bluuebunny/crossref_metadata_2025_split huggingface dataset:
P403 KOUNIS SYNDROME ASSOCIATED WITH COVID–19 INFECTION: CAUSE OR COINCIDENCE?
Authors: Orlando L , Trapani G , Vatrano M , Imbalzano E 
Published: May 2022

Abstract

Background
Histamine fish poisoning, known as scombroid syndrome, is a foodborne disease caused by histamine toxicity that results from eating specific types of spoiled fish. In some cases it can lead to the development of life–threatening anaphylactic reactions. In literature is widely recognized and accepted the possibility of correlated coronary involvements, cases described are rare, but even more rare if combined with the novel human coronavirus disease Covid–19 infection, the fifth documented pandemic since the 1918 flu pandemic. In this report, we describe a case of acute coronary syndrome in infected patient with Covid–19, for the first time. The occurrence of acute coronary events with allergic or hypersensitivity reactions has been described as the Kounis syndrome, but in few cases it has been associated with scombroid syndrome.

Case Report
A young woman came to our Emergency Department with erythematous lesions, mild itching, nausea, diaphoresis and weakness, after a meal with canned tuna. Her clinical situation worsened and she developed acute coronary syndrome due to vasospasm. After first negative result for rapid oropharyngeal swab test of SARS–CoV–2 RNA, waiting for molecular oropharyngeal swab during her hospitalization, a few days later she tested positive for SARS–CoV2 infection. Acute coronary syndrome in patients with scombroid syndrome is rare to find and more rare if associated with Covid–19–infection. This case demonstrated a linkage of Histamine fish poisoning with Kounis syndrome and SARS–CoV–2 infection, allowing us to foster the treatment decision–making process. Why should an emergency physician be aware of this? This syndrome can represent a life threatening, if not promptly and early known. An emergency physician must have this knowledge, to evaluate accurately the anamnesis of affected patients. Only a circumspect anamnesis can lead us to correct diagnosis and change our decision–making process for treatment.
P430 TUMORAL THROMBOTIC MICROANGIOPATHY: A RARE CAUSE OF ACUTE PULMONARY HYPERTENSION
Authors: D‘Addazio M , De Gaspari M , Porcelli G , Perazzolo Marra M , Mancuso D , Basso C 
Published: May 2022

Abstract

Introduction
Among the causes of acute pulmonary hypertension, the occlusion of the little pulmonary vessels caused by tumoral microemboli, even from an unknown neoplasm, is an infrequent condition with a very poor prognosis.

Clinical Case
A 55–years old woman with no relevant past medical history presented to the Emergency Department with dyspnea at rest, desaturation, palpitations and a brief episode of chest pain, after several days of fatigue and exertional dyspnea. ECG showed sinus tachycardia and signs of right ventricle pressure overload with inverted T waves in V3–V4 and in the inferior leads (Fig. 1). On laboratory tests there were high D–dimer values and a slightly elevated TnI. Blood gas analysis showed hypoxemic hypocapnic respirstory alkalosis. An Echocardiogram revealed severe dilatation and dysfunction of the right ventricle and signs of high probability of pulmonary hypertension (Fig. 2). Pulmonary CT scan ruled out embolism and showed irregular thickening of the interstitium and mediastinal lymphoadenopathy. Then, a rapid clinical deterioration happened, refractory to inotropes infusion and larger volumes of oxygen. The programmed diagnostic pathway cannot be pursued. On day 4, there was respiratory distress and pulseless electrical activity cardiac arrest during endotracheal intubation. ECMO mechanical support was positioned but on day 7 the patient died. Autopsy, made to discover the cause of pulmonary hypertension, revealed the presence of a colonic invasive adenocarcinoma with micropapillary pattern and thoracic and pelvic lymph–nodal metastases. Microscopic evaluation of the lungs showed a widespread neoplastic vascular invasion with microthromboemboli (Fig. 3).

Discussion
Tumoral thrombotic microangiopathy is a cause of pulmonary hypertension of multifactorial origin and should be suspected in cases of pulmonary hypertension without pulmonary embolism or interstitial lung disease. The rarity of this condition and the absence of an oncological medical history make difficult the diagnostic hypothesis. Besides, the lacking of an effective therapy makes the prognosis poor.
Stereotactic ablative radiotherapy in patients with refractory ventricular tachyarrhythmia
Authors: Molon Giulio , Giaj-Levra Niccolò , Costa Alessandro , Bonapace Stefano , Cuccia Francesco , Marinelli Alessio , Trachanas Konstantinos , Sicignano Gianluisa , Alongi Filippo 
Published: May 2022

Abstract
Stereotactic ablative body radiotherapy (SABR) is an innovative therapeutic approach in patients (pts) with a diagnosis of refractory ventricular tachyarrhythmia (VT) after the use of drugs, radiofrequency catheter ablation, and/or defibrillator (ICD) implant. The current efficacy data of SABR are limited and several prospective clinical studies are ongoing to support the use of ablative radiation dose to control VT. The aim of the current prospective pilot study is to report the efficacy and tolerability of SABR in ICD implanted pts with refractory VT in our centre. Non-invasive electroanatomical mapping (EAM), cardiac computed tomography (CT), and 18F-fluorodeoxyglucose positron emission (FDG-PET)-CT scan were used and combined with a radiation CT scan. A dose prescription of 25 Gy in a single dose was delivered by volumetric modulated arc therapy (VMAT) Linac-based. The primary endpoint was efficacy, defined as a reduction in ICD shocks after SABR treatment, while the secondary endpoint was safety. Six consecutive pts (five males and one female) implanted with an ICD and with three or more VT were enrolled. One pts died after 1 month, due to end-stage heart failure. Two pts experienced ICD shocks in VT 2 and 5 months after treatment. Three pts experienced no more ICD shocks on VT after therapy. Our data suggest the efficacy and safety of SABR treatment in pts with VT. Larger dataset of pts and longer follow-up are otherwise required to validate the impact of SABR as a standardized treatment in these pts.
A case of myopericarditis recurrence after third dose of BNT162b2 vaccine against SARS-CoV-2 in a young subject: link or causality?
Authors: Mapelli Massimo , Amelotti Nicola , Andreini Daniele , Baggiano Andrea , Campodonico Jeness , Moltrasio Massimo , Majocchi Benedetta , Mantegazza Valentina , Vignati Carlo , Ribatti Valentina , Catto Valentina , Sicuso Rita , Moltrasio Marco , Pontone Gianluca , Agostoni Piergiuseppe 
Published: May 2022

Abstract
The rate of post-vaccine myocarditis is being studied from the beginning of the massive vaccination campaign against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although a direct cause–effect relationship has been described, in most cases, the vaccine pathophysiological role is doubtful. Moreover, it is not quite as clear as having had a previous myocarditis could be a risk factor for a post-vaccine disease relapse. A 27-year-old man presented to the emergency department for palpitations and pericardial chest pain radiated to the upper left limb, on the 4th day after the third dose of BNT162b2 vaccine. He experienced a previous myocarditis 3 years before, with full recovery and no other comorbidities. Electrocardiogram showed normal atrioventricular conduction, incomplete right bundle branch block, and diffuse ST-segment elevation. A cardiac echo showed lateral wall hypokinesis with preserved ejection fraction. Troponin-T was elevated (160 ng/L), chest X-ray was normal, and the SARS-CoV-2 molecular buffer was negative. High-dose anti-inflammatory therapy with ibuprofen and colchicine was started; in the 3rd day high-sensitivity Troponin I reached a peak of 23000 ng/L. No heart failure or arrhythmias were observed. A cardiac magnetic resonance was performed showing normal biventricular systolic function and abnormal tissue characterization suggestive for acute non-ischaemic myocardial injury (increased native T1 and T2 values, increased signal intensity at T2-weighted images and late gadolinium enhancement, all findings with matched subepicardial distribution) at the level of mid to apical septal, anterior, and anterolateral walls. A left ventricular electroanatomic voltage mapping was negative (both unipolar and bipolar), while the endomyocardial biopsy showed a picture consistent with active myocarditis. The patient was discharged in good clinical condition, on bisoprolol 1.25 mg, ramipril 2.5 mg, ibuprofen 600 mg three times a day, colchicine 0.5 mg twice a day. We presented the case of a young man with history of previous myocarditis, admitted with a non-complicated acute myopericarditis relapse occurred 4 days after SARS-CoV-2 vaccination (3rd dose). Despite the observed very low incidence of cardiac complications following BNT162b2 administration, and the lack of a clear proof of a direct cause–effect relationship, we think that in our patient this link can be more than likely. In the probable need for additional SARS-CoV-2 vaccine doses in the next future, studies addressing the risk-benefit balance of this subset of patient are warranted. We described a multidisciplinary management of a case of myocarditis recurrence after the third dose of SARS-CoV-2 BNT162b2 vaccine.
Digitalised ECG measure of p-wave duration predicts incident heart failure
Authors: Ostrowska B , Lind L , Sciaraffia E , Blomstrom-Lundqvist C 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Uppsala University Hospital

Background and purpose
Early identification of patients at risk of congestive heart failure (HF) may potentially alter their poor prognosis. The aim was therefore to test whether the P-wave and PR-interval, simple non-invasive ECG measures reflecting systolic and diastolic atrial function, could predict incident HF.

Methods
The PIVUS (Prospective Investigation of the Vasculature in Seniors) study including all individuals aged 70 years (1016 individuals, 50% women) was used to identify predictors of HF. Subjects with prevalent HF, QRS duration ≥ 130 msec or atrial arrhythmias on baseline ECG were excluded. Cox proportional hazard analysis was used to relate P-wave duration (Pdur), amplitude (Pamp) and PR interval in lead V1, to incident HF. Adjustment was performed for gender, RR-interval, beta-blocking agents, systolic blood pressure, body mass index and smoking.

Results
A total of 107 of 836 (12,8%) subjects at risk, developed HF during 15 years follow-up. The multivariate analysis, showed a strong U-shaped correlation between Pdur and incident HF (p=0.0001), which was significant for a Pdur&lt; 60 msec [HR 2.75 (95% CI 1.87-4.06) at Pdur 40 msec]. There was no significant relationship between incident HF and the PR-interval, or the Pamp. A Pdur&lt;60 msec improved discrimination by 3.7% when added to the confounders described above (p=0.048).

Conclusions
A short P-duration, a simple and easy ECG measure, may potentially be a useful predictor of developing HF, enabling early detection and treatment of HF.
Fever following Covid-19 vaccination in subjects with Brugada syndrome: incidence and management
Authors: Santoro F , Crea P , Pellegrino PL , Cetera R , Gianfrancesco D , D’arienzo G , Bartolomucci F , El-Battrawy I , Brunetti ND 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Fever is a potential side effect of Covid-19 vaccination. Patients with Brugada syndrome (BS) have an increased risk of life-threatening arrhythmias when experiencing fever. A prompt treatment with antipyretic drugs is suggested in these patients.
Aim of the study: To evaluate the incidence and management of fever within 48 hours from Covid-19 vaccination among BS patients.

Methods
163 consecutive patients were enrolled in a prospective registry involving 5 European hospitals with a dedicated inherited disease ambulatory.

Results
Mean age was 50 ±14 years and 121 (75%) patients were male. Prevalence of Brugada ECG pattern type-1,-2 and -3 was 32 %, 44%, 24%, respectively. Twenty-eight (17%) patients had an implantable cardioverter defibrillator.
Fever occurred in 32 (19%) BS patients after 16±10 hours from vaccination, with peak of body temperature of 37.9±0.5 degrees. Patients with fever were younger (39±13 vs 48±13 years, p=0.04). No additional differences in term of sex and cardiovascular risk factors were found between patients with fever and not.
Twenty-seven (84%) out of 32 patients experienced mild fever and five (16%) moderate fever. Pharmacological treatment with antipyretic drugs was required in 18 (56%) out of 32 patients and was associated with resolution of symptoms.
No patient required hospital admission and no arrhythmic episode was recorded in patients with ICD within 48 hours after vaccination.

Conclusion
Fever is a common side effect in BS patients after Covid-19 vaccination. Careful evaluation of body temperature and prompt treatment with antipyretic drug may be needed.
Short-term electrocardiographic atrial remodelling after asd closure with the gco device in a pediatric population
Authors: Fumanelli J , Garibaldi S , Castaldi B , Di Candia A , Cuman M , Pizzuto A , Sirico D , Mirizzi G , Piacenti M , Cantinotti M , Assanta N , Di Salvo G , Santoro G 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background and Aim
The GORE® CARDIOFORM septal occluder (GCO) is an atrial septal defect/patent foramen ovale (ASD/PFO) closure device with theoretical advantages over other commercialized devices thanks to its softness and anatomical compliance.
Our aim was to evaluate the short and medium-term electrocardiographic changes after percutaneous ASD closure with GCO in a pediatric population.

Methods
We enrolled 39 patients with isolated ASD submitted to trans-catheter closure with GCO from January 2020 to June 2021. EKG was performed before (T0), at 24 hours (T1) and 6 months (T2) after ASD transcatheter closure. P wave dispersion was calculated as the difference between maximum and minimum P- wave duration, PR interval as the interval between beginning of the P wave and beginning of the QRS complex and QT dispersion as the difference between maximun and minimun of QTc intervals. At 6-months from device implantation, the patients were submitted to ambulatory EKG Holter recording.

Results
Patients’ age and BSA were 8.2±4.2 years (IQR 4.2-8.3, median 7.0) and 1.0±0.3 m2 (IQR 0.7-1.7, median 0.9), respectively. The strectched ASD diameter was 16.3±4.5 mm (median 16), resulting in QP/QS of 1.7±0.6 (median 1.5). At the baseline mean P wave dispersion was 40±15 msec and decreased to 30±13 msec (p&lt;0.002) at 24h, without any further change at 6 months (30±13 msec, p&lt;0.002). PR conduction significantly improved at 24 h from device implantation (from 175.0±20.8 to 144.0±22.7 msec, p=0.018) and did not significantly change at 6 months (164.0±19.5 msec, p=NS). QTc dispersion decreased at 24 hours (31.7±.20.3, p&lt;0.02) and at 6 months (28.0±18.1, p&lt;0.002) from device implantation. After device deployment, 2 pts (5%) developed transient, self-limited junctional rhythm and one of them needed a short course of anti-arrhythmic therapy for supra-ventricular tachycardia. No tachy/brady-arrhythmias were recorded at the 6-months follow-up EKG Holter monitoring.

Conclusions
Percutaneous ASD closure with the GCO device results in significant, sudden improvement of intra-atrial, atrio-ventricular and intraventricular electrical homogeneity. This benefit persists unaltered over a medium term follow-up. It might be due to a favourable volumetric remodelling that was not hindered by mechanical impact of the occluding prosthesis and could explain the low rate of arrhythmias found at the mid-term EKG evaluation.
Body Surface Mapping system - a potential diagnostic tool for unmasking delayed right ventricular epicardial activation in ARVC patients and phenotype-negative gene-carriers
Authors: Kommata B , Sciaraffia E , Blomstrom- Lundqvist C 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Selanders stiftelsen

Background
Life-threatening ventricular arrhythmias can occur at any stages of ARVC – the detection of early manifestations of the disease may have prognostic implications.

Purpose
The purpose was to explore the usefulness of a 252-leads noninvasive Body Surface Mapping (BSM) system for the detection of delayed epicardial activation in ARVC patients and phenotype-negative gene-carriers (GC).

Methods
Twelve patients with ARVC, 20 GC and 8 genotype and phenotype negative family members served as controls (C) were included. 12-lead ECG, signal-averaged-electrocardiogram, echocardiography, 252-lead BSM recordings and thoracic CT scan were performed in all subjects. The noninvasively reconstructed epicardial signals of the right ventricle (RV) were analysed using the Activation Time Editing tool of the BSM system. Local depolarisation was defined as the steepest negative dV/dt of the local epicardial signal. The time from the start of RV epicardial signals to the earliest local depolarisation (ELD) and to the latest local depolarisation (LLD), were measured for the whole RV and separately for the anterior free wall (AW) and inferior wall (IW). The duration of the activation, defined as LLD-ELD, was calculated for AW, IW and the whole RV.

Results
The ELDs was similar in all study groups whereas the LLD in the IW and whole RV was significantly longer among ARVC patients compared to C. Although the activation durations in the AW and IW did not differ between the groups, the activation duration of the whole RV was significantly longer in ARVC patients. A LLD cut off of 81ms in RV and an activation duration cut off of 49msec in RV discriminated ARVC patients from C with highest sensitivity and specificity. Based on these cut-offs, 35% of GC group had longer LLD times and 70 % had longer activation duration (figure 1).

Conclusions
ARVC patients as well as the majority of GC demonstrated prolonged LLD and/or activation duration times in RV compared to C, suggesting that the 252-leads noninvasive BSM system may be a useful tool for early detection of delayed RV epicardial activations. Larger studies are required to confirm our results.
Heart rate variability and meditation: a meta-analysis
Authors: Bin Waleed K , Lakhani I , Gong M , Liu T , Roever L , Christien Li KH , Rajan R , Qasim Ibrahimi M , Xia Y , Tse G , Chang D , Lee S 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Meditation can induce changes in autonomic balance, which can benefit cardiovascular health. The present meta-analysis evaluated changes in heart rate variability (HRV) in meditators.

Methods
PubMed and Embase were searched for primary prospective studies using the search terms ‘heart rate variability’ and ‘meditation’ until January 18th, 2019. The statistical significance of the difference between subgroups is evaluated by the standardized mean difference (SMD), 95% confidence interval (CI), and P-value. I2 value was used to assess the statistical heterogeneity between the included studies.

Results
Twenty-one studies involving 538 meditators (experienced= 209, beginners= 329) and 334 controls (mean age= 40.61, 35% male) were included. Regarding time-domain indices, no statistically significant differences were observed when assessing HRV between i) meditators versus controls (SMD= -0.17; 95% CI: [-0.50, 0.17]; p= 0.30; I2= 0%), ii) pre- versus post-meditation (SMD= -0.41; 95% CI: [-1.10, 0.28]; p= 0.25; I2= 80%) or iii) at baseline versus during meditation (SMD= -0.40; 95% CI: [-0.94, 0.14]; p= 0.14; I2= 72%). Pertaining to frequency-domain indices, analysis of low frequency (LF), normalized low frequency (LFnu) and high frequency (HF) between i) meditators versus controls, ii) at baseline versus post-meditation and iii) at baseline versus during meditation yet again did not show any variations. Seven studies assessed normalized high frequency (HFnu) at baseline versus during meditation collectively demonstrated a significantly higher HFnu during meditation in beginners with notable heterogeneity (SMD= 1.29; 95% CI: [0.09, 2.49]; p= 0.04; I2= 95). Moreover, LF/HF was evaluated by seven studies at baseline versus during meditation. Both meta-analysis (SMD= 0.76; 95% CI: [-0.17, 1.69]; p= 0.11; I2= 94%) as well as subset analysis of experienced meditators (SMD= -0.46; 95% CI: [-0.88, -0.03]; p= 0.03; I2= 0%) revealed a significantly lower LF/HF at baseline.

Conclusions
Short-term changes in HRV indices were observed during meditation, but there is limited evidence for significant long-term effects.
Optimizing catheter ablation of atrial fibrillation by a novel wide-band dielectric imaging system: first experience on real-time wall thickness measurement
Authors: Rottner L , Moser F , Schleberger R , Moser J , My I , Lemoine M , Dinshaw L , Kirchhof P , Ouyang F , Reissmann B , Metzner A , Rillig A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Conventional mapping systems do not provide wall-thickness data, which is, however, known to be a determinant of radiofrequency ablation lesion transmurality. KODEX-EPD is a novel open-platform system, which uses dielectric tissue properties to provide real-time, high-resolution cardiac images, tissue characteristics and wall-thickness measurement to guide ablation procedures.

Aim
The aim of this case series was to report on our first experiences with KODEX-EPD regarding estimation of myocardial wall-thickness during catheter ablation of atrial fibrillation (AF).

Methods
We retrospectively analyzed consecutive patients undergoing radiofrequency AF-ablation in combination with KODEX-EPD. A high-resolution image from the left atrium (LA) and the pulmonary veins (PV) was obtained prior to ablation using a spiral mapping catheter in conjunction with KODEX-EPD. Wall-viewer points were collected within the LA, the PVs and the left atrial appendage (LAA) using a standard radiofrequency non-contact force ablation catheter and analyzed for wall-thickness applying the latest KODEX-EPD software version (1.5.0, not yet commercially released). Wall-viewer points were divided into a total of 10 segments (PV ostia, anterior wall, posterior wall, LA roof, LA floor, LAA and PV carina, details see Figure 1) in order to characterize wall-thickness in respective areas.

Results
A total of 570 wall-viewer points in 5 patients were analyzed. Most of the wall-viewer points were collected at the PV ostia as well as along the posterior and anterior wall (449/570, 79%). Actual myocardial atrial thickness ranged from 1.6 to 3.9 mm. Thickest myocardial LA-tissue was measured at the anterior wall (median 3.1 mm) and thinnest at the LA-roof (median 2.2 mm). Figure 2 gives a detailed distribution of wall-thickness measurements at different sites in the LA and PVs.

Conclusion
Atrial wall thickness can be estimated in patients during AF ablation procedures using dielectric tissue properties. Further evaluation and validation of the method are needed to study its reliability and utility for clinical practice.