bluuebunny/crossref_metadata_2025_split huggingface dataset:
Near-zero fluoroscopy during electroanatomic mapping-guided pediatric catheter ablation
Authors: Chipa Ccasani F , Cruzalegui Gomez J , Cesar Diaz S , Greco A , Martinez Barrios E , Fiol V , Cerralbo P , Campuzano Larrea O , Brugada Tarradellas J , Sarquella-Brugada G 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The use of fluoroscopy in pediatric catheter ablation has decreased because of mapping systems. However, the safety, feasibility and efficacy of the technique in pediatric populations have yet to be delineated.

Objective
In this study, we present the efficiency and reliability of the electroanatomic mapping system in near/zero fluoroscopic pediatric catheter ablation.

Methods
The medical records of patients aged &lt;18 years who underwent ablation between April 2022 and November 2022 were evaluated. Fluoroscopy was not used in cases involving ablation of right sided-arrhythmia foci. Fluoroscopy was used only for trans-septal puncture or retroaortic approach/coronary angiography.

Results
A total of 28 patients underwent catheter ablation for supraventricular and ventricular tachyarrhythmia substrates under the guidance of mapping system. Fluoroscopy was used in only 4 (14.2%) of these substrates. The mean fluoroscopy duration in these 4 procedures was 4.2±3.13 min. No complications were noted. The acute success rate in achieving complete elimination of arrhythmia substrates was 100%. The recurrence rate was 3,5% (1/28) at follow-up.

Conclusion
The fluoroscopy can be completely eliminated in most pediatric catheter ablation procedures with the use of mapping systems by achieving high acute success rates and this technique is safe, feasible and effective.
Feasibility and proof of concept of a proprietary non-contact ablation system with low intensity collimated ultrasound
Authors: Leshem-Rubinow E , Weizman A , Sela R , Margolis G 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Heailum Medical Inc.

Background
Utilization of collimated acoustic energy transition as an ablation energy source has the advantage of propagation through blood with negligible absorption. This allows delivery of non-contact, directional and precise ablation lesions to cardiac tissue. In addition, with dual mode ultrasound technology real-time monitoring of the tissue is possible during ablation.

Aim
To evaluate a proprietary ultrasound-based ablation system in swine and define the characteristics of the isolated ablation lesions and lines performed in-vivo.

Methods
In female large white swines, bilateral thigh muscle prep ablations were performed using different time and energy ablation parameters while tip to tissue distance measured with the imaging B-mode and set to 10mm. Lesions were analysed for maximal depth and width. Additional assessment for contiguous linear ablation was performed in the thigh muscle, SVC and within the coronary sinus with the transducer rotated to the endocardial direction. Tissue was fixed in formalin and gross pathological examination with lesion measurement was performed.

Results
36 distinct ablation lesions were performed in the thigh prep model. No steam pops were observed for any of the lesions. Mean necrotic lesion depth was 5.35 ± 1.5mm, with increased time with greater influence on dimensions compared to small changes in energy delivered (Figure 1). Reversible damage influenced additional 29% of tissue depth, while 55% additional tissue width was reversible. Linear ablation performed at 2.5mm inter-lesion distance showed contiguous lines, with transmural effect in both SVC and coronary sinus.

Conclusions
A novel ultrasound based catheter ablation has the ability for non-contact effective ablation in cardiac tissue with directional and tailored energy selection to achieve transmural atrial ablation. Additional in-vivo experimentation will allow refinement of this tool for both isolated lesions and linear ablation while enabling tissue visualization.
Severe complications after pulmonary vein isolation for atrial fibrillation: a worldwide collaborative registry
Authors: Du Fay De Lavallaz J , Badertscher P , Reichlin T , Sticherling C , Kuehne M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Swiss Heart Foundation

Background
Pulmonary vein isolation (PVI) is the most commonly performed electrophysiological procedure. Severe complications such as tamponade, stroke, cardiac arrest and death are believed to be uncommon but detailed assessment of these complications in very large worldwide cohorts is lacking.

Purpose
To investigate the incidence, predictors, patient characteristics, management details and outcome of severe complications (cardiac tamponade, stroke, cardiac arrest, death) after PVI in a large worldwide collaborative registry with comprehensive patient-level data.

Methods
We contacted electrophysiologists from an established PVI-collaborative network and invited further center to participate, thereby gathering individual patient-data from 23 centers worldwide. Few datapoints were collected for the overall patients and exhaustive details were entered in a dedicated database for patients experiencing a severe complication.

Results
From the 23 participating centers a total of 33,889 procedures could be collected (median age 63 y.o., 30% female, 27% cryoballoon ablations). The incidence of severe complications was low (tamponade 0.7% (7/1000 PVIs), stroke 0.089% (&lt;1/1000 PVIs) or cardiac arrest (0.035%, &lt;1/1000PVIs)), and death was extremely rare (1.18/10,000 PVIs), Figure panel A). Female sex (OR 1.7 95%-CI [1.3-2.2], p&lt;0.001), a dilated left atrium (OR 1.9 95%-CI [1.4-2.8], p&lt;0.001) and the use of radiofrequency (OR 1.8 95%-CI [1.3-2.7], p=0.002) appeared as strong predictors for the composite endpoint of all severe complications (Figure panel B). Critical steps during the ablation were transseptal puncture and energy delivery and 14% of all tamponades led to procedure abortion (Figure panel C). Among the patients experiencing a tamponade, 13% required cardiac surgery and perforations were predominantly found in the left atrial appendage and in the PVs during surgery (Figure panel D). Patient outcomes despite a severe complication were good with 93% of patients discharged directly home after a median length of stay of 5 days (IQR 3-7).

Conclusion
This very large worldwide collaborative study highlighted that tamponade, stroke, cardiac arrest or death are rare after PVI. Female sex and the use of radiofrequency catheters were associated with a higher risk of severe complications. A non-negligible percentage of patients required cardiac surgery after tamponade, where a perforation was most commonly found in the left atrial appendage and PVs.
Effectiveness of nurse-led interventions to manage hypertension and lifestyle behaviour effectively: a systematic review and meta-analysis
Authors: Bulto L , Roseleur J , Noonan S , Pinero De Plaza A , Champion S , Dafny H A , Pearson V , Nesbitt K , Gebremichael L , Beleigoli A , Schultz T , Hines S , Clark R , Hendriks J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Hypertension is a leading risk factor in the development and worsening of cardiac arrhythmias, in particular atrial fibrillation. Practice guidelines recommend an integrated management approach which includes multidisciplinary teams.

Aim
to investigate the role of nurses in the management process, and to evaluate the effectiveness of nurse-led interventions on hypertension management, lifestyle behaviour and associated patient knowledge.

Methods
A systematic review with meta-analysis was conducted following Joanna Briggs Institute (JBI) guidelines. MEDLINE (Ovid), Emcare (Ovid), CINAHL (EBSCO), Cochrane library and ProQuest (Ovid) were searched from inception to February 2022. Randomised controlled trials (RCTs) examining the effect of nurse-led interventions on hypertension management were identified. Title and abstract, and full text screening, assessment of methodological quality, and data extraction were conducted by two independent reviewers using JBI (Joanna Briggs Institute) tools. A statistical meta-analysis was conducted using RevMan version 5.4.1.

Results
A total of 37 RCTs and 9,731 participants were included. The overall pooled data demonstrated nurse-led interventions significantly improved systolic blood pressure (MD -5.39; 95% CI -7.59, -3.34; I2 = 81.33; 23 RCTs; moderate certainty evidence) and diastolic blood pressure (MD –1.94 95% CI -3.27, -0.60; I2 = 79.66; 22 RCTs; moderate certainty evidence) compared to usual care. The duration of interventions contributed to the magnitude of blood pressure reduction. Nurse-led interventions effectively modified diet and physical activity, but the effect on smoking and alcohol consumption was inconsistent.

Conclusion
This review revealed beneficial effects of nurse-led interventions in hypertension management compared to usual care. Integration of nurse-led interventions in routine hypertension treatment and prevention services could play an important role in alleviating the rising global burden of hypertension and conditions it may be associated with.
Does Rassi score caracterize patients with Chagas disease with complex ventricular arrhythmias?
Authors: Costa P , Moreira D , Serafim K , Habib R , Sierra Reyes C , Andalaft R , Berbert G , Fragata C , Sassaki E , Lopes H , Armaganijan L , Valdigem B 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Rassi score (NYHA functional class III/IV HF [5 points], cardiomegaly [5 points], contractions abnormalities [3 points], non-sustained ventricular tachycardia [3 points], low amplitude QRS [2 points] and male sex [2 points]) is used in the clinic for risk stratification due to cardiovascular death in patients with Chagas disease (P-CD). Whether this score has any role in identifying patients at risk of complex ventricular arrhythmias has not been determined.

Objective
Assess whether there is an association between Rassi score and the presence of potentially malignant complex ventricular arrhythmias in P-CD.

Methods
79 P-CD (34 men, age 61±11 years-old), consecutively referred for 24h-Holter were divided into 2 groups: low risk Rassi score (57 P, 0-6 points) and medium-high risk (22 P, 7-20 points). The amount and complexity of ventricular arrhythmia (&gt; 30/ h, ventricular tachycardia [VT]), LVEF, heart rate turbulence (HRT) indexes (turbulence onset [TO] and turbulence slope [TS]) and HRT category (0 [without disautonomy], 1 and/or 2 [presence of disautonomy]) were evaluated.

Results
Compared to P-CD with low risk score, those with medium-high risk had more ventricular arrhythmias, lower LVEF, worse HRT indexes and more HRT categories 1 and/or 2 (see table below).

Conclusions
1) P-CD and Rassi score of medium to high risk have a greater amount of ventricular arrhythmias; 2) These findings can be explained by the presence of greater degree of disautonomy, assessed by HRT, and by the lower LVEF; 3) Prospective studies are necessary to confirm these findings in clinical practice.
Role of periprocedural HV interval assessment to determine the risk of atrioventricular block after transcatheter aortic valve replacement
Authors: Pagnoni M , Meier D , Luca A , Fournier S , Aminfar F , Maurizi N , Cook S , Goy J J , Togni M , Pruvot E , Muller O , Pascale P 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Fondation vaudoise de cardiologie interventionnelle.

Background
The identification of patients at risk of post-procedural high-grade atrio-ventricular block (HAVB) is one of the major unmet challenges in transcatheter aortic valve replacement (TAVR). Some studies have suggested that periprocedural electrophysiological (EP) testing might help to identify patients at risk, but its role is controversial.

Purpose
To determine whether the immediate postvalve deployment HV and the Delta-HV interval (difference between post- and prevalve deployment HV interval) are predictive of HAVB and pacemaker (PM) need over 1 year follow-up.

Methods
We prospectively analysed consecutive patients undergoing TAVR between August 2019 and October 2021, and without prior PM implantation. ECG and standardized HV interval measurements were performed pre- and postvalve deployment with the quadripolar catheter used for rapid pacing. The primary outcome was either documented HAVB beyond 24h after TAVR or ventricular pacing &gt;1% in patients who underwent prophylactic PM implantation because of abnormal EP testing in the days following TAVR. Minimal follow-up was 12 months.

Results
97 patients were included. The primary outcome occurred in 8 patients (8.3%): HAVB occurred in 7 patients (5 during hospitalisation and 2 within one month of follow-up), and 1 patient underwent PM implantation because of abnormal EP testing (HV interval≥70 ms) with ventricular pacing up to 11% despite an algorithm to minimize pacing. Among ECG and EP findings, univariate predictors of the primary outcome were the pre- and postvalve deployment PR interval and both the postvalve deployment HV and Delta-HV interval (Table 1). By ROC analysis, a Delta-HV interval ≥18ms predicted HAVB with 50% sensitivity and 90% specificity (AUC=0.708, PPV 31%), and an HV interval ≥ 60ms after TAVR predicted HAVB with 63% sensitivity and 79% specificity (AUC=0.681, PPV 21%) (Figure 1).

Conclusion
The yield of the periprocedural HV interval assessment alone is limited in ruling out the risk of HAVB since about half of the patients at risk fail to be identified. However, abnormal postvalve deployment HV or Delta-HV interval may identify a subgroup at particularly higher risk, with up to one third of HAVB during follow-up.
Seasonality and competition select for variable germination behavior in perennials
Authors: ten Brink Hanna , Haaland Thomas R , Massol François , Opedal Øystein H 
Published: May 2023

Abstract
The occurrence of within-population variation in germination behavior and associated traits such as seed size has long fascinated evolutionary ecologists. In annuals, unpredictable environments are known to select for bet-hedging strategies causing variation in dormancy duration and germination strategies. Variation in germination timing and associated traits is also commonly observed in perennials and often tracks gradients of environmental predictability. Although bet-hedging is thought to occur less frequently in long-lived organisms, these observations suggest a role of bet-hedging strategies in perennials occupying unpredictable environments. We use complementary analytical and evolutionary simulation models of within-individual variation in germination behavior in seasonal environments to show how bet-hedging interacts with fluctuating selection, life-history traits, and competitive asymmetries among germination strategies. We reveal substantial scope for bet-hedging to produce variation in germination behavior in long-lived plants, when “false starts” to the growing season results in either competitive advantages or increased mortality risk for alternative germination strategies. Additionally, we find that lowering adult survival may, in contrast to classic bet-hedging theory, result in less spreading of germination by decreasing density-dependent competition. These models extend insights from bet-hedging theory to perennials and explore how competitive communities may be affected by ongoing changes in climate and seasonality patterns.
Episcopal entries and urban liberties in late medieval and Renaissance France, c. 1200–c. 1600
Authors: Murphy Neil 
Published: May 2023

Abstract
In comparison to the ceremonial entries of French kings, little work has been done on episcopal entries. Whereas royal entries underwent a period of massive elaboration during the later Middle Ages and Renaissance, there was less change to bishops’ entries during this period, especially in towns where civic administrations used these ceremonies to compel bishops to acknowledge their rights. While less susceptible to modification than royal entries, important changes did occur to the episcopal entry by the later sixteenth century because of the increased Counter-Reformation emphasis on the power of the bishop, as well as the impact of the Wars of Religion. By the seventeenth century, the requirement to confirm urban liberties at entries was far less a part of an episcopal entry than it had been during the heights of this ceremony during the later Middle Ages. Nonetheless, the episcopal entry remained an important way for towns to recruit brokers.
An efficient algebraic multi-resolution sampling approach to 3-D magnetotelluric modelling
Authors: Li Jian , Guo Rongwen , Liu Jianxin , Wang Yongfei , Wang Xulong 
Published: May 2023

SUMMARY
Since electromagnetic (EM) fields diffuse more smoothly to greater depth, it physically makes sense to apply fine discretization to model structure at near surface with an increasingly coarser grid both in horizontal and vertical directions as the depth increases for the numerical solution of EM fields. For finite-difference magnetotelluric (MT) forward modelling on regular staggered grids, this can lead to difficulties in discretizing the curl–curl equation governing the EM diffusion in the earth at regions, where the grid resolution changes. In this paper, we propose an efficient algebraic multi-resolution sampling (MRS) method for MT forward modelling. In this method, we do not require the generation of physical subgrids and merely subsample the field components. The coefficient matrix for the subsampled components can be obtained by matrix multiplication based on the initial linear system of equations and field interpolation. To guarantee divergence-free current during the iterative solution process at low frequencies, which is considered crucial for the development of efficient iterative solvers, our forward modelling is based a regularization equation obtained by augmenting the curl–curl equation with an equivalent scaled grad–div operator for electrical fields (explicitly enforcing the divergence-free condition). The correctness of our algebraic MRS algorithm is examined based on a layered model. Its stability and efficiency is exploited by comparing our results with the forward modelling on unsampled staggered grids for the Dublin Test Model 1 (DTM1) and a complex model with realistic topography, indicating a time reduction of about 42–82 per cent.
Seasonal Malaria Chemoprevention Drug Levels and Drug Resistance Markers in Children With or Without Malaria in Burkina Faso: A Case-Control Study
Authors: Roh Michelle E , Zongo Issaka , Haro Alassane , Huang Liusheng , Somé Anyirékun Fabrice , Yerbanga Rakiswendé Serge , Conrad Melissa D , Wallender Erika , Legac Jennifer , Aweeka Francesca , Ouédraogo Jean-Bosco , Rosenthal Philip J 
Published: May 2023

Abstract

Background
Despite scale-up of seasonal malaria chemoprevention (SMC) with sulfadoxine-pyrimethamine and amodiaquine (SP-AQ) in children 3–59 months of age in Burkina Faso, malaria incidence remains high, raising concerns regarding SMC effectiveness and selection of drug resistance. Using a case-control design, we determined associations between SMC drug levels, drug resistance markers, and presentation with malaria.

Methods
We enrolled 310 children presenting at health facilities in Bobo-Dioulasso. Cases were SMC-eligible children 6–59 months of age diagnosed with malaria. Two controls were enrolled per case: SMC-eligible children without malaria; and older (5–10 years old), SMC-ineligible children with malaria. We measured SP-AQ drug levels among SMC-eligible children and SP-AQ resistance markers among parasitemic children. Conditional logistic regression was used to compute odds ratios (ORs) comparing drug levels between cases and controls.

Results
Compared to SMC-eligible controls, children with malaria were less likely to have any detectable SP or AQ (OR, 0.33 [95% confidence interval, .16–.67]; P = .002) and have lower drug levels (P &lt; .05). Prevalences of mutations mediating high-level SP resistance were rare (0%–1%) and similar between cases and SMC-ineligible controls (P &gt; .05).

Conclusions
Incident malaria among SMC-eligible children was likely due to suboptimal levels of SP-AQ, resulting from missed cycles rather than increased antimalarial resistance to SP-AQ.
Target trial emulation to assess real-world efficacy in the Epidemiological Strategy and Medical Economics metastatic breast cancer cohort
Authors: Antoine Alison , Pérol David , Robain Mathieu , Delaloge Suzette , Lasset Christine , Drouet Youenn 
Published: May 2023

Abstract

Background
Real-world data studies usually consider biases related to measured confounders. We emulate a target trial implementing study design principles of randomized trials to observational studies; controlling biases related to selection, especially immortal time; and measured confounders.

Methods
This comprehensive analysis emulating a randomized clinical trial compared overall survival in patients with HER2-negative metastatic breast cancer (MBC), receiving as first-line treatment, either paclitaxel alone or combined to bevacizumab. We used data from 5538 patients extracted from the Epidemiological Strategy and Medical Economics–MBC cohort to emulate a target trial using advanced statistical adjustment techniques including stabilized inverse-probability weighting and G-computation, dealing with missing data with multiple imputation, and performing a quantitative bias analysis for residual bias due to unmeasured confounders.

Results
Emulation led to 3211 eligible patients, and overall survival estimates achieved with advanced statistical methods favored the combination therapy. Real-world effect sizes were close to that assessed in the existing E2100 randomized clinical trial (hazard ratio = 0.88, P = .16), but the increased sample size allowed to achieve a higher level of precision in real-world estimates (ie, reduced confidence intervals). Quantitative bias analysis confirmed the robustness of the results with respect to potential unmeasured confounding.

Conclusion
Target trial emulation with advanced statistical adjustment techniques is a promising approach to investigate long-term impact of innovative therapies in the French Epidemiological Strategy and Medical Economics–MBC cohort while minimizing biases and provides opportunities for comparative efficacy through the synthetic control arms provided.

Database registration
clinicaltrials.gov Identifier NCT03275311.