bluuebunny/crossref_metadata_2025_split huggingface dataset:
Very long-term outcomes of patients undergoing catheter ablation of atrial fibrillation: a systematic review and meta-analysis
Authors: Ngo L , Lee W , Elwashahy M , Arumugam P , Ranasinghe I 
Published: October 2022

Abstract

Background
The efficacy of catheter ablation of atrial fibrillation (AF) is reported to stabilise at 5-year, but most studies report up to 3-year-outcomes only.

Objective
To perform a systematic review and meta-analysis of outcomes at 5-years following AF ablation.

Methods
We searched PubMed and Embase for studies reporting on ≥5-year outcomes following AF ablation, including freedom from atrial arrhythmia, all-cause death, stroke, and major bleeding. All meta-analyses were performed using the “meta” package in R with pooled incidence calculated using log transformation.

Results
Among 5,764 studies screened, 58 (n=41,344 patients) were included for analysis. The pooled mean age was 60.3y, 68.7% male, 78.4% paroxysmal AF, and radiofrequency was the most common ablation energy (72.4%). Most (51.5%) patients had hypertension, but the pooled rates of other comorbidities were low (heart failure: 9.0%, coronary artery disease: 12.8%, diabetes: 11.0%, and previous stroke: 8.5%). Pooled incidence of freedom from atrial arrhythmia at 5-years was 47.6% (95% CI 43.8%-51.6%, I2=98.4%) after a single procedure and increased to 64.3% (95% CI 59.6%-69.3%, I2=98.3%) after multiple procedures (Figure 1). The incidence was higher among patients with paroxysmal compared with non paroxysmal AF (55.9% vs. 28.7% and 82.2% vs. 47.6% after single and multiple procedures respectively). Retrospective studies reported slightly higher incidence of arrhythmia freedom (single procedure: 51.2% vs. 46.7%; multiple procedures: 66.9% vs. 61.9%) than did prospective studies. Few studies reported outcomes other than atrial arrhythmia free survival at 5-years (n=14) and incidences of these outcomes could only be pooled for multiple procedures. Pooled incidences of death, stroke, and major bleeding at 5-years were 8.0% (95% CI 4.2%-15.2%, I2=95.8%), 2.3% (95% CI 1.4%-3.6%, I2=72.9%), and 1.1% (95% CI 0.6%-1.8%, I2=32.5%), respectively (Figure 2).

Conclusion
At five-years, only up to 65% of patients undergoing AF ablations remained free from atrial arrhythmia although there was significant heterogeneity among individual studies. Encouragingly, these patients had low risk of dying, experiencing a stroke or major bleeding (all incidences&lt;10%).

Funding Acknowledgement
Type of funding sources: None.
COVID-19 associated Brugada pattern electrocardiogram: systematic review of case reports
Authors: Chen K C , Rathore A Z , Deol T , Liu K L , Wu E W , Su J S , Wannenburg T W , Catanzaro J N C 
Published: October 2022

Abstract

Objective
To summarize published case reports of patients diagnosed with COVID-19 infection and Brugada pattern electrocardiogram (ECG).

Background
Fever is a common clinical manifestation of COVID-19 infection. Fever has also been associated with unmasking Brugada pattern ECG in patients and may result in life-threatening arrhythmia. Little is known regarding COVID-19 associated Brugada pattern ECG. There is paucity of data and guidance in how to manage these patients.

Methods
To identify all published case reports, the latest Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was followed. A literature search was conducted using PubMed, EMBASE, and Scopus through September 2021. A systematic review was performed to identify the incidence, clinical characteristics, and management outcomes of COVID-19 patients with a Brugada pattern ECG.

Results
A total of 18 cases were collected. The mean age was 47.1 years and 11.1% were women. No patient had prior confirmed diagnosis of Brugada syndrome. The most common presenting clinical symptoms were fever (83.3%), chest pain (38.8%), shortness of breath (38.8%), and syncope (16.6%). All 18 patients presented with type 1 Brugada pattern ECG. Four patients (22.2%) underwent left heart catheterization, and none demonstrated the presence of obstructive coronary disease. The most common reported therapies included antipyretics (55.5%), hydroxychloroquine (27.7%), and antibiotics (16.6%). One patient (5.5%) died during hospitalization. Three patients (16.6%) who presented with syncope received either an implantable cardioverter defibrillator or wearable cardioverter defibrillator at discharge. At follow up, thirteen patients (72.2%) had resolution of type 1 Brugada pattern ECG.

Conclusion
COVID-19 associated Brugada pattern ECG is rare. Most patients may see resolution of the ECG pattern once their symptoms have improved. Increased awareness and timely use of antipyretics is warranted in this population.

Funding Acknowledgement
Type of funding sources: None.
Evaluation of five algorithms in predicting the sublocalisation of right ventricular outflow tract arrhythmia (RVOTA) when compared to 3D electroanatomical mapping origin
Authors: Sirbu Prisecaru R , Leatu C , Purcar O , Manitiu I 
Published: October 2022

Abstract

Introduction
The majority of idiopathic ventricular arrythmias arise from the right ventricular outflow tract (RVOT) and they represent nearly 10% of all ventricular tachycardia (VT) admissions. It is paramount to precisely predict the origin of RVOT arrhythmias to define the appropriate approach before the ablation procedure. Conventional 12-lead electrocardiogram (ECG) is a useful tool for analysing cardiac arrhythmias, and numerous ECG algorithms for predicting the origin of RVOT arrhythmias have been reported.

Purpose
To compare the predictive accuracy of five different algorithms as verified by successful ablation site using 3D electroanatomical non-contact mapping in patients with symptomatic and asymptomatic but high ventricular burden right ventricular outflow tract (RVOT) tachycardias.

Methods
28 consecutive patients admitted for radiofrequency catheter ablation for symptomatic and asymptomatic, but high ventricular burden idiopathic premature ventricular contractions (PVC) were recruited for this study. All patients had previous failed or intolerant to beta-blocker and/or at least one class IC anti-arrhythmic agents, and they had normal left ventricular ejection fraction. All patients had documented monomorphic PVC with left bundle branch block morphology and an inferior axis. Concordance of the arrhythmia origin based on ECG algorithm and 3D mapping system site were further evaluated. Of the five algorithms, two algorithms with easy-applicability and having a memorable design (Dixit and Joshi) and three algorithms with more complex and detailed design (Ito, Zhang, Pytkowski) were selected for comparisons.

Results
Assessment of the diagnostic accuracy showed that each of the five algorithms had only moderate accuracy, and the greatest accuracy was observed in the algorithm proposed by Pytkowski algorithm when assessed by a general cardiologist and Dixit and Pytkowski algorithms when evaluated by the electrophysiologist. However, when the algorithms were compared for their accuracy, specificity, sensitivity, no significant differences were found (p=0.99).

Conclusions
All the five published 12-lead ECG algorithms for RVOT location were similar in terms of the diagnostic accuracy, specificity, and sensitivity. In our study, Pytkowski algorithm exhibits the best accuracy and sensitivity among the algorithms, while predicting a precise location and when evaluation is performed by electrophysiologists and/or cardiologists.

Funding Acknowledgement
Type of funding sources: None.
Different underlying aetiologies in patients presenting with ventricular tachycardia fulfilling task force criteria for ARVC: initial suspicion based on the 12-lead electrocardiogram
Authors: Hoogendoorn J , Bosman L P , Van Der Heijden J F , Wilde A A , Van Den Berg M P , Yap S C , Riele A S J M , Zeppenfeld K 
Published: October 2022

Abstract

Background
The Task Force Criteria (TFC) for ARVC are highly sensitive, but lack specificity. Patients with atypical RV-involvement (aRVi) may have different underlying aetiologies and prognosis, requiring specific therapeutic interventions.

Purpose
We aimed to evaluate the role of the baseline ECG for initial suspicion of aRVi.

Methods
From the Netherlands Heart Institute Arrhythmogenic Cardiomyopathy (NHI-ACM) registry, patients were selected who 1) fulfilled TFC for definite ARVC, 2) presented with sustained VT, 3) underwent genetic testing. The first available ECG after VT was evaluated for AV-conduction and the presence and surface area (SA) of an R'-wave in V1-V3. ECGs with AV-conduction disturbances or an R'-wave with SA ≥1.65 mm2 were classified as suspicious for `atypical RV-involvement' (aRVi-ECG).
Patients with ARVC-related pathogenic/likely pathogenic variant (P/LP+) were classified as “typical ARVC”. Data of patients without an ARVC-related pathogenic/likely pathogenic variant (P/LP−) were reviewed by an expert panel and classified as either “typical ARVC” or “suggestive for another aetiology” based on consensus.

Results
In total 124 P/LP+ patients and 35 P/LP− patients were included. Nineteen patients had an aRVi-ECG, which appeared significantly more predominant in the P/LP− group (11 (9%) P/LP+ vs. 8 (22%) P/LP−, p=0.019). Of the P/LP− patients, seventeen (49%) were classified as “suggestive for another aetiology” (e.g. myocarditis, ischemia, sarcoid), including all 8 patients with an aRVI-ECG.
Among P/LP+ patients with an aRVi-ECG, 46% carried the Arg14del phospolamban variant and 64% died, versus 15% and 18% of P/LP+ patients without aRVi-ECG, respectively (Table 1).

Conclusion
For patients presenting with sustained VT and fulfilling the TFC for ARVC diagnosis, a baseline ECG suggestive for atypical RV-involvement should raise suspicion for a different underlying aetiology in patients without an ARVC-related P/LP variant. In P/LP+ patients, an aRVi-ECG may identify those with poor outcome.

Funding Acknowledgement
Type of funding sources: None.
Prevalence of unreported atrial fibrillation in electrocardiograms with ventricular-paced rhythm: a multicenter experience
Authors: Arcinas L , Seifer C M , Shaikh N 
Published: October 2022

Abstract

Introduction
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a major preventable cause of stroke. The diagnosis of AF on electrocardiogram is through the recognition of absent p waves and an irregularly irregular ventricular rhythm. However, in ventricular-paced patients, the rhythm on electrocardiogram (ECG) is often regular and may obscure AF diagnosis. Thus, unrecognized AF on ECG poses a potential risk among untreated ventricular-paced patients. There is scant published data reporting the prevalence of underrecognized and untreated ECG-detected AF among ventricular-paced patients.

Objectives
In the first part of this study, we aim (1) to determine the prevalence of AF and unreported AF on ECGs with ventricular-paced rhythm obtained across all 6 hospitals in our city, Canada. Using data obtained from (1), we then aim (2) to report the rates of untreated and unreported ECG-detected AF among ventricular-paced patients with an indication for anticoagulation, (3) to describe the length of delay in AF recognition and treatment among patients who should be considered for anticoagulation at the time of ECG-detected AF and (4) to identify possible strategies that can improve reporting of AF on ECGs with ventricular-paced rhythm using our institutional ECG software.

Methods
This is a retrospective multicenter review of ventricular-paced ECGs interpreted and reported by physicians using our institutional ECG software. ECGs were reviewed and confirmed by two independent cardiologists who were blinded from the reported interpretation of the ECGs.

Results
Of the sample of 1500 ECGs with ventricular-paced rhythm from 2017–2019, 2 independent cardiologists agreed that AF was present in 622 ECGs (41.5%). Of these, 251 (40.4%) were not reported to have AF by the interpreting physician.

Conclusions
Our study shows that there is a high prevalence of unreported AF on ECG in patients with ventricular-paced rhythm in our local hospitals. Further studies are warranted on describing whether this impacts treatment and outcomes among ventricular-paced patients. This study also highlights the importance of identifying possible strategies to improve reporting of AF on ECGs with ventricular-paced rhythm.

Funding Acknowledgement
Type of funding sources: None.
Phenocopia of brugada syndrome: an under-diagnosed entity?
Authors: Sanchez Contreras C , Juarez Escobar K Y 
Published: October 2022

Abstract

Introduction
Brugada phenocopy (BSF) presents as an electrocardiographic pattern similar to Brugada syndrome (BS), however, they differ in etiology, being that it will be found in association with any identifiable condition and when said condition is resolved, the electrocardiogram does not present the characteristic pattern. Since the recognition of the FSB, 122 cases have been registered worldwide, there are reports of ischemic heart disease, secondary to fluid and electrolyte imbalance, pulmonary thromboembolism, electrocution and inappropriate electrocardiographic filters, considering multiple nosological entities with a common electrocardiographic manifestation that has a different prognosis to BS Therefore, the recognition of the FSB requires a diagnostic study in order to establish specific treatment in a timely manner.

Purpose
To present 3 clinical cases of this little-known entity that did not present risk factors or family history in a cardiology reference center.

Methods
A search was carried out, finding three cases from 2015–2021, the first case a 22-year-old patient with a history of Duchenne familial dystrophy and hydroelectrolytic imbalance at admission with Brugada type 1 pattern (A) corrected after treatment (B), A 26-year-old female with pulmonary thromboembolism with a Brugada Type I pattern corrected after treatment, a 55-year-old female in the immediate postoperative period of revascularization surgery who, after 48 hours, corrected a Brugada type I pattern (C).

Conclusion
The differential diagnosis is based mainly on the fact that FBS is due to: secondary etiology, which, once resolved, will normalize the electrocardiographic pattern, negative challenge test with sodium channel blockers and low pretest for congenital BS, contrary to patients with BS that do not present these characteristics, so a differential diagnosis must be made in patients with a BS pattern.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Instituto Nacional de Cardiologia Ignacio Chavez
Effects of COVID-19 infection on ECG parameters in outpatients
Authors: Deniz H , Deniz F 
Published: October 2022

Abstract

Objective
Covid-19 infection has been declared as a pandemic disease by the World Health Organization (WHO) and has been associated with increased morbidity and mortality. More than 400 million people diagnosed with the disease has been reported until February 2022 [1]. Covid-19 infection mostly progresses with lung involvement and pneumonia, however, its effects on the cardiovascular system are also well-known. Studies have reported that Covid 19 infection can trigger cardiac events such as acute myocardial damage, acute myocarditis, acute coronary syndrome (ACS), ventricular arrhythmias, cardiogenic shock, and cardiac arrest [2]. Electrocardiogram (ECG) is an important tool to diagnose cardiac involvement. QTc interval, QT dispersion, Tp-e interval, Tp-e/QTc ratio are defined as ventricular repolarization parameters and these parameters are associated with increased risk of ventricular arrhythmia [3,4]. In our study, we aimed to evaluate to predict ventricular arrhythmia by ECG in Covid-19 patients.

Methods
Our study is a single-center, cross-sectional study. Patients diagnosed with Covid-19 in our center between July and October 2020 were included. 408 patients with positive SARS-CoV2 PCR test were detected and the ECGs of the patients were recorded at admission and 15 days after symptomatic recovery. After the exclusion criteria, remained 91 patients were analyzed. Conduction parameters (PR and QRS durations) and repolarization parameters (QTc interval, QT dispersion, Tp-e interval and Tp-e/QTc ratio) were evaluated in 12-lead ECG recordings.

Results
Ninety-one patients with Covid-19 infection were included. The group were consisted of 47 male (52%) and 44 female (48%). The mean age was 50.4 years. As a result of the statistical analysis, no significant difference was observed between the groups in terms of PR interval (142.2±21.4 ms vs. 140.1±19.0 ms; p=0.312). QRS duration was found significantly higher during active infection (91.4±12.2 ms vs. 88.8±10.9 ms; p=0.022). The mean QTc duration was detected longer in the first ECG, but no statistically significant difference was observed between the two groups (426.1±23.6 ms vs. 422.5±26.2 ms; p=0.237). QT dispersion (35.2±7.3 ms vs. 27.7±7.8 ms; p&lt;0.001), Tp-e interval (86.7±10.1 ms vs. 76.1±9.9 ms; p&lt;0.001) and Tp-e/QTc ratio (0.204±0.026 vs 0.180±0.025; p&lt;0.001) were found significantly higher during active infection

Conclusion
In our study, QRS complex, QT dispersion, Tp-e interval, Tp-e/QTc ratio were significantly higher during active infection. We considered these parameters as a contributor of the increased mortality by inducing ventricular arrhythmia and sudden death in Covid-19 patients during active infection.

Funding Acknowledgement
Type of funding sources: None.
Late ventricular potential for risk prediction of sudden cardiac death risk: a valuable tool or an unnecessary step?
Authors: Jeong J , Choi J I , Kim Y G , Choi Y Y , Min K J , Roh S Y , Shim J M , Kim J S , Kim Y H 
Published: October 2022

Abstract

Background/Introduction
Signal-averaged electrocardiography (SA-ECG) is a high-resolution electrocardiography that can detect late ventricular potential, which known to be a noninvasive tool for risk stratification of sudden cardiac death (SCD) by predicting reentrant ventricular tachyarrhythmia. There is a paucity of data with SA-ECG on SCD survivors without structural heart disease, whereas majority of previous studies had been focused on post myocardial infarction survivors.

Purpose
This study assessed the clinical utility of SA-ECG as a risk stratification modality for lethal arrhythmic event in patients at risk of SCD without definite structural heart disease.

Methods
Total 629 patients who experienced or had potential risk of SCD were studied with SA-ECG. Among them, 48 patients who were found to have significant structural heart disease were excluded, except arrhythmogenic right ventricular cardiomyopathy. Major arrhythmic event (MAE) was defined as composite of all-cause death, aborted SCD, and sustained VT during any time either before visit of clinic or during follow up period. Syncope and non-sustained VT was defined as non-major arrhythmic event. SA-ECG was defined positive when fulfilling three or more criterion: (1) unfiltered QRS duration ≥114ms, (2) filtered QRS duration ≥114ms, (3) duration of terminal QRS &lt;40uV exceeding 40ms, and (4) root mean square voltage in the terminal 40ms of ≤20ms.

Results
Among total 581 patients, 145 patients with positive SA-ECG showed higher incidence of MAE compared to patients with negative SA-ECG (21.4% vs. 6.7%, OR 3.816 [95% CI 2.208–6.597], p&lt;0.001, Table). As the number of positive SA-ECG criteria increases, incidence of MAE tended to increase sequentially, which was markedly noted from 2 positive to 3 positive criteria (10.7% to 20.8%, p&lt;0.001, Figure). In particular, patient with inherited arrhythmia showed higher rate of positive late potential compared to those with non-inherited arrhythmia (51.0% vs. 19.3%, p&lt;0.001).

Conclusion
This study showed that at least 3 out of 4 diagnostic criteria in SA-ECG can independently predict lethal arrhythmic events and the positive late potential was associated with lethal arrhythmic event that leads to SCD, suggesting risk prediction for SCD using SA-ECG in patients even without structural heart disease including inherited arrhythmias.

Funding Acknowledgement
Type of funding sources: None.
Premature atrial contraction on Holter electrocardiogram predicts the recurrence of atrial fibrillation after catheter ablation
Authors: Sunaga A , Tanaka N , Masuda M , Watanabe T , Kida H , Oeun B , Sato T , Sotomi Y , Dohi T , Okada K , Mizuno H , Nakatani D , Hikoso S , Inoue K , Sakata Y 
Published: October 2022

Abstract

Introduction
It is important to detect the recurrence of atrial fibrillation (AF) after catheter ablation (CA) early, but the method of detection has not been established. The purpose of this study is to determine whether 24-h Holter electrocardiogram (ECG) can predict the recurrence of AF after CA.

Methods
We studied 336 patients of 497 patients enrolled in EARNEST-PVI trial to investigate whether the total number of premature atrial contraction (PAC) and the maximum number of PAC run by 24-h Holter ECG at 6 months after CA predicted AF recurrence after 6 months. We excluded 86 patients with recurrence by 6 months after CA and 75 patients without Holter ECG at 6 months after CA.

Results
Median age was 66 years, male were 77% and median follow-up period was 1138 days. Receiver operating characteristic curve analysis identified the total number of PAC ≥270 beats and the maximum number of PAC run ≥8 beats as the optimal cutoff for prediction of AF recurrence. Kaplan-Meier analysis showed patients with the total number of PAC ≥270 beats had more frequent AF recurrence than those without (Kaplan-Meier estimated 3-year AF recurrence rate 34% vs. 17%, Log-rank P=0.001) and patients with the maximum number of PAC run ≥8 beats had more frequent AF recurrence than those without (Kaplan-Meier estimated 3-year AF recurrence rate 33% vs. 20%, Log-rank P=0.006). Multivariate analysis revealed that the total number of PAC ≥270 beats and the maximum number of PAC run were significantly associated with AF recurrence (hazard ratio [95% confidence interval] 1.83 [1.16–2.91], P=0.01 and 1.01 [1.01–1.02], P=0.001, respectively)

Conclusion
The total number of PAC and the maximum number of PAC run on the Holter ECG may be useful in predicting AF recurrence after CA.

Funding Acknowledgement
Type of funding sources: None.