bluuebunny/crossref_metadata_2025_split huggingface dataset:
P2 IMPACT OF CATHETER ABLATION ON ARRHYTHMIC STORM: A SINGLE–CENTER EXPERIENCE
Authors: Cutolo A , Bellin A , Antonucci A , Cavalli G , China P , Quinto L , Vitale R , Themistoclakis S 
Published: May 2022

Abstract

Background
Arrhythmic storm (AS) is a medical emergency whom management is multidisciplinary and includes antiarrhythmic medications, sedation and mechanical circulatory support, as well as catheter ablation, a procedure that is gaining growing relevance in clinical practice, supported by guidelines.

Methods and Aims
It is a retrospective observational study of patients admitted to Cardiology Department of Ospedale dell’Angelo for AS from 2016 to 2021. The primary endpoint was the rate of arrhythmic recurrences and their clinical predictors; the secondary endpoint was a composite of all– cause death, LVAD or cardiac transplant. Successful CA was defined as no inducibility of any VT at the end of the procedure.

Result
We evaluated 74 patients. Catheter ablation (CA) was performed in 56 patients, while in the other 18 patients, the treatment of the arrhythmic emergency was limited to medical therapy. At a median follow–up of 10 months (range 4–36 months), the overall arrhythmic recurrence rate was 39.1% and AS recurrence occurred in 11% of patients; the incidence of the composite end–point of all–cause death, LVAD implant or cardiac transplant was 20.2%. B–blockers (85% vs 100%, p = 0.025) and successful CA (60% vs 88.6%, p = 0.021) were associated with less arrhythmic recurrences. At multivariate analysis, a successful CA was an independent predictor of arrhythmic recurrence free survival (HR 0.32, [0.11–0.94], p = 0.039), and of ICD shocks free survival (HR 0.087, [0.02–0.37], p = 0.001). ICD shocks at admission (8.06 ± 9.8 vs 3.18 ± 4.24, p = 0.005), NYHA class III–IV (46.6% vs 5%, p = 0.001), medical treatment (53.3% vs 83%, p = 0.031), ICD shocks during follow–up (53.3% vs 18,6%, p = 0.004) and AS recurrence (33.3% vs 10.1%, p = 0.039) were associated with an increased rate of the secondary endpoint.

Conclusions
In our real world experience of patients admitted for AS, CA was a predictor of arrhythmic recurrence free survival and may have a role in improving quality of life and prognosis by reducing ICD shocks. CA was an independent predictor of the reduced incidence of all–cause death, LVAD implant or cardiac transplant, although this finding might reflect a more severe cardiac disease of the medically treated patients than a real benefit of CA on mortality.
P6 MICRA AV AS AN INNOVATIVE THERAPEUTIC OPPORTUNITY IN PATIENTS WITH A PAROXYSMAL ATRIOVENTRICULAR BLOCK OR AN ADVANCED OR PERSISTENT TYPE II 2ND–DEGREE ATRIOVENTRICULAR BLOCK
Authors: Dentico A , Ferrieri A , Epicoco G , Troccoli R , Carretta F , D‘Agostino C , Carretta D 
Published: May 2022

Abstract

Introduction
Micra AV is the technological evolution of Micra VR. It’s a monocameral leadless pacemaker that works like a VDD PM, synchronizing atrial activity with the ventricular one. The purpose of the study is to evaluate the response of Micra AV in patients with a paroxysmal atrioventricular block, in which a low percentage of stimulation is expected, and in patients with AVB with normal atrial activity.

Materials and Method
From August 2020 to June 2021 in our center were implanted 11 Micra AV: 4 for advanced AVB, 3 for a paroxysmal AVB and 4 post–extraction. To all patients it was given remote monitoring to guarantee a constant remote follow–up. For each one, were analyzed the values measured at the implant’s moment and those of periodic remote follow–ups, paying particular attention at the device’s percentage of stimulation. Furthermore, a questionnaire was submitted to detect the psychophysical condition, the way in which the device interferes in everyday life, any physical pain, the emotional state, always correlating post–operative with the pre–operative. Particular attention was paid to the decrease in the incidence of adverse events or post–operative complications. In this way, it was possible to focus the study on 3 aspects: technician, quality of post–implant life and the device’s approval.

Results
All patients no longer presented syncopes during a follow–up ranging from a minimum of 5 to a maximum of 10 months. About the analysis made on the percentage of stimulation, the results were obtained by dividing patients into 2 groups based on the nature of the block. Almost all patients with advanced AVB presents a percentage of stimulation that doesn’t exceed 20%; in subjects with paroxysmal AVB this remains below 2%. The results of the questionnaire instead show how the leadless PMs are more appreciated both for a lower aesthetic impact, and for minor functional consequences linked to the lack of catheters who often limit the patient. This results in a better patient–device relationship and better acceptance of the leadless device.

Conclusions
The use of a Leadless PM in patients with syncope is still to be deepened and for this we will have to follow these patients over time to have a wider cases. A certain data is that these PMs are more appreciated as they have less impact on the quality of patients’ life.
P15 AN OLD MYOCARDIAL INFARCTION UNMASKED BY UPGRADE TO HIS BUNDLE PACING: A CASE REPORT
Authors: Marinaccio L , Patrassi L , Vetta F , Marchese D 
Published: May 2022

Abstract

Case Report
We report the clinical case of a 71–year–old man who was implanted with a dual–chamber PMK for complete atrioventricular block in 2012. In 2013 he was treated with two percutaneous coronary intervention (PCI) and stenting of the left anterior descending coronary artery (LAD) and right coronary artery (RCA).In March 2021, he was referred to our hospital for acute heart failure. Transthoracic echocardiography showed diffuse hypokinesis, with a left ventricular ejection fraction (LVEF) of 28% (46% six months earlier). ECG showed atrial flutter and paced ventricular rhythm with notch of the QRS complex in all 12 leads (Figure B). After achieving good clinical compensation with intravenous diuretics, the patient underwent coronary angiography with evidence of an unchanged coronary situation compared with 2013; Given the constant right ventricular pacing in the apex, we considered the LVFE decline as a consequence of pacemaker–induced cardiomyopathy (PICM)5 and a successful upgrade to HB pacing was performed. The surface ECG showed selective HB pacing with QRS width comparable to the native ECG (Figure A) but different morphology, because of evidence of QS complexes in V3–V6 and II, III, aVF (Figure C); physiological pacing obtained with selective HBP had made evident electrocardiographic signs of a previous myocardial infarction (MI).

Discussion
Very difficult is the diagnosis of a previous MI during RV pacing; to date, although considered questionable, we have only the criteria of Kochiadakis and colleagues (Figure 2A): – Notch of 0.04–second duration on the ascending limb of the S–wave of leads V3, V4, or V5 (Cabrera‘s sign). – Notching of the ascending stroke of the R wave in leads I, aVL, or V6 (Chapman‘s sign).– Q waves of 0.03 second duration in leads I, aVL, or V6. – Notch of the first 0.04 seconds of the QRS complex in leads II, III, and aVF. – Q wave of 0.03 seconds duration in leads II, III, and aVF. Occurring through the normal conduction system, HB pacing should generate a physiological myocardial repolarization resulting in a paced QRS complex with morphology and duration equal to the basal ECG, without alterations in the ventricular repolarization phase. As proof of the above, it was possible to appreciate that the transition from RV pacing to selective HB pacing allowed to unmasked the signs of a previous infero–lateral IMA, showing clear QS complexes in II, III, aVF, V3–V6.

Conclusion
Extremely old age should not discourage PM implantation, when indicated; age is obviously predictor of long–term death but is not predictor of precocious mortality. Acute periprocedural complication rate is low and generally comparable to that of younger populations.
P17 DOACS EFFECTIVENESS AND SAFETY: FURTHER CONFIRMATIONS FROM REAL WORLD EXPERIENCE
Authors: Ciavolella M , Cianfrocca M , Braccioli C , Ceccacci R , Bisegni S , De Carolis M , Ciavolella F , Bidolli F , Frongillo D , Sarli G 
Published: May 2022

Abstract
The present analysis is aimed to evaluate the use and results of direct oral anticoagulants (DOACs) in the past years, in a group of patients presenting with multiple comorbidies and at medium–high thromboembolic risk. In the past years, our outpatient Center followed 929 patients (mean age at admission 76.5 + 9.2 years, range: 29–99 years, 501 men), 848 with non–valvular atrial fibrillation/flutter, and 81 with recent phlebopulmonar thromboembolism (PPTE). An anamnesis of previous cardiovascular events were present in 302 patients (32.5%): coronary artery disease (146), carotid or peripheral atherosclerosis (109), cerebral stroke or ischemia (116). Initial CHA2DS2–VASc and HASBLED score were respectively 3.9 and 2.3 points. Patients were initially treated with Apixaban (A) (301, 89 with reduced dose, according to clinical–prescriptive characteristics), Dabigatran (D) (332, 256 with low dose), Edoxaban (E) (161, 83 with reduced dose), Rivaroxaban (R) (135, 53 with reduced dose). All patients were followed–up periodically (every 6 months) with both clinical and instrumental controls (electrocardiogram, blood tests, etc.), re–evaluating risk factors, in order also to check indication and dosage appropriateness. After a mean follow–up of 3.8 years (range: 6 montsh–9 years), for a total of 3530.2 years*patient, 57 patients (6.1%) had stopped DOAC therapy, because of: severe renal failure (12), repeated bleeding (6), clinical criteria (19), mechanical valve insertion (7), detection of thrombophilia (5), left atrial appendage occlusion (3), frailty (5). In the remaining 872 patients, 33 strokes (7 relapses), 11 PPTE, 17 major bleedings, 24 clinically relevant bleedings, and 71 minor bleedings, occurred. DOAC dose reduction occurred in 101 patients (11.6%: 31on A, 25 on D, 16 on E, 29 on R), because of clinical criteria (28), renal failure (56), bleedings (17). A replacement with other DOACS occurred in 104 patients (11.9%: 7 on A, 71 on D, 5 on E, 21 on R), because of renal failure (29), digestive disorders (27), bleedings (32), thrombotic events (6), lactose intolerance (3), allergic reactions (7). Clinical–and instrumental periodical control of patients treated with DOACs confirmed their effectiveness and safety, even in a population at medium–high thromboembolic risk. Additionally, such a management may allow also a greater prescribing appropriateness, as well as a safer and reliable follow–up over time of these patients.
P19 ECHOGRAPHIC EVALUATION OF INFERIOR VENA CAVA AND FLUID CHALLENGE RESPONSE IN PAROXYSMAL ATRIAL FIBRILLATION: A PRELIMINARY STUDY
Authors: Cavallaro M , La Montagna C , Casaretti L , Aprile A , Corbacelli C , Ponticelli P , Tuccillo A , Irace L , Tuccillo B 
Published: May 2022

Abstract

Introduction
Volume depletion can trigger atrial fibrillation through the alteration of the balance of autonomic tone. Hemodynamic response to crystalloid infusion has never been investigated in Paroxysmal AF patients. In this pilot study we have evaluated volume expansion response using Doppler echocardiogaphy in a group of patients coming to our Emergency Department because of symptomatic paroxysmal AF.

Methods
In a group of consecutive Paroxysmal AF patients we performed a comprehensive echocardiographic examination including Vena Cava diameters and inspiratory collapse rate (from bidimensional subxiphoid view) and including Left Ventricular Outflow time–velocity integral (as mean value of 10 consecutive cardiac cycles). Those with mitral, aortic or tricuspid regrgitation of grade higher than 2+/4+, mitral stenosis, prosthethic mitral valve, FE &lt; 55%, estimated sPAP higher than 40 mmHg were excluded. Thus we selected 13 patients (mean age 67,25 years, range 34–83). Time–velocity integral of LVOT was re–evaluated after intravenous infusion of 500 cc of normal saline in 10 minutes. An increase of at least 10% of LVOT time–velocity integral from baseline was considered as positive response to volume challenge, as stated in previous studies (1,2).

Results
Fluid challenge showed positive response in 7/13 patients. From ROC curve analysis an inspiratory diameter of 9,5 mm or a respiratory collapse of 52% or more both had a 75% sensitivity for volume challenge responsiveness.

Conclusion
Accounting for small sample size this preliminary work suggests that non invasive bedside parameters easy to evaluate can guide Paroxysmal AF management with crysalloid infusion on top of standard therapy. 1. Preau S et al Crit Care Med 2016; 45: e290–7 2. Bortolotti P et al Ann Intensive Care 2018; 8: 79
P21 AGE–RELATED DIFFERENCES AND ASSOCIATED OUTCOMES OF S–ICD: INSIGHTS FROM A LARGE, EUROPEAN, MULTICENTER REGISTRY
Authors: Schiavone M , Gasperetti A , Gulletta S , Vogler J , Fastenrath F , Breitenstein A , Laredo M , Mitacchione G , Palmisano P , Compagnucci P , Kaiser L , Denora M , Hakmi S , Angeletti A , De Bonis S , Picarelli F , Casella M , Steffel J , Ferro N , Guarracini F , Santini L , Pignalberi C , Piro A , Lavalle C , Russo G , Pisanò E , Viecca M , Curnis A , Badenco N , Ricciardi D , Dello Russo A , Tondo C , Kuschyk J , Della Bella P , Biffi M , Tilz R , Forleo G 
Published: May 2022

Abstract

Background
The subcutaneous implantable cardioverter defibrillator (S–ICD) has become an alternative to transvenous ICDs (TV–ICD) in patients who do not need pacing. To date, there is little evidence directly comparing the rates of inappropriate shocks (IAS) in young vs old S–ICD recipients.

Purpose
Aim of our study was to assess differences in device–related complications and inappropriate shocks (IS) between teenagers/young adults and adult recipients of a subcutabeous implantable cardioverter defibrillator (S–ICD) device.

Methods
Two propensity–matched cohorts of teenagers + young adults (≤ 30–year–old) and adults (&gt; 30–year–old) were retrieved from the ELISIR registry. The primary outcome was the comparison of the inappropriate shock (IAS) rate; complications, freedom from sustained ventricular arrhythmic events, overall and cardiovascular mortality were deemed secondary outcomes.

Results
A total of 1491 patients were extracted from the ELISIR project. Teenagers + young adults represented 11.0% of the entire cohort. Two propensity–matched groups of 161 patients each were used for the analysis (Figure 1); median follow–up was 23.1 [13.2–40.5] months. 15.2% patients experienced inappropriate S–ICD shocks and 9.3% device related complications were observed with no age–related differences in IAS (16.1% vs 14.3%; p = 0.642) and complication rates (9.9% vs 8.7%; p = 0.701); Figure 2 shows a survival analysis from inappropriate shocks in the teen–ager/young adult cohort (red) and in the adult cohort (blue). At univariate analysis, young age was not associated with increased rates of IAS (HR 1.204 [0.675–2.148]: p = 0.529). At multivariate analysis (Figure 3), the use of SMART pass algorithm was associated to a strong reduction in IAS (aHR 0.292 [0.161–0.525]; p &lt; 0.001), while ARVC was associated with higher rates of IAS (aHR 2.380 [1.205–4.697]; p = 0.012).

Conclusion
In a large multicentered European registry of patients with S–ICD, 11.0% of all recipients were teenagers or young adults. The use of S–ICD in teenagers/young adults resulted safe and effective, and the rates of complications and IAS between teenagers/young adults and adults were not significantly different. The only predictor of increased IAS was a diagnosis of ARVC.
P23 TIMING OF EJECTION FRACTION REASSESSMENT AFTER SACUBITRIL–VALSARTAN INITIATION FOR INDICATION TO DEFIBRILLATOR IMPLANTATION. A SINGLE CENTER EXPERIENCE
Authors: Leci E , Carinci V , Bugani G , Greco C , D‘Angelo C , Pecoraro A , Casella G 
Published: May 2022

Abstract

Background
Sacubitril/Valsartan (SV) has been validated for heart failure (HF) with reduced ejection fraction (EF) treatment. SV is effective on hard end–points as well as symptoms and heart remodeling. Present guidelines reccomend at least 3 month of optimized medical therapy (OMT). However, the best timing of EF assessment after SV initiation in order to proceed with defibrillator (ICD) implantation, is still unknown.

Purpose
Evaluate timing of improvement of EF after SV initiation in patients (pts) with systolic HF, candidates to primary prevention ICD implantation.

Methods
From 1 of february 2018, we evaluated retrospectively clinical and echocardiographic data of all consecutive pts with EF &lt; 35% treated with SV and candidates to primary prevention ICD implantation. We evaluated clinical and echo follow up (Fup). Results have been analyzed with paired T–test.

Results
The study involved 95 pts (mean age 67±10 years, 70% male, ischaemic etiology 48%). Mean EF at enrollment was 30 ± 5% (ED vol 90 ±23 ml/m2; ES vol 62 ± 19 ml/m2, severe MR 23%) and NYHA III–IV 50%. In 58% pts reached the target dose of SV (97/103 mg bid). After a mean Fup of 6 months, mean EF of the study population increased to 37±7% (ED vol 80±19 ml/m2, ES vol 51±17 ml/m2, severe MR 5%, p &lt; 0.001), and NYHA III–IV decreased to 8% (p = 0.01). Interestingly, thirty–one pts (32%) had their first Fup within 3 months and showed already an improvement [meanEF 28±5% to 35±6%; ΔEF 7±6%; NYHA III–IV 10 %]. Moreover, 49 pts (51%) had last Fup echo after 1 year (mean 13±6 months) and showed a further EF improvement (meanEF 41±8%; ΔEF 12±9%; p &lt; 0.001).Sixteen pt (16%) underwent ICD (62%) or CRT–D (38%) implantation after 3±2 months of treatment and excluded from further FUP analysis. More favorable effects of treatment with SV were more evident in patient with non–ischaemic etiology of heart failure.

Conclusions
After SV initiation in systolic HF, favourable heart remodeling is clearly evident at 6 months FUP, but could be already observed after 3 months . These findings need to be validated from larger trials but suggest that the best timing of EF reassessment to decide for primary prevention ICD is likely between 3 and 6 months after SV initiation. However decision must be taken following close and individualized FUP for every patient, based on clinical characteristics and response to OMT.
P26 “FUNCTION FOLLOWS FORM”: THE ROLE OF THE CARDIAC MAGNETIC RESONANCE IN THE ARRHYTHMIC RISK STRATIFICATION IN PATIENTS WITH CARDIAC SARCOIDOSIS
Authors: Vetta G , Magnocavallo M , Della Rocca D , Mariani M , Piro A , Fedele F , Natale A , Chimenti C , Lavalle C 
Published: May 2022

Abstract

Background
Sarcoidosis is an inflammatory disorder characterized by non–caseating granulomatous infiltration in multiple organs, including the heart. The presence of granulomas within the myocardium can cause heart failure, atrio–ventricular block, ventricular arrhythmias (VA) and sudden cardiac death (SCD). Due to the patchy pattern of sarcoid infiltration, endomyocardial biopsy has a poor sensitivity and cardiac magnetic resonance (CMR) is becoming the gold standard imaging, detecting small area of myocardial fibrosis and scar using late gadolinium enhancement (LGE). The identification of LGE in patients with dilated cardiomyopathy is strongly associated with VA and SCD and similar findings were reported in cardiac sarcoidosis (CS) patients.

Methods
In order to assess the risk of VA and SCD related to LGE in the CS, we performed a meta–analysis including all the studies enrolling patients with suspected or confirmed CS undergoing CMR. We conducted a digital search in PubMed, Embase, Cochrane Database of Systematic Reviews, Web of Science, Scopus, and Google Scholar from inception through October 2021. Clinical outcomes of interest were arrhythmogenic events defined as VA (ventricular tachycardia or ventricular fibrillation), SCD or aborted SCD (appropriate ICD discharge) during follow–up.

Results
Eleven studies with a total of 1.123 CS patients (left ventricular ejection function [LVEF]: 59 ± 23%) with an appropriate follow–up were included in the final analysis. Overall, as depicted in the Figure 1, the identification of LGE at CMR was associated with a 13–fold increase risk in potentially lethal VA (R = 12.76, 95% CI [6.30–25.87]) than patients without LGE.

Conclusions
Our findings suggest that the presence of myocardial scarring as evidenced by the identification of LGE in CMR provides meaningful information about the arrhythmic risk stratification of CS patients.
P31 PERCUTANEOUS LEFT STELLATE GANGLION BLOCK AS PRE–TREATMENT STRATEGY FOR HIGH–RISK PATIENTS WHO ARE CANDIDATES FOR INVASIVE PROCEDURES POTENTIALLY ASSOCIATED WITH ADRENERGIC STIMULATION: AN HYPOTHESIS–GENERATING CASE REPORT
Authors: Casula M , Binaghi G , Mameli S , De Toni C , Scotto R , Schintu B , Scalone A , Tola G , Corda M 
Published: May 2022

Abstract

Introduction
Percutaneous left stellate ganglion block (PLSGB) has been reported as a safety and effective procedure for the management of refractory arrhythmic storm (AS). In this report we present a case of a man with refractory AS effectively treated with PLSGB, subsequently candidate for an invasive procedure potentially associated with adrenergic stimulation and propose the use of this technique as pre–treatment strategy in this clinical setting.

Case presentation
A 57–year–old man was admitted to our hospital for AS. Past medical history revealed that two years earlier he had been treated with primary percutaneous coronary intervention for ST–segment elevation myocardial infarction. Four months before admission he underwent coronary artery bypass graft surgery with concomitant mechanical mitral valve replacement, closure of an interventricular defect and, considering the severe left ventricular disfunction, he was implanted with an automatic defibrillator in primary prevention. At the time of admission, he was treated with lidocaine infusion with remission of arrhythmic events. Comprehensive diagnostic workup revealed no overt triggers for AS. Five days after admission, the patient experienced recurrence of ventricular arrhythmias (VA), refractory to amiodarone, lidocaine, and magnesium infusion, increased pacing rate, and sedation with dexmedetomidine. PLSGB was then attempted with the injection of lidocaine and ropivacaine using an anatomical approach with complete remission of arrhythmic events. After a week free from VAs, a new AS was observed and PLSGB was repeated using the same modality with complete arrhythmic resolution. Considering the advanced heart failure, the patient was candidate to heart transplantation (HT) and, before undergoing gastro– and colonoscopy required for inclusion in the HT program, with the aim to reduce the risk of VA recurrences triggered by potential adrenergic stimulation, we pre–treated the patient with PLSGB using only ropivacaine, with successful induction of temporary Horner syndrome (Fig. A). The endoscopy procedures were performed successfully with no VA events and the patient was then discharged waiting for HT.

Conclusion
We propose the use of PLSGB as a pre–treatment strategy for patients at high–risk of VAs who are candidates for invasive procedures potentially associated with adrenergic stimulation. This report could be hypotheses–generating for further studies on this topic.