bluuebunny/crossref_metadata_2025_split huggingface dataset:
Venoplasty can be performed safely and successfully in patients with subtotal and total venous occlusion needing additional transvenous electrodes
Authors: Maass A , Lankveld TAR , Gkouskos D , Groenveld HF , De Haan M , Rienstra M , Lipsic E , Vernooy K 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Lead failure, but also upgrade procedures from pacemaker to implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy (CRT) can be hampered by venous obstruction occurring in 10-25% of patients with prior transvenous electrodes. A relatively underused technique to overcome venous obstruction are lead percutaneous venous dilation procedures (venoplasty).

Purpose
We aimed to identify the feasibility of venoplasty procedures in two Dutch tertiary referral centers.

Methods
84 consecutive patients where venoplasty was attempted were included in the study and baseline parameters as well as procedural characteristics and complications were recorded. 42% of patients needed replacement of a defective electrode and 58% an upgrade to CRT or from pacemaker to ICD. Venous stenosis was defined as significant (70-90%), subocclusive (90-99%) and occlusive (100%) and the region was divided into three segments: subclavian vein, brachiocephalic vein and junction to the vena cava superior.

Results
The study included 30 pacemaker and 54 ICD patients, 68±12 years old, 80% were male. Body mass index was 26±3, left ventricular ejection fraction 32±12% and eGFR 63±24ml/min/1,73m2. At the time of the procedure, 2,1±0,8 electrodes were present and 1,2±0,2 electrodes were implanted, in 15% atrial, 52% RV and 52% LV electrodes. The procedures took 123±58 minutes and fluoroscopy dose was 5334±5390µGy/m2. There were 79 total occlusions of any segments and in addition, 51 subocclusive lesions needing venoplasty (table). 8 procedures were unsuccessful (9%), mostly due to failure to pass the occlusion. 3 patients (4%) had pocket hematoma not needing reintervention and one patient (1%) needed lead repositioning due to dislocation. There was no damage to any existing lead during the procedures. 89% of patients had a successful procedure without a complication needing reintervention.

Conclusions
Venoplasty is safe in subocclusive and occlusive venous stenosis and can be performed with high success using modern material potentially avoiding lead extraction or contralateral tunneling procedures.
Predicting long-term mortality following transvenous lead extraction using the lead extraction difficulty (LED) index score
Authors: Mitacchione G , Bontempi L , Arabia G , Forleo G , Cimino G , Amore L , Cerini M , Curnis A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Transvenous Lead Extraction (TLE) scoring systems have proven to be a reliable method to predict TLE difficulty, thus improving procedure safety and efficacy. Nevertheless, TLE has shown a significant mortality rate during the subsequent follow-up, up to 33% at 10 years, with historical data showing several procedural and clinical characteristics associate with this poor outcome.

Purpose
We aimed to investigate the association between difficult TLE procedures and long-term mortality, using a specific scoring system [Lead Extraction Difficulty (LED)] to identify difficult/simple procedures.

Methods
Consecutive patients underwent TLE procedures between January 2014 and January 2016 at Spedali Civili Hospital, Brescia, Italy, were prospectively considered to receive a follow-up during 2021. TLE difficulty was retrospectively assessed in all patients using the LED index score (number of leads to extract + years from implant of the oldest lead to remove + 1 [for a dual-coil implantable cardioverter defibrillator lead] – 1 [in case of confirmed vegetations along the lead]). According to the score, "high-difficult" procedures were defined for a LED &gt;10. Patient long-term follow-up was obtained by review of medical records from patient surveys or from the referring institution/family practitioner. Univariate analysis and multivariate logistic regression were used to identify factors associated with long-term mortality. Kaplan-Meier estimates were used to investigate survival during the follow-up. Two-sided P&lt;.05 was considered significant.

Results
A total of 466 permanent leads were removed in 249 patients with a clinical success rate of 99.1%, and without major acute complications. The mean time follow-up was 6.7 (5.9-7.1) years, with a cumulative all-cause mortality rate of 17.7%. Clinical characteristics, indication for TLE, and mortality during follow-up are reported in the Table. Among all variable associated with mortality at univariate analysis, only LED index &gt;10 independently predicted the mortality during the follow-up at logistic regression (OR 2.98; 95% CI: 0.081-1.4; p=0.028). Survival plots for individuals underwent high/low difficult TLE are shown in the Figure. Mortality at 1, 3, and 5 years following TLE was highest among patients with LED index &gt;10 (1.1%, 12.6%, and 26.3%, respectively).

Conclusions
Cumulative long-term mortality following TLE was confirmed to be high. Of interest it resulted highest among patients following high-difficult TLE procedure. LED index score resulted a useful tool to predict long-term mortality after procedure. This finding should be considered when approaching TLE procedures in order to estimate the risk/benefit ratio over the time.
Procalcitonin as a biomarker of cardiac implantable electronic device pocket infection: a prospective validation study
Authors: Knoll K , Oconnor M , Chouchane A , Haller B , Schaarschmidt C , Bock M , Foerschner L , Froehlich R , Kottmaier M , Bourier F , Reents T , Hessling G , Deisenhofer I , Kolb C , Lennerz C 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The implantation of cardiac implantable electronic devices (CIEDs) such as pacemakers and implantable cardioverter-defibrillators is increasing along with the complexitly of these devices. CIED infection is an uncommon, but severe complication associated with the presence of a device and is associated with a high mortality and morbidity. Lead-related infections and frank endocarditis are associated with a systemic inflammatory response and, in general, are readily identified. Isolated pocket infections do not produce such a systemic response and are thus more complex to diagnose. There is a reliance on clinical accumen and examination of local signs of infection. There is thus a need for a reliable biomaker to help identify cases of pocket infection.

Aim
Our group have previously shown procalcitonin (PCT) to be a potentially useful biomaker in the clinial situation of possible pocket infection. We aim to prospectively validate the proposed cut-off value of 0.05ng/ml for the procalcitonin (PCT) biomaker in an independent cohort, which we have previously identified as showing promise in this clinical situation.

Methods
In this prospective case-control validation study the PCT levels of 81 patients with confirmed pocket infections were compared to 81 controls, matched for age and renal function, presenting for elective generator replacement or lead revision unrelated to infection. Exclusion criteria included: concomitant infectious or inflammatory diseases, end-stage renal failure, active malignancy or receiving immunosuppressive therapy.

Results
A PCT over 0.05 ng/ml was found in 68% (n= 55) of pocket infections and 24% (n= 19) of controls. Using the pre­defined cut-off value of 0.05 ng/ml PCT had a sensitivity of 68% and a specificity of 77% for diagnosing pocket infections. ROC analysis revealed area under the curve of 0.752 (standard error 0.039, p &lt;0.001 ) for PCT. In patients presenting with minimal infective signs the sensivity remained high (67% vs 70% with extensive inflammation) and similarly remained high in thus who had received anti-biotic therapy prior to PCT sampling (65% vs 69%).

Conclusion
PCT is a potentially useful biomarker to aid the diagnosis of a pocket infection when used with the prospecitvely validated cut-off value of 0.05ng/ml. The sensitivity of the PCT positive result remained high even in patients pre-treated with antibiotics or with minimal clinical signs of inflammation.
Prognostic role of myocardial inflammation in patients with undefined left ventricular arrhythmogenic cardiomyopathy
Authors: Peretto G , Casella M , Merlo M , Benedetti S , Cappelletto C , Rizzo S , Dello Russo A , Casari G , Basso C , Sala S , Sinagra G , Cooper LT , Della Bella P 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Etiology identification and risk stratification represent major issues for patients presenting with undefined left ventricular arrhythmogenic cardiomyopathy (ULVACM).

Purpose
To investigate the role of genetics and histology for ULVACM classification, management, and risk assessment.

Methods
We retrospectively analyzed a multicenter cohort of patients (screened n=1037) with ULVACM defined by ventricular arrhythmia (VA) onset, nonischemic late gadolinium enhancement (LGE) limited to the LV, and no severe dilated cardiomyopathy (LVEF≥40%). We selected patients undergoing both next generation sequencing (NGS) screening and endomyocardial biopsy (EMB) for etiology definition. When feasible, immunosuppressive therapy (IST) was used to target active myocardial inflammation (AMI). The study endpoint was a composite of cardiac death, heart transplantation and malignant VAs (VT, VF, appropriate ICD treatment).

Results
The study cohort is composed by 135 ULVACM patients (age 43±14 years, 63% males, LVEF 55±7 %). NGS identified pathogenic or likely-pathogenic variants (PVs/LPVs) consistent with ACM in 21 cases (16%), whereas EMB showed AMI in 78 patients (58%), including 13/21 PVs/LPVs+ (62%). After reclassification of 86 patients (64%), only 49 (36%) remained ULVACM. IST was started in 41/78 AMI patients (53%), including 9/13 PVs/LPVs+ (69%). Twenty patients (15%) met the study endpoint by 12 months, and 36 (27%) by the end of the study (60±27 months). Beyond malignant VT onset, AMI was the only predictor of events by 12 months (HR 5.0, 95%CI 1.4-18.1, p=0.007). No prognostic role was found for PVs/LPVs, except for the subgroup (n=77) with nonsustained VT onset. Among AMI patients, those treated by IST had a significantly lower occurrence of events, both by 12-months (1/41 vs. 16/37, p&lt;0.001) and later (HR 0.05, 95%CI 0.01-0.21, p&lt;0.001). Results were independently confirmed in PVs/LPVs+ and PVs/LPVs- cases. Excluding the IST population, the association of multiple factors among VT onset, PVs/LPVs, and AMI, resulted in an improved discrimination of arrhythmic risk profiles.

Conclusion
The combined genetic and histological workup allowed reclassification of up to 64% ULVACM patients, and substantially contributed into prognostic assessment. Furthermore, EMB identified suitable candidates for IST, who showed better outcomes irrespectively of their genotype.
Machine learning can identify hypertrophic cardiomyopathy in pediatric patients using electrocardiogram
Authors: Guerrier K , Gunturkun F , Bennie I , Akbilgic O , Davis R , Towbin J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Le Bonheur Children’s Hospital

Background
Hypertrophic cardiomyopathy (HCM) is the most common genetic based heart disease and is associated with sudden cardiac death, particularly in young athletes. Standard measures of voltage abnormalities on electrocardiograms (ECGs) have demonstrated high false positive rates and poor correlation of LV thickness. Despite poor testing characteristics, ECGs continue to be part of most adolescent and family screening programs. While recent studies suggest that machine learning based analysis of ECGs may have utility in the identification of HCM in adult patients, there are limited data regarding its effectiveness in the pediatric population.

Purpose
The purpose of this study was to develop a deep learning model utilizing raw digital ECG data to accurately distinguish healthy pediatric patients from those with HCM.

Methods
ECGs from patients &lt; 19 years with HCM were compared to ECGs from age- and sex-matched patients that underwent evaluation with ECG and echocardiogram for chest pain, sports clearance, syncope, or abnormal ECG between January 2011 and March 2021. Patients with a known clinical history of primary causes of left ventricular hypertrophy such as aortic stenosis, systemic hypertension, and glycogen storage disease were excluded from the study. Unsupervised signal processing tools including descriptive statistics and wavelet transformation were used to extract features from 12-lead ECG signals. A cascaded convolutional neural network was developed combining a residual neural network to extract features from waveform 12-lead ECG signals with a 2-layer dense neural network to embed features from signal processing tools. Model performance was evaluated by 10-fold stratified cross validation.

Results
The analytic sample included 181 patients (72% male; 63% Caucasian). Mean age was 12.3 ± 5.8 years. A cascaded deep learning model classified patients into healthy or HCM categories with a cross validation sensitivity of 77.7% and specificity of 81.6%. The positive predictive value was 82% and AUC of 0.89 (0.84-0.94).

Conclusion
This CNN trained with a relatively small number of images was able to accurately identify HCM in pediatric patients from standard 12-lead ECG. Evaluation of its potential utility in larger populations is needed.
An automatic single beat algorithm to discriminate farfield from nearfield bipolar voltage electrograms from the pulmonary veins
Authors: Schlageter V , Badertscher P , Krisai P , Spies F , Luca A , Osswald S , Vesin JM , Kuehne M , Sticherling C , Knecht S 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): “Stiftung für Herzschrittmacher und Elektrophysiologie” Basel, Switzerland

Background
Confirmation of pulmonary vein (PV) isolation (PVI) during ablation of atrial fibrillation can be challenging due to superimposition of nearfield (NF) PV and farfield (FF) atrial bipolar voltage electrograms (BVE).

Purpose
To develop an automatic algorithm allowing to discriminate PV nearfield (PV-NF) from atrial farfield (atrial-FF) BVE from a circular mapping catheter during cryoballoon (CB) PVI based on a single-heartbeat analysis.

Methods
BVEs from a decapolar inner-lumen diagnostic catheter (Achieve, Medtronic) during CB PVI were manually classified as PV-NF, atrial-FF and combined FF-NF signal based on the characteristics and disappearance of the PV signal during isolation (Figure, upper row). BVE power spectra were computed using the fast Fourier transform (FFT) and the automatic classification of PV-NF, atrial-FF and combined FF-NF signals was performed using the power in different frequency bands (Figure, lower row). Support vector machine classifier was used to identify PV-NF BVE due to its highest predictive accuracy for the two classes PV-NF+ (PV-NF only and combined FF-NF) and PV-NF- (atrial-FF only). Validation of the approach was performed by comparison of a subset of 80 random samples, which were classified in addition by five experienced electrophysiologists.

Results
We analysed a dataset of 355 BVEs from 57 patients. The examples were balanced between the two classes PV-NF+ and PV-NF-. The mean duration (95% CI) of the BVE was 58 ms (26 to 86), 70 ms (50 to 100) and 94 ms (71 to 139) for PV NF, atrial-FF and combined FF-NF, respectively. The overall balanced accuracy including BVE from all PVs was 82.7% (95% CI: 80.3% to 85.1%). The analysis on individual PVs showed an accuracy of 96.6%, 85.2%, 80.8%, and 76.9% for the right inferior, right superior, left inferior and left superior PV, respectively. Validation of the algorithm in the subset of 80 patients showed a comparable accuracy, sensitivity and specificity in PV-NF detection between the automatic algorithm and the experienced electrophysiologists (82.8%, 89.2%, and 76.3%, compared to 85.2%, 91.9%, and 78.5%, respectively).

Conclusion
A reliable automatic based classification algorithm to identify PV-NF BVE could be developed based on a single-beat analysis. Real-time applications as well as using other electrode configurations may improve local signal interpretation.
Validation of a novel smartphone-based photoplethysmographic method for ambulatory heart rhythm diagnostics
Authors: Fernstad J , Svennberg E , Aberg P , Kemp-Gudmundsdottir K , Jansson A , Rosenqvist M , Engdahl J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Vinnova - The Swedish Agency for Innovation Systems.
Region Stockholm Innovation Fund.

Introduction
Devices for long-term and ambulatory recording of heart rhythm have limited availability within health care systems worldwide, potentially leading to missed diagnoses and limitations in peri-procedural heart rhythm management. As smartphones are becoming ubiquitous the availability of heart rhythm diagnostics and management of atrial fibrillation (AF) using smartphone photoplethysmography (PPG) compared to electrocardiography (ECG) is increasing. Previous validation studies of smartphone-PPG applications have all been performed under supervision in healthcare settings. In addition, no previous study has validated smartphone-PPG compared to simultaneous ECG recordings, with manual heart rhythm interpretation of the PPG recordings nor have they included patients with atrial flutter (AFL).

Purpose
The aim of this study was to validate a novel smartphone-PPG method for heart rhythm diagnostics in patients with AF and/or AFL when in use unsupervised in an ambulatory setting.

Methods
Unselected patients undergoing direct current cardioversion at a University Hospital for treatment of AF or AFL were asked to perform one-minute heart rhythm recordings post-treatment at least twice daily for 30 days in their home environment. All included were provided with an unmodified iPhone 7 smartphone running the CORAI Heart Monitor PPG application simultaneously with a single-lead ECG recording (KardiaMobile). PPG and ECG recordings were interpreted independently by two readers.

Results
In total 280 patients, with median age of 69.0 years (31% women) were included from November 2018 to July 2020 and registered 18 005 simultaneous PPG and ECG recordings. Of the PPG recordings 96.9% had sufficient quality for diagnosis compared to 95.1% of the ECG recordings (p &lt; 0.001). Precardioversion ECG recordings were interpreted as AF in 82.1%, AFL in 14.3% and as having insufficient quality for diagnosis in 3.6% of the patients. After removal of recordings with insufficient quality 69.7% of ECG recordings were interpreted as sinus rhythm, 28.2% as AF and 2.1 % as AFL. Manual interpretation of the PPG recordings diagnosed AF/AFL (sensitivity) in 97.7% and sinus rhythm (specificity) in 99.4% of the recordings compared to manually interpreted ECG recordings, with an overall accuracy of 98.9%. Results excluding recordings interpreted as AFL on ECG or PPG diagnosed AF (sensitivity) in 99.0% and sinus rhythm (specificity) in 99.7% of the recordings, with an overall accuracy of 99.5%.

Conclusion
A novel smartphone-PPG method can be used by patients unsupervised in their home environment for accurate heart rhythm diagnostics of AF and AFL with high sensitivity and specificity.
Quality of life instruments in atrial fibrillation: a systematic review of measurement properties
Authors: Sale A , Yu JJ 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Medtronic

Background
Atrial fibrillation (AF) is the most common arrhythmia worldwide. A key objective of AF management is symptom reduction, as quality of life (QoL) is lower for patients with AF. QoL outcomes are important for evaluating AF therapies primarily indicated for symptom control, including catheter ablation. The aim of this systematic review is to identify the most frequently used QoL instruments across AF ablation studies and to critically appraise their measurement properties.

Methods and results
A literature mapping exercise was completed to identify the most frequently used QoL instruments in AF ablation studies published in the past five years. A systematic review was then undertaken to critically appraise the measurement properties of the identified QoL instruments: EQ-5D, SF-36, AFEQT (AF Effect on QualiTy-of-Life), AFSS (AF Severity Scale), MLHF-Q (Minnesota Living with Heart Failure Questionnaire), AFQLQ (AF Quality of Life Questionnaire), ASTA (Arrhythmia Specific questionnaire in Tachycardia and Arrhythmia), and SCL (Arrhythmia Symptom Checklist, Frequency and Severity). The systematic review was designed using the COSMIN guidelines for systematic reviews of patient-reported outcome measurements, and was focused on the measurement properties of validity, reliability, and responsiveness. A systematic search of the literature was conducted in Ovid MEDLINE, Ovid Embase, Ovid PsycINFO, EBSCO CINAHL, and Cochrane CENTRAL. A meta-analysis was not feasible due to significant heterogeneity between studies and measurement properties, therefore results were synthesized qualitatively. 17 studies and 8 instruments were identified that met the eligibility criteria. ASTA and AFEQT had the best ratings across measurement properties with both instruments having good ratings for prom development and internal consistency. However, none of the studies assessed measurement error and cross-cultural validity. Measurement properties were inconsistent across different studies appraising the same instrument.

Conclusions
AFEQT and ASTA had the strongest measurement properties but not all measurement properties have been assessed. Considering the large number of indeterminate and insufficient ratings, future research should focus on cross-cultural validation, measurement error, responsiveness, and interpretability.