bluuebunny/crossref_metadata_2025 huggingface dataset:
Incremental value of continuous non-invasive blood pressure control to assess hypotension during atrial fibrillation ablation
Authors: Di Cori A , Fiorentini F , Parollo M , Mazzocchetti L , Barletta V , Segreti L , Viani S , De Lucia R , Canu A , Grifoni G , Sbragi S , Soldati E , Zucchelli G
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Atrial Fibrillation (AF) ablation is associated with continuous blood pressure (BP) variations related to anesthesiological regimen and energy delivery. Conventional BP monitoring with non-invasive periodic brachial BP controls can miss potential hypotensive events. Continuous non-invasive blood pressure (CNBP) measurement using the volume-clamp method (Clearsight) was demonstrated to be a reliable and effective tool for the assessment of BP during AF ablation.

Purpose

Aim of the study was to investigate the incidence of hypotensive events during AF ablation.

Methods

We included consecutive patients scheduled for AF ablation and monitored in parallel with a periodic (10 minutes) brachial BP cuff and in continuous with the CNBP System (Clearsight). All CNBP data were analyzed with the Acumen Analytics software for hypotension evaluation. According to the anesthesiological regimen, patients were divided in 2 Groups, the General Anesthesia (GA) and the Deep Sedation (DS) group. Area under the threshold (AUT, mmHg x min) of 65 mmHg and Time Weighted Average (TWA, mmHg, i.e., the AUT divided by the total duration of procedure in minutes) of area under threshold (MAP <65 mmHg) were compared between the two groups.

Results

Forty-eight patients were included, 10 (21%) in the General Anesthesia Group and 38 (79%) in the Sedation Group. Hypotension was detected in 18 patients, 9/10 (90%) were recorded in the GA group and 9/38 (23.7%) in the DS one. A total of 85 hypotensive events were recorded, 68 (80%) in the GA and 17 (20%) in the DS Group. In the overall population, mean duration of hypotensive events was 4.87 minutes (range 0 – 14.73 minutes), mean MAP < 65 mmHg was 54.25 ± 7.2 mmHg, mean AUT (MAP <65 mmHg) was 79.4 mmHg x min (range 0 – 1237.7) and mean TWA was 0.41 mmHg (range 0 – 6.9). Hypotensions were more often documented in GA than in DS patients (mean difference 6.35 events/procedure, C.I. 2.66 – 10.10, p<0.05) so as AUTs (mean difference 319.90 mmHg x min, C.I. 30.00 – 609.80, p=0.034) and TWAs (mean difference 1.64 mmHg, C.I. 0.18 – 3.09, p=0.032) which were significantly higher in the GA group. Brachial periodic BP measurement every 10 minutes missed the majority (n=52, 61.2%) of hypotensive events.

Conclusions

CNBP demonstrated a high incidence of hypotension during AF ablation, specially under GA, which are usually missed by the standard intermittent brachial non-invasive BP monitoring. Real time hypotension predictive CNBP indexes could be valuable in this setting.
Very high-power short-duration pulmonary vein isolation combined with anterior chest position of dispersive electrodes
Authors: Futyma P , Burda N , Kowal S , Futyma M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Pulmonary vein isolation (PVI) is a cornerstone management of atrial fibrillation (AF). Very high-power short-duration (vHPSD) radiofrequency catheter ablation (RFCA) can accelerate PVI procedure. Recently, special attention has been paid to the position of dispersive electrodes (DE) for optimization of RFCA application. However, these two methods have not yet been combined in the setting of PVI.

Purpose

To determine feasibility, safety, efficacy, and overall performance of vHPSD PVI with anterior chest position of DE.

Methods

Consecutive patients undergoing vHPSD PVI using flexible-tip catheter and anterior position of DE were included in the study. vHPSD protocol consisted of 70W RFCA applications lasting 4s. If needed, RFCA applications were extended using 50W until R-positive unipolar signal modification and/or until impedance drop ≥10% from baseline was achieved or were terminated in case of steam-pop occurrence. Demographical, clinical, procedural and follow-up data were collected.

Results

A total number of 43 patients (25 males, age 61±14years) were included in the study. 34 patients had paroxysmal AF (parox-AF group) and 9 patients had persistent AF (pers-AF group). Mean procedure time was 61±7min, mean RFCA time was 685±204s. All PVs were successfully isolated. Audible steam pops without sequele occurred in 6 (14%) cases. Major complications included one TIA without sequele. During follow-up 33 (77%) patients remained AF-free: 26 (76%) in parox-AF group vs 7 (78%) in pers-AF group (log rank p=0.0166). No atrioesophageal fistula or evidence of esophageal injury occurred.

Conclusions

Anterior chest position of DE combined with vHPSD approach for PVI is feasible, appears safe and effective. More data on possible protective properties against atrioesophageal fistula occurrence using the presented approach is warranted.
Postural orthostatic tachycardia syndrome associated with post-acute covid-19 syndrome is not mediated through smaller hearts or contractile dysfunction
Authors: Ahmad A , Mahdi A , Fedorowski A , Nygren-Bonnier M , Bruchfeldt J , Runold M , Desta L , Pernow J , Stahlberg M , Nickander J
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Swedish Heart-Lung foundation

Swedish Research Council

Introduction

Post-acute covid-19 syndrome (PACS) is a novel condition with persistent symptoms affecting different organs. We have previously reported postural orthostatic tachycardia syndrome (POTS) as one important long-term complication. The pathophysiological mechanisms behind PACS and associated POTS are largely unknown. It has previously been suggested that POTS patients have a smaller left ventricular mass (LVM) and volume contributing to the persistent symptoms of tachycardia, however it is currently unknown if these pathophysiological mechanisms are similar in PACS associated POTS. Furthermore, it has been shown that global longitudinal strain (GLS) and global circumferential strain (GCS) are more sensitive measures of contractile function compared to ejection fraction, however it is also currently unknown if GLS and GCS differs between PACS patients with and without POTS.

Purpose

To elucidate if patients with PACS associated POTS have a lower LVM compared to PACS without POTS, and if GLS and GCS differ between the groups.

Methods

In total, 31 patients that had suffered a mild SARS-CoV-2 infection diagnosed with PACS according to the WHO criteria were enrolled in this prospective cohort study. POTS was verified by head-up tilt test; 16 patients (age 40±10 years, 94% women) were POTS positive whereas 15 (45±11 years, 93% women) were POTS negative. All patients underwent cardiac magnetic resonance imaging, and global longitudinal strain (GLS) and global circumferential strain (GCS) were calculated.

Results

There were no differences between the groups with regards to left ventricular dimensions or mass, Table 1. There were no differences in GLS and GCS between the two groups (GLS: PACS and POTS positive -18±2% vs PACS and POTS negative -19±2%, p=0.53; GCS: PACS and POTS positive -17±3% vs PACS and POTS negative -19±3%, p=0.16), Figure 1.

Conclusions

PACS-related POTS is not associated with contractile dysfunction nor differences in cardiac geometrics, providing mechanistic insights in the pathophysiology of PACS associated POTS. Other specific pathophysiological mechanisms that underlie POTS associated with PACS needs to be established.
Dipole charge density mapping demonstrates superiority in catheter ablation of post-surgical atrial tachycardias
Authors: Gagyi R , Ramdat Misier N L , Yap S C , Wijchers S , Hoogendijk M , Bhagwandien R , Hussain A , Kharbanda R , Szili-Torok T
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial tachycardia (AT) frequently occurs after cardiac surgery or surgical ablation procedures. The novel dipole charge density-based mapping system (AcQMap) provides global chamber mapping and can detect multiple slow conduction zones and re-entry isthmuses; therefore, it has a potential added value in post-surgical AT ablation. We aimed to test the hypothesis that AcQMap guided catheter ablation (CA) procedures are safe, feasible, and may provide improved outcome compared to conventional sequential 3D mapping (CARTO) based CA.

Methods

Consecutive patients undergoing CA for post-surgical ATs guided by the AcQMap or the CARTO system were enrolled. Procedural safety characterized by procedural complications, and efficiency characterized by procedure duration, fluoroscopy use, radiofrequency (RF) application and duration, were analyzed. Acute success, one-year outcome as freedom from AT and atrial fibrillation were assessed.

Results

A total of 40 patients (mean age 58.2±13.0 years, 42.5% female), underwent CA of AT using the AcQMap (n=20) and CARTO mapping system (n=20). No differences were found in procedural complication (AcQMap 3 vs. CARTO 2 patients, p=0.63). There were no differences in procedure duration (188.1 vs. 153.8 minutes, p=0.08), fluoroscopy dose (165.0 IQR 121.0-254.0 vs. 107.0 IQR 28.8-284.0 mGy, p=0.16), RF application number (30.0 IQR 18.8-63.5 vs. 25.5 IQR 10.5-44.3, p=0.20) or duration (1397.0 IQR 690.5-1869.8 vs. 1238.0 IQR 499.0-2074.8 s, p=0.47). Acute success was 95.0% in AcQMap group and 80.0% in CARTO group (p=0.15). A total number of 70 ATs were mapped in 40 patients (35 in the AcQMap group and 35 in the CARTO group, average 1.6 ± 0.7). Four patients had focal ATs, 26 patients had macro re-entrant ATs, and 9 patients had ATs with both mechanisms. In one patient AT was not mappable with the CARTO system, empiric ablation was performed. There were no differences in AT mechanism between the patient groups (p=0.53). Cumulative AT recurrence rates were lower in AcQMap group compared to CARTO group (18.8% vs. 52.6%, p=0.01). Freedom from all arrhythmias was 75.0% in the AcQMap and 36.8% in the CARTO group (p < 0.01).

Conclusions

The AcQMap system is safe and feasible. Our data suggest that patients treated with AcQMap-guided CA developed fewer AT recurrences as compared to CARTO-guided procedures.
Tick Tock timing of permanent pacemaker implantation after transcatheter aortic valve replacement. A single center review
Authors: Rexha E , Schlichting A , Chung D , Tigges E P , Ubben T , Hassan K , Nejahsie Y , Gessler N , Willems S , Kaiser L , Hakmi S
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Permanent pacemaker implantation (PPI) for high degree atrio-ventricular block (AVB) is common in patients after transcatheter aortic valve replacement (TAVR). There is still no clear recommendation regarding the optimal timing of PPI and programming of the pacemakers (PM) in these patients.

Methods

Data of all 1363 patients who underwent TAVR in our center between July 2019 and September 2022 was included in this retrospective study. In patients with high degree AVB a PPI was performed either in the same procedure or at least within 24 h after TAVR. All patients underwent a PM-interrogation before discharge.

Results

A permanent PM was implanted in 122 of 1363 (9%) patients with a mean age of 82 years. AVB that required PPI occurred in 9.2% (100/1087) of the patients with a self-expandable (SE) valve and in 8% (22/276) of the patients with a balloon expandable (BE) valve. In 34 patients PPI was performed in the same TAVR procedure, and 88 patients were treated in an average of 3.5 days after TAVR. Right-sided PM was implanted in 27 out of the 34 (79.4%) intra-procedural cases and in 3 of the 88 (3.4%) post-procedural cases.

No major complications were reported. Two revision procedures were performed due to lead dislodgements in both groups respectively [(2/34 (5.9%); 2/88 (2.3%)]. Two pneumothoraces (2/88, 2.3%) were reported in the post-procedural PPI patients. The overall complication rate was 4.9 % (6/122).

The AV-conduction showed recovery in 37 Patients (37/122, 30%) during the first interrogation in an average of 2.1 days after TAVR [(9/34(26.5%); 28/88 (31.8%)]. The AV-hysteresis was programmed in 48 out of the 94 implanted dual chamber pacemakers during the first interrogation. The average length of stay in hospital in patients with intra-procedural PPI and in those who underwent PPI in a second procedure was 13.7 and 14 days respectively with no significant difference between both groups (p>0.05).

Conclusion

Intra-procedural PPI was not associated with significant reduction of in hospital stay. The percentage of AV-conduction recovery after TAVR was high, even in short term follow up. Patients could benefit from a longer monitoring to avoid PPI and programming of AV-hysteresis during the first interrogation in these population should be recommended. Randomized and long-term follow up data are needed.
A novel workflow for advanced mapping of repolarization dispersion from endocardial unipolar electrograms in patients with coved-type brugada syndrome
Authors: Latrofa S , Garibaldi S , Hartwig S , Panchetti L , Morelli M S , Martini N , Zaurino N , Mansi G , Mirizzi G , Startari U , Passino C , Emdin M , Piacenti M , Giannoni A , Rossi A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Accentuation of the action potential notch in the epicardium causes the prolongation of the epicardial action potentials in the right ventricular outflow tract (RVOT) and is the basis for arrhythmogenesis in patients affected by Brugada syndrome (BrS). Activation-recovery interval (ARI) approximates the action potential duration and may be used to study repolarization dispersion in BrS.

Purpose

Our aim was to investigate repolarization dispersion within the RVOT in spontaneous coved-type ECG BrS patients and in controls, evaluating also the relation between repolarization dispersion and conduction abnormalities to better define the electro-anatomical substrate of the disease.

Methods

BrS probands (n=13) and control subjects (n=4) underwent endocardial mapping of RV with the CARTO 3 system. BrS patients were also studied with programmed ventricular stimulation (PVS). Data was exported from the CARTO system and converted into MatLab format using OpenEP. A specific region of interest (ROI) including the sub-pulmonary RVOT and entire RV free wall was then selected using Paraview. With an automated algorithm, we measured ARI and ARIc (corrected using the "Bazett formula") for each point of the ROI, which were then interpolated to obtain ARI maps. We also acquired right ventricular activation time (RVAT) and maps for the assessment of slow conduction zones. By dividing RVAT color scale in 5 ms steps (isoSteps), isochronal activation areas were identified in the ROI.

Results

Out of the 13 BrS subjects, 4 had VT or VF inducible during PVS (PVS+) while 9 did not (PVS-). One patient had appropriate ICD shocks during follow-up. BrS patients had higher mean ARI and ARIc compared to controls (288.5±22.2 vs 251.5±8.4 ms, p<0.001; 312.0±30.4 vs 281.8±10.3 ms, p=0.023). ARI was found to be higher in PVS+ than in PVS- patients (294.8±27.1 vs 285.8±20.1 ms, p=0.5), as well as ARIc (327.7±49.9 vs 304.6±16.4 ms, p=0.49) although these differences were not significant. BrS patients showed a longer RVAT (106.0±21.4 vs 74.5±5.5 ms, p=0.003), and increased zones of crowding, as expressed by isochronal steps (13.85±2.94 vs 9.25±1.26, p=0.01). Notably, a strong correlation was found between ARIc and RVAT (Pearson R coefficient = 0.83, p<0.05), independently from the results of PVS (PVS+ R=0.99, p=0.01; PVS- R=0.83, p=0.06).

Conclusions

We introduced a novel workflow for the electrical substrate characterisation of subjects with BrS phenotype. Our preliminary data show the presence of repolarization dispersion along with conduction slowing in the RVOT of BrS patients compared to controls. In our population, repolarization dispersion and impairment of RVOT conduction were strongly related especially in inducible BrS patients.
Midterm results of bipolar ablation in patients with intramural substrate and recurrent VTs based on a single center experience
Authors: Ene E , Nentwich K , Deaconu A , Berkovitz A , Halbfass P H , Sonne K , Deneke T
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Catheter ablation of VTs and intramyocardial substrate (IS) remains a challenge that may require alternative mapping and ablation strategies such as bipolar ablation (BA) to achieve VT non inducibility. However, the long-term success of these alternative strategies is still uncertain.

Purpose

The aim of this study was to report the midterm center experience success of BA RF ablation of VT in patients with documented intramyocardial scar in cardiac imaging.

Methods

19 patients with documented intramyocardial substrate on cardiac imaging (cardiac MRI or cardio CT with delayed enhancement) and VT recurrences after at least one conventional catheter ablation were retrospectively included. The intraprocedural success (i.e. VT non inducibility at the end of procedure) respectively midterm success (i.e VT recurrence after 6 months from BA) were investigated. The ablation was performed using a special RF generator which permits bipolar RF ablation between 2 irrigated catheters.

Results

A total number of 19 patients were included (100 % men, mean age 66,7 ± 9,16 y/o). The mean LVEF was 39,5 ± 5,7. The distribution of underlying structural heart disease was as follow: 21 % ischemic cardiomyopathy (4 out of 19 patients), 52 % dilative cardiomyopathy (10 out of 19 patients) respectively 26 % other etiologies (5 out of 19 patients). A mean number of 2 ± 1 conventional VT ablation were previously performed. In almost all patients (94 %, 18 out of 19 patients) the clinical VT was induced before the BA (mean CL 342 ± 91ms). The BA was performed predominantly septal (84%, 16 out of 19 patients). In 3 patients an endo/epicardial BA was performed. No VT was inducible any more at the end of procedure in 15 patients (79 %). At a mean follow up of 1 ± 0,5 years no recurrence of clinical VT was noted but non-clinical VT recurrence was seen in 9 patients (47 %) exclusively in patients with septal substrate.

Conclusion

BA represents a good alternative strategy for CA in patients with IS and failed conventional VT ablation with good acute success but high VT recurrence rate in patients with septal IS.
Feasibility of novel atrial mechanical sensing method for leadless atrioventricular synchronous pacing
Authors: Kazawa S , Murakami H , Sakaida T , Okano T , Takada Y , Yazaki Y , Tanaka N , Satomi K
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

A novel leadless pacemaker enables atrioventricular synchronous pacing. However, there have been still difficulties to obtain high atrioventricular (AV) synchrony due to a mechanical sensing algorithm. We’ve reported a new sensing method for acquiring high AV synchrony regardless of heart rate. Our hypothesis is that this novel sensing method might facilitate better AV synchrony.

Purpose

The purpose of this study is to investigate the feasibility of our novel sensing method for the patients that ventricular activity completely depends on the ventricular pacing.

Methods

This study is a retrospective study conducted by 2 centers. From the 1st December, 2021 to the 31th October, 2022, leadless pacemakers with atrioventricular synchronous pacing were implanted to 32 patients in 2 centers. Among the 20 patients with sinus rhythm and complete AV block were analyzed. Two groups were compared in this study. Novel sensing setting was programmed during the hospitalization in Group 1, composed by 9 patients. Auto A3 threshold and auto A3 window end are turned off. An intentionally prolonged A3 window end and a low A3 threshold are programmed in a novel sensing method. Conventional setting (auto A3 threshold, auto A3 window end and auto A4 threshold were turned on) was programmed during the hospitalization in Group 2, composed by 11 patients. Device check was performed at the first outpatient clinic within 3 months after the implantation.

Results

Overall, 20 patients were analyzed. Baseline characters are described in Table 1. BMI (23.5±0.9 vs 20.4±0.8, p<0.05), BNP at the hospitalization (130.7±143.6 pg/ml vs 686.9±129.9 pg/ml, p<0.05) were different between 2 groups. Mean age, sex, past history of atrial fibrillation, hypertension, diabetes mellitus, dyslipidemia, past history of coronary artery disease, eGFR, previous cardiac surgery, left ventricular ejection fraction, E/A, left atrial diameter were no significant differences between 2 groups. Table 2 shows the comparison of the device parameters between 2 groups. In Group 1, AV synchrony (%AMVp) was significantly higher at the first outpatient clinic (81.0 ± 4.2 % vs 63.0 ± 5.7 %, p=0.03). A3 window end was significantly longer in Group 1 (883.3 ± 34.0 ms vs 757.0 ± 45.5 ms, p<0.05). A3 threshold was significantly lower in Group 1 (2.3 ± 0.5 m/s² vs 5.9 ± 0.7 m/s², p<0.05). There were no significant differences about A4 amplitude (1.8 ± 0.4 m/s² vs 1.0 ± 0.6 m/s², p=0.34) and A4 threshold (2.3 ± 0.3 m/s² vs 1.5 ± 0.4 m/s², p=0.12).

Conclusion

Novel sensing method might be a feasible sensing method to obtain higher AV synchrony than conventional algorithm. Further prospective studies will be required.
Axillary vein puncture versus cephalic vein cutdown for cardiac implantable electronic device implantation: a meta-analysis
Authors: Vetta G , Magnocavallo M , Parlavecchio A , Caminiti R , Polselli M , Sorgente A , Crea P , Pannone L , Lo Savio A , Pistelli L , Chierchia G B , Rossi P , Natale A , De Asmundis C , Della Rocca D G
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cephalic vein cutdown (CVC) and axillary vein puncture (AVP) are both recommended for transvenous implantation of leads for cardiac implantable electronic devices (CIEDs). Nonetheless, it is still debated which of the two techniques has a better safety and efficacy profile.

Methods

We systematically searched Medline, Embase and Cochrane electronic databases up to September 5th, 2022, for studies that evaluated the efficacy and safety of AVP and CVC reporting at least one clinical outcome of interest. The primary endpoint was acute procedural success. The effect size was estimated using a random-effect model as Risk Ratio (RR) and relative 95% Confidence Interval (CI).

Results

Overall, 8 studies were included, which enrolled 1926 patients and 3532 transvenous lead implants [66.3% (n=1277) males with an average age of 72.3±14.8 years]. Compared to CVC, AVP showed a significant increase in the primary endpoint (95.7 % vs 76.1 %; RR: 1.24; 95% CI: 1.09-1.40; p=0.001) (Figure 1). Total procedural time (Mean Difference [MD]: -8.25 min; 95%CI: -10.23- -6.27; p<0.0001; I2 =0%) and venous access time (MD: -6.24 min; 95%CI: -7.01- -5.47; p<0.0001; I2 =0%) were significantly shorter with AVP compared to CVC. No differences were found between AVP and CVC for incidence of pneumothorax (RR: 0.72; 95% CI: 0.13 - 4.0; p=0.71), lead failure (RR: 0.58; 95% CI: 0.23-1.48; p=0.26), pocket hematoma/bleeding (RR: 0.58; 95% CI: 0.15- 2.23; p=0.43), device infection (RR: 0.95; 95% CI: 0.14- 6.60; p=0.96) and fluoroscopy time (MD: -0.24 min; 95%CI: -0.75- 0.28; p=0.36).

Conclusion

Our meta-analysis suggests that AVP may improve procedural success and reduce total procedural time and venous access time compared to CVC.
Afterload dependence of right ventricular pacing-induced left ventricular dysfunction in patients with aortic stenosis undergoing transcatheter aortic valve implantation
Authors: Ruppert M , Lakatos B K , Osztheimer I , Molnar L , Zima E , Geller L , Kosztin A , Straub E , Papp R , Tarjanyi Z , Ladanyi Z S , Turschl T , Kovacs A , Merkely B
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): TKP2021-EGA-23

János Bolyai Research Scholarship of the Hungarian Academy of Sciences.

Introduction

Recent experimental data indicates that patients with left bundle branch block are particularly sensitive to increased arterial afterload. Nevertheless, whether the detrimental hemodynamic consequence of right ventricular pacing (RVP) is also associated with afterload dependency has not been investigated yet.

Purpose

Hence, the present preliminary study aimed to examine the acute effect of RVP on left ventricular (LV) function in patients with aortic stenosis before (with elevated arterial afterload) and after (without elevated arterial afterload) transcatheter aortic valve implantation (TAVI).

Methods

Patients with a previously implanted permanent pacemaker (PM) and significant aortic stenosis referred for TAVI at the Heart and Vascular Center of our university were screened for this observational study. Only those patients who had an intrinsic, regular, narrow QRS rhythm (including junctional escape rhythm) were included. Four patients with a DDD PM (with sick sinus syndrome and maintained AV conduction) and two patients with a VVI PM (with atrial fibrillation and AV block) were enrolled. Echocardiography was performed immediately before TAVI and on the second postoperative day. The ultrasound measurements were carried out during intrinsic, narrow QRS rhythm (80/min AAI pacing in patients with DDD PM and 30/min backup VVI pacing to allow the narrow QRS escape rhythm in patients with VVI PM) and during frequency-matched RVP with wide QRS (>150ms) (DDD pacing with a short AV interval ensuring ventricular capture or VVI pacing, respectively). From the sonographic recordings, speckle-tracking echocardiography-derived global myocardial work index (GMWI) was calculated by commercially available software to assess LV function.

Results

TAVI resulted in decreased mean aortic gradient (35.4±3.6 mmHg vs. 5.3±1.4 mmHg before vs. after TAVI, P<0.001) indicating successful alleviation of the increased arterial afterload. Compared to the intrinsic, narrow QRS rhythm, RVP reduced GMWI before and after TAVI as well. Nevertheless, a significant reduction was only noted when the increased afterload was present (pre-TAVI GMWI: 1710±169 vs. 1170±199mmHg%, P=0.008), while following pressure unloading only a strong tendency could be observed (post-TAVI GMWI: 1127±76 vs. 865±83mmHg%, P=0.065).

Conclusion

Our preliminary results indicate that RVP-induced LV dysfunction might be afterload dependent. Hence, in patients with aortic stenosis and a high percentage of ventricular pacing, afterload reduction could entail a great clinical benefit.
Long-term impact of pacemaker implantation after TAVI: a subgroup analysis according to previous intraventricular conduction disturbances
Authors: Lacerda Teixeira B , Grazina A , Castelo A , Mendonca T , Rodrigues I , Ramos R , Fiarresga A , Osorio P , Portugal G , Valente B , Silva Cunha P , Lousinha A , Cruz Ferreira R , Cacela D , Oliveira M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Transcatheter aortic valve implantation (TAVI) is a worldwide accepted treatment for severe aortic stenosis (AS). Conduction system disturbances, frequently requiring permanent pacemaker (PM) implantation, remain one of the most common procedural complication. Whether the permanent ventricular pacing has a deleterious impact on the prognosis of this population remains unclear.

Objectives

To assess the long-term impact of permanent PM implantation in clinical outcomes after TAVI.

Methods

We performed a retrospective analysis of consecutive patients (P) who underwent TAVI between 2009 and 2021 in a single tertiary center.P with a PM implanted before TAVI or with in-hospital mortality were excluded from the analysis. PM implantation post-TAVI was defined as an implant during hospital stay after TAVI or in the first month after discharge. Kaplan Meier survival curves were used to estimate the impact of permanent PM after TAVI, regarding the composite endpoint of all-cause mortality and heart failure (HF) hospitalization during a 4 years follow-up period, and a comparison performed according to the presence or absence of baseline intraventricular conduction disturbances.

Results

549 P (82±6.6 years, 56.8% female, left ventricular ejection fraction 53±10%, peak gradient 51±15.6 mmHg, aortic valve area 0.7± 0.2 cm2) were included. At baseline, 108 P (20%) had intraventricular conduction disturbances on ECG (50 P with right bundle branch block [RBBB] and 58 P with left bundle branch block [LBBB]). 127 P (23%) required PM implantation after TAVI. Baseline characteristics were similar between P with and without PM implantation, except for age, gender, previous valvular surgery and RBBB (Table 1). At 48 months follow-up, 35% (n=193) met the composite endpoint, that was similar between both groups (35.8% vs. 34.1%, p=0.731). Kaplan-Meier survival curves revealed no difference in the composite endpoint between the two groups (log-rank p=0.170). Further analysis of subgroups according to the presence or absence of baseline intraventricular conduction disturbances revealed a significant difference among the subgroup of P without previous intraventricular conduction disturbances that underwent PM implantation after TAVI (log rank p=0.02) (Fig 1). This difference in the composite endpoint after PM was not found in the subgroups of P with RBBB (log rank p=0.656) or LBBB (log rank p=0.975) at baseline (Fig 2).*

Conclusions

Permanent PM implant after TAVI does not have an impact on long-term HF hospitalization and mortality. However, in the specific subgroup of P without previous intraventricular conduction disturbances, PM implantation seems to be associated with worse prognosis.
Left ventricular size may predict a better CRT response
Authors: La Greca C , Prezioso A , Zanchi S , Pecora D
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

We know that women have better responses to cardiac resynchronization therapy (CRT) (1). A possible explanation for this greater benefit has been attributed to sex difference in left ventricular (LV) size: sex-specific differences disappear when we normalize QRS duration to left ventricular end-diastolic volume (LVEDV) (2). QRS narrowing index (QI) has been showed predicting reverse left ventricular remodelling following CRT (3; 4).

Purpose

We sought to analyse the relationship between LV dimensions pre-CRT and QRS narrowing index, as a predictor of LV remodelling, and the relationship between LV dimensions pre-CRT and echocardiographic response 1 year after CRT.

Methods

We collected data from our Cardiovascular Implantable Electronic Device (CIED) outpatients’ database, selecting patients who underwent CRT, with analysable echocardiographic images in our local PACS, and with clinical, electrocardiographic, and echocardiographic data pre-CRT and at 1-year follow-up.

Results

We reviewed electrocardiograms and echocardiograms of 203 patients (M=120, 59,11%) who underwent CRT from 2015 to 2020. A higher QRS/LVEDV ratio and a higher QRS/LV mass ratio were associated with higher QI (p=0.03 and p<0.001, respectively). A higher QRS/LVEDV ratio was associated with higher LVEF (p<0.001), lower LVEDV (p<0.001) and lower LVESV (p<0.001) at follow up. Similarly, a higher QRS/LV mass ratio was associated with higher LVEF (p=0.04), lower LVEDV (p=0.02) and lower LVESV (p=0.01) at follow up.

Conclusions

LV size seems to have a role in prediction of a better response to CRT. Both the QRS/LVEDV ratio that the QRS/LV mass ratio may predict better electrocardiographic an echocardiographic response.
Repolarization changes following left bundle branch area pacing versus conventional biventricular pacing in patients with dyssynchronous heart failure
Authors: Smits K C , Nguyen U C , Rijks J , Stipdonk A M W , Hermans B J M , Bressi E , Grieco D , Luermans J G L M , Vernooy K , Prinzen F W
Published: May 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Dutch Heart Foundation.

Background

Biventricular pacing (BiVP) is the standard treatment for patients with dyssynchronous heart failure. Despite the effectiveness of BiVP, 6% of patients develop ventricular tachyarrhythmia’s (VTAs) within one year following implantation. The relationship between BiVP and the development of VTAs is still under debate. The left-sided epicardium-to-endocardium activation during BiVP creates a nonphysiological activation and repolarization and might provoke VTAs. A relatively new treatment option is left bundle branch area pacing (LBBAP), in which the physiological activation of the left ventricle is restored. We hypothesize that LBBAP leads to a more homogenous repolarization compared to conventional BiVP.

Purpose

To compare time-dependent repolarization changes in patients with dyssynchronous heart failure receiving LBBAP versus BiVP.

Methods

Patients with dyssynchronous heart failure eligible for cardiac resynchronization therapy who underwent LBBAP (n=13) or BiVP (n=28) were retrospectively included. Standard 12-lead electrocardiograms (ECG) obtained prior to implantation [baseline], shortly following implantation (0-2 days,[acute]) and during follow-up (31-180 days, [FU]) were analyzed. The QT interval and Tpeak to Tend interval (Tpeak-Tend) were calculated using a semi-automatic approach in MATLAB. Repolarization differences between LBBAP and BiVP patients were determined using the Mann-Whitney U-test. Time-dependent changes within groups were determined using the Wilcoxon signed rank tests. Significance was defined as a p-value ≤0.05.

Results

The QT interval did not significantly change over time in BiVP patients, but it decreased immediately following implantation and during FU in LBBAP patients. At FU, QT interval was significantly lower in LBBAP than in BiVP patients (Figure 1, left panel). A slight increase in Tpeak-Tend interval over time in BiVP patients, while it tends to decrease over time in LBBAP patients can be seen in the right panel. Acutely and long term after implantation, Tpeak-Tend was significantly lower in LBBAP than in BiVP patients.

Conclusion

LBBAP is associated with lower QT and Tpeak-Tend intervals compared to BiVP during FU, suggesting that LBBAP leads to less heterogeneity of repolarization over time. These findings suggest a more physiological repolarization pattern in LBBAP compared to BiVP, which may decrease the risk of developing VTAs.
Analysis of the effects of atrial pacing on the timing of left ventricular pressure rise in normal conduction and left bundle branch block
Authors: Marciniak M , Albatat M , Hammersboen L , Stugaard M , Finstad E , Frostelid V C , Remme E , Odland H
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Norwegian Research Council.

Background/Introduction

The timing of left ventricular pressure rise (Td) relative to QRS-onset is associated with dispersion of regional work distribution and prolongs with dyssynchrony and dyssynergistic contractions. Td is short in normal conduction and shortening of Td can be achieved with effective biventricular pacing (BIVP). The effect of atrial pacing on Td is unknown and could be important for the interpretation of Td when utilized for cardiac resynchronization therapy.

Purpose

We wanted to test the effects from atrial pacing (AP) compared to sinus rhythm (SR) on Td in animals with narrow QRS (nQRS) complexes and after the creation of LBBB.

Methods

9 mongrel dogs were included in the study and handled according to ethics committee approved protocol/GLP. Pacing electrodes were placed epicardial on the left atrial appendage. Pressure was measured with a Micro-tip pressure sensor (Millar Inc.) in the LV and sampled at 1000Hz. LBBB was created with a retrograde placed 7F standard ablation catheter and confirmed by surface ECG and four endocardial electrodes. Td was measured from 10 consecutive beats. Mixed models were utilized for the repeated measurements.

Results

Analysis of the marginal means in pooled data showed that the average Td with AP was 96.7ms (95% CI: -195.7, 388.7), and in SR 96.5ms (95% CI: - 195.5, 389.0). The analysis with the Bonferroni correction for multiple comparisons revealed that the differences between pacing configurations were not statistically significant (p=0.80). The analysis revealed that AP on average lengthens Td by 0.3ms (95% confidence interval (CI): - 1.7, 2.2, p=0.8), compared to no pacing. The difference in Td in nQRS between AP and SR was 82.4ms (95% CI: 76.8, 88.1) and 82.1ms (95% CI: 76.4, 87.8) respectively (p=0.02) while the difference in Td in LBBB between AP and SR was 111.1ms (95% CI: 104.8, 117.4) and 110.9ms (95% CI: 104.581, 117.197) respectively (p=0.48). Standard deviation within 10 consecutive beats was 1.0ms (max 3.7ms, min 0.4ms, median 0.95ms), and AP did not influence Td measurement variability (p=0.53).

Conclusion(s)

We did not find any influence from atrial pacing in Td in this study. The significant difference between AP and SR in nQRS was extremely small and less than the sample interval of 1ms. The significance of this difference is attributed to the robustness of the Td measurement and does not represent a meaningful clinical significance. Td can be measured without being influenced by atrial pacing in both native conduction and with LBBB.
Low incidence rate of infections associated with cardiac implantable electronic device procedures in a large real-world patient cohort
Authors: Imberti J F , Vitolo M , Mei D A , Bonini N , Fontanesi R , Muto F , Gerra L , Sbarra F , Turco V , Casali E , Boriani G
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The incidence of death and infections in patients implanted with cardiac implantable electronic devices (CIEDs) are not fully known yet (1,2).

Purpose

To describe the incidence of death and device’s infection and its potential predictors in a contemporary cohort of CIED patients.

Methods

All consecutive patients implanted with a CIED at our tertiary institution were prospectively enrolled. Follow-up was performed every six months and clinical events recorded by expert electrophysiologists. For the purpose of the present analysis, we considered patients with a potential follow-up of at least 24 months.

Results

Between 01/09/2018 and 01/09/2020, a total of 838 patients were enrolled (34.6% female; age 77 [70-84]; PADIT score 2 [2-4]). Pacemaker (PM) and implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy and defibrillator (CRT-D) were implanted in 569 (68%) and 269 (32%) patients respectively. All patients had pre-implant antibiotic prophylaxis and 5.5% had an antibiotic-eluting envelope. Follow-up data were available for 832 (99.2%) patients. After a median follow-up of 42.3 (30.2-56.4) months, 212 (25.5%) patients died and 5 (0.6%) had a CIED infection. Four out of five patients required CIED extraction, while 1 patient antibiotics only. At multivariate Cox-regression analysis, age (hazard ratio [HR] 1.08; 95% confidence interval [CI] 1.05-1.10) and dialysis (HR 6.18; 95%CI 3.40-11.25) were independently associated with death, while first implant was associated with a lower risk as compared to subsequent procedures (HR 0.63; 95%CI 0.46-0.85) (Figure 1).

Conclusions

In large contemporary cohort of CIED patients, mortality was substantially high and associated with clinical factors depicting a population at risk. On the other hand, the incidence of CIED infections was low.
Efficacy of antibacterial envelope use in cardiac implantable electronic device infection prevention: insights from real world data
Authors: Ziacchi M , Biffi M , Iacopino S , De Silvestro M , Marchese P , Miscio F , Caccavo V P , Zanotto G , Dello Russo A , Donazzan L , Boriani G
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Infections of Cardiac implantable electronic device (CIED) are rare but serious complications impacting patients and the whole heath care system. Recently, a significative reduction in major CIED infections within 12 months of the procedure has been showed by the use of an absorbable antibiotic-eluting envelope. The aim of the analysis is to evaluate the impact of the use of the envelope on infection-related clinical events (including pocket hematoma, infection, and systemic infection) reduction in a real word patient population

Methods

Data on patients underwent CIED implantation or replacement were collected prospectively in the framework of One HospitalClinicalService project. Patients were divided into two groups according to the utilization of an absorbable antibiotic-eluting envelope or the non-usage of the envelope.

Results

Out of 1819 patients, 872 (47.9%) were implanted with an absorbable antibiotic-eluting envelope and denoted as the Envelope group. Accordingly, 947 (52.1%) patients were categorized as the control group. As compared to control, patients with envelope had higher thrombo-embolic risk, higher BMI, lower LV ejection fraction and in general had more comorbidities. During a mean follow-up of 1.4 year, the incidence rate per 100 patients-months of infective related events were significantly greater in the control compared to the Envelope group (2.85% vs 1.26%, p< 0.001). The 48-month cumulative incidence of infective related events was 6.7% in the control and 2.9% in the Envelope group (HR:0.47; 95%CI: 0.27-0.95, p= 0.032). Fig1 When considering a subgroup of 1170 patients matched by PADIT score, the incidence of infective related events was 1.0 % (6/585) in the envelope and 3.8% (22/585) in the envelope and control group, respectively, p=0.002.

Conclusions

In our analysis, the use of envelope in the general CIED population was effective to reduce the risk of systemic or pocket infection, or pocket hematoma
Disease progression in exercise-induced compared to desmosomal arrhythmogenic cardiomyopathy - a longitudinal cohort study
Authors: Aaserud L , Rootwelt-Norberg C , Aabel E W , Five C K , Hasselberg N , Castrini A I , Haugaa K H , Lie ØH
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Oslo University Hospital, Procardio Center for Innovation

Introduction

Arrhythmogenic cardiomyopathy (AC) is an inheritable heart disease caused by mutations in genes encoding the cardiac desmosomes, while exercise-induced AC (EiAC) has been proposed as an acquired similar phenotype in athletes. Little is known about the progression of EiAC compared to AC.

Purpose

To assess functional and structural disease progression in EiAC compared to desmosomal AC during long-term follow-up.

Methods

We consecutively included probands with definite AC diagnosis according to the 2010 Task Force Criteria and patients with EiAC in a longitudinal cohort study. EiAC was diagnosed in competitive endurance athletes (>24 MET-hours/week for >6 consecutive years) referred with symptomatic ventricular arrhythmias who had no family history, no genetic mutations associated with heart disease, and no other identified etiology after through clinical work-up. All patients in both groups were recommended to avoid high intensity exercise. Progression of the structural phenotype was assessed by regular repeated echocardiographic examinations during long-term follow-up. Right ventricular (RV) function and size were assessed by RV fractional area change (FAC), RV basal diameter (RVD) and RV outflow tract (RVOT) diameter. Disease progression was evaluated and compared using linear mixed model regression.

Results

Forty-one EiAC patients (15% women, age 45±13 years) and 84 AC probands (51% mutation positive, 35% women, age 43±15) were followed for 6.6 (IQR 3.7-10.5) and 7.9 (IQR 5.2-10.8) years, respectively. Key parameters from 570 echocardiographic examinations (184 EiAC and 386 AC) were assessed. There was no deterioration of RV function during follow-up in EiAC patients, in contrast to AC patients (FAC yearly progression rate: EiAC +0.02% [95% CI -0.27 to 0.31] vs AC -0.60% [95% CI -0.71 to -0.50] per year, p=0.001, Figure left panel). RV size did not increase in EiAC patients in contrast to AC patients (RVD: EiAC +0.01 mm [95% CI -0.00 to 0.03] vs AC +0.78 mm [95% CI 0.68 to 0.89] per year, p<0.001, Figure mid panel, and RVOT: EiAC +0.01 mm [95% CI -0.01 to 0.02] vs AC +0.47 mm [95% CI 0.38 to 0.56] per year, p<0.001, Figure right panel).

Conclusion

Patients with exercise-induced AC had no evidence of disease progression during long-term follow-up. These patients had a more benign disease trajectory than patients with desmosomal AC. Despite the limited sample size, these results seem reassuring for patients diagnosed with exercise-induced AC.
Machine learning approach on high risk treadmill exercise test to predict obstructive coronary artery disease by using P QRS and T waves features
Authors: Yilmaz A Y , Hayiroglu M I H , Salturk S S , Pay L P , Demircali A A D , Coskun C C , Varol R V , Tezen O T , Eren S E , Cetin T C , Tekkesin A I T , Uvet H U
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Treadmill Exercise Test (TET) application in terms of detecting Obstructive Coronary Artery Disease is defined to be limited due to low sensitivity and specificity rates. TET results and patients' clinical symptoms influence cardiologists' decision to perform Coronary Angiography (CAG) which is an invasive procedure. Since TET has high false positive rates, it can cause an unnecessary invasive CAG. To improve TET's utility and accuracy in the diagnosis and follow-up of CAD patients, new algorithms need to be proposed.

Purpose

Our primary objective was to develop a machine learning model capable of optimizing TET performance based on electrocardiography (ECG) waves characteristics and signals. we aimed to evaluate the performance of a new algorithm which was based on using ECG signal features such as time difference and amplitude values of P, QRS and T wave. P, QRS and T wave directly follow the cardiac cycle of the heart. For this reason, time and amplitude information of P, QRS, and T waves can improve success of TET results for OCAD detection.

Methods

TET reports from 294 patients who underwent CAG following high risk TET were collected and categorized into those with critical CAD and others. The signal was converted to time series format. A dataset containing the P, QRS, and T wave times and amplitudes was created. Using this dataset, five machine learning algorithms were trained with 5-fold cross validation. All these models were then compared to the performance of cardiologists on V5 signal.

Results

ML models were trained and tested on V5 signal features in this research. The performance of cardiologists was determined based on their ability to classify a TET report correctly by using only the V5 graph. The results from five machine learning models were clearly superior to the cardiologists' V5 signal performance (p < 0.0001). In addition, the XGBoost model, with an accuracy of 80.92±6.42% and an area under the curve (AUC) of 0.78±0.06, was the most successful model.

Conclusion

To the best of our knowledge, this is the first ML study to predict OCAD using time and amplitude features of P, QRS, and T waves. Machine learning models can produce high-performance diagnoses using the V5 signal markers only as it does not require any clinical markers obtained from TET reports. This can lead to significant contributions to improving clinical prediction in non-invasive methods.