bluuebunny/crossref_metadata_2025_split huggingface dataset:
1097 PREDICTORS OF WEANING FROM TEMPORARY MECHANICAL CIRCULATORY SUPPORT IN PATIENTS WITH CARDIOGENIC SHOCK
Authors: Venuti Angela , Sacchi Stefania , Gobbi Francesca Maria , Baldetti Luca , Calvo Francesco , Gramegna Mario , Pazzanese Vittorio , Ajello Silvia , Mara Scandroglio Anna 
Published: December 2022

Abstract

Introduction
In cardiogenic shock (CS) patients with temporary mechanical circulatory support (TMCS) the weaning process is crucial to verify patients’ myocardial recovery or device dependency. To date, there are no specific guidelines on weaning strategies.

Hypothesis
We investigated clinical predictors of successful weaning from TMCS and developed with them a novel prognostic scoring system.

Methods
Eighty CS patients (62.5 ± 11.8 years, 86.2% male, 63.7% with ACS) with Impella support were evaluated. Hemodynamic, echocardiographic and laboratory data were collected at admission (T0), 24 (T1), 48 (T2), 96 (T3) hours after TMCS implantation. CS patients were classified according to successful or unsuccessful weaning, defined as hemodynamic/myocardial recovery, and death/need for LVAD/heart transplant, respectively. Independent predictors of weaning and their discriminating cut-off values were identified. Finally, a prognostic weaning score (W-Score) was derived.

Results
Thirty-eight (47.5%) CS patients showed successful (SW-group) while 42 (52.5%) unsuccessful (UW-group) weaning from TMCS. Clinical characteristics were similar between the two groups. SW-group showed higher T1, T2, T3 LVEF (p=0.013, p=0.001, p=0.001), T1 CPO (p=0.04), T2 MAP (p=0.019) and lower T1, T2 inotropic score values (p=0.001, p=0.001), T2 HR and PCWP (p=0.01, p=0.008), T1 and T3 creatinine (p=0.018, p=0.009), lactate (p=0.009, p=0.002) and NT-proBNP (p=0.017, p=0.001). T1 LVEF, NT-proBNP and inotropic score together with T3 creatinine and lactate resulted independent predictors of SW (p&lt;0.05). T1 LVEF ≥ 10%, T1 inotropic score ≤ 8, T1 NT-proBNP ≤ 8068 ng/L, T3 lactate ≤ 1,59 mmol/L, T3 creatinine ≤ 1,76 mg/dl identified patients with SW (overall, AUC ≥0.7, p&lt;0.05). W-Score was developed enabling SW with a cut-off score ≥ 7 (80% sensitivity, 85% specificity, AUC 0.92, p &lt;0.001).

Conclusions
W-Score, based on T1 LVEF/inotropic score/NT-proBNP, T3 creatinine/lactate values may be useful to identify CS patients undergoing successful weaning from TMCS.
696 EFFECTS OF DIRECT IRRADIATION ON CARDIAC IMPIANTABLE ELECTRONIC DEVICES
Authors: Arabia Gianmarco , Mitacchione Gianfranco , Cerini Manuel , Salghetti Francesca , Cersosimo Angelica , Milidoni Antonino , Dell´aquila Andrea , Bontempi Luca , Curnis Antonio 
Published: December 2022

Abstract

Aims
Cardiac implantable electronic devices (CIEDs) may sustain damages during a course of radiation therapy, especially when the beam is directed onto the pulse generator, with device electrical reset and/or sudden battery drain. 2010 HRS/ASA expert consensus, and all CIEDs manufacturers, recommend to avoid devices direct irradiation with an accumulated dose that exceed 5 grays (Gy). In our prospective study we tested the effects of direct irradiation on CIEDs with different radiation doses, also higher than 5 Gy.

Methods
124 CIEDs of Medronic, Abbott, Biotronik, Boston Scientific, were collected during system upgrading or lead extraction procedures. All devices were considered if they had at least 80% of residual battery capacity. All CIEDs were programmed with same default electrical parameters. Depending by CIED type, pacing mode was configured in VVI, VVIR, VDDR or DDDR, and biventricular stimulation was activated, if present. ICDs electrical therapies were set-up with a pre-determined configuration. All devices were singularly placed in a 30 cm×30 cm plastic bowl containing 2 Lt of deionized water that was placed over 5 cm Rockwool to simulate the backscatter and irradiated by a linear accelerator (Elekta Synergy®). CIEDs were divided into two groups depending on irradiation dose delivered: 5 Gy and 10 Gy.

Results
No significant differences in battery drainage were observed after irradiation respect to baseline in 5 Gy as well 10 Gy group (7.8±3.1 vs. 7.4±2.1 [years] battery longevity, p=0.693; 7.6±3.1 vs. 7.3±2.1 [years] battery longevity, p=0.677, respectively) .
Moreover, all CIEDS saved the baseline program setting, without device reset events.

Conclusions
Our data confirm that CIEDs direct irradiation of 5 Gy is safe, of note, direct irradiation up to 10 Gy seems to be similarly safe concerning the risk of CIEDs electrical reset and/or unexpected battery drain.
375 ATRIAL FIBRILLATION BURDEN IN PATIENTS WITH IMPLANTABLE LOOP RECORDER AFTER A CRYPTOGENIC STROKE
Authors: Capocci Sofia , Berton Giampaolo , Zivelonghi Cecilia , Portolan Leonardo , Piccolo Solange , Strazzanti Mattia , Bolzan Bruna , Mugnai Giacomo , Tomasi Luca , Franchi Elena , Tomei Ruggero , Vassanelli Francesca , Luciano Ribichini Flavio 
Published: December 2022

Abstract

Background
After a cryptogenic stroke, long-term monitoring is recommended to start an anticoagulation therapy in patients with at least a documented paroxysm of subclinical atrial fibrillation (AF). Literature is sparse about the recurrence of AF (AF burden) after a cryptogenic stroke, but this might have significant implications in terms of therapeutic strategy.

Methods
This is a retrospective single-center study of 129 patients who received implantable loop recorders (ILRs), after a cryptogenic stroke, between March 2015 and March 2022. All patients were followed through remote monitoring for at least 6 months. The primary endpoint was AF detection; the secondary endpoints were the AF burden, the earliness (within or after 90 days from the ILR implant) of the first AF episode and if there was an association between these two variables.

Results
Mean age was 70.3 ± 10.4 years old (67 males, 51.9%); the mean value of left ventricular ejection fraction was 61% ± 5.8. Atrial fibrillation has been detected by ILR in 40.3% of patients (AF= 52 patients, NO AF= 77 patients) and each intracardiac electrogram was visually reviewed by two physicians. Median CHAD2S2-Vasc Score was 5 [4-6]; the median AF burden (assessed in 39 of the 52 patients) was 1.2% [0.1%-14.6%]; among these, 23 patients (59%) had the first episode within 90 days from the ILR implant versus 16 patients (41%) which experienced the first episode later than 90 days. AF burden was significantly higher in the first group (median 3.9% [1.2%-30.9%] vs 0.1% [0.03%-0.75%]; p=0.001). Of note the univariate analysis showed that both detection of the first AF episode within 90 days and echocardiographic findings of atrial disease (atrial dilation or diastolic dysfunction) were significantly associated with AF burden &gt; 1% (about 7 hours for month) (respectively OR 16.5; 95% IC=3.34-81.21, p=0.001 and OR 4.5; 95% IC=1.2-17.5, p=0.03); at the multivariate analysis the significance was confirmed for the earliness of the first AF episode (OR 14.6; 95% IC=2.8-76.75, p=0.002).

Conclusion
In this small, retrospective study, AF was detected by ILR, after a cryptogenic stroke, in more than one third of patients. AF onset during the first 90 days might be a marker of a high AF burden and might highlight patients who could benefit from a rhythm control strategy of AF. Larger studies and clinical outcomes evaluation of these patients are required to confirm our results.
594 HIDDEN CAUSES FOR UNEXPLAINED SINCOPE
Authors: Costantino Roberto , Napoli Gianluigi , Piscitelli Laura 
Published: December 2022

Abstract
Bicuspid aortic valve (BAV) is a congenital cardiac abnormality, affecting approximately 1%-2% of the general population (male &gt; female). A 33-year-old man was admitted to emergency department (ED) for syncope during exertion. He had a history of cigarette smoking with a known previously discovered BAV with mild stenosis.
TTE showed a severely calcified bicuspid aortic valve with severe stenosis and regurgitation.
ECGs showed frequent asymptomatic complete hearth block (CHB), unresponsive to isoprenaline infusion.
He underwent ministernotomy aortic valve replacement (AVR) with mechanical valve. During hospital stay, the 24h ECG telemetric monitoring did not show any A-V disturbance and TTE demonstrated normal prosthesis function. Pacemaker implantation was delayed, Follow-up was performed at 1, 6 and 10 months after surgery: 24h-ECG recordings were performed showing no A-V conduction disturbances.
At 1 year, during routine medical screening, cardiac frequency of 38 bpm was detected (ECG revealed sinus rhythm with CHB and junctional escape rhythm of 38 bpm). ICCU echocardiogram showed good ventricular and prosthesis function. Therefore, a dual-chamber MRI compatible pacemaker was implanted.
Few cases are reported in literature of young patients presenting with A-V block having a severely calcified aortic bicuspid valve. Their management is poorly explored, and therapies (medical therapy, aortic valve replacement and pacemaker implantation) are not fully evidence based.
In literature, 3 cases of possible reversibility of conducting system disorders after severe stenotic aortic valve surgery are described.
Noninvasive strategy was initially successful as demonstrated by both the post-operative absence of any AV conduction disturbance and/or symptoms and the close follow-up monitoring.
Despite of previous evidence, our experience demonstrates that a complete heart block can recur following aortic valve surgery, even in young patients. Initial presentation of CHB was intermittent, suggesting that the structural damage to the conducting system could not be irreversible; thus, it could positively respond to valve surgery. Unfortunately, in CHB with calciﬁc aortic stenosis patients should be considered for PM implantation at the time of aortic surgery. When a waiting strategy prevails, especially for young patients, close monitoring and follow-up must be warranted to early detect A-V disturbances recurrence.
48 A CASE OF RECURRENT VENTRICULAR TACHYCARDIA IN A PATIENT WITH GRANULOMATOSIS WITH POLYANGIITIS WITH A CHALLEGING IDENTIFICATION OF ARRHYTHMIC SUBSTRATE: THE ROLE OF MULTIMODALITY IMAGING
Authors: D´amico Anthea Tonia , Avenoso Davide , Ghiglieno Chiara , Porcellini Stefano , Dell´era Gabriele , Patti Giuseppe 
Published: December 2022

Abstract

Background
Granulomatosis with polyangiitis (GPA), previously known as Wegener's granulomatosis, is a pulmonary-renal syndrome affecting small and medium sized blood vessels. Cardiac involvement is rare and generally includes pericarditis, myocarditis and aortic valve disease. We report a case of recurrent sustained ventricular tachycardia (VTs) in a patient with GPA.

Case summary
A 67-year-old man with past medical history of GPA presented palpitations, chest pain and episodes of presyncope. Electrocardiographic tracing upon ED presentation showed sustained monomorphic VT (fig.1) associated with global hypokinesia of the left ventricle and moderately reduced ejection fraction at transthoracic echocardiography (TTE). As the patient was hemodynamically stable, prompt treatment with amiodarone was adopted with successful recovery of sinus rhythm. After a few hours, TTE was normal. However, as troponin I was markedly elevated, coronarography was performed and coronary disease was ruled out. Contrast-enhanced cardiac magnetic resonance imaging (ceCMR) revealed late gadolinium enhancement in basal anteroseptal mid wall, suggestive of myocardial scar tissue with non-ischemic pattern. No sustained ventricular arrhythmias were induced during electrophysiological study (EPS), even with an aggressive protocol (up to 4 extra stimuli and ventricular refractoriness) and electro-anatomical mapping of both ventricles failed to show any arrhythmic substrate. An implantable cardioverter defibrillator (ICD) was then implanted. After 4 months the patient was admitted for multiple episodes of sustained VT (with cycle length in the ICD monitoring window) refractory to drugs and three external defibrillations. Repeated EPS failed to induce sustained arrhythmias. High-density electroanatomical mapping of the right ventricle, however, showed fragmented potentials in the mid-posterior septal wall (fig. 2-3). After myocardial biopsy of the region of interest, radiofrequency catheter ablation of the area was performed with regression of the potentials. The results of endomyocardial biopsy demonstrated fibrosis. At 5 months of follow-up, the patient didn't relapse.

Discussion
Multimodality imaging is of paramount importance in identifying arrhythmogenic substrate and in characterizing the specific anatomical–functional components of VT circuits. In our patient high-density electroanatomical mapping was able to identify fragmented potentials and define the ablation target area, despite the mismatch with ceCMR.
292 QTC CORRECTION IN ATRIAL FIBRILLATION
Authors: De Sarro Rosalba , Vinciguerra Paolo , Licordari Roberto , Ceratti Simona , Perfetti Silvia , Luongo Alfredo , Savio Armando Lo , Cognata Olga La , Poleggi Cristina , Pugliatti Pietro , Crea Pasquale , Luzza Francesco , Dattilo Giuseppe 
Published: December 2022

Abstract

Background
QT interval varies with the heart rate (HR), so a correction in QT calculation is needed (QTc). Atrial fibrillation (AF) is associated with elevated heart rate (HR) and beat-to-beat variation in the length of the QT and RR interval making correction of the QT interval challenging.

Aim
to evaluate which correction formula better correlates with QTc in sinus rhythm after electrical cardioversion (ECV).

Methods
During a 3-month period, we considered patients who underwent 12-lead ECG recording for standard clinical indications and received an AF diagnosis. Exclusion criteria were the following: a QRS duration &gt;120 ms, chronical therapy with QT prolonging drugs, a rate control strategy, a non-electrical cardioversion. The final population was composed by 60 patients. The QT interval was measured in V2 lead as the 10-beat average and corrected using Bazzett's, Framingham, Fridericia and Hodges formulas during the last ECG taken during AF and the first one immediately after ECV. Moreover, QTc mean was calculated as mQTc (average of 10 QTc calculated beat per beat) and as QTcM (QTc calculated from the average of 10 raw QT and RR for each beat).

Results
Population was composed by 26 women (43%) with a mean age was 79 ± 11 years. Good correlations between mQTc and QTcM are present for each formula, even in atrial fibrillation or sinus rhythm. Comparing atrial fibrillation and sinus rhythm a significant change in HR was seen (63,9 ± 14,9 vs 99,5 ± 27,9, p&lt;0,001). Bazett's formula shown a significant change in mean QTc value between the two rhythms (421,5 ± 33,9 vs 446,1 ± 31,9; p&lt; 0,001 for mQTc and 420,9 ± 34,1 vs 441,8 ± 30,9; p = 0.003 for QTcM). On the contrary, QTc assessed by the Framingham, Fridericia, and Hodges formulas was similar to that in AF (Figure).

Conclusion
In ECG during atrial fibrillation, due its high heart rate, Bazzett's formula, although the most used, seems to be the most imprecise in QTc estimation.
968 LYME CARDITIS: COMPLETE AV DISSOCIATION PRESENTING AS DYSPNEA IN THE EMERGENCY DEPARTMENT
Authors: Sciara Pietro , Bandini Marta , Crociani Maria Federica 
Published: December 2022

Abstract

Background
Lyme carditis (LC), an early disseminated manifestation of Lyme disease, has important clinical implications for patients. High-degree atrioventricular block is the most common presentation of LC, and usually resolves with antibiotic therapy.

Clinical case
A 31 years-old man without remote pathological history and cardiovascular risk factors presents for resting dyspnea. In the EKG, findings of paroxysms third-degree atrioventricular block with a junctional escape rhythm were found. No abnormalities found on the transthoracic echocardiogram. After the tick bite reported about 1-2 months earlier, given the suspicion of Lyme carditis, serology for Borrelia Burgdoferi was tested, which was then positive, and empirical antibiotic therapy has been initiated. During the EKG monitoring, paroxysms of second-degree type I atrioventricular block and first-degree AVB were relevated. In few days, we assisted to a complete retrieval of normal atrioventricular conduction. Therefore, a loop recorder was implanted, cardiac resonance was performed and then discharged. About 4 weeks later the patient performed a stress test on the cycloergometer to identify frequency-dependent atrioventricular blocks, which was then negative.

Rationale
The suspicion and the early diagnosis of Lyme carditis is fundamental to identify this unusual transient condition, thus preventing unnecessary PM implantation in otherwise healthy young individuals.
178 ARRHYTHMIC STORM IN ATTR WILD TYPE AMYLOIDOSIS: AN UNUSUAL COMBINATION
Authors: Torselletti Lorenzo , Giulia Stronati , Barbarossa Alessandro , Ciliberti Giuseppe , Coretti Francesca , Belleggia Sara , Coraducci Francesca , Bastianoni Gianmarco , Paolini Federico , Alfieri Michele , Brugiatelli Leonardo , Dello Russo Prof Antonio , Guerra Prof Federico 
Published: December 2022

Abstract
Cardiac amyloidosis (CA) is characterized by extracellular protein fibril deposition in the myocardium leading to restrictive heart failure. Both atrial and ventricular arrhythmias are common in CA. Study have shown up to one half of patients with CA die suddenly. However, the most common cause of sudden death has been historically through to be secondary electromechanical dissociation rather than a lethal ventricular arrhythmia. We present the case of a 84 years old man, with a history of hypertension, dyslipidaemia, and prior smoking. In June 2020 the patient was admitted to the emergency room of our hospital due to an episode of hemodynamically unstable sustained ventricular tachycardia (SVT). The patient underwent electrical cardioversion with restoration of sinus rhythm. An echocardiogram that showed a slightly reduced ejection fraction (FE = 45%), severe concentric hypertrophy, grade 3 diastolic dysfunction with high pressures in the left ventricular (LV) cavity, and a reduced GLS (-13.8%) with a typical apical-sparing aspect. A cardiac magnetic resonance (Fig.1). was performed showing a diffuse area of LGE with a subepicardial pattern involving left ventricular and atrial segments, compatible with myocardial storage disease. In order to complete the diagnostic workout, we performed a bone scintigraphy (Fig.2). (Positive for CA, with Perugini score grade 2), a genetic test (negative for hATTR-CA mutations) and free light chain in serum (negative for AL-CA). The patient was discharged at home after ICD implantation in secondary prevention and prescribed appropriate heart failure therapy. In May 2022 the patient was readmitted in emergency room for dyspnea during an arrhythmic storm characterized by several SVTs and ICD interventions, and atrial fibrillation (FA). After stabilization of clinical parameters, the patient was hospitalized in our ward. We optimized medical therapy with metaprololo 100 mg 1 cp BID, cordarone 600 mg ev and mexiletina 200 mg cp BID. During the hospitalization we succeeded in reducing SVT burden. However, ventricular PVCs and slow SVT remained. For this reason, we decided to perform an electrophysiological study (EPS) followed by catheter ablation. The EPS found two low voltage areas (Fig.3). The first were found under the aortic valve; the second was an area of dense scar and fragmented potentials along the basal-posterior wall. After ablation of the first area we succeeded in removing clinical PVCs. During the ablation of the second area the procedure was complicated by ventricular fibrillation that required advanced life support and many electrical shocks. The patient was discharged at home in absence of further episodes of SVTs with optimized therapy At a three moths follow up no arrhythmic events were recorded.
950 THE ROLE OF THE BETA ANGLE IN THE MANAGEMENT OF PATIENTS WITH SUSPECTED BRUGADA SYNDROME: A METANALYSIS
Authors: Vetta Giampaolo , Magnocavallo Michele , Polselli Marco , Parlavecchio Antonio , Caminiti Rodolfo , Maria Cauti Filippo , Lo Savio Armando , Vetta Francesco , Rossi Pietro , Crea Pasquale , Natale Andrea , Bianchi Stefano , Della Rocca Domenico Giovanni 
Published: December 2022

Abstract

Background
The diagnostic value of the β-angle in the diagnosis of patients with Brugada Syndrome (BrS) is still unclear.

Objective
to evaluate the diagnostic accuracy of the β-angle and establish its best cut-off value.

Methods
We searched databases for studies evaluating sensitivity and specificity of the β-angle in patients with suspected BrS undergoing Sodium Channel Blocker Provocation Test (SCBPT). The pooled sensitivity and specificity were calculated, and the Summary Receiver Operating Characteristic curve was constructed. The effect size was estimated using a random-effect model as Odds Ratio.

Results
we included 4 studies enrolling 1471 patients (Positive SCBPT: 382 patients; Negative SCBPT: 1089 patients). Patients with positive SCBPT had a higher mean β-angle value than those with negative SCBPT (39.25° vs 22.52°; p&lt;0.0001). The best diagnostic accuracy was observed at the IV Intercostal space (Ic) (AUC: 0.82; 95% CI: 0.78-0.85) compared to IIIic (AUC:0.77; 95% CI: 0.74–0.81) and IIic (AUC: 0.68; 95% CI: 0.64–0.72), Figure 1. The risk of positive SCBPT was significantly increased in patients with a β-angle≥58° than those with a β-angle≥23° (OR:16.33 vs 3.39; p=0.0004).

Conclusion
A β-angle ≥58° represents the best diagnostic predictor for patients with suspected BrS.
1074 AXILLARY VEIN PUNCTURE VERSUS CEPHALIC VEIN CUTDOWN FOR CARDIAC IMPLANTABLE ELECTRONIC DEVICE IMPLANTATION: A METANALYSIS
Authors: Vetta Giampaolo , Parlavecchio Antonio , Magnocavallo Michele , Caminiti Rodolfo , Lo Savio Armando , Pistelli Lorenzo , Vetta Francesco , Dattilo Giuseppe , Della Rocca Domenico Giovanni , Crea Pasquale 
Published: December 2022

Abstract

Introduction
Transvenous lead implantation for pacemaker implantation is commonly performed by the cephalic vein cutdown (CVC), subclavian (SVP), or axillary vein puncture (AVP)(1). However, the CVC or AVP should be considered as first choice, according to the last guidelines, due to high rate of lead complications and pneumothorax of SVP.

Objective
To compare efficacy and safety of AVP compared with CVC for CIED implantation by a meta-analysis.

Methods
We systematically searched Medline, Embase and Cochrane electronic databases up to September 5th, 2022, for studies that evaluated the efficacy and safety of AVP and CVC reporting at least one clinical outcome of interest. The primary outcome was acute procedural success. The secondary outcomes were pneumothorax, lead failure, pocket hematoma/bleeding, device infection, total procedure time, venous access time and fluoroscopy time. The effect size was estimated using a random-effect model as Risk Ratio (RR) and relative 95% Confidence Interval (CI).

Results
A total of 8 studies were included enrolling 1926 patients with 3532 leads and average age of 72.3±14.8 years. AVP compared to CVC showed a significant increase in the procedural success (95.7% vs 76.1%; RR: 1.24; 95% CI: 1.09-1.40; p=0.001), (Figure 1). Total procedural time (Mean Difference [MD]: -8.25 min; 95%CI: -10.23- -6.27; p&lt;0.0001) and Venous access time (MD: -6.24 min; 95%CI: -7.01- -5.47; p&lt;0.0001) were significantly shorter with AVP compared with CVC. No differences were found between AVP and CVC for pneumothorax (RR: 0.72; 95% CI: 0.13 - 4.0; p=0.71), lead failure (RR: 0.58; 95% CI: 0.23-1.48; p=0.26), pocket hematoma/bleeding (RR: 0.58; 95% CI: 0.15- 2.23; p=0.43), device infection (RR: 0.95; 95% CI: 0.14- 6.60; p=0.96) and fluoroscopy time (MD: -0.24 min; 95%CI: -0.75- 0.28; p=0.36).

Conclusion
Our meta-analysis proved that AVP improves procedural success and reduces total procedural time and venous access time compared to CVC.
Figure 1 – Forest plots comparing Acute Procedural Success between Axillary Vein Puncture Versus Cephalic Vein Cutdown.