bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Novel Antibiotic Delivery Approach for Salvage of Cardiovascular-Implantable Electronic Devices with Localized Infection
Authors: Chorin E , Topaz M , Schwartz A L , Hochstadt A , Shotan A , Ashkenazi I , Kazatsker M , Nof E , Beinart R , Glikson M , Mazo A , Milman A , Banai S , Rosso R , Viskin S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Present guidelines endorse complete removal of cardiovascular-implantable electronic devices (pacemakers/defibrillators), including extraction of intracardiac electrodes, not only for systemic infections but also for localized "pocket infections."

Objectives
We evaluated the efficacy of delivering "Continuous, In-situ-Targeted, ultra-high concentration of Antibiotics" (CITA) into the infected subcutaneous the device-pocket, obviating the need for device/lead-extraction.

Methods
The CITA-Group consisted of 80 patients with pocket infection who were treated with CITA during 2007-2021. Of them, nine patients declined lead-extraction because of prohibitive operative risk, and six patients had questionable indications for extraction. The remaining 65 patients with pocket infection, who were eligible for extraction but opted for CITA treatment, were compared to 81 patients with pocket infection and similar characteristics who underwent device/lead-extraction as primary therapy.

Results
Eighty patients with pocket infection were treated with CITA during 2007-2021. CITA was curative in 85% (68/80) patients, who remained free of infection (median follow-up: 3 years, interquartile range 1 – 6.8 years). In the case-control study of CITA vs. device/lead extraction, cure rates were higher after device/lead-extraction than after CITA [96.2%; (78/81) vs. 84.6%; (55/65), p=0.027]. However, rates of serious complications were also higher after extraction [12 (14.8%) vs. 1 (1.5%), p=0.005]. All-cause 1-month and 1-year mortality were similar for CITA and device/lead-extraction (0% vs. 3·7%, p=0·25 and 12·3% vs. 13·6%, p=1·00, respectively). Extraction was avoided in 90·8% (59/65) extraction-eligible patients treated with CITA.

Conclusions
CITA is a safe and effective alternative for patients with pocket infection who are unsuitable or unwilling to undergo extraction.
Sequential use of different mechanical rotational tools greatly improves success of lead extraction
Authors: Bracke F , Rademakers L M , Verberkmoes N J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Both Evolution RL and Tightrail mechanical rotational tools (MRT) have shown good success rates with low complication rates for lead extraction.

Purpose
To demonstrate the incremental value of switching between the two MRT devices to improve outcome.

Methods
We performed a retrospective single centre study of consecutive lead extractions from the time when both devices were available, and in whom at least one MRT device was used as primary extraction tool. If the initial MRT device did not show any progress after a prolonged attempt, we switched to the other tool. If still unsuccessful, or leads became unsuitable for MRT extraction, a femoral back up with the Needle’s Eye snare was attempted. We consider the outcome on a per lead basis.

Results
From 1/2015 till 9/2022, at least one MRT device was the primary extraction tool in 162 pts (median age 71.7 [64.1 - 78.5], 28.4% female, 49.9% ICD patients, indication infection 95.7%). MRT was used in 243 of 405 leads implanted for more than 1 year. A Tightrail was used as back up in 15 leads (9.7%) of 155 Evolution attempts, augmenting clinical successful outcome from 81.3% to 91.0%. An Evolution served as back up in 10 leads (11.4%) of 88 Tightrail procedures, increasing clinical successful outcome from 77.3% to 88.6%. After femoral bail out the clinical successful outcome increased respectively to 98.1% and 98.9% for Evolution RL and Tightrail primary attempts. Major complications occurred in 2 pts with the Evolution RL (one intrapericardial tear; the second a late tamponade possibly from a perforated temporary pacing lead), in none with the Tightrail. There were no complications after switching tools.

Conclusion
Switching between MRT devices can be very effective in case of stalled progress during lead extraction.
Comparison between thoracic ultrasound and chest x-ray in non-infective early complications detection after cardiac implantable electronic devices implantation procedures
Authors: Floris R , Guerra F , Dell'era G , Pimpini L , Ghiglieno C , Fais L M , Cucco A , Faggioni A , Claretti C , Orru F , Demontis M V , Dello Russo A , Delogu G 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
In the immediate postoperative of cardiac implantable electronic devices (CIED) implantation procedures, literature and practice suggest the use of chest radiography as a gold standard diagnostic tool for early local complications such as pneumothorax, hemothorax and pericardial effusion. The introduction of bedside thoracic ultrasound into clinical practice guarantees a tool that is easy to use and highly appropriate for the early diagnosis of pleural pathologies. However, its use in the context of cardiac stimulation is not yet validated and is not mentioned in international consensus documents.

Purpose
The purpose of this study was to evaluate the rate of early mechanical complications in the post-implantation of cardiac stimulation devices and to compare the diagnostic power of the two methods.

Methods
397 consecutive patients who underwent intracavitary device implantation or upgrade with the puncture of a central venous vessel were prospectively enrolled in a multicenter study from November 1, 2021, to September 30, 2022. In the two days following surgery, all patients underwent chest radiography, when possible in the supine position, and chest ultrasound at the patient's bed to detect early complications of the implantation.

Results
Acute mechanical complications following the implantation of CIED accounted for 5.3%, of which 13 were pneumothorax (3.3%), in over 92% of cases of mild degree. The diagnosis was made by chest ultrasound alone in 10 cases (77%), in 2 cases (15.3%) by radiography alone and in 1 case (7.7%) by both methods (p-value 0.006). In 3 patients it was necessary to place a pleural drainage, in 2 cases the diagnosis was made with ultrasound alone and in 1 case with radiography alone (p=ns).
Eight pericardial effusions (2%) were also observed, all of a mild degree, diagnosed exclusively with ultrasound methods and did not require drainage. No cases of hemothorax were observed.

Conclusion
In our experience, thoracic ultrasound performed at the patient's bed following the implantation of a CIED has a diagnostic power superior to standard chest radiography in diagnosing early mechanical complications of the procedure, without subjecting the patient to early mobilization or ionizing radiation.
Single center experience with a novel short rotating dilator sheath in transvenous lead extraction
Authors: Hofer D , Frei C , Steffel J , Breitenstein A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Transvenous lead extraction has become a frequent procedure in the context of device lead management and various tools are available. The aim of this study was to investigate the efficacy and safety of the novel short rotating dilator sheath TightRailTM Sub-C (Sub-C) designed to facilitate vessel entry in the beginning of a transvenous lead extraction procedure necessitating active mechanical extraction tools.

Methods
For this retrospective single center analysis, we included consecutive patients undergoing transvenous lead extraction using the Sub-C from January 2018 until February 2020 at a university heart center.

Results
A total of 87 leads were extracted within 45 patients using the Sub-C extraction sheath. The mean dwell time of the leads was 112 ± 9.1 months. Complete procedural success was achieved in 95.6% (43/45) and clinical procedural success in 97.8% (44/45). Two major complications (4.4%, 2/45, 1 device pocket bleeding, 1 hemothorax) occurred, but neither were directly related to the Sub-C.

Conclusion
The TightRailTM Sub-C appears to be a safe and efficient short rotating dilator sheath for achieving vessel entry in the beginning of a transvenous lead extraction procedure.
Non-invasive electrocardiographic mapping using an endo-epicardial system based on extracellular potentials shows better accuracy for atrial arrhythmias than ventricular arrhythmias
Authors: Parreira L , Carmo P , Marinheiro R , Amador P , Mesquita D , Pinho J , Marques L , Nunes S , Chambel D , Zubarev S , Chmelevsky M , Ferreira A , Adragao P 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private hospital(s). Main funding source(s): Learning Health

Background and aim
Electrocardiographic imaging (ECGI) is capable of performing an activation map with a single beat. The endo-epicardial system based on extracellular potentials allows for the reconstruction of endo-epicardial potentials both in the ventricles and the atria. The aim of this study was to compare the accuracy of the system to predict the site of origin (SOO) of ventricular focal arrhythmias (VAs) versus atrial focal arrhythmias (AAs).

Methods
We studied 55 consecutive patients referred for ablation of VAs or AAs that had an ECGI performed before ablation. Ablations were performed with remote magnetic navigation or manually. The localization of the VAs and AAs based on the ECGI and invasive electroanatomic mapping was performed using a segmental model of the atria and the ventricles. A perfect match (PM) was defined as a predicted location within the same anatomic segment, whereas a near match (NM) as a predicted location within the same segment or a contiguous one. The number of leads used for ECGI mapping, the agreement between the ECGI and the invasive map, and the success of the procedure were evaluated.

Results
Ablation was performed in 49 patients. We mapped 54 arrhythmias, 37 VAs (37 patients) and 17 AAs (12 patients). The results according to the atrial or ventricular origin of the arrhythmia are depicted in the table. Patients with AAs were older, no other differences were significant. The ECGI system correctly identified the SOO of both VAs and AAs in the same segment or a contiguous one in 100% of AAs and 97% of VAs, p=1.000. However, the percentage of a PM (Figure) was higher for AAs than for VAs (100% vs 76%, p=0.044).

Conclusions
The endo-epicardial ECGI correctly identified the origin of both ventricular and atrial arrhythmias. However, the accuracy was higher for the latter.
Prediction of early death after atrial fibrillation diagnosis: a french nationwide study
Authors: Bisson A , Lemrini Y , Romiti G , Proietti M , El-Bouri W , Angoulvant D , Lip G Y H , Fauchier L 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial fibrillation (AF) is associated with important mortality. Dedicated clinical scores to predict mortality have been developed but perform modestly and are not specific for this population. Machine learning models are developing in the field of AF and may be able to outperform existing tools for the prediction of mortality.

Purpose
This study aimed to train and evaluate machine learning models for the prediction death occurrence within this critical period of the year following atrial fibrillation diagnosis and to compare predictive ability to usual clinical scores.

Methods
We used for this purpose a nationwide cohort of 2,435,541 newly diagnosed atrial fibrillation patients seen in all the French hospitals from 2011 to 2019. Three ML models (logistic regression, random forests, deep neural networks) were trained to predict mortality within the first year on a train set (70% of the cohort). The best model was selected to be evaluate on the test set (30% of the cohort). Discrimination of the best model was evaluated using the C index. We finally compared our best model with previously published scores.

Results
Within the first year following AF diagnosis, 342,005 patients (14.4%) died after a mean time of 83 (SD 98) days in whom 107,715 were from cardiovascular deaths (31.5%). Among 110 variables, the 18 most predictive variables were identified and selected using a Random Forest algorithm: age, metastasis, resuscitated cardiac arrest, cancer, congestive heart failure, decubitus ulcers, renal failure, pneumonia, lung disease, difficulty in walking, malnutrition, anemia, impaired mobility, liver disease, renal disease, blood transfusion and urinary tract infection. After training 3 ML algorithms, the best ML model selected was a deep neural network with a C index of 0.785 (95% CI, 0.781-0.789) on the test set. The incidence of all cause death at one year rises in a stepwise fashion from 13.8 per 1000 patients for the first quintile to 352.4 per 1000 for the fifth quintile. Compared to traditional clinical risk scores, the selected model was significantly superior to the CHA2DS2-VASc and HAS-BLED scores, and dedicated scores such as Charlson Comorbidity Index and Hospital Frailty Risk Score to predict death within the year following AF diagnosis (C indexes: 0.597; 0.562; 0.643; 0.626 respectively. P&lt;0.0001) (Figure 1). The ability to predict AF was improved as shown by the net reclassification index and integrated discriminatory improvement increase (P&lt;0.0001, respectively) and decision curve analysis (Figure 2).

Conclusion
Machine learning algorithms predict early death after AF diagnosis with a better ability than previously developed traditional clinical risk scores. A ML approach may help clinicians to better risk stratify AF patients at high risk of mortality.
Artificial intelligence-guided automated measurement of pulmonary vein diameter in patients with atrial fibrillation
Authors: Kwon O S , Yang S , Lim B , Jin Z , Kim D , Park J W , Yu H T , Kim T H , Joung B , Lee M H , Hwang C , Pak H N 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): This research was supported by Basic Science Research Program through the National Research Foundation of Korea(NRF) funded by the Ministry of Education(2022R1I1A1A01071083). This work was also supported by the Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety) (Project Number: RS-2022-00141473).

Background
In the planning of atrial fibrillation (AF)-related procedures, predicting left atrial (LA) anatomy and pulmonary vein (PV) diameter is important for the effectiveness and safety of the procedures but requires a labor-intensive measurement process. Here, we propose an artificial intelligence (AI) based PV diameter measurement algorithm for the computed tomogram (CT)-based automated PV evaluation.

Methods
We implemented a mesh-based convolutional neural network for the surface segmentation of four PVs and the LA appendage (LAA) in a 3D LA surface mesh. Our algorithm includes two originative methods of surface depth feature and cohesion loss function to improve the performance. We trained the model with the LA mesh of 210 AF patients’ CT scan and validated the accuracy of surface segmentation and PV diameter with independent 158 samples.

Results
Using an AI-based automated LA measurement model, we achieved an average Intersection over Union (IoU) of 83.4% and a regional IoU from 78.4 to 87.2 % in 158 LA meshes. When we added the surface depth feature, the IoU was improved by 31.7% compared to the conventional 3D feature. The cohesion loss function reduced the fragmentation rate of the surface label by 3.2%. Post-processed PV diameters did not differ from manually measured left (P=0.56) and right upper PV diameters (P=0.08) but differed in both lower PVs (p&lt;0.001). The eccentricity variance of the PV ostia did not differ between AI-measured and manually measured PVs (P=0.68~0.84).

Conclusion
We proposed an AI-guided automated algorithm for surface segmentation and PV diameter measurement and validated it at both upper PVs and the eccentricity of the PV ostia. Our algorithm can be applied to the automated sizing of LA appendage and improve labor-intensive manual segmentation.
Impact of coronary artery bypass grafting on ventricular repolarization indexes
Authors: Costa P , Sanchez Mas R , Correa Costa S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Ventricular repolarization indexes (VRI) tend to be altered in patients with chronic coronary artery disease, which are associated with a higher risk of malignant arrhythmias and higher mortality. Coronary artery bypass grafting (CABG) is capable of reducing mortality, as well as improving arrhythmic burden in this population. However, we do not know whether these benefits can be explained by improvement in VRI.

Purpose
To determine whether there is improvement in VRI after CABG, as well as to analyse possible effects of clinical and surgical variables on these indexes.

Methodology
A total of 150 patients who underwent CABG were included. Through the evaluation of preoperative and hospital discharge electrocardiograms, the QT interval, the interval from the peak to the end of T wave (Tp-Te) and the Tp-Te/ QT ratio were analysed. The values obtained before and after CABG were compared, as well as their association with clinical and surgical variables.

Results
The population was predominantly male (77.3 %), mean age of 61.6±8.3 years-old and mean LVEF of 58.8±10.6 %. A reduction in the QT interval (398.93±34.68 vs 365.47±50.38 ms, p &lt; 0.001), in the Tp-Te interval (72.2±17.2 vs 61.6±19.5 ms, p &lt; 0.001) and in the Tp-Te/ QT ratio (0.18±0.17 vs 0.04±0.05, p = 0.004) after CABG. There was no correlation between VRI and clinical and surgical variables.

Conclusion
CABG had a important impact in the reduction of QT and Tp-Te intervals, as well as the Tp-Te/ QT ratio, suggesting that the acute improvement in the coronary perfusion is directly associated with the improvement in these VRI.
Automated atrial fibrillation detection with a smartwatch and smart-ring in individuals with cardiovascular disease
Authors: Briosa E Gala A , Sharp A J , Schramm D , Ries W , Pope M T B , Leo M , Paisey J , Curzen N , Betts T R 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Wearable technology is increasingly used to identify episodes of atrial fibrillation (AF). However, most validation studies using single-lead electrocardiograms (ECGs) only included patients with either sinus rhythm or AF and, therefore, likely overestimate the sensivities and specificities of AF detection algorithms.

Purpose
We sought to evaluate the diagnostic accuracy of the Apple Watch and CART-I ring AF algorithms in a broad cohort of patients with pre-existing cardiovascular disease.

Methods
In this single-centre prospective study, individuals with known cardiovascular disease underwent simultaneous 12-lead ECG recordings with a 30-second single-lead ECG from an Apple Watch Series 6 and a CART-I Ring. The order of devices was randomly assigned. Two cardiologists independently evaluated the 12-lead ECGs for the presence of AF; any disagreements were resolved by a third cardiologist. The wearable devices’ algorithm labelled ECGs as "AF", "Not AF" or "Unclassified". Diagnostic accuracy was determined by calculating the sensitivity and specificity for each device and comparing them using McNemar’s test. The primary analysis included Unclassified ECGs, which categorised as false-positive (no AF on the 12-lead ECG) or false-negative (AF on the 12-lead ECG). A separate analysis excluded all Unclassified ECGs.

Results
We enrolled 400 consecutive patients. Seven patients had suboptimal 12-lead ECGs and were excluded from the analysis. The median age was 63 (58-75) years, and 73% of the population was male. Baseline demographics are depicted in Table 1. A total of 1573 ECGs were analysed. Forty-two percent of patients were in AF, 9.9% were in an atrial tachycardia, 3.3% had sinus rhythm with frequent ectopy. If all ECGs were included, the CART-I ring's AF sensitivity was significantly higher than the Apple Watch, at 86.6% (95% CI: 80.6%-91.1%) and 67.4% (95%CI: 60.0%-74.1%), respectively (Fig 1). Similarly, AF specificity was higher with CART-I ring (89.4% [95%CI: 84.7%-92.8%]) when compared to the Apple Watch (74.9% [95%CI 68.9%-80.1%]). The Apple Watch had more Unclassified ECGs than CART-I ring (78 vs. 2, respectively). They were divided into three categories: 14.1% as HR 50 bpm, 10.21% as HR &gt; 120 bpm, and 76.9% as Inconclusive (Table 2). When Uclassified ECGs from the Apple Watch were excluded, AF sensitivity and specificity improved by 16.33% (p=0.002) and 13.38% (p&lt;0.001), respectively.

Conclusion
In patients with cardiovascular disease, the diagnostic accuracy of AF detection from a single-lead ECG was lower than previously reported. The CART-I ring's AF sensitivity and specificity outperformed those of the Apple Watch. One in three patients with AF went undetected by the Apple Watch.
P-wave duration and interatrial block as predictors of new-onset atrial fibrillation: A systematic review and meta-analysis
Authors: Koutalas E , Zagoridis K , Intzes S , Symeonidou M , Zagoridou N , Karagogos K , Spanoudakis E , Kanoupakis E , Kochiadakis G , Dinov B , Dagres N , Hindricks G , Bollmann A , Nedios S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Early detection of atrial fibrillation (AF) could improve patient outcomes. P-wave duration (PWD) and interatrial block (IAB) are known predictors of new-onset AF and could improve selection for AF screening. This meta-analysis reviews the published evidence and offers practical implications.

Methods
Publication databases were systematically searched and studies reporting PWD and/or morphology at baseline and new-onset AF during follow-up were included. IAB was defined as partial (pIAB) if PWD≥120 ms or advanced (aIAB) if the P-wave was biphasic in the inferior leads. After quality assessment and data extraction, random-effects analysis calculated odds ratio (OR) and confidence intervals (CI). Subgroup analysis was performed for those with implantable devices (continuous monitoring).

Results
Among 16.830 patients (13 studies, mean 66 years old), 2.521 (15%) had new-onset AF over a median of 44 months. New-onset AF was associated with a longer PWD (mean pooled difference: 11.5 ms, 13 studies, p&lt;0.001). The OR for new-onset AF was 2.05 (95% CI: 1.3-3.2) for pIAB (5 studies, p=0.002) and 3.9 (95% CI: 2.6-5.8) for aIAB (7 studies, p&lt;0.001). Patients with pIAB and devices had higher AF-detection risk (OR: 2.33, p&lt;0.001) than those without devices (OR: 1.36, p=0.56). Patients with aIAB had similarly high risk regardless of device presence. There was significant heterogeneity but no publication bias.

Conclusion
Interatrial block is an independent predictor of new-onset AF. The association is stronger for patients with implantable devices (close monitoring). Thus, PWD and IAB could be used as selection criteria for intensive screening, follow-up or interventions.