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#33654574   2021/02/15 To Up

Letter from the Editor in Chief.


Moussa Mansour

2592 related Products with: Letter from the Editor in Chief.

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#33654573   2021/02/15 To Up

Acute Safety and Efficacy of Fluoroless Cryoballoon Ablation for Atrial Fibrillation.

Pulmonary vein isolation (PVI) is widely used for the ablation of atrial fibrillation, with prior reports suggesting good efficacy. Due to the widespread use of three-dimensional electroanatomic mapping systems and advances in intracardiac echocardiography, fluoroless ablation has been made possible. Fluoroless ablation with a cryoballoon (CB), however, has not been widely performed because of the need to prove occlusion of the vein with contrast dye and fluoroscopy. The objective of this study is to show that CB ablation can be performed safely and effectively without fluoroscopy. A dual-center, case-control study was performed of patients undergoing CB PVI with a fluoroless approach and a control group with traditional fluoroscopic techniques. The absence of color-flow Doppler signals around the periphery of the CB on intracardiac echocardiography and an increase in mean pressure by 5 mmHg, loss of the A-wave, and an increase in the V-wave as measured with continuous-wave pressure monitoring were adopted as indicators of vein occlusion in the absence of fluoroscopy. Temperature at 30 seconds, minimum temperature, time to isolation, procedure length, and complications were evaluated. During the study period of November 15, 2018 to November 15, 2019, a total of 100 patients underwent CB PVI at the participating centers. A total of 50 patients were enrolled in the fluoroless arm [35 men (70%), mean age: 64.9 ± 12 years, mean left atrium size: 44.2 ± 16 mL/m, left ventricular ejection fraction: 61% ± 5%], while 50 patients were enrolled in the control arm with similar characteristics. Four hundred forty-one 441 PVs were evaluated in the study cohort compared to 339 PVs in the control arm. When comparing fluoroless and traditional techniques, the mean temperature at 30 seconds was -31.7°C ± 6°C versus -32.8°C ± 5°C (p = 0.037), the minimum temperature was -47.4°C ± 6°C versus -47.7°C ± 9°C (p = 0.677), the time to isolation was 56.8 ± 28 seconds versus 74.8 ± 45 seconds (p = 0.212), and the procedure time was 102.2 ± 27.3 seconds versus 104.5 ± 16.9 seconds (p = 0.6436). Ultimately, his proof-of-concept study revealed that fluoroless ablation can be performed with success and efficiency outcomes similar to those of a traditional ablation approach. This suggests that the ablation of atrial fibrillation with CB can be performed safely and effectively without the use of fluoroscopy by experienced operators.
Daniel Alyesh, Ganesh Venkataraman, Austin Stucky, John Joyner, William Choe, Sri Sundaram

1622 related Products with: Acute Safety and Efficacy of Fluoroless Cryoballoon Ablation for Atrial Fibrillation.

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#33654572   2021/02/15 To Up

Diathermy-induced Ventricular Fibrillation.

Diathermy is extensively used in patients for intracardiac device implant and extraction. While diathermy helps with adequate hemostasis, it may rarely be associated with fatal dysrhythmias. We report a case of diathermy-induced ventricular fibrillation during device extraction. The case highlights the importance and supports the involvement of a defibrillation facility during pacemaker revisions requiring diathermy.
Sanoj Chacko, Saud B Haseeb, Sohaib Haseeb, Joseph DeBono, Howard Marshall

1477 related Products with: Diathermy-induced Ventricular Fibrillation.

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#33654571   2021/02/15 To Up

Characteristics of Cardiac Memory in Patients with Implanted Cardioverter-defibrillators: The Cardiac Memory with Implantable Cardioverter-defibrillator (CAMI) Study.

This study sought to determine factors associated with cardiac memory (CM) in patients with implantable cardioverter-defibrillators (ICDs). Patients with structural heart disease [n = 20; mean age: 72.6 ± 11.6 years; 80% male; mean left ventricular ejection fraction (LVEF): 31.7 ± 7.6%; history of myocardial infarction in 75% and nonsustained ventricular tachycardia (NSVT) in 85%] and preserved atrioventricular conduction received dual-chamber ICDs for primary (80%) or secondary (20%) prevention. Standard 12-lead electrocardiograms were recorded in AAI and DDD modes before and after seven days of right ventricular (RV) pacing in DDD mode with a short atrioventricular delay. The direction (azimuth and elevation) and magnitude of spatial QRS, T, and spatial ventricular gradient vectors were measured before and after seven days of RV pacing. CM was quantified as the degree of alignment between QRS and T vectors (QRS -T angle). Circular statistics and mixed models with a random slope and intercept were adjusted for changes in cardiac activation, LVEF, known risk factors, and the use of medications known to affect CM occurring on days 1 through 7. The QRS-T angle strongly correlated (circular r = -0.972; p < 0.0001) with a T-T angle. In the mixed models, CM-T azimuth changes [+132° (95% confidence interval (CI): 80°-184°); p < 0.0001] were counteracted by the history of MI [-180° (95% CI: -320° to -40°); p = 0.011] and female sex [-162° (95% CI: -268° to -55°); p = 0.003]. A CM-T area increase [+15 (95% CI: 6-24) mV*ms; p < 0.0001] was amplified by NSVT history [+27 (95% CI: 4-46) mV*ms; p = 0.007]. These findings suggest that preexistent electrical remodeling affects CM in response to RV pacing, that CM exhibits saturation behavior, and that women reach CM saturation more easily than men.
Kazi T Haq, Jian Cao, Larisa G Tereshchenko

2401 related Products with: Characteristics of Cardiac Memory in Patients with Implanted Cardioverter-defibrillators: The Cardiac Memory with Implantable Cardioverter-defibrillator (CAMI) Study.

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#33654569   2021/02/15 To Up

Supraventricular Tachycardia and Postural Orthostatic Tachycardia Syndrome Overlap: A Retrospective Study.

Postural orthostatic tachycardia syndrome (POTS) and supraventricular tachycardia (SVT) are disease states with distinctive features but overlapping clinical manifestations. Currently, studies on the presence of underlying SVT in patients with POTS are lacking. This retrospective study analyzed 64 patients [mean age: 43 years; 41 (61%) women] who had a POTS diagnosis and were found to have concomitant SVT during rhythm monitoring from September 1, 2013 to September 30, 2019 at our Syncope and Autonomic Disorders Clinic. The outcomes assessed were changes in disease severity, frequency of symptoms, heart rate, and blood pressure between before and after SVT ablation. The most frequent types of SVT noted on the electrophysiologic study were atrioventricular nodal reentrant tachycardia (57.81%), atrial flutter (29.68%), atrioventricular reentrant tachycardia (9.37%), atrial tachycardia (1.56%), and junctional tachycardia (1.56%). After SVT ablation, all 64 patients experienced an improvement in symptoms. Palpitations and lightheadedness experienced the most improvement after the procedure (72% vs. 31%; p < 0.001 and 63% vs. 22%; p < 0.001, respectively). There was a significant improvement in the resting heart rate (81.1 ± 12.8 vs. 75.8 ± 15.6 bpm; p < 0.002), but the orthostatic tachycardia on standing persisted (93.6 ± 16.5 vs. 77.3 ± 19.8 bpm; p = 0.14). Underlying SVT in patients with POTS can be missed easily. A strong suspicion and long-term ambulatory cardiac rhythm monitoring can help in diagnosing the condition.
Zeid Nesheiwat, Arooge Towheed, Joseph Eid, Jeremy Tomcho, Pinang Shastri, Carson Oostra, Beverly Karabin, Blair Grubb

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#33654568   2021/02/15 To Up

A Case of Biatrial-dependent Tachycardia.

We present an interesting case of atrial flutter in a patient with previous pulmonary vein isolation. The entirety of the atrial flutter cycle length was mapped to the left atrium; however, an atrial flutter could not be terminated from the left side. Subsequently, the right atrium was mapped and an area of earliest activation was noted in the junction between the superior vena cava and right atrium. Ablation performed in this area terminated the flutter. We believe that both the left atrium and the portion of the right atrium indicated were part of the circuit and herein discuss the likely mechanism of the biatrial dependence of this tachycardia.
Khalil Kanjwal, Shakeel Jamal, Abdul Q Haji

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#33654161   2021/03/02 To Up

Workflow towards automated segmentation of agglomerated, non-spherical particles from electron microscopy images using artificial neural networks.

We present a workflow for obtaining fully trained artificial neural networks that can perform automatic particle segmentations of agglomerated, non-spherical nanoparticles from scanning electron microscopy images "from scratch", without the need for large training data sets of manually annotated images. The whole process only requires about 15 min of hands-on time by a user and can typically be finished within less than 12 h when training on a single graphics card (GPU). After training, SEM image analysis can be carried out by the artificial neural network within seconds. This is achieved by using unsupervised learning for most of the training dataset generation, making heavy use of generative adversarial networks and especially unpaired image-to-image translation via cycle-consistent adversarial networks. We compare the segmentation masks obtained with our suggested workflow qualitatively and quantitatively to state-of-the-art methods using various metrics. Finally, we used the segmentation masks for automatically extracting particle size distributions from the SEM images of TiO particles, which were in excellent agreement with particle size distributions obtained manually but could be obtained in a fraction of the time.
Bastian Rühle, Julian Frederic Krumrey, Vasile-Dan Hodoroaba

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#33652772   2021/02/26 To Up

Evaluation of Four Lateral Flow Assays for the Detection of Urinary Antigen.

Urinary antigen tests (UATs) are often used to diagnose Legionnaires' disease as they are rapid and easy to perform on readily obtainable urine samples without the need for specialized skills compared to conventional methods. Recently developed automated readers for UATs may provide objective results interpretation, especially in cases of weak result bands. Using 53 defined patient urine samples, we evaluated the performance of the BinaxNOW Antigen Card (Abbott), ImmuView and (SSI Diagnostica), STANDARD F Ag FIA (SD Biosensor), and Sofia FIA (Quidel) simultaneously with their respective automated readers. Automatic and visual interpretation of result bands were also compared for the immunochromatography-based BinaxNOW and ImmuView UATs. Overall sensitivity and specificity of UATs were 53.9-61.5% and 90.0-94.9%, respectively. All four UATs successfully detected all samples from serogroup 1-positive patients, but most failed to detect samples for spp., or other serogroups. Automatic results interpretation of results was found to be mostly concordant with visual results reading. In conclusion, the performance of the four UATs were similar to each other in the detection of urinary antigen with no major difference between automated or visual results reading.
Alicia Y W Wong, Alexander T A Johnsson, Aina Iversen, Simon Athlin, Volkan Özenci

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