bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pacemaker implantation using electroanatomical mapping system Carto 3: technical protocol, single centre experience
Authors: Elices Teja J , Duran Bobin O , Lopez Lopez A , Perez Perez A , Franco Gutierrez R , Gonzalez Juanatey C 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background / Purpose: Three-dimensional electro-anatomical mapping systems (EAM) reduce fluoroscopy exposure during ablation procedures. The aim of this study is to evaluate the security and feasibility of performing pacemaker implantation with EAM routinely on a more regular basis (without fluoroscopy) and to draft a technical protocol to perform these implants.

Methods
Eight non-selected patients with pacemaker indication that had been referred to the electrophysiology unit of our institution underwent a dual chamber pacemaker implantation with EAM system Carto 3 (Biosense Webster, Irvine, CA, USA). All implants were performed by the same operator and, in all cases, the same lead model was employed. All difficulties that arose during the implantations were solved applying the actions contained in the protocol described below. First - Creation of three anatomical maps with Carto 3: venous access, right atrium and right ventricle. Annotate the end of the venous sheath. Second- For right ventricle lead positioning, connect the pacemaker lead to the Carto 3 system as an external catheter. Place the right ventricle lead, fix it and perform measurements. Third - Fuse the three maps with the "anatomical merge" tool. Fourth - Using the "design line" tool, draw a line from the tip of the lead to the end of the venous sheath following the expected trajectory of the lead in its correct position. Measure that distance. Calculate (substrate) the theoretically remaining lead. Fifth - With a ruler, measure the portion of the lead remaining out of the sheath. Sixth - Reposition the lead, if necessary.
Seventh - Repeat the same procedure for the atrial lead and complete the implant procedure.
Finally - Verify leads position with fluoroscopy (optional).
Results : Eight patients received a dual chamber pacemaker, 75% male with a mean age 82,88 ±4,97 years. The most frequent indication was AV block (75%). The implant was performed through cephalic vein access (37,5%), subclavian vein access (50%). Mean procedure time (skin to skin) was 94 ±15 minutes. There were no complications related to the implant nor was it necessary to replace the lead.
Conclusions : Pacemaker implantation with Carto 3 is a safe and reliable. The learning curve is not steep and the operator should be confident enough only after a few procedures. The protocol developed facilitates the implant procedure. Fluoroscopy timeCase12345678Fluoroscopy time (s)474786246060Dose area product (Gy*cm2)4,270,3710,0290,0630,0630,020,1230,018Abstract Figure. Carto image: dual chamber pacemaker.
Lower pacemaker implantation rates for atrioventricular block during COVID-19
Authors: Zweiker D , Puntus T , Egger F , Kriz R , Koch J , Hellebart P , Huber K , Nuernberg M 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The first wave of the COVID-19 crisis was associated with a reduction of patients presenting with acute cardiovascular disease. However, there is only limited data showing the trend of pacemaker implantations and their indications.

Purpose
To evaluate pacemaker implantations before, during and after the first COVID-19 wave, stratified by indication.

Methods
We analysed the weekly rates of pacemaker implantation at our centre during the first national lockdown for COVID-19 at the between 16 March 2020 and 29 April 2020 (weeks 12-17 / 2020), compared to the implantation rates 6 weeks before (weeks 6-11 / 2020), 6 weeks afterwards (weeks 18-23 / 2020), and the same time frame in 2017-2019. To reduce bias due to postponed planned procedures, we stratified pacemaker implantations into the following groups: total implantations (including box changes), new pacemaker implantations, implantation due to AV block, implantation due to supraventricular conduction disturbances, and other implantations.

Results
The total number of total weekly implantations was reduced from 10.7 (weeks 6-11 / 2020) to 4.2 (weeks 12-17 / 2020; -60.1%, p = 0.02). We found no significant reduction in the same time frame in 2017-2019 (6.5 vs. 6.1 per week, p = 0.29). We found a similar effect in "new" pacemaker implantations (8.5 vs. 3.2 per week, -62.7%, p = 0.02) and AV block (5.0 vs. 1.5 per week, -70%, p = 0.03). There was no reduction in pacemaker implantation due to sick sinus syndrome (2.5 vs. 0.8 per week, -66.7%, p = 0.12) and other indications (1.0 vs. 0.8 per week, -16.7%, p = 0.86).
In the six following weeks (18-23 / 2020), the total numbers (6.0 per week) and indications other than AV block rose to baseline (p &gt; 0.05), but patients with AV block were still less prevalent (1.7 per week, p = 0.04).

Conclusion
The reduction of total and new pacemaker implantations during the COVID-19 lockdown was mainly based on a reduced pacemaker implantation rate for AV block. This effect persisted even after the national lockdown. This analysis implies that a significant number of patients with AV block may have avoided medical contact during and after the lockdown and therefore have experienced increased mortality.
One-center experience in leadless pacemakers after heart valve replacement
Authors: Martinez-Sande JL , Gonzalez L , Garcia-Seara J , Rodriguez-Manero M , Fernandez-Lopez XA , Gonzalez Juanatey JR 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Leadless pacemakers (LPM) have demonstrated adequate electrical performance and safety in patients with multiple commorbidities. Limited information has been published about patients with LPM and heart valve replacements.

Purpose
We were interested to present our experience in patients with LPM and heart valve replacements.

Methods
This was a prospective observational study in which we include all consecutive LPM implantation in a 5 year period (June 1 2005 to January 1 2020). Clinical, electrical and echocardiographic characteristics were described and evaluated in 2 different groups with and with-out surgical procedure.

Results
A total of 242 LPM were implanted. We describe clinical and echocardiographic characteristics in patients table 1. There were no significant differences in electrical performance in between both groups (Figure 1).

Conclusions
In our series with LPM we observed adequate electrical performance as well as safety at implant and follow-up in patients with heart valve replacements. No valve procedure185Valve procedure61pAge79.2 (±6.4)79.7 (±8)0.6395Men114340.78866Hypertension151440.899914Diabetes Mellitus58190.635131COPD3470.345258Renal insufficiency29160.000717Ischemic cardiomiopathy36140.495789LVEF59.9 (±7.6)590.036577Single mechanical replacement18Single bioprosthetic replacement12Bioprosthetic valve + TV annuloplasty3Bioprosthetic valve + MV & TV annuloplasty1Mechanical valve + TV annuloplasty2Sigle MV annuloplasty1MV & TV annuloplasty2Abstract Figure.
Long-Term clinical outcomes of subcutaneous implantable defibrillator therapy in patients with heart failure and reduced ejection fraction: a single center experience
Authors: Ben Kilani M , Jacon P , Carabelli A , Venier S , Defaye P 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): P. JACON consultant: Boston Scientific France

Introduction
The implantable cardioverter defibrillator (ICD) is the most effective therapy for prevention of sudden cardiac death in high-risk patients with heart failure and reduced ejection fraction (HFrEF). The subcutaneous implantable cardioverter defibrillator (S-ICD) has been considered as a comparable and relatively safer alternative to transvenous ICD in patients (pts) without pacing indication.

Purpose
Our aim was to assess the clinical "real-life" outcomes of S-ICD in patients with HFrEF and primary or secondary prevention, over a long-term follow-up (FU) period after S-ICD implantation.

Methods
All pts with HFrEF (left ventricular ejection fraction ≤35%) implanted with a S-ICD and a FU above 6 months were included in a cross-sectional monocentric study. Pts were followed by remote monitoring.

Results
88 pts were included (52 ± 12.8 years old, male 87.5%). Indications were: primary 92% and secondary 8% prevention (ischemic cardiopathy 46%; dilated 46%; hypertrophic 5%; congenital 2%; valvular 1%). The mean left ventricular ejection fraction was 27%. 9 pts had a previous transvenous ICD implanted, but required revision because of infection or lead defects. The mean FU period was 33 ± 18 months with a mortality rate of 10% (S-ICD-related death secondary to inappropriate (inap) shocks for one patient). 5 pts underwent S-ICD system extraction after a mean FU period of 30 ± 21 months. Reasons were infectious complication (1 pt), pacing indication (2 pts) and S-ICD lead dysfunction (2 pts). Extraction after heart transplant was performed in 4 pts. During FU, 18 pts (20.5%) experienced at least one therapy: 8 pts (9%) with appropriate (ap) (3.3% per year) and 11 pts (12%) with inap shocks (4.36% per year). A total number of 24 ap shocks have been observed (3 ± 4 ap shocks per patient, several shocks for 3 pts), the first shock occurred after a mean FU period of 24 ± 14 months. 2 pts were referred to VT ablation and no recurrence of events was observed after medical therapy modification for the other pts. For the 11 pts with inap shocks, time to the first event was 19 ± 20 months. Reasons were: supraventricular arrhythmias (18%), T wave (36%) and noise (54%) oversensing. There was 1.8 ± 1.6 shock per patient with several shocks for 4 pts. Among pts with inap shocks, 2 pts required S-ICD system extraction, 1 pt died, while reprogramming and medical therapy options were efficient in other pts.

Conclusion
In pts with HFrEF at high risk of sudden cardiac death, S-ICD has proven to be effective in treating ventricular arrhythmias. However, more investigations must be conducted to explain the real-life high rate of inappropriate therapies. Abstract Figure. Survival-free from therapies curve
Prognostic Nutritional Index as the Predictor of Long-Term Mortality among HFrEF Patients with ICD
Authors: Cinier G , Hayiroglu MI , Pay L , Yumurtas AC , Tezen O , Eren S , Kolak Z , Cetin T , Ozcan KS , Turkkan C , Ozbilgin N , Tekkesin AI , Alper AT , Gurkan K 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The benefit of implantable cardiac defibrillator (ICD) in patients with heart failure and reduced ejection fraction (HFrEF) could be limited in a particular group of patients. Low prognostic nutritional index (PNI) indicates malnutrition and pro-inflammatory condition. We sought to investigate the value of PNI in predicting long-term mortality among HFrEF patients with ICD.

Methods
Electronic database was searched for identifying patients with HFrEF who were implanted ICD in our institution between 2009 and 2019. Demographic and clinical characteristics of included patients were recorded. PNI was calculated according to the formula: 10 x serum albumin (g/dL) + 0.005 x total lymphocyte count (per mm3). Patients were divided into the quartiles according to PNI values. Differences between the groups were analysed by the log-rank test. A forward Cox proportional regression model was used for multivariable analysis.

Results
One thousand and hundred patients were included to the study. The underlying heart failure etiology was ischemic and non-ischemic in 77.3% and 22.7% of patients respectively. Mortality rate in Q1 (5.1%) was considered as the reference. In the unadjusted model the mortality rate was 9.5% [hazard ratio (HR) 1.76, 95% confidence interval (95% CI) (0.92 – 3.38)] in Q2, 10.2% (HR 1.88, 95% CI 0.99 – 3.58) in Q3 and 39.6% (HR 8.12, 95% CI 4.65 – 14.17) in Q4. The same trend was consistent in the age- and sex-adjusted, comorbidities-adjusted and covariates-adjusted models.

Conclusion
Among patients who were implanted ICD secondary to HFrEF, lower PNI value predicted all-cause mortality during long-term follow up. This is the first study demonstrating the value of PNI in this population. Table 1Admission Prognostic Nutritional Index (n = 1100)Q1 (n = 275)Q2 (n = 275)Q3 (n = 275)Q4 (n = 275)Long-term mortalityNumber of deaths142628109Mortality, %5.19.510.239.6Mortality, HR (%95 CI)Model 1: unadjusted1[Reference]1.76 (0.92 - 3.38)1.88 (0.99 - 3.58)8.12 (4.65 - 14.17)Model 2: adjusted for age, sex1[Reference]1.70 (0.90 - 3.48)1.79 (0.94 - 3.42)7.76 (4.42 - 13.61)Model 3: adjusted for comorbiditesa1[Reference]1.85 (0.96 - 3.55)1.89 (0.99 - 3.60)9.02 (4.34 - 14.12)Model 4: adjusted for covariatesb1[Reference]1.66 (0.88 - 3.21)1.60 (0.80 - 3.05)6.45 (3.61 - 12.5)Cox proportional analysis and logistic regression models for the long-term mortality by the prognostic nutritional indexAbstract Figure 1
Predictors for early mortality in patients with implantable cardiac defibrillator for heart failure with reduced ejection fraction
Authors: Cinier G , Hayiroglu MI , Pay L , Yumurtas AC , Tezen O , Eren S , Kolak Z , Cetin T , Ozcan KS , Turkkan C , Ozbilgin N , Tekkesin AI , Alper AT , Gurkan K 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Implantable cardiac defibrillators (ICD) are recommended in heart failure with reduced ejection fraction (HFrEF) patients to reduce arrhythmic deaths. The only contraindication for not implanting ICD is life expectancy of less than 1 year. We aimed to identify risk factors associated with mortality within 1 year following the device implantation.

Methods
Data from our hospital’s electronic database system was extracted for patients who were implanted ICD secondary to HFrEF between 2009 and 2019. Those who died within 1 year following the device implantation were analyzed in the present paper. Multiple Cox regression analysis using the backward logistical regression method was applied to determine the best predictors that affect 1-year mortality

Results
Overall 1107 patients were included in the present analysis. ICD was implanted in 77.2% and 22.8% for ischemic and non-ischemic HFrEF respectively. Mortality rate at 1-year following the device implantation was 4.7%. In multivariate analysis age [Hazard ratio (HR), 1.04; Confidence 95% Intervals (CI), 1.02 – 1.06; P = 0.001], atrial fibrillation (AF) (HR, 4.12; 95% CI, 2.34 – 7.24, P &lt; 0.001), NYHA class &gt; 2 symptoms (HR, 5.33; 95% CI, 2.92 – 9.73, P &lt; 0.001), blood urea nitrogen (BUN) (HR, 1.02; 95% CI, 1.00 – 1.03, P = 0.03) and albumin (HR, 0.52; 95% CI, 0.34 – 0.80, P = 0.003) independently predicted 1-year mortality

Conclusion
In patients with HFrEF and implanted ICD, older age, presence of AF and NYHA class &gt; II symptoms, elevated BUN and reduced albumin levels predicted 1-year mortality. Table 1 Multivariate analysis P value HR (95% CI) Age 0.001 1.038 (1.015 - 1.062) Atrial fibrillation &lt;0.001 4.119 (2.342 - 7.241) NYHA &gt; 2 &lt;0.001 5.328 (2.917 - 9.731) Blood urea nitrogen 0.034 1.017 (1.001- 1.034) Albumin 0.003 0.520 (0.337 - 0.801) Multivariate Cox regression analyses for 1-year mortality after implantation
Endocardial left ventricular pacing Where are we a systematic review
Authors: Santos H , Santos M , Almeida I , Paula S , Miranda H , Figueiredo M , Neto M , Sa C , Sousa C , Chin J , Almeida S , Almeida L 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Endocardial left ventricular pacing is a technique used in cardiac resynchronization therapy (CRT), when a coronary sinus implant is not possible, conventional CRT was an unsuccess and in CRT nonresponders. We performed a systemic review to evaluate its risks and benefits.

Objective
Review the evidence regarding the efficacy and safety of endocardial left ventricular pacing.

Methods
A systemic research on MEDLINE and PUBMED with the term "endocardial left ventricular pacing", "biventricular pacing" or "endocardial left pacing". 1038 results were identified, however, just publish papers (excluding abstract) with more than 16 patients was admitted in these analyses. Comparisons pre and post CRT regard New York Heart Association (NYHA) functional classification, left ventricular ejection fraction (LVEF) and QRS width was performed. Mean differences (MD) and confidence interval (CI) was used as a measurement of treatment.

Results
Eleven studies were selected, including a total of 560 patients. The studies were performed with different techniques, trans-atrial septal technique, trans-ventricular septal technique and transapical technique. Mean age 66.93 years old, 90.54% male, median ejection fraction of 28.86%, NYHA class of 3.03, QRS width 167,50 mseg. Ischemic etiologic in 43.88%, atrial fibrillation in 45.35% and left bundle branch block in 55.20%. Was reported several complications after the procedure, 8 pocket infection (7 studies), 17 transient ischemic attacks (10 papers), 17 ischemic stroke (all), 35 tromboembolic events (all) and 115 deaths, nevertheless, follow up in the different studies was diverse and heterogeneous. Significant improvement was registered in NYHA class (MD 0.64, CI 0.56-0.72, p &lt; 0.00001, I2 = 89%) (reported in 7 studies), LVEF (MD 6.20, CI 5.09-7.32, p = 0.002, I2 = 69%) %) (reported in 8 studies) and QRS width (MD 31.35, CI 26.11-36.60, p &lt; 0.00001, I2 = 89%) %) (reported in 5 studies), (all p &lt; 0.00001).

Conclusions
Left ventricular endocardial pacing is a feasible alternative to conventional CRT, when the last one is not possible. With clinical, electrocardiogram and echocardiogram improvement in several series. First data regarding this procedure were associated with higher stroke incidence, something contrary to the last study’s results. Nevertheless, at the moment just small series present this technique with heterogenous results and different approaches, being important further investigation.
Impact of pacing configuration and right ventricular lead location on dynamic atrioventricular delay optimization
Authors: Thibault B , Chow A , Mangual J , Badie N , Waddingham P , Mcspadden L , Betts T , Calo L , Leyva F 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Abbott

Introduction
Automatic adjustment of atrioventricular delay (AVD) with SyncAV has been shown to improve electrical synchronization. However, the effect of pacing configuration and right ventricular (RV) lead location on SyncAV programming is unknown.

Purpose
Evaluate the effect of pacing configuration and lead location on SyncAV optimization during biventricular (BiV) and LV-only pacing, with and without MultiPoint Pacing (MPP).

Methods
Patients with LBBB and QRS duration (QRSd) ≥ 150 ms scheduled for CRT-P/D device implantation with quadripolar LV lead were enrolled in this prospective study. RV lead location was classified at implant by the operator via fluoroscopy. QRSd was measured post-implant from 12-lead surface ECG by blinded experts during the following pacing modes: intrinsic conduction, BiV (BiV = RV + LV1), MPP (MPP = RV + LV1 + LV2), LV-only single-site (LVSS = LV1 only), and LV-only MPP (LVMPP = LV1 + LV2). For each mode, SyncAV was enabled (e.g. BiV + SyncAV) with the patient-tailored SyncAV offset that minimized QRSd. For BiV and LVSS, LV1 was the latest activating LV cathode; for MPP and LVMPP, LV1 + LV2 were the two LV cathodes with the widest possible separation (≥30mm). All modes used minimal RV-LV and LV1-LV2 delays.

Results
Fifty-three patients (68% male, 36% ischemic, 26% ejection fraction, 169 ms intrinsic QRSd) completed device implant and QRSd assessment. RV leads were implanted in either the septum (48%) or apex (52%), according to implanting physician preference. Relative to intrinsic conduction, BiV + SyncAV and MPP + SyncAV reduced QRSd by 23% and 27%, respectively (p &lt; 0.01). LVSS + SyncAV reduced QRSd by 22% (p &lt; 0.01 vs BiV + SyncAV), and LVMPP + SyncAV reduced QRSd by 25% (p &lt; 0.05 vs MPP + SyncAV). RV apex or septum lead location did not have a significant impact on QRS reduction for each pacing configuration. As a percent of PR interval, optimal SyncAV offsets were similar for BiV + SyncAV and MPP + SyncAV (16% vs 13%, p = 0.05), and for LVSS + SyncAV and LVMPP + SyncAV (18% vs 21%, p = 0.46), but were significantly higher for LV-only settings vs. corresponding BiV/MPP settings (p &lt; 0.05 for both pairs). For BiV + SyncAV, apical vs septal RV leads required greater SyncAV offsets (22% vs 11%, p &lt; 0.05). SyncAV offsets also tended to be higher in apical vs septal RV leads for MPP (21% vs 11%), LVSS (20% vs 15%), and LVMPP (25% vs 16%), but without statistical significance.

Conclusion
SyncAV improves acute electrical synchronization in CRT patients with LBBB, particularly with patient-specific SyncAV programming. Pacing configuration (RV + LV or LV only, with or without MPP) and RV lead location (apex or septum) could potentially influence optimal SyncAV programming. Abstract Figure.
The role of three dimensional transeosephageal echocardiography in predicting the effect of cardiac resynchronization therapy on mitral regurgitation in patients with low ejection fraction heart fail
Authors: Demirtola A , Tan TS , Mammadli A , Akbulut IM , Dincer I 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Purpose
Cardiac resynchronization therapy (CRT) has a positive effect on the improvement of functional mitral regurgitation in patients with low ejection heart failure. However geometric changes in the mitral valve apparatus, subvalvular structures and their contribution to the improvement of mitral regurgitation after CRT have not been clearly defined. The aim of our study was to evaluate the geometric parameters of mitral valve apparatus measured with 3Dimensional (3D) transesophageal echocardiography (TEE) before CRT implantation and to determine the parameters predicting the improvement of mitral regurgitation after CRT.

Methods
Thirty patients with moderate or severe mitral regurgitation with low EF heart failure planned for CRT implantation and had an indication for TEE were included in the study. Effective regurgitant orifice (ERO) and regurgitant volume (RV) measurements were performed before CRT implantation. Detailed quantitative measurements of mitral valve were done from recorded images by 3D TEE. ERO, RV measurements were repeated to evaluate mitral regurgitation at the end of 3rd month.

Results
There were no significant changes in left ventricular EF and left ventricular diameters at the end of 3rd month, whereas ERO and RV values were decreased. A statistically significant difference was found in posterior leaflet angle between mitral regurgitation responder and non-responder groups. (28,93 ± 8,41 vs 41,25 ± 10,90, p = 0,006).

Conclusion
Heart failure patients with moderate or severe functional mitral regurgitation who underwent CRT implantation were found to have lower posterior leaflet angle measured by 3D TEE in the patient group whose mitral regurgitation improved after CRT. Abstract Figure.