bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term follow-up of heart transplant patients treated with permanent pacemaker: a monocentric study
Authors: Tua L , Turco A , Acquaro M , Scelsi L , Greco A , Ghio S , Savastano S , Sanzo A , Vicentini A , Petracci B , Vullo E , Vicini Scajola L , Pelenghi S , Oltrona Visconti L , Rordorf R 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background and purpose
Permanent pacemaker implantation (PPMi) is needed in about 5% of patients following heart transplant (HTx) primarily due to sinus node dysfunction (SND), which commonly occurs in an early phase, or to atrio-ventricular block (ABV), which is common later on. Currently, data on rate of ventricular pacing (VP) is lacking and little is known on long-term outcomes after PPMi.

Methods
This was a retrospective, monocentric study. Among 1123 patients treated with HTx, all with biatrial technique, from november 1985 to march 2019 at our institution, 61 (5.4%) patients needed PPMi. PM parameters, clinical and echocardiographic data were collected at 1 month and at 1-3-5-10 years follow-up. The primary aim was to analyse the percentage of right ventricular pacing in the overall population and in subgroups stratified by the timing of PPMi and by pacing indication. Secondary endpoints were to analyze long-term outcomes according to the percentage of ventricular pacing and to the type of implanted PM (single vs. dual chamber).

Results
Among patients treated with PPMi (68.9% single-chamber), 62.2% were implanted for SND and 36% for AVB. Early PPMi (&lt; 3 months after HTx), occurred in 34.4% of patients, mainly due to SND, while late PPMi (&gt; 3 months after HTx) occurred in 65,6% with an equal distribution between SND and AVB. Median follow-up time from HTx was 140 months and 82 months from PPMi. Overall mean rate of VP was 21%. Rate of VP was higher in patients implanted early rather than late after HTx, both at 1 month (91% vs 2%, P = 0,002) and at 1 year after the procedure (43 vs 1, P = 0,037). Patients with AVB had a greater rate of VP compared to those implanted for SND, irrespective of timing of implantation and these findings were still present at 3 and 5 years follow-up (62 vs 1%, P = 0,011 at 3 years and 80 vs 6%, P = 0,002 at 5 years). VP declined progressively after PPM implantation. No differences were observed in terms of 10-years mortality between early vs late PPMi, dual vs single-chamber and mean VP &gt; 21% vs ≤ 21%.

Conclusions
Patients treated with PPMi after HTx show on average low percentage of VP over long-term follow-up. AV block indication and early implantation are associated with a higher percentage of VP. The rate of VP, the timing of PPMi and the use of single vs dual chamber PM do not affect overall prognosis or left ventricular systolic function. Our data may justify implantation of a single-chamber PPM, which bears less complications and procedural time, in the majority of HTx patients needing PPMi.
How many patients treated for bradycardia may be eligible for His bundle pacing?
Authors: Chattopadhyay R , Chousou P , Thomas R , O"brien J , Pierres F , Hayes J , Vassiliou V , Pugh PJ 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Pacing-Induced Cardiomyopathy (PICM) can lead to significant morbidity, requiring treatment by device upgrade procedures. The risk of occurrence is directly related to the burden of right ventricular pacing, which can be reduced by careful device programming. When frequent ventricular stimulation cannot be avoided, pacing the conduction system may offer an alternative to myocardial pacing and reduce the risk of PICM. The most recent international pacing guidelines recommend that His-bundle pacing should be considered among 1) patients with EF 36-50% and expected to require &gt;40% ventricular pacing (Vp &gt; 40%) (class IIa); and 2) patients requiring pacing who have block at the level of the AV node (class IIb).

Purpose
This study sought to determine how many patients undergoing bradycardia pacing would have fulfilled those criteria.

Methods
This was a single-centre retrospective study over a 5 year period to the end of April 2020. Demographic and clinical details of patients receiving device implants were obtained from the Pacing Service Database, along with the indication for pacing, electrocardiographic and echocardiographic data. A cardiology consultant with a special interest in pacing reviewed each case with regards to the likelihood of requiring &gt;40% ventricular pacing. Heart block at the level of the AV node was considered present if patients presented with a narrow QRS in conjunction with second or third degree heart block.

Results
1,265 patients underwent pacemaker implant for bradycardia during the study period, 888 for conduction system disease (198 second degree block, 333 complete heart block), 349 for sinus node disease and 28 for other indication. Figure 1 gives a breakdown of patients with conduction system block according to i) level of block; ii) ejection fraction; iii) expectation or not of Vp &gt; 40%. In total, 166 patients had a class IIa indication for His-bundle pacing. 227 patients had block at the level of the AV node, of whom 36 also fulfilled the class IIa criteria for His-bundle pacing; 191 patients (16% of the total) had a sole class IIb indication for His-bundle pacing. Adjusting for the 176 patients who did not undergo echocardiography, up to an additional 45 patients may be expected to have an indication for His-bundle pacing

Conclusion
As many as 32% of patients in a bradycardia pacing population may be eligible for His-bundle pacing. This has significant implications for training and service provision. Abstract Figure 1. Flowsheet showing distribution
Success and failure for implantation of left bundle branch pacing using stylet-driven pacing leads : a single center experience
Authors: So T 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background/Introduction :Left bundle area pacing is a new modality of physiological pacing. By screwing the pacing lead deep into the interventricular septum, the left bundle branch could be recruited for pacing purpose. Initially left bundle area pacing was performed with fixed helix lead supported by the delivery catheter. On the other hand, there are studies showing the feasibility of using a style-driven extendable helix with the new delivery sheath for left bundle area pacing.
Purpose :To study the feasibility of left bundle area pacing and explore factors associated with success and failure
Methods :This is a retrospective study from September 2020 to January 2021 in a local hospital. Baseline patient characters, procedural characters, acute complication and reason for failure were recorded. Logistic regression was done to explore factors associated with success and failure.
Results :In 14 patients, the mean age is 81 +/- 6.8 years with 28% female. Pacing indications were sick sinus syndrome (n = 3) and atrio-ventricular block (n = 11). The success rate is 64% (n = 9/14). The average R wave sensing was 11.4 +/- 4.5mV, the average V pacing threshold was 0.88 +/- 0.23V @ 0.4ms and average impedance was 633 +/- 93.6 Ohm. There were no septal perforation nor pericardial effusion after implantation. The most common reason for failure is lead dislodgement during implantation (n = 4) and the other reason is failure to locate and capture the left bundle (n = 1). In logistic regression, there was no clinical risk factor identified to predict failure for implantation , i.e. diabetics ( OR 0.95, p =0.15), hyperlipidaemia (OR 0.87, p =0.94), chronic renal disease (OR 0.88, p = 0.94), coronary heart disease (OR 0.37, p = 0.66). Gender(OR 4.5, p = 0.37), age(OR 1.1, p = 0.32) and hypertension(OR 25, p = 0.25) may appear to predict failure for implantation but the results were not statistically significant.
Conclusion :Left bundle area pacing could be feasible and safely implanted using style-driven lead with good pacing parameters. No clinical factor is identified to predict the failure of implantation, the main reason for failure is dislodgement of lead during implantation. Similar finding was noted in a study comparing lumen-less lead and stylet-driven lead.2 In this study found that reason for failure of left bundle area pacing using style-driven lead was due to repetitive lead dislodgement after slitting the delivery sheath, fail advancement of lead into septum and loose septal endocardium. Stability and ability to screw into septum remain a great obstacle for left bundle area pacing using stylet-driven lead. This study is limited by small sampling size and single center retrospective study. Further studies are needed to see the long term outcome of left bundle area pacing using style-driven lead and investigate other methods to predict success/ failure of implantation, such as the role of imaging.
Long term stability of the subcutaneous cardioverter defibrillator implanted by means of the intermuscular two incision technique
Authors: Bisignani G , Bisignani A , Cavaliere AL , Lovecchio M , Valsecchi S , De Bonis S 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background To ensure effective defibrillation with the subcutaneous implantable cardioverter defibrillator (S-ICD), both the lead and the generator must be adequately positioned extrathoracically. We assessed the long-term adequacy of the S-ICD system position and its stability in a group of patients who received the S-ICD by means of the two-incision intermuscular technique.
Methods The PRAETORIAN score uses chest radiography to provide feedback on S-ICD positioning, and identifies patients with high defibrillation thresholds. We compared radiographs taken immediately after implantation and on 12-month follow-up examination.
Results We analyzed data from 38 patients with the S-ICD generator positioned in an intermuscular pocket. The median PRAETORIAN score was 38 [25th to 75th percentile: 30 to 60]. Two (5%) patients had a score of 90 (intermediate risk of conversion failure). The thickness of the adipose tissue between the coil and the sternum was ≤1 coil width in 72% of patients, the generator was on, or posterior to, the midline in 94% of patients, and the amount of fat tissue between the generator and the thoracic wall was less than the generator width in 78% of patients. No generator or electrode dislodgments were detected on analyzing radiographs collected at the 12-month visit. In all patients, assessment of the PRAETORIAN score confirmed the values calculated on post-implantation analysis. During follow-up, no ineffective therapies, sudden cardiac or device-related deaths occurred.
Conclusions The position of the S-ICD system implanted using the two-incision intermuscular technique was adequate at the time of implantation and remained stable after 12 months.
Gradually increasing impedance in patients with pacemakers and implantable defibrillators: a watchful waiting strategy
Authors: Maass A , Klingenberg M , Groenveld HF , Mulder BA , Blaauw Y , Rienstra M 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Pacing impedance measurements are important in the surveillance of pacemaker and implantable cardioverter/defibrillator (ICD) devices. Whereas sudden changes in impedances can reflect lead fracture or isolation defects, gradually increasing impedances are thought to occur because of calcifications at the endomyocardial interface. In many cases, these leads are replaced prophylactically but this has not been studied systematically.

Purpose
We aimed to identify the outcome of right ventricular (RV) electrodes with high impedances that were left active in this single center study.

Methods
All patients in the electronic patient database were screened for impedances &gt;1200Ohms. 41,201 individual recordings led to 207 individual patients. 161 patients were excluded from the analysis due to sudden impedance increase, temporarily high impedances or wrong entry. Of the remaining 46 patients, baseline characteristics as well as pacing impedance, sensing values, pacing thresholds, and shock impedance in case of ICDs were recorded.

Results
There were 17 pacemaker and 29 ICD patients, 68 ± 15 years old, 70% were male. Glomerular filtration rate at baseline was 81 ± 22 ml/min/1.73m2. Baseline RV impedance was 597 ± 123Ohms. During follow-up impedances increased to 1875 ± 682Ohms (p &lt; 0,001). Pacing thresholds increased from 0,6 ± 0,4V to 3,0 ± 1,9V (p &lt; 0,001). Sensing remained stable. The median time from implant to impedance rise &gt;1000Ohms was 5,5 (3,4-7)years and median follow-up thereafter 2,4 years (1,2-4,2). During follow-up, no intervention was performed for 33 leads (72%). No events occurred. 13 leads (28%) were replaced , 9 prophylactically (mostly because of ICD advisory leads), 3 because of high pacing thresholds and high percentage pacing and one lead because of noise oversensing, probably unrelated as it occurred 7 years after impedance increase.

Conclusions
A watchful waiting strategy appears to be a safe option for patients with ICDs and pacemakers with low percentage pacing. As impedance increase cannot be used for surveillance for imminent lead fracture, other means such as short interval counts and non-sustained oversensing have to be employed and should be combined with remote monitoring.
Prevention of sudden cardiac death by the implantable cardioverter-defibrillator in adults with inherited heart disease. long term follow-up
Authors: Herruzo Rojas M , Gomez Lopez A , Martin Toro MA , Gonzalez Perez PJ , Morales Ponce FJ 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

BACKGROUND
Inherited heart diseases include all inheritable channelopathies or cardiomyopathies. Sudden cardiac death (SCD) might be the first and last clinical presentation. ICD implantation is established as a therapeutic tool according to risk criteria.

OBJETIVES
The aim of this study is to analyze the population characteristics in ICD/ CRT-ICD recipients in patients with inherited heart disease and establish possible risk predictor factors of arrhytmogenic events during follow-up.
MÉTHODS: This is a prospective single-center registry. We included all patients from January1, 2012, to December 31, 2020 who subsequently underwent ICD/ ICD-CRT implantation.

RESULTS
A total of 172 patients were included with a mean age of 60.47 ± 13,1 years and a mean follow-up duration of 49.71 ± 41.8 months. The most frequent underlying cardiac condition was dilated cardiomyopathy (58.1%), followed by hypertrophic cardiomyopathy (15.7%), arrythmogenic cardiomyopathy (2.3%), long QT syndrome (1.7%), Brugada syndrome (1.2%), catecholaminergic (2.9%) , idiopathic (7%) and others (11%). 89 ICDs (51.7%) and 83 ICD-CRTs (48.2%) were implanted for primary prevention of SCD.
During follow-up, 13.4% of the patients experienced arrhythmogenic events. Only 4.1% of the patients experienced inappropriate shock, secondary to supraventricular arrhythmias all of them. Genetic testing was done in only 14.1% of our patients.
In the 27 cases of hypertrophic cardiomyopathy, 25 (92.6%) underwent ICD implantation for primary prevention. 14 patients (51.9%) had family history of SCD, 8 (29.6%) had unexplained syncope and 16 (59.3%) had ventricular tachycardia in the Holter monitoring. The mean left atrial size was 44.15 ± 7.2mm, mean maximum LV-wall thickness 22.85 ± 5,25mm, and a mean LVOT gradient of 30.56 ± 31.3mmHg, with a mean actual HCM SCD-score of SCD over 5 years of 5.84 ± 3.53%. According to traditional parameters, 100% of the HCM sample meet criteria for ICD implantation in primary prevention compared to 66.7% according to the new score.
During follow-up 2 patients (7.4% ) experienced arrhythmogenic events, and 3 patients (11.1%) had inappropriate shocks secondary to supraventricular arrhythmias.
Genetic testing was done in 22.2% of the patients and was positive for a known pathogenic mutation in half of the cases.
None of the parameters evaluated in the current score, a high risk of SCD according to it, having old high risk criteria or implanted of ICD in secondary prevention were related in our study with more arrhytmogenic events.

CONCLUSIONS
ICD implatation for primary prevention is the main indication in our population. Either classic factors or the new HCM SCD-score were no related in our study with the presence of arrhytmogenic events during follow-up.
Slow VT treatment in a contemporary population of primary prevention ICD recipients
Authors: Angeletti A , Ziacchi M , Martignani C , Massaro M , Statuto G , Sorrentino S , Piemontese GP , Capobianco C , Spadotto A , Minguzzi A , Diemberger I , Biffi M 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Implantable cardioverter defibrillator (ICD) is an effective therapy for sudden cardiac death (SCD). 2015 HRS/EHRA/APHRS/SOLAECE expert consensus document suggests long VT detection, above 185 bpm, as optimal ICD programming to reduce unnecessary therapies in primary prevention (PP).

Purpose
The aim of our study is to evaluate incidence, safety and efficacy of ICD treatment for VT arrhythmias below 185 bpm, in a contemporary population of PP ICD recipients with long detection intervals (LDI), morphological discrimination algorithm and antitachycardia pacing therapies (ATP) before shock.

Methods
We conducted a single centre retrospective study enrolling 236 patients implanted with a primary-prevention indication from January 2013 to June 2019. Patients were implanted with single or dual chamber single-lead transvenous ICD. All patients had standard device setting with long (at least 20 s in VT and 7 s in VF) VT/VF detection above 150 bpm and therapies starting from 171 with up to 5 ATP and multiple shocks. PainFREE-like bursts and Schaumann-like ramps ATP were always set in VT zone. Of each patient we collected a detailed report of up to five appropriate events and three inappropriate events. Arrhythmia diagnosis was confirmed from 3 independent expert physicians. Date of the event, cycle length, type of morphology (polymorphic or monomorphic), therapies with their effect were collected.

Results
During a mean follow-up of 42 months, 47 (20 %) and 18 (8%) patients had at least one appropriate and inappropriate activation, respectively. The detailed-events analysis shows that 16 (7%) patients had 38 (30%) appropriate events with rate &lt;188 bpm. At these rate ATP were 97% effective. 14 (38%) of inappropriate activations were caused by arrythmias with ventricular rate below 188 bpm and half of these received a shock; 30% of inappropriate shocks were due to arrhythmia with rate &lt;188 bpm. 73% of treated events, with rate &lt;188 bpm, were appropriate. Only 5.6% (n = 10) of ATP attempts cause arrhythmia acceleration.

Conclusions
One third of detected arrhythmias had a rate below 188 bpm and 73% were true VT. In this slow VT zone, ATP had a high success rate with low percentage of acceleration.
Prognostic impact of subcutaneous implantable cardioverter-defibrillator appropriate and inappropriate shocks
Authors: Oliveira L , Cavaco D , Rodrigues G , Matos D , Carvalho MS , Carmo J , Santos PG , Costa F , Carmo P , Santos I , Morgado F , Mendes M , Adragao P 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Previous studies have shown an adverse prognosis for patients with transvenous implantable cardioverter-defibrillators (ICD) who receive both appropriate and inappropriate shocks. There is a paucity of data regarding the prognosis of inappropriate shocks in patients with a subcutaneous ICD (S-ICD).

Purpose
To assess and characterize S-ICD appropriate (AS) and inappropriate shocks (IAS) and their impact on mortality.

Methods
Single center observational registry of 162 consecutive patients who underwent S-ICD implantation for primary and secondary prevention between November 2009 and September 2020. Only follow-up data of at least 6 months was analysed to identify predictors of both IAS and AS and their mortality impact.

Results
A total of 144 patients were included in the analysis. Mean age was 42.2 ± 16.6 years and 75% of the patients were male. One hundred and four patients (72.2%) implanted the S-ICD in primary prevention. The most common etiology was ischemic cardiomyopathy (22.9%) followed by hypertrophic cardiomyopathy (18.8%) and dilated idiopathic cardiomyopathy (14.6%). During a mean follow-up of 42.3 ± 29.9 months a total of 48 patients (33.3%) experienced at least one S-ICD shock. Twenty-nine (20.1%) patients received AS due to VT/VF and 31 patients (21.5%) received IAS. Eighteen (58.1%) of the IAS were due to oversensing/noise/discrimination errors and the remaining due to supraventricular tachycardia. Overall, patients with AS (HR 4.93, 95% CI 1.58-15.36, p = 0.006) and higher number of total AS (HR 1.10, 95% CI 1.00-1.20, p = 0.044) were associated with higher mortality during follow-up. S-ICD IAS therapy did not affect overall mortality (HR 1.71, 95% CI 0.21-14.0, p = 0.616). Conclusions: In patients with S-ICD, those who receive AS, in contrast to IAS, seem to have a worse prognosis. Large scale studies are needed to confirm this hypothesis and to explain this findings. Abstract Figure. Survival curves for AS and IAS