bluuebunny/crossref_metadata_2025_split huggingface dataset:
181 SAFETY AND EFFICACY OF SUBCUTANEOUS IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS LEAD REMOVAL: A SINGLE CENTER EXPERIENCE
Authors: Pittorru Raimondo , Bernardo Dall´aglio Pietro , Valerio Falzone Pasquale , Giacomin Lazzari Enrico , De Manuel , Iliceto Sabino , Migliore Federico 
Published: December 2022

Abstract
The aim of this monocentric experience was to evaluate the efficacy and safety of subcutaneous implantable cardioverter-defibrillators (S-ICDs) lead removal procedures.

Background
S-ICD represents a therapeutic option for patients at high-risk of sudden cardiac death, in whom pacing or cardiac resynchronization therapy is not required. Furthermore, S-ICD is a suitable alternative in patients who had underwent to transvenous lead extraction, expecially to limit lead-related complications of transvenous ICD. However, data are lacking about the safety and feasibility of S-ICD lead removal procedures.

Methods
We enrolled a population consisted of 11 consecutive patients requiring S-ICD lead removal between May 25, 2014, and June 26, 2022. The primary endpoint of the study was procedural success, defined as the removal of all the lead and lead material from the subcutaneous space. Secondary endpoints included procedural complications and the need for specific removal tools.

Results
S-ICD lead removal procedures were performed in 11 patients (mean age 47 ± 14, 82% men, 64% in primary prevention). Indications for S-ICD removal procedures were replace with inappropriate sensing (n=2), generator and lead infection (n= 3), pocket erosion (n=1), system malfunction (n=2), ineffective therapy (n=1) and, finally, heart transplantation (n=2). The median time from S-ICD lead implantation to S-ICD removal was 16 (6-38) months. The primary endpoint was achieved in 100% of the patients, without procedural failure. Simple traction of the S-ICD lead was successful in 8 patients (73%), whereas 3 patients (27%) required non-powered mechanical sheath to remove lead adhesions around the coil. No addictional incision were needed in order to lead removal. No procedure-related complications occurred. Patients with device infection underwent to S-ICD removal earlier than patients without (11 months [6.5 to 15.2 months ] vs 31 months [16.5 to 45.5 months]).

Conclusions
Although simple manual traction is effective in most patients, additional tools are required in few cases, raising the question, if also the S-ICD lead removal should performed in centers with lead extraction experience with available advanced tools.
621 TRANSVENOUS LEAD ADVANCEMENT IN PAEDIATRIC PACING TO OVERCOME GROWTH STRETCHING
Authors: Porco Luigina , Silvetti Massimo Stefano , Cicenia Marianna , Tamburri Ilaria , Silvetti Giacomo , Campisi Marta , Saputo Fabio Anselmo , Battista Virginia , Drago Fabrizio 
Published: December 2022

Abstract

Background
One of the main complications of transvenous leads implanted in paediatric patients is the stretching of the lead caused by the somatic growth. It may cause pacing and sensing defects and lead dislodgement or even fracture. Absorbable lead ligature and atrial loop may reduce this risk. However, the loop may induce traction or may unroll too early and therefore impair lead function. Lead extraction and replacement is another solution, although it has some procedural risks in young patients. Lead advancement through pushing it from the pocket may solve growth-induced traction and spare the electrode throughout childhood until post-puberty.

Objective
of the study is the retrospective analysis of the outcome of the transvenous lead advancement in children with a pacemaker (PM) in a single tertiary paediatric center.

Methods
consecutive patients with a VVIR PM implanted for isolated congenital complete atrioventricular block (no structural heart disease) in alternative right ventricular (RV) pacing sites, with lead stretching underwent a trial of lead advancement during general anaesthesia, cefuroxime antibiotic profilaxis, from 2014 to 2021. After venous angiography showed venous patency, the PM pocket was opened, the lead was released from subcutaneous adherences and with a stylet was gently advanced to create a semi-loop in the atrium without dislodging the tip. Lead data (threshold, sensing, impedance) were compared before and after the procedure. Data are expressed as median (25th-75th centiles).

Results
8 patients underwent PM implantation at 6.8 (5.8-8.0) years of age, 20 (18-21) kg, 116 (106-120) cm, with the lead positioned at parahisian(3)/mid-septum (5 pts) sites. During a follow-up of 3 (1-5) years, advancement procedures were 1.5 (1.0-4.3) per patient. Between procedures, delta age was 16 (12-20) months, height 8 (7-11) cm and weight 5 (3-7) kg. All leads were successfully advanced without any procedural complications. Procedure time (skin to skin) was 96 (73-108) minutes, fluoroscopy was 0.5 (0.2-1.4) mGy, 16 (10-46) microGy/m2. Electrical lead parameters did not showed significant differences between consecutive control times.

Conclusion
the advancement of transvenous leads in children is a safe and effective procedure, with low fluoroscopy exposure, without significant acute and chronic complications. This procedure seems to preserve transvenous leads until growth has completed.
1055 MALMÖ POTS SYMPTOM SCORE: ASSESSING SYMPTOM BURDEN IN POSTURAL ORTHOSTATIC TACHYCARDIA SYNDROME
Authors: Spahic Jasmina Medic , Hamrefors Viktor , Johansson Madeleine , Ricci Fabrizio , Melander Olle , Sutton Richard , Fedorowski Artur 
Published: December 2022

Abstract

Background
Postural orthostatic tachycardia syndrome (POTS) is a common cardiovascular autonomic disorder characterized by excessive heart rate increase on standing and symptoms of orthostatic intolerance, posing significant limitations on functional capacity. No objective tool exists to classify symptom burden in POTS.

Methods
We conducted a case-control study in 62 POTS patients and 50 healthy controls to compare symptom burden between groups using the newly developed, self-rating, 12-item, Malmö POTS Score (MAPS; 0-10 per item, total range 0-120) based on patients’ own perception of symptoms through visual analogue scale assessment. We have also explored correlations between symptom severity assessed by MAPS, basic clinical parameters and postural haemodynamic changes.

Results
POTS patients showed significantly higher total MAPS score (78±20 vs. 14±12, p&lt;0.001), higher baseline systolic blood pressure (BP), diastolic BP and heart rate (HR)(p&lt;0.001) compared with healthy controls. The most prominent symptoms in POTS were palpitations, fatigue, and concentration difficulties. Haemodynamic parameters on standing were significantly correlated with palpitations in POTS after adjustment for age and sex (lower systolic and diastolic BP, and higher HR) (p&lt;0.001 for all). Orthostatic HR was significantly associated with concentration difficulties and total MAPS score. The optimal cut-point value of MAPS to differentiate POTS and healthy controls was ≥42 (sensitivity, 97%; specificity, 98%).

Conclusions
Symptom severity, as assessed by MAPS score, is 5-fold higher in POTS compared with healthy individuals. The new MAPS score can be useful as a semi-quantitative system to assess symptom burden, monitor disease progression and evaluate pre-test likelihood of disease.
336 TEMPORAL CONNECTION BETWEEN HOME MONITORING TRENDS OF THORACIC IMPEDANCE AND SUSTAINED VENTRICULAR ARRHYTHMIAS
Authors: Rodio Giovanna , Iacopino Saverio , Pisanò Ennio C , Calvi Valeria , Rovaris Giovanni , Marini Massimiliano , Giammaria Massimo , Caravati Fabrizio , Maglia Giampiero , Maines Massimiliano , Orsida Daniela , Santamaria Matteo , Bisignani Giovanni , Baroni Matteo , Lissoni Fabio , Duca Antonio , Luzzi Giovanni , Giacopelli Daniele , Gargaro Alessio , D´onofrio Antonio 
Published: December 2022

Abstract

Introduction
Implantable cardioverter defibrillators (ICDs) provide daily values of thoracic impedance (TI) that are inversely correlated with fluid accumulation in the lungs. Since sustained ventricular arrhythmias (SVA) are known to have a short-term relationship with heart failure exacerbations, our objective was to assess TI trends temporally related to SVA episodes.

Methods
This study analyzed data daily transmitted from patients with ICD or cardiac resynchronization therapy defibrillator (CRT-D) of the nationwide Home Monitoring Expert Alliance network. Device-detected SVAs were adjudicated for appropriateness. Patients were randomly split into a derivation and validation cohort. To identify the most significant TI trend (TI-index), several numerical TI transformations were tested in a cross-sectional analysis of the derivation cohort modelling the odds of first SVA with univariate logistic regressions. In the same cohort, the threshold of the selected transformation was identified to maximize the projected specificity. The relative risk of SVA for TI-index above threshold was estimated in the validation cohort by applying Cox proportional hazard models stratified by individual patients to 60-day duration windows. Analyses were performed separately in the ICD and CRT-D groups.

Results
The study cohort included 2,384 patients with 69 years of age (interquartile range: 60, 77); 19% were women, 42% had coronary artery disease, and 43% had a CRT-D. After a median follow-up of 2.0 (1.0, 3.4) years, there were 3,298 appropriate SVA episodes in 727 patients (30%).
The derived IT-index consisted of the percentage of 6-day intervals of the rolling average of TI values showing monotone decrease in the last 82 days. The increase in the risk of SVA was 3% (p&lt;0.0001) per unit of percentage. The threshold of 60% of intervals with monotone decrease was associated with 99.9% projected specificity and 70.3% accuracy.
In the validation cohort, the TI-Index was associated with a 42% increased risk of SVA episodes in the ICD group (hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.05-1.92, p=0.023). The TI-index exceeded the 60% threshold before the episode in 38% of the detected episodes. The association was not significant in the CRT-D group (HR 0.96, 95% CI 0.62-1.47, p=0.84).

Conclusions
In our analysis of remote monitoring data, a specific monotonic decreasing trend of TI was temporally associated with SVA in patients with ICD. Careful monitoring of TI can identify a period of susceptibility to ventricular arrhythmias that deserves more intensive attention.
161 ABLATION OF EPICARDIAL VENTRICULAR TACHYCARDIA ORIGINATING IN THE AREA OF PERICARDIAL ADHESIONS INDUCED BY STEREOTACTIC RADIOABLATION IN A PATIENT WITH ISCHEMIC CARDIOMYOPATHY
Authors: Ruzzarin Alessandro , Torri Federica , Agbariah Andrea , Manfrin Massimiliano , Bertagnolli Livio 
Published: December 2022

Abstract
This is the case of a 64-year-old male patient with prior inferior wall myocardial infarction, wearing a cardiac resynchronization therapy defibrillator and suffering from recurrent ventricular tachycardia (VT). The patient had undergone a transitory successful endocardial radiofrequency catheter ablation (RFCA) in 2013 and a stereotactic ablative body radiotherapy (SABR) in 2021, targeting the VT originating in the inferior wall myocardial scar. The patient was referred to our institution due to recurrent highly symptomatic slow-VT. A coronary angiography ruled out coronary artery disease (CAD) progression and a RFCA was rescheduled. Given the suspected epicardial origin of VT based on a 12-lead ECG, the decision was made to perform a combined epi-endocardial ablation. SABR-induced pericardial adhesions prevented posterior pericardial access, thus requiring an anterior access approach (Figure 1, Panel A, yellow star). Following epicardial and endocardial electroanatomic mapping (EAM), VT ablation relied on a substrate-based approach. Local abnormal ventricular activities (LAVAs), detected both in the accessible epicardial inferior wall of the left ventricle and at the opposite endocardial site, were eliminated by radiofrequency (RF) current. Upon completion of endocardial ablation, ventricular pacing induced hemodynamically unstable VT, exiting from the epicardial region corresponding to the SABR-induced pericardial adhesions. Mechanical adhesiolysis, using the elbow of the open-irrigated ablation catheter, was performed to disrupt SABR-induced pericardial adhesions in the inferior wall. The epicardial EAM performed with the open-irrigated catheter recorded LAVAs in the infero-posterior wall of the left ventricle, corresponding to the SABR-disrupted pericardial adhesions. A RF current was delivered, targeting LAVAs at this site (Figure 1, Panel B: the central green dot corresponds to the area of disrupted pericardial adhesions). At the end of the procedure, no sustained VT was induced by programmed ventricular stimulation.

Conclusion
SABR constitutes a novel and promising non-invasive radioablative treatment of VT, potentially associated with cardiac toxicity. To our knowledge, this is the first reported case of combined epicardial and endocardial RFCA of recurrent VT after SABR. Based on the first RFCA report and exclusion of CAD progression, we hypothesized that SABR might have favoured progression of the inferior low voltage area. With this case report, we would like to demonstrate that even if pericardial adhesions could be a consequence of SABR, gentle catheter-driven manoeuvres can be enough to disrupt the adhesions and to achieve full EAM. Further research is mandatory to shed light on SABR's long-term arrhythmogenic role.
55 ARE TWO PACEMAKERS BETTER THAN ONE? SYNCOPE WITHOUT PRODROMES IN A YOUNG PM-DEPENDENT SUBJECT: A CASE STUDY
Authors: Sabatini Antonella , Baessato Francesca , Tomaino Marco 
Published: December 2022

Abstract

Patient presentation and follow-up
A 33-year-old woman was admitted to the ER of our hospital because of syncope without prodromes during her routine cycling training.
The patient's clinical history is characterized by congenital heart disease, interventional and cardiac surgical procedures in 1992-2021: percutaneous aortic valve (AoV) reconstruction for severe aortic stenosis in bicuspid AoV; conservative surgical Ao valvuloplasty and mitral valve (MV) commissuroplasty; MV substitution surgery; surgical AoV and MV replacement; surgical iatrogenic IVD closure. Atrial fibrillation became chronic and, following repeated interventions, an iatrogenic AV block developed requiring pacemaker implantation. In Dec. 2019, a submuscular PM (epicardial leads) was implanted (Medtronic Adapta DDDRR programmed in VVIRR for permanent atrial fibrillation). 2 years later, a transvenous-lead PM was implanted (Biotronik Evity 8 SR-T VVI-RR MRI conditional) without extracting the Medtronic PM (re-programmed in “back-up” VVI 30 bpm).

Patient management and treatment
A conservative strategy was adopted by programming the Biotronik/endocardial device in VOO-R mode stimulation only, while waiting for the total discharge of the old (Medtronic/epicardial) device. An alternative strategy could have been the removal of the epicardial PM. PM follow-up was performed via “remote” control and clinical checks in our Congenital Heart Disease Center.
The complex clinical history and the choice of up-grading to an endocardial device without removing the epicardial device, has caused a predictable condition that was overlooked.
The entry into operation of the ERI VOO 65 bpm mode of the epicardial device, in addition to causing a physiological increase in the pacing threshold of the epicardial catheter itself, produced the inhibition of the endocardial device whenever there was a pacing capture failure of the epicardial system. This situation set asystole off and consequent patient's loss of consciousness.

Conclusions
812 FOLATES-RELATED ERYTHROCYTE DIVERSION LEAD TO ATRIAL CARDIOMYOPATHY/FIBRILLATION THROUGH EPCS DYSFUNCTION
Authors: Sgarra Luca , Desantis Vanessa , Potenza Maria Assunta , Montagnani Monica , Grimaldi Massimo 
Published: December 2022

Abstract

Background
Recent advances support the concept that pre-persistent Atrial Fibrillation (AF) and paradoxical embolism do not explain the wholeness of embolic strokes, thus suggesting a broad Atrial Cardiomyopathy (AC). Pathogenic mechanisms underlying AC are still largely unknown. Folate cycle disorders are a yet underrated dysmetabolism. MTHFR-inherited defects could hinder both endothelial and circulating endothelial progenitor cell (EPCs) functioning, therefore providing one-shot explanation to both atrial stasis (increasing atrial fibrosis and generating atrial hypocontractility even in sinus rhythm) and endothelial dysfunction (ED).

Purpose
This study aims to enquire for the hypothesis that: 1) atrial fibrosis (AFib – intended as a relative percentage of low voltage area in the context of left atrial endocavitary voltage mapping) would relate to folate cycle disorders (intended as both: a)MTHFR C677T inherited mutations and b)bone-marrow function disorders, here referring to erythropoiesis diversions) and 2) AF patients would show dysfunctional EPCs.

Methods
We studied 59 consecutive patients admitted to the cardiology Unit of the General Hospital “F.Miulli”, with preserved EF, subjected to AF ablation. AFib was quantified by bipolar peak-to-peak voltage areas (&lt;0,5 mV) with respect to the wholeness of the picked voltage points. Blood count cell was evaluated by a commercial laboratory test. EPCs isolation and characterization were performed by Ficoll-Hypaque gradient and following flow cytometry analysis for cell surface antigens: CD45, CD34, CD133, VEGFR2 and KDR. EPCs functional wound healing assay was performed to determine the number of EPCs migrated to the “wound”, measuring the percentage of relative wound closure compared with matched-controls.

Results
Baseline characteristics did not differ between Sample and Control groups. % of Afib significantly differs between C677T MTHFR homozigosis patients (n=15) with respect to non-C&//T MTHFR homozygosis patients (n=44 p &lt; 0,02). Once univariate analysis was performed, subsequent multivariate analysis highlights highest fit once merged RBC, RDW-SD and folates values were inputed: Goodness of fit was proper, modelling good (Low figure - R2=0,39; p=0,0001). Either RBC, RDW-SD and folates coefficient reached significance (p &lt; 0,0001; p &lt; 0,01; p &lt; 0,05 respectively). Number of EPCs significantly differs between AF patients and matched controls (p &lt; 0,001).

Conclusions
Our findings support the hypothesis that genetically determined folates dysmetabolism (MTHFR dysfunction) promotes AFib via a complex cardiac-bone marrow networking involving circulating EPCs and unraveled by erythropoiesis diversions. Such results suggest a pathogenic role of folate cycle disorders in the AC development
23 IMPLANTABLE CARDIOVERTER DEFIBRILLATOR (ICD) EXPLOSION AFTER GUNSHOT: WHEN DEVICE PROTECTS TWICE
Authors: Sorvillo Graziano , Giano Angelo , Manzo Michele , Ciccarelli Michele , Galasso Gennaro , Vecchione Carmine , Esposito Cristina 
Published: December 2022

Abstract
A 70 years old man presented to the emergency department with “accidental” gunshot wound at left hemithorax and left shoulder/arm. Initial clinical assessment showed stable vital signs and implantable cardioverter defibrillator(ICD) protruding outside from large wound in the infraclavicular region. The ICD, previously implanted for secondary prevention of ventricular tachycardia, appeared burned and the battery was exploded. Urgent chest computed tomography scan was performed with evidence of left omeral displaced fracture, large hematoma without arterial injury and many shotgun pellets in left shoulder/arm. The ICD generator was disconnected from passive fixation leads and removed. Patient was stabilized and omeral fracture was fixed. Following leads extraction was successfully performed in hybrid operating room with cardiac surgery standby considering the difficulty of the procedure, the type of leads (double coil, passive fixation) and the risk of complications. The patient was discharged home in good clinical conditions after re-implantation of novel ICD in right infraclavicular region.
Emerging technologies are promising in making lead extractions safer and more accessible for patients worldwide. This clinicl case report will provide the most up-to-date indications and procedural approaches for lead extractions and insight on the future trends in this field.
432 SACUBITRIL/VALSARTAN AND RISK OF SUPRAVENTRICULAR ARRHYTHMIAS AS DETECTED BY REMOTE MONITORING IN HEART FAILURE PATIENTS
Authors: Stronati Giulia , Marchese Procolo , Pimpini Lorenzo , Flori Marco , Scarano Michele , Gennaro Francesca , Antonicelli Roberto , Busacca Paolo , Parato Vito Maurizio , Grossi Pierfrancesco , Dello Russo Antonio , Guerra Federico 
Published: December 2022

Abstract

Introduction
Sacubitril/valsartan (ARNI) has demonstrated a significant benefit compared to angiotensin inhibitor (enalapril) in decreasing both morbidity and mortality in patients with heart failure with reduced ejection fraction (HFrEF). While. recent studies demonstrated that in HFrEF patients, ARNI decreased ventricular arrhythmias no data is available with regards to the supraventricular arrhythmic burden in HFrEF patients with an implantable cardioverter defibrillator (ICD) or cardiac resynchronisation therapy-defibrillator (CRT-D) and remote monitoring. The aim of out study was to assess if ARNI therapy was able to significantly reduce supraventricular arrhythmias. More specifically the primary endpoint was the incidence of AT/AF episodes, as detected by the device. Secondary endpoints included the total burden of AT/AF, the mean number of premature ventricular contractions (PVC) per hour and the percentage of biventricular pacing per day (in patients with CRT-D).

Methods
We conducted a multicentre, observational, prospective registry : the SAVE THE RHYTHM (SAacubitril Valsartan rEal-world registry evaluating THE arRHYTHMia burden in HFrEF patients with implantable cardioverter defibrillator). We enrolled all patients with HFrEF, ICD or CRT-D actively followed through remote monitoring and starting treatment with sacubitril/valsartan. All patients were followed-up for at least one year.

Results
At the end of enrollment, 265 patients from 5 centres had at least one sacubitril/valsartan prescription (88% males, age 68±10 years). The annual incidence of AT/AF episodes decreased from 16.6% before sacubitril/valsartan to 12.8%, 6.7% and 0.7% according to the maximum tolerated dose (24/26 mg, 49/51 mg and 97/103 mg, respectively; p=0.026). After treatment with sacubitril/valsartan, patients with at least one episode of AT/AF decreased from 32.6% to 26.5% (24/26 mg), 24.3% (49/51 mg) and 6.9% (97/103 mg); p=.041. A significant decrease in the number of PVC (-28 per hour) and in the rate of appropriate shock (-0.8% per year) were seen in patients with a previous diagnosis of paroxysmal or persistent AF. Patients with permanent AF (n=7) experienced no benefits from sacubitril/valsartan therapy in terms of arrhythmic burden reduction. Patients with a CRT device (41%) experienced a significant increase in biventricular pacing time (+3% per day).

Discussion
Therapy with sacubitril/valsartan could decrease arrhythmic burden in patients with non-permanent AF and HFrEF and reduce subclinical supraventricular arrhythmias in patients with no history of AF.