bluuebunny/crossref_metadata_2025 huggingface dataset:
HV interval measure immediately before TAVI with SEV for predicting pacemaker implantation
Authors: Olivas Medina D , Juan-Salvadores P , Salgado-Barreira A , Garcia-Campo E , Teijeira-Fernandez E , Cabanas-Grandio P , Pardo-Fresno M , Fernadez-Obanza E , Lopez-De La Garza H , Baz-Alonso J A , Jimenez-Diaz V A , Iniguez-Romo A
Published: October 2024

Introduction

Although improvements, new onset persistent disturbances in electrocardiogram (ECG) after transcatheter aortic valve implantation (TAVI) remains up to 34% at hospital discharge (1), needing permanent pacemaker implantation (PPM) in self-expanding valves (SEV) as high as 15-27% (2,3). In post TAVI scenario, European Society of Cardiology guidelines recommend an electrophyisiologic study centered in His-ventricular electrogram (HV) interval measure for assessing risk of progression to high auriculoventricular block (AVB), if abnormal a PPM is indicated (4,5). We aim to predict PPM through basal HV interval measurement prior TAVI with SEV. Furthermore, we aim to compare different current SEV with basal HV interval and the distinct rate of PPM before discharge.

Methods and Results

Single-center prospective cohort study, patients with severe aortic stenosis scheduled for TAVI, sinus rhythm at intervention day, without PPM or history of PPM indication were included. At time of TAVI, contralateral venous puncture to femoral arterial access was made, a tetrapolar catheter was advanced and placed at the septal aspect of tricuspid valve searching for His electrogram. A mobile polygraph was used to measure ECG parameters and HV interval before TAVI. Then, a tetrapolar catheter was advanced to ventricle to perform rapid stimulation as part of habitual valve implantation protocol. After procedure, we performed rhythm surveillance for at least >48-72 hours and based in electrical evolution one of three decisions was made: 1)PPM implant, 2)late post TAVI HV interval re-measure or 3)clinical daily ECG vigilance, if this last was normal, unchanged from basal or with new but stable conduction disturbances, discharge were indicated following ESC guidelines.

A total of 41 patients were enrolled, median age 84±4 years, 24 females (54.5%), PR mean 198±42ms, QRS mean 112±30ms. 18 had a 1st degree AVB (40.9%) of whom 13 (72.5%) had a PR ˂240ms. EPS data showed prior HV interval mean of 55±9ms. A Mild abnormal HV interval (56-69ms) were seen in 21 patients (51.2%), of whom 12 had a narrow QRS. SEV implanted were 11 (25%) Medtronic CoreValve Evolut+, 5 (11.4%) Biosensors Allegra, 25 (56.8%) Abbott Navitor. Post TAVI procedure, 5 (12.2%) women and 8 (19.5%) men met criteria for PPM implantation before discharge. One woman was implanted 6 days after discharge due to high AVB (66ms HV interval prior TAVR). In a multivariate analysis including sex, age, PR, QRS and HV interval >55ms, valve type the RR (IC 95% 1.37-30.99) risk of PPM was 6.52 folds higher (p=0.019).

Conclusions

An HV interval >55ms before TAVI with SEV increases risk of PPM after TAVI and before hospital discharge. There was no difference in PPM implantation after TAVI between different SEV types in our center.
Patients on the ledge; ablation of incessant tachycardia. A single centre registry
Authors: Kamel O , Nasr A N , Abdelfattah M A , Ahmed E A , Wanees M W , Hammouda T H
Published: October 2024

Background

Incessant tachycardia was first described by Cassidy (1). in 1924, it is strongly associated with tachycardia induced cardiomyopathy. There is no data about its true incidence however, it seems to be more common during infancy and childhood.

Objectives

To present 5-year single centre experience in ablating incessant tachycardia in a cohort of pediatric and adult patients.

Methods

From 2018 to 2023, We reviewed patients presented to our centre with incessant tachycardia, their clinical data, ECGs, imaging modalities, procedures details & outcomes were examined thoroughly.

Results

Over 5 years, 900 patients were referred to our centre for ablation, among them 25 patients (2.7%) presented with incessant tachycardia. Of them: 10 patients were pediatrics (40%), the youngest was 40 days old, 3.4 Kg, 6 patients were haemdynamically unstable necessitating ventilation& IV supports, 14 patients had impaired EF, with the lowest EF of 20%.(A) Regarding the diagnosis, 14 patients had AT (4 CS ostium, 3 LAA, 2 parahisian, 2 Crista, 1 LSPV, 1 TA, 1RAA), 4 AVRT (2 concealed parahisian accessory pathways & 2 PJRT), 3 VT (2 scar related VT, 1 anterior papillary muscle), 4 AFL (3 CTI flutter & 1 mitral isthmus flutter). All patients were ablated using 3D mapping system except 4 pediatric patients (2 AT from CS, 2 concealed parahisian accessory pathways) due to accesses limitations or unavailability of 3D mapping, single catheter technique was used in one patient weighing 3.4kg with AT from CS (only one venous access accommodating 5F catheter could be obtained)(B), Rt & Lt jugular accesses were used for ablation of RAA AT in a pediatric patient with bilaterally occluded femoral veins.(C) NCC was used as a safe access for ablating parahsisan AT & accessory pathways in our cohort.(D) All patients had successful ablation with full recovery for those with impaired function except 2 patients of scar related VT as their EF was impaired previously. Regarding the complications, one patient had DVT and another patient had retroperitoneal hematoma, both were managed conservatively.

Conclusion

Incessant tachycardia ablation is quite challenging but carries good results. Careful planning, experienced team & selection of the appropriate approach are the keys for successful safe procedures.
Ventricular parasystole as a new indicator suggesting ventricular arrhythmias in cardiac sarcoidosis
Authors: Ikee T , Nakajima K , Nakamura T , Oka S , Miyazaki Y , Wakamiya A , Ueda N , Kamakura T , Wada M , Ishibashi K , Inoue Y , Miyamoto K , Nagase S , Aiba T , Kusano K
Published: October 2024

Background

In cardiac sarcoidosis (CS), it is considered that inflammation occurs in localized areas such as the basal septum. Inflammation has been suggested to be associated with ventricular fibrillation (VF). Meanwhile, ventricular parasystole is strongly associated with VF in non-ischemic cardiomyopathy. However, the relationship between CS and ventricular parasystole remains unclear.

Purpose

The purpose is to examine the frequency of parasystole in cases of VF and ventricular tachycardia (VT) in CS, and whether there is a correlation between the inflammatory activity of sarcoidosis and the origin of ventricular parasystole.

Methods

We evaluated ventricular arrhythmias (VA) in a cohort of 213 consecutive cases diagnosed with CS from 1989 to 2021 (median age 69 years, 104 males, median LVEF 36%) in our center. We investigated parasystole in cases that developed VA, using 5,313 electrocardiograms, 94 Holter electrocardiograms, and 3,174 ICD interrogation records. Classic parasystole is defined as three ventricular ectopic beats with the same morphology at a fixed interval but different coupling intervals (CI) in a 10-second continuous ECG. A new definition of parasystole requires two ventricular ectopic beats with a CI difference of more than 120ms. We also investigated the correlation of the inflammation site with ECG morphology.

Results

VAs were observed in 95 individuals (33.7%), and 22 developed VF (23.2%). In the VF group, parasystole was observed in 12 of 22 individuals (classic: 5, new: 7), and in the VT group observed in 20 of 73 individuals (classic: 5, new: 15), with parasystole being significantly more frequent in the VF group (P=0.018) and classic parasystole (P=0.033). In VF patients with recorded 12-lead ECGs of parasystole, the inflammation site on PET within 3 months of the VA and PVC origin matched in all 4 out of 4 cases, but no VF starting from ventricular parasystole ectopic beats was recorded.

Conclusion

Ventricular parasystole was detected in 54.5% of CS patients with VF. There is a possibility that the presence of parasystole and the inflammatory activity in the CS can predict the occurrence of VF.
Predictor of wasted implantable cardioverter defibrillator for secondary prevention
Authors: Akagawa R , Otsuki S , Wada R , Suzuki N , Ikami Y , Hasegawa Y , Chinushi M , Inomata T
Published: October 2024

Background

ICD is the ﬁrst line treatment to prevent sudden cardiac death from recurrence of VT/VF. However, patients with organic heart disease have many comorbidities, and some patients die without history of appropriate ICD therapy in lifetime.

Purpose

The aim of this study is to examine the predictors of death without appropriate ICD therapy in lifetime, among ICD patients for secondary prevention with organic heart disease.

Methods

We enrolled consecutive patients implanted with ICD/CRT-D for secondary prevention between 2000 and 2022. We excluded patients without organic heart disease, and alive patients without history of appropriate ICD therapy. Inappropriate candidate (Wasted-group) for defibrillator was defined as the patient who died without history of appropriate ICD therapy or died within one year from appropriate ICD therapy. Appropriate candidate (Appropriate-group) was defined as the patient who had been alive over one year from appropriate ICD therapy (Wasted-group:36, Appropriate-group:131).

Results

During a follow-up of 8.3 ± 5.3 years, a total of 93 (56%) patients died, including 6 (4%) patients died within one year from ICD/CRT-D implantation. Among the 36 patients of Wasted-group, 28 patients died without history of appropriate ICD therapy. Higher age, ischemic cardiomyopathy, non-ARVC, a past history of VF, diabetes mellitus, and higher serum creatinine was the predictor of Wasted-group (P<0.05). Wasted ICD risk score was constructed with the summation of these predictors for predicting candidates of Wasted-group. When the Wasted ICD risk score was ≥3, positive predictive value and negative predictive value were 39.7% and 89.4%, respectively (AUC=0.77, P<0.001).

Conclusion

Patients with a Wasted ICD risk score <3 is likely to receive appropriate ICD therapy in lifetime. Therefore, Wasted ICD risk score might be useful to decide to need for ICD therapy, regarding elderly patients who would be hesitant to have ICD implanted.Wasted ICD risk score
Resuscitation of people with a do-not-resuscitate order: when does it happen and what are the outcomes?
Authors: Paratz E , Nehme E , Burton S , Heriot N , Bissland K , Rowe S , Fahy L , Anderson D , Stub D , La Gerche A , Nehme Z
Published: October 2024

Background

Do-not-resuscitate (DNR) orders allow competent individuals to state their wishes to not receive resuscitation. Despite the existence of a DNR order, resuscitative efforts may still occur.

Purpose

To identify rates and outcomes of resuscitation attempts for people with DNR orders.

Methods

The statewide out-of-hospital cardiac arrest (OHCA) registry in Victoria, Australia (population 6.5 million) identified rates of DNR orders and resuscitative efforts in ≥60-year-olds from 2006-2021.

Results

Of 47,322 patients ≥60 years old with OHCA, 2,688 (5.7%) had a DNR order. DNR order was communicated to emergency call-takers in only 332 (12.4%) cases. Bystander resuscitation was commenced in 1,074 (40.0%) patients, with EMS terminating efforts in 346 (32.2%) patients on arrival but commencing resuscitation in 189 others. Strongest predictors of bystander resuscitation were shockable rhythm (OR 7.75, 95% CI 5.04-11.9) and OHCA in public location (OR 4.8, 95% CI 2.0-11.3). Predictors of EMS terminating resuscitation efforts were OHCA in residential aged care facility (OR 1.93, 95% CI 1.47-2.5) and older age (OR 1.02, 95% CI 1.00-1.04). Transfer to hospital was undertaken in 107 patients, with strongest predictors being return of spontaneous circulation (OR 91.1, 95% CI 51.7-160.7) and witnessed OHCA (OR 7.5, 95% CI 3.9-14.5). Only 7 (0.3%) transported patients survived to discharge, with 5 deceased at 12-month follow-up.

Conclusion

Approximately 5% of EMS-attended OHCAs in ≥60-year-olds involve a patient with a DNR order, with low rates of awareness of DNR orders. Resuscitation is commenced in 47% of patients, and 4% are transported to hospital with very poor outcomes. Strategies to communicate DNR status and respect patients’ autonomy are extremely important.
Prevalence and characteristics of the catecholamine induced QT prolongation syndrome
Authors: Bordet M , Mansourati J , Rajalu A , Cotard V , Thollet A , Probst V , Gourraud J B
Published: October 2024

Background

We have recently described large families of idiopathic ventricular fibrillation characterised by catecholamine-induced QT interval prolongation (CIQTP). The patient presented with a normal QT duration at rest but an abnormal QT prolongation during a mental stress test (MST).

Objective

The aim of this study was to investigate the role of this new syndrome in inherited arrhythmic diseases.

Methods

Consecutive patients and their relatives, identified after unexplained familial sudden cardiac death or sudden cardiac arrest, were enrolled in the study in the presence of:

- no other diagnosis after cardiac ultrasound, stress test, pharmacological test with adrenaline and ajmaline.

- positive MST defined by a prolongation of the QT interval (>-11ms) during MST (as previously published).

Results

134 families with unexplained SCD were examined. CIQTP was diagnosed in 15 families, representing a prevalence of 11.2%.

Family screening of these 15 families identified a total of 43 individuals. Seven (16%) had symptoms prior to diagnosis, including sudden cardiac arrest in one.

At baseline, the QTc interval was measured at 440+/-23 ms.

MST increased the QTc interval by 49+/-33 ms. The identification of QT interval prolongation was less important in the exercise test (delta QTc 17+/-52 ms at 4 minutes after exercise) and the epinephrine test (delta QTc 19+/-36 at 1 minute according to the Krahn protocol).

Treatment with beta-blockers was initiated in 19 patients (44%) on the basis of symptoms and major prolongation of the QT interval during the MST.

After a mean follow-up of 7+/-2 years, only one patient developed ventricular fibrillation. This episode occurred during a short period when he was no observant for the treatment. Since then, there has been no recurrence of the arrhythmia on beta-blocker therapy. All other patients, including those who were previously symptomatic remained symptom-free on treatment.

Conclusion

CIQTP may explain a significant part of sudden cardiac arrest or syncope in young patients. Conventional screening using ECG, exercise test and epinephrine challenge may not be able to unmask CIQTP. Then MST may be systematically proposed for the screening of patient and their family. In CIQTP patients beta blocker therapy appears to be highly efficient to prevent symptoms.
Leadless pacemaker - lead parameters stability and battery longevity in the mid-term follow-up
Authors: Certo Pereira J , Amador R , Reis Santos R , Bello R , A Gomes D , Rodrigues G , Matos D , Carmos J , Santos I , Galvao Santos P , Carmo P , Moscoso Costa F , Cavaco D , Belo Morgado F , Adragao P
Published: October 2024

Background

A leadless pacemaker (L-PM) has been designed to avoid the need for a pacemaker pocket and transvenous lead. Long-term safety will largely depend on the need for replacements, mainly due to battery depletion (end-of-life). While the mean L-PM battery longevity predicted by the manufacturer is 12 years, real-world longevity data are still scarce. We aimed to describe L-PM parameters’ stability and battery longevity during the mid-term follow-up.

Methods

Single-center registry of consecutive patients undergoing L-PM implantation from May 2015 to November 2023. Procedural characteristics, lead parameters and battery longevity were collected immediately after implantation and during the most recent follow-up visit.

Results

Overall, 261 consecutive patients had a transcatheter L-PM implanted through a femoral vein (mean age 78±10 years; 66% male). Mean procedural duration was 44±28min and fluoroscopy time was 4,4±3,9min. The device was successfully implanted in all but one patient. The main indications for permanent pacing were high-degree atrioventricular block [N=130 (50%)], atrial fibrillation with pauses [N=78 (30%)], and sinus node disease [N=28 (11%)]. Immediately after implantation, three cases (1,2%) of pericardial effusion (one with tamponade) were reported. In one case (0,4%), a conventional pacemaker was implanted due to L-PM acute dysfunction. No other procedure-related complications, including dislodgment, were reported at discharge.

After a mean follow-up of 2,8±1,7years, the pacing threshold and R-wave amplitude remained stable [0,67mV vs. 0,62mV (p=0,9); and 10,3mV vs. 16,1mV (p<0,001), respectively] and mean ventricular pacing was 54±38%. Expected battery longevity was >8 years (maximum value) in 84% of the patients. In the subgroup of patients with >5 years of follow-up (N=20; mean follow up of 6,3±1,8years), the expected battery longevity was >8 years in 85% (N=17) of the patients. In three cases, the L-PM was upgraded to cardiac resynchronization therapy or left bundle branch area pacing due to pacing-induced left ventricular dysfunction. There was one case of L-PM end-of-life 6 years after implant (pacing threshold 0,5mV; ventricular pacing 100%), in which a second L-PM was successfully implanted. Overall, 78 (31%) patients died, a mean of 2,2±1,9 years after L-PM implantation, none related to the device.

Conclusion

In this real-world cohort, L-PM maintained stable pacing parameters and, in the mid-term follow-up, only one battery depletion was observed while expected longevity remained above 8 years in the large majority of patients. Longer follow up will allow better understanding of both technical and clinical aspects relevant to manage end-of-life devices.Table 1Figure 1
Half of implantable cardioverter-defibrillator patients remain at risk of painful shocks in the last moments of life
Authors: Yilmaz D , Al Jaff A A M , Egorova A , Van Erven L
Published: October 2024

Background

Patients with implantable cardioverter-defibrillators (ICDs) are at risk of receiving painful shocks near the end of life due to ongoing tachytherapy. Position papers of various international societies emphasize the need for advance care planning and timely deactivation of tachytherapy. This study aims to assess the real world practice of deactivating ICD tachytherapy prior to death over a consecutive 18-year period and strives to identify areas for improvement.

Methods

Medical records were reviewed of all patients who were carriers of an ICD or CRT-D and under follow-up at our university medical center. Those who deceased between 2006 and 2023 were identified from the municipal civil registry and their follow-up data were extracted from electronic patient records. The cause of death and status of ICD therapy at the time of death was analysed.

Results

During the study period, 1724 patients with an ICD expired (mean age 73 ± 10 years; 265 (15%) females; 1396 (81%) primary prevention; median time from initial ICD implantation 7.5 [interquartile range: 4 to 12] years. Baseline characteristics of patients who had tachytherapy deactivated prior to death did not differ significantly from those who did not. Overall, 769 (43%) devices were deactivated before death. The proportion of patients with deactivated tachytherapy prior to death gradually increased over time, surpassing to just >50% in the past decade (p<0.001), Figure 1. Causes of death differed between the two groups (p=0.022), Figure 2. The majority of patients with deactivated tachytherapy prior to death died due to: heart failure (38%); non-cardiac causes (23%) e.g. myocardial infarction or valvular disease; malignancy (23%) and other non-cardiac causes such as infectious diseases, stroke and trauma (31%). However, substantial proportions of patients dying from causes that could potentially be identified as an end-of-life phase, remained at risk of shocks in the last moments of life due to active tachytherapy (30% heart failure, 11% malignancy, 25% other non-cardiac causes).

Conclusions

The rate of patient with deactivated ICD tachytherapy before death doubled within the initial 4 years of the study period and more or less stabilized thereafter, thus leaving nearly half of ICD patients susceptible to painful shocks in their final moments of life. This underlines the necessity of timely advance care planning, including discussions regarding discontinuation of ICD therapy during the end-of-life phase.
Smaller intrinsic QRS area and smaller reduction of QRS area during cardiac resynchronisation therapy are associated with higher risk of ventricular arrhythmias and appropriate ICD therapy
Authors: Marinko S , Platonov P G , Borgquist R
Published: October 2024

Background

Cardiac resynchronisation therapy (CRT) patients are at high risk for ventricular arrhythmias (VAs), and little is known about which characteristics are associated with an increased risk for arrhythmic events.

Purpose

To investigate the association between QRS area parameters and the risk for VAs in patients with heart failure undergoing primary preventive CRT with defibrillator (CRT-D) implantation.

Methods

All patients receiving CRT-D between 2015 and 2020 at a large-volume tertiary care center were retrospectively evaluated. Digital 12-lead electrocardiograms (ECGs) were collected before and after CRT implantation. Patients were included if they had native LBBB and were implanted with a primary preventive CRT-D. Kors’ regression transformation was used to derive vectorcardiographic QRS area from the 12-lead ECGs. QRS area parameters were analysed in relation to a primary endpoint of first appropriate ICD therapy, i.e., ATP or shock therapy.

Results

177 patients with LBBB (68.9 years [60.7–73.8]; 21.5% female; 52.9% New York Heart Association (NYHA) class III-IV; LVEF 25.9±6.3%) were followed over a median follow-up time of 2.5 years [1.6–3.0] after CRT-D implantation. 27 patients reached the primary endpoint. The median pre-CRT QRS area was 134.5 μVs [102.3–163.8]. Multivariable Cox regression identified a small pre-CRT QRS area (HR, per 10 μVs decrease, 1.30; [1.12–1.51]; p=<.001) and a small post-CRT reduction in QRS area (HR, per 10 μVs decrease, 1.30; [1.13–1.49]; p=<.001) as independent predictors of an increased risk of appropriate ICD therapy. In analyses with a scoring variable combining pre-CRT QRS area and QRS area reduction both above or below median, the combination of a small pre-CRT QRS area and a small QRS area reduction was strongly associated with an increased risk of reaching the endpoint (HR, per point increase, 2.47; [1.2–4.9]; p=0.01).

Conclusion

A small intrinsic QRS area, by itself or in combination with a small reduction of post-CRT QRS area, was strongly associated with a higher risk of ventricular arrhythmias in this cohort of CRT-D treated patients. In conjunction with other parameters, further risk stratification for arrhythmic events could be achieved by assessing QRS area data pre- and post-CRT.Figure 1.K-M pre-CRT QRS area quartilesFigure 2.K-M QRS area score
Comparative safety outcomes of leadless versus transvenous cardiac pacemaker: a systematic review and meta-analysis
Authors: Ohn M H , Luen N P , Jouhra F , Ahmed F Z
Published: October 2024

Introduction

Leadless Cardiac Pacemakers (LCP) have emerged as a promising alternative to Transvenous Pacemakers (TVP) for managing bradyarrhythmias, especially in cases where TVP options are limited, such as venous access issues in haemodialysis patients or high infection risk individuals. However, long-term safety data, including mortality and hospitalisation rates, are lacking, hindering informed clinical adoption decisions.

Purpose

This systematic review and meta-analysis compares safety endpoints of LCP with TVP.

Methods

A systematic search of PubMed, Medline, Embase, Scopus, Web of Sciences, and gray literature was conducted following PRISMA guidelines from release of the Micra LCP to market until May 15, 2023. Meta-analysis was performed using RevMan 5.4.

Results

Twenty-four studies including data from 33,450 patients (12,802 LCP, 20,648 TVP) were evaluated. The mean age of the population was 77.5 ± 10.6 years, with a mean left ventricular ejection fraction (LVEF) of 58.6 % ± 6.7. Follow-up durations ranged from 6 to 36 months. Compared to TVP, the LCP was associated with significantly fewer overall complications, major complications, acute, mid-term complications, hospitalisations, re-interventions, and device dislodgements (p<0.05). Mortality, tricuspid regurgitation, pacemaker-induced cardiomyopathy, and heart failure hospitalisation rates did not significantly differ. Although LCP showed higher cardiac injury risk, no significant difference in cardiac tamponade rates was observed (Figure 2). LCP exhibited increased vascular-related complications but decreased lung injury, endocarditis, device, and pocket-related issues.

Conclusion

In the largest review of LCPs, we report that LCP is associated with significantly lower rates of overall complications compared to conventional TVP. This knowledge is critically important as more LCPs enter clinical practice and serves as a baseline against which future data can be evaluated. Nevertheless, proper skill training may help to mitigate the risk of vascular and cardiac injury. These findings underscore the importance of conducting randomized controlled trials to comprehensively evaluate the safety of LCP compared to TVP.Cardiac complication
Safety and efficacy of leadless pacemaker extraction using a novel retrieval tool: a multicenter analysis
Authors: La Fazia V , Carola Gianni C G , Brandon Doty B D , Kirollos Gabrah K G , Domenico Giovanni Della Rocca D G D R , Nicola Pierucci N P , Mohanty Sanghamitra M S , Preem Geeta Torlapati P G T , Mohamed Bassiouny M B , Amin Al-Ahmad A A A , Luigi Di Biase L D B , Rodney Horton R H , Weeduran Bode W B , Devi Nair D N , Andrea Natale A N
Published: October 2024

Background

Leadless pacemakers (LP) have emerged as a safe and effective alternative for cardiac pacing, increasingly adopted by the medical community. While rare, complications such as pacemaker syndrome or device dislodgment can occur. In such instances, the extraction of the leadless pacemaker and its replacement with a new device should be considered.

Purpose

This multicenter study aimed to describe the use of the Aveir retrieval sheath during Micra extraction procedure and to assess the success rates and potential complications associated with the procedure.

Methods

In this observational study, we analyzed prospectively collected data from 14 patients that underwent leadless pacemaker using Abbott retrieval catheter at three high volume centers for pacemaker extraction and leadless implant in United States.

Thought femoral vein the Aveir steerable retrieval catheter is advanced to the right atrium and then across the tricuspid valve. Under TEE and fluoroscopy guidance the snare is advanced over the Micra, and the button is secured. A protective sleeve is advanced over the LP. With application of traction to snare and countertraction with the sleeve against the endocardium, the LP is free from the myocardium and removed via the sheath. (Fig. 1)

The procedural duration should be intended as the combined total of the time taken for the extraction of the existing pacemaker and the implantation time of the new device.

Extractions performed during the first year were described as early and thereafter as late.

Procedural success was described as complete extraction of LP without procedural complication.

Results

The reason for early explant was LP dislodgment and for late explant was pacemaker syndrome. Median time to extraction was 4±2 months in early explant and 35±9 months in late explant. Procedural time in early and late groups was 68.7 and 72.3 min respectively (P=0.32). Fluoroscopy time in early and late groups was 12.2 and 16.4 respectively (P= 0.18). LP was then replaced with a transvenous pacemaker. Success was 100% in both groups. No complication occurred in both groups.

Conclusion

Micra pacemaker using Aveir retrieval catheter is an effective tool irrespective of dwell time.
The prothrombotic state in patients with type 2 diabetes mellitus and ischemic heart failure: an association with endothelial dysfunction
Authors: Nowak K , Siniarski A , Karcinska A , Yika A D C , Matrejek A , Stepien K , Nessler J , Gajos G , Zalewski J
Published: October 2024

Background

Heart failure (HF) is associated with a substantial prothrombotic state and an increased risk of thromboembolism, regardless of the presence of atrial fibrillation (AF). Although oral anticoagulation in HF with known AF is recommended, there is no conclusive evidence supporting clinical benefits of chronic anticoagulation in HF subjects without AF. Other factors enhancing prothrombotic state, often concomitant with HF, are type 2 diabetes mellitus (T2D) and coronary artery disease (CAD). T2D as well as CAD are independently associated with a hypercoaguability due to multiple mechanisms including endothelial dysfunction and oxidative stress. Dysfunction of endothelium was observed in patients with HF, however a little is known about its influence on prothrombotic state in a very high risk HF population.

Purpose

This study aimed to investigate whether the prothrombotic state in patients with T2D, CAD, and HF, depends on the left ventricular ejection fraction (LVEF) or endothelial function.

Methods

We assessed 54 patients with stable chronic HF, CAD, and T2D. Based on the echocardiography examination 28 of them were those with HF with reduced ejection fraction (HFrEF) and 26 of them were classified as HF with preserved ejection fraction (HFpEF) according to current guidelines. Fibrin clot density reflected by clot permeability (Ks) and thrombin generation were evaluated. Endothelial function was determined in flow-mediated (FMD) and nitroglycerin-mediated dilatation (NMD) tests of the brachial artery.

Results

Subjects in both groups were comparable in terms of cardiovascular risk factors except for lower glomerular filtration rate (GFR) by 18.1%. HFrEF patients had lower Ks by 20.3%, along with higher endogenous thrombin potential (ETP) by 18.9% and maximum thrombin level (Peak) by 24.1% as compared with HFpEF. While there were no differences in FMD and NMD between subjects, we found negative correlations of NMD with ETP and Peak (r=-0.448, P=0.001; r=-0.304, P=0.034, respectively). Moreover, the proportion of NMD and FMD along with GFR and LVEF were also significantly associated with both thrombogram parameters (<0.01 for all). By the multivariate analysis of the whole population, NMD, LVEF, low-density lipoprotein and GFR were independent predictors of ETP (R2=0.530, P<0.001) while NMD, LVEF, and GFR predicted Peak levels (R2=0.327, P=0.002).

Conclusion

We showed for the first time that patients with ischemic etiology of HFrEF and T2D presented altered fibrin clot properties and enhanced thrombin generation compared to HFpEF subjects. It might be hypothesized that endothelial dysfunction induced by T2D could intensify hypercoagulability in patients with HF.Figurę 1
The impact of left venticular filling pressure indexed to cardiac output on exercise capacity in heart failure subjects
Authors: Huang W M , Sung S H
Published: October 2024

Background/Introduction

Exercise intolerance is the most common symptom of patients with heart failure (HF), regardless of the phenotypes. We aim to investigate the determinants of exercise capacity in chronic stable HF with reduced, mildly reduced, preserved, and recovered ejection fraction (EF).

Methods

Ambulatory HF subjects were recruited for a combined cardiopulmonary exercise test and exercise stress echocardiography. Peak oxygen consumption (peak VO2) and minute ventilation-carbon dioxide production relationship (VE/VCO2 slope) were obtained. Impaired exercise capacity was referred to a peak VO2 of <14 ml/kg/min, and a VE/VCO2 slope of >34 was defined as ventilatory inefficiency.

Results

Among a total of 66 participants, there were 16 HF with reduced EF, 18 HF with mildly reduced EF, 12 HF preserved EF, and 20 HF recovered EF. While both LVEF, global longitudinal strain (GLS), E/e’ ratio and diastolic dysfunction indices were crudely associated with peak VO2 and VE/VCO2 slope, only diastolic dysfunction indices were independently predictive of impaired exercise capacity (odds ratio and 95% confidence intervals: 3.847, 1.369-10.810). GLS at rest was independently correlated with ventilatory inefficiency (1.404, 1.050-1.877). Among the exercise indices, the peak medial E/e' to cardiac output ratio was independently associated with impaired exercise capacity (3.478, 1.313-9.214) and peak GLS was best related to ventilatory inefficiency (1.403, 1.076-1.828).

Conclusions

Among resting and exertional echocardiographic variables, the peak medial E/e' to cardiac output ratio, a non-invasive assessment of exertional left ventricular filling pressure indexed to cardiac output, was the major determinant of exercise capacity in patients with different HF phenotypes.
A novel risk score incorporating frailty or congestion status predicted mortality in patients with heart failure with preserved ejection fraction.
Authors: Iwakura K , Tanaka N , Okada M , Okamura A , Watanabe H , Seo M , Hayashi T , Yano M , Yamada T , Yasumura Y , Hikoso S , Okada K , Nakatani D , Sotomi Y , Sakata Y
Published: October 2024

Introduction

In patients with heart failure (HF), frailty or congestion is strongly associated with clinical outcomes. However, existing risk prediction models for HF prognosis do not incorporate these important clinical factors. The estimated plasma volume status (ePVS) is an easy-to-calculate index to estimate plasma volume. which is associated with the prognosis in HF patients.

Purpose

This study intends to construct an inclusive risk prediction model for all-cause mortality in patients with HF with preserved ejection fraction (HFpEF), incorporating evaluations of frailty and congestion alongside traditional risk factors.

Methods

We analyzed data from 1212 patients (81±9 years, 55% female) registered in the PURSUIT-HFpEF (Prospective, Multicenter, Observational Study of Patients with Heart Failure with Preserved Ejection Fraction) study, a multicenter registry of patients hospitalized for acute decompensated HFpEF. We evaluated clinical factors including Clinical Frailty Scale (CFS) and blood test results collected before discharge. We calculated ePVS at discharge using the Duarte formula as ePVS (mL/g)=100×(1-hematocrit)/hemoglobin (g/dL). Patients were followed for median of 713 days (IQR 369-1088 days) to observe all-cause death.

Patients were randomly assigned to the derivation and validation cohorts (2:1 ratio). Using the Bayesian Information Criterion (BIC), a stepwise model selection was executed on 51 clinical parameters, including CFS and ePVS, to identify independent predictors of mortality. A risk model for mortality was constructed based on these predictors and their coefficients. The accuracy of the risk score was validated using time-dependent ROC curves both in the derivation cohort (n=801) and in the validation cohort (n=411).

Results

During the follow-up period, all-cause death was observed in 315 patients (25.9%). Age, sex, CFS, NT-proBNP and ePVS were selected as independent predictors of all-cause death. The score shown in the Table was applied to each factor, and the sum of the scores was calculated as the risk score. The AUC of the risk score for predicting 1-year mortality in the derivation cohort was 0.79 (95% CI 0.74, 0.85). The optimal cut-off value of 6 provided a sensitivity and specificity of 74.9% and 74.4%, respectively. The AUC for 1-year mortality in the validation cohort was 0.70 (95% CI 0.63, 0.77).

Conclusions

The novel risk prediction model incorporating CFS and ePVS effectively predicted mortality in HFpEF. This model could be a valuable tool for risk stratification.Table
Effect and mechanism of Adipokine Omentin-1 on cardiac hypertrophy in heart failure with preserved ejection fraction
Authors: Li Q X , Liu Z Q , Ma X T , G F , Wang Z J
Published: October 2024

Background

Omentin-1 secreted by epicardial adipose tissue can inhibit ventricular remodeling and improve early cardiac function after myocardial infarction. Our previous studies have identified the omentin-1 receptor as integrin receptors αvβ3 and αvβ5. However, the effect of omentin-1 on heart failure with preserved ejection fraction (HFpEF) remains poorly understood.

Purpose

The present study aims to study the role and mechanism of omentin-1 in cardiac function and myocardial cell structure in HFpEF.

Methods and Results

The influences of omentin-1 were investigated in HFpEF mice (HFD (60% calories from lard) and L-NAME (0.5 g/L in drinking water)), which were treated in vivo. Echocardiography showed better diastolic function in HFpEF mice treated with omentin-1 (5 ug/kg/h) subcutaneously for 4 weeks, and tissue staining showed alleviated myocardial fibrosis and myocardial hypertrophy. The RNA sequencing analysis revealed variations in the gene expression related to ketone body metabolism in HFpEF mice after omentin-1 treatment (600 ng/ml). The supernatant was obtained from mouse bone marrow macrophages treated with ultrapure endotoxin and ATP and was utilized as the macrophage-conditioned medium for culturing primary cardiomyocytes, which were stimulated with isoproterenol for 48 hours to construct the HFpEF cardiomyocyte model. In the heart tissue of HFpEF mice and HFpEF cardiomyocytes treated with omentin-1, there was a notable increase in the expression of a pivotal enzyme of ketone body metabolism- succinyl-CoA transferase (SCOT), and a decrease in the expression of hypertrophy signal. The myocardial hypertrophy model was established by stimulating the myocardial cell line H9C2 with isoproterenol. Following the inhibition of the integrin receptor and PI3K-AKT pathway, the impacts of omentin-1 on SCOT and myocardial hypertrophy signal expression in hypertrophic cardiomyocytes were eliminated.

Conclusion

This study provides evidence for the effects of omentin-1 on cardiac function and myocardial structure in HFpEF and proposes that omentin-1 may stimulate the downstream PI3K/AKT pathway via integrin receptors on cardiomyocytes, leading to increased expression of SCOT and improvement of cardiomyocyte hypertrophy.
Biomarkers for monitoring patients with cardiac amyloidosis during transthyretin-stabilizer therapy
Authors: Vogel J , Jura S , Buehing F , Wernhart S , Carpinteiro A , Rassaf T , Michel L
Published: October 2024

Introduction

Cardiac amyloidosis is characterized by deposition of amyloid fibrils in the heart, leading to structural abnormalities and functional impairments resulting in heart failure. Amyloid transthyretin amyloidosis cardiomyopathy (ATTR-CM) is the most common form with increasing incidence due to growing awareness and improved diagnosis. The ATTR stabilizer tafamidis serves as the first specific therapy approved for ATTR-CM, and many promising substances are in late-stage clinical trials. With growing numbers of patients receiving stabilizer therapy, valid tools for monitoring treatment response and detecting disease progression are currently lacking. Here, we aim to assess systemic and cardiac biomarkers in patients receiving stabilizer therapy.

Method

All individuals diagnosed with ATTR-CM at our university hospital, were systematically assessed for eligibility in this study. We enrolled patients who were undergoing therapy with tafamidis. Biomarkers including Hemoglobin (Hb), Creatinine, estimated glomerular filtration rate (eGFR), International Normalized Ratio (INR), C-reactive protein (CRP), Troponin and NT-proBNP were examined at baseline and during 6 and 12 months follow-up. Wilcoxon signed rank test was used for statistical analysis. The study was approved by the local ethics committee (23-11500-BO).

Results

194 patients were included in the analysis with median age of 80 (76-83) years (86,6% male). Results showed an impaired renal function at baseline (all mean ± SD) with creatinine 1.24 ± 0.46 mg/dl and eGFR 58.64 ± 18.24 ml/min/kg with statistically significant increase after 6 months in creatinine (1.31 ± 0.51 mg/dl, p<0.001) and eGFR (55.06 ± 17.65 ml/min/kg, p<0.001) and after 12 months (creatinine 1.35 ± 0.54 mg/dl, p<0.001, eGFR 53.27 ± 17.68 ml/min/kg, p<0.001). Hb showed a significant increase after 6 (13.61 ± 1.78 g/dl, p<0.001) and 12 months (13.6 ± 1.79 g/dl, p<0.001), compared to baseline (13.41 ± 1.71 g/dl, p<0.001). Comparison of baseline values for CRP (0.08 ± 1.18 mg/dl), Troponin (86.33 ± 190.6 ng/l), NT-pro BNP (4703 ± 4385 pg/ml) and INR (1.25 ± 0.46) after 6 (CRP p=0.28, Troponin p=0.7, NT-pro BNP p=0.97, INR p=0.91) and 12 months (CRP p=0.12, Troponin p=0.59, NT-pro BNP p=0.78, INR p=0.28) showed no significant changes.

Conclusion

Although troponin and BNP are routinely used and recommended as biomarker for monitoring patients with ATTR-CM, the diagnostic value may be insufficient to assess therapy response. Results emphasize the need to identify new biomarkers to adequately reflect the specific aspects of ATTR-CM disease progression. This study reveals significant alterations in creatinine and eGFR due to a worsening of kidney function, but an increase of Hb, suggesting a potential indicator for treatment response. Future research should explore innovative approaches like proteomic analysis as promising approach for both diagnostic and prognostic biomarkers.
Patient journey from the appearance of red flags to the diagnosis of transthyretin cardiac amyloidosis (ATTR-CM) in Japan: a nationwide retrospective study using a medical claims database
Authors: Minamisawa M , Konishi H , Kitano Y , Abe H , Togo K , Izumiya Y
Published: October 2024

Introduction

Transthyretin amyloid cardiomyopathy (ATTR-CM) is an under-recognized cause of common cardiovascular conditions in the elderly, with relatively high rates among patients diagnosed with heart failure (HF) with preserved ejection fraction. In addition to cardiac symptoms such as HF, extracardiac symptoms such as carpal tunnel syndrome (CTS) and lumbar spinal stenosis (LSS) are also red flags for ATTR-CM. Tafamidis is currently the only disease-modifying therapy approved for the treatment of patients with ATTR-CM and is likely to be more effective in the earlier stage. Patients with ATTR-CM often undergo a long and difficult diagnostic journey because of the nonspecificity of clinical manifestations, resulting in delays in establishing the correct diagnosis.

Purpose

To identify the timing of appearance of comorbidities in patients with ATTR-CM during diagnosis.

Methods

In this retrospective, non-interventional, observational study using a claims database (dataset period: April 1, 2014–August 31, 2021), adult patients with a diagnosis of ATTR-CM or prescription for tafamidis 80 mg were included. The index date was defined as the first date of recording ATTR-CM diagnosis or the prescription of tafamidis 80 mg, whichever was earlier. The baseline period was defined as the period between the index date and 6 months before the index date. The onset date was defined as the first date of recording diagnosis of the first red-flags that was suspicious for ATTR-CM.

Results

Of 11,101,578 patients in the database, 246 patients with ATTR-CM met the inclusion criteria. A total of 239 patients were included, of whom 139 had received tafamidis 80 mg. The median (range) age at the index date was 79.0 (46.0–95.0) years, and 79.9% (191/239) were male. The most frequently reported comorbidity defined as onset of ATTR-CM was conduction disorders (88.7%) followed by atrial fibrillation/atrial flutter (50.6%), hypertensive heart disease (19.7%), aortic stenosis (15.9%), and hypertrophic cardiomyopathy (11.7%), with the median (interquartile range [IQR]) time to the index date being 15.5 (5.0–24.5), 14.0 (5.0–22.0), 9.0 (2.0–18.0), 5.0 (2.0–16.0), and 12.0 (6.5–21.5) months, respectively (Fig. 1). LSS (23.9%), neuropathy (13.0%), and CTS (7.5%) were frequently observed as extracardiac symptoms at baseline, and the median (IQR) time from appearance to the index date was 19 (9.0–28.0), 5.0 (1.0–16.0), and 18.0 (14.0–25.0) months, respectively (Fig. 2).

Conclusions

This study elucidated the time lag between the appearance of cardiac and extracardiac complications of ATTR-CM and its diagnosis in real-world clinical settings. These novel findings highlight the potential for earlier detection of ATTR-CM.
Incident HFpEF and time-dependent changes in markers of LVDD severity in women and men with pre-clinical LVDD
Authors: Van Ommen A M L , Dal Canto E , Diez-Benavente E , Cramer M J , Teske A J , Verhaar M , Taha K , Handoko M L , Duncker D J , Verhaar M , Rutten F H , Onland-Moret N C , Den Ruijter H M
Published: October 2024

Background

Over time, left ventricular diastolic dysfunction (LVDD) can progress towards heart failure with preserved ejection fraction (HFpEF). Yet, the identification of those at high risk of progression is challenging, and guidance on follow-up or preventive treatment is lacking.

Purpose

To study the incidence of HFpEF and changes over time in markers of LVDD severity in women and men with pre-clinical LVDD. In addition, we evaluate whether blood pressure and kidney function affect progression of LVDD.

Methods

We reinvited 146 participants from the HELPFul study (58% women and 42% men) with pre-clinical LVDD after a median follow-up of 4.3 [IQR: 3.9-4.7] years (Figure 1). The follow-up measurements were similar to baseline and encompassed a structured interview, physical examination, blood draw, electrocardiogram and (exercise) echocardiography. We determined HFpEF incidence and report changes over time in cardiovascular risk factors as well as echocardiographic characteristics and biomarkers of LVDD. Additionally, we studied whether changes in blood pressure and kidney function affected LVDD progression using generalized mixed models. LVDD progression was defined as an increase in plasma NT-proBNP levels and HFA-PEFF major functional and morphological abnormalities. All analyses were performed for women and men combined as well as stratified by sex.

Results

Fifteen (10%) of the 146 participants developed HF of whom 13 had HFpEF (9 women and 4 men) during follow-up. Over time, systolic and diastolic blood pressure levels remained stable while mean kidney function (eGFR) declined from 89±14 to 81±17 mL/min/1.73m2. Median NT-proBNP plasma levels increased from 71 [IQR: 44, 120] to 100 [IQR: 51, 157] pg/mL. The prevalence of major functional abnormalities according to the HFA-PEFF score increased from 84 to 91%, while the prevalence of morphological abnormalities increased from 25% to 39% (Figure 2). A higher systolic blood pressure in women and a higher diastolic blood pressure in men was associated with an increase in NT-proBNP plasma levels over time. Additionally, lower eGFR levels were related to increased NT-proBNP plasma levels over time in both men and women. There was a significant rise in the prevalence of major functional and morphological abnormalities with time, but blood pressure and kidney function did not affect this change over time.

Conclusions

A small proportion of women and men with preclinical LVDD developed incident HF over a 5-year follow-up period. High blood pressure and reduced kidney function were associated with increased levels of NT-proBNP over time. This highlights the need to further explore cardiorenal protection as a method to prevent HFpEF.Study design and HF outcomesLongitudinal changes in LVDD markers