bluuebunny/crossref_metadata_2025_split huggingface dataset:
Defibrillation success after subcutaneous implantable cardioverter-defibrillator generator replacement is not affected by impedance increase
Authors: Van Der Stuijt W , Pepplinkhuizen S , Quast ABE , Smeding L , Olde Nordkamp LRA , Wilde AAM , Knops RE 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Routine defibrillation testing during implant and replacement of the subcutaneous implantable cardioverter-defibrillator (S-ICD) is recommended per current guidelines. Recently, concerns have been raised about an increase in shock impedance and consequent shock failure during defibrillation testing in S-ICD patients undergoing a generator replacement.

Purpose
We aim to describe the defibrillation success rate in relation to the shock impedance in patients undergoing S-ICD generator replacement in our large tertiary center.

Methods
In this retrospective analysis, data from replacement procedures were collected from all patients who underwent an S-ICD generator replacement in our center from June 2014 to December 2020. Defibrillation testing was performed with at least one shock of ≤65J, and a successful shock was defined as terminating the ventricular arrhythmia within 5 seconds after the shock.

Results
A total of 133 patients underwent an S-ICD generator replacement, 5.8 ± 0.9 years after initial implant. Reasons for replacement were: reaching of elective replacement indicator (n = 119), early battery depletion (n = 9), complaints of generator pocket (n = 3) and device malfunction (n = 2). Defibrillation testing was performed in 111 patients (86.5%) undergoing a replacement procedure. Shock impedance data from both the implant and replacement procedure were available in 101 patients. The median shock impedance of these patients during their replacement procedure was significantly higher than during their implant, 79Ω (IQR 66-94) and 66Ω (IQR 57.5-81) respectively (Z = -5.552, p &lt; 0.001). Despite the higher shock impedance, first shock during defibrillation testing was successful in 105/111 patients (94.6%), with a success rate of 97.3% after two attempts. In the remaining three patients, the ventricular arrhythmia could only be terminated with a 80J shock. This was the case during both their initial implant and their replacement procedure. Shock impedance increase between implant and replacement was not significantly higher in patients with a successful first shock compared to patients with an unsuccessful first shock (Δ+11.1 ± 20.0Ω versus Δ+12.7 ± 27.6Ω, p = 0.86).

Conclusion
In this large retrospective analysis, we have shown a first shock success rate during S-ICD generator replacement of 94.6%, which is similar to the success rate of defibrillation testing after initial implant. After multiple attempts, defibrillation testing success rate was 100%. Even though the median shock impedance during replacement was significantly higher than during the initial implant, there was no difference in impedance increase in patients with a successful shock compared to patients with an unsuccessful shock. Abstract Figure. Defibrillation success
Single center experience of ICD implantation in pediatric age
Authors: Fumanelli J , Reffo E , Castaldi B , Sirico D , Di Salvo G , Leoni L 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Despite sudden cardiac death (SCD) is a rare phenomenon in pediatric age, the use of the implantable defibrillator (ICD) is progressively increasing in consideration of its life-saving role both in primary and in secondary prevention. Our work aims at evaluating our pediatric population from the point of view of distribution according to heart disease, indication and implantation technique. We also want to verify the protective role of the device in terms of SCD prevention, acute and chronic complications and to evaluate the role played by the device as a bridge to transplantation.
METHODS The retrospective study includes patients under the age of 18 underwent ICD implantation, following the guidelines and recommendations currently in force, in the time period between March 2000 and July 2020. Each device has been programmed in a personalized way based on age and cardiac pathology. The subjects were divided into three groups depending on the cardiac pathology. All patients were then followed-up by evaluating the appropriate shocks, the acute and chronic complications, especially the inappropriate shocks.
RESULTS The study group includes 55 subjects (41 males and 12 females) with a mean age of 14 ± 4 years and a mean follow-up time of 6.2 years. Thirty subjects had cardiomyopathy (CM), 15 electrical disease (ED) and 10 congenital heart disease (CHD) respectively. We used three different implantation technique (endocavitary, subcutaneus and hybrid technique) depending on the size of the patient and the cardiac anatomy.
There is no gender difference as regards the indication to the implant in primary/secondary prevention (67% in secondary prevention vs 33% in primary prevention). CHD and CM are mostly implanted in primary prevention. The rate of appropriate shocks in secondary prevention is higher than that in the primary one regardless of the disease.
Thirty-eight percent of patients received appropriate shock, of which 66.7% were patients who had received defibrillator as a bridge to heart transplant. Two patients (3.6%) received inappropriate shocks on supraventricular tachycardia. There were no acute post-implantation complications. None dysfunctions or ruptures of the shock catheter or episodes of T wave oversensing took place. Peri-procedural and post-transplant mortality is zero, except for a deceased subject awaiting transplantation due to congestive heart failure.
CONCLUSIONS The study confirmed the protective role of the device, in terms of prevention of sudden cardiac death, and its relevance as bridge to heart transplantation in pediatric age. An implant technique adequate to the size, age and heart disease of the patient associated with an adequate programming of the device significantly reduced inappropriate shocks in our patients.
The value of c-reactive protein to albumin ratio in predicting long term mortality among hfref patients with implantable cardiac defibrillators
Authors: Cinier G , Hayiroglu MI , Kolak Z , Tezen O , Yumurtas AC , Pay L , Eren S , Cetin T , Ozcan S , Turkkan C , Ozbilgin N , Tekkesin AI , Alper AT , Gurkan K 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Patients with heart failure with reduced ejection fraction (HFrEF) who received implantable cardiac defibrillator (ICD) still remain at high risk due to pump failure and comorbid conditions. C-reactive protein to albumin ratio (CAR) may be of value for identifying those with high risk for mortality despite ICD implantation.

Methods
Those who were implanted ICD for HFrEF in our institution between 2009 and 2019 were included. CAR was calculated as ratio of C-reactive protein (CRP) to serum albumin concentration. Patients were grouped into tertiles in accordance to CAR at the time of implantation. After follow up of 48 ± 35 months, survival times of tertiles were compared by using Kaplan-Meier survival method.

Results
Thousand and eleven patients constituted study population. Ischemic cardiomyopathy was primary diagnosis in 92.3%. Of those 14.5% had died after discharge. Patients in tertile 3 (T3) had higher risk of appropriate shock (19.3% vs 23.7% vs 38.0%) and mortality (4.2% vs 11.0% vs 28.5%) compared to those in other tertiles. Multivariable analysis revealed that when patients in T1 were considered as reference, both those in T2 and T3 had independently higher risk of appropriate shocks and mortality. These effects were consistent in the unadjusted and adjusted multivariable models.

Conclusion
Among patients with HFrEF and ICD, elevated CAR increased the risk of appropriate device shock and mortality at long term. Table 1Admission C-reactive protein/Albumin ratio (n = 1011)T1 (n = 337)T2 (n = 337)T3 (n = 337)Mortality, %4.211.028.5Mortality, HR (95% CI)Model 1: unadjusted1[Reference]3.85 (2.12 - 11.20)8.14 (2.46 - 28.56)Model 2: adjusted for age, sex1[Reference]3.20 (1.90 - 9.48)6.32 (2.12 - 20.12)Model 3: adjusted for comorbiditesa1[Reference]4.85 (2.06 - 14.12)10.86 (4.12 - 44.82)Model 4: adjusted for covariatesb1[Reference]2.72 (1.66 - 7.12)5.72 (2.04 - 18.05)Frequency, %19.323.738.0Appropriate shock, HR (95% CI)Model 1: unadjusted1[Reference]1.38 (0.44 - 6.88)2.48 (1.34 - 5.82)Model 2: adjusted for age, sex1[Reference]1.42 (0.48 - 7.24)3.02 (1.52 - 6.24)Model 3: adjusted for comorbiditesa1[Reference]1.34 (0.38 - 6.66)2.74 (1.40 - 7.28)Model 4: adjusted for covariatesb1[Reference]1.30 (0.34 - 5.68)2.28 (1.16 - 8.28)Cox proportional analysis and logistic regression models for the appropriate shock and the long-term mortality by CAR.Abstract Figure 1
Are His bundle pacing or His bundle plus coronary sinus pacing superior to conventional cardiac resynchronization therapy in improving heart failure? Results from a controlled study
Authors: Senes JS , Mascia GM , Bottoni NB , Oddone DO , Donateo PD , Grimaldi TG , Calogero CM , Bertolozzi JB , Puggioni EP , Brignole MB , Coluccia GC 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

BACKGROUND
His bundle pacing (HBP), alone or optimized in association with coronary sinus pacing (HBP + LV) has recently been proposed as an alternative to conventional cardiac resynchronization therapy (CRT). However, there is lack of controlled studies that assessed clinical outcome.

METHODS
We did a single-centre, propensity-score matched, case-control study of comparison of HBP and HBP + LV versus conventional CRT in patients with heart failure (HF) and standard indications for CRT. The study group patients (n = 27) were consecutively enrolled in the years 2019. The control group patients (n = 27) were selected, by propensity score matching, among those CRT implantations performed, in the years 2015-2018.

RESULTS
In the active group, HBP alone was preferred in 12 (44%) patients, HBP + LV pacing in 12 (44%) patients and HBP failed in 3 (11%) patients. In the control group, conventional CRT was achieved in 26 (96%) patients and failed in one. Paced QRS width was shorter in the active than in the control group (128 ± 18 ms vs 148 ± 27 ms, p = 0.004). During a mean of 9.6 months of follow-up, in the intention-to-treat analysis, a composite clinical outcome of death, hospitalization for HF or worsening HF occurred in 3 (11%) in the active group and in 4 (15%) in the control group, p = 0.58. No difference was also observed with softer endpoints: NYHA class (1.9 ± 0.7 versus 2.1 ± 0.7), subjective improvement (74% versus 74%) and LV ejection fraction (40.7% versus 40.7%).

CONCLUSION
Compared with standard CRT, a shorter QRS width can be obtained with HBP alone or HBP + LV but we were unable to show a better clinical outcome. There is urgent need for large, randomized trials. Results by intention-to-treat analysisVariableActive groupN = 27Control groupN = 27PFollow-up, months9.7 ± 4.89.5 ± 4.50.90QRS width, ms128 ± 18148 ± 270.004Combined primary endpoint3 (11%)4 (15%)0.58• Death for HF10• Hospitalization for HF24• Worsening HF-1Subjective improvement20 (74%)20 (74%)1.24NYHA class1.9 ± 0.72.1 ± 0.70.15LV ejection fraction (%)40.7 ± 11.540.7 ± 12.21.00HF = heart failure; NYHA = New York Heart Association; LV = left ventricleAbstract Figure. Flow of active group patients
Reduction in QRS area correlates with hemodynamic response during CRT-device implantation
Authors: Ghossein MA , Van Stipdonk AMW , Salden FCWM , Engels EB , Zanon F , Westra S , Maass AH , Rienstra M , Prinzen FW , Vernooy K 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background Previous studies have shown that reduction in QRS area after cardiac resynchronization therapy (CRT) is associated with improved long-term clinical outcome.
Purpose To investigate whether reduction in QRS area is associated with hemodynamic improvement and whether QRS area reduction could be used for CRT optimization, with respect to LV lead position and device programming in individual patients.
Methods A total of 78 patients with indication for CRT were prospectively included in 4 hospitals. QRS area was calculated from vectorcardiograms that were synthesized from 12-lead ECG’s. Acute hemodynamic response was assessed invasively as the maximum rate of percentual left ventricular (LV) pressure (%LVdP/dtmax) rise. QRS area reduction was studied in relation to LV-lead position (n = 26), proximal versus distal LV lead position (n = 27), and VV-delay (n = 25).
Results Combining all measurements in all patients showed a significant correlation between QRS area reduction and %LVdP/dTmax increase (R = 0.49, P &lt; 0.0001). Also, when one fixed routine implantation setting was used for each patient (lateral lead position, distal, AV-delay 120-150ms, VV-delay 0ms) this correlation was present (R = 0.45, p &lt; 0.0001, figure panel A). In 21 patients in which at least 3 lead positions were available there was also a significant correlation between QRS area reduction and %LVdP/dtmax increase (average R = 0.69, p &lt; 0.0001, panel B). For VV-delay, 25 other patients as well showed a significant correlation (average R = 0.53, p &lt; 0.0001).
Conclusion Within patients, QRS area reduction is associated with %LVdP/dtmax increase with various LV lead positions and VV-intervals. Therefore, QRS area, which is an easily obtainable and objective parameter, might be a promising tool for optimization of LV lead position and device programming in CRT. Abstract Figure.
The pacemaker ventricular lead position and outcomes in patients upgrading to crt
Authors: Silva BV , Brito J , Rodrigues T , Silverio Antonio P , Couto Pereira S , Alves Da Silva P , Lima Da Silva G , Cunha N , Teixeira P , Carpinteiro L , Cortez -Dias N , Pinto FJ , Sousa J 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction

Adverse hemodynamic effects of right ventricular pacing are known, and the optimal right ventricular lead position is still being a matter of debate. According to the guidelines, upgrade to cardiac resynchronization therapy (CRT) is recommended in patients with indication for pacemaker and left ventricular ejection fraction less than 50% or who need more than 40% of ventricular pacing.

Purpose

To compare clinical outcomes and ejection fraction in patients with previous pacemaker (apical versus septal right ventricular pacing) who are upgrated to CRT.

Methods

Single-center retrospective study of 94 consecutive patients who had previous pacemaker and upgraded to CRT over a 4-year period. Of these patients, 64 had previous apical lead pacemaker and 30 had previous septal lead pacemaker. Data on comorbidities, New York Heart Association (NYHA), left ventricular ejection fraction and hospitalizations due to heart failure were collected.
The results were obtained using Chi-square, Mann-Whitney and t-test.

Results
Patients with septal pacemaker had significantly more diabetes (p = 0.04) and chronic obstructive pulmonary disease (p = 0.01), tended to be more symptomatic (p = 0.198) and had more days of hospitalization before and after pacemaker implantation (12 ± 3 versus 7 ± 2 days and 8 ± 4 versus 3 ± 1 days, respectively), mostly due heart failure decompensation.
Although there were no significant differences in the initial ejection fraction in patients with apical or septal pacemaker implantation (31.2 ± 1.2% and 29.1 ± 1.5%, respectively, p = 0.323), the time to upgrade to CRT was significantly shorter in patients with septal pacemaker implantation (1999 ± 227 days versus 3005 ± 279 days, p = 0.005).
After upgrading to CRT, patients with apical lead had a significant increase in ejection fraction (8.2%, p = 0.011), while patients with septal lead had a non-significant improvement of ejection fraction (4.5%, p = 0.448). In both, apical and septal lead patients, there was a significant improvement in NYHA class after upgrade to CRT (p = 0.03 and p = 0.02, respectively).

Conclusion

Although patients with septal lead had more comorbidities and hospitalizations due to heart failure, they do not benefit from the upgrade to CRT, unlike what happens in patients with apical lead. These findings can be explained by the fact that the septal lead minimizes ventricular desynchrony induced by right ventricular pacing.
Impact of homeometric autoregulation using a stepwise change in heart rate on dP/dtmax and time to peak dP/dt with resynchronization therapy
Authors: Odland H , Ross S , Gammelsrud LO , Cornelussen R , Kongsgard E 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Norwegian South East heath Authorities

Background
We investigated the homeometric autoregulation utilizing a stepwise change in heart rate on dP/dtmax and time to peak dP/dt (Td) with biventricular pacing (BIVP) and the LV lead positioned in the apical, anterior and lateral positions. Pacing at low HR (LHR) and high heart rates (HHR) changes contractility through homeometric autoregulation (Bowditch effect) without changing the resynchronization itself.

Purpose
To determine the effect of a change in contractility through homeometric autoregulation on two different effect measures of resynchronization therapy.

Methods
Twenty-nine patients in heart failure with LBBB underwent CRT implantation with continuous LV pressure registration. The LV lead was first placed in either apical or anterior position followed by a permanent placement in a lateral position. Sequential BIVP pacing was performed for one minute, at a rate 10% above intrinsic heart rate (LHR = 75 ± 9bpm), before dP/dtmax measurements were recorded, and the sequence was repeated with pacing rate increased by 30% (HHR = 98 ± 11bpm). Td was defined as the time from pacemaker stimuli to peak dP/dt. Mixed linear models were used for statistics, numbers are estimated marginal means ± SEM. Significance was set at p &lt; 0.05.

Results
DP/dtmax was higher with HHR in lateral position (1036 ± 41mmHg/s) than with LHR (933mmHg/s). The same was observed for all other lead positions. However, there was no difference between lateral position with LHR and apical position with HHR (930 ± 44mmHg/s). There were no differences in Td between LHR and HHR, but Td was shorter with BIVP in lateral position at pacing LHR (158 ± 4ms) and HHR (155 ± 4ms) than in all other positions. Overall dP/dtmax increased by 10% from LHR to HHR (888 ± 41mmHg/s vs. 980 ± 41 mmHg/s), while overall Td decreased by 2.4% from 168 ± 4ms to 164 ± 4ms. We found a linear relationship between Td and dP/dtmax (R = 0.7) with β=-0.07 that would indicate a 6ms reduction in Td going from LHR to HHR. The overall change in Td from LHR to HHR could therefore be attributed to the change in dP/dtmax.

Conclusion
Homeometric regulation does not influence Td, but Td is sensitive to changes in resynchronization and pacing lead position. Td is shorter with BIVP in lateral position at both high and low HR as would be expected from a biomarker of resynchronization. HR influences dP/dtmax so distinction between optimal and non-optimal positions using dP/dtmax may be difficult without knowledge of homeometric state.
Is diversity harmful? - Mixed-brand cardiac implantable electronic devices undergoing magnetic resonance imaging
Authors: Koenig C , Hellebart P , Koch J , Egger F , Puntus T , Kriz R , Huber K , Nuernberg M , Zweiker D 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Many patients with cardiac implantable electronic devices (CIED) need to undergo magnetic resonance imaging (MRI). However, a significant proportion has a CIED system in place that has not been classified "MRI-conditional" because of generators and leads from different brands ("mixed-brand" group), although the individual components per se are MRI-conditional. There is only limited data available concerning the outcome of these patients with "mixed-brand" CIED systems undergoing MRI.

Purpose
To analyse complications or adverse effects in "mixed-brand" CIED patients undergoing MRI, compared to patients with a fully "MRI-conditional" CIED system.

Methods
A retrospective single-centre study was performed, including patients undergoing MRI between January 2013 until May 2020. Short- and long-term outcomes were compared between both groups. We defined the primary endpoint as death or any adverse event necessitating hospitalization or CIED revision in association with the MRI examination. Secondary endpoints were the occurrence of any surrogate for beginning device or lead failure or patient discomfort during MRI.

Results
A total of 227 MRI examinations, including 10 thoracic MRIs, were carried out in 158 patients, with a range of 1-9 MRIs per patient. Mean age was 73 years and 52 (32.9%) patients were female. We identified 38 patients undergoing 54 procedures in the "mixed-brand" group and 89 patients undergoing 134 MRI procedures in the "MRI-conditional" group. In 31 patients undergoing 39 MRI examinations the MRI-conditionality could not be determined. "Mixed-brand" patients were older than MRI-conditional patients (mean 77 vs. 72 years, p = 0.003). The primary endpoint occurred in 0% in the "mixed-brand" group and in 2.2% in the "MRI conditional" group (p = 1.000). Complications were as follows: Two patients had first diagnosed atrial fibrillation directly associated with the procedure, of whom one additionally had a transient CIED dysfunction. No patient in the "mixed-brand" group and three patients (3.4%) in the "MRI conditional" group met the secondary endpoints (p = 0.554). In patients with undeterminable MRI conditionality the complication rate was similar (0% for both the primary and secondary endpoints).

Conclusion
The complication rate of CIED patients undergoing MRI was low. There was no signal for increased risk of adverse events in patients with a CIED without MRI certification due to mixed brands systems compared to patients with "MRI-conditional" CIED systems.