Predicting Atrial Fibrillation Recurrence After Catheter Ablation Through Time Variability of P-wave Features

[EN] Nowadays, the first-line therapy for paroxysmal atrial fibrillation (PAF) is pulmonary vein isolation through catheter ablation. However, the success rate of this procedure is still not as high as desirable. Thus, preoperative prediction of early AF recurrence after ablation is a challenge to select optimal candidates for the intervention. To this end, some promising predictors based on the P-wave in short ECG signals have been proposed in the last years. However, evolution of the P-wave along the time has still not been analyzed. Hence, the present work studies how time variability of two features of the P-wave predicts midterm cryoablation failure. For 45 PAF patients, a standard 12-lead ECG signal was obtained for 5 minutes before ablation. An automatic algorithm was then used to delineate all P-waves in lead II, and duration and amplitude were computed. The resulting time series were characterized by their mean, standard deviation and coefficient of variation (CV). Correlating these measures with ablation outcome, the CV for both parameters obtained the best discrimination between patients. In fact, compared with the mean value, the CV for both features obtained accuracies 10% greater, thus achieving values of 70%. These outcomes entail that time variability of the P-wave can reveal new information about the proarrhythmic condition of the patients, thus improving predictions of ablation failure.Ruiz, A.; Arias, MA.; Puchol, A.; Pachon, MI.; Rieta, JJ.; Alcaraz, R. (2020). Predicting Atrial Fibrillation Recurrence After Catheter Ablation Through Time Variability of P-wave Features. IEEE. 1-4. https://doi.org/10.22489/CinC.2020.366S1

Comparative Study of Convolutional Neural Networks for ECG Quality Assessment

[EN] In the last years, convolutional neural networks (CNNs) have become popular in ECG analysis, since they do not require pre-processing stages, nor specific pre-training. However, their ability for ECG quality assessment has still not been thoroughly assessed. Hence, this work introduces a comparison about the ability of several CNN algorithms to classify between high and low-quality ECGs. Taking advantage of the concept of transfer learning, five common pre-trained CNNs were analyzed, such as AlexNet, GoogLeNet, VGG16, ResNet18 and InceptionV3. They were fed with 2-D images obtained by turning 5 second-length ECG segments into scalograms through a continuous Wavelet transform. To train and validate the algorithms, 1,168 noisy ECG intervals, along with other 1,200 ECG excerpts with sufficient quality for their further interpretation, were extracted from a public database. The obtained results showed that all CNNs provided mean values of accuracy between 89 and 91%, but notable difference in terms of computational load were noticed. Thus, AlexNet was the fastest algorithm, requiring notably less CPU usage and memory than the remaining methods. Consequently, this CNN exhibited the best trade-off between high-quality ECG identification accuracy and computational load, and it could be considered as the most convenient algorithm for ECG quality assessment.This research has been supported by the grants DPI2017-83952-C3 from MINECO/AEI/FEDER EU, SBPLY/17/180501/000411 from Junta de Comunidades de Castilla-La Mancha and AICO/2019/036 from Generalitat Valenciana.Huerta, A.; Martinez-Rodrigo, A.; Puchol, A.; Pachon, MI.; Rieta, JJ.; Alcaraz, R. (2020). Comparative Study of Convolutional Neural Networks for ECG Quality Assessment. IEEE. 1-4. https://doi.org/10.22489/CinC.2020.370S1

AR/ER Ratio Correlates with Expression of Proliferation Markers and with Distinct Subset of Breast Tumors

The co-expression of androgen (AR) and estrogen (ER) receptors, in terms of higher AR/ER ratio, has been recently associated with poor outcome in ER-positive (ER+) breast cancer (BC) patients. The aim of this study was to analyze if the biological aggressiveness, underlined in ER+ BC tumors with higher AR/ER ratio, could be due to higher expression of genes related to cell proliferation. On a cohort of 47 ER+ BC patients, the AR/ER ratio was assessed by immunohistochemistry and by mRNA analysis. The expression level of five gene proliferation markers was defined through TaqMan®-qPCR assays. Results were validated using 979 BC cases obtained from gene expression public databases. ER+ BC tumors with ratios of AR/ER ≥ 2 have higher expression levels of cellular proliferation genes than tumors with ratios of AR/ER < 2, in both the 47 ER+ BC patients (P < 0.001) and in the validation cohort (P = 0.005). Moreover, BC cases with ratios of AR/ER ≥ 2 of the validation cohort were mainly assigned to luminal B and HER2-enriched molecular subtypes, typically characterized by higher proliferation and poorer prognosis. These data suggest that joint routine evaluation of AR and ER expression may identify a unique subset of tumors, which show higher levels of cellular proliferation and therefore a more aggressive behavior

Teste de Induçao de Taquicardia por Reentrada Eletrônica em Pacientes Portadores de Marcapasso Bicameral

Introduçao: A taquicardia por reentrada eletrônica pode ser um efeito adverso em pacientes portadores de marcapassos bicamerais (DDD, DDDR e VDD) na presença de conduçao ventrículo-atrial. Pode ocorrer especialmente em pacientes cujos marcapassos apresentam falhas de comando e sensibilidade atrial ou falhas na programaçao. Material e Método: Foram avaliados 118 portadores de marcapasso bicameral, com implante por doença do nó sinusal (DNS) e bloqueio atrioventricular total (BAVT), por meio de monitoramento eletrocardiográfico computadorizado e programador/interrogador de marcapasso. Resultados: Taquicardias por reentrada eletrônica foram induzidas em 30 pacientes por meio de um protocolo que produziu perda de comando atrial, aumento da sensibilidade atrial, elevaçao da freqüência de estimulaçao e reduçao do PVARP (post-ventricular atrial refractory period). Discussao: O aumento do número de implantes de marcapassos e ressincronizadores e as novas programaçoes dos geradores tornaram a taquicardia por reentrada eletrônica uma forma de taquiarritmia cada vez mais freqüente. Conclusao: O teste de induçao de TRE mostrou-se eficaz e seguro. Recomenda-se a sua integraçao ao conjunto de testes de avaliaçao de portadores de marcapasso bicameral, principalmente aqueles em que a conduçao ventrículo-atrial é evidente ou que apresentam DNS

Teste de Induçao de Taquicardia por Reentrada Eletrônica em Pacientes Portadores de Marcapasso Bicameral

Introduçao: A taquicardia por reentrada eletrônica pode ser um efeito adverso em pacientes portadores de marcapassos bicamerais (DDD, DDDR e VDD) na presença de conduçao ventrículo-atrial. Pode ocorrer especialmente em pacientes cujos marcapassos apresentam falhas de comando e sensibilidade atrial ou falhas na programaçao. Material e Método: Foram avaliados 118 portadores de marcapasso bicameral, com implante por doença do nó sinusal (DNS) e bloqueio atrioventricular total (BAVT), por meio de monitoramento eletrocardiográfico computadorizado e programador/interrogador de marcapasso. Resultados: Taquicardias por reentrada eletrônica foram induzidas em 30 pacientes por meio de um protocolo que produziu perda de comando atrial, aumento da sensibilidade atrial, elevaçao da freqüência de estimulaçao e reduçao do PVARP (post-ventricular atrial refractory period). Discussao: O aumento do número de implantes de marcapassos e ressincronizadores e as novas programaçoes dos geradores tornaram a taquicardia por reentrada eletrônica uma forma de taquiarritmia cada vez mais freqüente. Conclusao: O teste de induçao de TRE mostrou-se eficaz e seguro. Recomenda-se a sua integraçao ao conjunto de testes de avaliaçao de portadores de marcapasso bicameral, principalmente aqueles em que a conduçao ventrículo-atrial é evidente ou que apresentam DNS

Cardioneuroablation: Catheter Vagal Denervation as a New Therapy for Cardioinhibitory Syncope

The vasovagal syncope is the most frequent cause of transient loss of consciousness, especially in young people without significant heart disease. The malignant cardioinhibitory form is caused by abrupt and intense vagal reflex with or without defined triggers. Refractory cases to preventive measures and pharmacological handling has been treated with definitive pacemaker implantation. Besides showing questionable results, pacemaker implantation is highly rejected by young patients. In the late 1990s, we proposed specific vagal denervation by catheter ablation and spectral mapping, for paroxysmal AF, functional bradyarrhythmias and severe cases of malignant cardioinhibitory syncope giving rise to cardioneuroablation. Recently, many authors worldwide have been reproducing the cardioneuroablation results where elimination or significant reduction of the vagal response were observed, which abolished symptoms in more than 75% of patients followed up to 14 years, without complications. Therefore, cardioneuroablation has shown to be a real therapeutic option in malignant syncope cardioinhibitory and in any exclusive vagal mediated bradyarrhythmia without the need for pacemaker implantation

Modern venomics--Current insights, novel methods, and future perspectives in biological and applied animal venom research

Venoms have evolved >100 times in all major animal groups, and their components, known as toxins, have been fine-tuned over millions of years into highly effective biochemical weapons. There are many outstanding questions on the evolution of toxin arsenals, such as how venom genes originate, how venom contributes to the fitness of venomous species, and which modifications at the genomic, transcriptomic, and protein level drive their evolution. These questions have received particularly little attention outside of snakes, cone snails, spiders, and scorpions. Venom compounds have further become a source of inspiration for translational research using their diverse bioactivities for various applications. We highlight here recent advances and new strategies in modern venomics and discuss how recent technological innovations and multi-omic methods dramatically improve research on venomous animals. The study of genomes and their modifications through CRISPR and knockdown technologies will increase our understanding of how toxins evolve and which functions they have in the different ontogenetic stages during the development of venomous animals. Mass spectrometry imaging combined with spatial transcriptomics, in situ hybridization techniques, and modern computer tomography gives us further insights into the spatial distribution of toxins in the venom system and the function of the venom apparatus. All these evolutionary and biological insights contribute to more efficiently identify venom compounds, which can then be synthesized or produced in adapted expression systems to test their bioactivity. Finally, we critically discuss recent agrochemical, pharmaceutical, therapeutic, and diagnostic (so-called translational) aspects of venoms from which humans benefit.This work is funded by the European Cooperation in Science and Technology (COST, www.cost.eu) and based upon work from the COST Action CA19144 – European Venom Network (EUVEN, see https://euven-network.eu/). This review is an outcome of EUVEN Working Group 2 (“Best practices and innovative tools in venomics”) led by B.M.v.R. As coordinator of the group Animal Venomics until end 2021 at the Institute for Insectbiotechnology, JLU Giessen, B.M.v.R. acknowledges the Centre for Translational Biodiversity Genomics (LOEWE-TBG) in the programme “LOEWE – Landes-Offensive zur Entwicklung Wissenschaftlich-ökonomischer Exzellenz” of Hesse's Ministry of Higher Education, Research, and the Arts. B.M.v.R. and I.K. further acknowledge funding on venom research by the German Science Foundation to B.M.v.R. (DFG RE3454/6-1). A.C., A.V., and G.Z. were supported by the European Union's Horizon 2020 Research and Innovation program through Marie Sklodowska-Curie Individual Fellowships (grant agreements No. A.C.: 896849, A.V.: 841576, and G.Z.: 845674). M.P.I. is supported by the TALENTO Program by the Regional Madrid Government (2018-T1/BIO-11262). T.H.'s venom research is funded by the DFG projects 271522021 and 413120531. L.E. was supported by grant No. 7017-00288 from the Danish Council for Independent Research (Technology and Production Sciences). N.I. acknowledges funding on venom research by the Research Fund of Nevsehir Haci Bektas Veli University (project Nos. ABAP20F28, BAP18F26). M.I.K. and A.P. acknowledge support from GSRT National Research Infrastructure structural funding project INSPIRED (MIS 5002550). G.A. acknowledges support from the Slovenian Research Agency grants P1-0391, J4-8225, and J4-2547. G.G. acknowledges support from the Institute for Medical Research and Occupational Health, Zagreb, Croatia. E.A.B.U. is supported by a Norwegian Research Council FRIPRO-YRT Fellowship No. 287462

Health Services Utilization, Work Absenteeism and Costs of Pandemic Influenza A (H1N1) 2009 in Spain: A Multicenter-Longitudinal Study

Background: The aim of this study was to estimate healthcare resource utilization, work absenteeism and cost per patient with pandemic influenza (H1N1)2009, from its beginning to March 2010, in Spain. We also estimated the economic impact on healthcare services. Methods and Findings: Longitudinal, descriptive,multicenter study of in- and outpatients with confirmed diagnosis of influenza A (H1N1) in Spain. Temporal distribution of cases was comparable to that in Spain. Information of healthcare and social resources used from one week before admission (inpatient) or index-medical visit (outpatient) until recovery was gathered. Unit cost was imputed to utilization frequency for the monetary valuation of use. Mean cost per patient was calculated. A sensitivity analysis was conducted, and variables correlated with cost per patient were identified. Economic impact on the healthcare system was estimated using healthcare costs per patient and both, the reported number of confirmed and clinical cases in Spain. 172 inpatients and 224 outpatients were included. Less than 10% were over 65 years old and more than 50% had previous comorbidities. 12.8% of inpatients were admitted to the Intensive Care Unit. Mean length of hospital stay of patients not requiring critical care was 5 days (SD =4.4). All working-inpatients and 91.7% working-outpatients went on sick leave. On average, work absenteeism was 30.5 days (SD=20.7) for the first ones and 9 days (SD= 6.3) for the latest. Caregivers of 21.7% of inpatients and 8.5% of outpatients also had work absenteeism during 10.7 and 4.1 days on average respectively. Mean cost was J6,236/inpatient (CI95%=1,384-14,623) and J940/outpatient (CI95% =66-3,064). The healthcare economic burden of patients with confirmed influenza was J144,773,577 (IC95% 13,753,043-383,467,535). More than 86% of expenditures were a result of outpatients" utilization. Conclusion: Cost per H1N1-patient did not defer much from seasonal influenza estimates. Hospitalizations and work absenteeism represented the highest cost per patient