bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1466Leadless pacemaker mid and long term follow-up in a single center-study
Authors: Martinez Sande J L , Garcia-Seara J , Gonzalez-Melchor L , Cacho-Antonio C E , Fernandez-Lopez X A , Rodriguez-Manero M , Abou-Jokh C , Lopez-Canoa J N , Gonzalez-Juanatey J R 
Published: June 2020

Abstract

Introduction and objectives
Initial results of Leadless pacemakers (LPM) has been promising in worldwide, nevertheless there are still no long term experience published, so the objective of our study was to evaluate electrical parameters at mid and long term follow-up, describing as well total complications and mortality in a single center-study.

Methods

This was a prospective, observational clinical trial that included 183 consecutive patients, with an indication for a single-chamber pacemaker implantation.

Results

All successful implantation included a total of 183 patients with a mean age of 79,2 ±6,6 years (range 54-93y/o); 111 (60,6%) were men and more frequent rhythm was permanent atrial fibrillation (160), including those in which a node ablation was performed in the same procedure (22). Clinical and echocardiographyc characteristics are described in table 1.Mean follow-up was of 26 ±10 months including: 64 patient at 24 months, 46 at 36 months and 7 patients at 48 months. Electrical parameters are represented in figure 1, which were stable and flawless at long term follow-up. Total complications were 3,3%, with only 2 patient requiring surgery for resolution (1,7%), and all were acute during LPM implantation. A total of 17 patients (9,3%) died with no relation to pacemaker.

Conclusions
In our experience, leadless pacemakers electrical performance continues stable, appropriate at long term follow-up, and no other complications developed.
Baseline Characteristics of Patients Age(years) 79.2 ± 6.6[54-93] Male gender, n (%) 118 (60.6%) Hypertension, n (%) 149 (81.7%) Diabetes mellitus, n (%) 64 (34.9%) COPD, n (%) 33(18.3%) Renal dysfunction, n (%) 30 (16.7%) Valvular disease, n (%) 74 (41.1%) Atrial Fibrillation, n (%) 161 (98.0%) LVEF(%) 60.0 ± 8 OAC, n (%) 123(67.2%) NOAC, n (%) 23 (10.0%)
Abstract Figure. Electrical performance
P541Cardiac resynchronization therapy: left or non-left bundle branch block? That is the question
Authors: Aguiar Ricardo I , Nunes-Ferreira A , Rigueira J , Rodrigues T , Cunha N , Antonio P S , Morais P , Pereira S C , Bernardes A , Santos I , Magalhaes A , Neves H , Pinto F J , De Sousa J , Marques P 
Published: June 2020

Abstract

Introduction
Cardiac resynchronization therapy (CRT) is associated with reduced mortality and improved quality of life in patients (pts) with low ejection fraction (EF) and conduction delays. Patients with left bundle branch block (LBBB) seem to be the ones who benefit the most from CRT and there is controversy about its efficacy in patients with non-LBBB.

Purpose
To compare the prognostic impact and the response rate to CRT in patients with LBBB and non-LBBB.

Methods
Prospective single-center study of patients who implanted CRT between 2015 and 2019. Clinical, electrocardiographic and echocardiographic evaluations were made before CRT implant and between 6-12 months post-implant. Patients with EF elevation ≥ 10% or left ventricle end-systolic volume (ESV) reduction ≥ 15% were classified as responders. Patients with EF elevation ≥ 20% or LV ESV reduction ≥ 30% were classified as super-responders. All the parameters were compared between patients with or without LBBB. Prognostic impact of resynchronization therapy was evaluated by comparing total mortality using the Cox regression and Kaplan-Meier methods.

Results
From 2015-2019, 566 CRTs were implanted (26.1% female, 72 ± 10.2 years old, follow-up duration 18.9 ± 15.8 months). From these patients, 59% had LBBB (69% males, mean age 71.6 ± 10.8 years, 34.5% ischemic, EF &lt; 30% in 65.5%). The cardiovascular risk factors and comorbidities were similar in both populations (with and without LBBB), except for diabetes which was more frequent in non-LBBB patients (33% vs 50.6%, p = 0.007). Mean duration of QRS was similar between LBBB vs non-LBBB patients (163 ± 19ms vs 160 ± 22ms, p = NS) and baseline ejection fraction was also equivalent (29.8 ± 13.6% vs 27.9 ± 8.9%).
The prevalence of complications and surgical revisions were similar in both groups.
The response rate according to left ventricle remodelling criteria was higher in LBBB pts (65.9% vs 49.1%, p &lt; 0.05), but the super-responders were similar in both groups (32.5% vs 26.4% p = NS).
The 4-year survival rate of patients with LBBB and non-LBBB was similar (86.5% vs 85.3%).

Conclusion
In our population the response rate to CRT was higher in LBBB pts. However, and despite the actual controversy about the efficacy of CRT in non-LBBB, the long-term mortality was similar in patients with or without LBBB.
Abstract Figure. lon-term survival
P1149Subcutaneous implantable cardioverter-defibrillator when Transvenous ICD is not a viable option
Authors: Russo V , Molini S , De Bonis S , Ziacchi M , Ricciardi G , Migliore F , Viani S , Lavalle C , Pangallo A , La Greca C , Brambilla R , Tordini A , Ospizio R , Lovecchio M , Rago A 
Published: June 2020

Abstract

Funding Acknowledgements
NO FUNDING

OnBehalf
RHYTHM DETECT Registry

Background
The class of recommendation for S-ICD implantation in patients who have inadequate vascular access is I according to AHA-ACC-HRS Guidelines and IIb according to ESC Guidelines. Data are lacking about the use of S-ICD for patients in which a transvenous ICD is not a viable option because of the inability to deploy a transvenous lead.

Purpose
To describe current practice and to measure outcomes associated with S-ICD use in patients in which a transvenous ICD is not a viable option.

Methods
942 consecutive patients underwent S-ICD implantation at 22 Italian centers from 2014 to 2019. We identified 101 (11%) patients who received S-ICD because of the reported impossibility of deploying a transvenous lead.

Results
21 patients presented with inadequate vascular access but no previous device in place. One patient had a mechanical prosthesis in tricuspid position. The remaining 79 patients received the S-ICD after removal of a prior system implanted, and venous occlusion was diagnosed after lead extraction, or partially or completely failed lead removal. In 24 of these patients a functional transvenous pacing system was left in place for persisting pacing needs. Patients were 60 ± 15 years old, 85% were male, 77% had ischemic or non-ischemic dilated cardiomyopathy, ejection fraction was 36 ± 13%. At implantation, acute conversion test was performed in 64 patients and shock energy of ≤65J was successful in 62 (96.9%) patients. During a median follow-up of 18 months, 6 patients died for non-device related reasons and 1 patient underwent heart transplantation. One patient underwent device replacement for battery depletion and one patient underwent leadless pacemaker implantation. Minor complications (hematomas not requiring system revision) were reported in 2 patients. Appropriate therapies were delivered in 4 patients and 8 patients experienced inappropriate therapies (in 3 patients due to double counting during pacing); all resolved with device reprogramming. Conclusions: In current clinical practice, a minority of S-ICD patients receive the device because of inadequate vascular access. The profile of these patients is similar to that of the typical ICD population in the context of primary sudden death prevention, but many of them present with pacing indications. Acute and mid-term efficacy of S-ICD seemed high. Few complications occurred during follow-up. Particular attention must be paid to device programming for those patients with concomitant pacing systems, in order to prevent inappropriate therapies.
852Lead abandonment and subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation in a cohort of patients with ICD lead malfunction
Authors: Russo V , Viani S , Migliore F , Tola G , Bisignani G , Biffi M , Dello Russo A , Sartori P , Rordorf R , Ottaviano L , Perego G B , Papa A , Segreti L , Lovecchio M , Bongiorni M G 
Published: June 2020

Abstract

Funding Acknowledgements
NO FUNDING

OnBehalf
Rhythm Detect Registry

Background
Currently, when an implantable-cardioverter defibrillator (ICD) lead becomes nonfunctional, a class IIa recommendation exists for either lead abandonment or for removal. The benefits of removal include creation of an access for insertion of a new lead. However, the subcutaneous ICD (S-ICD) does not require the insertion of any leads into the cardiovascular system, and may represent an additional option for patients not requiring pacing.

Purpose
To report outcomes associated with a strategy of lead abandonment and S-ICD implantation in the setting of lead malfunction.

Methods
We analyzed all consecutive patients who underwent S-ICD implantation after abandonment of malfunctioning leads and we compared outcomes with those of patients who underwent transvenous extraction and subsequent reimplantation of a single-chamber transvenous ICD (T- ICD).

Results
43 patients were implanted with an S-ICD after abandonment of malfunctioning leads, while in 62 patients extraction and subsequent reimplantation of a T-ICD. The two groups were comparable (Age 55 ± 16 vs. 54 ± 33years, BMI 26 ± 3 vs. 24 ± 4kg/m2, LVEF 43 ± 15 vs. 48 ± 8%). S-ICD defibrillation test success rate at implantation was 96% at 65J. In the extraction group, no major complications were reported during extraction, while the procedure failed and an S-ICD was implanted in 4 patients. During a median follow-up of 21 months, the rate of major complications was not higher in the S-ICD group than in the T-ICD group (HR 1.07; 95%CI 0.29–3.94; P = 0 .912; Figure), as well as the rate of minor complications (HR 2.13; 95%CI 0.49–9.24; P = 0 .238).

Conclusions
In case of ICD lead malfunction, extraction prevents potential long-term risks of abandoned leads, e.g. increased complications for a possible future mandatory extraction indication such as infection, and allows magnetic resonance imaging. Nonetheless in this series, the strategy of lead abandonment and S-ICD implantation appeared to be feasible and safe with no significant increase in adverse outcomes for patients not requiring pacing and may represent an option in selected clinical settings (very high risk or failed extractions, older patients, etc.). Longer follow-up studies are needed to fully understand the potential risks of lead abandonment.
Abstract Figure
P1168Redefining first degree AV block: constant fusion pacing CRT is easier in longer PR interval patients
Authors: Vacarescu C , Luca C T , Petrescu L , Mornos C , Goanta E V , Crisan S , Lazar M A , Cozlac R A , Cozma D 
Published: June 2020

Abstract

Background
LV only pacing is non-inferior to BiV pacing, and recent publications showed that DDD CRT without RV lead is safe in patients with normal atrioventricular (AV) conduction, although there are no device algorithms available for fusion pacing and PR interval variability is understudied in this population. Purpose: To analyse AV behaviour in pts with DDD CRT and the impact to effective fusion maintenance.

Methods
Consecutive pts with right atrium/left ventricle (RA/LV) DDD CRT pacing system were included. Prospective data were collected at every 6 months follow-up visits: device interrogation, exercise test (ET), echocardiography. CRT assessment during ET analysed loss of LV capture with special focus on maintaining constant fusion pacing during exercise. We defined 2 groups of pts: longer PR interval pts (200-250 ms) and normal PR interval pts (˂200 ms). In case of LV loss of capture or unsatisfactory LV fusion pacing, device reprogramming was performed individualised for each patient and BB/ivabradine dose titration was done to achieve stability of PR spontaneous interval. Patients were rescheduled in no later one month to be reassessed by ET.

Results
55 pts (29 male) aged 62 ± 11 y.o. were included, 36 pts with normal PR and 19 pts with longer PR. During follow-up (45 ± 19 months), a total of 235 ETs were performed with mean exercise load 118 ± 35 watts. In the normal PR group 14 pts (39%) had inadequate pacing or loss of LV capture during ET due to physiological shortening of PR interval vs. 4 pts (21%) in the long PR group. Loss of LV capture by exceeding maximum tracking rate (MTR) was noted in 6 pts (17%) with normal PR vs. 2 pts (11%) with longer PR. Post ET device optimisation included: reprogramming rate adaptive AV interval (23 ± 8 ms decrease in normal PR pts vs. 12 ± 7 ms in longer PR pts, p &lt; 0.0001) and individualised programming of MTR. BB/ivabradine optimisation was performed in 32% of pts with normal PR vs. 13% of pts with longer PR.

Conclusions
A lower rate of optimisations after exercise test was needed in pts with a slightly longer AV conduction to achieve stability of fusion pacing DDD CRT without device algorithms. Larger studies are needed to assess AV conduction variability and the benefits of fusion pacing CRT in pts with longer PR interval.
Abstract Figure.
P1125 Safety and efficacy of ventricular tachycardia ablation during sinus rhythm in patients with structural heart disease
Authors: Fernandez-Armenta Pastor J , Silva E , Soto-Iglesias D , Penela D , Acosta J , Jauregui B , Bisbal F , Linhart M , Fernandez M , Borras R , Villuendas R , Cano L , Berruezo A 
Published: June 2020

Abstract

Funding Acknowledgements
Project “PI-0057-2017”, funded by Junta de Andalucía and co-funded by European Union (ERDF/ESF, “Invesing in your future”)

Background
The best strategy for scar related ventricular tachycardia (VT) ablation is not yet established. Recently, the use of ventricular assist devices is being proposed to allow ablation during unstable VT.

Purpose
Analyze the results of a multicenter registry of substrate-guided VT ablation performed primarily during stable rhythm.
Methods
This prospective multicenter registry included 433 VT ablation procedures performed in 372 consecutive patients with structural heart disease undergoing VT ablation. Substrate ablation (scar dechanneling technique) during sinus rhythm without initial VT induction was the standard protocol. Any episode of sustained VT or appropriate ICD therapy was considered VT recurrence.
Results
Myocardial infarction was the arrhythmogenic substrate in 64% of patients. 90.5% of patients were male, mean age 64 ± 13 years. Mean LVEF was 38 ± 13%.No ventricular assist device was used in any case. After substrate ablation no VT was inducible in 69% of cases. End-procedure non-inducibility was achieved in 73.1% of cases. Complication rate was 6.7 %. 30-days mortality was 1.9% (7 patients), including one procedure related death. At one year after first procedure 17 patients died (4.5%). Age, chronic obstructive pulmonary disease and renal failure were independent predictors of mortality. One-year freedom from VT recurrence was 84%.

Conclusion
Substrate-guided VT ablation during stable rhythm as main approach for scar-related VT treatment is associated to low complication and recurrence rates in this prospective multicenter study.
64effects of long-term exercise training and detraining on endothelial function and arterial stiffness in patients with atrial fibrillation: a randomized controlled trial with 1-year follow-up
Authors: Kim S , Han D , Jeong I , Lee H , Koh Y , Lee S 
Published: June 2020

Abstract

Introduction
Exercise training (ET) improves endothelial function and arterial stiffness in patients with cardiovascular disease. However, whether ET improves endothelial function and arterial stiffness in patients with atrial fibrillation (AF) is unclear. If it does, for how long the effects are sustained remains to be determined.

Methods
In a prospective study, 58 patients with AF (age, 62 ± 7 years) were randomized into an ET group for 12 months (CT, n = 13), a group with 6-month detraining after a 6-month ET (DT, n = 15), and a medical treatment only group (MT, n = 30). For ET, cycling on a bicycle ergometer was performed in the DT and CT groups 3 times a week for 6 and 12 months, respectively. Each session started with a 10-minute warmup at 60% to 70% of the maximal heart rate (HRpeak), followed by four 4-minute intervals at 80% to 90% of the HRpeak, with 3 minutes of active recovery at 60% to 70% of the HRpeak between intervals, ending with a 5-minute cooldown period. Peak exercise oxygen consumption (Vo2), intimal-medial thickness (IMT) of the carotid artery measured on high-resolution ultrasonography, and left ventricular function were measured at baseline, after 6 months of training, and after additional 6 months of continuous training or detraining follow-up assessments. In addition, plasma von Willebrand factor (vWF), endothelin-1, nitric oxide, tumour necrosis factor alpha, interleukin-1 beta, interleukin-6, and interleukin-10 levels were measured as indices of endothelial function.

Results
The 6-month ET increased peak Vo2 (CT: 29.0 ± 6.5 ml/[kg·min] and DT: 26.0 ± 8.2 ml/[kg·min] vs. MT: 23.0 ± 5.2 ml/[kg·min], p = 0.04) and decreased plasma vWF levels (CT: 103.7 ± 30.7 IU/dL and DT: 106.0 ± 31.2 IU/dL vs. MT: 145.0 ± 47.7 IU/dL, p = 0.01). Detraining significantly reduced the ET-induced increase in Vo2 and decreased the vWF to baseline level, although continuous ET maintained changes in Vo2 (CT: 28.1 ± 5.3 ml/[kg·min] and DT: 22.4 ± 6.6 ml/[kg·min] vs. MT: 21.5 ± 4.8 ml/[kg·min], p = 0.043) and in vWF (CT: 84.3 ± 39.1 IU/dL vs. DT: 122.2 ± 27.5 IU/dL and MT: 135.9 ± 50.4 IU/dL, p = 0.014). However, carotid arterial IMT, and resting left ventricular systolic and diastolic functions showed no significant changes, with no inter-group differences after 6 months of training and 6 months of continuous training or detraining.

Conclusions
The decreased vWF level suggested that ET can be a strong non-pharmacologic option to improve endothelial function in patients with AF. However, it can rapidly lose its effects after detraining. Therefore, physicians should encourage their patients to participate in a continuous exercise program to sustain its benefits in terms of improved exercise capacity and endothelial function in patients with AF.
P1452Low fluoroscopy approach with a novel ablation technology in right side procedures: a large multicenter experience from the CHARISMA registry
Authors: Cauti F M , Piro A , Di Belardino N , Tola G , Anselmino M , Pecora D , Scaglione M , Rossi L , Pedretti S , Solimene F , Mantovan R , Di Cori A , Rossi P , Iaia L , Bianchi S 
Published: June 2020

Abstract

Funding Acknowledgements
NO FUNDING

Background
Electrophysiological studies and ablation procedures expose both physicians and patients to a significant amount of radiation. Nowadays, most of 3-D mapping systems allow for improved tracking of catheters with possible reduction in radiation exposure. No data exists on the ability to minimize fluoroscopy time and dose while using the Rhythmia mapping system.

Purpose
To report preliminary data on feasibility and safety of a low fluoroscopic approach using the Rhythmia mapping system in SVT procedures.

Methods
The CHARISMA study is a non-randomized, multicenter, prospective study in which consecutive patients indicated for arrhythmia were enrolled. For our purpose consecutive right-side procedures performed through a low fluoroscopy approach with the Rhythmia mapping system were analyzed. The mapping system was used to create the 3D geometry of chambers of interest and anatomic reference points and to visualize the catheters from the beginning to the end of the procedure. Fluoroscopy was used only if deemed necessary.

Results
204 unselected consecutive cases of SVT from 11 centers were included in the study (mean age = 55 ± 18 years, 53% male, 85 AVNRT, 75 AFL, 28 AP, 9 AT and 7 other right atrial procedures). In all the cases, diagnostic EP and ablation catheters were positioned using only the low fluoroscopic guided mapping approach. During the study, a total of 7157 s of fluoroscopy was needed in 204 patients (51 ± 137 s per procedure). One hundred fourty-one procedures (69%) were completed with less than 10 seconds of fluoroscopy, whereas in 169 (83%) of the cases the fluoroscopy time was lower than 60 seconds. Low fluoroscopy approach with less than 10 seconds was less frequently obtained in case of AFL (46, 61.3%) compared to AVNRT ablation (65, 76.5%, p = 0.041) whereas no differences were found comparing with AP (21, 75%, p = 0.248). The median reconstructed RA volume was 94[65-133] ml in a median mapping time of 11 [6-16] min. The median number of radiofrequency ablations to terminate each arrhythmia was 5 [3-12] (total RF delivery time of 293 [180-505] sec). A 100% rate of acute success was observed in our case series. No complications occurred.

Conclusions
In our preliminary experience, arrhythmias ablation through low fluoroscopy approach and the use of a novel ablation technology seems to be safe, feasible, and effective in common right atrial arrhythmias. Use of fluoroscopy can be nearly avoided in most cases, without any reduction of the safety and effectiveness profile.
P1440Left atrial appendage closure for stroke prevention in nonvalvular atrial fibrillation with Watchman device versus Amplatzer Cardiac Plug. Results of the multicenter Russian trial
Authors: Davtyan K V , Simonyan G , Kalemberg A A , Topchyan A H , Lebedev D S , Mozgovoy P V , Romanov A B , Shabanov V V , Merkulov E V , Pevzner D V , Boytsov S A , Drapkina O M 
Published: June 2020

Abstract

Background
The data are limited on comparative efficacy and safety of the left atrial appendage occlusion (LAAO) using the Watchman device (WD) and Amplatzer Cardiac Plug (ACP) for stroke prevention in nonvalvular atrial fibrillation (AF) patients.

Objective
To assess the safety and efficacy of the WD compared with ACP for stroke prevention and adverse events in patients with AF.

Methods
200 consecutive patients (median age 67.5yrs, 94 female, median CHA2DS2VASc score - 4, median HASBLED score 3) with nonvalvular AF and contraindications to oral anticoagulation therapy from 5 medical centers in Russia, who undergone LAAO implantation using WD (n = 108; WD group) and ACP (n = 92; ACP group) were enrolled into this study. The coprimary end point was the composite of TIA/stroke and procedure-related complications during follow up. Secondary end points included successful LAA occluder implantation rate and incidence rates of significant leakage. Patients were followed at 45 days, 3, 6 and 12 months after enrollment. At each follow-up visit the data regarding clinical events and healthcare utilization were collected.

Results
During the follow-up TIA/stroke has occurred in 6.2% of patients in the WD group with no such events in ACP group (6.2% vs 0%, p = 0.012). The composite safety-efficacy survival rate in WD group was 91.7% versus 92.4% in ACP group (p = 0.85). The periprocedural major complications rate (pulmonary trunk perforation with fatal haemotamponade, nonfatal haemotamponade with pericardiocentesis, device embolisation) was significantly higher in ACP group compared with WD group (5.4% vs 0%, p = 0.005). There was no significant difference in overall events rate between groups (3.7% vs 7.6%, p = 0.2). Successful LAA occluder implantation was performed in all 92 (100%) patients with ACP and in 105 (97,2%) with WD (p = 0.053). The significant leakage (≥5mm) was 3.03% in WD group with no such events in ACP group (3.03% vs 0%, p = 0.059).

Conclusion
LAAO using ACP was associated with higher major procedure-related complications rate. Despite a higher TIA/stroke rate in WD group, the composite efficacy and safety survival rate of LAAO using the WD and ACP was comparable during 12 month follow up.