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Additional file 1. Supplemental Material. Appendix A. Supplemental information on search strategy. Appendix B. Adapted scale from the Newcastle-Ottawa quality assessment scale for cohort studies. Fig. S1. Flowchart for study inclusion. Fig. S2. Funnel plots on the cross-sectional and longitudinal association of diabetes with non-paroxysmal AF (vs paroxysmal AF). Table S1. Classification of AF types, based on the presentation, duration, and spontaneous termination of AF episodes. Table S2. Recruitment setting. Table S3. AF definitions across studies. Table S4. AF monitoring in studies investigating the longitudinal association of diabetes with AF types. Table S5. "Leave one out" sensitivity analysis. Table S6. Sensitivity analyses in the meta-analysis of longitudinal studies investigating the association of diabetes with non-paroxysmal AF (vs paroxysmal AF). Table S7. Quality assessment scale.

Aim The association of standard 12-lead electrocardiogram (ECG) markers with benefits of the primary prophylactic implantable cardioverter-defibrillator (ICD) has not been determined in the contemporary era. We analysed traditional and novel ECG variables in a large prospective, controlled primary prophylactic ICD population to assess the predictive value of ECG in terms of ICD benefit. Methods and results Electrocardiograms from 1477 ICD patients and 700 control patients (EU-CERT-ICD; non-randomized, controlled, prospective multicentre study; ClinicalTrials.gov Identifier: NCT02064192), who met ICD implantation criteria but did not receive the device, were analysed. The primary outcome was all-cause mortality. In ICD patients, the co-primary outcome of first appropriate shock was used. Mean follow-up time was 2.4 ± 1.1 years to death and 2.3 ± 1.2 years to the first appropriate shock. Pathological Q waves were associated with decreased mortality in ICD patients [hazard ratio (HR) 0.54, 95% confidence interval (CI) 0.35–0.84; P Conclusion Pathological Q waves were a strong ECG predictor of ICD benefit in primary prophylactic ICD patients. Excess mortality among Q wave patients seems to be due to arrhythmic death which can be prevented by ICD.

Life expectancy of contemporary cardiac pacemakers is limited due to the use of an internal primary battery. Repeated device replacement interventions are necessary, which leads to an elevated risk for patients and an increase of health care costs. The aim of our study is to investigate the feasibility of powering an endocardial pacemaker by converting a minimal amount of the heart's kinetic energy into electric energy. The intrinsic cardiac muscle activity makes it an ideal candidate as continuous source of energy for endocardial pacemakers. For this reason, we developed a prototype able to generate enough power to supply a pacing circuit at different heart rates. The prototype consists of a mass imbalance that drives an electromagnetic generator while oscillating. We developed a mathematical model to estimate the amount of energy harvested from the right ventricle. Finally, the implemented prototype was successfully tested during in-vitro and in-vivo experiments.

OBJECTIVES The aim of this study was to investigate the impact of valvular and nonvalvular atrial fibrillation (AF) in patients undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND AF has been associated with adverse clinical outcomes after TAVR. However, the differential impact of valvular as opposed to nonvalvular AF has not been investigated. METHODS In a retrospective analysis of a prospective registry, valvular AF was defined as AF in the setting of concomitant mitral stenosis or the presence of a mitral valve prosthesis. The presence of mitral stenosis was determined by pre-procedural echocardiography. The primary endpoint was a composite of cardiovascular death or disabling stroke at 1 year after TAVR. RESULTS Among 1,472 patients undergoing TAVR between August 2007 and June 2018, AF was recorded in 465 patients (31.6%) and categorized as nonvalvular in 376 (25.5%) and valvular in 89 (6.0%). AF scores including HAS-BLED, CHADS2, and CHA2DS2-VASc were comparable between patients with nonvalvular and valvular AF. The primary endpoint occurred in 9.3% of patients with no AF, in 14.5% of patients with nonvalvular AF (hazard ratio: 1.57; 95% confidence interval: 1.12 to 2.20; p = 0.009), and in 24.2% of patients with valvular AF (hazard ratio: 2.75; 95% confidence interval: 1.71 to 4.41; p

BACKGROUND Abnormal 12-lead electrocardiogram (ECG) can predict cardiovascular events, including sudden cardiac death. We tested the hypothesis that ECG provides useful information on guiding implantable cardioverter defibrillator (ICD) therapy into individuals with impaired left ventricular ejection fraction (LVEF). METHODS Retrospective data of primary prevention ICD implantations from 14 European centers were gathered. The registry included 5111 subjects of whom 1687 patients had an interpretable pre-implantation ECG available (80.0% male, 63.3 ± 11.4 years). Primary outcome was survival without appropriate ICD shocks or heart transplantation. A low-risk ECG was defined as a combination of ECG variables that were associated with the primary outcome. RESULTS A total of 1224 (72.6%) patients survived the follow-up (2.9 ± 1.7 years) without an ICD shock, 224 (13.3%) received an appropriate shock and 260 (15.4%) died. Low-risk ECG defined as QRS duration

BACKGROUND Atrial fibrillation recurrence (AFR) is common after pulmonary vein isolation (PVI), and the rate does not differ between radiofrequency (RF) and cryoballoon (CB) ablation. The aim of this study was to assess the impact of the ablation modality used at the index PVI on the outcome after redo PVI in patients with paroxysmal AF. METHODS In this prospective, single-center, non-randomized study, consecutive patients with paroxysmal AF who have undergone the index PVI with either RF ablation (RF group) or 2nd-generation CB (CB group) were included. The primary endpoint was freedom from recurrence of atrial arrhythmia lasting > 30 s. RESULTS A total of 105 patients undergoing redo PVI for paroxysmal AF were included (median age 61 years; 24% female; left ventricular ejection fraction (LVEF) 57 ± 8%; left atrial volume index (LAVI) 34 ± 11 mm). Index PVI was done either with focal RF (n = 81) or with CB (n = 24) and redo PVI only with focal RF. Total procedure time (139 vs. 113 min, p = 0.10) and RF delivery time (1017 vs. 870 s, p = 0.33) of the redo PVI were not significantly different. After a median follow-up of 371 (185-470) days, there were no differences between the RF and CB groups regarding the AFR rate after the second PVI (24 vs. 23%, p = 0.89). The Kaplan-Meier analysis showed no difference between the groups regarding AFR freedom time (p = 0.81). In multivariable logistic regression, only coronary artery disease was identified as an independent long-term predictor of AFR (OR 4.15, 95% CI 1.17-14.71, p = 0.027). CONCLUSIONS The ablation modality used at the index PVI has no impact on long-term outcome after redo PVI in patients with paroxysmal AF.

OBJECTIVE Cardiac pacemakers are powered by batteries, which become exhausted after a few years. This is a problem in particular for leadless pacemakers since they are difficult to explant. Thus, autonomous devices powered by energy harvesters are desired. METHODS We developed an energy harvester for endocardial implantation. The device contains a microgenerator to convert a flexible turbine runner's rotation into electrical energy. The turbine runner is driven by the intracardiac blood flow, a magnetic coupling allows hermetical sealing. The energy harvester has a volume of 0.34 cm 3 and a weight of 1.3 g. Computational simulations were performed to assess the hemodynamic impact of the implant. The device was studied on a mock circulation and an in-vivo trial was performed in a domestic pig. RESULTS In this article we show that an energy harvester with a 2-bladed 14 mm diameter turbine runner delivers 10.2 ± 4.8 μW under realistic conditions (heart rate 80/min, stroke volume 75 ml) on the bench. An increased output power (> 80 μW) and power density (237.1 μW/cm 3) can be achieved by higher stroke volumes, increased heart rates or larger turbine runners. The device was successfully implanted in vivo. CONCLUSION The device is the first flow-based energy harvester suitable for catheter-based implantation and provides enough energy to power a leadless pacemaker. SIGNIFICANCE The high power density, the small volume, and the flexible turbine runner blades facilitate the integration of the energy harvester in a pacemaker. This would allow overcoming the need for batteries in leadless pacemakers.

BACKGROUND Radiofrequency catheter ablation of idiopathic ventricular arrhythmias (VAs) is performed to eliminate symptoms and to prevent or reverse arrhythmia-induced cardiomyopathy. Preprocedural prediction of the chamber of VA origin is critical for patient counseling, procedure planning, and guidance of invasive mapping. OBJECTIVE We aimed to assess the performance of manual expert versus automated 12-lead electrocardiogram (ECG) analysis in the prediction of VA origin. METHODS Patients with ablation of idiopathic VA and sustained success were included. The VA origin was defined as the site where ablation caused arrhythmia suppression. Standard baseline 12-lead ECGs with documentation of the VA were analyzed manually in a blinded fashion by three electrophysiologists and three electrophysiology (EP) fellows. In addition, the same standard 12-lead ECG was analyzed by an automated computer algorithm using a vectorcardiographic approach. RESULTS Thirty-eight patients (median age, 47 [interquartile range, 37-58]; 68% female) were enrolled. The VA originated from the right ventricle in 24 (63%) and the left ventricle in 14 (37%) patients. The electrophysiologists and EP fellows identified the VA chamber of origin with a similar accuracy of 73% and 72% (P = .72). The automated algorithm showed a higher accuracy of 89% (P = .03 compared with electrophysiologists and EP fellows). This resulted in a sensitivity of 95% and specificity of 86%. CONCLUSION While the manual ECG analysis of the standard 12-lead ECG by both electrophysiologists and EP fellows correctly identified the chamber of VA origin in around 75% of cases, an automated vectorcardiographic computer algorithm achieved an accuracy of 89% with clinically acceptable diagnostic parameters.

BACKGROUND Myocardial scarring from infarction or nonischemic fibrosis forms an arrhythmogenic substrate. The Selvester QRS score has been developed to estimate myocardial scar from the 12-lead electrocardiogram. OBJECTIVE We aimed to assess the value of an automated version of the Selvester QRS score for the prediction of implantable cardioverter-defibrillator (ICD) therapy and death in patients undergoing primary prevention ICD implantation. METHODS Unselected patients undergoing primary prevention ICD implantation were included in this retrospective, observational, multicenter study. The QRS score was calculated automatically from a digital standard preimplantation 12-lead electrocardiogram and was correlated to the occurrence of death and appropriate and inappropriate shocks during follow-up. Analyses were performed in groups defined by QRS duration < 130 ms vs ≥ 130 ms. RESULTS Overall, 1047 patients (872 [83%] men; median age 64 years IQR [55-71]) with ischemic (648, 62%) or nonischemic (399, 38%) cardiomyopathy were included. The median QRS duration was 123 ms (interquartile range [IQR] 111-157 ms), and the median QRS score was 5 (IQR 2-8). The QRS duration was .05). CONCLUSION The automatically calculated Selvester QRS score, an indicator of myocardial scar burden, predicts mortality and appropriate and inappropriate shocks in patients undergoing primary prevention ICD implantation with a prolonged QRS duration.