bluuebunny/crossref_metadata_2025_split huggingface dataset:
Negative SA-VA difference during entrainment of a supraventricular tachycardia: a new criterion for the diagnosis of focal atrial tachycardia
Authors: Adelino Recasens R , Bazan V , Sarrias A , Jimenez J , Rodriguez Garcia J , Bisbal F , Aranyo J , Villuendas R , Almendral J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Ventricular overdrive pacing during tachycardia is one of the most common and useful maneuvers to assess de differential diagnosis of supraventricular tachycardia (SVT). Focal atrial tachycardia (FAT) usually presents long ventriculo-atrial (VA) interval, which is a passive interval since FAT is not an atrio-ventricular reentry. Therefore, during ventricular entrainment of a FAT, the stimulus-atrial (SA) interval will depend solely on the retrograde VA conduction time, if retrograde conduction exists. This retrograde conduction time is usually shorter than the VA Interval during tachycardia, thus being able to cause a negative SA-VA difference. This does not occur in other types of SVT, where the SA-VA difference helps to differential diagnosis, but positive values have been described.

Purpose
Our aim was to analyze whether the SA-VA value discriminates FAT from the other types of SVT, in patients with SVT and VA conduction when stimulating the ventricle during tachycardia.

Methods
Multicenter data of SVT entrainment were collected retrospectively, including FAT, atrioventricular nodal reentry tachycardia (AVNRT), and atrioventricular reciprocating tachycardia (AVRT). The numeric value of SA-VA difference was calculated for each case. The best SA-VA cut-off point for the diagnosis of TAF was determined, evaluating the sensitivity and specificity of this value for the diagnosis of TAF with respect to the gold standard (classical criteria).

Results
Continuous ventricular pacing during tachycardia succeeded in accelerating the atrium to the pacing rate in 80 cases out of the total studied cases: 32 (40%) AVNRT, 28 (35%) AVRT and 20 (25%) FAT. All FAT cases had a negative SA-VA value and all AVNRT and AVRT cases obtained positive SA-VA (Figure 1). SA-VA value lower than 0 ms was the best cut-off point (using ROC curve, Figure 2) with an area under the curve of 1. SA-VA difference lower than 0 ms (or negative SA-VA difference) showed 100% sensitivity and specificity for the diagnosis of FAT.

Conclusions
Negative SA-VA difference is a new and accurate criterion for the diagnosis of focal atrial tachycardia.
A novel dipole charge density mapping system integrated in robotics offers advantages for ablation of atrial tachycardias: first-in-human experience
Authors: Gagyi R , Noten AME , Wijchers S , Yap SC , Hoogendijk M , Szili-Torok T 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Catheter ablation (CA) for atrial tachycardia (AT) and atrial flutter (AFL) offers favorable acute and long-term outcomes. Until recently, mapping of AT/AFL was only possible with sequential mapping methods using manually controlled catheters. Even by implementing multielectrode mapping, some limitations exist during mapping of short-lived arrhythmias and ATs with unstable CL. Remote magnetic navigation (RMN) with its atraumatic catheter design has superior safety profile and excellent accuracy. Recently, a novel high-resolution mapping system (AcQMap) can be used in combination with RMN (AcQMap-RMN).

Purpose
To assess the feasibility, safety and efficacy of AcQMap-RMN guided ablation in the management of complex ATs.

Methods
All patients undergoing CA for AT/AFL using AcQMap-RMN were included. The AcQMap system utilizes two different types of mapping: Single Position Map (SMP) and SuperMap, allowing mapping of both non-sustained and sustained ATs. Procedural efficiency was characterized by procedure time, total ablation time and radiation doses. Acute success was defined by arrhythmia source elimination. Efficacy data are based on 12-month follow up and number of redo procedures. Procedural safety was evaluated by intra- and post-procedural complications.

Results
A total number of 76 patients were referred for CA with AT/AFL (mean age 59.0±13.2), including 3 patients with inappropriate sinus tachycardia and 73 patients with AT/AFL. Out of 73 patients, 8 had perinodal AT. From the remaining 65 patients, 38 had de novo, 22 had post-PVI, and 5 patients had post-MAZE AT/AFL. Twenty-nine patients had short-lived ATs and were mapped exclusively by SPM. The mean procedure time was 175.9±61.4 min, mean ablation time 964.0 (IQR 422.0-1693.0) s, and mean radiation dose was 152.0(IQR 86.7-294.0) mGy. Acute success was documented in 70 procedures (92.1%). From de novo AT/AF patients 4 (10.5%), from post-PVI and post-MAZE AT/AFL patients 3 had recurrence at the end of the follow-up period (11.1%). Four patients had redo procedure. Three patients had post-procedural complications including 2 patients with groin hematoma and 1 patient with transient ischemic attack.

Conclusion
AcQMap-RMN integration offers improved efficiency, high success and low complication rates in complex AT ablation.
Zero fluro compared to fluoroscopy guided radiofrequency ablation of typical atrial flutter
Authors: Spinthakis NS , Mclachlan FM , Hawley AH , Podd SJP , Lovell ML 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
There is growing evidence of the harm caused by radiation exposure for both patients and health professionals. Current use of electroanatomical 3D mapping systems has allowed the application of zero fluro technique in order to reduce exposure. The efficacy and accuracy of these mapping systems is becoming more apparent, reserving traditional fluoroscopic techniques for simple anatomical cases. Hence, the use of radiation with no electroanatomical mapping for the ablation of typical flutter, still remains the mainstay of treatment in most centers.

Purpose
We aimed to investigate whether a zero fluro approach in typical atrial flutter ablation results in similar outcomes compared to traditional fluoroscopic techniques.

Methods
This was a single center retrospective study of (n=388) consecutive patients undergoing typical atrial flutter ablation between 2018 and 2020. Majority of cases were performed under conscious sedation (i.v. midazolam and fentanyl) with two sheaths into the right femoral vein under ultrasound guidance. A steerable Livewire™ quadripolar or an Inquiry™ deccapolar diagnostic catheter was advanced into the coronary sinus. 3D mapping was performed with Ensite Precision™ or Carto 3™. Fluoroscopy was performed in LAO 300 with ablation performed at 6 o’clock on the tricuspid annulus back to inferior vena cava. Ablation catheters used 30-60 seconds per lesion. Procedural endpoints included a bidirectional block across cavotricuspid isthmus and clinical and electrocardiographical recurrence during follow up at 3 months. Baseline characteristics were examined for confounders.

Results
Atrial flutter ablation was successful in 95% of the procedures with no difference between the two groups (p=0.07). There was a significant exposure to radiation (2.494 ± 3.596 gy/cm² vs 0.1 ± 0.7 gy/cm², p=0.001) and in total fluoroscopy time (8 ± 5.7 min vs 0 ± 0 min, p=0.001) in the fluro guided group compared to zero fluro group. Total ablation time was not significantly different between the two groups (16.1 ± 11.6 min vs 14.7 ± 10.2 min, p=0.40). Patients undergoing fluro guided ablation had a significantly longer procedure when compared to the zero fluro group (77.4 ± 44.8 min vs 66.1 ± 37.1 min, p=0.006). There was no difference in baseline characteristics or procedural complications between the two groups (table 1).

Conclusion
Ablation of typical atrial flutter can be performed safely and effectively with zero fluro techniques using only 3D anatomical mapping. This work adds to the growing body of evidence to support the use of these technologies in the management of simple cardiac arrhythmias, in order to eliminate the use of radiation and its effect in carcinogenesis, by making them current standard of care.
Long-term If current blockade increases right atrial mRNA expression of HCN4, encoding proteins for If
Authors: Scridon A , Halatiu VB , Balan AI , Cozac DA , Moldovan V , Banescu C , Serban RC 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by a grant of the Romanian Ministry of Education and Research, CNCS - UEFISCDI, within PNCDI III

Background
Numerous long-term pharmacologic manipulations of cardiac ion channels have shown potential to modify the expression of genes encoding proteins for those channels.

Purpose
We aimed to investigate whether long-term pharmacologic inhibition of the hyperpolarization-activated inward current (If) using ivabradine affects the right atrial expression of genes encoding for hyperpolarization-activated cyclic nucleotide-gated (HCN) channels, responsible for If.

Methods
The right atrial mRNA expression of HCN1, HCN2, and HCN4, and of the neuron-specific HCN3 isoform was quantified in 6 control (Control) and 12 ivabradine-treated (IVA; 10 mg/kg, 4 weeks) adult male Wistar rats. The expression levels of the target genes were normalized with GAPDH housekeeping gene levels and compared between the two groups.

Results
Right atrial HCN1 and HCN2 expression levels were both similar (both p &gt;0.05) between the IVA and the Control rats. There was also no significant difference in the right atrial expression of the neuron-specific HCN3 isoform between the two groups (p = 0.22). However, the right atrial expression of HCN4, the most highly expressed HCN isoform in the sinus node, was significantly higher in the ivabradine-treated compared to the non-treated rats (p = 0.02).

Conclusions
Our study shows that chronic If blockade using ivabradine significantly up-regulates right atrial HCN4 expression. Although the examined samples contained both nodal and non-nodal tissue, since HCN4 is highly expressed in the nodal pacemaker cells and only sparsely in the remaining atrial myocardium, it is likely that the HCN4 changes observed in our study reflect sinus node alterations. HCN4 and a consequent If up-regulation could render the sinus node less sensitive to acute vagal inputs and protect against excessive vagal-induced bradycardia. Further studies will have to evaluate this hypothesis.
Anatomically-guided cardioneuroablation for recurrent neurally mediated syncope
Authors: Wichterle D , Stiavnicky P , Jansova H , Stojadinovic P , Haskova J , Peichl P , Cihak R , Kautzner J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardioneuroablation (CNA) has been proposed as a new therapeutic approach in selected patients with recurrent neurally mediated syncope and documented cardioinhibitory component.

Purpose
We report on procedural data and clinical outcomes of consecutive patients who underwent anatomically-guided CNA at our center in the period of 2014 - 2021.

Methods
A study investigated 145 otherwise healthy patients (age: 40 ± 14 years, 56% males) with recurrent reflex syncope and the physiological result of the atropine test. Biatrial radiofrequency (RF) ablation was performed under general anesthesia by irrigated-tip catheter at empirical sites of ganglionated plexi (GP) with the navigation by CARTO-3 system and intracardiac echocardiography. Anterior right GP and posteromedial left GP were always targeted to modulate the innervation of both sinoatrial (SAN) and atrioventricular (AVN) nodes, irrespective of clinical manifestation of the disease. The loss of responsiveness of both nodes to extracardiac vagus nerve stimulation was the procedural endpoint. Right vagus or bilateral vagus nerve stimulation was used in 86% and 54% of procedures, respectively.

Results
Enrolled patients had documented cardioinhibitory disorder of SAN (59%), AVN (30%), or both nodes (11%). CNA (duration: 157 ± 31 min; RF time: 15 ± 6 min; radiation dose: 84 ± 135 µGy.m²) resulted in sinus rate acceleration by 28 ± 12 bpm, shortening of AH interval by 15 ± 31 ms, an increase of Wenckebach point by 28 ± 33 bpm, shortening of AVN effective refractory period by 110 ± 115 ms, and sinus node recovery time by 508 ± 666 ms. During a median follow up of 26 (IQR: 12-39) months, CNA was repeated in 9 patients and is scheduled in 3 other (total 8%). Pacemaker was implanted only in 4 (3%) patients after single (n = 2) or repeated CNA (n = 2). Corresponding Kaplan-Meier curves are provided in the Figure. Any-syncope-free survival is comparable to that reported in active arms of historical and recent pacemaker studies.

Conclusions
CNA is a reasonably effective treatment option for patients with functional cardioinhibitory syncope. CNA can be performed by anatomically-guided ablation at empirical GP sites. Our study corroborates the clinical utility of CNA as a viable alternative to pacemaker implant in selected patients.
Improved prediction of electrical storm in patients with prior myocardial infarction and implantaImproved prediction of electrical storm in patients with prior myocardiable cardioverter defibrillator
Authors: Faga V , Anguera I , Oloriz T , Nombela-Franco L , Teruel L , Dallaglio PD , Perez Guerrero A , Gomez Hospital JA , Rodriguez Garcia J , Rodriguez Garcia MA , Adelino Recasens R , Merce J , Viedma J , Comin Colet J , Di Marco A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Aims
To evaluate predictors of electrical storm (ES), including chronic total occlusion in an infarct-related coronary artery (infarct-related artery CTO, IRACTO), in a cohort of patients with prior myocardial infarction (MI) and implantable cardioverter-defibrillators (ICD).

Methods
Multicenter observational cohort study including 643 consecutive patients with prior MI and a first ICD implanted between 2005 and 2018 at three tertiary hospitals. All the patients included in the study had undergone a diagnostic coronary angiography before ICD implantation. The variable prior ventricular arrhythmias (VA+) was positive in patients with secondary prevention ICDs and in those with at least one appropriate ICD therapy after primary prevention implantation.

Results
During a median follow-up of 42 months 59 patients (9%) suffered ES. The presence of at least one IRACTO not revascularized (IRACTO-NR) was associated with a significantly higher cumulative incidence of ES (14.5% vs 4.8%, p&lt;0.001). IRACTO-NR maintained a significant association with ES after adjustment for potential confounders (HR 2.3, p=0.005) and was an independent predictor of ES together with VA+ and LVEF. The best cut-off of LVEF to predict ES was ≤38%. A risk-prediction model based on IRACTO-NR, VA+ and LVEF≤38% identified three categories of ES risk (low, intermediate and high), with progressively increasing cumulative incidence of ES (2.2%, 9% and 20%).

Conclusion
In a cohort of patients with prior MI and ICD, IRACTO-NR is an independent predictor of ES. A new risk-prediction model allowed the identification of three categories of risk, with potentially important clinical implications.
Discussions on implantable cardioverter defibrillator deactivation in patients receiving radiation therapy
Authors: Salum E , Turner S , Syeda A , Singh SM 
Published: May 2022

Abstract

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

Background
Established guidelines discuss ICD deactivation and end of life care in ICD patients. A previous study has suggested that 45% of patients with an ICD and do not resuscitate order have not discussed ICD deactivation. In patients receiving radiation therapy for cancer ICD deactivation should be discussed given the life limiting nature of cancer, however it is unclear how frequently this topic is discussed in clinical practice.

Objectives
To report on the frequency of discussions of ICD deactivation in a population of patients receiving radiation therapy for cancer.

Methods
Our hospital is a large regional cancer and cardiac center in Canada. Consecutive patients of our institution presenting to our ICD clinic for ICD checks prior and during receipt of radiation therapy between 2005 and 2019 were included (n=43). Electronic medical records were reviewed to determine demographics, clinical characteristics, documentation of discussions on ICD deactivation, and survival at 1-year.

Results
The cohort was predominantly male (84%), with a primary prevention ICD (65%) without resynchronization capacity (74%). Discussions on ICD deactivation with subsequent deactivations occurred in 12 (28%) patients. During a median follow-up of 4 years 25 patients died, with 28% of these patients dying within 2 years of the ICD clinic encounter. Discussions on ICD deactivation were more frequent in patients who received a palliative care consultation.

Conclusions
End of life conversations regarding ICD deactivation in patients undergoing radiation therapy for cancer are rare. Collaboration with palliative care teams may facilitate conversations on ICD deactivation during this opportune time.
The prevalence of Type-1 Brugada pattern in African American: a large population study from the United States
Authors: Rattanawong P , Fatunde O , Ko Ko N , Shen W , Sorajja D 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The prevalence of Type-1 Brugada pattern in Caucasians and Asians have been estimated to be 20 and 180 per 100,000. However, the prevalence of Type-1 Brugada pattern in African Americans has never been studied.

Purpose
This study aims to identify the prevalence of Type-1 Brugada pattern in African Americans.

Methods
Medical records of African American patients ages 18 years old or older with at least one 12-lead electrocardiogram (ECG) performed at 16 hospitals from 5 states in a single healthcare system between January 1, 2011 to December 31, 2020 were included. The search engine software was used to identify patients with keywords (Brugada pattern, Brugada ECG, Brugada Type-1, or Brugada syndrome) documented in the electronic medical record. The 12-lead ECGs were retrospectively analyzed by 2 cardiologists. Any inconsistencies were reviewed by a third cardiac electrophysiologist. Type-1 Brugada pattern was diagnosed according to the recent Heart Rhythm Society Expert Consensus Statement.

Results
Among 43,116 African American patients, (46.9% males), 6 patients (mean age 44.8±13.9 years, 100% males) had Type-1 Brugada pattern documented on at least one 12-lead ECG. The prevalence of Type-1 Brugada pattern in this large patient population of African American was 13.9 per 100,000. None of the patients had major arrhythmic event at 6.7±4.7 years follow-up.

Conclusions
The prevalence of Type-1 Brugada pattern in African American is lower than Caucasian and Asian populations. The risk of major arrhythmic event of Type-1 Brugada pattern in African American appears to be low; however longer follow-up data is needed.
Phenotypic characteristics of patients with arrhythmogenic left ventricular cardiomyopathy and sustained ventricular tachycardias
Authors: Sanchez Munoz JJ , Munoz Esparza C , Penafiel Verdu P , Gonzalez Alarcon J , Polo Garcia LA , Gimeno Blanes JR , Garcia Alberola A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The Padua criteria proposed for the diagnostic approach to Arrhythmogenic Cardiomyopathy (AMC) introduced new diagnostic criteria to recognize patients with a phenotype of the left ventricular variants of AMC (ALVC). Unlike ARVC, the arrhythmogenicity of this left phenotype has not yet been established.

Objectives
This study aims to analyze the phenotypic characteristics in a group of patients with ALVC and ventricular arrhythmias (VA).

Methods
Thirty-seven related patients with ALVC and VA were included and these were evaluated at the Inherited Cardiac Disease Unit of a Tertiary Hospital.

Results
Between 2000 and 2021, a total of 207 patients were diagnosed with ALVC. Thirty-seven patients (18%) presented VA; 25 ( 67%) sustained ventricular tachycardia (SVT), 10 ( 27 %) non sustained ventricular tachycardia (NSVT) and 2 ventricular fibrillation (VF). Eighteen 18/37 (49%) biventricular and 19/37 (51%) dominant . Twenty-five, 67 % male, aged 41.8 ± 13.4 years. A genetic study was performed in 36 ( 97%), and the pathogenic mutations were identified in desmoplakin in eighteen, plakophilin-2, desmoglein-2 and phospholamb in three, titin and filamine in two; desmin, plakoglobin and lamin A in one. There was one variant of uncertain significance in desmocollin-2, desmoplakin and titin. A low amplitude QRS voltages (LAQRS) in limb leads was present in 14/33 patients . Inverted T waves in right (V1-V3) in 4/33 patients and in left precordial (V4-V6) were present in 9/33 patients. The average left ventricular ejection fraction (LVEF) was 41%± 14 and myocardial fibrosis evidenced by contrast-enhanced CMR as LGE was presented in 22 patients. Ventricular arrhythmias with a right bundle branch block (RBBB) morphology were most frequent (7/12 ), denoting the origin from LV. All VT with LBBB morphology appeared in biventricular cases (5/12). Reverse pattern break was present in three patients. EAM showed bipolar or unipolar endocardial scar left ventricle in 6/10 and bipolar or unipolar endocardial scar right ventricle in 3/10 patients. Epicardial scar was present in 4 patients ( 3 LV, 2 RV). An implantable cardioverted defibrillator (ICD) therapy was performed in 25 patients for primary or secondary prevention of sudden death. Heart transplantation was carried out for three patients.

Conclusions
A substancial number of patients with ALVC have presented ventricular arrhythmias. Ventricular arrhythmias with a right bundle branch block (RBBB) morphology were the most frequent. All of VT with LBBB morphology appeared in biventricular cases. The mutation in DSP was the most prevalent in patients with ALVC and VT. Patients with ALVC and VA are characterized by a ventricular function that is not significantly impaired; however, fibrosis in LGE is widespread.