bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of clinical expertise and choice of wearable device on accuracy to detect atrial fibrillation via single-lead ECGs
Authors: Weidlich S , Mannhart D , Serban T , Krisai P , Knecht S , Du Fay De Lavallaz J , Schaer B , Osswald S , Kuehne M , Sticherling C , Badertscher P 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Manual interpretation of single-lead ECGs (SL-ECG) is often required to confirm a diagnosis of atrial fibrillation (AF). However, accuracy to detect AF via SL-ECGs may vary according to clinical expertise and choice of the wearable device.

Aims
To compare the accuracy to detect AF via single-lead ECG from five different wearable devices (Apple Watch, Fitbit Sense, KardiaMobile, Samsung Galaxy Watch, Withings ScanWatch) between cardiologists, internal medicine (IM) residents, and medical students.

Methods
In this prospective study, invitations to an online survey were distributed via digital invitations among physicians from major Swiss hospitals and medical students from Swiss universities. Participants needed to classify 50 SL-ECGs (from 10 patients and 5 different devices) into three categories: sinus rhythm, AF, or inconclusive. This classification was compared to the diagnosis from an almost simultaneously recorded 12-lead ECG interpreted by two independent cardiologists. In addition, participants were asked to choose the best/worst quality/readability of each manufacturer’s SL-ECG. (Figure A)

Results
Overall 450 participants rated 10’865 SL-ECGs. Sensitivity and specificity for the detection of AF via SL-ECG was 75% and 92% for cardiologists, 70% and 86% for IM residents, 55% and 65% for master medical students (year 4-6) and 45% and 58% for bachelor medical students (year 1-3), p&lt;0.001, (Figure A). Participants which stated prior experience in interpreting SL-ECGs demonstrated a sensitivity and specificity of 65% and 81% compared to a sensitivity and specificity of 56% and 67% for participants with no prior experience in interpreting SL-ECGs, p&lt;0.001. Of all participants, 107 rated all 50 ECGs. Diagnostic accuracy of the first five interpreted SL-ECGs was 60% (IQR 40-80%) and diagnostic accuracy of the last five interpreted SL- ECGs was 80% (IQR 60-90%), p&lt;0.001. No significant difference in the accuracy of AF detection was seen between the 5 different wearable devices, p=0.58. 203 participants (45%) and 226 participants (50 %) ranked SL- ECGs from the Apple Watch as the best quality and readability, respectively.

Conclusion
SL-ECG can be difficult to interpret. Accuracy to correctly identify AF depends on clinical expertise, while the choice of the wearable device seems to have no impact.
Value of implant-based telemonitoring in the high-risk population of ventricular assist device patients
Authors: Guckel D , El Hamriti M , Rojas Hernandez S , Fox H , Costard-Jaeckle A , Gummert J , Fink T , Sciacca V , Braun M , Khalaph M , Imnadze G , Schramm R , Morshuis M , Sommer P , Sohns C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Telemonitoring of heart failure (HF) patients is an evolving field. Prior studies presented promising results. However, the relevance of telemonitoring in the specific cohort of end-stage HF patients on ventricular assist device (VAD) therapy has not been analysed yet.

Purpose
This study aimed to evaluate the benefit of daily implant-based multiparameter-telemonitoring in high-risk HF-patients on VAD therapy with an implantable cardioverter-defibrillator (ICD) or a cardiac resynchronization defibrillator (CRT-D) including telemonitoring function. Beyond that, patients’ outcome and complication rates were evaluated.

Methods
A total of 30 end-stage HF-patients (65 ± 10 years, 89 % male) with a VAD and an ICD or a CRT-D with telemonitoring function were included in this observational single center study. Long-term follow-up data (4.28 ± 2.62 years) were assessed.

Results
All patients (n=30, 100%) received daily ICD or CRT-D telemonitoring. In the majority of patients (73%, n=22) the telemedical center had to take actions a mean of 3 times. Most events (84%, n=45) were identified within 24 hours. An acute alert due to sustained ventricular arrhythmias (VAs) occurred in 13 patients (65%) with 46% of them (n=6) requiring a shock delivery. Eight patients (62%) were hospitalized due to symptomatic VAs. Inadequate shocks were recognized in 3 patients (23%). In 12 patients (92%) immediate medication adjustments were recommended. Relevant lead problems were revealed in 13 patients (43%) with 6 patients (46%) undergoing consecutive lead revisions. Device-reprogramming was recommended in 50% of all VAD-patients (n=15). Compared to HF-patients without remote monitoring, daily telemonitoring significantly reduced the number of in-hospital device controls by 44% (p&lt;0.01).

Conclusions
Daily implant-based-telemonitoring increased patient safety as it allowed for pre-emptive interventions and an immediate detection of cardiac arrhythmias and device/lead problems. Even in this high-risk HF-patient population, telemonitoring significantly reduced the number of in-hospital device-controls. Further studies are warranted to confirm these initial observations.
Incidental findings at FDG PET/CT in carriers of cardiovascular implantable electronic devices
Authors: Diemberger I , Mei R , Massaro G , Fraccascia N , Vetrone L , Bezzi D , Calderoni L , Marinelli V , Bonfiglioli R , Valzania C , Nanni C , Fanti S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
FDG-PET/CT clinical use for cardiovascular implantable electronic device (CIED) infection is of relevant importance, since it provides information about presence and extension of the infection. However, asymptomatic patients with incidental FDG uptake on CIED are challenging.

Purpose
The primary objective of this observational study was to assess the diagnostic role of FDG PET/CT in patients without a suspicious of CIED infection. The secondary objective was to identify qualitative and semiquantitative predictors of CIED infection.

Methods
From 2017 to 2019 all FDG-PET/CT scans of CIED patients were analysed, the indications were a suspicious of CIED or non-cardiovascular infection, or oncological follow up. Four expert nuclear medicine physicians blindly reviewed all scans, focusing on FDG uptake in pocket and/or in extracardiac lead parts. They reported standardized uptake values (SUV), liver and blood pool target-to-background ratios, metabolic tumour volume (MTV). 6 months follow up after PET/CT scan was performed for eventual CIED extraction because of infection.

Results
320 FDG-PET/CT scans were considered. Median age was 74 [33-94] years, 219/320 (68%) males. 122/320 (38%) scans presented FDG uptake around pocket and/or extracardiac lead parts; and 65/320 (20%) scans reported suspicious uptake. We identified these cut-off criteria as predictors of CIED extraction: TARGET SUV max &gt;2.6 (sensitivity 71%, specificity 89%), LIVER-TARGET SUV max &gt;1.3 (sensitivity 68%, specificity 89%). Both these values also demonstrated to be good predictors of CIED infection after 6 months follow up (p&lt;0,001).

Conclusion
FDG-PET/CT uptake in asymptomatic CIED patients is underestimated and may be related to subtle CIED infection. By introducing high-specific SUV cut-off values, a considerable impact on patient management is expected.
Does radiotherapy effect the voltage output of cardiac implantable electronic devices (CIEDs)?
Authors: Fenwick A , Manley S , Lowrey M , West N , Shepherd E 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Purpose
Current guidelines for the management of patients undergoing radiotherapy with cardiac implantable electronic devices (CIEDs) were published in 1994. They recommend that the total dose received by the device should be estimated before treatment, devices should not be placed in the direct radiation beam and the cumulative dose should not exceed 2Gy to any part of a pacemaker (0.5Gy for ICDs). This is because radiotherapy can cause malfunctions in cardiac implantable devices. At doses higher than this, relocation of the device is recommended. Device malfunctions are suggested to correlate with a beam energy of ≥10MV. One malfunction that poses a high risk to patients is a change in voltage output amplitude. This study assessed if low-energy flattening filter and high energy flattening filter-free photon beam radiation caused a change in the voltage output amplitude of cardiac implantable devices.

Method
40 cardiac implantable devices were divided into two treatment groups and irradiated in vitro with a cumulative 48Gy dose of 6MV radiation at 600MU/min in 8 fractions or a 48Gy dose of 10MV radiation at 2400MU/min. The voltage output amplitude of all devices was collected using an oscilloscope and an amplitude change of ≥25% was classed as a clinically significant malfunction.

Results
In the 6X treatment group, 0/19 devices showed a clinically significant change. No statistical significant difference was found between the median peak voltage output amplitude before fraction 1 and after fraction 8 (U = 149.5, p = 0.3733, n =19). In the 10MV treatment group, 2/21 devices showed a clinically significant change. These devices showed a voltage output amplitude increase of 28.07% and 36.97%. However, no statistical significant difference was found between the median peak voltage output amplitude before and after radiation (U = 149.5, P = 0.0746, n = 21). Although insignificant, there was clearly a larger change across all devices in the 10FFF group compared to the 6X group. Results were not statistically significant between manufacturers but defibrillators were statistically significantly more likely to malfunction than pacemakers.

Conclusion
The recommended dose of radiotherapy for patients with a CIED should be carefully considered on an individual basis. Due to neutron production and its effect on rapid access memory (RAM) and complementary metal oxide semiconductor (CMOS) circuitry, high-energy ≥10MV radiation can affect the voltage output amplitude, despite its statistical insignificance. Based on this limited report it is unlikely that the voltage output amplitude of CIEDs will be affected by clinically relevant doses of radiotherapy, but it may have long term implications on battery life. These results could eliminate the risk of increased infection due to relocation of devices, provide patients with optimised treatment and enable a more effective service for improved patient management.
Blood stream infection in patients with implantable-cardioverter defibrillator admitted to non-cardiology units: incidence, diagnostic work-up and outcome
Authors: Oezkartal T , Demarchi A , Conte G , Pongan D , Caputo M L , Klersy C , Bernasconi E , Granger C B , Auricchio A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
There is limited knowledge on the incidence of blood stream infections (BSI) in patients with implantable cardioverter defibrillators (ICDs) or cardiac resynchronization therapy devices (CRTs), as well as about the diagnostic work-up and outcome when these patients are admitted to non-cardiology units.

Purpose
We assessed the incidence of BSI in patients with an ICD or CRT, evaluated the diagnostic work-up performed, and investigated the outcome.

Methods
This is a single-center, retrospective cohort analysis of all 515 patients implanted with a de-novo ICD or CRT between 2012 and 2021 at our centre, and subsequently admitted to a non-cardiology unit of any public hospital in Canton Ticino with a BSI (≥ 2 positive blood cultures). Device infection was defined according to the 2019 International Cardiac Implantable Electronic Device (CIED) Infection Criteria.

Results
A total of 43 patients were diagnosed with BSI during a median follow-up of 48 months (IQR 24-78 months). Incidence rate for BSI was 19 (95%-CI 14 – 26) and 23 (95%-CI 14 – 35) per 1000 patient-years for ICDs and CRTs, respectively. The most common source for BSI was urinary tract infection (21%), which was mostly caused by gram positive pathogens (68%) with coagulase-negative staphylococci being the most frequent one (39%). Definite CIED infection rate in patients presenting with BSI was 11.6% (see table). The majority of patients (56%) had no cardiac imaging including transthoracic or transesophageal echocardiography; a PET-CT was performed in only 4 patients (9%). Nearly all patients (86%) were treated with short-term antibiotics; in contrast, system extraction (2.3%) and chronic antibiotic therapy (4.7%) were rarely performed. Throughout the entire follow-up period, patients with BSI had a 8-fold higher probability (HR 7.8, 95% CI 4.8-12.7; p&lt;0.001) of all-cause mortality compared to those without BSI.

Conclusions
Awareness in non-cardiology units about possible device infection in patients with BSI is rather low leading to limited diagnostic work-up and ultimately to a high mortality rate of these patients.
Initial results of a prospective, multicenter study on the use of a biosynthesized cellulose membrane as a separation in de novo CIED implantations
Authors: Starck C T , Falk V , Kaemmel J , Lanmueller P , Heck R , Huemer M , Attanasio P , Nagel P , Butter C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Public Grant: EIC Accelerator pilot –SME Instrument (H2020-EIC-SMEInst-2018-2020)
Private Company: Hylomorph AG

Background
Fibrosis is the result of foreign body reaction against the hardware of cardiac implantable electronic devices (CIEDs). Generator pocket fibrotic adhesions increase the complexity and risks of CIED revision surgeries. There is limited evidence that synthetic or ex vivo resorbable envelopes can prevent or reduce fibrosis.

Objective
We conducted a multicenter, prospective, single-arm, interventional study of microengineered biosynthesized cellulose (BC) as separation layer for CIED pockets. Patients who were undergoing a CIED de novo implantation were included to receive the protective device. The primary end point was the maintenance of a detectable barrier between the CIED generator and the surrounding tissue at 12 months. The secondary end point for safety was procedure-related or system-related complications within 12 months.

Methods
High resolution ultrasound (HRUS) imaging of the protective layer, the CIED and the surrounding tissue of the generator pocket were collected at the day of implant, and at one, six-, and twelve-months follow-up visits in 35 patients (of 46 recruited). The images were individually processed and analyzed.

Results
HRUS imaging allowed the reproducible detection of (1) the CIED interface as fiducial reference marker, (2) the densification of the surrounding tissue and (3) the segregation between the two. A detectable separation between the CIED and the surrounding tissue was identified in all patients at all follow-up visits demonstrating the enforcement of a durable and stable barrier. The evolution of HRUS signal intensity indicated a time-dependent densification compatible with the buildup of fibrotic tissue around the generator. The thickness of this tissue was measured rendering values below 1 mm. Mean time for cellulose membrane application was 7.5±4 minutes. Investigational device related major complications were 0%.

Conclusion
Adjunctive use of an antifibrotic device established a durable separation between the CIED and the surrounding soft tissue in the generator pocket without a significantly higher incidence of complications or a relevantly increased procedural time. HRUS imaging indicated a limited buildup of denser tissue around the generator and no adhesions inside the cellulose membrane. Altogether these results suggest that BC may be beneficial for post-implantation pocket health as an alternative to envelopes of synthetic or animal origin and may enable easy pocket access in revision procedures.
The association of P-terminal force value and increased risk for ischemic stroke among admitted patients in a tertiary hospital: a retrospective case-control study
Authors: Manalili M K C , Declaro R A D , Dionisio J D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cerebrovascular disease is the second leading cause of mortality in the Philippines, with prevalence of 0.9 to 2.6%.³ However, recent researches show that left atrial abnormality, even without atrial fibrillation, increases risk for ischemic stroke.

Purpose
This study aims to determine the association of P-terminal force value in V1 (PTFV1) and ischemic stroke. Secondary objectives are to elucidate the relationships of PTFV1 and dilated left atrium (LA), and dilated LA and ischemic stroke.

Methods
This is a retrospective case-control study which included adult Asian patients managed as first-time ischemic stroke, with an age-, gender- and co-morbidity-matched control group. A total of 290 patients were evaluated. Binary logistic regression was used in the analysis of the primary outcome, while independent T-test and chi-square test were utilized for the secondary outcomes.

Results
PTFV1 and ischemic stroke had a statistically significant positive association. Every 1 unit change of PTFV1 confers 1.7% increased risk for ischemic stroke. Furthermore, a higher PTFV1 was significantly correlated with dilated LA. However, there was no significant association between dilated LA and ischemic stroke.

Conclusion
PTFV1 confers an easier way to diagnose patients with left atrial abnormality, and stratify those with increased risk for ischemic stroke.
Surpassing the complex substrate of accessory pathways ablation in ebstein anomaly
Authors: Laranjo S , Lourenco G , Portugal G , Cunha P , Sousa L , Trigo C , Pinto F , Ferreira R , Oliveira M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background and Aims
Data regarding long-term follow-up of radiofrequency catheter ablation (RFCA) of accessory pathways (APs) in patients (P) with Ebstein's anomaly are limited. This type of procedure is considered challenging due to multiple and broad APs. The present study aimed to describe the electrophysiological features of APs in P with Ebstein's anomaly, and report our RFCA experience with an open-window electroanatomic 3D mapping using high-density mapping catheters in these patients.

Methods and results
A retrospective study of 15 consecutive Ebstein anomaly P with APs who underwent an electrophysiologic study and RFCA from 2013 to 2022. There were a total of 21 manifested non-decremental APs. APs were mainly located on the posterior, posteroseptal, and posterolateral tricuspid annulus. The index procedure was unsuccessful in six P, with the need for a redo procedure. This redo procedure was performed with a high-density catheter (Pentaray, Biosense or HD-Grid, Abbott), using the open-window annotation algorithm (Abbott's NavX Precision or BiosenseWebster Carto3), guided by CT integration and intracardiac echo. Broad APs were documented in all these six patients (width range 2-15cm) and successfully ablated. In one P, the AP encompassed ¾ of the TA, resulting in a complete AV block after the procedure, having fitted a pacemaker. All P remained free from tachycardias during 15±8 months of follow-up, with the majority (n=12) having sinus rhythm with morphology of right bundle branch block, while three patients showed a narrow QRS.

Conclusions
RFCA in P with Ebstein anomaly is challenging, but safe, and has a high long-term success rate. APs are predominantly right-sided, manifest and localized to the lower half of the anatomic tricuspid annulus. Some APs have broad widths. In this population, the new high-resolution mapping catheters, using the open-window annotation, produce an improved anatomical resolution of the APs, increasing the odds of success.
Prognostic significance of addition of electrocardiographic findings to the MAGGIC heart failure risk score
Authors: Dogan O , Ikitimur B , Barman H A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None. Main funding source(s): Researchers

Background
The Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) is a scoring system that is easy to use in outpatient or inpatient settings and was developed to predict the survival of heart failure (HF) patients after hospitalization.

Aim
This study aims to determine the prognostic significance of MAGGIC risk score combined with electrocardiography (ECG) parameters in decompensated patients with heart failure with reduced left ventricular ejection fraction (HFrEF) who were hospitalized for worsening HF.

Methods
A total of 562 HF patients with New York Heart Association (NYHA) II-IV functional class who were discharged after hospitalization for decompensated HF between 2013 and 2018 in a single center were included. MAGGIC risk scores of all participating patients were calculated according to baseline characteristics gathered using data from the initial hospitalization for HF. In addition, electrocardiographic findings of all patients were examined.

Results
During the follow-up period (4.5 ± 1.2 years) 177 patients died. MAGGIC scores were observed to be higher in non-survivors compared to surviving patients (28.69 ± 7.01 vs. 22.82 ± 6.05, p &lt; 0.001). After a multivariate analysis, MAGGIC score (OR:1.090, p &lt; 0.001), development of cardio-renal syndrome (OR:2.035, p &lt; 0.001), presence of left bundle branch block (LBBB) (OR:1.931, p &lt; 0.001), atrial fibrillation (AF) (OR:1.817, p &lt; 0.001), and fragmented QRS (fQRS) (OR:1.671, p = 0.002) on ECG were found to be independent predictors of mortality. While the MAGGIC score was shown to predict mortality (AUC = 0.739), its predictive power was improved when combined with AF (AUC = 0.752), LBBB (AUC = 0.745), and fQRS (AUC = 0.757) respectively, as well as in the combined final model (MAGGIC score, AF, LBBB, fQRS) (AUC = 0.787).

Conclusions
Our findings showed that addition of electrocardiographic findings to the MAGGIC heart failure risk score has prognostic significance in decompensated patients with HFrEF.