bluuebunny/crossref_metadata_2025_split huggingface dataset:
P101 HIGH–DENSITY MAPPING OF KOCH‘S TRIANGLE DURING SINUS RHYTHM AND TYPICAL AV NODAL REENTRANT TACHYCARDIA INTEGRATED WITH THE DIRECT RECORDING OF ATRIOVENTRICULAR NODE STRUCTURES POTENTIAL: A MULTICENTER NON–RANDOMIZED STUDY
Authors: Matteucci A , Russo M , Galeazzi M , Botto G , Castro A , Zingarini G , Del Giorno G , Papa A , Di Belardino N , Segreti L , Pepi P , Casale M , Treglia S , Nicolis D , Carbone A , Lavalle C , Malacrida M , Pandozi C , Colivicchi F 
Published: May 2023

Abstract

Background
Atrioventricular nodal re–entrant tachycardia (AVNRT) is humans‘ most frequent regular tachycardia. Nevertheless, understanding the exact mechanism and pathways involved in the circuit that sustains the arrhythmia is still incomplete. Also, the recording of nodal potential was performed previously in animals with relative success, but not in humans. The aim of our study is to identify the potential of the compact atrioventricular node (AVN) and inferior extensions by using an electroanatomic mapping of the right atrium and the Koch‘s triangle in sinus rhythm and during AVNRT.

Methods
From March 2021 to July 2022, 79 patients with AVNRT underwent high–resolution mapping and complete ablation in 12 Italian Hospitals. No patients with atrial fibrillation or sustained ventricular tachycardia were included. The diagnosis of AVNRT was established according to standard criteria and diagnostic pacing manoeuvres. The presence and location of SP potentials, i.e., Jackman potential (JP) and Haïssaguerre potential (HP) were evaluated in each patient. The electroanatomic mapping obtained were merged with cardiac computerized tomography (CT) scan.

Results
Forty–five cases of successful AVNRT ablation were included in the analysis. The AVN potential has been demonstrated to be a very low frequency signal distinct from atrial, His bundle or ventricular activations, that can be recorded from electrodes overlying the region of the compact AVN by using a non–conventional bipolar electrogram filtering both during sinus rhythm and slow fast AVNRT. AVN potential was identified in all cases in the mid–septal region (#5) in both sinus rhythm and tachycardia. The mid–septal region and the postero–septal regions (#7) bounded anteriorly by the tricuspid annulus and posteriorly by the lateral wall toward the crista terminalis showed a higher prevalence of HP than other regions (46.7% in region #5 and 51.1% in region #7, p&lt;0.0001 vs other regions, respectively). JPs seemed to have a converse distribution across the KT and they were mainly observed in the mid–postero–septal region (73.3%). After 359±121 days of follow–up, no patients had a recurrence of AVNRT.

Conclusion
The exact anatomical site and pathways involved in AVNRT are still unclear as well as the analysis and characterisation of the AVN potential. Our results represent the first evidence of the recording of AVN potential. Further studies and technological improvements are needed to confirm our results.
P102 DIFFERENCES IN HIGH–DENSITY MAPPING OF KOCH‘S TRIANGLE DURING TYPICAL AV NODAL REENTRANT TACHYCARDIA INTEGRATED AND NOT INTEGRATED WITH DIRECT RECORDING OF ATRIOVENTRICULAR NODE STRUCTURES POTENTIAL: A MULTICENTER NON–RANDOMIZED STUDY
Authors: Matteucci A , Galeazzi M , Russo M , Botto G , Castro A , Zingarini G , Del Giorno G , Papa A , Di Belardino N , Segreti L , Pepi P , Nicolis D , Carbone A , Lavalle C , Casale M , Treglia S , Malacrida M , Pandozi C , Colivicchi F 
Published: May 2023

Abstract

Background
Despite the sustained efforts and advances in the fields of anatomy, histology, immunohistochemistry and cardiac mapping, the definition of the AVNRT circuit in humans is still incomplete. This discouraging result can be explained by many reasons, but the most important one has been the impossibility to map the AVNRT circuit without recording the electrical activity of the AVN and its extensions, which represent the diastolic interval in the tachycardia cycle. The aim of this study was to compare high density activation mapping integrated and not integrated with AV node potential recordings to establish the importance of annotation of AV nodal structure electrical activity in defining Koch’s triangle activation during AVNRT.

Methods
Electroanatomic 3–D reconstruction and propagation automated mapping of atrial activation during both sinus rhythm and tachycardia was performed using a basket catheter (64 electrodes of 0.4–mm2 area; 2.5–mm spacing, Orion, Boston Scientific, Natick, MA) and the Rhythmia electroanatomic mapping system in group 1 patients (X). In group 2 patients (45) the AV node potential (a very low frequency signal distinct from atrial, His bundle or ventricular activations, recorded from electrodes overlying the region of the compact AV node and its extensions by using a non–conventional bipolar electrogram filtering of [0.05/1 – 250] Hz) were also recorded both during slow fast AVNRT.

Results
The integrated map showed that during AVNRT, the activation wavefront descends from the Tendon of Todaro region (fast pathway area) and rises along the septal leaflet of the tricuspid valve through the RINE and reaches the AV bundle probably via the LNB bypassing the compact AV node almost completely. This kind of activation of the Koch’s triangle was not reconstructed by the non–integrated map. Moreover, the recording of the potentials of the AV node structures makes it possible to obtain a 100% coverage of the tachycardia cycle which was only 32% in the non–integrated maps (p &lt; 0.0001).

Conclusion
The recording of the electrical activity of AV nodal structures allows a better definition of the circuit of typical slow–fast AVNRT which, in the majority of the cases, is completely localised in the right atrium.
P104 LASER BALLOON APPROACH FOR PULMONARY VEIN ISOLATION IN MARFAN SYNDROME
Authors: Bernardini A , Sciara P , Paoletti Perini A , Signorini U , Milli M , Giomi A 
Published: May 2023

Abstract

Background
Marfan syndrome (MFS) is an autosomal dominant disorder of the connective tissue and it’s associated with an increased incidence of atrial fibrillation (AF), due to scar–mediated processes and sites of atrial ectopy. Limited data exist regarding ablation techniques in these patients. The frailty of atrial walls correlated to connective disease makes the ablation challenging with an increased risk of complications. Laser–balloon (LB) approach for pulmonary vein isolation (PVI) could be a promising strategy due to the possibility to ablate a large volume of tissue with a single application of energy, short procedure times, and real–time monitoring of balloon–tissue contact. We present a case in which LB technology was applied for PVI in an MFS patient

Clinical case
A 44–year–old woman with MFS and paroxysmal AF underwent PVI. The echocardiographic examination showed mild aortic and mitral valve regurgitation, the first due to a slight dilation of the aortic root, the latter associated with mitral valve prolapse. Atrial volume was normal. No other comorbidities were present. The procedure was executed in general anesthesia. A decapolar catheter was inserted in the coronary sinus and used later to stimulate the phrenic nerve during the ablation of the right pulmonary veins (Fig.1C). Left atria (LA) was reached after an ultrasound–guided transeptal puncture. High–density mapping of the LA was performed to assess the number and geometry of PVs (Fig.1A). A LB catheter was used to perform laser ablation at the level of PV antrum, delivering 13 W in automatic rapid mode in regions with optimal contact and 5.5 W in areas with more represented blood–tissue interface. LA mapping after ablation assessed the effective isolation of pulmonary veins (Fig.1B). No complications occurred during the procedure.

Conclusion
a laser–balloon approach for PVI in MFS patients seems feasible and safe. To our knowledge, this is the first application of this technology on MFS patients. Larger data are needed to confirm our findings.
P110 INTRAVASCULAR LITHOTRIPSY FOR THE TREATMENT OF SEVERELY CALCIFIED LEFT MAIN CORONARY STENOSIS
Authors: Pavani M , Giacobbe F , Zanda G , Sagazio E , Vadalà P , Galiffa V , Taglialatela V , De Filippo O , Annibali G , Abdirashid M , Bernardi A , Benenati S , Arena M , Ferrari F , Cordone S , Piedimonte G , Rolfo C , Cerrato E , Varbella F 
Published: May 2023

Abstract

Background
Even if pilot studies have been conducted to validate Intravascular Lithotripsy, most challenging cases were excluded, including unprotected Left Main (LM) coronary stenosis.

Methods
We retrospectively enrolled patients treated with IVL in a real–world multicenter registry from 21 centers among Italy and Spain from January 2020 to November 2021. The primary safety endpoint was freedom from major adverse cardiovascular events (cardiac death, target vessel revascularization, stent thrombosis) at 30 days. The primary effectiveness endpoint was procedural success (defined as stent delivery with a residual stenosis &lt;20% and without intra–procedural MACE). Secondary endpoint were 6–months and 12–months MACE rates.

Results
From a total amount of 470 patients enrolled in our registry, 41 underwent IVL to LM stenosis. Most of them were males (78.0%). The clinical presentation was acute coronary syndrome (ACS) in 41.4% of cases. Mechanical circulatory support was necessary in 4 cases (9.7%). IVL before stent implantation was planned in 90% of cases. The primary safety endpoint occurred in 97.6%. of patients. The primary effectiveness endpoint was achieved in 97.6% of cases. Interestingly, at 6 months and 12 months, no MACE was recorded.

Conclusions
Intravascular lithotripsy for the treatment of severely calcified Left Main stenosis seems to be a safe and effective option with very high procedural success rate and low MACE rate at follow–up.
P111 RADIAL ACCESS FOR THE PERCUTANEOUS TREATMENT OF CHRONIC CORONARY OCCLUSIONS: A SINGLE CENTER EXPERIENCE
Authors: Salvi N , Fedele S , Di Russo C , Sciahbasi A , Patrizi R , Cera M , Boncompagni D , Renda M , Minardi S , Granatelli A 
Published: May 2023

Abstract

Background
In the last years the improvement of interventional techniques for the treatment of coronary total occlusions (CTO) trough percutaneous coronary intervention (PCI) allowed a significant increase of the number and success rate of these procedures. At the same time, transradial access is increasingly being used for CTO–PCI even though there are concerns about its efficacy in this setting because of the higher procedural complexity. Aim of our study was to review the procedural success of all the CTO–PCI performed in our center according to the vascular access utilized.

Methods
We retrospectively evaluated all the CTO–PCI performed in our center from January 2018 to December 2019. These procedures were divided in two groups according to the vascular access employed: all femoral access procedures (Group 1) or procedures with at least one radial access (Group 2). The primary end–point of the study was the procedural success. Major procedural complications, the duration of the procedure and the volume of contrast used were also evaluated.

Results
A total of 66 CTO procedures have been performed: 15 procedures in Group 1 (66 ± 14 years, 80% males) and 51 in Group 2 (66 ± 9 years; 80% males, P= NS). In Group 2, 14 procedures were performed using only radial access whereas in 38 procedures a combination of radial and femoral access have been utilized. There were no significant differences in the main cardiovascular risk factors between the two groups. In Group 2, 5 procedures were performed by retrograde approach while in Group 1 all procedures were performed by antegrade approach. There were no significant differences between Group 1 and Group 2 in terms of contrast volume used (376 ± 137 mL and 345 ± 101 mL respectively, P=0.40) or in terms of procedure time duration (132 ± 49 min and 149 ± 71 min respectively, p=0.13). Procedural success was similar in the two groups: 86% in Group 1 and 80% in Group 2 ( P=0.86). There was one only major clinical complications in group 1 ( one stroke) and no complications in Group 2.

Conclusion
In our experience, the use of radial access alone or in combination with a single femoral access is safe and effective to perform CTO–PCI.
P115 "WHEN THE GOING GETS TOUGH, THE TOUGH GET GOING": LARGE THROMBOSIS ASPIRATION DURING PERCUTANEOUS APPENDAGE OCCLUSION
Authors: Scarpino T , Pascale V , Alessandro F , Gerbasi E , Ciconte V 
Published: May 2023

Abstract

Background
An 83–year–old woman with permanent atrial fibrillation was referred for percutaneous left atrial appendage closure (LAAC) following a spontaneous intracranial hemorrhage caused by pituitary macroadenomas that the patient refused to excise. Pre–procedural EET revealed no formed thrombus. Intravenous unfractionated heparin (UFH) was administered. After multiple attempts, the device (Amplatzer Amulet) was correctly positioned but before final release, a large thrombus was noted within the left atrium, attached to delivery system. A further 4000 IU of UFH and 300 mg of salicylic acid were administrated, and a subsequent 300 s activated clotting time was recorded. Under continuous negative pressure in the delivery sheath via a 50 mL Luer–Lock syringe, suction of the thrombus was performed. Similarly, the device was released and the delivery system withdrawn into the delivery sheath and removed. Final EET revealed no residual thrombus within the left atrium with adequate device compression and no peri–device leaks. No further aspiration through the sheath was possible, indicating successful thrombus retrieval into the delivery sheath.

Discussion
Device–related thrombus (DRT) is a possible and terrible complication of percutaneous LAAC due to patient–specific (hypercoagulability disorders, renal insufficiency, nonparoxysmal AF) and/or procedural factors (LAAO depth of implantation &gt;10 mm from the pulmonary vein limbus, pericardial effusion). For this patient, potential causes could be both the long intervention time required for correct positioning of the device and non–optimal pre interventional medical therapy and procedural options included either recapturing the device into the delivery sheath and abandoning the procedure or surgical thrombectomy. Both options would increase the risk of clot dislodgement and embolization. An off–label device deployment under continuous negative pressure was performed reducing embolic risk by minimizing both mechanical forces on the thrombus as well as procedural time.

Conclusion
Therefore, shorter procedural times and optimized preoperative medical therapy could reduce DRT risk. The evidence for the use of cerebral protection devices in the setting of LAAO insertion is limited to a small single case series. Randomized multicentric studies are necessary to approve routine use of these devices when the patient is deemed to be at high risk of thromboembolism based on clinical or intraprocedural factors.
P123 TRANSCATHETER ABLATION OF SUPRAVENTRICULAR ARRHYTHMIAS IN PATIENTS SUFFERING FROM HYPERTROPHIC CARDIOMYOPATHY: A PROPENSITY SCORE–BASED ANALYSIS
Authors: Pierri A , Albani S , Buongiorno A , Ricotti A , Grossi S , De Rosa C , Mabritto B , Bongioanni S , Luceri S , Negri F , Grilli G , Barbisan D , Burelli M , Biondi F , Cireddu M , Berg J , Musumeci M , Di Donna P , Vianello P , Del Franco A , Scaglione M , Barbati G , Berchialla P , Russo V , Imazio M , Porto I , Canepa M , Peretto G , Francia P , Autore C , Castagno D , Gaita F , Olivotto I , Merlo M , Sinagra G , Musumeci G 
Published: May 2023

Abstract

Background
To date, the prognostic impact of transcatheter ablation (T–Abl) of supraventricular arrhythmias (SA) in HCM patients has not been satisfactorily elucidated.

Objectives
To assess the impact of T–Abl on clinical outcomes in a large cohort of HCM patients.

Methods
In this retrospective multicenter study, 570 consecutive HCM patients with SA were enrolled, 425 receiving medical therapy and 145 undergoing T–Abl. 1:1 propensity score matching (PSM) led to the inclusion of 234 patients (117 intervention group, 117 medical group) in the final analysis for endpoint evaluation. The primary outcome was a composite of all–cause mortality, heart transplantation (HT) and worsening heart failure (HF). Additionally, an inverse probability weighted (IPW) model was elaborated.

Results
At PSM analysis, after a median follow-up of 57.3 months, the primary endpoint occurred in 31 (26.5%) patients in the intervention group vs 38 (32.5%) in the medical group (p=0.871). Thromboembolic strokes and major arrhythmic events in the intervention vs the medical group were 9.4% vs 9.4% (p=0.367) and 5.1 vs 7.7% (p=0.741), respectively. Fewer patients in the intervention vs medical group experienced SA recurrences (64.1% vs 84.6%, p&lt;0.001) and transition to permanent SA patterns (21.4% vs 37.6%, p=0.007). IPW analysis showed consistent results. Severe complications related to T–Abl were uncommon (0.7%).

Conclusions
At 5–year follow–up, T–Abl does not improve major clinical outcomes in a large cohort of HCM patients. Nevertheless, T–Abl seems to facilitate the maintenance of sinus rhythm and decelerate the progression to permanent SA. Lastly, T–Abl is usually safe in HCM.
P128 CTLA–4 AND PD–1 BLOCKING AGENTS AFFECTS LONGITUDINAL AND RADIAL STRAIN IN PRECLINICAL MODELS, INCREASES SYSTEMIC CXCL12, CARDIAC FIBRONECTIN EDA, S–100 CALGRANULIN, GALECTINE–3 AND NLRP–3/MYD–88/CHEMOKINE PATHWAYS
Authors: Quagliariello V , De Lorenzo C , Passariello M , Di Mauro A , Cipullo C , Paccone A , Iovine M , Bruzzese F , Palma G , Luciano A , Maurea N 
Published: May 2023

Abstract

Background
Immune checkpoint inhibitors (ICIs) have significantly changed the oncology clinic in recent years, improving survival expectations in cancer patients. ICI therapy have a broad spectrum of side effects from endocrinopathies to cardiovascular diseases. In this study, pro–inflammatory and pro–fibrotic effects of short–term ICIs therapy in preclinical models were analyzed.

Methods
Firstly, in a human in vitro model, human cardiomyocytes co–cultured with hPBMC were exposed to ICIs (with CTLA–4 or PD–1 blocking agents, at 200 nM) for 72h. After treatment, production of DAMPs and 12 cytokines were analyzed in the supernatant through colorimetric and enzymatic assays. C57/Bl6 mice were treated with CTLA–4 or PD–1 blocking agents (15 mg/kg) for 10 days. Before (T0), after three days (T3) and after treatments (T10), ejection fraction, fractional shortening, radial and longitudinal strain were calculated by using bidimensional echocardiography (Vevo 2100,Fujfilm). Fibrosis, necrosis, hypertrophy and vascular NF–kB expression were analyzed through Immunohistochemistry. Myocardial expression of DAMPs (S100– Calgranulin, Fibronectin and Galectine–3), MyD88, NLRP3 and twelve cytokines have been analyzed. Systemic levels of SDF–1, IL–1β and IL–6 were analyzed before, during and after ICIs therapy.

Results
Radial and longitudinal strain were decreased after 10 days of ICIs therapy. Histological analysis of NF–kB expression shows that short–term anti–CTLA–4 or anti–PD–1 treatment increased vascular and myocardial inflammation. No myocardial hypertrophy was seen with the exception of the pembrolizumab group. Myocardial fibrosis and expression of galectin–3, pro–collagen 1–α and MMP–9 were increased after treatment with all ICIs. Both anti–CTLA–4 or anti–PD–1 treatments increased the expression of DAMPs, NLRP3 inflammasome and MyD88 and induced both in vitro and in vivo the secretion of IL–1β, TNF–α and IL–6. Systemic levels of SDF–1, IL–1β and IL–6 were increased during and after treatment with ICIs.

Conclusions
Short therapy with PD–1 and CTLA–4 blocking agents increases vascular expression of NF–kB, systemic SDF–1, IL–1β, IL–6 levels and myocardial NLRP3, MyD88 and DAMPs expression in preclinical models. A pro–inflammatory cytokine storm was induced in myocardial tissues and in cultured cardiac cells after ICIs therapy.
P129 RARE CASE OF A GIANT THYMIC CYST: A CHALLENGING DIFFERENTIAL DIAGNOSIS OF A PARACARDIAC CYSTIC LESION
Authors: Schiavo M , Foroni M , Coccolo F , Graziosi M , Attinà D , Dolci G , Galiè N 
Published: May 2023

Abstract

Background
Benign thymic cysts are a rare clinical entity, representing approximately 3% of all mediastinal masses and can be congenital or acquired. We report a case of a 58–year–old female with a giant benign thymic cyst which entered in differential diagnosis with pericardial cyst and pericardial effusion. Case presentation: A 58–year–old female was brought to our hospital due to new onset dyspnoea and fatigue. She had a history of a mediastinal liquid mass incidentally discovered 9 years before which was interpreted at that time as a loculated pericardial effusion (Fig. 1). An echocardiogram was performed and it revealed increased size of the known lesion without any signs of hemodynamic compromise (Fig. 2). A magnetic resonance showed a voluminous liquid lesion that originated from the anterior mediastinum, extending caudally to the diaphragm with maximum dimension on the right hemithorax of 16 x 12 x 9 cm and on the left hemithorax of 10 x 5 x 13 cm (antero–posteriorly, transversely and cranio–caudally respectively) (Fig. 3). It was initially interpreted as a pericardial cyst. All the findings were then collegially reviewed and it was suspected of being a giant thymic cyst especially due to its rapid growth and spatial evolution over time. The cyst was surgically removed using a thoracoscopic approach. Histological examination confirmed the thymic origin of the cyst and excluded malignancy. At three month follow up, the patient presented no symptoms, and the echocardiogram was normal.

Discussion
The echocardiographic features of mediastinal cysts are not specific for the type of cystic lesion, so the origin and location of the cyst can be used for differential diagnosis. Computed tomography has the best spatial resolution, while the magnetic resonance has better capacity to differentiate the content of the cyst, especially when it is not a homogeneous liquid lesion. In our case, the growth over nine years was a crucial hint to suspect the thymic origin of the lesion. On the other hand, the sole evaluation of the last imaging exam would have made the diagnosis more challenging because of its huge dimensions, which made the exact site of origin almost impossible to identify.

Conclusion
Our case is a rare example of a giant thymic cyst which was extremely difficult to differentiate from other paracardiac cystic lesions and required integrated imaging and discussion by a team of experts of different specialties to make the correct diagnosis.