bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of left bundle branch area pacing to restore narrow QRS in patients with right bundle branch block
Authors: Kupper J , Lejeune S , Garnir Q , Wauters A
Published: May 2024

Background/Introduction

Left bundle branch area pacing (LBBaP) is an innovative technique used to capture conduction tissue and maintain ventricular synchrony during pacing.

There are few data about the efficacy of LBBaP in right bundle branch block (RBBB).

Purpose

To compare the response to LBBaP, evaluated by the change in QRS duration (QRSd) after pacing, in patients with RBBB, left bundle branch block (LBBB) or without conduction disorder.

Methods

A total of 162 patients with pacemaker indication underwent LBBaP with stylet driven lead with dedicated sheaths, between November 2020 and April 2023. ECG characteristics were evaluated. Data are presented in mean ± standard deviation (SD) or n (%). Paired sample t-test was used to compare QRSd before and after pacing.

Results

Indications for pacing were atrioventricular block (AVB) 48,4 %, sinus node dysfunction (SND) 37,7 %, AVB and SND 10,7 % and cardiac resynchronization therapy 3,1 %. LBBaP was successfully performed in 98 % (159/162) of patients (78 ± 10 years, 62 % male). Overall, baseline QRSd was 113,2 ± 26,7 ms and paced QRSd was 112,3 ± 14,8 ms (p = 0,662), with left ventricular activation time (LVAT) of 69 ± 14 ms (table 1).

Baseline ECG showed 18 LBBB, 29 RBBB and 11 undetermined conduction disorder. In every kind of conduction disorder, paced QRSd was reduced to < 120 ms (table 2).

Notably, paced QRSd was < 120 ms, regardless of baseline QRSd. In patients with most important pre-existing conduction disorder (QRS ≥ 145 ms), an impressive reduction in QRSd was observed (Delta = -40,8 ms , table 1).

Conclusion

LBBaP with stylet driven lead is an effective approach to obtain short paced QRS regardless of baseline QRSd and of the nature of the initial conduction disorder. This opens new perspectives for cardiac resynchronization in patients with RBBB.
Oral flecainide therapy and myocardial pacing: preliminary data from a prospective multicenter registry
Authors: Niglio F , Santoro F , Palmisano P , Gianfrancesco D , Ragnatela I , Pellegrino P L , D'arienzo G , Coluccia G , Bartolomucci F , Brunetti N D
Published: May 2024

Background

Antiarrhythmic drugs, class I are widely used for prevention of atrial fibrillation recurrence. However, previous studies found that these drugs could affect pacing thresholds among pacemaker recipients.

Aim of the study: evaluate short -term effect on myocardial pacing following therapy with oral flecainide (200 mg/daily).

Methods

45 consecutive pacemaker recipients were prospectively enrolled in a multicenter registry. These patients had preserved left ventricular ejection fraction, a dual chamber pacemaker with symptomatic sustained high-rate atrial fibrillation episodes and stable output atrial and ventricular thresholds. Patients were followed with ambulatory and/or remote monitoring.

Results

mean age was 74±1 years, 48% pts were male and AF burden was 8±16%. Pacemaker implantation was performed 3.9±0.3 year before study enrollment.

Three (6%) out of 45 patients were excluded due to drug sided effects including dyspnea (n=1), diplopia

(n=1) and toxicity during acute renal insufficiency (n=1).

Flecainide treatment was associated with a significant reduction of atrial fibrillation burden (from 8±16% to 5±12%, p<0.01).

At 30 days follow-up since Flecainide starting therapy both atrial and ventricular sensing significantly

decreased (3.6 ± 2.2 vs 3.4 ± 2.1mV p=0.01; 12.5±6.6 vs 11.8±6.3 mV p=0.01), while there was a slight

increase of both atrial and ventricular capture thresholds (0.77±0.61V@0.4ms vs 0.80±0.42V@0.4ms

p=0.01; 0.80±0.53V @0.4ms vs 0.83±0.33V @0.4ms p=0.01). No patient required pacemaker parameters reprogramming.

Conclusions

oral flecainide therapy among pacemaker recipients at 30 days follow-up seems to be safe

and do not affect device function. Further studies with additional follow-up data are warranted.
LV systolic function assessment in conventional cardiac pacing: a simple and forgotten parameter - MAPSE
Authors: Cirin L , Luca C T , Gaita D , Hocher A , Faur A , Cozgarea A , Gurgu A , Vacarescu C , Cozma D
Published: May 2024

Background

Mitral annular plane systolic excursion (MAPSE) was a widely used M-mode echocardiographic marker of left ventricular longitudinal systolic function. On the other hand, right ventricle (RV) apical pacing is associated with left ventricle (LV) dysfunction development due to dysynchronous activation, while non-apical pacing may provide a more physiological LV activation. The aim of this study is to ascertain the clinical usefulness of MAPSE in the assessment of LV contractile function in patients with permanent RV pacing.

Methods

Consecutive patients with indication for permanent cardiac pacing (with ventricular pacing percentages over 20% - Vp>20%) were retrospectively enrolled from 2019 to 2023. All patients were assessed by echocardiography with MAPSE, left ventricule ejection fraction (LVEF) and diastolic filling patterns being measured at the time of implant and at subsequent follow-ups.

Results

359 patients (age range 41-80yo; mean age=60,5yo) were included, 244 men and 115 women, 173 implanted with single-chamber devices and 186 dual-chamber. 259 patients were paced from the RVA (right ventricle apex) and 62 had septal lead positioning. The mean follow-up period was 18±2 months. The results showed that a MAPSE cut off value of ≤10 mm was associated with a LVEF<42±2%, while MAPSE values >10mm were associated with LVEF>45±3% (p<0.01). RV septal pacing was associated with a higher average MAPSE value (14,28 mm) than RVA pacing (13,47).

Conclusions

MAPSE seems to corelate well with LVEF in RV conventional pacing. Younger patients with preserved LVEF and less than grade II diastolic dysfunction were not associated with a significant decrese in MAPSE value. However, older patients with HFmrEF and RVA pacing seem to have a more substantial reduction in MAPSE value, suggesting that non-apical or conduction system pacing might be beneficial in this subgroup. MAPSE seems to be a quick and reliable echocardiographic marker of LV systolic function in patients with permanent cardiac pacing. It may be used as an early predictive marker for heart failure in conventional RV paced patients.
Emergency leadless pacing implantation is feasible and safe out-of-hours
Authors: O'rourke F , Sevier L S , Elliot J E , Creta R H , Hunter R H , Sporton S S , Sawhney V S , Schilling R S , Finlay M F
Published: May 2024

Introduction

Leadless pacing is increasingly used in patients with contraindications to transvenous systems. However, a common presentation of life-threatening bradyarrhythmia is in the out-of-hours emergency setting. The perceived complexities of leadless implantation anecdotally inhibit their use as destination devices implanted in the acute setting. Our centre offers a 24-7 emergency pacing service, we examined our use of leadless pacemaker implantation for patients requiring out of hours emergency pacing at our centre from December 2021 to December 2023.

Purpose

The purpose of this study looking to examine the feasibility and safety of leadless pacing in out of hours emergency situations.

Methods

This is a single centre retrospective cohort study examining all patients (pts) undergoing leadless pacemaker implantation at 1 hospital. Out of hours (OOH) implantation was defined as being after 18:00 during the week and any time during the weekend. Clinical and procedural parameters were compared between in-hours and out of hours (OOH) implantation. Haemodynamic instability was defined as any patient requiring inotrope support.

Results

118 leadless pacing systems were implanted between 0/1/12/2021 and 01/12/2023; 95 being performed in-hours and 23 OOH. Pacing indication was high-degree AV block in 20 pts (87%) in the OOH group, with frailty (8pts), dialysis (4pts) and infection (3pts) being listed as the most common reasons for selection of a leadless system in the OOH group. OOH pts had greater haemodynamic instability [in-hours: 3pts (3.2%) vs OOH: 4pts (17.4%)]. Procedural time (mean ± Standard deviation, mins) was similar between groups [52.4 (±3.6) in-hours vs 59.7(+/- 6.4) OOH; p= 0.33] as was fluoroscopy time (mins) [in-hours: 4.9 (+/- 1.0) vs OOH: 5.1(+/- 2.3) p=0.97] and radiation dose (cGy*cm²) [in-hours: 56.73 (+/- 9.87) vs OOH: 53.8(+/- 14.1), p=0.89].

3 (3.1%) major complications occurred in the in-hours group [tamponade (2pts), infection (1pt)]. One pt in the OOH group had a significant post procedure access site bleed (4.3%), but no tamponade occurred in this group.

Four pts (4.2%) died before discharge in the in-hours group, four patients (17.4%) died in the OOH group, reflecting their poor premorbid condition.

Conclusions

Leadless pacemakers can be safely implanted in the emergency, out of hours setting. In selected patients, this technology can offer an immediate destination therapy as an important alternative to placing a temporary system.
Clinical impact of ICD implantation in octogenarians: a longitudinal cohort study
Authors: Spoladori M , Crocamo A , Capoccia F , Rizzello D , Vrenozaj R , Bettella A , Palumbo A A , Cavalli S , De Maria M , Zilioli C , Bearzot L , Gonzi G L , Niccoli G , Ardissino D , Notarangelo M F
Published: May 2024

Background

The implantation of defibrillators (ICDs) in patients over 80 years old is becoming increasingly common; however, evidence-based data regarding the actual clinical benefit in this population remain limited and contradictory. While age seems not to affect mortality and arrhythmia risk in octogenarians undergoing secondary prevention, the mortality reduction benefit given by ICD implantation for primary prevention appears to decrease with advancing age, likely due to the high number of non-arrhythmic deaths.

Purpose

This study aims to assess the long-term incidence of ventricular arrhythmias and mortality in a real-world cohort of octogenarian patients undergoing ICD implants.

Methods

This was an observational, retrospective, longitudinal cohort study. Demographic, clinical, and radiological data were collected for all patients undergoing ICD implantation between 2014 and 2021. Deaths from all causes and significant arrhythmic events (sustained ventricular tachycardias and ventricular fibrillation) detected during routine device controls and remote monitoring were recorded. Then was performed an univariate Kaplan-Meier analysis, stratifying the population by age in relation to the two study endpoints: ventricular arrhythmias and all-cause mortality.

Results

Out of a total of 700 patients, 512 underwent ICD implantation before the age of 80 (mean age at implantation 64±12), while 188 underwent ICD implantation after the age of 80 (mean age at implantation 82±3.2). No significant differences were found between these two groups in terms of gender (82% vs. 83% male; p 0.12), indication for implantation (74% vs. 75% primary prevention; p 0.79), and the presence of late gadolinium enhancement (LGE) on cardiac MRI (68% vs. 77%; p 0.14). Octogenarians were more frequently affected by ischemic heart disease (54% vs. 65%; p 0.01) and were more frequently treated with Amiodarone (17% vs. 24%; p 0.02). At the end of the average 8-year follow-up, octogenarians had significantly higher all-cause mortality than younger patients (HR=2.35 [1.88-3.16]; p<0.05), with survival curves diverging from 3 years after implantation. However, ventricular arrhythmic events were significantly reduced in octogenarian patients (HR=0.88 [0.87-0.89]; p<0.05).

Conclusions

In a real-world population of octogenarian patients, the clinical benefit of ICD implantation for primary prevention appears diminished, considering the trade-off between ventricular arrhythmias and mortality, in both ischemic and non-ischemic cardiomyopathy patients.
LVSP and LBBP result in similar or improved LV synchrony and hemodynamics compared to biventricular pacing
Authors: Poviser L , Stros P , Jurak P , Kautzner J , Whinnett Z , Jastrzebski M , Waldauf P , Hozman M , Osmancik P , Curila K
Published: May 2024

Background

The effect of left ventricular myocardial septal pacing (LVSP) and left bundle branch pacing (LBBP) on ventricular synchrony and LV hemodynamics is poorly understood in unselected cardiac resynchronization therapy (CRT) patients.

Aim

To investigate the impact of LBBP and LVSP on ultra-high-frequency ECG (UHF-ECG) ventricular synchrony and hemodynamics in CRT patients.

Methods

In consecutive CRT patients with LBBB, ventricular synchrony was assessed using UHF-ECG. LV hemodynamics was assessed using invasive systolic blood pressure measurement during multiple transitions between LBBP, LVSP, and biventricular pacing (BVP). LV synchrony was assessed by LV lateral wall delay (LVLWd) from the first to the last from V5-V8 activations. Hemodynamic effects were expressed as relative changes in systolic blood pressure.

Results

Thirty patients with an LVEF of 29 ± 6% and mean QRSd of 169 ± 24 ms were included. Twenty had non-ischemic cardiomyopathy. QRSd during BVP, LVSP, and LBBP was the same, but LBBP provided shorter LVLWd than BVP (-9 ms (-16; -4), p = 0.004); the difference between LVSP and BVP was not significant (-4 ms (-10;2), p = 0.2). LBBP was associated with higher systolic blood pressure than BVP (4% (2; 5) p < 0.001), while LVSP was not (1% (1; 2), p = 0.1. LV hemodynamic improvements during LBBP and LVSP vs. BVP were more pronounced in non-ischemic than ischemic patients.

Conclusion

The differences in ventricular synchrony between LBBP, LVSP, and BVP were demonstrated using UHF-ECG but not QRSd. LBBP, but not LVSP, was associated with better LV synchrony and hemodynamics than BVP.Local activation times in V1–V8Ventricular dyssynchrony and hemodynamic
Cardiac resynchronization therapy using endocardial versus trans-coronary sinus, epicardial left ventricular pacing: the Epi-Endo study
Authors: Okafor O , Zegard A , Stegemann B , Kalla M , Lencioni M , De Bono J , Marshall H , Leyva F
Published: May 2024

Aims

Some studies have suggested that cardiac resynchronization therapy (CRT) using endocardial left ventricular (LV) pacing (Endo-CRT) is superior to a conventional transvenous, epicardial CRT (Epi-CRT). To determine whether, in CRT recipients, endocardial LV pacing is haemodynamically superior to trans-coronary vein (trans-CV) LV epicardial pacing.

Methods and results

At implantation patients (n=16; aged 68.9±8.32 years; 13 male) underwent Epi-CRT and Endo-CRT in basal, mid and apical myocardial segments, delivered using the trans-CS lead and an intra-cavitary, roving EP catheter to achieve juxtapositions of the epicardial and endocardial side of the LV free wall respectively. Myocardial scar was quantified using cardiovascular magnetic resonance. An acute haemodynamic response (AHR) was defined as a ≥10% increase in the maximal rate of rise of LV pressure (%LV dP/dtmax) in relation to RV pacing (DOO). When the 84 paired segments were taken together, the %ΔLV dP/dtmax was higher with Endo-CRT than with Epi-CRT (9.9±8,6% vs 7.9±8.3% respectively, p<0.002; 52.3% vs 28.6% responders [p<0.045). However, Endo-CRT was not always superior to epi-CRT in individual patients. For example, in basal segments, only 5/10 (50%) patients were converted from non-responders with epi-CRT to responders with endo-CRT whereas 1/4 (25%) epi-CRT responder was converted to a non-responder with endo-CRT (Figure). There was no difference in ΔLV dP/dtmax between Epi-CRT and endo-CRT in segments with myocardial scar.

Conclusions

On average, endo-CRT provides a better AHR than epi-CRT. Within patients, however, endo-CRT is not always better.Epicardial versus Endocardial CRT
Clinical and long term safety outcomes of conduction system pacing compared to biventricular pacing : a large retrospective cohort study
Authors: Lachance R , Ayala-Valani L , Pelchat L P , Badra M , Dussault C , Roux J F , Ayala-Paredes F A
Published: May 2024

Background

Biventricular pacing (BVP) is the gold standard for cardiac resynchronization therapy (CRT). Recently, studies have shown promising results for conduction system pacing (CSP) as an alternative to BVP. However, the small study samples and paucity of data concerning long term safety of these devices prevent CSP from being used as first line therapy.

Purpose

This study examines clinical outcomes and long term safety of CSP compared to BVP.

Methods

We conducted a retrospective cohort study from patients receiving CSP or BVP. All patients implanted with either CSP (N = 282) or BVP (N = 216) from 2018 to 2023 were included. Patients had to complete at least 3 months of follow-up and CSP patients had to pace at least 20% of time at first visit. The outcomes were defined as at least one heart failure hospitalization and the complication rates for both arms.

Results

Median [IQR] follow-up time was 1.64 years [0.73 – 2.80]. Heart failure admissions were numerically lower for CSP group but when adjusted to confounders the adjusted odds ratio was 0.75 in the CSP group compared to BVP ([95% CI, 0.43-1.31]; P = 0.32). Long term complication rates (infection, lead dysfunction, diaphragmatic stimulation requiring system revision, etc.) were lower in the CSP group (4 [1.4%] vs 10 [4.7%]; odds ratio, 0.21 [95% CI, 0.06-0.69]; P = 0.01). Short term complication rates (lead displacement, infection, pneumothorax, etc.) were however similar for both arms (16 [5.7%] vs 11 [5.1%]; odds ratio, 1.53 [95% CI, 0.64-3.65]; P = 0.33). In two patients, septal lead extraction after over a year was possible without any sequelae. The change in the QRS duration went from 150 ms to 149 ms for group (p=NS) and from 153ms to 144ms for comparable CSP group (P = 0,01). Left ventricular ejection fraction (LVEF) increased from 28% to 40% in the BVP group and from 32% to 40% in the CSP group with pre intervention LVEF less than 50% (P < 0.0001 for both groups). Procedure duration was significantly shorter for CSP (82.3 minutes [32] vs 93.1[39.1]; P = .0002).

Conclusion

CSP approach achieves similar clinical results as BVP, with significantly less complications, shorter implant times, shorter QRS durations and comparable LVEF improvement. All these favorable results are obtained using less leads and simpler devices.
Multicenter hemodynamic assessment of the LOT-CRT strategy: when is one lead enough for resynchronization?
Authors: Jastrzebski M , Foley P , Vijayaraman P , Whinnett Z , Upadhyay G A , Schaller R D , Gardas R , Richardson T , Kudlik D , Stadler R W , Zimmerman P , Waxman R , Cornelussen R N , Lyne J , Herweg B
Published: May 2024

Background

Left bundle branch area pacing (LBBAP) has been postulated as an alternative to traditional cardiac resynchronization therapy via biventricular pacing (BiV) in heart failure patients with wide QRS. Limited data is available regarding the acute hemodynamic response of LBBAP and the combination of LBBAP and coronary venous (LVcv) pacing (LOT-CRT).

Purpose

We sought to compare the acute hemodynamic and ECG effects of traditional CRT (BiV or LV-only) versus LBBAP and LOT-CRT in CRT candidates with advanced conduction disease.

Methods

In this multi-centre study (5 EU and 7 US centres), 48 subjects (mean age 65.8 years, 67% males, LV ejection fraction 29.4%) with either nonspecific interventricular conduction delay (NIVCD, n = 29) or left bundle branch block (LBBB; n =19; based upon strict criteria AHA/ACC/HRS plus Strauss) underwent an acute hemodynamic study to determine the % change in +LV dP/dtmax from baseline atrial pacing versus BiV, LBBAP, or LOT-CRT. Each therapy pacing configuration was applied 4 times at 5 different atrioventricular (AV) delays. QRS shortening was assessed using standard 12-lead ECG.

Results

Successful LBBAP lead implantation was achieved in 27 patients (56%) using current EHRA criteria. Twenty-one patients (44%) were categorized as deep septal pacing (DSP), due to suboptimal lead penetration or advanced left conduction system disease with broad paced QRS complexes and absent V1-r-wave. The increase in AV-optimized dP/dtmax for the different pacing configurations is displayed in the Figure, left panel. LOT-CRT dP/dtmax % improvement was 25.8%, significantly higher than LBBAP configurations (p<0.01), either unipolar-LBBAP (19.3%), or bipolar-LBBAP (16.4%), but not different from BiV (26.4%). QRS shortening was greater in LOT-CRT (29.5ms) vs. unipolar-LBBAP (11.9ms), bipolar-LBBAP (11.7ms), or BiV (18.5ms), all p<0.01. Sub-group analysis indicated the hemodynamic benefit of adding LVcv pacing when LBBAP strategy was pursued (Figure, right panel) depended on obtaining LBBAP rather than DSP (p < 0.01) and baseline QRS duration (p = 0.03). The largest benefit was observed among subjects with a baseline QRS wider than the observed cohort mean (171ms) and DSP only, where LOT-CRT provided 14.5% (5.0-24.1%) greater dP/dtmax improvement and 20.8ms (12.8-28.8ms) greater QRS duration shortening than unipolar DSP.

Conclusions

In a CRT cohort with advanced conduction disease, LOT-CRT provided greater acute hemodynamic benefit than LBBAP strategy (i.e. including also DSP cases). Patients with wider QRS or suboptimal outcome of LBBAP strategy (DSP) are more likely to benefit from addition of a LVcv lead to implement LOT-CRT.Figure 1
Re-classification of response to cardiac resynchronization therapy: the long-term effect of echocardiographic non-progression
Authors: Behon A , Merkel E D , Schwertner W R , Kuthi L K , Veres B , Masszi R , Osztheimer I , Zima E , Geller L , Kosztin A , Merkely B
Published: May 2024

Introduction

Approximately one-third of patients undergoing cardiac resynchronization therapy (CRT) implantation fail to show echocardiographic improvement and are categorized as non-responders, despite of probable beneficial clinical response.

Purpose

We aimed to evaluate the long-term outcome of CRT patients by their echocardiographic response outsorting those with unchanged parameters.

Methods

Altogether 1019 patients undergoing CRT implantation between 2000-2020 in our center were analyzed retrospectively. Patients were grouped by their echocardiographic response defined as LVEF change upto12 months: super-responders ≥20% (n=113), responders 6-19% (n=448), non-progressors 0-5% (n=244), and progressors <0% (n=214). The primary endpoint was the composite of all-cause mortality, heart transplantation, or left ventricular assist device implantation.

Results

During the median follow-up time of 4.7 years 547 (54%) patients died, 35 (31%) super-responders, 223 (50%) responders, 133 (55%) non-progressors, and 156 (73%) progressors. The mean change in LVEF occurred as follows: super-responders 24.5% ± 4.1%, responders 11.5% ± 3.8%, non-progressors 2.8% ± 1.8%, and progressors -6.6% ± 4.5% (p<0.001). Univariate Cox regression analysis revealed that non-progressors had a similar outcome to responders (HR 1.17; 95%CI 0.94-1.45; p=0.15) and a superior outcome to progressors (HR 0.60; 95%CI 0.48-0.76; p<0.001), which was also confirmed by multivariate analysis: non-progressors vs. responders (HR 1.25; 95%CI 0.98-1.58; p=0.07) and non-progressors vs. progressors (HR 0.62; 95%CI 0.47-0.80; p<0.001).

Conclusion

In our current analysis, non-progressors had a superior outcome to progressors suggesting that CRT moderates the remodeling process. These findings indicate their selection and the re-classification of CRT response by echocardiographic changes.Survival by responseMean change in LVEF by response
Patient satisfaction followed by remote monitoring
Authors: Mendez Zurita F , Grande Osorio M , Majo Ramirez D , Rodriguez Font E , Alonso Martin C , Guerra Ramos J , Moreno Weidmann Z , Campos Garcia B , Gilces Bravo E , Ybarra Falcon C , Ramirez De Diego I , Sanchez Martin L , Lucero Calabuig P , Vinolas Prat X
Published: May 2024

Introduction

Remote monitoring (RM) of cardiac implantable electronic devices has increased significantly in the last years. The safety and efficacy of RM have been demonstrated, however, there are few data on patient satisfaction. The objective of this study was to evaluate the satisfaction of patients with an implanted pacemaker (PM) followed through remote monitoring.

Methods

Patients implanted with a conventional or leadless PM who had been using RM system for at least 3 months were included. Patients had to be able to understand and answer questionnaires, having no significant cognitive impairment. An specific, and previous validate, patient satisfaction RM questionnaire with 30-item, self-completed, measured on a 5-point Likert scale (0=No, nothing, 4=Yes, a lot) was administered. The questionnaire is structured in 5 dimensions: Information on cardiac condition, device convenience, transmission process, satisfaction with medical monitoring, and benefits. The results are presented as mean. The difference between mean was analyzed using the T-Student test.

Results

A total of 98 patients were included (77.8±8.2 years old, 67% male), 82 % had conventional PM and 18 % leadless PM. According RM connectivity 70% had daily automatic transmission, 12% automatic transmission and 18% manual transmission. On average, participants answered 83% of the items. The overall satisfaction of the patient was high (3.66). The mean score for each dimension is summarized in Table 1. The Device convenience had the highest mean (3.75), and the Transmission process had the lowest mean (3.56). There was no difference between patients with a conventional pacemaker versus leadless pacemakers (Fig 1, p=0,30).

Results

Patients with PM followed through RM have a high level of satisfaction when evaluated using an specific questionnaire. The level of satisfaction is independent of the type of PM or the connectivity of the system.Table 1Mean dimension score by device type
Early relevant alerts from remote monitoring in heart failure patients with a cardiac implanted electronic device: what implications for long term outcome?
Authors: Mei D A , Imberti J F , Sbarra F , Serafini K , Mantovani M , Leo G , Cherubini B , Gerra L , Vitolo M , Bonini N , Mauro E , Turco V , Casali E , Boriani G
Published: May 2024

Background

Alarms generated by remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) have been associated with worse clinical outcomes in patients with heart failure (HF). However, whether the timing of RM alerts impact on the clinical trajectories of HF patients is still debated.

Purpose

To examine the impact of alerts occurring in the first 180 days after CIED implant on clinical outcomes, as well as potential predictors.

Methods

we retrospectively enrolled all patients with a history of HF implanted with a CRT-D or an ICD at our tertiary. We collected data regarding ATP, shock and HF score above threshold (defined as multiparametric scores provided and validated by all CIED manufacturers). We defined early relevant alerts (Early-RA) as alarms received during the first 180 days after implant. The primary clinical outcome of the study was a composite of death or HF hospitalization. Logistic and Cox regression analyses were used to determine associations. The occurrence of early-RA was used as a time dependent covariate.

Results

A total of 272 patients were included in the analysis (median age 67.4 years, IQR 58.6-74.6, 19.9% female). Twenty patients had an early-RA (7.3% of the overall study population) and were found to be older, more severely symptomatic for HF, with a higher prevalence of atrial fibrillation (AF) and chronic kidney disease (CKD) (all p values<0.05). On the other hand, HF etiology and prevalence of CRT-D did not differ between the two groups.

At univariate logistic regression analysis, we found the following factors as significantly associated with early-RA: age (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.00-1.10), NYHA class (OR 2.44, 95% CI 1.01-5.82) and CKD (OR 3.41, 95% CI 1.21-8.98), but these results were not confirmed at the multivariable logistic regression.

After a median follow-up of 959 days (IQR 432-1484), patients reporting an early-RA had more primary outcome events (45.0% vs 12.3% p<0.001). At time-dependent multivariable Cox regression analysis adjusted for age, sex, left ventricular ejection fraction and type of CIED, we found that early-RA were independently associated with a higher risk of the primary outcome (hazard ratio [HR] 3.61, 95%CI 1.42-9.18) (Figure). Early-RA were also associated with a higher risk of death (HR 5.58, 95% CI 1.68-18.50) while no significant association was found for HF hospitalization (HR 2.46, 95% CI 0.80-7.57, p=0.116).

Conclusions

The occurrence of alerts detected by RM of CIEDs in a relatively early phase (within 180 days from implant), is associated with a higher risk of a composite of death and HF hospitalization in HF patients.Study Outcome according to Early RATime dependent Cox regression
Lead break during extraction - predisposing factors and impact on procedure complexity and outcome on the basis of analysis of 3825 procedures
Authors: Kutarski A , Jachec W , Czajkowski M , Stefanczyk P , Kosior J , Nowosielecka D , Tulecki L
Published: May 2024

Background

There are no reports describing lead break (LB) during transvenous lead extraction (TLE). Our aim was to compare the effectiveness of different approaches and tools used for LB removal during 127 procedures.

Methods

Retrospective analysis of 3825 consecutive TLEs using mechanical sheaths.

Results

Fracture of the lead defined as LB with a long lead fragment (LF) occurred in 2.48%, LB with a short LF in 1.20%, LB with the tip of the lead in 1.78% and LB with loss of a free-floating LF in 0.57% of cases. In total, extractions with LB occurred in 6.04%. In cases in which lead remnant was equivalent to a lead fragment (more than the lead tip only) there was a 50.31% chance of removing the LF in its entirety and an 18.41% chance of significantly reducing its length (to less than 4 cm). Risk factors for LB are similar to those for major complications and increased procedure complexity: long lead dwell time [OR=1.018], higher LV ejection fraction, multiple previous CIED-related procedures and extraction of passive fixation leads. A superior approach was the most popular (75.59%), femoral (15.75%) and combined (8.66%) approaches were the least common. Broken lead fragments (BLFs) were removed in their entirety in 63.78% and BLF length was significantly reduced (to less than 4 cm) in 24.41%. The best results were achieved when BLFs were longer (>4 cm) (66.67%), either free-floating or in the pulmonary circulation (68.42%) but not in cases of short BLFs (20.0%). Complete procedural success was achieved in 70.87% of procedures, the lead tip retained in the heart wall and short BLFs were found in 25.98%, whereas BLFs > 4 cm were left in place in 3.15% of procedures only. There was no relationship between approach in lead remnant removal and long-term mortality. All forms of LB were associated with increased procedure complexity and major complications (9.96% and 1.53%). There was no procedure-related death among such patients and LB did not affect survival after TLE.

Conclusions

1. LB during TLE occurs in 6.04% of procedures and it increases procedure complexity and risk of major complications. Thus, the possibility of LB should be taken into account when planning lead extraction strategy and training. 2. Effectiveness of fractured lead removal is satisfactory. 3.Risk factors for lead fracture are implant duration (16.27 years on average), ventricular leads (71.65%), passive fixation leads (97.63%) and pacemaker leads (92.13%), but not ICD leads (only 7.87% of lead fractures). 4. Broken lead removal using a coronary sinus access sheath as a "subclavian workstation" for continuation of dilatation with conventional tools deserves attention.
LECOM (Lead Extraction COMplexity): a new scoring system for prediction of a difficult procedure
Authors: Jachec W , Nowosielecka D , Ziaja B , Polewczyk A , Kutarski A
Published: May 2024

Background

Transvenous lead extraction (TLE) can become far more complex when unanticipated difficulties arise.

Aim

The aim of this study was to develop a simple scoring system that allows prediction of difficulty and complexity of this important procedure.

Methods

Based on a retrospective analysis of 3741 extraction procedures (extended fluoroscopy time, need for second-line instruments, and advanced techniques and instruments), a 5-point Complex Indicator of Difficulty of T(LE) Procedure (CID-TLEP) scale was developed. Two or more points on the CID-TLEP scale indicated a higher level of procedure complexity.

Results

Multivariate regression analysis showed that patient age below 51 years at first CIED implantation, number of abandoned leads, number of previous CIED-related procedures, passive fixation leads to be extracted, multiple leads to be extracted, and a ratio of dwell time of oldest extracted lead to patient age during TLE of >0.13 are significant predictors of higher levels of lead extraction complexity. The ROC analysis demonstrated that the total number of points (the sum of the odds ratios of the above variables) of >9.697 indicated a 21.83% higher probability of complex TLE (sensitivity 74.08%, specificity 74.46%). Finally, the logistic function model was employed, and a simple equation for Lead Extraction COMplexity was constructed to predict the probability of a difficult procedure. The risk of complex extraction (in percentage) was calculated as [1/(1 + 55.34·0.754X)]·100 (P < 0.001).

Conclusion

(1) The LECOM score can effectively predict the risk of a difficult transvenous lead extraction procedure, and (2) Predicting the probability of a more complex procedure may help clinicians in planning lead removal and improving patient management. (3) Simple on-line calculator should be available to predict a difficulty of planned TLE procedure and to allow to send more demanding patient to more experienced high-volume centre.
Low serum irisin levels predicted newly atrial fibrillation in patients with any phenotypes of chronic heart failure
Authors: Berezin A E , Lichtenauer M , Hoppe U , Berezina T A , Obradovic Z , Berezin O O
Published: May 2024

Background

Atrial fibrillation (AF) continues to be a major health problem among patients with known cardiovascular disease including heart failure (HF). AF is not only powerful risk factor for newly HF, but also it contributes to untoward clinical course of the condition. Although, natriuretic peptides are well-validated biomarkers to predict poor clinical outcomes of HF, their accuracy for AF in patients with different phenotypes of HF is not optimal. Recent studies showed that adipocytokines including irisin affect the risk of AF occurrence. We hypothesized that serum irisin can have additional discriminative potency for AF among HF in patients.

Methods

The study group comprised 541 consecutive patients with chronic HF aged 41 to 76 years recruited for the study from October 2020 to December 2022. We included 153 patients with any phenotypes of HF who were hospitalized due to paroxysmal or persistent AF and a control group of 388 age- and sex-matched individuals admitted to hospitals due to exacerbation of HF. All patients included in the study were examined by conventional general clinical and physical investigations, B-mode echocardiography and Doppler. The plasma levels N-terminal-natriuretic pro-peptide (NT-proBNP), high sensitivity (hs) C-reactive protein, tumor necrosis factor-alpha (TNF-alpha), hs-troponin T, adropin, apelin, leptin, adiponectin, and irisin were measured using ELISA.

Results

Compared with patients from control groups, patients with AF had greater left atrial volume index (LAVI), higher serum levels of NT-proBNP, hs-CRP, TNF-alpha, and lower left ventricular ejection fraction (LVEF), irisin and apelin levels. There were no significant difference between groups in left ventricular mass index, the serum levels of hs-troponin T, adropin, leptin, and adiponectin. Multivariate linear regression adjusted to LVEF and LAVI revealed that irisin and NT-proBNP were the predictors for AF. We found that the well-balanced cut-off point for serum concentration of irisin (AF versus non-AF) were 10.5 ng/mL (area under curve [AUC] = 0.96, sensitivity = 81.0%, specificity = 88.0%; P = 0.0001). Cutoff point of NT-proBNP that distinguished patients with AF and without AF was 750 pmol/L (AUC = 0.96; sensitivity = 72.7%, specificity 76.5%, р = 0.0001). Multivariate Cox regression model yielded that the serum levels of irisin < 10.5 ng/mL (odds ratio [OR] = 1.40; P = 0.001) and NT-proBNP > 750 pmol/mL (OR = 1.22; P = 0.012), LAVI > 34 mL/m2 (OR = 1.06; P = 0.010) remained to be strong predictors for newly AF. Add-on of irisin < 10.5 ng/mL to the predictive model constructed from NT-proBNP (> 750 pg/mL) significantly improved discriminatory potency of the whole model for HF.

Conclusion

We found that decreased serum levels of irisin significantly predicted newly AF in patients with any phenotypes of HF.
Risk factor profile and outcomes in young patients presenting with acute ST-segment elevation myocardial Infarction
Authors: Qayoom R , Naseer A , Khokhar M I , Aijaz S , Hanif B
Published: May 2024

Introduction

ST-elevation myocardial infarction (STEMI) is more prevalent in the elderly population1, but is now becoming more common in the younger population. It has been of particular concern due to its potential for premature death and long-term morbidity. Early identification and timely modification of risk factors in this population is critical2,3. Secondary prevention issues in populations are well studied, and such data for young adults are lacking in the literature.

Purpose

The purpose of this study was to compare pattern of traditional CVD risk factors, hospital mortality and major adverse cardiac events at discharge in young versus old patients (≤45years and above 45 years age respectively) admitted with STEMI and undergoing primary PCI.

Methods

This retrospective cohort study was conducted on consecutive patients presenting with STEMI between June 2013 and June 2018 in a single centre cardiac only tertiary care setup. Institute’s registry is fashioned along and is affiliated with US NCDR. Patients with cardiac arrest or cardiogenic shock at arrival were excluded. MACE was defined as post PCI cardiac arrest or cardiogenic shock, heart failure, major bleed or hospital death.

Results

Total of 5343 patients were admitted with STEMI during study period, after exclusion data of 1642 patients were analyzed.

Table 1 demonstrates demographic and historical characteristics of the study population. Among young patients, the frequency of the male gender,any tobacco use and family history of premature coronary artery disease were significantly higher (all p values < 0.001). While in older STEMI patients frequency of heart failure, hypertension, prior myocardial infarction, diabetes mellitus ,abnormal creatinine clearance (<90 mL/min/1.73 m²) , multi-vessel coronary disease, advanced Killip class and higher body mass index was more prevalent (all P<0.001).

Table 2 demonstrates predictors of in hospital death and MACE. Among young patients advanced Killip class and femoral access site(all P values <0.001), diabetes mellitus (p=0.03), abnormal creatinine clearance(p=0.04),and left ventricular ejection fraction less than 40%(p=0.01), were more significant in-hospital mortality predictor where as advanced Killip class,Left ventricular ejection fraction less than 40% male gender(p=0.04), diabetes mellitus(p=0.001),femoral access site(p=0.001), and Left ventricular ejection fraction less than 40% were more significant MACE predictors (all P<0.001).

Conclusion

There were no significant difference in hospital mortality and MACE among young versus old STEMI patients when adjusted for diabetes mellitus, abnormal creatinine clearance (<90 mL/min/1.73 m²), multi-vessel coronary disease, advanced Killip class. Tobacco use is the main modifiable risk factors for young patients with STEMI. Surprisingly, being a woman and having a positive family history with premature coronary artery disease were protective.
Changes in public interest in sudden cardiac arrest: a big data analysis
Authors: Han J , Baykaner T
Published: May 2024

Background

Search engine queries (SEQ) are considered a surrogate for public interest, with the most popular global search engine processing ~ 1.2 trillion online queries annually and >1 billion health-related queries daily.1 Big data from SEQ trends have been used for disease surveillance and may be able to offer insights for public health interventions, such as detecting respiratory illness outbreaks and understanding cardiac disease patterns.2-4 Sudden cardiac arrest (SCA) occurs in ~5 million people annually worldwide; October is internationally designated for SCA awareness, with public health campaigns aimed to improve early recognition of and early defibrillation for SCA. Use of big data from SEQ as a public health tool to assess changes in public interest surrounding SCA campaigns has not been explored.

Purpose

To characterize changes in public interest in SCA via analysis of internet SEQ trends.

Methods

Google Trends was queried for the terms "cardiac arrest", "cardiopulmonary resuscitation" (CPR), "automated external defibrillation" (AED) and "myocardial infarction" (MI) worldwide for the past 5 years (11/2018 – 11/2023). Relative search volumes (RSV, expressed in scale from 0-100) and related queries were analyzed. Baseline RSV for each term was defined as 2 weeks pre-peak. Numerical percentage and Chi square tests were used for statistical comparison.

Results

Compared to baseline, RSV for "cardiac arrest" significantly increased in correlation with the SCA of 2 professional athletes: Christian Eriksen (football, Denmark) on 6/12/2021 (+321%, p<0.001), Damar Hamlin (American football, United States) on 1/2/2023 (+653%, p<0.001) and collegiate athlete Bronny James (basketball, United States) on 7/24/2023 (+164%, p<0.001). (Figure) RSV significantly increased for "cardiopulmonary resuscitation" (+61% and +170% respectively, p<0.001 for both) and "Automated external defibrillator" (+141% and +192% p<0.001 and p=0.003, respectively) during the same period for pro-athletes but not for the college athlete (p=1.0 and p= 0.84 respectively). While none of the athletes had MI, RSV for "myocardial infarction" also had correlating increases over baseline for all 3 athletes (+35%, p<0.001 +30%, p<0.001 and +22%, p=0.027, respectively). RSV did not significantly change for any search terms during October SCA awareness months during the study period (all p>0.05).

Conclusions

Public interest in SCA, CPR and AED surge when SCA occurs in well-known individuals such as athletes, rather than with scheduled public health campaigns; co-surge in MI interest likely indicates on-going public confusion between SCA and MI. Analyses of big data from SEQ could assist cardiovascular societies in planning targeted SCA educational campaigns by building upon periodic natural surges in public interest in SCA, CPR and AED; this should include continued education on the differences in recognition and treatment of SCA and MI.
Genetic, sociodemographic, lifestyle, and clinical risk factors of heart failure aggravation events: data from the UK Biobank
Authors: Hwang T , Yang P , Jang E , Choi S , Kim D , Yu H , Kim T , Uhm J , Song J , Pak H , Lee M , Joung B
Published: May 2024

Background

Heart failure (HF) is the leading cause of readmission and hospitalization.

Purpose

This study examined the associations and clinical utilities of genetic, sociodemographic, lifestyle, laboratory, and clinical risk factors on HF aggravation.

Methods

Data were from 5,345 UK Biobank middle-aged adults with established HF at enrolment. We performed Cox proportional hazard regression analyses to investigate the associations related to HF admission after enrolment utilizing 24 variables encompassing sociodemographic, clinical, lifestyle, and laboratory data. To assess the impact of genetic factors, we additionally adjusted each polygenic risk score (PRS) for the three medical histories: hypertension, atrial fibrillation (AF), and coronary heart disease (CHD), where the hazard ratios were statistically significant.

Results

Over a median follow-up of 11.5 [10.9-12.2] years, 247 (4.6%) HF admission events occurred. Among the 24 variables, statistically significant hazard ratios were observed for 10 variables, with hypertension (3.31, 2.19-5.02), AF (2.06, 1.53-2.75), current smoking (1.63, 1.09-2.46), and coronary heart disease (1.58, 1.17-2.13) showing the highest hazard ratios, while female gender (0.65, 0.46-0.91) exhibited the smallest hazard ratio. After adjusting for each PRS individually, HTN PRS (HR 1.06, 0.94-1.21) and AF PRS (HR 1.02, 0.90-1.16) were not statistically significant, whereas CHD PRS (HR 1.15, 1.02-1.31) showed significance in relation to HF admission. In the HF admission prediction model, the C index was 0.859 (0.838-0.880) with clinical variables, and it marginally increased to 0.864 (0.843-0.885) when all factors, including the genetic factor, were applied.

Conclusions

Sociodemographic, clinical, laboratory, lifestyle, and genetic factors are each associated with HF aggravation with male gender, hypertension, AF, low eGFR, cigarette smoking, and CHD PRS.
Surgical treatment for obstructive sleep apnea prevents arrhythmic events: a nationwide population-based study
Authors: Jung L , Kim S H , Kim D H
Published: May 2024

Background/Introduction

Obstructive sleep apnoea (OSA) is a well-established risk factor for the development and exacerbation of cardiac arrhythmias. Continuous positive airway pressure therapy is recommended as the primary non-invasive treatment for OSA. However, suboptimal patient compliance remains a common challenge.

Purpose

This study explores the benefits of surgery in reducing the occurrence of arrhythmias associated with OSA. The study aims to investigate the impact of surgery in managing OSA-associated arrhythmias.

Methods

Data from the Korean Health Insurance, from January 2009 to December 2020, were retrospectively compiled and analysed to investigate the clinical outcomes of 359,851 individuals with OSA. Propensity score matching (PSM) at a 1:4 ratio was employed to compare patients who underwent surgery with those who did not. A final cohort of 117,665 participants (85.4% men, aged 60 years old or younger: 94.2%) was established, with 23,533 having undergone surgery for OSA and 94,132 receiving non-surgical management. Over a five-year follow-up period, the occurrence rates of atrial fibrillation (AF), premature beats (premature atrial contractions or premature ventricular contractions), ventricular arrhythmias, sudden cardiac arrest, atrioventricular block, and sinus node dysfunction were evaluated.

Results

Across the six types of arrhythmias, the cohort that underwent surgery for OSA consistently exhibited a lower incidence of arrhythmias than the non-surgical cohort. In the PSM analysis, a statistically significant reduction in the incidence of AF, premature beats, and sudden cardiac arrest was observed in groups of patients who underwent surgery for OSA. Among those who developed AF, the group that underwent surgery for OSA had a fivefold higher incidence than the non-surgical group (hazard ratio [HR] 5.384, 95% confidence interval [CI] 3.459-8.381). The incidence of premature beats was more than four times higher in the non-surgical group (HR 4.284, 95% CI 2.96-6.177, p<0.0001), and sudden arrest was more than 24x higher in the non-surgical group (HR 24.089, 95% CI 3.348-173.312).

Conclusion

This study suggests a potential causative relationship between OSA and arrhythmias. Additionally, surgical intervention for OSA may be considered an effective strategy for preventing arrhythmias in young patients. Further clinical research is warranted to validate and refine these observations.Figure 1Figure 2