bluuebunny/crossref_metadata_2025 huggingface dataset:
Worse outcomes in patients with cardiac sarcoidosis and involvement of the right ventricle in cardiac magnetic resonance
Authors: Dinov B D , Seidemann J S , Henfling C H , Ebbinghaus H E , Latuscynski C L , Paetsch I P , Jahnke C J , Laufs U L , Sossalla S S , Ueberham L U
Published: May 2024

Background

Cardiac sarcoidosis (CS) can manifest with variety of unspecific symptoms. It can mimic all types of cardiomyopathies but most often it resembles dilated cardiomyopathy. Involvement of right ventricle (RV) is rare and may lead to a false diagnosis of arrhythmogenic right ventricular cardiomyopathy and delay of the immunosuppressive therapy.

Purpose

The aim of this research was to study the characteristics and the outcomes of this peculiar subtype of patients.

Methods

We analyzed 112 patients diagnosed with CS after elaborate work-up with cardiac magnetic resonance (CMR), FDG PET and endomyocardial biopsy (EMB). All patients underwent follow-up for occurrence of combined endpoint of death, LV assist device implantation or heart transplantation. Patients with evidence of late gadolinium enhancement (LGE) involving RV (RV group) were identified and compared to the rest (DCM group) for baseline clinical characteristics, arhythmic outcomes and combined endpoint.

Results

Involvement of the RV in CMR was observed in 19 (17%) patients. Patients in the RV group were more frequently male: 84% vs. 57%, P = 0.032. EMB confirmed CS in 63% vs. 19.4% in the DCM group; P= 0.0001. LV ejection fraction in the RV group was comparable to the DCM group: 42±14% vs. 45±14%; P = 0.3. Furthermore, in the RV group the rates of sustained ventricular tachycardia were significantly higher than the DCM: 68% vs. 34%; P = 0.009. Long-term immunosuppressive therapy was started in 74% in RV and in 70% of the DCM group; P=0.77. Despite this, during follow-up, the rate of death, LVAD implantation or heart transplantation was significantly higher in the RV than in the DCM group; 26.3% vs. 7.5%; P = 0.03. In binary logistic analysis, the OR for the combined endpoint was 4.4; 95% CI 1.2-15.7.

Conclusions

Patients with CS and RV involvement in CMR have worse outcomes as compared to patients presenting as DCM, despite the comparable LV EF and immunosuppressive therapy.
Catheter ablation of premature ventricle complex from multiples site of origin guided by an ultra-high density mapping system in a single-center
Authors: Albarran-Rincon R , Rodaev V , De La Torre Carazo F , Ramos Ardanaz P , Garcia De Yebenes M , Garcia-Bolao I
Published: May 2024

Background

Frequent premature ventricle complex (PVC) could induce cardiomyopathy in some patient. PVC ablation by radiofrequency (RF) is a well-stablished procedure in high density PVC patients and results are consistent and robust in literature, with somewhat differing success rates reported.

Catheter ablation of radiofrequency guided by ultra-high density mapping systems (UHDMS), enable a much more accurate reconstruction of the site of origin (SOO). Furthermore, we obtained this anatomic recreation with the analysis of a few number of beats. The UHDMS have demonstrated to be feasible and safe in a wide range / large spectrum of arrhythmic substrates, however, there is lack of evidence of its usefulness in the ablation of PVC.

Purpose

To determine the safety and utility, both in the acute phase and in the short-medium term, of employing a UHDMS in PVC catheter ablation in a retrospective cohort of patients treated at a single centre.

Methods

Catheter ablation procedures guided by an UHDMS carried out from July 2015 to January 2021 in a single-center of Spain were retrospectively included. The primary outcomes analyzed were: acute success rate, short-medium success rate (6-month efficacy after ablation), and complication rate related to the procedure.

Results

One hundred and two procedures, corresponding to 92 patients (mean age 59 ± 14 years, 63% male, 74% without cardiomyopathy, mean LVEF of 60%), were analyzed. The acute success rate was 93%. According the SOO, the lowest acute success rate was PVC from epicardial level (LV Summit) (75%). At 6-month follow-up after the first procedure, the short-medium success rate was up to 84% (no recurrence of the PVC ablated). There were three acute complications related to the procedure (complication rate 2,94%). In 19% (21 out 102) of the procedures, at least two arrhythmic substrates were successfully ablated in a single intervention.

Conclusion

Catheter ablation guided by an UHDMS showed an excellent safety profile in PVC ablation procedures. Beyond this minor complication rate, this type of technique has improved acute and short-term success rates. This allows us to assert that this type of technique grants a very high success rate and improves previously results. Last but not least, this new approach was useful and accurate in complex patients, providing good results in ablation procedures of two or more arrhythmic substrates without altering the safety profile.
Improving functional substrate delineation for ablation of ventricular tachycardia using high-density electroanatomic mapping and double ventricular extra stimuli protocol
Authors: Guichard J B , Regany-Closa M , Vazquez-Calvo S , Serrano-Campaner J , Pellicer-Closa B , Falzone P V , Eulogio F , Borras R , Arbelo E , Guasch E , Tolosana J M , Sitges M , Mont L , Porta-Sanchez A , Roca I
Published: May 2024

Background

A partial delineation of targets for ventricular tachycardia (VT) ablation may contribute to a suboptimal success rate. Abnormal electrograms (EGMs) with low-voltage near-field components might be concealed within high-amplitude far-field signals. Our hypothesis posited that acquiring functional mapping after double ventricular extrastimuli (S3 protocol) could reveal relevant areas of functional substrate overlooked during sinus or S1 mapping.

Purpose

To assess the benefit and feasibility of functional substrate mapping using a full ventricle S3 protocol and to evaluate its colocalization with conducting channels (CCs) identified in late gadolinium enhancement cardiac magnetic resonance (LGE-CMR).

Methods

(Figure 1) - An S3 mapping protocol with a drive train of S1 followed by S2 (effective refractory period (ERP) +30ms) and S3 (ERP+50ms) from the RV apex was conducted in 40 consecutive patients undergoing scar-related VT ablation. Deceleration zones (DZs) and areas of late potentials (LPs) were identified for all maps (S1, S2, and S3). Pre-procedural non-invasive substrate assessment was performed with LGE-CMR and post-processing using a commercially available system with automated CC identification.

Results

The S3 protocol was completed in 34 of the 40 procedures (85.0%). Repeated induction of ventricular arrhythmias prevented the full S3 protocol in 5 patients (15.0%). Functional substrate identified during S3 activation mapping was significantly more extensive than that identified using S2 and S1, including a higher number of DZs (2.94, 2.47, and 1.82, respectively; p<0.01) and a wider area of LPs (44.1cm2, 38.2cm2, and 29.4cm2, respectively; p<0.001). The percentage of CCs unmasked by DZs and LPs using S3 maps was significantly higher than the ones using S2 and S1 maps(78%, 65%, and 48%; p<0.001, and 88%, 81%, and 68%; p<0.01, repectively). After VT ablation based on an S3 protocol, 77.9% of patients have been VT free during a median follow-up of 13.6 months.

Conclusions

(Graphical abstract -Figure 2) - This novel substrate-based protocol for assessing functional substrate is feasible in most patients, enables better identification of ablation targets, and has the potential to improve patient prognosis post-ablation.Methods - The S3 protocolConclusion - Graphical abstract
Effects of hemodynamic support on arrhythmia-free survival following catheter ablation of ventricular arrhythmias
Authors: Guckel D , Nesapiragasan V , El Hamriti M , Fink T , Sciacca V , Imnadze G , Khalaph M , Sommer P , Sohns C
Published: May 2024

Background

Radiofrequency-guided catheter ablation is an established therapy for ventricular tachycardia (VA). Hemodynamic support (HS) is often required for patients suffering from incessant VA to guide ablation. Data on the outcome of patients receiving HS during VA ablation procedures are lacking.

Purpose

The aim of this observational study was to analyze the acute procedural success as well as long-term 36-month-VA-recurrence rates and mortality in patients requiring HS during VA ablation procedures.

Methods

Data from consecutive patients receiving HS during VA ablation procedures between 2015-2023 were analyzed. HS was defined as the use of an Impella, an extracorporeal membrane oxygenation (ECMO) or a left ventricular assist device (LVAD). HS-group patients were compared to patients that underwent VA ablation procedures without HS. All patients were continuously followed up in our outpatient clinic. Data on procedural parameters, acute success and complications as well as long-term VA-free survival and mortality were analyzed.

Results

A total of 95 consecutive patients (mean age 60.9 ± 11.0 years, 15% female) were included. 62 patients (65%, mean age 60.4±9.4 years, 16% female) receiving HS (ECMO or Impella: n=26, 42%; ECMO+Impella: n=7, 11%; LVAD: n=29, 47%) were compared to those without (mean age 61.7±13.5 years, 12 % female). In the HS-cohort a significantly lower left ventricular ejection fraction (LVEF) (p<0.001), a higher New York Heart Association (NYHA) functional class (p=0.013) and a more frequent antiarrhythmic drug use (p=0.045) was documented. Fluoroscopy times were significantly longer in the HS-group (HS: 10:22 ± 07:04 vs. no HS: 05:52 ± 02:50 minutes, p<0.001). Acute procedural success (HS: n=59, 95% vs. no HS: n=33, 100%, p=0.549) and major procedure complications (HS: n=4. 6% vs. no HS: n=4. 6%, p=1.000) were comparable between the two groups. Nevertheless, patients receiving HS had a significantly higher in-hospital mortality (HS: n=20, 32 % vs. no HS: n=2, 6%, p=0.004). The estimated 36-month-VA-free survival was comparable between the groups (Log-rank p=0.114). But Kaplan-Meier-plot analyses revealed a significantly higher estimated mortality in patients receiving HS (Log-rank p=0.002) (Figure 1). Between the subgroups (ECMO or Impella vs. LVAD) no statistically relevant differences were observed (Log-rank p=0.466). Multivariate analyses revealed HS as an independent predictor for mortality (Hazard ratio (HR) 3.259, Confidence Interval (CI) 1.060-10.015, p=0.039), but not for VA-recurrence.

Conclusion

In the specific cohort of patients receiving HS, VA ablation procedures seem to be safe and effective with comparable acute and long-term success- and complication-rates. The need for HS seems to be associated with an increased risk for mortality. Further studies are required to validate our initial observations.Kaplan-Meier-plot on 36-month survival
Coronary venous ethanol ablation of refractory left ventricular summit arrhythmias: comparison with radiofrequency ablation
Authors: De Smet M A J , De Becker B , Francois C , Tavernier R , Duytschaever M , Knecht S , Le Polain De Waroux J B
Published: May 2024

Background

Radiofrequency (RF) ablation of ventricular premature beats (VPBs) and ventricular tachycardia (VT) arising from the left ventricular (LV) summit is challenging and may fail due to anatomical inaccessibility of the substrate. Coronary Venous Ethanol Ablation (CVEA) has been suggested as a bailout strategy following failed RF ablation of LV Summit Arrhythmias (LVSA). Comparison with RF ablation strategies are lacking.

Purpose

To compare CVEA with RF ablation for the treatment of LVSA.

Methods

Between January and November 2023, 20 patients were treated with CVEA for LVSA. Results were compared to 36 patients that underwent RF ablation for LVSA (Panel A). Endo- and/or epicardial RF ablation was performed based on local signal precocity and pace-mapping. Coronary venogram-guided mapping of coronary sinus side-branches was performed using an angioplasty wire connected to our EP-recording system using a crocodile clamp. The target veins were specifically selected based on early presystolic potentials and confirmed by matching VPB pace-maps. For the treatment, angioplasty balloon(s) measuring 2-2.5×6-8 mm were employed to administer ethanol into the target branch of the coronary sinus. Data are reported as mean ± standard deviation, unless otherwise indicated. P-values are two-tailed.

Results

(Panel B): Patient characteristics were similar for both groups, except for the number of prior failed ablation procedures (75% males; mean age: 63 ± 13 y; 31 with structural heart disease; mean LVEF 39 ± 9%; VPB burden 25 ± 12%; Number of (NS)VT 72 ± 151; 65% redo in case of CVEA, 28% for RF). Mean pace-match was 97 ± 1% (99.8% max.) for CVEA versus 93 ± 8% (97% max.) for RF ablation (P = 0.002). Earliest presystolic signal was -70 ms (-49 ± 12) for CVEA versus -50 ms (-31 ± 12) for RF (P = 0.0002). Acute success, defined as elimination of VPB/VT was 95% versus 83% for CVEA and RF ablation respectively. VPB burden at Holter was 1 ± 3% 6-8 weeks after CVEA versus 8 ± 10% following RF ablation (P = 0.024). In patients with VT, number of (NS)VT decreased by 90% after CVEA (P = 0.014), while this was not significant for RF ablation. After a median follow-up of 8 months (IQR 2-10), 15% of CVEA patients showed residual non-LV summit ventricular arrhythmia as compared to 39% showing recurrence of LV summit VPB or VT following RF ablation. No patients died. One patient developed tamponade following RF ablation and one patient received PCI in the CVEA group.

Conclusion

Retrograde coronary venous ethanol ablation is an effective ablation strategy for the treatment of LV summit arrhythmias, also compared to conventional RF ablation.
Genotype, phenotype and outcomes of patients with hypertrophic cardiomyopathy referred for ablation of ventricular tachycardia
Authors: Meretta A , Schaerli N , Kimura Y , Wijnmaalen H P , De Riva M , Piers S R D , Bootsma M , Zeppenfeld K
Published: May 2024

Background

Sustained monomorphic ventricular tachycardia (SMVT) is the most common ventricular arrhythmia (VA) subtype in patients with hypertrophic cardiomyopathy (HCM) who have received an implantable cardioverter defibrillator (ICD). However, data on catheter ablation (CA) are limited and available series typically report results of non-genotyped patients with relatively mild hypertrophy and/or apical aneurysms.

Purpose

This study describes genotype, phenotype and outcome of consecutive HCM patients referred for CA ablation of refractory SMVT.

Methods and results

Nine out of 787 patients referred for catheter ablation of SMVT between 01/2016 – 10/2023 had a HCM phenotype, 8/9 with dominant septal hypertrophy, none with LV outflow tract obstruction, and only 1/9 with an apical aneurysm. The median maximal wall thickness was 25 mm (IQR 20,2 – 26,9 mm) and the median left ventricular ejection fraction 34 % (IQR 26-42%). Six patients had a class IV/V variant in the myosine binding protein C (MYBPC3) gene, in 3 no disease-causing variant was identified. All patients with MYBPC3 mutation presented with an electrical storm/incessant VT refractory to antiarrhythmic drugs (AAD), including amiodarone (6/6) and amiodarone + class I AAD (3/6). In an attempt to control VT, 4/6 patients with a MYBPC3 variant required ≥2 ablation including bail out strategies (transcoronary alcohol-ablation, bipolar ablation, half-saline), surgical substrate resection and intraoperative cryoablation (3/6) and radiotherapy (2/6). After a median follow-up of 25 months (IQR 2-75) after the last intervention, all patients with MYBPC3-variants had VT recurrence, 3/6 died and 1/6 underwent heart transplantation. In contrast, patients without class IV/V variants, did not require bail-out strategies; VT recurred in one (single episode) and one patient died, 24 months after CA.

The time course of the disease, management and outcome for patients with and without disease causing mutation is illustrated, with the first ablation as center line (figure).

Conclusions

Only 1 % of patients referred for CA of SMVT to a high-volume center had a HCM phenotype. A MYBPC3 variant was identified in 67%, and, in contrast to prior reports, 89% had severe hypertrophy. VT free survival appears to be particularly poor in MYBPC3 variant carriers despite availability of all treatment modalities. In these patients, early screening for advanced heart failure management including heart transplantation is important.
Radiofrequency catheter ablation using QDOT MICRO: single-center experience in treating outflow tract premature ventricular complexes
Authors: Ciconte G , Salerno R , Negro G , Rondine R , Boccellino A , Napolano A , Maiolo V , Giannelli L , Sabatelli L , Calovic Z , Vicedomini G , Pappone C
Published: May 2024

Aims

This study sought to examine the efficacy of radiofrequency catheter ablation (RFCA) for premature ventricular complexes (PVCs) originating from the outflow tracts. The investigation utilized the QDOT MICRO™ (QDOT) catheter, known for enabling a temperature-controlled ablation strategy.

Methods and results

The study began in November 2022 at a single center. All patients (n=100, 57% male, mean age 49±18) were prospectively and consecutively enrolled and underwent PVCs ablation with QDOT-MICRO™ catheter. The procedural and efficacy data of the study population were compared with those of a control group composed of a cohort of 100 propensity score-matched patients who underwent the same procedure with the ThermoCool® SmartTouch® Catheter using the Ablation Index strategy. Acute procedural success was defined as the elimination of the targeted PVCs at the termination of the procedure. Clinical success was defined as at least an 80% decrease in PVCs burden. Follow-up visits with 24- to 48-h Holter monitoring were performed at baseline and 1, 3, and every 3 months thereafter. Both patients with follow-up <6 months and non-outflow tracts PVCs were excluded. In the study cohort, the average PVCs burden was 21,13% (IQR: 12,50, 24,44) and the RVOT PVCs were 58% (n=58). The mean procedure and fluoroscopy times were 113±103 and 18±15, respectively, and significantly differ between both groups (p=0.02 and p<0.001, respectively). Signals detected by the microelectrodes at the effective site of ablation differed significantly from those recorded by the standard bipolar electrodes (p<0.001). No major complication occurred during the procedures, and there was no procedure-related mortality. The freedom from PVCs recurrences was 86% in the QDOT group and 84% in the STSF group.Freedom from PVCs recurrences at a mean follow-up of 11.5±1.6 months did not significantly differ between both groups (86% vs 84%, respectively; p=0.65).

Conclusion

This study suggests that RFCA using the QDOT MICRO™ catheter is not only effective but also comparable to the standard approach for treating outflow tract PVCs. Moreover, the study highlights shorter fluoroscopy and procedure times, reinforcing the catheter's efficiency and safety. The use of microelectrodes proved beneficial in enhancing precision in RF delivery.
Long-term outcomes associated with subcutaneous implantable cardioverter-defibrillators in patients with hypertrophic cardiomyopathy
Authors: Rella V , Maurizi N , Bernardini A , Brasca F M , Salerno S , Meda M , Mariani D , Torchio M , Conte G , Auricchio A , Parati G , Olivotto I , Perego G B , Cecchi F , Crotti L
Published: May 2024

Background

In patients with Hypertrophic Cardiomyopathy (HCM) S-ICD is usually the preferred option as pacing is generally not indicated. However, limited data are available on its current practice adoption and long term follow-up.

Purpose

The present study was designed to examine in a multicenter, open-label, long-term study, the patient’s selection process for S-ICD implantation, the short and long term complications, the appropriate shock (AS) rates, shock efficacy and outcome.

Methods

Consecutive HCM patients with an S-ICD implanted between 2013 and 2021 in 3 international centers were enrolled in this prospective observational study. Baseline, procedural and follow-up data together with clinical evaluation, ECG, echocardiography, and telemetry checks of the S-ICD were regularly collected.

Results

Seventy patients (64% males) were enrolled, implanted at 41±15 years, 62 (89%) in primary prevention with a mean ESC SCD risk score of 4,5±1.9%: 25 (40%) at low risk, 17 (27%) at intermediate and 20 (33%) at high risk. Patients were followed-up for 5.1±2.3 years (327 person-years). Notably, 25 (36%) were followed for more than 6 years up to 10 years. Two patients (3%) received an appropriate shock on ventricular fibrillation and 17 (24%) were diagnosed with a de-novo atrial fibrillation, sub-clinical in 6 (9%). One TIA and 2 strokes were reported. Inappropriate shocks occurred in 4 patients (6%), all before Smart-Pass algorithm implementation. Eight patients experienced device related adverse events (11%).

Conclusions

S-ICDs in HCM patients followed for over 5 years showed to be effective in the conversion of VF in 2 ESC SCD high risk patients (3%) and useful in the detection of sub-clinical AF in 6 (9%). S-ICDs are implanted in patients with an overall low-intermediate ESC SCD risk, probably reflecting both the inclusion of additional risk markers (i.e extensive LGE, reduced EF and apical aneurism) and the physician perception of low device-related complications S-ICD is generally safe, but greater scrutiny may be required to avoid overtreatment in HCM patients with milder risk profiles.Real world use and candidacy of S-ICDAppropriate and inappropriate shocks
Long-time exposure to sunlight is associated with the risk of sudden cardiac arrest and coronary heart disease
Authors: Kim M , Sung J H , Jang E S , Kim D H , You S C , Hwang K K , Bae J W , Kim D W , Yang P S , Joung B Y
Published: May 2024

Background

With ongoing climate change, the duration of sunshine hours will likely increase over the coming decades that escalating air temperature. Little is known about the potential cardiovascular risk from this climate factor.

Purpose

The aim of this study was to test whether duration of sunlight exposure is associated with incident sudden cardiac arrest (SCA), coronary heart disease (CHD), and hospitalization for heart failure (HF) and whether this association depends on seasonal variation.

Methods

A total of 308,851 participants from UK Biobank were included and were followed for a median time of 11.8 years. Participants reported how many hours they respectively spent the daylight outdoors on summer and winter typical days. Extreme outliers (>12 hours/day in summer and >8 hours/day in winter) were excluded. Average exposure time was calculated to unify the daylight outdoors time standard. Duration of sunlight exposure (average, summer, and winter) were categorized using quantiles and a restricted cubic spline for outcomes. Multivariate cox proportional hazard regression adjusted by age, sex, demographics, lifestyle, clinical and environmental factors was used for the analysis.

Results

During a follow-up, 1,572 (0.51%), 11,557 (3.74%) and 2,145 (0.68%) participants were diagnosed with SCA, CHD and hospitalization for HF. Compared with the participants exposed to short-time sunlight (average ≤ 1.5 hours/day), those who exposed to long-term sunlight (average ≥ 3.5 hours/day) had increased risk of SCA (HR 1.22, 95% CI 1.06 to 1.40) and CHD (HR 1.22, 95% CI 1.06 ~1.40). The associations between long-time exposure to sunlight and SCA were largely attributable to summer (HR 1.22, 95% CI 1.06 to 1.39) and not winter (HR 1.02, 95% CI 0.86 to 1.20), respectively. An hour increase of sunlight exposure was associated with increased risk of SCA in summer (HR, 1.03; 95% CI, 1.01 to 1.05), but not in winter (HR, 1.03, 95% CI, 0.99 to 1.06). Subgroup analysis identified that exposure to long-term sunlight was consistently increased risk of SCA, regardless of age, sex, body mass index, previous cardiovascular diseases, total physical activity, types of physical activity in last 4 weeks, use of sun/UV protection, sedentary time, natural environment percentage (buffer 1000m), and PM2.5. Finally, long-time exposure to sunlight was also associated with increased risk of CHD, but not associated with increased risk of HF hospitalization.

Conclusions

Findings from the present study indicate that daily long-time exposure to sunlight that increase in air temperature is a risk factor for SCA and CHD. These associations revealed graded relationship according to the duration of exposure to sunlight and more pronounced in summer. Our results suggest that public health efforts to reduce cardiovascular risk should take a wide range of exposure time to sunlight into account.
Impact of comorbidities on survival and complications in patients implanted with leadless pacemakers: a national, multicenter study
Authors: Oezkartal T , Conte G , Breitenstein A , Haeberlin A , Sticherling C , Ammann P , Grebmer C , D'alto A , Schoeni L , Bruno J , Bergonti M , Caputo M L , Klersy C , Auricchio A
Published: May 2024

Background

The number of leadless cardiac pacemaker (LCP) implantations has increased over the recent years, being more frequently performed in elderly patients with multiple comorbidities.

Purpose

The aim of this study is to analyze periprocedural complications and outcome of LCP patients according to their comorbidity status.

Methods

This is a Swiss multi-centre, retrospective cohort study including all consecutive patients implanted with a LCP (Medtronic Micra VR or AV) between 2015 and 2022. Charlson Comorbidity Index (CCI) was determined and patients were divided into two groups: CCI ≤ 5 (low comorbidity) and CCI > 5 (high comorbidity). Periprocedural complications, in-hospital death, and all-cause mortality were assessed.

Results

A total of 863 patients (median age 81 years (IQR 76 – 86), male sex 65%) were included in the study, of which 58% had a CCI ≤ 5. Baseline characteristics of the 2 groups are summarized in the table. Patients in the high comorbidity group were older male presenting more frequently with ischemic cardiomyopathy, diabetes, chronic obstructive pulmonary disease, moderate to severe chronic kidney disease and malignancies. Urgent implantations were more frequent in the high comorbidity than in the low comorbidity group (65% vs. 50%, p<0.001). Overall periprocedural complication rate was 2.9% (n = 25) without significant differences between the two groups (2.9% in both groups, p = 1.0). Pericardial effusion requiring pericardiocentesis was the most frequent periprocedural complication (n = 8, 0.9%). Median hospitalization was significantly longer (5 vs. 3 days, p<0.001), and in-hospital mortality significantly higher (3.6% vs. 0.6%, p=0.002) in the high comorbidity group. None of the in-hospital deaths was deemed a periprocedural complication. Median follow-up was 15.4 months. As shown in the figure, all-cause mortality was significantly higher in the high morbidity group (HR 2.9, 95%-CI 2.2-3.8, p<0.001) resulting in a mortality of 58% at 3 years.

Conclusions

LCP implantation in patients with multiple comorbidities was equally safe with similar peri-procedural complication rates as compared to patients with less comorbidities. However, both in-hospital death and all-cause mortality during follow-up were significantly higher in the high comorbidity group, because patients were older and sicker. Given that costs of LCPs are substantially higher than standard transvenous pacemakers, further studies are necessary to assess cost-effectiveness in patients with high comorbidity and reduced life expectancy.Figure - Survival estimate according CCITable - Baseline characteristics
The pacing threshold improvement of leadless pacemaker is better when mid or high right ventricular septal (RVS) approach than lower RVS approach after follow-up of 3 months
Authors: Kim D , Kim Y J , Jin M N , Park J B
Published: May 2024

Introduction

Leadless pacemaker procedures are rapidly increasing in last decade. Compared to conventional trans-venous pacemaker, pacing threshold of leadless pacemaker is important parameter for longevity (reference 1.). For the safety, right ventricular septum (RVS) is recommended as the pacing location. Recent study (reference 2.) showed that pacing thresholds in most leadless pacemaker implantation patients with elevated thresholds decrease after implant. Therefore, leadless pacemaker repositioning may not be necessary if the pacing threshold is ≤2 V. However, according to pacing location with mid-or above septum versus low or apical septum, pacing threshold stability and improvement during follow-up period after implantation is not clear.

Method

68 cases of leadless pacemaker implantation in 2 hospitals with 3 physicians was analysed. According to pacing location, we divided 2 groups with mid or above RVS and lower RVS. Patients with pacing location on mid or above RVS was 27 (Group A). Other patients with pacing location on lower RVS was 41 (Group B). During follow-up (mean 6 months), we analysed pacing threshold and QRS duration on electrocardiography (ECG) after implantation.

Results

Table 1. shows baseline characteristics including age, sex, and comorbidity were not different significantly between 2 groups. Only HF is lower in group A (14.8% versus 36.6%, p=0.044). Table 2. shows the comparison of 2 groups. Initial threshold of lower RV septal approach (Group B, 0.39±0.14V/0.24ms) showed better than mid or high septal approach (Group A, 0.70±0.33V/0.24ms), p <0.001. However, 3 months later, pacing threshold decreased lower in Group A (mid or above RVS, 0.49±0.17V/0.50ms) than Group B (lower RVS, 0.67±0.50V/0.24ms), p <0.001. Therefore, the change of pacing threshold is improved in Group A (mid or above RVS, -0.20±0.24V/0.24ms) than Group B (lower RVS, 0.28±0.51V/0.24ms), p <0.001. However, other parameters including QRS duration and LVEF after implantation was not different between 2 groups.

Conclusion

The improvement of pacing threshold in mid or high RVS approach demonstrates that pacing threshold stability is more dominant than lower RVS approach. Our data shows that, after follow-up of 3 months, pacing threshold improvement of leadless pacemaker after implantation is better when mid or high RVS approach than lower RVS approach.Figure 1.Table 1. and 2.
Leadless pacemaker implantation versus conventional transvenous cardiac pacing early after transcatheter aortic valve replacement: a safe and relevant option?
Authors: Le Guily G , Rosier G , Vacher E , Poirier A , Le Page S , Ben Kilani M
Published: May 2024

Background

Leadless pacemakers (LPM) are known to have lower postoperative complications than conventional transvenous cardiac pacing especially in frail patients (pts) with many comorbidities.

The aim of this study was to assess the "real-life" feasibility and outcomes of LPMs compared to transvenous pacemakers (TPMs) in patients who underwent transcatheter aortic valve replacement (TAVR).

Methods

This is a retrospective single center study including all consecutive patients who received LPM or TPM (either single or double chamber) implantation early after a TAVR over a one-year period since September 2022 with a follow up period of at least 3 months.

Results

71 pts were included (mean age 82,56 ± 7,1 years old). 16 pts underwent LPM implantation (22,5%). Leadless system pacing was preferred in pts with history of active systemic infection 43,8%, complex conventional vascular approach 12,5 %, deterioration of general condition and clinical frailty 18,8% and history of breast cancer in 25 % pts.

Mean time between appearance of conductive disorders and pacemaker implantation was longer (2,9± 2,8 vs 1,5 ± 1,3 days; p=0,06) in the LPM group probably due to organizational issues. Procedure duration was significantly shorter in the LPM group (46 ±20,5 vs 69 ± 21,1 min; p = 0,01). There was no statistically significant difference in fluoroscopy time between the 2 groups even though this parameter was longer in the LPM group (6,8 min vs 5,6 min; p = 0,413). Significantly lower thresholds were observed in pts with LPM implantation (0,45 ± 0,33 vs 0,66 ± 0,25 V; p = 0,017) with no statistically significant difference between the 2 groups concerning the per-operative impedance value.

Median time from pacemaker implantation to discharge was 3,12 ± 3,26 vs 4,78 ±7,16 days after LPM and TPM implantation respectively (p = 0,195). There were less complications in the LPM group (1,4 % vs 9,9 %; p = 0,471). Complications were: arteriovenous fistula for 1 pt with LPM vs 2 pocket hematomas, 1 pneumothorax, 1 per-operative cardiac arrest and 3 leads dislodgements in pts with TPM. The mortality rate was significantly higher in the LPM group (4,2 % vs 2,8 %; p = 0,038) although no pacemaker related deaths were reported in both groups and no significant difference between the 2 groups was noted concerning rehospitalisations for cardiovascular cause (p= 0,407).

Conclusion

Early LPM implantation after TAVR is a feasible alternative to conventional pacing with significantly shorter procedure durations and better pacing thresholds. Our experience confirms the global clinical frailty of patients receiving LPM after TAVR but underlines the favorable safety profile of leadless system pacing with a low rate of complications.
Outcomes of tine-based leadless pacemakers retrieval: a multicenter study
Authors: Jurisic S , El-Chami M , Schiavone M , Gasperetti A , Tondo C , Gulletta S , Tandri H , Kowal J , Forleo G , Rovaris G , Saleh K , Steinwender C , Deharo J C , Hofer D , Breitenstein A
Published: May 2024

Background

Leadless cardiac pacemakers (LCP) are well established in daily practice and comparable in safety as well as efficacy to conventional transvenous pacemakers. With increasing implant volumes, more patients may need extraction and retrieval of these devices. Data on extractability of LCPs is however scare.

Purpose

The aim of this study is to analyze indication, techniques, efficacy and safety of LCP extractions in a multicenter international registry.

Methods

This is an international, multicenter retrospective registry. Demographic parameters, indication of LCP extraction, success and complication rate were analyzed.

Results

A total of 50 patients (median age 71 years (IQR 64-81), 34% female) were included in this study. 52% of patients received the LCP for complete AV block. The primary underlying cardiac condition was coronary artery disease in 42%. The main indication for LCP extraction was rise in threshold with loss of capture (32%), upgrade to biventricular pacemaker (26%) or upgrade to transvenous dual-chamber device (14%) (Figure 1). The overall success rate of device extraction was 96% with a mean dwell time of the LCP of 715 days (range 0-1477 days). In most cases, a steerable sheath with a single loop snare (71%) was used (Figure 2). Procedure related adverse events were low and included two pericardial effusion (not requiring any intervention) and one case of a device embolization that was retrieved successfully in the same setting. Overall mortality at 7 days was 0 %.

Conclusion

Retrieval/extraction of chronically implanted LCP appear to be safe and feasible in centers with expertise in femoral snaring.Indication for LCP retrievalTools used for LCP extraction
Precordial activation sequences from low frequency analysis in left bundle branch block patients: left bundle branch area pacing vs right ventricular pacing
Authors: Sales Belles C , Minchole A , Cabrera-Ramos M , Pueyo E , Ramos-Maqueda J
Published: May 2024

Introduction

Left bundle branch area pacing (LBBAP) provides a more synchronous and physiological ventricular activation than conventional right ventricular pacing (RVP) in LBBB patients. QRS duration (QRSd) is the standard measurement for assessing depolarization synchrony, but it only provides information about the activation time and not about the activation sequence.

Purpose

Our aim is to assess the activation sequence by precordial activation delay (pAD) using a low-frequency (LF) ECG method comparing baseline and paced ECG in LBBAP and RVP patients.

Methods

Twelve-lead ECGs recordings were acquired from 29 patients with LBBB (16 LBBAP and 13 RVP) after 24 hours of sequential LBBAP or RVP. LF-ECG was employed for QRS-complex analysis. The activation time for each lead was computed and an activation sequence constructed by linking them. pAD was calculated as the time between the first and the last lead activation. pAD provides information about both, the delay in ventricular depolarization as indicated by its magnitude, and the depolarization direction (as it can take a positive or negative value indicating a left or right ventricle delay, respectively).

Results

At baseline, both groups (LBBAP and RVP) showed the latest activation at V5-V6, supported by positive median pAD values with no statistically significant differences between both groups (50 (21, 65) vs. 54 (17, 67) ms, p=0.93). LBBAP reduced V6 delay and pAD values compared to the baseline QRS (basal: 50 (21, 65) vs. paced: 2 (-18, 25) ms, p<0.001) while RVP did not exhibit any difference (basal: 54 (17, 67) vs. paced: 36 (19, 53) ms, p=0.33). LBBAP provided lower pAD values when compared to RVP (2 (-18, 25) vs. 36 (19, 53) ms, p<0.01).

Conclusions

pAD measured using a LF-ECG analysis is a feasible method to evaluate depolarization synchrony and provides complementary information to QRSd. In contrast to RVP, LBBAP generates a physiological ventricular activation sequence in patients with LBBB.Baseline patients characteristicsVentricular activation sequences and pAD
The role of atrial pacing site in reducing filling pressures by accelerated pacing in virtual HFpEF patients
Authors: Van Loon T , Habel N , Van Empel V , Linz D , Delhaas T , Lustgarten D , Vernooy K , Meyer M , Lumens J
Published: May 2024

Background

Patients with heart failure with preserved ejection fraction (HFpEF) and pacemakers have been shown to benefit from moderately accelerated pacing rates compared to the standard 60bpm. HFpEF patients often present with prolonged P-wave duration (PWD) and atrial fibrillation. Right atrial appendage pacing (RAAP) lengthens PWD, RA septal (RASP) has a neutral effect, while Bachmann’s bundle pacing (BBP) normalizes or shortens PWD compared to sinus rhythm. The mechanical and hemodynamic effects of atrial pacing site selection remain unknown.

Aim

To investigate the impact of RAAP, RASP and BBP on cardiac mechanics and hemodynamics in an established cohort of virtual HFpEF patients undergoing accelerated pacing.

Method

HFpEF with prolonged PWD was simulated using the validated CircAdapt computational model of the human cardiovascular system. First, left ventricular (LV) diastolic dysfunction was simulated by decreasing LV myocardial relaxation rate and compliance, such that mean left atrial (LA) pressure (mLAP) was 15mmHg. Second, PWD was prolonged by prescribing a gradual electrical activation delay from RA to LA of 140ms. We then simulated atrial pacing with three different lead positions (Fig.1, left) and gradually increased pacing rate with a constant 120-ms paced atrioventricular (AV) delay. The CircAdapt model computed regional LA strain and mLAP with RAAP, RASP, and BBP. Cardiac output (5L/min) and mean arterial pressure (92mmHg) were kept constant in all simulations.

Results

Simulated BBP demonstrated the most synchronous LA mechanical activation and function, characterized by uniform segmental LA strain patterns and highest LA reservoir strain (LASR) (Fig.1, middle, with colored arrows highlighting the mechanical dyssynchrony). Hemodynamically (Fig.1, right), BBP acutely decreased mLAP (-1.0mmHg) at the initial heart rate of 60bpm, while RAAP increased it (+0.3mmHg). As pacing rate accelerated, BBP reduces filling pressure (mLAP: -2.8mmHg), more than RASP (-1.8mmHg) or RAAP (-1.2mmHg) at 80bpm. At high pacing rates, RASP and RAAP adversely increase mLAP, due to the prolonged atrial contraction duration and shorter LV filling time.

Conclusion

Our simulations of different atrial pacing sites in virtual HFpEF patients suggest that BBP yields the most synchronous LA activation pattern and a more substantial reduction in filling pressures with accelerated atrial pacing compared to RASP. Reduction in mLAP with accelerated pacing was attenuated with RAAP. While our study concentrated on a specific paced AV interval, the favorable outcomes observed with BBP could be further improved by including different, rate-adaptive, AV protocols.Fig 1.
Evaluation of the quality of life of patients with leadless pacing system during 1 year follow-up period
Authors: Baimbetov A , Bizhanov K , Yakupova I , Jukenova A
Published: May 2024

Background

Leadless pacemakers (LesPM) are a new safe alternative technology for pacing the right ventricle. However, not enough information is available on their potential benefits for quality of life (QoL) in patients with LesPM. The purpose of the study was the quality of life comparison of patients with LesPM and conventional pacemakers (ConvPM).

Methods

The study included patients who underwent implantation of a single-chamber pacemaker from December 2018 to March 2023. We used the SF-36 Questionnaire to assess quality of life at baseline and after 12 and 24 months of follow-up. We also used a questionnaire consisting of 10 specific questions related to the implantation procedure.

Results

Total of 50 patients were included (25 LesPM; 25 ConvPM). There were no differences in baseline characteristics between groups (LesPM vs. ConvPM), except for age (47.5 vs. 57.3 years; P = 0.012) and diabetes 28% vs. 21%; P = 0.021). Baseline SF-36 did not differ between groups. After 6 months of follow-up, patients in the LesPM group showed significantly higher scores on physical function (47 vs 32; P<0.001), physical role (53 vs 37; P=0.004) and mental health (67 vs 52; P=0.017), even after adjusting for covariates. Pacemaker-related discomfort and physical limitations were significantly lower in the LesPM group.

Conclusion

LesPM is associated with a better quality of life than ConvPM, both in terms of physical and mental health. Patients who underwent LesPM implantation reported less procedure-related discomfort, physical limitations, and anxiety.
Anatomical considerations for the subcutaneous implantable cardioverter-defibrillator (SICD) implantation: a cadaver-based analysis
Authors: Khalil P , Hossein M , Barremkala M , Grogan J , Williamson B
Published: May 2024

Background

Subcutaneous implantable cardioverter-defibrillators (SICDs) offer primary and secondary prevention of sudden death without transvenous leads in individuals not requiring pacing therapy. Intermuscular placement of the SICD generator between the latissimus dorsi (LDM) and serratus anterior (SAM) muscles is often recommended. This specific technique results in reduced defibrillation impedance and subsequently optimal defibrillation thresholds, reduced risk of pocket complications and infections, reduced device migration, and enhanced patient comfort and cosmetic outcomes.

Despite the recommendation for an intermuscular implant technique utilizing a mid-axillary incision line, there is limited research describing this anatomical space to avoid complications. In this anatomic study, we examined this anatomical space. Our aim was to provide a better understanding of the interplay between the involved muscles and a proper location of an incision line. We also defined the location of the long thoracic nerve (LTN) relative to this space, which if transected, would lead to a winged scapula.

Methods

We examined 18 cadavers; 12 (66.7%) were female donors and 6 (33.3%) were males. We measured the distance from the anterior border of the LDM in relation to the cadaver back (A) and in relation to the anterior-posterior diameter of the chest (B). We performed these measurements at the 5th and 7th rib levels, and then averaged these measurements. We also measured the distance from the back to where the LTN enters SAM at the 4th, 5th, and 6th ribs.

Results

Analysis of the obtained data showed that the mean distance from the back to the anterior border of LDM at the 5th rib was 7.55 cm (5.65 – 10.85 cm) and at the 7th rib was 7.60 cm (5.35– 10.35 cm). Mean distance from the back to the anterior LDM border in both 5th and 7th ribs combined was 7.58 cm (5.50 – 1.06 cm). The mean anterior-posterior diameter of the chest wall at the fifth rib was 21.45 cm (18.55 – 24.75 cm). The mean A/B ratio (that is the ratio between the distance from the back to the anterior LDM border in comparison to the anterior-posterior chest diameter) was 0.4 with a standard deviation of +/- 0.1 (range 0.27-0.45).

The LTN was running anterior to the LDM border at the 4th rib level, and posterior to the LDM border at the 5th and 6th ribs level. The LTN entered the SAM at the 4th rib level in 6.6%, at the 5th rib in 46.6% and at the 6th rib in 46.6% of cadavers.

Discussion

Intermuscular technique for S-ICD implantation is recommended as the preferred procedural approach. In our postmortem study, the anterior LDM border was variable but posterior to the mid-axillary line with a variable A/B ratio of 0.27 – 0.45.

Our study also demonstrates the proximity of the long thoracic nerve (LTN) in comparison to the anterior LDM border. Caution should be taken when implanting S-ICD devices to avoid LTN injury.
Implant failure predictors of left bundle branch pacing used as cardiac resynchronization therapy: importance of left ventricular diameter and QRS morphology
Authors: Graterol F R , Pujol-Lopez M , Borras R , Ayala B , Guasch E , Regany-Closa M , Guichard J B , Castel M A , Arbelo E , Porta-Sanchez A , Sitges M , Roca-Luque I , Doltra A , Mont L , Tolosana J M
Published: May 2024

Background

Left bundle branch pacing (LBBP) is considered an alternative to cardiac resynchronization therapy (CRT). However, LBBP is not suitable for all heart failure patients.

Purpose

The aim of our study was to identify predictors of unsuccessful LBBP implantation in CRT candidates.

Methods

A cohort of consecutive patients with indications for CRT were included. Clinical, echocardiography and electrocardiographic variables were prospectively recorded.

Results

A total of 157 patients were included in the analysis. The LBBP implant was successful in 129/157 (82.2%) patients, and the implant failed in 28/157 patients (17.8%). The causes of failed implantation were as follows: unsatisfactory paced QRS (21/28; 75%); impossibility of screwing the helix (4/28; 14.3%); lead instability (2/28; 7.1%); and high pacing thresholds (1/28; 3.6%). Left ventricular end diastolic diameter (LVEDD), nonspecific intraventricular conduction delay morphology (IVCD), and QRS width were predictors of failed implants according to the univariate analysis. In a multivariable regression analysis, LVEDD [OR 1.44 per 5 mm increase (95% CI 1.13, 1.82) p=0.003] and IVCD [OR 2.96 (95% CI 0.74, 11.84) p=0.09] were independent predictors of unsuccessful LBBP implantation. An LVEDD of 60 mm has 75% sensitivity and 67% specificity to predict LBBP implant failure.

Conclusions

When LBBP was used as CRT, LVEDD and IVCD predicted unsuccessful implantation. IVCD triples the possibility of failed implantation independently of LVEDD. Caution should be exercised when considering these parameters to plan the best pacing strategy in patients.