bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk factors for gram-negative infection of cardiovascular implantable electronic devices: retrospective multicenter study - CarDINe study
Authors: Pascale R , Abdullah TA , Fabbricatore D , De Potter T , Ripa M , Durante-Mangoni E , Leventopulos G , Domenichini G , Iacopino S , Akova M , Diemberger I , Viale P , Giannella M 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Dr. Fabbricatore is supported by a research grant from the CardioPaTh PhD Program

Background
Gram-negative bacteria (GNB) are unfrequently isolated from patients with cardiac implantable electronic device (CIED) infection. However, data about risk factors for GNB-CIED-infection and associated clinical outcome are missing.

Methods
Multicenter, retrospective case-control-control study. Adult patients undergoing CIED implantation from Jan 2015 to Dec 2019 were included and classified as case (C) if diagnosed of GNB-CIED-infection; control 1 (C1) if diagnosed with Gram positive bacteria (GPB)-CIED infection; and control 2 (C2) if no CIED-infection was diagnosed during the study period. Patients were matched by center and risk period (from CIED implantation to infection diagnosis ±1 month), with a minimum follow-up period after infection diagnosis of 180 days.

Results
Study cohort consisted of 134 patients (33 C, 53 C1 and 42 C2) from 11 centers. Overall, 99 (73.9%) were male, median age 73 (IQR 66-81) years. Cardiac diseases leading to CIED implantation were bradi-arrythmia (48%), hearth failure (23.5), and primary prevention (20.6%). There were not differences for demographic variables and Charlson Index between C, C1 and C2. Time from implantation to infection diagnosis was similar between C and C1 [274 (39-621) vs 220 (58-866) days, p=0.581]. Shariff score was lower in C compared with C1 [1(1-2) vs 2 (1-3); p&lt;0.001]. C reported more frequently than C1 a prior infection (not CIED related) (33% vs 16%, p=0.08). GN and GP causative agents of CIED-infection are depicted in Fig.1. No differences regarding CIED-infection type (pocket site, endocarditis) were observed between C and C1. Interestingly, PET-FDG was more frequently performed in C compared with C1 (41.2% vs 17%, p=0.013), with a trend toward higher yielding (83% vs. 50%, p=0.16). CIED extraction was performed in 79.4% and 92.5% (p=0.07) of C and C1, respectively. Length of stay was similar between groups [17 (7-39) vs23 (12-41) days, p=0.326]. 6-month survival was significantly lower in C compared with C1 and C2 at Kaplan Meier analysis (Fig.2).

Conclusions
GNB-CIED infection is associated with higher 6-month mortality than GPB- or no-CIED infections, prior GNB infection may favor subsequent GNB-CIED infection, the role of PET-FDG in diagnosing GNB-CIED infection seems to be key.
Safety and efficacy of transvenous lead extraction using mechanical (non-laser) extraction tools
Authors: Oconnor M , Schmid P , Knoll K , Schaarschmidt C , Bock M , Bahlke F , Georgi M , Froehlich R , Kottmaier M , Reents T , Bourier F , Hessling G , Deisenhofer I , Kolb C , Lennerz C 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The rate of transvenous lead extraction (TLE) is increasing with an increasing rate of complex devices being implanted. TLE is now a routine part of cardiac device management and up to date data on the safety and efficacy of TLE with modern tools and techniques is essential to management decisions regarding non-infectious indications for lead extraction.

Purpose
To evaluate the safety and efficacy of TLE in a contemporary cohort using mechanical (non-laser) extraction tools.

Methods
We present a contemporary, prospective review of TLE at our high-volume cardiac centre. All patients undergoing TLE from June 2016 and June 2019 were enrolled in our local database and baseline clinical data, procedural information and outcome data were collected.

Results
In total 561 leads were explanted (n=153) or extracted (n=408) from 341 patients over the study period. Patients were predominantly male (71%) with a mean age of 65 ± 17 years. The most common indication for lead removal was lead failure (45.2%, n=154) followed by infection of the pocket or device (29.3%, n=100). The mean dwell time of the 408 extracted leads was 7.2 years; 35% had a dwell time of 5-10 years, 23% had a dwell time &gt;10 years and 4% had a dwell time &gt;20 years (Figure 1). In total, complete success was achieved in 96.4% (n=541) leads, clinical success in a further 2.1% (n=12) and failure only in 1.4% (n=8). Clinical success was high (93%) even in leads with dwell time &gt;20 years (Figure 2). There was an overall complication rate of 0.9% (3/341) for major complications and 1.5% (5/341) for minor complications. There were no deaths.

Conclusions
Our data would suggest that there are ongoing improvements in the safety profile and success rates of lead extraction undertaken by experienced operators now with a major complication rate of &lt;1%.
Arrhythmia burden, rhythm interventions and outcome in a large Swiss multicenter population of d-TGA patients with atrial switch
Authors: Nozica N , Asatryan B , Aur S , Greutmann M , Schwerzmann M , Bouchardy J , Gass M , Duru F , Pascale P , Reichlin T , Pruvot E , Wolber T , Roten L 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Patients with dextro-transposition of the great arteries (d-TGA) and atrial switch face a high life-time risk of arrhythmias.

Purpose
To describe the incidence of arrhythmias, associated cardiac interventions and outcome in a large Swiss population of patients with d-TGA and atrial switch.

Methods
In this multicenter analysis we included all consecutive patients with d-TGA and atrial switch treated at three Swiss tertiary care hospitals. The primary outcome was survival free from left ventricular assist device (LVAD), heart transplantation (HTx) and death. The secondary outcome was survival free from ventricular tachycardia, ventricular fibrillation and sudden cardiac death.

Results
We identified 207 patients (34% females; median age at last follow-up 35 years) with d-TGA and atrial switch. Arrhythmias occurred in 97 patients (47%) at a median age of 22 years. A pacemaker or an implantable cardioverter/defibrillator was implanted in 39 (19%) and 13 (6%) patients, respectively, and 33 (16%) underwent a total of 51 ablation procedures to target 60 intra-atrial reentry tachycardias, 4 AV nodal reentry tachycardias and one atrial fibrillation (Figure 1). The primary outcome occurred in 21 patients (10%) and the secondary outcome in 18 (9%) (Figure 2). Primary and secondary outcomes were more common in patients with concomitant ventricular septum defect (VSD) than in those without (hazard ratio [HR] 3.06; 95% confidence interval [CI] 1.29-7.27, p=0.011; and HR 3.62; 95% CI 1.43-9.18, p=0.007, respectively).

Conclusions
At a median age of 35 years, arrhythmias occur in almost half of patients with d-TGA and atrial switch and associated rhythm interventions are frequent. One in ten patients does not survive free from LVAD and HTx and outcome is worse in patients with concomitant VSD.
Improvement of a convolutional neural network using synthetic ECGs for the diagnosis of different atrial rhythms
Authors: Alvarez-Acosta L , Rodriguez-Martin N , Ruiz-Hernandez PM , Torres-Gonzalez N , Valdivia-Miranda D , Bermudez-Perez C , Rubio-Sierra D , Hernandez-Afonso J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The diagnostic capacity of convolutional neural networks has demonstrated its potential for the diagnosis of different ECG alterations. An important limitation of these networks is that there are classes that are underrepresented in the population, such as the Brugada pattern compared to right bundle branch block or Atrial Flutter (AFL) compared to atrial fibrillation (AF). This asymmetry that exists in any population ECG database is one of the limitations (F1-Score) that could be improved, either with even larger databases (impractical) or by creating synthetic representations of the ECG.

Purpose
Using a tool that allows the drawing of specific electrocardiographic patterns first and subsequently, the random creation of different ECGs based on said pattern, the diagnostic capacity of any unbalanced convolutional network could be improved.

Methods
Initially, a database with 95,000 ECGs from our health area was used. From this data set, 5,810 ECGs were taken that were labeled in three classes (1) Sinus Rhythm (SR), 2) AF and 3) AFL by two arrythmologists, 4,637 for training and 1,173 for validation. It was observed that the network was unbalanced (SR: 81.3% of the total, FA: 16.4% of the total and AFL: 2.2% of the total). After having demonstrated the good capacity of the network for the diagnosis of these three atrial rhythms, it was observed that the diagnostic dispersion matrix erred precisely between the ECGs of AF and AFL (figure 1). Based on this idea, it was decided to create a random pattern-based ECG creation tool. Different atrial flutter patterns were created and 2000 ECGs were synthetically created with variations of the ECG frequency, voltages and morphology. A new neural network was subsequently trained with the addition of these ECGs to the original database and its diagnostic capacity was evaluated on the same initial validation set.

Results
The new network showed a 88,3% sensitivity (vs 82,6%), a 100% specificity (vs 98,5%) and an 92% (vs 87,8%) accuracy. It specially had an improvement in AFL ECGs (70,2% vs 61%) and minor improvements in AF ECGs (90,8% vs 89,4%) and SRs ECGs (100% vs 98,6%) accuracy.

Conclusions
The creation of synthetic ECGs to improve the diagnostic capacity of neural networks for infrequent events is feasible. This application allows the development of networks applicable in real life, in this case, for the diagnosis of atrial arrhythmias.
Mobile app-based symptom-rhythm correlation assessment in patients with persistent atrial fibrillation
Authors: Hermans ANL , Gawalko M , Pluymaekers NAHA , Verhaert DVM , Van Der Velden RMJ , Betz K , Evens S , Luermans JGLM , Den Uijl DW , Baumert M , Vernooy K , Rienstra M , Van Gelder IC , Hendriks JM , Linz D 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
In patients with persistent atrial fibrillation (AF) it is difficult to determine the association between patient self-reported symptoms and the underlying heart rhythm (symptom-rhythm correlation [SRC]). No standardized strategy to assess SRC in AF patients is available.

Purpose
We assessed for the first time SRC in persistent AF patients using a mobile health approach of simultaneous photoplethysmography (PPG)-based rhythm monitoring and active interrogation of patient-reported symptoms, which provides a novel approach to systematically assess SRC in persistent AF.

Methods
Consecutive persistent AF patients planned for electrical cardioversion (ECV) used a mobile app to record a 60-second PPG and report symptoms once daily and in case of symptoms for four weeks prior and three weeks after ECV. Within each patient, SRC was quantified by the SRC-index defined as the sum of symptomatic AF recordings and asymptomatic non-AF recordings divided by the sum of all recordings.

Results
Of 88 patients (33% female, age 68±9 years) included, 78% reported any symptoms during recordings. The overall SRC-index was 0.61 (0.44-0.79). The study population was divided into SRC-index tertiles: low (&lt;0.47), medium (0.47-0.73) and high (≥0.73). Patients within the low (vs high) SRC-index tertile had more often heart failure and diabetes mellitus (both 24.1% vs 6.9%). Extrasystoles occurred in 19% of all symptomatic non-AF PPG recordings. Within each patient, PPG recordings with the highest (vs lowest) tertile of pulse rates conferred an increased risk for symptomatic AF recordings (odds ratio [OR] 1.26, 95% coincidence interval [CI] 1.04-1.52) and symptomatic non-AF recordings (OR 2.93, 95% CI 2.16-3.97). Pulse variability was not associated with reported symptoms.

Conclusion
In persistent AF patients, simultaneous mobile app-based symptom and rhythm monitoring revealed a relatively low overall SRC, suggesting that the majority of patients experienced symptoms irrespective of AF. Extrasystoles can explain a minority of symptomatic non-AF PPG recordings. Pulse rate, but not pulse variability, is the main determinant of reported symptoms during AF and non-AF PPG recordings. Further studies are required to test whether mobile app-based SRC assessment can be implemented in current workflows and integrated into a personalized symptom and rhythm control AF management approach.
The diagnostic value of pulse oximetry with data transmission via a smartphone for the diagnosis of respiratory disorders in chronic heart failure
Authors: Shorikov P , Shorikov EI , Shorikova D , Bordiyan V , Ismael O 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
All diagnostic systems used to clarify breathing disorders during sleep are divided into 4 types. The level of evidence for their use depends on the number of recorded parameters and reflects the amount of information obtained during the study. The simplest type includes screening systems that measure the level of blood saturation.
The aim of our work was to study the diagnostic value of pulse oximetry as a screening method for the diagnosis of breathing disorders during sleep in patients with chronic heart failure.

Materials and methods
A comparative study of the two methods included 70 patients (50 men and 20 women), whose average age was 55.5 ± 11.2 years. All patients underwent contact pulse measurement using a smart watch with data sending via a smartphone. In parallel, control was carried out with a resuscitation cardiac monitor.

Results
When analyzing the distribution of patients into groups according to the number of episodes of a decrease in oxygen saturation by more than 3% during pulse oximetry and during cardiorespiratory monitoring. Thus, less than 5 events per hour were recorded in 16 (22.8%) patients according to pulse oximetry data and in 18 (25.7%) patients according to cardiorespiratory monitoring data; from 5 to 15 events per hour - in 17 (24.2%) patients according to the results of two methods, from 15 to 30 events per hour - 18 (25.7%) and 11 (15.7%) patients, respectively, and more than 30 events per hour - in 16 (22.8%) and 11 (15.7%) patients, while there was no statistically significant difference between the groups.
Thus, the sensitivity of the remote pulse oximetry method with the option of transmitting via a smartphone in detecting breathing disorders during sleep of varying severity (the number of episodes more than 5 per hour) was 94.4%. The specificity of the method of computerized pulse oximetry when detecting a sign of the presence of more than 5 events per hour is 79.2%. The predictive value of a positive result was 91.1%, i.e. in patients with a desaturation index of more than 5 events per hour according to pulse oximetry data, respiratory disorders will be confirmed by monitoring with a probability of 91.1%.

Conclusions
Pulse oximetry with data transmission via a smartphone is an accurate screening diagnostic method among cardiac patients for a broader detection of breathing disorders during sleep.
Photoplethysmography telemonitoring during the first week after atrial fibrillation ablation: Feasibility and clinical implications
Authors: Manninger M , Rohrer U , Eberl AS , Andrecs L , Loibnegger S , Pratl B , Hermans A , Hendriks J , Pluymaekers NAHA , Zirlik A , Linz D , Scherr D 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
The incidence of early atrial fibrillation (AF) recurrence within the first week after AF ablation and its predictive value for late AF recurrences are unclear. TeleCheck-AF is a remote on-demand mobile health (mHealth) infrastructure, which is based on a mobile phone app using photoplethysmography (PPG) technology (Fibricheck) allowing rate and rhythm monitoring through teleconsultations. The feasibility and clinical implications of PPG telemonitoring specifically during the first week after atrial fibrillation ablation is unknown.

Methods
Within the TeleCheck-AF project, the Medical University offered a total of 382 consecutive patients undergoing AF ablation (between June 1st 2020 and December 15th 2021) photoplethysmography (PPG) telemonitoring with "FibriCheck" during the first week after the ablation procedure. Patients received a QR code for activation of the software on their smartphone and were connected to the clinician’s telemedicine portal. They were instructed to perform rhythm monitoring three times per day and in case of symptoms. Clinicians assessed the tracings and contacted the patients if therapeutic steps were indicated.

Results
In total, 119 patients (31%) agreed to perform telemonitoring after ablation. Patients undergoing telemonitoring were younger compared to those who refused participation (58±10years vs. 62±10years, p&lt;0.001). 34% were female, median CHA2DS2-VASc-Score was 1 (0-6). 62% of patients had paroxysmal AF and 37% had persistent AF. One of four patients (24%) had already undergone previous ablations. Most index ablations were radiofrequency ablations (89%; 7% cryo; 4% pulsed field ablation). Median follow up duration was 281 (16-620) days.
27% of patients had tracings suggestive of AF in the week following the index ablation. Telemonitoring resulted in clinical interventions ins 24% of patients: amiodarone was started in 8%, class I antiarrhythmic drugs were up titrated in 7%, cardioversion was scheduled in 5%, antiarrhythmic drugs were reduced due to symptomatic bradycardia in 3% of patients.
During follow-up, 22% of patients had ECG-documented AF recurrences. PPG recordings suggestive of AF in the week after ablation were predictive of late recurrences (p&lt;0.001).

Conclusion
Rhythm monitoring with a PPG-based mHealth application was feasible and often resulted in clinical interventions. Due to its high availability, PPG-based follow-up actively involving patients after AF ablation may close a diagnostic and prognostic gap and increase active patient-involvement.
Figure 1: Schematic overview of the telemonitoring process. After the ablation, the patient measures PPGs for one week, dashboard view for clinician shows regular rhythm (green, atrial fibrillation (red) and unclear tracings (blue).
Biosensors in cardiology. T-CARE project: a preliminary study on an innovative wearable telemonitoring system
Authors: Amati F , Santobuono VE , Bozza N , Latorre M , Memeo R , Favale S 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): REGIONE PUGLIA

Introduction
The demographic trend evolution and the modification of health needs highlight the requirement for a novel organization of the healthcare system. Telemedicine allows the assistance of patients remotely, breaking down geographical barriers.

Purpose
The aim of the present study was to assess the validity of a novel wearable system to monitor EKG, heart rate and pulse oximetry in patients with chronic cardiac diseases. The equippement included a T-shirt with electrodes and a band with a photopletimosgraphic sensor, connected to a tiny dock station (Figure 1, panel A).

Methods
We enrolled 38 patients admitted to the coronary care unit at our hospital in Italy, 71% male, mean age 67 years, mean EF 45%. The main characteristics of the sample are listed in Table 1. The system was entirely automatic. Health parameters recording started as soon as patients wore T-shirt and band. Data were transmitted by Bluetooth technology to an external control unit. Recordings could be stored or could be checked in real time from a control room. Data were compared to measurements obtained by traditional monitoring system (telemetry).

Results
The devices tested in this study showed a satisfying level of reliability in monitoring heart rate, pulse oximetry, QT interval, QRS complex duration, and onset of arrhythmic events. Indeed, the difference between traditional monitoring system and the new wearable equipment in acquiring health parameters was not statistically significant (Figure 1, panel B). However, alerts produced by arrhythmias different from atrial fibrillation were not completely reliable.

Conclusions
The most important aspect of this new equipment was the need of minimal patient’s interaction. This system was not inferior to traditional telemetry in recording health parameters.
High-rate atrial pacing to reduce left-sided filling pressures: a combined computational and clinical pilot study
Authors: Van Loon T , Boerdonk P , Sack K , Cornelussen R , Jackson T , Delhaas T , Linz D , Luermans J , Vernooy K , Lumens J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): This work was supported by the Netherlands Organisation for Scientific Research (NWO- ZonMw, VIDI grant 016.176.340 to J.L.) and the Dutch Heart Foundation (ERA-CVD JTC2018 grant 2018T094; Dr. Dekker Program grant 2015T082 to J.L.)

Background
In heart failure patients, interventions to reduce elevated left ventricular (LV) filling pressure improve symptoms and reduce the risk of hospitalization. In this combined computational-clinical study, we explore high-rate atrial pacing as an alternative intervention to reduce LV filling pressure.

Methods
First, the theoretical basis was explored in a computational model of reduced LV compliance and various fixed atrioventricular delays. Second, an explorative clinical study was conducted in 19 paroxysmal atrial fibrillation (AF) patients undergoing pulmonary vein isolation (PVI) with sinus rhythm at the beginning of the procedure. Prior to the PVI, atrial pacing rate was gradually increased from resting heart rate to Wenckebach point with 10bpm increments. LA pressure was continuously monitored with a fluid-filled transseptal catheter.

Results
Computational modelling demonstrated a parabolic relationship between atrial pacing rate and LA pressure depending on atrioventricular delay (Figure A). In patients (Figure B), intermediately increased rates (60bpm[60-70], median[IQR], to 90bpm[73-100], respectively) reduced LA pressure from 16.0mmHg[14.0-20.5] to 14.0mmHg[10.8-16.8]. Highly increased rates (130bpm[120-140]) significantly increased LA pressure to 26.0mmHg[21.5-27.8].

Conclusions
Both the model simulations and the subsequent clinical pilot study support the hypothesis that high-rate atrial pacing can reduce left-sided filling pressure. However, inter-patient variability of response to high-rate pacing was observed, to which simulations identified atrioventricular conduction to be a potential source.