bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardioneuroablation focused on the atrioventricular node: a comparison of right and left atrial approach
Authors: Wichterle D , Jansova H , Stiavnicky P , Peichl P , Stojadinovic P , Haskova J , Cihak R , Kautzner J 
Published: October 2022

Abstract

Background
Radiofrequency catheter ablation of posteromedial left ganglionated plexus is a critical step to eliminate the vagal input to the atrioventricular node (AVN) for the treatment of symptomatic episodes of functional AV block. This ganglionated plexus can be effectively targeted from the coronary sinus (CS) or from the endocardial aspect of the right (RA) and left (LA) atria.

Purpose
We investigated the effect of ablation at individual sites on the suppression of parasympathetic modulation of AVN.

Methods
The study included 20 patients (age: 42±13 years, 45% males) who underwent cardioneuroablation in general anesthesia. Posteromedial left ganglionated plexus was ablated from [1] the CS (proximal 2-cm segment), [2] the RA aspect (between the fossa ovalis and inferior vena cava), and [3] the LA aspect (middle bottom part adjacent to inferior rim of fossa ovalis). Patients were randomly (1:1) assigned to CS-to-RA or RA-to-CS ablation order. LA ablation was always the last step. The response to extracardiac vagus nerve stimulation (ECVS; 50 Hz, 0.05 ms, 1 V/kg [&lt;70V], 5 s) while atrial pacing (100 bpm) was recorded at baseline and after each ablation step. The number of non-AV-conducted beats during the ECVS was considered a measure of AV nodal denervation. Both right and left vagus nerves were sequentially stimulated and the stronger response of the AV node was taken into account.

Results
Temporal development of outcome measure with the progression of ablation is shown in Figure 1. CS ablation resulted in much stronger AV nodal denervation compared to RA ablation (P=0.02). However, RA ablation still provided some effect on top of CS ablation. The combination of CS + RA ablation resulted in complete AVN denervation in 8 (40%) patients. Subsequent LA ablation increased the number of denervated patients to 14 (70%). Two more patients were subsequently denervated by ablation elsewhere. In four patients, AVN denervation was not achieved but their responsiveness to ECVS was significantly suppressed compared to the baseline.

Conclusions
All ablation clusters targeting posteromedial ganglionated plexus convey complementary effects. Biatrial cardioneuroablation seems essential for efficacious suppression of parasympathetic modulation of AVN.

Funding Acknowledgement
Type of funding sources: None.
Diagnostic value of electroanatomical mapping in patients with suspected arrhythmogenic cardiomyopathy
Authors: Berg J , Villatore A , Sivilotti F , Pili G , Sala S , Della Bella P , Peretto G 
Published: October 2022

Abstract

Background
Case series suggested that low voltage areas (LVA) on invasive electroanatomical mapping (EAM) could identify arrhythmogenic cardiomyopathy (ACM) at an earlier stage as compared to late gadolinium enhancement (LGE) and fatty infiltration on cardiac magnetic resonance (CMR). Data comparing LVA with structural abnormalities on CMR are lacking.

Purpose
To report the prevalence of substrate abnormalities identified by EAM vs. CMR in a cohort of patients with suspected ACM.

Methods
We retrospectively identified 66 consecutive patients with suspected ACM, who underwent EAM following clinical onset with ventricular arrhythmias. The cutoff value for EAM-defined LVA was &lt;0.5 mV bipolar, &lt;8 mV unipolar. Data from a prior CMR, performed no more than 12 months before, were used for comparison.

Results
The study cohort (mean age 47 years, range 21–76; 83% males; mean left ventricular ejection fraction 53%, range 28–70%) was composed of patients with suspected ACM involving either the right (n=62) or the left ventricle (n=4) following presentation with sustained monomorphic ventricular tachycardia. EAM was obtained by isolated endocardial, epicardial, or combined approach, respectively, in 11 (17%), 15 (23%) and 40 (61%) patients. Overall, 61 patients (92%) had documented LVA, of whom 89% showed an epicardial localization. In the same population, CMR identified a lower prevalence of substrate abnormalities (LGE 65%; fatty infiltration 50%). In particular, there were 27 patients (41%) with EAM-defined LVA and absent substrate abnormalities on CMR. Based on the 2010 Task Force Criteria and the 2021 Padua Criteria, a definite diagnosis of ACM was missing for a total of 19 patients (29%): due to the uniform identification of LVA in the absence of CMR abnormalities, EAM helped to establish the most likely diagnosis of ACM in all of them (19/19).

Conclusions
Our data suggest that EAM is capable of identifying substrate abnormalities in a consistent proportion of patients with suspected ACM and absent abnormalities on CMR. In this setting, the implementation of LVA to the current diagnostic criteria could improve the diagnostic yield for ACM.

Funding Acknowledgement
Type of funding sources: None.
Prognosis of hypertrophic cardiomyopathy in Japanese patients with an implantable cardioverter defibrillator -focus on apical hypertrophic cardiomyopathy
Authors: Nakano M , Kondo Y , Nakano M , Kajiyama T , Ito R , Kitagawa M , Sugawara M , Chiba T , Ryuzaki S , Yoshino Y , Kobayashi Y 
Published: October 2022

Abstract

Background
Patients with hypertrophic cardiomyopathy (HCM) are at high risk of lethal arrhythmias, and implantable cardioverter defibrillators (ICD) are widely used for prevention of sudden cardiac death (SCD). Apical HCM is a phenotype variant of HCM, with hypertrophy predominantly affecting apex, that was initially described 30 years ago. Apical HCM patients may have different clinical prognosis compared with other subsets of HCM. In previous studies, apical HCM patients seem to have a more benign prognosis than other types of HCM. However, little is known about the long-term outcomes of apical HCM patients and there are many unclear points. Moreover, there are few reports about the clinical prognosis in apical HCM patients with an ICD.

Objective
The aim of this study is to identify the difference between the prognosis of apical and the other types of HCM patients with an ICD.

Methods
We retrospectively analyzed the database of our ICD clinic. All subjects underwent ICD implantation between October 2006 and September 2018. We classified HCM patients into LV outflow tract obstruction (LVOTO) and midventricular obstruction (MVO), apical HCM and other non-obstructive types. We divided all the patients into apical and other types of HCM, and examined their background, incidence of appropriate ICD therapies, hospitalization for heart failure, electrical storm and death.

Results
A total of consecutive 64 Japanese HCM patients with an ICD (follow-up period, 86±24 months; age, 65±14 years; male sex, 83%; left ventricular ejection fraction, 56±14%; LV max wall-thickness, 19±7mm; LV apical aneurysm, 9.4%; 5-year risk of SCD, 4.4±2.1) were enrolled in this study. We classified them into 14 apical HCM and 50 other types of HCM patients. The clinical characteristics and major clinical events of these patients are shown in the Table 1. During the follow-up periods, there were no significant differences in the incidence of electrical storm, hospitalization for heart failure and death between the 2 groups (p=0.11; p=0.60; p=0.39). Appropriate ICD therapies occurred in 6 of 14 (43%) patients with apical HCM and 5 of 50 (10%) patients with other types of HCM (p=0.010). The risk factors of patients with apical HCM patients are shown in Table 2.

Conclusions
Appropriate ICD therapy was more prevalent in patients with apical HCM, compared to patients with other types of HCM. Aggressive intervention such as catheter ablation for ventricular tachycardia and ventricular fibrillation may be considered in patients with apical HCM and higher score of 5-year risk of SCD. Further studies are needed to clarify the manifestations and long-term outcome of apical HCM patients.

Funding Acknowledgement
Type of funding sources: None.
Non-sustained ventricular arrhythmias at exercise ECG predict severe ventricular arrhythmias in arrhythmic mitral valve prolapse
Authors: Five C K , Hasselberg N E , Chivulescu M , Rootwelt-Norberg C , Ribe M P , Dejgaard L , Castrini A I , Aabel E W , Haugaa K H 
Published: October 2022

Abstract

Background
A subset of patients with mitral valve prolapse experience ventricular arrhythmias (VA) and even sudden cardiac death, defined as arrhythmic mitral valve prolapse (AMVP). Risk stratification of VA is challenging in this relatively young population. The predictive role of exercise testing has not been investigated.

Purpose
We aimed to explore if VA burden on exercise ECG can predict severe ventricular arrhythmic events in AMVP patients.

Methods
We included consecutive AMVP patients without prior severe VA referred to our tertiary center. Exercise bicycle ECG test by standard protocol was performed at inclusion. Non-sustained VT (nsVT) during exercise testing was defined as ≥3 consecutive ventricular beats with a rate ≥100/min lasting &lt;30 seconds. Our endpoint of severe VA during follow-up was defined as aborted cardiac arrest, sustained ventricular tachycardia, nsVT with syncope or appropriate ICD shock therapy detected by either ECG, Holter monitoring, implantable loop recorder or primary preventive ICD.

Results
We included 91 AMVP patients without prior severe VA (51±16 years of age, 63% women) with exercise test at baseline. NsVT occurred in 5 patients during exercise testing. During 67±7 months of follow-up, 5 (5.5%) patients experienced severe VA. In all, 3 of the 5 (60%) with nsVT at exercise test experienced severe VA during follow-up, compared to only 2 of 86 (2%) without nsVT at exercise testing (age adjusted hazard ratio [HR] 35 [95% CI 5–249], p&lt;0.001). Survival free from severe VA was worse in those with nsVT at exercise test (log rank p&lt;0.001) (Figure 1).

Conclusions
Non-sustained VT occurring during exercise ECG testing was a strong marker of subsequent severe VA in AMVP patients without previous severe VA. These novel findings indicate that exercise testing may improve risk stratification in AMVP patients.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): The Research Council of Norway.
Arrhythmia detection using insertable cardiac monitors after a negative electrophysiology study in Brugada syndrome: observations from a multicenter Spanish registry
Authors: Garcia-Izquierdo Jaen E , Palacios-Rubio J , Ripoll-Vera T , Hernandez-Betancor I , Ramos-Ruiz P , Diaz-Infante E , Macias-Ruiz R , Segura-Dominguez M , Garcia-Rodriguez D , Aguilera-Agudo C , Jimenez-Sanchez D , De La Rosa Y , Castro-Urda V , Toquero-Ramos J , Fernandez-Lozano I 
Published: October 2022

Abstract

Background/Introduction
Risk stratification in Brugada syndrome (BrS) remains controversial. In this respect, the role of electrophysiology study (EPS) has been subject of debate. It is common practice in some centers to implant an insertable cardiac monitor (ICM) after a negative EPS, especially in the presence of unexplained symptoms. However, the diagnostic value of this approach has never been specifically addressed.

Purpose
We aimed to describe the baseline characteristics and the main findings of a diagnostic work-up strategy using an insertable cardiac monitor (ICM) after a negative EPS in patients with BrS.

Methods
We retrospectively evaluated data from a multicenter registry including 56 BrS patients from 7 referral hospitals who received an ICM to help risk stratification. Only patients with a negative EPS (ie, non-inducible VT/VF) prior to ICM implantation were considered for this analysis. EPS protocols differed across hospitals (see Figure 1)

Results
A total of 26 patients from 5 different hospitals were studied. Mean age was 33.0±12.8 and 77% were male. Spontaneous type 1 pattern was present in 12 patients (46%). Positive genotype was found in 10 (38%) and family history of sudden cardiac death was present in 11 (42%). Previous symptoms were syncope/presyncope in 15 patients (58%) and palpitations in 3 patients (12%). The rest of the patients (30%) were asymptomatic. After a median follow-up of 33.4 months (IQR 16.5 and 43.1 months), none of the patients presented ventricular arrhythmias. ICM allowed the detection of other arrhythmias in 5 patients (19%), which led to specific therapeutic actions in all but 2 of them (see Table 1). ICM-detected arrhythmias correlated with previously reported symptoms only in one of the patients.

Conclusion
The results of this exploratory analysis support the notion that EPS in BrS has a high negative predictive value for risk stratification. ICM implantation after a negative EPS may allow the detection of incidental arrhythmias during follow-up. Despite the apparent low correlation of these findings with previously reported symptoms, this strategy may lead to important treatment decisions in a significant proportion of patients.

Funding Acknowledgement
Type of funding sources: None.
Healthcare professionals knowledge of inherited cardiac arrhythmias ica their views towards and confidence in caring for a person with an ica in a surgical environment
Authors: McGlinchey L , Barr O , Black P 
Published: October 2022

Abstract

Background
Inherited Cardiac Arrhythmias (ICA) are potentially life-threatening conditions which may be induced by several factors during the perioperative period. Safety and quality of care of patients may be affected by insufficient knowledge, or confidence by healthcare professionals in surgical areas.

Purpose
To determine the knowledge of ICAs by healthcare professionals, their views towards and confidence in caring for a person with an ICA in a surgical environment.

Methods
In Phase One, a twenty-four item questionnaire was distributed to registered nurses and midwives, surgeons and anaesthestists within surgical areas of seventeen hospitals of the Republic of Ireland and Northern Ireland.

Results
Completed questionnaires were returned from 154 participants in Phase 1 involving all four professions of the participant cohort. This comprised of one hundred and seventeen nurses, seven midwives, ten surgeons and nineteen anaesthetists. Sudden Adult/Arrhythmic Death syndrome (SADs) was heard of by 91% of participants, and 54% have heard of ICA. The majority of participants were not at all confident or only slightly confident (48% and 32%) in caring for patients with an ICA. Eighty-four percent were not aware (61.7%) or not sure if they were aware (22.7%) of the drugs to avoid in ICA conditions such as Long QT and Brugada syndrome. Those aware (11%) of drugs to avoid were seven anaethetists, two midwives and eight nurses. Of the ten surgeons, none were aware of the drugs to avoid. When all participants were asked how relevant is knowledge of ICA to your current role 5.8% said it was not at all relevant, 29.2% said it was slightly relevant, 31.8% moderately relevant and 28.6% extremely relevant. Ninety-five percent (95%) of participants would like further education about these conditions delivered mainly by online sessions and face to face workshop methods.

Conclusions
There is limited knowledge of and confidence in caring for people with Inherited Cardiac Arrhythmias in surgical areas of the hospitals surveyed. Education is required in relation to awareness and identification of people with these conditions, signs and symptoms, unmasking and triggering a cardiac event and what medications need to be avoided. Patients may not be aware they have an Inherited Cardiac Arrhythmia, so healthcare professionals' awareness is crucial with the ability to recognise and respond appropriately to a possible cardiac event. There is a need to address these gaps as these have potential serious implications for people with an ICA during their perioperative journey.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): The Cormac Trust
Stellate ganglion blockade for treatment of ventricular arrhythmia storm: a meta-analysis
Authors: Zafeiropoulos S , Bikou A , Farmakis I T , Doundoulakis I , Giannakoulas G , Zanos S 
Published: October 2022

Abstract

Background
Autonomic neuromodulation and particularly stellate ganglion blockade (SGB) has been tested in ventricular arrhythmia (VA) storm, but there is so far no robust evidence to inform clinical practice and its use remains limited.

Purpose
We aimed to summarize the efficacy and safety of SGB in patients with VA storm.

Methods
We searched PubMed, the Cochrane Library and Scopus from inception to 15th March 2022, for studies performing either pharmacological or electrical SGB in the context of drug-refractory VA storm. Case series with less than 10 patients were excluded. We performed a single-arm random effects meta-analysis of studies to calculate the pooled proportion estimate of freedom from VA recurrence after SBG and the overall mean change of VA burden from baseline.

Results
Of 409 articles identified and screened, we considered eligible six studies comprising a total of 106 patients. The mean age was 61.6±13.9 years, 79.2% were male, the mean left ventricular ejection fraction was 28.8±12.7%, and 47.1% had underlying ischemic cardiomyopathy. In five trials the patients received pharmacological SGB with bupivacaine, ropivacaine, or/and lidocaine (left-sided or bilateral), while in one study transcutaneous magnetic stimulation of the left stellate ganglion was used. The pooled proportion of patients free of VA recurrences was 65% (95% CI 51–78%, I2=46%) at the first 24 hours post-SGB (Figure 1A), and 54% (95% CI 43–64%, I2=0%) at 72 hours (Figure 1B). The number of VA episodes was significantly reduced from a mean baseline of 7.01±8.34 episodes/24h before SGB to 0.93±1.64 episodes/24h after SGB. The mean absolute reduction of VA episodes was 5.44 (95% CI 2.83–8.05, I2=88%) (Figure 1C) while the mean absolute reduction of external or internal defibrillation events was 3.36 (95% CI 0.62–6.09, I2=84%) (Figure 1D). No serious procedure-related complications were reported. The overall in-hospital mortality was 28.4%.

Conclusions
SGB appears an effective and safe treatment in patients with VA storm with approximately 1 in 2 patients exhibiting complete suppression of VA for 72 hours and an approximately 80% mean relative reduction in VA burden.

Funding Acknowledgement
Type of funding sources: None.
Ventricular fibrillation amplitude spectral area as a guide to deliver the optimal energy level for defibrillation
Authors: Gentile F R , Compagnoni S , Baldi E , Primi R , Bendotti S , Currao A , Aramendi E , Isasi I , Contri E , Palo A , Savastano S 
Published: October 2022

Abstract

Introduction
In case of cardiac arrest due to ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT), the optimal energy should be the lowest energy effective to achieve defibrillation minimizing the current-induced myocardial damage. Therefore, it would be ideal to minimize the energy level as well as the number of shocks during resuscitation. ECG-based VF waveform analysis features such as amplitude spectral area have been recently introduced as predictors of shock success, but their predictivity for shock success with low energy level is not known.

Purpose
To assess whether amplitude spectral area (AMSA) of VF is able to predict the efficacy of low energy level defibrillation in out-of-hospital cardiac arrest (OHCA) patients.

Methods
All the OHCAs with at least one shockable rhythm that occurred from January 2015 to December 2020 were considered. AMSA values were calculated by retrospectively analyzing the data collected by the Corpuls 3 monitors/defibrillators and by using a 2-second-pre-shock ECG interval.

Results
Among 4619 OHCAs, resuscitation was attempted in 2982 (64%) and at least one shock was delivered in 697 (15%). AMSA values and defibrillation energy were available for 791 shocks, of which 45% received shock at low energy (&gt;150J) and 55% at high energy (&gt;150J). The rate of efficacy between the two groups was similar (44% vs 38%, p=0.102). However, in patients efficaciously treated with shock at low energy, AMSA was higher compared to those treated with shock at high energy [13.2 mV Hz (IQR 10.2–17) vs 10.8 mV Hz (IQR 8–13.8), p&lt;0.001]. Moreover, AMSA values were significantly different when comparing ineffective shock at low energy with effective shock at high energy [6.6 mV Hz (IQR 4.6–10) vs 10.8 mV Hz (IQR 8.1–13.8), p&lt;0.001] and similar when comparing ineffective shock at low and high energy [6.6 mV Hz (IQR 4.6–10) vs 6.3 mV Hz (IQR 4.5–8.7), p=0.21]. By dividing AMSA values into three tertiles, the rate of shock success at low energy was statistically different: [T1 (0.7–6.2 mV Hz) 4.2%; T2 (6.2–10.8 mV Hz) 13%; T3 (10.8–63.2 mV Hz) 42%; Chi-squared p&lt;0.001 and p for trend &lt;0.001]. After correction for age, sex, amiodarone use and call to shock time, AMSA values corresponding to the third and second tertile were associated with higher probability of shock success at low energy compared to the lowest tertile [T3 OR 15 (95% CI 7–30), p&lt;0.001; T2 OR 3 (95% CI 1–7), p=0.002].

Conclusion
Ventricular fibrillation amplitude spectral area is a predictor of shock success at a low energy level. This could be useful to optimize both time and dose-energy to patients, yielding the highest chance for successful defibrillation while reducing the number of futile shocks and thus limiting the total current myocardial energy as well as CPR interruptions.

Funding Acknowledgement
Type of funding sources: None.