bluuebunny/crossref_metadata_2025_split huggingface dataset:
Concealed cardiomyopathy as a frequent cause of idiopathic ventricular fibrillation in a representative Czech cohort of survivors of sudden cardiac arrest (SCA)
Authors: Krebsova A , Votypka P , Peldova P , Haskova J , Tavacova T , Peichl P , Segetova M , Roubicek T , Vancura V , Kubus P , Sramko M , Macek Jr M , Zoubkova V , Janousek J , Kautzner J 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health of the Czech Republic

Introduction
The complex diagnostic work up in SCA survivors often does not yield a concrete cardiological diagnosis. Moreover, there is conflicting evidence whether genetic testing could support or guide clinical diagnostics.

Purpose
To assess the molecular architecture of idiopathic ventricular fibrillation in cases without apparent evidence of specific structural or arrhythmic cardiac disease at initial diagnostic work up in a representative Czech cohort.

Patients and Methods
Between 2013 - 2020 we have ascertained 100 SCA survivors (54 M / 46 F; age range at cardiac arrest 5-69 years). Genetic counselling was followed by massively parallel DNA sequencing using custom-made panels comprising 100 cardiac conditions-related genes. Subsequently, thorough cardiological screening examinations in first degree relatives were carried out. Presence of pathogenic variants was validated by Sanger DNA sequencing and through family segregation analyses.

Results
Highly likely or certain molecular aetiology (i.e. based on the presence of Class 4 or 5 variants) was disclosed in 20/100 (20%) in PKP2 (3x), SCN5A (4x), RYR2 (3x), TTN (2x), PLN, FLNC, PRKAG2, KCNH2, KCNQ1, SLC4A, TNNT2, and DSP. Interestingly, the KCNE1 p.Asp85Asn (LQT 5 lite) variant, was detected in further 3/100 cases, representing a recognized risk factor for ventricular arrhythmias.

Conclusions
Genetic testing facilitates stratification of the cause of arrhythmia in a substantial portion of SCA survivors. The utility of positive outcomes of genetic testing was substantiated in 10/20 gene positive patients, where the genetic stratification led to diagnosis of concealed arrhythmogenic cardiomyopathy, whose extent of morphological changes was under the diagnostic sensibility of imaging modalities or ECG. Our results enable individualized care in SCA survivors and assure targeted preventive approaches in their relatives.
Management of Nanostim leadless pacemaker early-life battery failures. A single center experience
Authors: Oosterwerff F , Salavati A , Adiyaman A , Ghani A , Smit JJJ , Ramdat Misier A , Delnoy PPHM , Elvan A 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background/introduction Early studies of the Nanostim leadless pacemaker demonstrated technical feasibility effective pacing performance at the short-term. However, recently the Nanostim proved to be susceptible to early-life battery failures.
Purpose In this study, we addressed the following research questions:
1) What percentage of Nanostim LPs experience early-life battery failure?
2) Is Nanostim extraction and subsequent pacemaker reimplantation safe and effective?
3) Is three monthly follow-up under the Nanostim advisory effective at preventing Nanostim LP related in-between hospitalizations?
Methods In a retrospective study, we collected data of 49 Nanostim implanted patients with a mean follow up of 3 (±1.5) years at our tertiary hospital.
Results Nanostim early-life battery failure in our population was 37% (18/49). Extraction of 14 Nanostim pacemakers (device age 1040 ± 467 days) in an older population (80 ± 7 years) was safe (0 complications) and effective (80% extraction success, 100% reimplantation success). All known cases of early-life battery failure were identified during the three monthly follow-up consultations.
Conclusions Nanostim LP early-life battery failure is substantially higher than previously reported.
In case of dysfunction Nanostim extraction in an older population is safe and effective. Three monthly follow-up is effective at preventing in-between Nanostim related hospitalization. Abstract Figure. Management of Nanostim battery failure
Non-selective and selective His bundle pacing both preserve left ventricular activation time and pattern
Authors: Arnold A , Shun-Shin MJ , Keene D , Howard JP , Chow J , Miyazawa AA , Qureshi N , Lefroy DC , Koa-Wing M , Linton NWF , Lim PB , Peters NS , Kanagaratnam P , Francis DP , Whinnett ZI 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): British Heart Foundation

Background: His bundle pacing can be achieved in two ways
selective His bundle pacing, where the His bundle is captured alone, and non-selective His bundle pacing, where local myocardium is also captured resulting a pre-excited ECG appearance. We assessed the impact of this ventricular pre-excitation on left and right ventricular dys-synchrony.

Methods
We recruited patients who displayed both selective and non-selective His bundle pacing. We performed non-invasive epicardial electrical mapping to determine left and right ventricular activation times and patterns.

Results
In the primary analysis (n = 20, all patients), non-selective His bundle pacing did not prolong LVAT compared to select His bundle pacing by a pre-specified non-inferiority margin of 10ms (LVAT prolongation: -5.5ms, 95% confidence interval (CI): -0.6 to -10.4, non-inferiority p &lt; 0.0001). Non-selective His bundle pacing did not prolong right ventricular activation time (4.3ms, 95%CI: -4.0 to 12.8, p = 0.296) but did prolong QRS duration (22.1ms, 95%CI: 11.8 to 32.4, p = 0.0003).
In patients with narrow intrinsic QRS (n = 6), non-selective His bundle pacing preserved left ventricular activation time (-2.9ms, 95%CI: -9.7 to 4.0, p = 0.331) but prolonged QRS duration (31.4ms, 95%CI: 22.0 to 40.7, p = 0.0003) and mean right ventricular activation time (16.8ms, 95%CI: -5.3 to 38.9, p = 0.108) compared to selective His bundle pacing.
Activation pattern of the left ventricular surface was unchanged between selective and non-selective His bundle pacing. Non-selective His bundle pacing produced early basal right ventricular activation, which was not observed with selective His bundle pacing.

Conclusions
Compared to selective His bundle pacing, local myocardial capture during non-selective His bundle pacing produces right ventricular pre-excitation resulting in prolongation of QRS duration. However, non-selective His bundle pacing preserves the left ventricular activation time and pattern of selective His bundle pacing. When choosing between selective and non-selective His bundle pacing, left ventricular dyssynchrony is not an important factor. Abstract Figure: Selective vs Non-Selective HBP
Clinical outcomes with ventricular pacing or dual-chamber pacing for sinus-node dysfunction: a nationwide matched control study
Authors: Fauchier L , Bodin A , Bisson A , Herbert J , Ah-Fat V , Spiesser P , Pierre B , Clementy N , Babuty D 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Introduction.Evidence from randomized trials suggests that, in patients with sinus-node dysfunction (SND), physiologic pacing (dual-chamber, DDD) may be superior to single-chamber (ventricular, VVI) pacing because it is associated with lower risks of atrial fibrillation and stroke, better exercise capacity and lower risk of pacemaker syndrome. However, benefits on mortality and risk of heart failure have not been demonstrated and these issues have not been fully evaluated in large "real life" analyses.
Objective.The aim of our study was to assess and compare clinical outcomes within the first 30 days and during a longer-term follow-up with the two types of pacing at a nationwide level for patients with SND.
Methods and results.Using the administrative hospital database in France 2010-2020, 52,974 patients with SND were included in the analysis: 4,069 patients had VVI pacing and 48,905 had DDD pacing. Patients with leadless VVI pacemakers were excluded of the analysis. After propensity score matching 2,213 patients with VVI pacemaker were matched 1:1 with 2,213 patients treated with DDD pacemaker. In the matched analysis, patients with DDD pacemakers had a lower rate of all-cause (hazard ratio HR 0.711, 95%CI 0.61-0.828) and cardiovascular death (HR 0.628, 95%CI 0.48-0.818) within the 30 days after implantation. There were no significant differences for incidence of tamponade (HR 0.666, 95%CI 0.11-3.992), pneumothorax (HR 1.000, 95%CI 0.32-3.105), hemothorax (HR 0.800, 95%CI 0.21-2.982), major bleeding (HR 0.824, 95%CI 0.68-1.005) and transfusion (HR 1.016, 95%CI 0.83-1.243). During subsequent follow-up (mean: 3.0 ± 2.8 years), risk of all-cause death in the matched population was significantly lower in the DDD group than in the VVI pacemaker group (HR 0.683, 95%CI 0.60-0.784). Patients with SND treated DDD pacemakers also had a lower risk of cardiovascular death (HR 0.569, 95%CI 0.44-0.732), new-onset atrial fibrillation (HR 0.638, 95%CI 0.58-0.706), ischemic stroke (HR 0.685, 95%CI 0.53-0.887) and hospitalization for heart failure (HR 0.758, 95%CI 0.68-0.850) than those treated VVI pacemakers, whilst risk of endocarditis was not significantly different (HR 0.986, 95%CI 0.50-1.951).
Conclusion.Patients with SND treated with DDD pacemakers had better clinical outcomes compared to those treated with VVI pacemakers. DDD pacing was associated with lower risks of death, cardiovascular death, new-onset atrial fibrillation, ischemic stroke, hospitalization for heart failure. DDD pacing was neither associated with a higher risk of complication on the short-term nor of endocarditis on the longer-term.
Conduction disturbances after TAVR: rates of pacemaker implantation, burden of ventricular pacing and prognostic significance
Authors: Bricoli S , Benatti G , Vignali L , Tadonio I , Notarangelo MF , Crocamo A , Gonzi G , Placci A , Bottoni N , Biagi A , Rossi L , Guiducci V , Losi L , Zardini M 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

BACKGROUND
The occurrence of conduction disturbances remains frequent after TAVR. However, the effect of PM on mortality is controversial and many patients may recover spontaneous AV conduction during follow-up.

PURPOSE
To evaluate the incidence of PM implantation after TAVR, PM dependency and burden of ventricular pacing during follow-up and their influence on mortality.

METHODS AND RESULTS
We performed a retrospective analysis of all consecutive 293 patients who underwent TAVR from 2015 to 2019 at our hospital, regional hub for this procedure. Patients were classified into 3 groups: patients without PM (no-PM), patients with a PM implanted prior to TAVR (pre-PM) and patients requiring a PM following TAVR (post-PM) and their clinical and procedural characteristics are listed in Table 1.
The rate of PM implantation after TAVR was 20,8%, at a median of 3.6 days after the procedure. The most common indication was complete AV block. A VVIR pacemaker was implanted in 28 patients, a DDD/DDDR PM in 27 patients and 2 patients received a CRT device. Among post-PPM patients, only 16% were PM-dependent at 2-month and 1-year follow-up. All of them received a PM for complete AV block (AVB). At 1-year follow-up, RV pacing burden was 60% among AVB patients and 23% in patients with a PM implanted for other reasons. PM implantation after TAVR was not associated with a mortality difference at 30-day, 1-year and long-term follow-up. Pre-PPM patients showed a higher mortality rate at long-term follow-up although not statistically significant.

CONCLUSIONS
Our data suggest that a single chamber device should be preferred in patients implanted for reasons other than complete AVB; in patients with AVB, the use of dual chamber device with an algorithm to minimize RV pacing should be the most suitable choice. Overall (293)No PPM (216)Pre-PPM (19)Post-PPM (57)p-valueAge, median(IQR)82(80-86)82(80-86)82(79-87)82(80-86)0,53Female, n(%)160(55)129(59)6(32)25(44)0,40NYHA III-IV, n(%)191(65)147(68)15(79)29(51)0,06Logistic Euroscore, mean (IQR)7,53(3,5-8,3)7(3,5-8)9,83(3,6-12)6(3,5-7,4)0,51Right bundle-branch block, n(%)21(7)13(6)na8(14)0,04AVA, mean ± SD0,69 ± 0,190,7 ± 0,190,7 ± 0,160,66 ± 0,180,23Self-expandable valve, n(%)181(62)123(57)12(63)46(81)0,001Balloon-expandable valve, n(%)102(35)86(40)7(37)8(14)0,0003Implant depth, mean ± SD6,87 ± 2,96,32 ± 2,65,71 ± 39,12 ± 30,0001Abstract Figure. Kaplan-Meier survival curve
Leadless pacemaker implant with concomitant atrioventricular node ablation: a single center study with longterm followup
Authors: Martinez Sande JL , Garcia-Seara J , Gonzalez-Melchor L , Rodriguez-Manero M , Torrelles-Fortuny A , Perez-Poza M , Abou-Jokh C , Gonzalez-Ferrero T , Garcia-Vega D , Fernandez-Lopez XA , Gonzalez-Juanatey JR 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Feasibility of concomitant leadless-pacemaker(LP) implantation plus atrioventricular node ablation(AVNA) is unknown. Moreover, safety issues in the long run are also undetermined. It seems theoretically attractive since it could avoid one additional procedure and catheter could be introduced through the same sheath employed for the LP. On the contrary, risk of dislocation/electrical variations could represent a shortcoming .

Objective
We aim to report 1) feasibility of concomitant AVNA after a LP implantation and 2) long-term outcomes.

Methods
Single center, prospective and observational study of 243 consecutive patients with an indication for single-chamber pacemaker placement. The implantation procedure was carried out using a femoral approach and conventional technique. Successful implantation was accomplished in 242/243 patients referred for leadless implantation. In one patient, a complete obstruction of the inferior vena cava was documented, and a conventional unicameral pacemaker was implanted.

Results
33 out of 242 patients underwent immediate AV ablation. Mean age was 75.2 ± 8.3 years. Were predominantly females: 25(75.7%) and indication was fast conduction atrial fibrillation(n = 25), atypical flutter or atrial tachycardia (n = 8). Mean acute "R wave" was 11.3mV, threshold of 0.55Vx0.24ms and impedance of 833Ω. Uneventful AV node ablation was performed in all of them immediately after LP implantation. Additional mean fluoroscopic time was 3.0 minutes.
There were no vascular or arrhythmic complications after the implantation. After a mean follow-up of 19.9± 12 months, all patients remained alive without notable event, and electrical parameters remained unchanged.(Figure 1)

Conclusions
Conconmitant AVN ablation after LP implantation seems feasible without remarkable complications in the long run. In our experience, this approach appears more comfortable for the patients and less time-consuming than conventional pacemaker implantation with sequential AV node ablation. There were no device macrodislodgements or unexpected device malfunctions in the follow-up period. Abstract Figure. Electrical performance
Pacemaker therapy in the elderly and very elderly: survival and prognostic factors
Authors: Del Castillo-Carnevali HA , Marschall A , Torres-Lopez M , Basabe-Velasco E , Gomez-Sanchez I , Fraile-Sanz C , Goncalves-Sanchez F , Rodriguez-Torres D , Rueda-Linares A , Coto-Morales B , Dejuan-Bitria C , Cinza-Rey R , Marti-Sanchez D , Alvarez-Anton S 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The number of elderly patients undergoing pacemaker (PM) implantation is constantly growing. However, information on survival and prognostic factors of this particular patient group is scarce.

Objective
The objective of this study was to determine the survival of elderly and very elderly patients undergoing PM implantation, as well as to investigate prognostic factors of mortality.

Methods
This is a retrospective observational study of a single centre. Patients ≥ 80 years of age, that underwent PM implantation between January 2017 and December 2018 in our centre, were included for chart review. Very elderly patients were defined as those with ≥ 90 years of age.

Results
A total of 269 patients were included in the study with a mean age of 85 (±4.1) years. 53 patients were ≥ 90 years of age. 52% of the patients were male. 24.5% of the elderly patients and 41.5% of the very elderly patients received a single chamber PM. Median follow-up time was 28 (14-30) months, with no significant differences between the two groups of patients. The mortality rate for elderly patients was 15.7% for the elderly and 32.1% for the very elderly (p = 0.002). Generating multivariate Cox regression models, the following parameters showed to be significant predictors of all-cause mortality: Age (1.37 (1.02-1.29), p = 0.005), chronic kidney disease (5.57 (2.47-12.56), p &lt; 0.001), COPD (3.74 (1.19-11.55), p = 0.023) and cancer (3.57 (1.02-12.51), p = 0.046). In the group of the very elderly only age (1.58 (1.10-2.27), p = 0.014) and cancer (3.76 (2.38-4.18), p = 0.003) significantly predicted mortality.

Conclusions
Our study shows a good life expectancy of elderly and very elderly patients, that underwent PM implantation, with a survival rate that is comparable to the general population. The primary prognostic factors were non-cardiological and co-morbidities, such as chronic kidney disease, cancer and COPD, had a stronger association with mortality than age.
A leadless pacemaker in the real-world setting: Patient profile and performance over time
Authors: Garweg C , Clementy N , Mondoloy P , Winter S , Bordachar P , Sharman D , Jung W , Eschalier R , Theis C , Defaye P , Anderson C , Pol A , Roberts PR 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Medtronic, Inc.

OnBehalf
Micra Acute Performance EMEA Investigators

Background
The first in-man implant of the Micra leadless pacemaker occurred in December 2013. While prior trials demonstrated a high implant success rate and favorable safety and efficacy results; whether the patient population and outcomes have changed over time is not well studied.

Purpose
To characterize the evolution of patient profile and outcomes for patients receiving a leadless pacemaker through the pre-market and post-market environment.

Methods
Patients undergoing a Micra leadless pacemaker implant attempt from the initial Micra Investigational Device Exemption [IDE] and current Micra studies (Micra post-approval registry [PAR], Micra acute performance [MAP] study) were analyzed. Patient characteristics and pericardial effusions regardless of severity were summarized.

Results
The 3466 patients included in the analysis underwent a Micra implant attempt and were enrolled during consecutive timeframes: patients from the Micra IDE study (n = 726) underwent a Micra implant attempt from 2013-2015, patients from the PAR (n = 1814) from 2015-2018, and patients from Micra MAP cohort (n = 926) from 2018 – 2020. Implant success was &gt;99.0% in all 3 studies. Median age ranged from 78 – 79 years among the 3 studies without significant difference. There were more patients requiring dialysis in the MAP cohort compared to the PAR or IDE cohorts (10.3%, 7.9%, and 3.9%, respectively; P &lt; 0.001), but fewer patients with congestive heart failure (8.3%, 13.1%, and 18.0%; P &lt; 0.001). Pacing indication was significantly different between the studies, with fewer patients in MAP having an indication of bradyarrhythmia associated with atrial fibrillation (AF) and more having an indication associated with atrioventricular block without AF (P &lt; 0.001). The number of patients considered to be precluded for a transvenous pacemaker implant increased significantly from the initial IDE study to the PAR and MAP studies (6.2%, 23.9%, and 44.1%, respectively, P &lt; 0.001). Implant site placement was mostly apical for the IDE but shifted to mostly septal placement in the PAR and MAP (septal placement: 33.3%, 64.0%, and 79.5%, respectively). The rate of pericardial effusion regardless of severity was 1.79% (n = 13) in the IDE, 0.83% (n = 15) in the PAR, and 0.97% (n = 9) in MAP (figure). Mean pacing thresholds among MAP EMEA patients were low (0.61 ± 0.40V) at implant and remained stable through 12 months (0.62 +/- 0.41V).

Conclusion
Despite patient differences over time, the Micra leadless pacemaker was implanted with a high success rate and a low perforation rate, in-line with prior reports. Abstract Figure. Pericardial effusion rate by study
How good is operator opinion at predicting high ventricular pacing burden among patients receiving device therapy for bradycardia?
Authors: Chattopadhyay R , Chousou P , Thomas R , Hayes J , O"brien J , Pierres F , Vassiliou V , Pugh PJ 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Current guidelines indicate that pacing methods that maintain physiologic ventricular activation (biventricular pacing or His-bundle pacing) should be chosen over right ventricular pacing (Vp) among patients with EF 36-50% who are expected to Vp &gt;40% of the time. There are no guidelines to help predict which patients will receive a high burden of Vp and this is left to operator
opinion. We sought to ascertain whether operator opinion is an accurate predictor of high burden of Vp.

Methods
This was a single-centre single-blinded observational study of patients who received pacemaker implant for treatment of bradycardia between April 2015 and 2019 and had at least 12 month follow-up data on record. Patients’ demographic, clinical, electrocardiographic and echocardiographic data were reviewed in a blinded fashion by a senior implanting physician, who estimated whether the Vp at 12 months would exceed 40%. The Vp at approximately 12 months was obtained from the pacing records and compared with the prediction.

Results
Some 982 patients underwent pacemaker implantation during the study period, 698 for conduction system disease (CSD), 267 for sinus node disease (SND) and 17 for other conditions. Overall, 856 had valid follow-up data. Of these, 543 (63.4%) were predicted to Vp &gt;40% , and 527(61.6%) were documented as having Vp &gt;40%. The sensitivity and specificity of operator prediction were 93.2% and 84.2%, with positive and negative predictive values of 90.4% and 88.5%. Table 1 illustrates analyses of different populations by clinical parameter. In sub-group analysis, complete heart block and PR &gt; 300ms were significant factors for accurate prediction of Vp &gt; 40%, however clinical features, such as syncope, were poor discriminators.

Conclusion
In this single-centre study, among patients receiving pacemaker implant for treatment of bradycardia, operator prediction of the burden of Vp &gt;40% has an acceptable degree of accuracy. Sub-group analysis suggests that certain clinical parameters could make this prediction easier. Table 1. Comparison of operator opinion SND CSD CHB SND+PR &lt; 160 PR &gt; 300 Syncope Non-syncope n 698 267 216 84 60 409 344 Sensitivity 44.4% 97.7% 100% 6.3% 100% 86.4% 87.9% Specificity 98.3% 62.0% 45.2% 97.1% 0%* 89.9% 79.6% PPV 87.0% 90.6% 91.6% 33.3% 98.3% 94.2% 92.2% NPV 87.9% 87.9% 100% 81.5% - 77.6% 70.5% * only 1 patient did not RV pace &gt;40% - this was not predicted. SND – sinus node disease; CSD – conduction system disease; CHB – complete heart block, PPV – positive predictive value; NPV – negative predictive value