bluuebunny/crossref_metadata_2025_split huggingface dataset:
Are reentrant atrial tachycardias sensitive to adenosine administration?
Authors: Guido Lopez L E , Martinez Cossiani M , Merino D , Martinez Maldonado M E , Castrejon Castrejon S , Jauregui Abularach M , Escobar Cervantes C , Carton Sanchez A J , Ugueto Rodrigo C , Cobarro Galvez L , Contreras Lorenzo C , Severo Sanchez A , Rivero Santana B , Juarez Olmos V , Merino Llorens J L 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Adenosine (ADN) infusion may terminate focal atrial tachycardia (AT). However, the effect of ADN on reentrant atrial tachycardia (RAT) is unclear and based on case reports and small series. These latter included mostly patients with cavotricuspid isthmus-dependent atrial flutter and provided conflicting results, with RAT termination found when it involved the septal or the tricuspid/mitral valve regions.

Purpose
The aim of this study was to test the response (termination, transient suppression or no effect) to ADN infusion on RATs and to evaluate differences according to the AT location.

Methods
The effect of ADN was prospectively studied at the time of catheter ablation in consecutive patients with AT. Only patients with RAT were included. This latter mechanism was established by activation and entrainment mapping and confirmed by catheter ablation. A 10 mg adenosine 5'-triphosphate (ATP) bolus was administered in all to evaluate the effects on AT cycle length and termination. Additional ATP bolus of 20 or 30 mg was administered if no AV block for at least 2 secs was obtained with the former ones.

Results
58 patients (67, ±13 years old; 11 female) with 79 RAT were included. 38 RATs were right sided (34 cavotricuspid isthmus-depend atrial flutters, 1 lateral right atrium reentry, 1 upper loop reentry, 1 superior vena cava reentry, and 1 septal reentry around the coronary sinus) and 41 were left sided (21 perimitral reentry, 16 peripulmonary vein reentry and 4 with a small free wall reentry). No RAT was terminated or had a &gt;20 ms cycle length prolongation following ADN administration. There was no transformation of the RAT into other mechanisms of AT or atrial fibrillation by ADN in any case. There were no complications.

Conclusion
RATs are insensitive to ADN infusion, with neither termination nor cycle length prolongation.
Electroanatomical mapping-system guided vs. intracardiac echocardiography-guided slow pathway ablation: a randomized, single-center trial
Authors: Bocz B , Debreceni D , Janosi K , Simor T , Kupo P 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Radiofrequency (RF) catheter ablation of the slow pathway (SP) in atrioventricular nodal reentry tachycardia (AVNRT) is highly effective; however, it may require prolonged fluoroscopy and RF time. Procedural outcomes may improve by using electroanatomical mapping systems (EAM), and/or intracardiac echocardiography (ICE).

Purpose
Our aim was to compare EAM-guided vs. ICE-guided approach for SP ablation in patients with AVNRT.

Methods
In our single-center study, 65 patients underwent SP ablation due to AVNRT were randomized to ICE-guided or EAM-guided groups. Procedural outcomes (total procedure time, puncture-to-mapping time, mapping-to-last ablation time), fluoroscopy parameters (total fluoroscopy time, radiation dose) and ablation data (number of RF applications, total ablation time) were analyzed.

Results
ICE guidance reduced puncture-to-mapping time (39.6±7.6 min vs. 32.7±8.2 min; p&lt; 0.001) and total procedure time (68.5 (62.8; 75.3) min vs. 59.5 (56;64) min; p&lt; 0.001). Total fluoroscopy time was shorter (0 (0;0) sec vs. 79 (61; 121.5) sec; p&lt; 0.001), and radiation dose was lower (0 (0;0) mGy vs. 3.1 (2.2; 4.5) mGy; p&lt; 0,001) with the use of EAM. No significant difference was detected regarding mapping-to-last ablation time (6 (2.5;17,0) min vs. 3 (2; 8.3) min; p= 0.13), the number of RF applications (5 (3; 7) vs. 3.5 (3; 5.5); p= 0.30), and total ablation energy (3625 (2513; 5402) J vs. 2676 (1912.5; 5291.5) J; p= 0.10), however total ablation time was shorter in the ICE-guided group (127.5 (86.8; 181) sec. vs. 98.5 (81; 193.5) sec; p= 0.04). No complication occurred. Acute success rate was 100% and there was no recurrence during the follow up.

Conclusions
In our randomized trial enrolled 65 patients underwent SP ablation due to AVNRT, EAM-guided approach reduced fluoroscopy time and fluoroscopy dose, however total procedural, puncture-to-mapping time, as well as total ablation time was longer compared to the ICE-guided group.
A focus on pregnancy course and outcomes in women with complete atrioventricular block: a single center experience
Authors: Abdrakhmanov A , Ainabekova B , Nuralinov O , Smagulova A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
arrhythmias are the most common cardiac complication in pregnant. However, data on pregnancy course and outcomes of women with bradyarrhythmias is limited.

Purpose
we aimed to determine pregnancy course and both maternal and fetal outcomes in women with complete atrioventricular block.

Methods
Out of the 122 pregnant with arrhythmias within the study period of January 2015 to December 2021, 11 patients with complete atrioventricular block were included in this prospective study (study group). All pregnant were without structural pathology of the heart. Clinical signs, treatment as well as outcome data were recorded. Results were compared with the control group (other types of arrhythmias).

Results
The median age was 25.8 (inter-quartile range 3.1) years, the median gestation age was 18.3 (inter-quartile range 2.8) weeks. Unpaced pre-existing congenital heart block were in three cases (27.3%). In eight women atrioventricular block diagnosed for the first time during gestation (72.7%). All patients in study group had varying symptoms of arrhythmia like dizziness, presyncope and syncope. Course of gestation characterized with increased incidences of uterine contractile activity in women with complete atrioventricular block (27.3% vs 2.1%, p&lt;0,001). Implantation of pacemaker was performed in all cases of complete atrioventricular block in pregnant patient. Implantation procedure carried with minimal fluoroscopy with echocardiographic guidance and EnSite NavX mapping system. There were no any procedure related complication and termination of pregnancy. Uterine blood flow violation was numerically lower in study group, although statistically differences not found. In the majority of cases were vaginal delivery at 39,4±1,8 weeks of gestation in both groups (82% vs 85%, p=0.548). All infants were live-born and without malformation. Incidences of placental abruption and preeclampsia were significantly higher in women with complete atrioventricular block (18.2% vs 2.13%, p&lt;0,001). There were no maternal and fetal mortality in both group.

Conclusions
Complete atrioventricular block is rare in pregnant. Despite increased incidence of uterine contractile activity, placental abruption and preeclampsia in women with complete atrioventricular block, neonatal outcome is benign.
Does optimized daytime/nighttime programming reduce insertable cardiac monitor event burden?
Authors: Burke M , Rajan A , Perschbacher D , Mahajan D , Herrmann K 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Boston Scientific.

Background
Insertable Cardiac Monitors (ICM) are widely used for long term cardiac arrhythmia monitoring and diagnosis. ICMs can generate episodes (and associated alerts) that are non-actionable from a clinical standpoint leading to alert fatigue. In particular, non-actionable bradycardia and pause events may occur at nighttime due to reduced sympathetic tone during sleep. We have used stored auto-detected events to better understand optimal programming with nighttime settings to eliminate potentially clinically non-actionable episodes and improve clinic workflow.

Objective
Evaluate the reduction in clinic episode review burden in bradycardia (brady) and pause episodes with a new daytime/nighttime programming optimization in LUX-Dx ICM.

Methods
We analyzed data from 2,555 patients implanted with LUX-Dx ICM that included 132,928 detected brady and pause episodes stored remotely. We evaluated optimized settings with separately programmed nocturnal (11p-7a) and nominal daytime (7a-11p) rates and durations as compared to full-time nominal settings (24-hour nominal). Optimized nocturnal programming was set to trigger event storage on a heart rate setting of ≤30 bpm as well as a duration setting of ≥5s for nocturnal brady and pause episodes. The nominal day time and 24-hour settings for brady and pause episodes were HR ≤40bpm and duration ≥3s. The episode burden was analyzed retrospectively using stored episodes comparing optimized versus full-time nominal programming.

Results
A simulation using the optimized settings showed that 98% and 90% of the nocturnal bradycardia (n = 1909) and pause episodes (n = 1198) had a HR &gt;30bpm, and duration &lt;5s respectively. As a result, the optimized settings for nocturnal episodes reduced 75% and 56% of bradycardia and pause episodes, respectively. (See Figure 1). At a patient level, 63% and 25% of patients had a substantial reduction (&gt;=50%) in brady and pause episodes, respectively.

Conclusion
The optimized programming settings, which simply adjusts for nocturnal physiology, may substantially improve clinical workflow by reducing potentially clinically non-actionable episodes and associated alerts detected by the LUX-Dx ICM. More clinical correlative studies are needed to understand patient risk.
Genetic testing in children with Brugada syndrome: results from a large prospective registry
Authors: Pannone L , Osey R , Gauthey A , Sorgente A , Della Rocca D G , Overeinder I , Bala G , Almorad A , Stroker E , Sieira J , La Meir M , Brugada P , Chierchia G B , Van Dooren S , De Asmundis C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/introduction
A pathogenic/likely pathogenic (P/LP) variant can be found in 20-25% of patients with Brugada syndrome (BrS) and a P/LP variant in SCN5A is associated with a worse prognosis. However, the diagnostic yield and the prognosis of gene testing in pediatric BrS syndrome is unclear.

Purpose
The aim of this study is to define the diagnostic yield of SCN5A gene testing with ACMG standardized variant classification in a large cohort of pediatric BrS. Furthermore, a correlation between the clinical outcomes and the genetic background of children with BrS in comparison with adult BrS is aimed.

Methods
All consecutive patients diagnosed with BrS, between 1992 and 2022 were enrolled in a prospective monocentric registry. Inclusion criteria were: 1) BrS diagnosis; 2) Genetic analysis for SCN5A gene and 3) classification of gene variants following current ACMG guidelines. Pediatric patients were defined if ≤ 12 years of age. The primary endpoint was ventricular arrhythmias (VA) occurrence, defined as documented SCD, aborted SCD, ventricular tachycardia or ventricular fibrillation or appropriate ICD intervention.

Results
A total of 500 BrS patients were included, 41 pediatric patients and 459 adult patients.
Among children with BrS, 19 patients (46.3%) had a P/LP variant (P+) in SCN5A gene. No P/LP variants could be identified in 22 (53.7%) pediatric patients (P-). After a mean follow-up of 140.2 months, 3 children (7.3%) experienced a VA, treated with appropriate ICD shock. Inappropriate shocks occurred in 3 pediatric patients (7.3%). At survival analysis, P- pediatric patients had higher VA free survival during the follow-up, compared with P+ pediatric patients (Log-Rank p=0.021), Figure 1. There was no difference in VA free survival between pediatric and adult BrS patients both without (P-), (Log-Rank p=0.19) and with (P+) a P/LP variant (Log-Rank p=0.91), Figure 2.

Conclusion
In a large BrS cohort, the diagnostic yield for SCN5A P/LP variants in the pediatric population is 46.3%. P+ children with BrS have a worse arrhythmic prognosis.
The V1 transition ratio: electrocardiographic criterion for predicting the success of ablation for outflow tract premature ventricular contractions
Authors: Ohya H 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Several electrocardiographic (ECG) criteria have been proposed for distinguishing left from right ventricular outflow tract premature ventricular contractions (OTPVCs) origins. However, electrocardiographic criteria predicting successful catheter ablation (CA) for OTPVCs are still unknown regardless of right and left ventricular origins.

Methods
We enrolled 63 patients who underwent CA for OTPVCs from September 2020 to August 2022, except patients with bundle branch block and axis deviation in 12-lead ECG. Radiofrequency catheter ablation (RFCA) was performed using 3D-mapping system and irrigation catheter.
Electrocardiographic parameters of successful and unsuccessful patients were retrospectively analyzed. The transition ratios were calculated by the percentage R-wave during PVC (R/R+S) PVC divided by the percentage R-wave in sinus rhythm (R/R+S) SR . Success of CA for OTPVCs was defined as absence of targeted PVCs during all follow up visits and PVC burden &lt;5% on follow-up period.

Results
54 patients (85.7%) were success and 9 patients (14.3%) were unsuccess. Age, sex, Ejection Fraction (EF) and the burden of PVCs before CA were similar between 2 group. (Age: 50±15 vs 54±12 years, p=0.51, male: 46.3 vs 53.7%, p=0.73, EF: 66(58-73) vs 69(59-74), p=0.52, burden of PVCs: 22(17-29) vs 15(13-33)%, p=0.45). V1 transition ratio of unsuccessful group was significantly higher than successful group. (0.70(0.32-1.49) vs 1.55(1.09-9.37), p=0.013) V2 and V3 transition ratios were not significantly different between the two groups. The best cutoff values of V1 transition ratio were 1.0 (AUC 0.78, 95%CI: 0.61-0.94, sensitivity 0.70, specificity 0.88).

Conclusion
V1 transition ratio&gt;1.0 is more likely to be associated with a higher rate of RFCA failure of OTPVCs.
The long-term outcome of malignant outflow tract ventricular tachycardia in patients without structural heart disease
Authors: Kim Y R , Lee K H , Yoon N S , Park H W , Cho J G 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Idiopathic ventricular tachycardia (VT) originating from the outflow tract (OT) is usually considered a benign condition. However, in some rare cases, patients with the malignant OT-VT suffer from syncope or even sudden cardiac death (SCD).

Objectives
The purpose of this study was to clarify the long-term clinical outcome of catheter ablation for malignant OT-VT with no sturctural heart disease (no SHD).

Methods
Fifty two consecutive patients (28 women and 24 men; mean age, 45 years; range, 20-77 years) ablated or implanted cardiac defibrillator (ICD) for malignant OT-VT were followed for median 5 years from 2001 to 2019. Primary end point defined recurrent VT/VF episodes.

Result
All 52 patients underwent electrophysiologic study (EPS). Among these patients, catheter ablation successfully elimiated VT focus in 37 (71.2%), partially suppressed VT in 9 (17.3%), and failed to controll VT in 6 (11.5%) [5 of 6 failed to induce clinical tachcyardia and 1 of 6 failed to ablate VT due to multipe PVC]. There was no acute procedureal complication. ICDs were implanted in 16 patients. 12 of these 16 patients were presented with VF or SCD. One of these 16 patients had recurrent VT in 3 years after ablation and three of 16 patients failed to induce clinical tachcyardia. During a mean follow up 58 months (range, 6-161 months), 19 (36.5%) of 52 patients suffered from recurrent VT/VF episodes. Among the 37 patients with successful ablation, 10 (27.0%) patients reached primary endpoints. More importantly, two patients (with only syncope and no prior VF) experienced SCD, one at 6 years after a successful ablation and the other at 3 years after partially modification of VT focus.

Conclusion
Catheter ablation for the malignant OT-VT in patients with no SHD showed safe and tolerable outcomes. It may consider as an early treatment option for these patients. However, even after the successful ablation, a periodical follow-up is crucial in some patients for preventing sudden cardiac deaths.
Ventricular tachycardia site of origin prediction by a QRS axis-based algorithm confirmed by heterogenous tissue channel localization obtained from artificial-intelligence-powered CMR analysis
Authors: Mazzocchetti L , Parollo M , Sbragi S , Barletta V , Segreti L , Di Cori A , De Lucia R , Grifoni G , Soldati E , Viani S , Branchitta G , Carluccio M , Canu A , Paperini L , Zucchelli G 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
A previously validated algorithm allows to accurately identify ventricular tachycardia (VT) exit site in a 17-segments American Heart Association left ventricle model in patients with structural heart disease (SHD). ADAS3D is a novel artificial-intelligence cardiac magnetic resonance (CMR) post-processing software which enables heterogeneous tissue channel (HTC) identification.

Purpose
The aim of this study is to compare inferred VT exit site between QRS-axis based model and HTC identification from CMR post-processing.

Methods
All subjects allocated to a CMR-guided or aided approach from a multicenter randomized clinical trial were analyzed. Patients with available 12-lead ECG of clinical VT obtained before ablation were analyzed in terms of concordance between VT site of origin inferred from a QRS-axis and location of HTCs in a 17-segments model.

Results
10 out of 15 patients had 12-lead ECG of clinical VT (80% male, 60% with ischemic cardiomyopathy, mean age 63,5±16,95 years, mean tachycardia cycle length 373,7±99,55 ms). 7 out of 10 patients (70,00%) had at least one HTC located at VT exit site as predicted by a QRS axis-based algorithm. In all remaining cases (3 out of 10) HTC location was found in a segment adjacent to ECG-derived exit site. All patients underwent CMR-guided or CMR-aided VT ablation with acute clinical success (noninducibility of the clinical VT).

Conclusion
VT site of origin prediction via a QRS axis-based algorithm allows for reasonable prediction of HTC presence at inferred site of origin. Larger studies are needed in order to confirm such findings and their potential clinical implications.
Automated external defibrillator delivery by a drone in a mountainous region to treat sudden cardiac arrest
Authors: Fischer P , Rohrer U , Nuernberger P , Manninger M , Scherr D , Von Lewinski D , Zirlik A , Wankmueller C , Kolesnik E 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): ZOLL

Introduction
Out-of-hospital cardiac arrest (OHCA) poses a tough medical challenge with poor survival rates. Factors that may enable survival include resuscitation measures initiated by a bystander, early use of an automated external defibrillator (AED), and further performance of advanced life support. The latter will arrive on scene with an inevitable time-delay due to logistics challenges and potential AED unavailability, especially in rural areas. Here, drones might deliver an AED in order to increase the probability of survival.

Methods
Ten paramedics and nineteen medical laypersons were confronted with a person suffering from OHCA within a field test scenario in a mountainous region (Bodental, Carinthia, Austria) without detailed information. The scenario included a mock-call to the emergency response center responsible for the Austrian State Carinthia that dispatched a semi-autonomously flying drone towards the caller’s GPS coordinates. During the emergency call, participants should perform cardiopulmonary resuscitation (CPR) measures and were informed that a drone delivers a training-AED. Various timepoints (time to (tt) emergency call, tt start CPR, tt drone start, tt first shock, hands-off times) as well as CPR quality were subject of analysis.

Results
The paramedics realized the cardiac arrest after 21 ± 11 seconds, the emergency call was performed after 40 ±43 seconds, the drone started after 5:15 ± 2:11 minutes and dropped off the AED after 10:52 ± 2:06 minutes, and the first shock was delivered after 12:15 ± 2:03 minutes. 70 % performed adequate chest compressions and 50 % provided sufficient mouth-to-mouth ventilation. Hands-off times were 50 ± 22 seconds. Only 37 % of the medical laypersons reported to know the algorithms for basic life support while 32 % performed adequate chest compressions and 68 % performed adequate mouth-to-mouth ventilation. In this group, the cardiac arrest was realized after 51 ±40 seconds, the emergency call was performed after 53 ±43 seconds, the drone started after 6:15 ± 1:33 minutes and dropped off the AED after 10:54 ± 1:56 minutes, and the first shock was delivered after 14:04 ± 2:10 minutes. Hands-off times were 2:11 ± 0:39 minutes.

Conclusion
The delivery and usage of an AED via a semi-autonomously flying drone in a remote region is feasible and safe. The drone delivery of an AED in mountainous regions can lead to early application of shocks. CPR quality performed by medical laypersons is suboptimal and emphasises the need for regular trainings.
Zero and near zero fluoroscopy catheter ablation of premature ventricular contractions: a multicentre experience
Authors: Mugnai G , Velagic V , Malagu M , De Asmundis C , Tomasi L , Bolzan B , Chierchia G B , Ribichini F L , Stroker E , Bertini M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Catheter ablation has become an established treatment option for premature ventricular complexes (PVCs). It is well known that the use of fluoroscopy exposes patients and medical staff to potentially harmful stochastic and deterministic effects of ionising radiations.

Purpose
We sought to analyse procedural outcomes in terms of safety and efficacy using a "zero" or "near zero" X rays approach for treatment of PVCs.

Methods
The present retrospective, multicentre, observational study included 131 patients having undergone catheter ablation of PVCs using zero or "near zero" (less than 2 minutes) fluoroscopy between 2016 and 2020. Baseline characteristics of the population, acute success and complications derived from the procedure were evaluated, as well as recurrence rate during follow-up.

Results
Median age was 51.0 years old [38-63], males were 77 (58.8%). Most often cause of ablation were palpitations (90.0%), followed by reduced left ventricular ejection fraction (4.6%) and pre-syncope (14.5%). Among the study population, 26 (19.8%) had a cardiopathy. The median PVC burden before ablation was 15.1% [6%-22.4%]. The most frequent PVC origin was right ventricular outflow tract (n=72; 55.0%) followed by the left ventricle (n=21; 16.0%), LVOT and cusps (n=18; 13.7%) ,aortomitral continuity (n=7; 5.3%).
A 3D electro-anatomical mapping system was used in all cases as well as a contact force catheter for mapping and ablation. The mean maximum radiofrequency power applied was 32.9 ± 4.1 W (370 s median time). Median number of applications was 4.5 and mean total procedural time was 117.3 ± 47.5 minutes. Median best prematurity was 31.5 ms. We used isoprenaline in order to induce PVCs in 42% of cases and suppression of PVC was achieved in 127 patients (96.9%). There was only 2 complication (femoral hematoma and arteriovenous fistula conservatively treated). At 12 months, a complete success was documented in 109 patients (83.2%), a reduction in PVC burden was achieved in other 18 patients (13.7%) and a failure was recorded in 4 patients (3.1%).

Conclusion
The PVC ablation with "zero" or "near-zero" fluoroscopy is a safe procedure with no major complications and good rates of success and recurrence in our multicentre experience.