bluuebunny/crossref_metadata_2025_split huggingface dataset:
External validation study of the 2014 European Society of Cardiology Guidelines in relation to 2020 ACC/AHA guidelines on sudden cardiac death prevention in hypertrophic cardiomyopathy
Authors: Frochaux A , Maurizi N , Porretta AP , Nana Davies S , Pascale P , Janreaud X , Pruvot E , Monney P 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Strategies for reliable selection of high-risk hypertrophic cardiomyopathy (HCM) patients for prevention of sudden cardiac death (SCD) with implantable cardioverter-defibrillators (ICDs) are still debated.

Purpose
Assess the sensitivity of sudden death risk strategies (2014 ESC SCD 5-year risk score and 2020 ACC/AHA risk factor strategy) in predicting lethal arrhythmic events (LAE), appropriate ICD shocks, SCD or out of hospital cardiac arrest among a cohort of HCM patients

Methods
Sixty-five patients (42±17 y) with a clinical diagnosis of HCM were enrolled in our institution from 1990 to 2021. Among them, 28 patients (43%) underwent a genetic test and a pathogenic/likely pathogenic sarcomeric variant was detected in 23 cases (82%). Patients were managed according to the best available treatment strategy for HCM in the different clinical eras.

Results
Of the 65 patients, 28 cases (43%) received an ICD, including 23 for primary and 5 for secondary prevention. During a follow-up period of 15 years (median, 15 [6, 21], range 1 to 33 years, 1014 patients/year), a total of 10 LAE were observed (0.98%/year). According to ESC SCD 5-year Risk Score, 7 (10%) were at high risk, 14 (22%) at intermediate to high risk, and 44 (68%) at low risk. Median SCD 5-year risk score of 3.5% ± 2.1. ACC/AHA risk factors categorized patients as 35 (54%) at high risk, 24 (37%) at intermediate to high risk, and 6 (9%) at low risk. A total of 4 (2.8%) patients experiencing SCD events were misclassified as low-risk patients by the ESC SCD Risk Score, whereas none by the ACC/AHA model. Of the 7 patients categorized as high risk by the ESC SCD Risk Score, 2 (29%) experienced a LAE, whereas of the 35 patients at high risk by the ACC/AHA, 9 (26%) suffered a LAE. No difference in the area under the curve was showed for the 2020 ACC/AHA SCD risk stratification strategies with respect to 2014 ESC SCD 5-year-risk score (0.72; 95% CI 0.60–0.83, 0.66; 95% CI 0.49–0.84, p =0.55).

Conclusions
In this HCM cohort followed up over an extended period of more than 15 years, LAE remained relatively low (0.98%/year). SCD risk stratification recommended by the 2014 ESC SCD 5 year risk score did not showed a better discrimination than that of 2020 ACC/AHA stratifications, despite the latter proved to be more sensible in the identification of the low risk patients. More than half of our cohort was classified with a recommendation by the 2020 ACC/AHA for an ICD implantation. A larger multicenter, independent, and prospective study with long-term follow-up is warranted to better elucidate these results.
ECG descriptors of ventricular repolarization are associated with cardiac events in a gene-specific manner in long QT syndrome patients
Authors: Morgat C , Denjoy I , Fressart V , Badilini F , Vaglio M , Messali A , Maison-Blanche P , Leenhardt A , Extramiana F 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Assistance Publiques Hôpitaux de Paris (APHP)

Background
Congenital long QT syndrome (LQTS) is still associated with syncope and a risk of sudden cardiac death despite the dramatic reduction in mortality associated with beta-blocker therapy. Current risk stratification tools are imperfect.

Objective
To assess the contribution of automated scalar ECG descriptors of ventricular repolarization for arrrhythmic risk stratification in genotyped LQTS patients.

Methods
Patients with genotyped type 1, 2 or 3 LQTS with at least 1 digital ECG recording have been included in the study. History at diagnosis, and follow-up data were collected. Cardiac events included syncope, aborted cardiac arrest, appropriate implantable cardioverter-defibrillator therapy in VF zone, and sudden death.
ECG were analyzed using the BRAVO algorithm embedded in the CalECG software, version 4.1.0. QT interval duration was manually checked but ECG descriptors of Ventricular Repolarization were fully automatic.
Multivariate cox regression analysis were performed to identify parameters associated with cardiac events.

Results
467 patients (58% female, median age at diagnosis=25, LQT1,2,3 54%, 39%, 7%) were followed-up during 15.2±9.2 years. Rate of cardiac event was 1.2/100 patients-year before diagnosis and 0.9/100 patients-year during follow-up.
QTc duration was associated with the occurrence of cardiac events in the whole study population (HR=1.01 95%CI 1.0-1.01, p=0.03). Ventricular repolarization parameters associated with cardiac events were different according to LQTS type. Cardiac events were associated with increased time to accumulate 50% of T-wave energy (HR=1.53 95%CI 1.04-2.26, p=0.03) in LQT1 but with a decrease in T-wave slopes (ascending slope HR=0.63 95%CI 0.17-0.75, p&lt;0.01) in type 2 LQTS patients. QTc duration was not independently associated with cardiac events in genotype specific multivariate models.

Conclusions
T-wave morphology parameters are associated with cardiac events in a gene-specific manner. Change in T-wave symmetry and T-wave flattening are associated with cardiac events in type 1 and type 2 LQTS respectively. The descriptors of ventricular repolarization are promising parameters or risk stratification beyond QTc duration in LQTS patients.
A positive toxicology screen is a rare finding in sports-related sudden cardiac deaths
Authors: Hansen CJ , Svane J , Isbister J , Ben-Haim Y , Morentin B , Molina P , Behr E , Lucena J , Semsarian C , Sheppard MN , Tfelt-Hansen J 
Published: May 2022

Abstract

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

Introduction
Sports-related sudden cardiac deaths (SrSCD) are rare events often occurring in healthy individuals. An underlying cardiac disease may, in combination with strenuous exercise, trigger lethal arrhythmias. Intake of drugs (legal and illicit) increases the risk of sudden cardiac death (SCD), but knowledge on toxicological findings in SrSCD remains sparse.

Purpose
This study aimed to characterize the SrSCD population in an international consortium by investigating the epidemiology and autopsy findings in SrSCD.

Methods
Participating centers of the consortium (Denmark, Australia, England, Spain) provided data on all forensically autopsied SCDs aged 12—49 years in their respective cohorts, spanning from 2000—2019. Demographics, autopsy findings, and toxicology screen were assessed. A toxicology screen was considered positive if any drug was detected, except drugs related to resuscitation.

Results
Of all 5,029 SCDs, we identified 435 (9%) SrSCD. The majority (88%) died during sports while the remaining 12% died within one hour from exercise. SrSCD occurred more often in males (91% vs 71%, p&lt;0.001) who were younger (32 vs 36 years). In SrSCD, the autopsy more frequently revealed an underlying structural cardiac cause of death (64% vs 54%, p&lt;0.001); the most frequent causes of death among SrSCDs were sudden unexpected death (SUD), ischemic heart disease (IHD), and arrhythmogenic cardiomyopathy (ACM). Toxicological screens were performed in approx. 90% of cases, regardless of relation to sport. Among SrSCD cases, the rate of a positive toxicology was less than half compared to other SCDs (18% vs 44%, p&lt;0.001). The most frequent toxicological findings among SrSCDs were ethanol, central stimulants, cannabinoids, and non-opioid analgesics.

Conclusions
Sports-related SCD accounted for 9% of all SCDs in our population aged 12—49 years. The majority of sports-related deaths (88%) occurred during exercise activity. SrSCDs more often had an underlying structural cardiac disease, mainly IHD and ACM. Positive toxicology screens were half as frequent in SrSCDs compared with non-SrSCDs.
Prediction of thrombosis in atrial fibrillation with compact atrial shape representation
Authors: Harrison J , Lorenzi M , Legghe B , Iriart X , Cochet H , Sermesant M 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): IHU LIRYC ANR-10-IAHU-04
ERACoSysMed PARIS Project

Background
The impact of LA shape on clot formation in AF is yet to be understood

Purpose
To analyze the impact of LA, PVs and LAA orientations on clot formation

Methods
Pts with history of AF and an indication for LAA closure underwent pre-operative cardiac CT. Those with either a prior history of embolism or a clot detected on arterial and venous-enhanced CT images were categorized as clot positive. On CT images, the LA was segmented and meshed. Automated labelling of PVs and LAA was employed to build a compact skeleton representation of the LA (by registering labels from a template to all cases, and by connecting the center of mass of each labels). LA skeletons were used to train a novel Neural Network model for joint classification of heterogeneous data, such as images taken at different phases of the cardiac cycle. Such model consists of one encoder per dataset followed by a common classifier, enforcing a joint representation of all datasets in the same latent space. This is made possible by writing the task as a variational problem to optimise, we call this model a multi-channel variational classifier. The model was trained to predict clot positive patients and its generalizability was assessed on a test population.

Results
237 pts were included (age 74±8, 70% males, CHADS-VASc 4.3±1.2). CTs were acquired during systole in 117 and diastole in 120. 100 (42%) patients were considered clot positive. Segmentation, labeling and skeletization was successfully achieved in all pts. The model was trained using a 10-Fold cross validation. We compared the results after training on diastole and systole cases independently and by jointly training on both datasets. At testing, our model reached a 0.72 overall accuracy for the prediction of LAA clots (0.83 for systole and 0.61 for diastole), while training separately on systole and diastole was prone to strong overfitting and mode collapse with 0.52 and 0.48 accuracy, respectively.

Conclusion
While LA shape, LA size, PV and LAA orientations alone may not be sufficient for robust clot prediction, we introduce a compressed representation of the global anatomy that closely relates to LAA thrombosis, possibly identifying global features related to adverse hemodynamics. The method is reproducible and introduces a novel approach to accommodate heterogeneous diastole and systole datasets.
Use of a novel multi-disciplinary meeting to aid decision making for cardiac implantable electronic devices and the management of patients with arrhythmias
Authors: Esmonde S , Mckeag N 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Heart team meetings are well established for the management of coronary artery disease. We recently developed a novel weekly multi-disciplinary meeting (MDM) to aid decision making in the selection of patients suitable for treatment with cardiac implantable electronic devices (CIEDs) and the management of patients with arrhythmias. In this study, we present the results of an audit of the service.

Purpose
To illustrate the workload, range of conditions and decisions, and electronic communication used in the MDM.

Methods
Patients from all of Northern Ireland can be listed for discussion at the meeting using the Northern Ireland Electronic Clinical Record (NIECR). The same electronic record is used to log the result of the discussion (Figure 1). These records were analyzed for all patients discussed at the meeting from August 2019 to March 2021. Demographic and outcome (decision and mortality) data were recorded.

Results
A total of 614 patients were discussed (median age 63.0 years, 68.2% male). The mean weekly number of patients discussed was 7.5 per week. A total of 621 decision outcomes were made. 37 patients (6.0%) had died at the time of data collection. A summary of the major disease for discussion and outcome from discussion is shown in Figure 2.

Conclusion
A wide variety of patients, diseases and issues were discussed over this period. Conduction system disease was the most common disease, highlighting the challenges in treating this population. Furthermore, the most common outcome from discussion was conservative management. This may reflect the fact that arrhythmias are now frequently detected in asymptomatic patients without structural heart disease. This small study clearly demonstrates that there is interest in such a meeting to help in the management of these complex patients.
Current practices and expectations to reduce Electrophysiology catheters environmental impact: a large EHRA/LIRYC European survey
Authors: Boussuge-Roze J , Boveda S , Anic A , Conte J , Chun JKR , Marijon E , Legentil X , Mekongo V , Sacher F , Jais P 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Boston Scientific

Background
Despite aiming at improving patients’ health, healthcare consumes a large amount of resources and contributes to 4.6% of the global GHG/carbon emissions, 71% of the footprint being due the supply chain. It also produces millions of tons of complex waste per year. Yet, sustainability in EP remains a complex challenge as the performance and safety for patients are critical.

Objective
To set the ground to reduce electrophysiology (EP) catheters’ environmental impact.

Methods
A survey was conducted to poll European EP centers on 24 questions on sustainability practices and expectations.

Results
278, mostly EP doctors (84%, 76% male, 43yo), working in a public environment (89%, &gt;100 procedures/year in 53% and &gt; 500 in 36%) participated. A majority of EP doctors uses 2 to 4 more catheters/sheath per paroxysmal AF ablation procedure. MAPPING/ABLATION catheters are discarded after the procedure (73&78%), with partial re-cycling (electrodes) in 23&26 %. Local/external sterilization is rarely used (12% & 9%).
Catheters’ packaging are discarded in medical or general waste (38 & 31%) while it is recycled in only 19%.
EP Healthcare professionals are highly motivated in being environment friendly in their personal (82%) and in EP practice (62%). They identify a lack of interest from their hospital in 59% (only 16% having an executive in charge). Other barriers are the complexity of sustainability processes (48%), the effort required to change practice (47%), infectious risk (41%), lack of training (37%) and cost (33%). EP Healthcare professionals would favor sustainable mapping /ablation catheters if performances were preserved (60 & 50%). They consider re-use as the most relevant solution (60%) while being currently illegal in some European countries. Packaging should be reduced in size or made reusable. Finally, they consider that regulatory (31%), education (19%) and recommendations by companies (19%) would encourage the field to transition to more environmentally friendly practices. Interestingly, age, gender, type of practice, country or experience did not impact the results.

Conclusion
EP Healthcare professionals demonstrate a willingness to adopt sustainable practices. They consider re-use as the most relevant approach as of today. 60/50 % would favour sustainable mapping/ablation catheters providing preserved performances. Leaping to the next level of sustainability will request development of new sustainable solutions, models and technologies. Reaching this urgent goal will require governments, industry, hospitals and doctors to work closely in a coordinated approach.
Use of a neural network to generate a whole atrium 3D reconstruction of electrographic flow and basket catheter geometry from biosignals alone
Authors: Gagyi R , Szili-Torok T , Grund A , Ahapov K , Ruppersberg P , Kong M , Haeusser P 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Electrographic flow (EGF) mapping detects and quantifies patterns of electrical wavefront propagation in the atrial myocardium from basket catheter recordings. However, no single catheter can map the entire endocardial surface simultaneously. Creating panoramic maps of the whole atrium may be possible by reconstructing multiple basket positions obtained within a few minutes of each other.

Purpose
Present a method of 3D reconstruction of EGF maps generated from individual basket recordings using QRS morphologies and CT anatomies.

Methods
EGF maps were generated from unipolar signals recorded over 1 minute from 64-pole basket catheters. QRS morphologies recorded by each individual electrode were used to train a neural network (NN) on the reconstruction of the basket geometries in 3D. The NN uses the similarities between QRS morphologies to represent multiple recordings in one coherent 3D space and spatially integrate phenomena across multiple recordings without any external navigation system.

Results
A basket catheter was placed in the superior vena cava of a chronic AF canine model. The catheter was manually pulled back in steps of 5mm under fluoroscopic supervision. After reconstruction of the 3D electrode positions, a successive displacement of 3.5±1.2mm per step was reproduced. We applied the proposed method on recordings of 18 patients where an EGF source was identified. Independently, an expert determined the source locations on a 3rd party navigation system, based on 10 predefined regions in the left atrium. In 83% of the cases, the proposed method projected the sources in the same or adjacent region.

Conclusion
Novel 3D reconstruction from QRS signatures enables integration of EGF maps from multiple basket recordings that can be aligned with CT anatomy. Due to the real-time EGF map acquisition, synthesizing maps from more than 1 basket position provides a more panoramic visualization of complex atrial flow patterns.
Comparison of systemic inflammation activity and patients immune status in patients with various forms of atrial fibrillation and flutter
Authors: Ilchyshyna O YA 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): National Scientific Centre "M. D. Strazhesko Institute of Cardiology"

Aims
The inflammatory theory of atrial fibrillation and flutter arrhythmogenesis has attracted researcher`s attention in recent years, so the aim of our work is to compare the immune status of patients and systemic inflammation in paroxysmal and persistent atrial fibrillation and flutter in hypertensive people.

Materials and methods
The study involved 103 patients with hypertension and arrhythmias, who were divided into three main groups: group 1 (n = 35) - with paroxysmal atrial fibrillation (AF), group 2 (n = 38) - with persistent form of AF, group 3 (n = 30) - with persistent form of atrial flutter (AFl). For comparison, 2 control groups were formed: 4 (n = 23) - patients with hypertension, but without a history of arrhythmias and 5 (n = 21) - almost healthy people. The immune status of these patients was assessed by determining the level of monocytes (Mc), lymphocytes subpopulations and T-regulatory cells (T-reg) in the peripheral blood using flow cytometry. The activity of systemic inflammation was determined by serum highly specific C-reactive protein (CRP) level.

Results
It was noted that he number of classical CD14++CD16- and intermediate CD14++CD16+ Mc was significantly higher in patients with persistent AF and AFl comparing with patients without arrhythmias and healthy people (p&lt;0.005). This fraction of Mc is able to produce proinflammatory cytokines and activate the local renin-angiotensin system, thus triggering the processes of fibrosis in the myocardium. Amount of non-classical CD14+CD16++ Mc was significantly lower in the second group both quantitatively and in percentage (p&lt;0.005). The count of T cells with natural killer (TNK) activity was higher in all groups comparing to normal value, so statistical significance was observed only in comparison with the fifth group. The highest quantity of T-reg cells was found in healthy people comparing to other groups and a strong mathematical significance was obtained in all cases (p &lt;0.005), both comparing the values in percentage and in μl. Patients with cardiac arrhythmias had signs of active systemic inflammation, such as high level of highly specific CRP. The highest one was in 2 group and exceeded the normal level by 6.7 times (8.31 ± 0.42) versus 1.25 ± 0.01) mg per l (p &lt;0.001).

Conclusions
Patients with AF and AFl on the hypertension background comparing to hypertensive patients without arrhythmias or healthy people have a higher intensity of systemic inflammation because of higher levels of highly specific CRP, increased activity of proinflammatory subpopulation of monocytes, higher amount of T-cells with natural killer activity and reduced T-regulatory cells, whose main function is to control the immune response.
Understanding the contribution of stretch-activated ion channels to cardiac arrhythmogenesis using computational modelling
Authors: Buonocunto M , Lyon A , Delhaas T , Heijman J , Lumens J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Dutch heart foundation, ERA-CVD

Introduction
Cardiac electrophysiology and mechanics are strongly interconnected. Among other things, their interaction is mediated by cardiac mechano-electric feedback through stretch-activated ion-channels (SACs). These channels are also thought to contribute to the development of arrhythmias, but their precise role remains unclear.

Purpose
To elucidate the contribution of SACs to arrhythmias using a novel computational model of cardiac electromechanics.

Methods
We implemented two types of SACs in the O’Hara-Rudy model (ORd) of human ventricular electrophysiology: potassium-selective SACs and non-selective SACs (conducting sodium and potassium). The model was calibrated based on experimental human and rodent data of cardiomyocytes undergoing stretch. The calibration also considered inter-species differences, age, and upregulation of SACs under disease conditions. Subsequently, we varied the amplitude, duration, and timing of the simulated stretch to investigate their effects on action potential (AP).

Results
The model reproduced APs measured experimentally. Early afterdepolarizations, delayed afterdepolarizations, and ectopic beats were observed when applying stretch with short duration (e.g. 20ms) and high amplitude (e.g. 40%). When varying the time of application, stretch applied closer to the subsequent beat (cycle length: 1000ms) also shortened the following AP duration (APD) (shortening of 30ms with stretch at t=600ms, 130ms at t=800ms). Higher sensitivity to stretch was observed when simulating disease-related remodelling of SACs. Milder effects (no APD shortening with stretch at t=600ms and t=800ms) were seen with a lower stretch amplitude (e.g. 10% with SACs disease-related remodelling, 15% without). Failure of repolarization only occurred when sustained stretch (1000ms duration) of more than 10% (with SACs disease-related remodelling) or 15% (without) was applied.

Conclusions
Using a novel human electromechanical computational model, we quantified the contribution of SACs to cardiac AP changes. We showed that both disease-related SAC remodelling and variations of amplitude, timing, and duration of cardiomyocyte stretch modulated the effects on cardiac electrophysiology. We also showed that SACs may lead to afterdepolarizations and shorten the subsequent AP duration, factors which may potentially contribute to the generation of arrhythmias.