bluuebunny/crossref_metadata_2025_split huggingface dataset:
A novel scoring system to predict cardiac device implantation in patients presenting with syncope
Authors: Khan A A , Shah N , Raison K , Khan T , Esmail M , Watkin R , Basavarajaiah S 
Published: October 2022

Abstract

Background
Cardiac syncope occurs when the heart fails to maintain cardiac output to match cerebral need and can occur due to either mechanical/structural defect of the heart or secondary to an arrhythmia. It has a raised 1-year mortality with some figures estimating this as high as 30%. Implantable loop recorders (ILR) are a useful diagnostic tool in patients presenting with syncope or pre-syncope to ascertain a cardiac cause. A higher number of patients are presenting with advancing age and undergoing ILR implantation. Subsequently, they end up requiring a cardiac implantable electronic device (CIED) implantation, adding to additional costs, exposure to procedural complications and frequent hospitalisations.

Purpose
To investigate the number of patients undergoing CIED implantation following implantation of ILRs for syncope and identify predictors of CIED implantation in patients presenting with syncope.

Methods
A retrospective analysis of 736 patients who underwent ILR implantation at our teaching hospital trust between November 2012 to October 2020. Data on demographics, clinical characteristics, pathology results, ECGs, holter findings and CIED implanted was collected using the local electronic patient record system. The data was analysed using SPSS software. Univariable and multivariable regression analysis and ROC curve analysis was carried out to determine prediction model for CIED implantation.

Results
The mean age of patients who underwent an ILR implantation was 65±19 years. 22% of patients required CIED implantation, 68% of patients did not require a cardiac device and were safely discharged and 10% of patients died during follow up. Age (p&lt;0.001), male sex (p=0.006), impaired left ventricular function (p=0.04) and presence of hypertension (p=0.04) were found to be independent predictors of CIED implantation on univariable and multivariable regression analysis (see Table 1).

Conclusions
Old age, presence of coronary artery disease, impaired left ventricular function and presence of hypertension are inter-linked and in our study were found to be key predictors of poor prognosis and thus requiring CIED implantation. We propose a scoring system based on age &gt;75, male sex, presence of ischaemic heart disease, heart failure and hypertension as key markers of conduction abnormalities requiring CIED implantation (see fi−ure 1).

Funding Acknowledgement
Type of funding sources: None.
Effects of electromagnetic interference produced by smartphones on patients with permanent pacemakers (EMS-PPM study)
Authors: Wisaratapong T , Pechaksorn N 
Published: October 2022

Abstract

Background
Since the 1990s, the electromagnetic field generated by mobile phones using 2G/3G communication networks has been shown to affect pacemaker functions. Over the past two decades, improvements in pacemaker technology, such as feed-through filters, combined with mobile 4G networks have significantly reduced the incidence of adverse effects. However, the safety of newer-generation mobile phones using 5G networks in patients with modern-generation pacemakers has not yet been studied.

Methods
We enrolled 489 patients with pacemakers from three different manufacturers. The pacemaker mode was programmed for overdrive pacing and sensing mode when an intrinsic rhythm was present. A smartphone (Samsung S21+5G) was placed directly over the pulse generator and right ear. The phone was tested under four conditions: standby mode, 5G internet connection, incoming and outgoing calls for each location. Real-time ECG monitoring and patient symptoms were recorded to determine the occurrence of electromagnetic interference. The possibility of electromagnetic interference with the interrogation telemetry was also investigated.

Results
A total of 4824 tests were performed on 489 patients. Most pacemakers were dual-chamber (82%) and MRI-compatible systems (83%). The average implantation duration is 4.3±3.5 years, 4.8±3.9 years, and 5.5±4.4 years for the pulse generator, right atrial lead, and right ventricular lead, respectively. No electromagnetic interference was detected either pulse generator or right ear location. Interference to telemetry was demonstrated in 11.5% of the patients. Almost (98.2%) occurred mainly during incoming calls. Single-chamber pacemakers, non-MRI compatible systems, older pulse generators, older leads, and unipolar settings were significantly related to the higher incidence of interference to interrogation telemetry.

Conclusion
The risk of electromagnetic interference between modern smartphones with 5G networks and pacemakers is negligible. Nevertheless, interference to interrogation telemetry may still occur.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Faculty of Medicine, Prince of Songkla University
Patient reported symptoms in emergency health care service in patients with complete atrioventricular block
Authors: Sorensen E , Moller A , Lippert F , Kober L , Kragholm K , Folke F , Blomberg S , Christensen H , Torp-Pedersen C , Bang C 
Published: October 2022

Abstract

Aim
To examine initial symptoms in emergency and medical helpline calls of patients prior to hospital admission and pacemaker implantation due to recent onset of complete atrioventricular block.

Methods
In the capital region of Denmark, Copenhagen, citizens who require medical assistance can contact either the regional 24h non-urgent medical helpline 1813 or the emergency number 1–1-2 (equivalent to 9–1–1). In both services, the symptoms/purposes of the calls are registered by health professionals. We identified calls from patients who received a pacemaker due to recent onset complete AV block. Prior to analysis, symptoms were categorized as fainting, dizziness, other CNS symptoms, chest pain, other cardiac symptoms, breathing problems, trauma/exposure, unconsciousness, unclear problems, and other atypical symptoms.

Results
We identified 451 calls (261 emergency calls and 190 non-emergency calls) which included information on symptom presentation prior to hospital admission due to first time diagnosis of complete atrioventricular block, that resulted in pacemaker implantation (Figure). Typical symptoms such as fainting and dizziness accounted for only 12.6% (57/451) and 13.3% (60/451), respectively. Chest pain (13.6%, 61/451) and other cardiac symptoms (5.3%, 24/451) accounted for roughly one in five patient complaints. Across both service types, patients &gt;80 years (median age) was more likely to call for help due to trauma/exposure, while complaints of fainting trended towards younger patients and the 1-1-2 emergency number. Median time from first call to pacemaker implantation was 2–3 days for fainting, dizziness, and chest pain, compared to 6–8 days for other CNS symptoms and other atypical symptoms (Table).

Conclusion
Typical symptoms such as fainting and dizziness accounted for only 13% in patients with complete atrioventricular block. Instead, these patients presented with a wide variety of initial symptoms, including chest pain, breathing problems, unclear problems, or trauma. Finally, symptom presentation seemed to affect the time to pacemaker implantation.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Danish Heart Foundation
Results of permanent lead implantation at the His bundle without the use of an electrophysiological unit
Authors: Israel C , Marinos R , Tribunyan S , Deelawar S , Angleitner A , Kalyani M , Feldmann T , Almahallawi H 
Published: October 2022

Abstract

Background
His bundle pacing (HBP) promises physiological cardiac stimulation using the conduction system for a synchronous ventricular excitation, excluding the risk of pacing-induced cardiomyopathy. In daily practice, HBP is rather rarely used in Germany, in part because it has been recommended to use an electrophysiological unit (EPU) for registration of the His bundle potential and the HV interval. We attempted HBP replacing the EPU by a normal pacing system analyzer (PSA) with high resolution of the electrogram (EGM) which is used during daily clinical routine (Figs. 1 & 2).

Methods
Consecutive patients (pts) with attempted HBP in our department were included in this prospective study. We used a 4,1F and a 7F lead together with specific sheaths to reach the His bundle. Mapping was performed using a conventional PSA (atrial channel, unipolar mode, 20 mm/mV). We recorded the success of the implantation for HBP, selective versus non-selective His bundle capture, parameters of sensing and pacing performance, operation and fluoroscopy times, the number of lead implantation attempts and QRS duration before and after HBP.

Results
Implantation of a system for HBP was attempted in 265 pts (mean age 78±12 years, 102 female, mean left ventricular ejection fraction 55±8%) and was successful in 244 (92%), selective His bundle capture was achieved in 55%, non-selective in 37%. Implantation success rates increased from 86% (earliest quartile) to 98% (latest quartile). Mean operation time was 95±46 min, mean fluoroscopy time 11±10 min; a mean of 6±7 attempts (median: 3) were necessary. Mean R wave amplitude was 5±4 mV, mean threshold 0,7±0,5 V at 1,0 ms. QRS duration before implantation was 111±29 ms, post implantation 88±20 ms.

Conclusions
HBP in daily clinical routine can be successful in &gt;90% of cases without an EPU. Mean operation and fluoroscopy times were similar to those needed for biventricular pacing. An extremely narrow paced QRS could be achieved that indicates extremely good synchronization with HBP.

Funding Acknowledgement
Type of funding sources: None.
CardioneuROablation for reflex syncope: efficacy and effects on autonoMic cArdiac regulatioN. The Roman 1 study
Authors: Piotrowski R , Baran J , Sikorska A , Krynski T , Kulakowski P 
Published: October 2022

Abstract

Purpose
To assess the effects of CNA on syncope recurrences in patients with VVS

Methods
The Roman 1 study was a prospective, randomized, investigator-initiated trial comparing CNA versus optimal standard therapy in patients with asystolic VVS. Patients were included if they had documented symptomatic cardioinhibitory or mixted spontaneous VVS (at least 3 seconds of asystole), frequent and/or severe symptoms (at least one syncope or 3 presyncopal events during preceding 12 months or very severe syncope in the past, leading to injury) and positive atropine test (&gt;30% increase in sinus rate). CNA was performed using RF ablation of the ganlionated plexi from the left and right atrium. Follow-up lasted 2 years. Primary endpoint was time to first syncope recurrence. One of secondary endpoints were changes in quality of life (QoL) assessed using dedicated questionnaire The Impact of Syncope on Quality-of-Life Questionnaire University of Calgary.

Results
48 patients (17 males, mean age 38±10, 24 – CNA group, 24 – control group) entered the study. Baseline demographic and clinical characteristics were similar in both groups. The primary end-point – syncope recurrence, occurred in 2 (8%) patients from the CNA group versus 12 (50%) controls (p=0.00037, see Kaplan-Meier curve). QoL significantly improved in the CNA group (30±10 vs 10±7 points, p=0.0001) whereas remained stable in controls (31±10 vs 30±10 points, p=0.5501).

Conclusion(s)
This is the first randomized study documenting efficacy of CNA in patients with asystolic VVS. Larger studies are needed to confirm these findings.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Centre of Postgraduate Medical Education
Long-term incidence of pacemaker implantations and bradycardia among cross-country skiers
Authors: Svedberg N , Sundstrom J , Hambraeus K , James S , Andersen K 
Published: October 2022

Abstract

Background
Bradycardia is more common among well-trained athletes. The associations of training with pacemaker implantations are less known. We aim to investigate the association of endurance training with incidence of bradycardia and pacemaker implantations in a cohort of endurance athletes. Furthermore, we aim to establish potential sex differences of such associations.

Methods
Swedish skiers (209,072) that completed 1 or more races in the 30 to 90 km cross-country skiing event Vasaloppet (1989–2011) and a matched sample (n=531,949) of nonskiers were followed until first event of bradycardia or pacemaker implantation. The Swedish National Patient Register of in-patient and specialized outpatient care was used to obtain the date of diagnoses. Cox regression was used to investigate associations of number of completed races and finishing time with incidence of bradycardia and pacemaker implantations.

Results
Male skiers had higher incidence of bradycardia (hazard ratio [HR], 1.14; 95% CI, 0.99–1.30) and pacemaker implantations (HR, 1.14; 95% CI, 1.02–1.28) than male nonskiers. Male skiers completing most races or with the fastest finishing times had the highest incidence. The incidence of bradycardia (HR, 0.96; 95% CI, 0.70–1.30) and pacemaker implantations (HR, 0.97; 95% CI, 0.75–1.25) among female skiers in Vasaloppet was not different to that of female nonskiers. There was a trend that female skiers completing most races or with fastest finishing times had lower incidence.

Conclusions
Male skiers had higher incidence of bradycardia and pacemaker implantations. Female skiers in Vasaloppet had non-different incidence of bradycardia and pacemaker implantations. Men with the highest number of races and fastest finishing times had the highest incidence of pacemaker implantations. This indicates that bradycardia associated with training is not always as benign as previously suggested. The response appears to be different between sexes.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Uppsala UniversityCKF Dalarna
Endo- and epicardial mapping of spontaneous ventricular fibrillation during acute myocardial infarction in a porcine model
Authors: Sattler S , Hesselkilde E Z , Orini M , Taggart P , Pehrson S , Jespersen T , Tfelt-Hansen J 
Published: October 2022

Abstract

Introduction
Ventricular fibrillation (VF) during the first minutes of acute myocardial infarction (AMI) is among the most frequent causes of sudden cardiac death. Albeit mechanisms for arrhythmogenesis during ischemia are well understood on a cellular level, little is known in an in-vivo setting.

Aim
Aim of this study was the development and characterization of a porcine model of AMI and spontaneous VF with continuous electrical mapping using a non-contact mapping system (EnSite Array) in the left ventricle (LV) and an electrode sock covering the whole heart. Activation-recovery intervals (ARI), beat-to-beat variation in repolarization (BVR), and ectopic activation were measured.

Methods
Nineteen Danish Landrace pigs (56±4 kg, heart weight 251±20 g) were anaesthetized, equipped with electrophysiological (EP) catheters in the coronary sinus, right and LV as well as a multi electrode array (St. Jude, EnSite Array) catheter in the LV. Thoracotomy was performed and the sock electrode was placed on the pericardium covering the anterior and the posterior surface of the heart. Finally, the mid-left anterior descendent artery was occluded with a percutaneous transluminal coronary angioplasty balloon to induce AMI and kept in place for 45 minutes followed by 20 minutes of reperfusion. Data from both systems were analyzed offline using a custom-made software.

Results
All pigs had stable hemodynamic parameters during the procedure. Spontaneous VF occurred in 8/19 pigs during the occlusion period. Epi- and endocardial mapping showed similar shortening of ARI in the infarcted area (Figure 1A). AMI shortened ARI in the ischemic area to a greater extend in pigs that developed VF (Figure 1B) and caused beat-to-beat variation in repolarization (BVR) in later phases (Figure 1C). Ectopic beats proceeding spontaneous VF varied in activation site and subsequent repolarization (Figure 1D, left). Multiple short-coupled ectopic beats destabilized the electrical substrate further and led to progressive ARI shortening (Figure 1D, last 4 beats).

Conclusion
We present the first whole heart mapping experiments of spontaneous VF during AMI with endo- and epicardial mapping. Pigs with VF had shorter ARI, greater dispersion but similar BVR during AMI compared to those without VF. These findings provide a deeper understanding of arrhythmogenesis during AMI and can help to develop new antiarrhythmic drugs or to assess risk factors of VF.

Funding Acknowledgement
Type of funding sources: None.
Sex differences among patients with tachyarrhythmias and bradyarrhythmias following acute myocardial infarction
Authors: Alnsasra H , Tsaban G , Cooper J , Haim M 
Published: October 2022

Abstract

Background
Acute myocardial infarction (AMI) is commonly complicated by ventricular, supraventricular tachycardias and high-grade atrioventricular block (HAVB) which may result in increased morbidity and mortality.

Purpose
To evaluate the sex differences in tachyarrhythmias and HAVB, and their associated outcomes following AMI.

Methods
Using the Acute Coronary Syndrome Israeli Survey (ACSIS) survey database from 2000–2018, we analyzed the specific incidence rates for arrhythmias including: sustained ventricular tachycardia (VT), ventricular fibrillation (VF), new-onset atrial fibrillation (AF) and HAVB in men and women after AMI. Unadjusted and multivariable-adjusted logistic regression analyses were performed to assess the sex differences of in-hospital arrhythmias after AMI. Multivariate cox proportional hazard models were performed to assess the impact of arrhythmias on 1-year mortality.

Results
In this cohort study of 14280 patients with 3159 (22.1%) women and 11121 (77.9%) men, 316 (2.2%) experienced ventricular arrhythmias (VAs) (sustained VT or secondary VF) with similar rates among men and women (2.3% and 2.2%, respectively, p=0.62). Compared to men, women were less likely to experience primary VF (1.6% vs 2.3%, p=0.034), but more likely to experience AF (8.6% and 5.0%, p&lt;0.001). 372 (2.6%) patients experienced HAVB with higher rates of HAVB in women than men (3.7% and 2.3%, respectively, p&lt;0.001).
After multivariate analyses, the association with primary VF was attenuated (adjusted Odds Ratio (OR) = 0.80, p=0.15) but women remained more likely to experience AF (adjusted OR =1.24, p=0.01) and HAVB (adjusted OR =1.28, p=0.04). The occurrence of VAs was found to be associated with increased mortality in both men (adjusted Hazard Ratio (HR) =3.68, p&lt;0.01) and women (adjusted HR=3.87, p&lt;0.01) without a significant difference between the groups (p for interaction=0.203). The occurrence of AF was found to be associated with increased mortality in both men (adjusted HR=1.64, p&lt;0.001) and women (adjusted HR=1.34, p&lt;0.001) with a significant difference between the groups (p for interaction&lt;0.001). HAVB was found to be associated with increased mortality in both men (adjusted HR=2.31, p&lt;0.001) and women (adjusted HR=2.26, p&lt;0.001) without a significant difference between the groups (p of interaction=0.21).

Conclusions
The incidence rates of VAs after AMI were similar in men and women, except for primary VF, which was more common among men. Women experienced more AF and HAVB than men. VAs, AF and HAVB were found to be associated with increased mortality.

Funding Acknowledgement
Type of funding sources: None.
Correlations between endocardial voltage mapping, diagnosis and genetic in patients with arrhythmogenic right ventricular cardiomyopathy
Authors: Maury P , Delasnerie H , Sauve R , Beneyto M , Domain G , Voglimacci Q , Waintraub X , Mondoly P , Rollin A , Gandjbakhch E 
Published: October 2022

Abstract

Background
The relations between voltage mapping and diagnosis or genetic background of patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) have not been investigated so far.

Objective
To investigate if diagnosis or genetic background were linked to voltage mapping in ARVC.

Method
97 patients with proved or suspected ARVC undergoing 3D endocardial mapping and genetic testing have been retrospectively included. Presence, localisation and extension of low voltage areas were correlated to ARVC diagnosis and presence of a culprit mutation.

Results
68 patients (70%) fulfilled ARVC diagnosis according to the Task Force criteria and 43 (44%) had ARVC-causal mutations. 78 (80%) presented with some bipolar or unipolar endocardial scar. 60/ 78 patients with endocardial scar (77%) fulfilled the criteria for a definitive ARVC diagnosis versus 8/19 patients without scar (42%) (p=0.003).
In the 68 patients with a definitive diagnosis of ARVC, the presence of endocardial scar was similar whether an ARVC-causal mutation was present or not (35/40 vs 25/28, p=ns). While there was slightly more infero-lateral scars in patients carrying a pathogenic genetic variant (34/40 vs 18/28, p=0.04), there was no difference for right ventricular outflow tract (24/40 vs 17/28) and apical scars (12/40 vs 11/28) or for multiple scars (26/35 vs 14/25 patients with scars). Scar extension was greater in patients with pathogenic variants (bipolar 12±10 vs 6±10%, p=0.02, and unipolar 22±13 vs 12±15%, p=0.01).

Conclusion
3D endocardial mapping could have an important role for refining ARVC diagnosis. Trends for larger and more infero-lateral scars were observed in mutated patients, without difference according to the mutated genes.

Funding Acknowledgement
Type of funding sources: None.
SCN5A mutations and the role of genetic background in the pathophysiology of Brugada syndrome
Authors: Probst V , Ribouleau G , Geoffroy O , Mabo P , Mansourati J , Pasquie J L , Babuty D , Al Arnaout A , Petit B , Billon O , Thollet A , Sacher F , Gourraud J B 
Published: October 2022

Abstract

Background
Mutations in SCN5A are identified in approximately 20% to 30% of probands affected by Brugada syndrome (BrS). However, in familial studies, the relationship between SCN5A mutations and BrS remains poorly understood. The aim of this study was to investigate the association of SCN5A mutations and BrS in a group of large genotyped families.

Methods
Families were included if at least 3 family members were carriers of the SCN5A mutation, which was identified in the proband. Families were recruited from 12 tertiary centers in France between 1995 and 2020. Type 1 ST elevation was defined by ≥2 mm J-point elevation with coved ST segment and negative T wave.

Results
Forty-nine large families composed of 600 members including 304 mutation carriers (51%) were studied. The signature type I ECG was present in 160 mutation carriers (BrS-ECG+; 53%). In 42 families, we found 33 individuals affected by BrS but with a negative genotype (mutation-negative BrS-ECG+). Among them, 5 patients have an ECG suggestive of BrS but without the complete signature type I ECG. Among these 33 mutation-negative BrS-ECG+ individuals, 3 (9%), belonging to 3 different families, had a spontaneous type I ECG, whereas 28 had a type I ECG only after the administration of sodium channel blockers. Three of these 33 individuals (9%) had also experienced syncope. Mutation carriers had, on average, longer PR (190±36 ms vs 154±29 ms, p&lt;0.0001) and QRS (107±19 vs 92±29 ms, p&lt;0.0001) intervals than noncarriers, demonstrating that these mutations exerted functional effects.

Conclusions
Our results suggest that SCN5A mutations are not directly causal to the occurrence of a BrS-ECG+ and that genetic background may play a powerful role in the pathophysiology of BrS. These findings are consistent with the notion that the pathophysiology of BrS includes various elements beyond mutant sodium channels.

Funding Acknowledgement
Type of funding sources: None.