bluuebunny/crossref_metadata_2025_split huggingface dataset:
Echocardiographic pattern of left ventricular function recovery in tachycardia-induced cardiomyopathy patients
Authors: Serban T , Du Fay De Lavallaz J , Mannhart D , Knecht S , Kuehne M , Sticherling C , Badertshcer P 
Published: October 2022

Abstract

Background
Tachycardia-induced Cardiomyopathy (TIC) represents a reversible type of cardiomyopathy (CM) that is underdiagnosed. Prior pilot studies suggested a specific left ventricular (LV) function recovery pattern in TIC patients. Cardiac chamber remodeling in TIC, however, remains incompletely understood.

Purpose
We aimed to explore differences in LV dimensions and functional recovery in TIC patients when compared to a control group of patients with other forms of CM and functional recovery.

Methods
We identified patients with reduced left ventricular ejection fraction (≤50%) and/or atrial fibrillation or flutter treated between 2015 and 2022. Patients had at least two serial transthoracic echocardiographies (TTE). The minimal interval between the TTEs had to be at least 3 months, and the left ventricular ejection fraction (LVEF) had to either improve (≥15% in absolute value) or normalize (LVEF at follow-up ≥50%). Patients were then divided into two groups: A) patients with atrial fibrillation or atrial flutter at baseline and sinus rhythm at follow-up. These patients were assumed to have TIC. B) Patients with sinus rhythm at both baseline and follow-up, consisting of patients with other forms of CM. The change in ventricular dimensions and function (indexed left ventricular end-systolic – LVESDI, end-diastolic diameters – LVEDDI – and volumes – LVEDVI, LVEF, and fractional shortening – FS) were compared within and across group A and B at baseline and at follow-up. The groups were compared using Kruskal (for independent data) and Wilcoxon (for paired data) tests. A p&lt;0.05 was considered significant.

Results
A total of 261 patients were included (34% female, median age 68 years). The median time between TTEs was 25 months. 104 (39.8%) patients were considered to suffer from TIC and 157 (60.2%) patients were considered to suffer from other forms of CM. The changes in ventricular dimensions and function in both groups are shown in Figure 1 and Table 1. The TIC group showed no improvement in LVEDVI from baseline to the follow-up examination, while the control group showed significant improvement in LVEDVI (1.7% [−24.7, 22.8] vs. 12.4% [−7.1, 29.3], p=0.008). There was no difference in LVEDDI recovery between TIC and control patients (1.7% [−7.3, 10.3] versus 3.1% [−5.4, 10.2], p=0.578).

Conclusions
TIC patients have a specific pattern of functional recovery with similar improvements in systolic function and diameters compared with patients with other CMs, while diastolic parameters remained impaired.

Funding Acknowledgement
Type of funding sources: None.
Left atrial overload detection in ECG using frequency domain features with convolutional neural network
Authors: Kucukseymen S , Uslu S , Ozdemir S 
Published: October 2022

Abstract

Background/Introduction
Volume and pressure alterations in the left atrium (LA) are utilized as important biomarkers due to their association with numerous cardiac pathologies. Because of the anatomical peculiarities of the LA, echocardiographic evaluation is quite challenging. There are many conducted studies to determine LA hemodynamic biomarkers using ECG signals, however, the low specificity has been seen as a common problem.

Purpose
Within the scope of this study, we aimed to develop a fully automatic artificial intelligence algorithm. Therefore, the frequency domain properties of the ECG signal were examined by wavelet transform and deep learning algorithm to detect the left atrial overload (LAO) from the ECG signal. We also compared the effectiveness of lead selection (Lead II and V1 Lead) to detect LAO.

Methods
Physionet-PTB-XL database was used for ECG inputs. 10 s ECG waveform of 403 healthy people and 352 LAO patients used for feature extraction after carefully filtering. Each signal was segmented to a 1.5 s epoch and in total 4530 ECG was used for training (70%) and test (30%) of deep learning algorithms. Two different deep learning models were developed for the automatic detection of LAO. In the first approach (1D convolutional neural network, 1D-CNN) segmented raw ECG was used, and in the second approach (2D convolutional neural network, 2D-CNN) each segmented ECG was transformed to scalograms with continuous wavelets transform. All models were tested for both leads.

Results
Our results show that frequency-domain features are highly capable to detect LAO compared to time-domain features and either Lead II and V1 Lead can be used for the detection of LAO. The success rate of 1D-CNN is 72% for Lead-II and 75% for V1 Lead while the success rate of 2D-CNN is 92% for both leads.

Conclusions
The most important limitation in the diagnosis of LAO by ECG is the low specificity. In this study, a model that eliminates this limitation has been developed by using the frequency characteristics of the ECG and artificial intelligence algorithms and tested with a large population. Considering its high success rate, 2D-CNN model has the potential to help the clinician by detecting the pathology with a cheaper, operator-independent method, and a short-term measurement.

Funding Acknowledgement
Type of funding sources: None.
Evaluation of a multisensory algorithm to prevent acute decompensation of heart failure in patients implanted with a cardioverter defibrillator: rationale and design
Authors: Garcia R , Mansourati J , Gras D , Probst V , Khattar P , Himbert C , Saulnier P J , Constantin-Jacquot V , Gueffet J P , Minois D , Pierre B , Defaye P , Marijon E , Boveda S , Degand B 
Published: October 2022

Abstract

Background
Heart failure (HF) is a chronic disease affecting 64 million people worldwide and places a severe burden on society because of its mortality, numerous re-hospitalizations and associated costs [1–4]. HeartLogic is an algorithm incorporating several biometric parameters which aims to predict HF episodes. It provides an index which can be monitored remotely, allowing preemptive treatment of congestion to prevent acute decompensation [5–7].

Objectives
We aim to provide real-world data on the impact of pre-emptive HF management, guided by the HeartLogic index on unscheduled HF hospitalizations in a substantial cohort of patients.

Methods
The HeartLogic French Study is an investigator-initiated, prospective, multi-centre, non-randomized study. All in all, 310 patients with a history of HF (left ventricular ejection fraction ≤40%; or at least one episode of clinical HF with elevated NT-proBNP ≥450 ng/L) and implanted with a cardioverter defibrillator enabling HeartLogic index calculation will be included across 10 French centers. The HeartLogic index will be monitored remotely on a weekly basis for 12 months and in case of HeartLogic index ≥16, the local investigator will contact the patient for assessment and adjust HF treatment as necessary. The primary endpoint is unscheduled hospitalization for HF. Secondary endpoints are all-cause mortality, cardiovascular death, HF-related death, and unscheduled hospitalizations for ventricular or atrial arrhythmia. Blood samples will be collected for biobanking, and quality of life will be assessed. A blind and independent committee will adjudicate the events.

Conclusions
The HeartLogic French Cohort Study will provide robust real-world data on HF hospitalization in a cohort of patients managed with the HeartLogic algorithm allowing preemptive treatment of congestion.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Boston Scientific
Incidence of thyroid dysfunction following initiation of amiodarone treatment in patients with and without heart failure: a nationwide cohort study
Authors: Ali S A A , Ersboll M E , Vinding N J V , Butt J H B , Rorth R R , Selmer C S , Westergaard L M W , Mogensen U M M , Weeke P E W , Jons C J , Gustafsson F G , Fosbol E F , Kober L K , Kristensen S L K 
Published: October 2022

Abstract

Background
Although thyroid dysfunction is a well-known complication of amiodarone treatment, population-based estimates of the short- and long-term incidence of this complication are lacking. In addition, it is not clear whether heart failure (HF) exacerbates this risk.

Purpose
To examine the short- and long-term incidence of thyroid dysfunction following initiation of amiodarone treatment in patients with and without HF.

Methods
All Danish residents who initiated amiodarone treatment between 2000–2018 without a history of thyroid dysfunction was identified using nationwide registries. Thyroid dysfunction, defined as a composite of levothyroxine, anti-thyroid medication, or a diagnosis of hypothyroidism, hyperthyroidism, or thyroiditis, was assessed at 1-year follow-up. In a landmark analysis, we estimated the 5-year outcomes with patients grouped according to the cumulated dose (CD) of amiodarone within the first year (regardless of whether treatment duration was shorter than 1 year). The Aalen-Johansen estimator and a cause-specific Cox regression model were applied to compare risk across groups.

Results
In total, 43,724 patients were identified of whom 16,939 (38%) had a history of HF. Compared to patients without HF, those with HF were at a similar age (71 vs 70 years), more likely men (74% vs 65%), and more often had a history of ventricular tachycardia (19% vs 6%), ischemic heart disease (60% vs 43%), aborted cardiac arrest (8.0% vs. 3.0%), ICD or CRT (30% vs 19%), all p-value &lt;0.01 and less atrial fibrillation (72% vs 73%, p-value 0.02). At 1-year follow-up, the cumulative incidence of thyroid dysfunction was 5.3% in patients with a history of HF vs. 4.2% in patients without HF, adjusted hazard ratio (HR) 1.55 (95% CI, 1.47–1.62), Figure 1. In the landmark analysis, the 5-year cumulative incidences and adjusted HRs of thyroid dysfunction were 5.3% (HR 0.66 [95% CI 0.62–0.70]) in patients with 1-year CD of amiodarone &lt;27.38 g (average daily dose [ADD] &lt;75 mg), 14.0% (reference) for patients with CD 27.38–45.63 g (ADD 75–125 mg), 20.0% (HR 1.28 [95% CI 1.21–1.36]) for patients with CD 45.64–63.88 g (ADD 126–175 mg), and 24.5% (HR 1.39 [95% CI 1.31–1.47]), for patients with CD&gt;63.88 g (ADD &gt;175 mg), (Figure 2).

Conclusions
In patients who initiated amiodarone treatment, around 5% had evidence of thyroid dysfunction at 1-year follow-up with a slightly higher incidence in those with a history of HF. A dose-response relationship was observed between the 1-year amiodarone cumulative dose and the subsequent 5-year cumulative incidence of thyroid dysfunction.

Funding Acknowledgement
Type of funding sources: None.
Alleviation of AF related symptoms following acute conversion of recent-onset, symptomatic atrial fibrillation to sinus rhythm with flecainide acetate oral inhalation solution
Authors: Camm A J , Crijns H J G M , Elvan A , Tuininga Y , Badings E , Kuijper A F M , De Jong J S S G , Lee M , Schellings D , Van Gelder I C , Ruskin J , Kowey P , Dufton C , Maupas J , Belardinelli L 
Published: October 2022

Abstract

Introduction
Pharmacological restoration of sinus rhythm (SR) in patients with symptomatic atrial fibrillation (AF) is expected to be accompanied by prompt alleviation of symptoms to avoid the need for electrical cardioversion (ECV) and/or hospitalization. The feasibility and safety of acute cardioversion of recent-onset (≤48 hours) symptomatic AF to SR with flecainide acetate oral inhalation (FlecIH) solution was shown in the Phase 2, open-label INSTANT trial. We examined symptoms, heart rate, time to discharge and need for ECV reported among patients in the INSTANT trial whose AF was successfully converted to SR (“conversion group”; N=25) versus those whose AF did not convert to SR (“no conversion group”; N=29).

Methods
Conversion success was determined using 12-lead Holter monitoring during a 90-minute observation period. Patients in the no conversion group were offered alternative treatment per the investigator discretion. Symptoms, vital signs, time to discharge, and the need for ECV were evaluated through Day 5.

Results
Data from 54 patients (33.3% female) with a mean age of 62.1 years and a mean BMI of 26.8 kg/m2 were analyzed. All patients reported at least one AF-related symptoms at baseline (palpitations=85%; dizziness=35%; shortness of breath=37%; chest discomfort=39%) and 83.3% presented with AF symptoms ≤24 hours in duration. At 90 minutes, 80.0% of the conversion group were asymptomatic compared to 37.9% of the no conversion group (p&lt;0.001). Mean (SD) ventricular rate at 90 minutes was 70.6 (12.5) bpm in the conversion group compared to 100.4 (29.4) bpm in the no conversion group (p&lt;0.001). Median time to discharge was 2.3 (IQR: 0.75) hours for the conversion group compared to 3.6 (IQR: 1.02) hours for the no conversion group (p=0.001). By Day 5, 23 (79.3%) patients in the no conversion group had undergone ECV; no patients in the conversion group experienced AF recurrence by Day 5 (0% required ECV; p&lt;0.001).

Conclusions
Conversion of recent onset AF to SR with inhaled flecainide was associated with a reduction in symptoms, normalization of heart rate, rapid hospital discharge and avoidance of ECV during a 5-day follow-up period.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): InCarda Therapeutics
Absence of atrial fibrillation in the blanking period following cryoballoon pulmonary vein isolation – does it always portend a good prognosis?
Authors: Milstein N , Saberito M , Bhatt A , Habibi M , Sichrovsky T , Preminger M , Shaw R , Mittal S , Musat D 
Published: October 2022

Abstract

Background
Cryoballoon (CB) pulmonary vein isolation (PVI) is an accepted method for ablation in patients with paroxysmal and persistent atrial fibrillation (PAF, PeAF). Freedom from AF in the blanking period (BP), conventionally defined as the first 3-months post-PVI, has been associated with the best long-term outcomes. However, the influence of antiarrhythmic drugs (AADs) during the BP on long-term outcomes is not well understood.

Objective
To compare long-term outcomes between patients who were and were not on an AAD prior to ablation and remained free from AF during the 3-month BP post CB PVI.

Methods
We enrolled consecutive AF patients undergoing CB PVI; all pts had an implantable loop recorder (ILR). No patient had any AF in the first 90 days post CB PVI. We divided the patients into three groups: (1) never had exposure to an AAD; (2) were intolerant to/failed AAD and thus were not taking an AAD at time of ablation; and (3) were on AAD at time of ablation. In the latter group, every effort was made to stop the AAD before the end of the BP.

Results
The cohort included 96 pts (66±10 years; 60 [63%] male; 55 [57%] PAF; CHA2DS2-VASc 2.5±1.4). There were 23 (24%) patients in group 1, 13 (14%) patients in group 2, and 60 (63%) pts in group 3. Patients in group 3 were more likely to have PeAF; AADs were stopped at a median of 36 days IQR (27, 91) in this group. Patients were followed for 1-year during which time 28 (29%) patients had recurrent AF (despite having no AF during the BP). The best outcome was seen in patients who never used an AAD; the worst outcome was seen in patients who were on an AAD at time of ablation (Figure 1).

Conclusion
Our data show that absence of AF during a 3-month post CB PVI BP alone does not guarantee good-long term outcome, unless the patient was never treated with an AAD. In contrast, in patients ablated while taking an AAD, recurrent AF was observed in 37% even though they were completely AF-free during the BP.

Funding Acknowledgement
Type of funding sources: None.
Chronic amiodarone therapy and mortality among atrial fibrillation patients; insights from a real-life contemporary population
Authors: Tsaban G , Gordon M , Omari Y , Kezerle L , Alnsasra H , Buturlin K , Bareza S , Wagshal A , Novack V , Konstantino Y , Haim M 
Published: October 2022

Abstract

Background
Although associated with potentially serious side effects, amiodarone is the most effective pharmacotherapy to achieve rhythm control among patients with atrial fibrillation (AF). Recent clinical trials advocate early rhythm control in AF. The effect of amiodarone treatment on mortality among patients with AF in real-life remains largely debatable. The primary aim of this analysis was to compare all-cause mortality rates across amiodarone treatment status

Methods
This is a retrospective study among patients from the Southern district of Clalit Health Services in Israel between January 1st, 1999 and July 1st, 2021 including all prevalent atrial fibrillation cases, hospitalized with AF as a primary diagnosis. Patients treated with amiodarone were matched in a 1:1 manner with controls not exposed to amiodarone based on age, sex, living area, and atrial fibrillation diagnosis duration. To avoid immortal time bias, follow-up times of the matched controls were left adjudicated to truncate the amiodarone-free period of their matched cases. We performed survival analyses using multivariable Cox regression controlling for potential confounders.

Results
During the study period, 7,048 patients who initiated amiodarone treatment were identified, of whom 6,449 were matched with controls. The mean age was 71.5 years, and 46.4% were women among the matched population. At baseline, the amiodarone-treatment group had higher rates of diabetes (38.3% vs. 32.6%, chronic renal failure (17.2% vs. 10.8%), coronary heart disease (31.6% vs. 19.6%) peripheral vascular disease (13.1% vs. 9.8%), and congestive heart failure (33.8% vs. 20.7%; p&lt;0.001 for all). The amiodarone-treatment group had higher rates of oral-anticoagulant therapy (82.0% vs. 59.4%, p&lt;0.001). During a mean follow-up time of 5.7 years, 2849 (44.2%) patients died in the amiodarone group and 3072 (47.6%) patients in the control group [adjusted-hazard-ratio: 0.85 (confidence-interval 95%: 0.80,0.91), p&lt;0.001].

Conclusion
In a large contemporary real-life population with AF, amiodarone treatment was associated with a lower risk for death, despite a higher burden of comorbidities among patients treated with amiodarone. These results support findings from randomized clinical trials advocating aggressive rhythm control therapy to reduce mortality and suggest that amiodarone is a potentially effective treatment to achieve this aim.

Funding Acknowledgement
Type of funding sources: None.
Zero-fluoroscopy ablation of the cavotricuspid isthmus guided by intracardiac echocardiography in patients with typical atrial flutter
Authors: Luani B , Ismail A , Kaese S , Pankraz K , Schmeisser A , Wiemer M , Braun-Dullaeus R C , Genz C 
Published: October 2022

Abstract

Introduction
In previous studies we have demonstrated the advantages of electrophysiology catheter navigation by intracardiac echocardiography (ICE). In this prospective study we investigated ICE-guided zero-fluoroscopy ablation of the cavotricuspid isthmus (CTI) involving a decapolar diagnostic and an irrigated radiofrequency (RF) ablation catheter in patients with typical atrial flutter (AFL).

Methods and results
Twenty-seven consecutive patients (mean age 73.4±11.6 years, 18 male) with ECG-recordings suggesting ongoing (n=19) or recent CTI-dependent AFL underwent an electrophysiological study (EPS) utilizing solely ICE for catheter navigation. All EPS could be successfully accomplished without the need for fluoroscopy. CTI-dependent AFL was confirmed by entrainment manoeuvre in all patients with ongoing AFL. Mean EPS duration was 44.0±20.3 minutes and mean ablation procedure duration was 22.3±16.4 minutes. RF ablation was applied for 6.3±3.1 minutes (50 Watts, irrigated RF-ablation in all patients). After the last RF application, bidirectional CTI-Block was confirmed by differential pacing in all patients. Echocardiographic parameters such as CTI-length, prominence of the eustachian ridge (ER), and depth of the CTI-pouch on the ablation plane (Figure 1) were assessed to analyse their correlation with EPS- or ablation procedure duration. CTI-pouch was shallower in patients with ablation procedure duration above median (4,9±1.09mm vs. 6.3±0.9mm, p=0.048), suggesting a more laterally ablation plane in these patients, where the CTI musculature is stronger. CTI-length or ER-prominence above the respective median did not correlated with longer EPS duration. However, in some cases with prominent ER inversion of the ablation catheter was needed to achieve contact of catheter-tip to the tissue. An asymptomatic intramural hematoma was diagnosed by ICE after successful ablation in one patient, no other major or minor complications were documented in this study.

Conclusions
Zero-fluoroscopy CTI ablation guided solely by intracardiac echocardiography in patients with CTI-dependent AFL is feasible and safe. ICE visualisation may help to localize the optimal ablation plane, to detect and correct poor tissue contact of the catheter tip and recognise early potential complications during the ablation procedure.

Funding Acknowledgement
Type of funding sources: None.
Adverse events associated with PentaRay Mapping Catheter – MAUDE database analysis
Authors: Bandarupalli T , Mandapati R , Shah K , Bharadwaj R , Contractor T , Lakkireddy D , Garg J 
Published: October 2022

Abstract

Background
The 20 pole PentaRay Mapping Catheter is a high-definition mapping catheter with five soft, flexible spines providing better and faster acquisition. Despite its design, the catheter is not without glitches.

Objective
We queried the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database for adverse events related to the use of the PentaRay mapping catheter.

Methods
The Manufacturer and User Facility Device Experience (MAUDE) database was searched for reports received between October 1, 2019, to October 31, 2021, to capture all adverse events associated with PentaRay mapping catheter using the term “PentaRay” in the “brand name” section. The adverse events were adjudicated to various categories based on the review of the event description for each medical device report (MDR).

Results
A total of 159 events were reported in 148 MDRs during the study period. The most common device related issues were: damaged splines 18.2% (n=29), device entrapment 17% (n=27), thrombus on device 15.1% (n=24), foreign material on splines 8.8% (n=14), sensor error 3.8% (n=6). Of the patient related events, 13.8% (n=22) were pericardial effusion, 5% (n=8) cardiac arrest, 1.2% (n=2) coronary vasospasm/STEMI, 0.6% (n=1) heart block, 0.6% (n=1) air embolism, 0.6% (n=1) tear in pulmonary veins. These events lead to procedure abortion 27.7% (n=44) and procedural delay 11.3% (n=18).

Conclusion
Several issues have been reported with the PentaRay mapping catheter leading to to procedure abortion, delay and patients related adverse events. Understanding and troubleshooting may help improve patient outcomes.

Funding Acknowledgement
Type of funding sources: None.