difficult to map and ablate. The development of microcatheters allows access to the septal coronary venous system, which facilitates its mapping.

Purpose
To describe the strategy for mapping and ablation of ventricular LV-Summit extrasystoles in the first 6 cases at our center, performed using a 2F octapolar microcatheter, as well as the results obtained.

Methods
6 cases of left ventricular summit PVCs were recruited between January 2019 and October 2022. TTE and/or MRI were performed as well as initial Holter, evidencing a high density of PVCs. The studies were carried out with intracardiac echo and anatomical reconstruction with a navigator. The coronary sinus was cannulated with a 6F guide catheter for venography. Mapping of the septal coronary venous system was performed with a 4F vertebral catheter and angioplasty guidewire, connecting the guidewire to the polygraph where good precocity (up to -30 ms) was obtained with a QS pattern in the monopolar lead during PVCs. An octapolar catheter was advanced, obtaining maximum precocity and appreciating fragmented late potentials and local abnormal ventricular activities (LAVA) during sinus rhythm with greater precocity during extrasystole and achieving a topostimulation of 95% concordance with PVCs. Radiofrequency applications were made with an irrigated contact catheter in the areas facing the octapolar catheter until acute suppression of PVC was achieved and its absence was verified after infusion of isoprenaline.

Results
The mean age of the sample was 60 years, 3 of them women, with a mean LVEF of 51% and a daily average of PVCs of 17.28%. Three of the patients had previously studied cardiomyopathies. After ablation, antiarrhythmics were stopped in 80% of cases and beta-blockers in 40%. The percentage of PVCs was significantly reduced (mean after the procedure 4.4%, p = 0.04) with a single recurrence at follow-up. No complications were recorded.

Conclusions
The microcatheter-guided ablation of the septal coronary venous system is a safe and effective procedure for the removal of left ventricular summit PVCs.
Long term results of catheter ablation in patients presented with ventricular storm
Authors: Coteli C , Zekeriyayev S , Ates A H , Yorgun H , Aytemir K 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background and Objective
Catheter ablation is a treatment option in patients with ventricular tachycardia (VT storm, especially when refractory to medical treatment. In this trial, we aimed to evaluate the long-term results of catheter ablation in patients with VT storm.

Method
Between January 2015 and January 2022T, we enrolled a total of 65 VT storm patients who underwent catheter ablation. All patients who have either documented episodes of VT or appropriate ICD shocks more than 3in the last 24 hours. Medical treatment with antiarrhythmic drugs was given to all patients before catheter ablation. After the procedure, all-cause mortality, hospitalization due to stroke/myocardial infarction/heart failure, ICD shocks, and anti-tachycardia pacing therapies were recorded during follow-up.

Results
Among the whole study population (the median age is 65 years (17-85); 56 (86.2%) males) 37 (56.9%) had ischemic CMP, 24 (36.9%) had non-ischemic CMP whose 8 were ARVD, and 3 (4.6%) HCMP. The median left ventricle ejection fraction was 30% (12 – 65%). Activation mapping was performed in 60 patients, and the critical isthmus was ablated in 60 patients whose 22 had more than one critical ablation site. In 3 patients, only substrate mapping was performed, and substrate homogenization was done. In 2 patients, premature ventricular ectopy, which inducted VT, ablation was performed. Epicardial mapping was performed in 23 patients (35.4%). The median follow-up duration was 23 months (1-94 months). During follow-up, 23 patients died, 43 were hospitalized, and four presented again with VS storm. In 13 patients, appropriate shock/pacing therapy was observed. After the index procedure, re-do catheter ablation of ventricular tachycardia was performed in 8 patients. The mean postprocedural VT-free survival time was estimated at 76.5 months (SE:5.0, 95% CI: 66.6-86.4).

Conclusion
Catheter ablation therapy is an effective option for both acute and long-term management of patients with VT storms. However, postprocedural mortality and morbidity remain high in long-term follow-up duration. Long-term results may be related to the comorbidities and nature of underlying cardiac disorders.
Sex differences in catheter ablation for ventricular tachycardia in structural heart disease: a single center 10-years experience
Authors: Tanese N , D'angelo G , Cireddu M , Baratto F , Della Bella P , Bisceglia C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Women are underrepresented in studies concerning ventricular tachycardia (VT) catheter ablation (CA). Different etiologies and type of structural heart diseases (SHD) are well established in women; nonetheless conflicting results about efficacy and safety of CA in women have been reported.

Purpose
To evaluate acute and long-term outcome of VT CA in SHD in women compared to men in a high-volume tertiary Center.

Methods
All consecutive procedures were included from January 2010 to December 2021. Clinical characteristics, VT etiologies and procedure data of female patients were compared to male population. Catheter ablation was performed according to standard protocol in our center. In mappable VTs, the reentry circuit was characterized, and ablation aimed at VT interruption during radiofrequency (RF); otherwise, a substrate modification approach aiming at late potentials abolition or ablation at sites of slow conduction during sinus rhythm was performed. Following ablation, prevention of any VT inducibility and substrate modification was considered ablation endpoint. Acute results, complications, and VT recurrences during follow up were analyzed comparing the two groups.

Results
Among 1608 overall VT CA procedures, 141 procedures were performed in 117 women. Female were younger, with less comorbidities, less ischemic VT etiology and higher left ventricular ejection fraction (LVEF) as compared to men (Table 1). They were also less likely ICD carriers. No significant differences were found with regards to: epicardial approach (39.7% vs 35.3%, p=0.68); VT inducibility at baseline (57.4% vs 67.6%, p=0.14), VT termination during RF (87.6% vs 77.6%, p=0.51), and prevention of any VT inducibility at the programmed electrical stimulation (PES) after ablation (79.5% vs 78.1%, p=0.7). Major complications occurred in 4.9% of females as compared to 4.3% of male patients. At median follow-up of 25 months, VT recurrences occurred in 24.7% of female population and 27.5% of male group (p=0.42). Cumulative VT-free survival was comparable in both groups (Figure 2).

Conclusions
Women with SHD have favorable acute and long-term outcome of VT ablation, despite a high prevalence of non-ischemic etiologies. VT recurrence rate and procedure safety is comparable to male patients, suggesting that catheter ablation can be offered as an effective treatment to women with refractory ventricular arrhythmias.
Determining physiological VT ablation targets in the era of early VT ablation
Authors: Burg M , Anderson R D , Gonna H , Al-Shaheen A , Shapira E , Ben-Dor A , Hayam G , Baron T , Masse S , Nanthakumar K 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Professor Nanthakumar is a recipient of the Mid-career Investigator Award from the Heart & Stroke Foundation of Ontario.

Background
Ablation targets in the era of early ventricular tachycardia (VT) ablation will likely be driven by substrate-based physiological target approaches rather than activation mapping. Decrement evoked potentials (DeEP) have been co-localized to the diastolic VT circuit and are used as a method to perform VT ablation when VT cannot or should not be induced.1 Traditionally these potentials are evoked by a single extrastimulus. The incremental utility of a second extrastimulus in detecting these potentials has not been evaluated.

Purpose
We studied the utility of the second extra stimulus (S3) in detecting substrate ablation over the first extra stimulus (S2) following a drivetrain (S1) of 8 beats at 600ms.

Methods
DeEP was measured as the time difference between the pacing stimulus and the nearfield local activation delay on the bipolar electrogram during the S1 drivetrain and after the S2 or S3 respectively. Decrement of ≥10ms was considered a positive DeEP site. A total of 157 sites from 6 patients with VT were analysed. The incremental value of S3-induced DeEP was compared to the S2-induced DeEP.

Results
The mean decrement was significantly greater on the S3 compared to the S2 (41.8±35.6ms for S3 vs 25.8±20.4ms for S2, P &lt;0.0001). The mean incremental value of the S3 was 15.9ms (95% CI, 11.5-20.3ms). From the 157 intracardiac electrograms studied, 79.1% had a positive DeEP with S2 alone. At the same electrode locations, an additional S3 evoked DeEP in 82.2% of sites.

Conclusion
When physiological substrate is present on the first extra stimulus, the second extra stimulus magnifies the identification of the target. However, we found in our study that the second extrastimulus uncovered a hidden arrhythmogenic substrate in only 3.1% additional mapped sites. Consequently, the utility of the second extrastimulus in identification of hidden substrate needs to be balanced with the risk of induction of potentially unstable rhythms.