bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical risk factors associated with ventricular fibrillation during first ST-elevation myocardial infarction
Authors: Warming PE , Glinge C , Jabbari R , Stampe NK , Dusi V , Tan HL , Bezzina CR , Crotti L , De Ferrari GM , Engstrom T , Schwartz PJ , Wilde AAM , Tfelt-Hansen J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union’s Horizon 2020 research and innovation programme under acronym ESCAPE-NET, registered under grant agreement No 733381

Introduction
Sudden cardiac death (SCD) remains a major public health issue. Most cases in the general population are caused by ischemic heart disease, and often occur in patients without known ischemic heart disease. The assessment of risk factors may point to novel causal pathways or new targets for intervention and risk prediction of SCD.

Objective
The aim of this study was to evaluate the effect of family history of sudden death, prior history of atrial fibrillation (AF), and anterior infarct location on ECG on the development of ventricular fibrillation (VF) during first ST-elevation myocardial infarction (STEMI).

Methods
We performed individual participant data meta-analyses of three European case-control studies including first STEMI patients (aged 18-80 years) with VF (cases) and without VF (controls) before revascularization (GEVAMI, AGNES, and PREDESTINATION). Analyses were done using fixed-effect, inverse variance weighted meta-analysis and multivariable logistic regression. Potential confounding variables were identified using causal diagrams and missing data were handled with multiple imputation for each cohort separately.

Results
We included 1664 cases and 2497 controls (median age (IQR) = 59 (51-67) years, 20% females) in the analyses. After adjusting for potential confounding, we found an independent and additive association between the three exposures and VF (see picture): for family history of sudden death odds ratio (OR) 1.59 (95% confidence interval: 1.37-1.85), for AF OR 2.41 (1.49-3.89), and for anterior myocardial infarction OR 1.50 (1.32-1.71). Further investigation indicated increased effect of family history with multiple sudden deaths in the family, a stronger effect of AF on VF developing within the first minutes of symptoms, and the effect of anterior infarctions being modified by enzymatically determined infarct size. The three risk factors showed an additive effect: with one factor present OR 1.59 (1.38-1.84), two factors OR 2.41 (1.95-2.99), and all three factors OR 5.49 (1.43-21.1). Complete case analysis gave similar results for all analyses.

Conclusions
Family history of sudden death, history of AF, and anterior infarct location with significant interaction with enzymatic infarct size were all independently and additively associated with an increased risk of VF in patients with a first STEMI.
Automated detection of scar-related ventricular tachycardia origins from implanted device electrograms: a combined computational-AI platform
Authors: Monaci S , Qian S , Gillette K , Puyol-Anton E , Rajani R , Plank G , King A , Bishop MJ 
Published: May 2022

Abstract

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

Background
Existing strategies that identify ventricular tachycardia (VT) ablation targets either employ invasive and time-consuming electrophysiological (EP) mapping, or non-invasive modalities that utilise standard electrocardiogram (ECG) signals. Success of these pre-procedure ablation approaches in localising re-entrant VTs often relies on VT induction, which could be avoided by utilising recordings of clinical VT episodes stored as electrograms (EGMs) in implanted devices. Such a non-invasive approach that localises VT substrates from EGMs may aid ablation planning, enhancing safety and speed.

Purpose
Our goal is to automate scar-related VT localisation by utilising EGM recordings of VT episodes from implanted devices. To achieve this, deep-learning algorithms will be trained on computational data to return VT sites of origin from implanted device EGMs. Ultimately, we intend to utilise this computational-artificial intelligence (AI) framework to detect ablation targets of clinical VT episodes and guide pre-procedure ablation planning non-invasively.

Methods
A comprehensive library of ECGs and EGMs from simulated paced beats (~15000) and scar-related VTs (500) was generated across five detailed torso models within a fast EP computational environment, combining reaction-eikonal and lead field methods. ECG (or EGM) traces from simulated paced beats were used to initially pre-train two convolutional neural network (CNN) long short-term (LSTM) attention-based architectures. Subsequently, signals of the in-silico, re-entrant VTs were used to re-train the networks to output the sites of origin of these episodes in a standardised ventricular coordinate space. Finally, the retrained CNN architectures were tested on re-entrant VTs of unseen models, and median localisation errors (LEs) were estimated against known VT origins from simulations.

Results
The performance of the networks to localise scar-related VT episodes was asserted for each torso model. When a torso model was only seen during initial training on simulated paced beats, implanted device EGMs and ECGs successfully localised VT sources with LEs 10.04 – 16.36 mm and 10.05 – 12.79 mm, respectively. When a torso model was not seen during pacing or VT training, recreating potential clinical application settings where ECGs or EGMs of clinical VTs would be the only inputs to the networks, LEs ranged 12.42 - 22.79 mm and 12.41 - 19.68 mm for EGM and ECG-based testing, respectively.

Conclusions
Our study successfully detected VT ablation substrates with accuracy that could be beneficial in clinical ablation settings. The proposed computational-AI framework may be used to automate the localisation of scar-related VTs from clinical ECGs or EGM recordings from implanted devices, ultimately aiding ablation planning.
Ganglion stellate blockade in the treatment algorithm of the malignant electric storm: one center, five years and 72 procedures in 59 patients
Authors: Jiravsky O , Spacek R , Chovancik J , Hudec M , Miklik R , Sknouril L , Stepanova R , Fiala M 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Malignant electric storm (ES) is a life-threatening condition with a high mortality rate. With years of increasing numbers of implanted ICDs, we witness increasing numbers of patients treated for ES. The role of local suppression of sympathetic nerve activity using ultrasound-guided anesthetic ganglion stellate blockade (GSB) is still under investigation with the first favorable published data from prospective cohorts.

Objective
To present data from a cohort of consecutive patients treated for ES at our cardiac center using a two-stage algorithm including GSB.

Method and Cohort
Between 2017 and 2021, 59 patients were treated using the two-stage algorithm ( when the first stage of standard procedures failed - ions, antiarrhythmic drugs, ischemia correction, heart rate modification, sedation, and GSB was performed as the second stage of the algorithm when ventricular arrhythmia recurred) in 72 GSB procedures.
57 GSB in men (79.2%)/15 GSB (20.8%) in women. Mean age 68.1 +/- 12.1 years. Mean LV EF 29.6 +/- 8.9%. 22 GSB in diabetic patients (30.6%). Ischemic etiology of ES in 41 cases (56.9%). Monomorphic ventricular tachycardia dominated among arrhythmias with 53 cases ( 73.6%). Betablocker and amiodarone were administered in 67 and 56 cases, respectively ( 93.1 and 77.8%).
A statistically significant decrease of 87.7% in ventricular arrhythmias treated with shock ICD or ATP was seen ( decrease from 57.2 to 1.43 episodes 48 hours before vs. 48 hours after GSB, p&lt;.0001) (Table 1).
Hemodynamically unstable patients on continuous catecholamines responded significantly less to the two-step algorithm, including GSB. Horner’s syndrome and other demographic and medication parameters did not appear to predict a better response to GSB (Table 2 ). No serious adverse events were observed. In one case, intermittent ( couple hours) vocal chord paresis after bilateral GSB has been observed.

Conclusion
The two-stage algorithm for the treatment of ES, including ganglion stellate blockade, has shown stable high efficacy over the years with exceptional safety. However, the actual efficacy must be proven in a double-blinded study to allow the widespread method to the clinical practice.
Integration of structural and functional data in VT ablation -- SENSE2 protocol mapping
Authors: Collinson J , Bangash F , Dungu J , Gedela S , Westwood M , Manisty C , Farwell D , Tan S , Savage H , Vlachos K , Schilling R , Hunter R , Srinivasan N 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
We have previously developed the sense protocol functional substrate mapping technique for VT ablation(1). However, functional substrate characterizaiton can involve protracted mapping time.

Purpose
We incorporated the integration of MRI data using ADAS-3D software into the mapping workflow, to integrate structural mapping information into the functional mapping substrate characterization, in order to improve procedural efficiency.

Methods
CMRs were performed in 20 patients with ischemic related VT and VT therapy in the previous 6 months. These were processed with the ADAS-3D software to characterize the extent of ventricular scars and also ADAS corridors which may correlate with VT channels. Focused substrate maps were then performed in patients, guided by the extent of ADAS scar and corridors, looking at the scar substrate in intrinsic rhythm and then functional channels using single extra pacing from the RV at 20ms above ERP (SENSE2 Protocol). Specifically healthy areas 2cm beyond the scar borderzone based on ADAS were not mapped, in order to reduce substrate mapping time and complete geometries were not created. Following delineation of functional channels pacemapping and entrainment mapping were used to confirm targets for ablation.
The ADAS 3D MRI was integrated into the into the VT substrate map on Ensite-Precision with alignment to the aorta, RV and PA (Figure 1). We compared our data with previous functional mapping data without the integration of MRI.

Results
20 patients (age 70 years; 19 male subjects) underwent ablation. Mean EF 28%. Median procedure time was 161 minutes compared with 246 minutes (in our previous study)(p=&lt;0.001) Mean substrate mapping time was 32 mins vs 63 mins (p=&lt;0.001). Mean ablation time was 22 mins vs 32 mins (p=0.11). 85% (17 of 20) patients were free from symptomatic VT/ anti-tachycardia pacing or implantable cardioverter defibrillator shocks at a median follow-up of 171 days. The mean VT burden was reduced from 22 events per patient in the 6 months’ pre-ablation to 1 event per patient in the median follow up period of 171 days post ablation (p=0.02). Mean shocks per-patient burden decreased from 3.5 to 0.08 in the same time period(p=0.03).

Conclusion
The SENSE2 protocol involves the integration of structural and functional data into the VT workflow for substrate characterization. It enables focused substrate maps to be performed without the need for complete geometry to be created in large ventricles. Outcomes compare favourably with our previous data but with significantly shorter procedure times. This streamlined workflow has the potential to improve care in VT ablation by shortening procedure times with similar outcomes which may reduce risks for the patient.
Figure 1: Comparison of Voltage Map with MRI scar & corridors using ADAS
Efficacy and safety of VT ablation of electrical storm
Authors: Mueller J , Nentwich K , Berkovitz A , Halbfass P , Ene E , Sonne K , Simu GR , Chakarov I , Deneke T 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Data about VT ablation in patients with electrical storm (ES) is limited. This study sought to compare the prognostic outcome of patients with ES to those with ventricular tachyarrhythmias but without ES undergoing VT ablation on mortality, VT recurrence rates, rehospitalization rates and major adverse cardiac events (MACE).

Methods
In this large single-centre study patients presenting with ES and undergoing VT ablation from June 2018 to April 2021 were compared to patients undergoing VT ablation due to ventricular tachyarrhythmias but without ES. The primary prognostic outcome was cardiovascular mortality, secondary endpoints were VT recurrence rates, rehospitalization rates and MACE all after a median follow-up of 22 months.

Results
A total of 311 patients underwent a first VT ablation due to ventricular tachyarrhythmias and were included (63 ± 14 years; 86% male). Of them 108 presented with ES. In the ES cohort dilated cardiomyopathy as underlying heart disease was significantly increased (p=0.008), whereas all other cardiomyopathies were equally distributed. Major complications were equal among both groups (p&gt;0.05). Ablation of the clinical VT was achieved in 95% of all patients without ES and in 94% of all patients with ES (p&gt;0.05). Noninducibility of any VT was achieved in 91% without ES and in 76% with ES (p=0.001). This was also reflected in higher VT induction rates in non-invasive programmed stimulation before hospital discharge among ES patients (40% vs. 19%; p=0.031). After a median of 22 months of follow-up, patients with ES revealed slightly increased cardiovascular mortality rates (17% vs. 9%; log-rank p=0.061; HR 1.902; CI 95% 0.961 – 3.765; p=0.061). Furthermore, ES patients suffered from increased VT recurrence rates (59% vs. 40%; log rank p=0.006), rehospitalization rates (73% vs. 49%; log rank p=0.001) and MACE (71% vs. 45%; log rank p=0.001). ES patients displayed a 1.7-fold increased risk for VT recurrence (HR 1.701; CI 95% 1.160 – 2.493; p=0.006), a 1.9-fold increase for rehospitalization (HR 1.885; CI 95% 1.366 – 2.600; p=0.001) and a 1.9-fold increase for occurrence of MACE (HR 1.935; CI 95% 1.398 – 2.679; p=0.001). Presence of ES was the only independent predictors of VT recurrence and occurrence of MACE, whereas ES and decreased LVEF were independent predictors of rehospitalization.

Conclusions
VT ablation in patients with ES is challenging and these patients reveal highest risk for recurrent VTs, rehospitalization and MACE. These patients need close follow-ups and optimal guideline-directed therapy.
Prognosis of patients with and without septal substrate after VT ablation due to electrical storm
Authors: Mueller J , Nentwich K , Berkovitz A , Halbfass P , Ene E , Sonne K , Simu GR , Chakarov I , Deneke T 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Data about VT ablation in patients with electrical storm (ES) is limited. This study sought to compare the prognostic outcome of patients undergoing VT ablation after electrical storm with and without a septal substrate on mortality, VT recurrence rates, rehospitalization rates and major adverse cardiac events (MACE).

Methods
In this large single-centre study patients presenting with ES and undergoing VT ablation were included from June 2018 to April 2021. Patients with septal substrate were compared to patients without septal substrate. The primary prognostic outcome was cardiovascular mortality, secondary endpoints were VT recurrence rates, rehospitalization rates and MACE all after a median follow-up of 22 months.

Results
A total of 108 patients underwent a first VT ablation due to electrical storm and were included (65 ± 13 years; 86% male; 45% ischemic cardiomyopathy). Cardiovascular risk factors were equally distributed among both groups (all p&gt;0.05). Major complications occurred in 11% of all patients with increased postinterventional third degree AV blocks among patients with septal substrate (9% vs 0%; p=0.062). Noninducibility of the clinical VT was achieved in 98% of all patients without a septal substrate and in 91% of all patients with a septal substrate (p=0.136). Noninducibility of any VT was achieved in 88% without a septal substrate and in 66% with a septal substrate (p=0.011). However, in non-invasive programmed stimulation before hospital discharge VT inducibility did not differ among both groups (p&gt;0.05). After 1 year and a median of 22 months follow-up, patients with septal substrate died significantly more often due to cardiovascular causes (25% vs. 7%; log-rank p=0.021). In univariate analysis cardiovascular mortality for ES patients with septal substrate was 3.9 fold higher (HR 3.979; CI 95% 1.124 – 14.092; p=0.032). Independent predictors of adverse outcome in multivariable regression analysis were presence of septal substrate (HR 4.836; p=0.026) and increased numbers of VTs inducible during VT ablation (HR 1.635; p=0.007). VT recurrence during follow-up was 59% and equally distributed among both groups (log rank p=0.911). Rehospitalization rates (log rank p=0.532) and rates of MACE (log rank p=0.463) were equal.

Conclusions
Presence of a septal substrate is associated with adverse long-term cardiovascular mortality in patients admitted for VT ablation after electrical storm. Despite decreased ablation success in these patients VT recurrence rates were not increased during follow-up.
Fast high-resolution late gadolinium enhancement magnetic resonance imaging for an accurate detection of myocardial radiofrequency catheter ablation lesions
Authors: Sridi S , Stuber M , Jais P , Cochet H , Bustin A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Whole- heart high-resolution free-breathing late gadolinium enhancement (HR-LGE) is a key sequence for detecting radiofrequency catheter ablation (RFCA) lesions. However, long acquisition time is the main limitation especially for dyspneic and claustrophobic patients.

Purpose
We aimed to introduce an accelerated HR-LGE technique for the detection of myocardial RFCA lesions.

Method
An under sampled (3-fold) navigator-gated whole- heart HR-LGE (acquired resolution of 1.25 mm3) sequence combined with advanced patch-based low-rank reconstruction was implemented on a 1.5 CMR scanner. Three sheep prospectively underwent radiofrequency ablation at multiple endocardial and epicardial sites. The animals were imaged 3 months later using conventional post-contrast LGE (PSIR, voxel size 1.8x1.4x6mm) and the proposed sequence. A reader graded image quality and diagnostic value of both LGE imaging.

Results
The acceleration allowed for acquisition times of 3 min 22s ± 20 s at 1.25 mm resolution. Compared with 2D PSIR, HR-LGE showed comparable image quality (P= 0.03). All LGE- positive segments on 2D PSIR in LV myocardium were also detected on HR-LGE (6 segments). Two additional enhanced segments were only visible on HR-LGE (8 segments). LGE-positive segments in RV myocardium were detected on HR-LGE (4 segments) while 2D PSIR was either definitely negative (2 segments) or uncertain (2 segments).

Conclusion
Accelerated whole-heart HR- LGE allows an accurate detection of left and right myocardial RFCA lesions.
The outcome spectrum for Dilated Cardiomyopathy and Ventricular Tachycardia: results from the prospective, multicenter, DCM-VT ablation study
Authors: Zeppenfeld K , Wijnmaalen AP , Ebert M , Baldinger SH , Vaseghi M , De Riva Silva M , Gaspar T , Tedrow U , Deneke T , Soejima K , Shivkumar K , Carbucicchio C , Berruezo A , Hindricks G , Stevenson WG 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): The study was partially supported by an investigator initiated grant from Biosense Webster (a Johnson & Johnson company)

Background
Recurrent sustained ventricular tachycardia (VT) due to nonischemic dilated cardiomyopathy (DCM) is difficult to treat and long-term outcome data are limited.

Objective
We aimed to identify predictors for mortality or heart transplantation (MHT) and VT recurrence.

Methods
Consecutive DCM patients accepted for VT catheter ablation (RFCA) in 9 centers were prospectively enrolled and followed.

Results
Of 281 consecutive patients (age 60±13yrs, 85% men, LVEF 36±12%) 35% had VT storm, 20% incessant VT, and 68% failed amiodarone. During a median follow-up of 21 (IQR 6-30) months after RFCA (epicardial in 58%, no RFCA due to inaccessible target in 6.4%), 67(24%) patients died/underwent HT and 138(49%) had VT recurrence (45 within 30 days defined as early); the cumulative 4-year rate of VT or MHT was 70% and of MHT 38%.
In multivariable analysis predictors of MHT were early VT recurrence (HR 2.92 (CI1.37-6.21), p&lt;0.01), amiodarone at discharge (HR 3.23 (CI1.43-7.33, p&lt;0.01), renal dysfunction (HR 1.92 (CI1.01-3.64), p=0.046), and LVEF (HR 1.36 (CI 1.0-1.84), p=0.052). A LVEF ≤32% was the optimal threshold to identify patients at risk for MHT (AUC 0.75).
MHT per 100 person-years was 40.4 after early VT recurrence and significantly higher, compared to 14.2 after later VT recurrence and to 8.5 after RFCA with no VT recurrence (both p&lt;0.01). Mortality rates for patients with VT recurrence after 30 days were not significantly higher than for patients with no VT recurrences
Patients with early recurrence and LVEF≤32% had a 1-year MHT rate of 55% (figure). VT recurrence was predicted by prior ICD shocks, basal antero-septal VT origin, and procedural failure but not LVEF.

Conclusion
DCM patients needing RFCA for VT are a high-risk group. Following RFCA half remain free of VT recurrences. Early VT recurrence with LVEF&lt;0.32 identifies those with a very high risk and screening for mechanical support/ HT should be considered. Late VT recurrence after RFCA does not predict worse outcome.
High power bipolar ablation of a thick myocardium: ex-vivo study using externally-irrigated large-tip ablation catheters
Authors: Futyma P , Zarebski L , Burbelka A , Pawlik A , Futyma M 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Bipolar radiofrequency catheter ablation (Bi-RFCA) can overcome some challenges related with treatment of intramural ventricular arrhythmias. However, there’s no data if Bi-RFCA can be effective in the setting of a thick myocardium.

Aim
To estimate safety and efficacy of high-power long-duration Bi-RFCA in the setting of a thick myocardium and to demonstrate feasibility of external irrigation for large-tip ablation catheters (AC).

Methods
The study was performed in a saline bath containing a fresh bovine heart. Bi-RFCA of the left ventricular (LV) and right free wall, interventricular septum, papillary muscle and LV summit at power settings of 70W was performed using two solid-tip 8mm AC in a parallel orientation. Irrigation using normal saline of each AC was provided from a long sheath advanced to the level of 2nd (distal irrigation – DI) or 3rd (proximal irrigation – PI) AC electrode. Post-Bi-RFCA lesions were evaluated macroscopically.

Results
Mean intercatheter distance was 28±11 mm, range 12-50 mm and a total number of 12 high-power Bi-RFCA lesions were performed. Mean Bi-RFCA time was 108±42s. Complete transmurality was achieved in 4 (33%) of lesions (mean 17±3 mm thickness, range 12-20 mm) whereas borderline transmurality was observed in further 2 (17%) lesions (mean 23±0,5 mm thickness, range 22-23 mm). No transmurality was present in the remaining 6 (50%) lesions (mean 38±7 mm thickness, range 30-50 mm). Steam pops occurred in 25% of Bi-RFCA applications. Temperature drop during external irrigation was significantly higher in the DG group vs PG 15°C vs 7°C, p=0,0046).

Conclusions
Bi-RFCA of a myocardial thickness above &gt;30mm is challenging. High-power (70W) long-duration Bi-RFCA is associated with substantial incidence of steam pops. Further histopathological studies should evaluate levels of transmurality using high power Bi-RFCA at muscle thickness between 20-30mm. External irrigation of solid-tip large AC is feasible and can significantly reduce AC tip temperature.