bluuebunny/crossref_metadata_2025_split huggingface dataset:
Targeting ventricular tachycardia originating from the anterolateral papillary muscle with stereotactic body radioablation therapy
Authors: Khaykin Y , Comsa D , Le K , Gao-Kang J , Pirbaglou M , Sadek M , Pantano A , Taremi M 
Published: October 2024

Abstract

Background
Ventricular Tachycardia (VT) is prevalent in the setting of non-ischaemic cardiomyopathy (NICM), a heterogeneous group of conditions characterized by myocardial dysfunction in the absence of coronary artery disease. Challenges of catheter ablation to treat VT in NICM patients are well known, and recurrence rates can be as high as 58%. Stereotactic body radioablation therapy (SBRT) involves precise delivery of radiation to arrhythmogenic substrates, and represents a novel treatment to reduce recurrent implantable cardioverter defibrillator (ICD) therapies in patients with refractory VT. Though SBRT has shown preliminary effectiveness in reducing VT episodes, its effectiveness in NICM patients has not been widely evaluated.

Purpose
To evaluate SBRT effectiveness in NICM patients with scars at the basal anterolateral papillary muscle at a tertiary care center between November-December 2022.

Methods
Eligible patients had their VT substrate mapped using a single-use ECGI vest and a 4D-CT simulation scan. In addition, MRI scans were used to aid anatomical identification of the anterolateral papillary muscle which could not be seen on the non-contrast diagnostic CTs. SBRT was delivered in a single fraction of 25 Gy under image guidance. Effectiveness of the treatment was evaluated as changes in frequencies of total antitachycardia pacing (ATP) and ICD shock episodes from 6 months pre-, and within to 3, 6, and 12 months follow up post SBRT.

Results
Participants were 3 males with NICM, aged 56, 60, and 73 with previous dual chamber ICD implantation, 2 of whom had a history of VT ablation/ VT storm and paroxysmal atrial fibrillation. All participants had basal lateral scar, and were receiving beta blockers, mexiletine, and amiodarone with refractory VT before SBRT treatment. Prior to SBRT, ICD device interrogation showed a total of 119 (77, 7, and 35 in patients 1-3 respectively) ATPs, and 27 (10, 1, and 16 in patients 1-3 respectively) ICD shocks delivered. At 12 month follow-up, none of the participants experienced any episodes of ATP or ICD shock. Ejection fraction remained consistent pre-post SBRT.

Conclusion
SBRT showed remarkable success in reducing ATP and ICD shock episodes, facilitating uncomplicated 1 year follow-up in 3 male patients with NICM and VT from the anterolateral papillary muscle.
The effect of afterload on right ventricular pacing-induced left ventricular dysfunction: a translational study
Authors: Ruppert M , Lakatos B K , Balint T , Nagy D , Ladanyi Z S , Sayour A A , Olah A , Barta B A , Molnar L , Osztheimer I , Straub E , Zima E , Geller L , Radovits T , Merkely B 
Published: October 2024

Abstract

Introduction
Right ventricular (RV) pacing (RVP) impairs left ventricular (LV) function. Nevertheless, the interaction between arterial afterload and RVP-associated LV dysfunction has not been investigated yet.

Purpose
We sought to examine the effect of afterload on RVP-evoked LV hemodynamic changes in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) as well as in a small animal model of sustained LV pressure overload (PO).

Methods
Thirty-five patients with AS and a previously implanted pacemaker underwent detailed echocardiographic examination immediately before TAVI and also on the second postoperative day. The ultrasound measurements were carried out during intrinsic, narrow QRS rhythm and during frequency-matched RVP as well. Global myocardial work index (GMWI) was calculated to assess LV contractility. In parallel, LV pressure-volume analysis was performed in Wistar rats with transverse aortic constriction (TAC) or sham operation (Sham) during intrinsic narrow QRS rhythm (termed as TAC-Vsense and Sham-Vsense) as well as during RVP (termed as TAC-Vpace and Sham-Vpace). RVP was achieved in rats by an octopolar electrophysiology catheter placed in the RV.

Results
RVP decreased LV contractility in AS patients before and after TAVI as well. Nevertheless, the extent of RVP-evoked LV dysfunction was alleviated following pressure unloading (ΔGMWI: -37±7 vs. -25±8%, before TAVI vs. after TAVI, P&lt;0.05). Similarly, although RVP was associated with reduced LV contractility in both the TAC (the slope of the maximum rate of LV pressure rise-end-diastolic volume relation [dPdtmax-EDV]: 92±8 vs. 53±6mmHg/s/µl, TAC-Vsense vs. TAC-Vpace; P&lt;0.05) and Sham groups (dPdtmax-EDV: 74±5 vs. 60±9 mmHg/s/µl, Sham-Vsense vs. Sham-Vpace; P&lt;0.05), the negative inotropic effect of RVP was found to be stronger in the TAC compared to the Sham group (ΔdPdtmax-EDV: -42±4 vs. -19±6%; TAC vs. Sham, P&lt;0.01). Furthermore, reduction of the maximal rate of LV pressure decrease (ΔdPdtmin: -20±3 vs. -5±5%, TAC vs. Sham, P&lt;0.01) and prolongation of the active relaxation time constant (Δτ: 22±3 vs. 6±3%, TAC vs. Sham, P&lt;0.01) also occurred to a greater extent in case of sustained LV PO, indicating augmented diastolic dysfunction.

Conclusion
Our translational results indicate that RVP-induced LV dysfunction might be afterload dependent.
Impact on preoperative estimation of atrial mechanical amplitudes with vdd leadless pacemaker
Authors: Komai Y , Kajiyama T K , Takanashi Y T , Yoshino Y Y , Ryuzaki S R , Chiba T C , Ito R I , Nakano M N , Kondo Y K , Kobayashi Y K 
Published: October 2024

Abstract

Background
It would be useful to determine whether the device can sense the mechanical atrial amplitude (A4) before the implantation of a VDD leadless pacemaker (Micra AV^RT, Medtronic, US).

Purpose
To evaluate whether identifiable A4 is associated with preoperative echocardiographic parameters.

Methods
Echocardiographic measurements were performed to quantify atrial motion of the interventricular septum in patients who received a leadless pacemaker implantation. We visually divided the septum into five segments from the base to the apex. As shown in Figure 1, the myocardial velocity of each segment measured on tissue doppler imaging (TDI) was defined as EV1, EV2, EV3, EV4, and EV5 (m/s), respectively. After the implantation, amplitude of A4 was compared to the local EV.

Results
We retrospectively analyzed 30 patients who had Micra AV implanted into the right ventricular septum by imaging examination and had measurable EV for each segment. The mean age was 82.3±7.8 years, 15 (50%) patients were female, 11 (37%) patients had organic heart disease, and 23 (77%) patients had atrial ventricular block. The mean LVEF and A4 amplitude were 60.4 ± 8.9% and 2.7 ± 1.8 m/s^2, respectively, and the mean atrial mechanical sensing rate (AMSR) was 79.9±24.0%. The A4 amplitude was positively correlated to the AMSR (r=0.48), while the AMSR was significantly better in patients with A4 amplitude over 1.0 m/s^2 (88.0 ± 10.4% vs. 41.0 ± 33.6%, p=0.04). The A4 amplitude was correlated to the EV of the implantation site estimated from fluoroscopy and echocardiography (r=0.62) in Figure 2. 24 patients had local EV over 3.0 cm/s, and among them, 22 (92%) patients had A4 amplitude over 1.0 m/s^2.

Conclusion
Local EV over 3.0 cm/s, as determined by preoperative echocardiography, might predict high-frequency AMSR.
Atrial rates during treated ventricular tachycardia in patients with implantable cardioverter defibrillators: clinical implications of a vagal sinus node response
Authors: Martin R , Maclean E , Sevier L , Page H , Ganeswaran T , Lamelas R , Whittaker-Axon S , Martin S , Ahluwalia N , Tonko J , Monkhouse C , Lambiase P , Dhinoja M 
Published: October 2024

Abstract

Introduction
Autonomic tone plays an important role in the genesis and sustenance of ventricular tachycardia (VT). Whilst sympathetic hyperactivity is an established driver of ventricular arrhythmias, sinus node response during VT varies broadly between patients, and can be paradoxical.

Purpose
We hypothesized that device-detected changes in sinus node rate could be an important surrogate of the autonomic response to VT, and may exert significant – and potentially modifiable – haemodynamic consequences independent of ventricular activity.

Methods
Device electrograms were analysed from consecutive patients with dual chamber implantable cardioverter defibrillators (ICDs) requiring anti-tachycardia pacing (ATP) or defibrillation for sustained monomorphic VT. Atrial rates were measured before VT onset (‘baseline’) and again at the point of detection by the device. Sinus node response was characterized as ‘stable’ (atrial rate remained within 10% of baseline), ‘sympathetic’ (atrial rate increased &gt;10%) or ‘vagal’ (atrial rate decreased &gt;10%). Patients who did not maintain ventriculoatrial dissociation or who presented in atrial tachyarrhythmia were excluded. Symptoms and electrical response to ICD therapies were recorded.

Results
172 treated episodes of VT were included from 97 patients (median age: 69 years, 65% male, 31% ischaemic cardiomyopathy, median ventricular rate: 205bpm, median ejection fraction: 30%). Sinus node response was stable in 55%, sympathetic in 24% and vagal in 21%. A vagal response was associated with ATP-refractory VT (OR: 2.2 (1.1-4.8) p=0.03) and, when adjusting for ventricular rate, was independently associated with symptoms of presyncope or syncope (adjusted OR: 6 (2.7-13.7), p&lt;0.0001).

Conclusions
This preliminary analysis suggests that a vagal sinus node response during VT is associated with adverse outcomes in ICD patients. Vagolytic therapy has recently been demonstrated to improve haemodynamic tolerance during VT ablation; whether supportive atrial pacing during VT could mitigate symptoms and potentiate arrhythmia termination in ICD patients warrants further exploration.
Figure 1: Change in sinus node rate during sustained monomorphic ventricular tachycardia in patients with dual chamber ICDs, stratified by the occurrence of presyncopal symptoms or syncopeFigure 1
All-cause mortality and incidence of appropriate therapy from a primary preventive implantable cardioverter defibrillator in patients with non-ischemic dilated cardiomyopathy
Authors: Nguyen T M , Melichova D , Salte I M , Gjertsen E , Heggelund G , Kleiven Ø , Brunvand H , Edvardsen T , Haugaa K 
Published: October 2024

Abstract

Background
The DANISH study published in 2016 indicated limited benefit of primary prevention implantable cardioverter-defibrillator (ICD) in patients with non-ischemic dilated cardiomyopathy (niDCM). We aimed to investigate the long-term outcome and incidence of ICD therapy in patients with niDCM implanted on primary prevention indication during 2014-2022.

Methods
A total of 116 patients with niDCM were prospectively included for primary prevention ICD implantation between 2014 and 2022 in the multicenter IMPROVE study (clinical trials NCT02286908). All patients were examined with electrocardiogram, echocardiography and blood sampling at inclusion. The primary outcome was all-cause mortality, and the secondary outcome was appropriate ICD therapy. Outcomes were compared in patients included from 2014 to end of 2016 (DCM2014-16, n=49) and from 2017-2022 (DCM2017-22, n=67).

Results
At inclusion, patients in DCM2017-22 were younger (54 years [interquartile range (IQR) 44-68] vs. 64 years [IQR 55-70], p=0.001), had higher left ventricular ejection fraction (LVEF) (33% [IQR 25-38] vs. 24% [IQR 21-31], p&lt;0.001) and less frequently received cardiac-resynchronization therapy defibrillator (6% vs. 29%, p=0.001) compared to DCM2014-16. Over a median 4.4-year follow-up, the all-cause mortality was 14%, of which 10% occurred in the DCM2017-22 patients (2.6 events/100 person-years), and 18% in the DCM2014-16 patients (4.0 events/100 person-years), p=0.38. There was no difference in appropriate ICD therapy between the two groups (p=0.90).

Conclusion
Patients receiving primary prevention ICD for niDCM after publication of the DANISH study were younger with higher LVEF, indicating a change in clinical practice after the publication. Despite this, there was no significant reduction in all-cause mortality or difference in appropriate ICD therapies. Unchanged mortality and event-rates may indicate the correct identification of high-risk patients.
Assessment of quality of life and ICD shock-related anxiety in Asian patients with implantable cardioverter defibrillator in the PainFree SST study
Authors: Kondo Y , Sears S F , Bart G , Sterns L D , Schloss E J , Meijer A , Auricchio A , Kurita T 
Published: October 2024

Abstract

Background
The implantable cardioverter defibrillator (ICD) reduces mortality in patients at risk of sudden cardiac death. However, it is not known if the psychological status of ICD patients differs by geography. The aim of this analysis is to compare Quality of Life (QoL) and ICD shock-related anxiety between ICD patients in Asian with those in other countries.

Methods
The PainFree SST study was a prospective, multicenter, global study that enrolled 2770 patients including 225 from from Asia (181 from Japan, 25 from India, and 19 from Malaysia). The EuroQol 5-D (EQ-5D) measured QoL and the Florida Shock Anxiety Scale (FSAS) measured ICD shock-related anxiety. These questionnaires were administered bi-annually and monthly for 6 months after a shock. Change in QoL and shock anxiety was analyzed used linear mixed models for repeated measures.
Results: Both the EQ-5D health score and FSAS score were higher in Asian patients compared to patients in the other countries post-implant (EQ-5D: 69.5 ± 18.3 points vs 66.5 ± 19.3 points, p&lt;0.0001, FSAS: 19.7 ± 9.4 points vs 16.4 ± 7.7 points, p&lt;0.0001), and stayed higher for the entire follow-up period (Figure 1). The EQ-5D health score was significantly reduced after a shock (Asian: -18.1 points, p&lt;0.0001; other countries: -7.5 points, p&lt;0.0001) with a greater reduction in Asian patients (p=0.0035) . Recovery in the month following a shock was greater in Asian patients (+19.8 vs +3.6 points, p&lt;0.0001). The FSAS score was significantly increased after a shock (Asian: +6.4 points, p&lt;0.0001; other countries: +4.8 points, p&lt;0.0001) and the increase was similar between geographies (p=0.20). The recovery effect at 1 month was greater in Asian patients (-5.8 vs -1.7 points, p=0.0003) (Figure 2).

Conclusions
Asian patients were more anxious about a shock in spite of greater QoL, compared with those in other countries. After a shock, Asian patients had a greater decrease in QoL and a similar increase in anxiety but recovery was greater in both measures in the month following a shock.Figure 1Figure 2
Dual-chamber CRT-D using ICD lead implantation in the LBBAP position
Authors: Imnadze G , Bocchini Y , Fink T , Eitz T , Sciacca V , Niehaus C , El Hamriti M , Khalaph M , Guckel D , Braun M , Didenko M , Sohns C , Sommer P 
Published: October 2024

Abstract

Background
Interest in conduction system pacing (CSP) has increased in recent years. For left bundle branch area pacing (LBBAP), 4F and 6F pacing leads have been shown to be effective and safe. No information is available on the potential use of ICD leads for LBBAP.

Aim
The objective of the study was to demonstrate the feasibility of implanting an ICD lead in the LBBAP position to reduce the number of leads for CRT-D therapy.

Patients and Methods
We implanted the 7F ICD lead in the LBBAP position through a new 10F CSP delivery sheath in ten consecutive patients. Periprocedural data, QRS morphology and degree of QRS reduction were analyzed.

Results
Ten consecutive patients (one female) aged 69.5±9.2 years were treated with the above-mentioned method. Eight patients had ischemic cardiomyopathy and two patients had nonischemic cardiomyopathy. All patients had a CRT-D indication. Eight patients had a wide QRS complex with complete LBB and a QRS complex of 184.8±25.8 ms. Two patients had a narrow QRS complex but first-degree AV block with a PR interval greater than 240 ms. Left ventricular ejection fraction was 31.8±8.6%. Operative and fluoroscopy times were 103.6±30.3 minutes and 10.5±6.1 minutes, respectively. On average, 1.7 ± 0.6 screwing attempts were required per patient. The intraprocedural LBBAP threshold was 0.78±0.6V/1.0ms, the impedance was 530.8±86.5 ohm, and the R-wave amplitude was 9±3.3mV. The unipolar paced QRS complex was 123.6±15.9ms, the bipolar paced QRS complex was 129.5±12.8ms, and the bipolar paced QRS complex on the next day was 133.3±11.7.
The mean duration from stimulus to R-wave peak in lead V6 was 82.9 ± 19.7 ms. The R-wave interpeak interval between leads V6 and V1 was 43.4 ± 9.7 ms. All but one patient received an effective defibrillation threshold test at 30J (n=8) and 36J (n=1). One patient was not tested during the procedure due to high risk.

Conclusion
This first-in-human study of ICD lead implantation in the LBBAP position demonstrated its feasibility and efficacy in achieving conduction system stimulation. This approach may lead to a reduction in the number of leads implanted for cardiac resynchronization therapy.
Figure 1. A- RAO view, angiography of the RV for verification of the TVA-summit. B- LAO view, angiography from the CSP- sheath after reaching final position of the LBBAP lead (right sided interventricular septum - yellow dotted line). C – 12 lead ECG (speed 50mm/sec) demonstrating paced and native QRS complexes. D – Fluoroscopy in RAO view, final result. E – Fluoroscopy in LAO view, final result. F – Transthoracic echocardiography the next day (4Ch view) demonstrates optimal LBBAP lead position.. RAO – right anterior oblique; LAO – left anterior oblique; TVA – tricuspid valve anulus; CSP – conduction system pacing; LBBAP – left bundle branch area pacing.Figure 1.
LBBAP versus conventional CRT reimplantation after transvenous lead extraction: report from a monocentric experience
Authors: Baroni M , Preda A , Carbonaro M , Fortuna M , Caccia A , Guarracini F , Colombo G , Vargiu S , Varrenti M , Frontera A , Gigli L , Mazzone P 
Published: October 2024

Abstract

Background
Cardiac resynchronization therapy – defibrillator (CRT-D) reimplantation after transvenous lead extraction (TLE) can be challenging due to fibrotic remnants and absence of target veins. Left bundle branch area pacing (LBBAP) is emerging as an alternative to conventional CRT, but data is lacking about its feasibility after TLE.

Purpose
To explore the feasibility and safety of LBBAP as alternative to conventional CRT though epicardial pacing (EP) in patients undergoing CRT-D TLE.

Methods
We prospectively enrolled all patients admitted for complete CRT-D extraction and replacement from July 2022 to September 2023. At the moment of reimplantation, the choice between EP and LBBAP was made on the basis of posterolateral CS branches viability at post-extraction CS venography. Procedural success was defined as effective stimulation and absence of major complications while the primary endpoints were procedural time, QRS complex duration and electrical lead parameters. Patients undergoing LBBAP and EP reimplantation were compared.

Results
Twenty-six patients were enrolled (mean age 68.3 ± 7.2 years, p = 0.538; 12% females, p = 0.859). The most frequent cause of device extraction was pocket infection (58%, p = 0.773). Seventeen (65%, p = 0.783) patients had estimated high risk of procedural severe complications measured by EROS score. Overall, 80 leads were extracted. Mechanical extractors and snares were deemed necessary in 35 cases (43%, p = 0.917) and in 2 cases, respectively. Almost all patients (n=25, 96%) underwent right-sided reimplantation. Procedural success was achieved in 24 cases (92%). Compared to standard CRT through EP, LBBAP reimplantation accounted for a faster procedure (109.5 ± 34.2 vs. 126.5 ± 46.8 min; p = &lt;0.001), less radiologic exposure (877.0 ± 234.6 vs. 1332.0 ± 515.1 sec, p &lt;0.001) and better ventricular pacing thresholds (0.7± 0.1 vs. 1.8± 0.6 V, p &lt;0.001). Despite a similar pre-extraction paced QRS duration (127.4 ± 13.8 vs. 133.0 ± 14.4 msec; p = 0.610), LBBAP reported significant improvement in final QRS duration (105.0 ± 13.1 vs. 127.1 ± 10.4 msec, p &lt; 0.001) with major reduction in QRS duration (- 10.9 ± 7.5 vs - 6.8 ± 10.1, p &lt; 0.001).

Conclusion
After a CRT TLE procedure, LBBAP reimplantation accounted for lower procedure duration, lower radiologic exposure, narrower QRS and lower ventricular pacing thresholds, demonstrating to be a valuable alternative to EP.
A larger reduction of spatial mean QRS-T angle during cardiac resynchronisation therapy is associated with a lower risk of mortality and heart failure hospitalisation
Authors: Marinko S , Cortez D , Platonov P G , Bergfeldt L , Borgquist R 
Published: October 2024

Abstract

Background
Predicting clinical outcome in heart failure patients undergoing cardiac resynchronization therapy (CRT) remains challenging, necessitating improved risk stratification for CRT recipients. Previous studies have shown an association between large spatial peak and mean QRS-T angles and cardiovascular disease. Little is known, however, about their relation to clinical outcome following CRT.

Purpose
To investigate the association between spatial peak and mean QRS-T angles and long-term clinical outcome following CRT initiation.

Methods
All patients with native LBBB receiving CRT at a large-volume tertiary care center between 2015 and 2020 were retrospectively evaluated. Spatial peak and mean QRS-T angles were derived from digital pre- and post-CRT 12-lead ECGs that were processed using Glasgow algorithm and Kors’ regression transformation. The QRS-T angles and their change after CRT were analyzed in relation to the primary composite endpoint of heart failure hospitalisation or all-cause mortality using Cox regression analysis adjusted for clinical covariates (age, gender, CRT-P or CRT-D, secondary ICD indication, ischemic etiology, NYHA class, LVEF, diabetes, atrial fibrillation, baseline QRS duration, NT-proBNP, and eGFR).

Results
The study group comprised 250 patients (a median age [Q1–Q3] of 72.2 years [64.5–76.3]; 22% female; 58% New York Heart Association (NYHA) class III-IV; LVEF 27% [22–30]) who were followed over a median follow-up time of 4.5 years [3.2–5.8] after CRT implantation. The median post-CRT spatial peak and mean QRS-angles were 142° [116–160] and 152° [127–166], and the median angle was decreased by 16° [-0.6–41] and 14° [-0.4–38], respectively. Both a larger post-CRT mean QRS-T angle (HR 1.20, 95%CI 1.08-1.33, p=&lt;.001) and peak QRS-T angle (HR 1.08, 95%CI 1.01-1.17, p=0.046) were associated with the primary endpoint. A larger reduction of mean QRS-T angle, but not peak QRS-T angle, was associated with a risk reduction (HR 0.87, 95%CI 0.79-0.95, p&lt;0.003). In Kaplan-Meier analysis, patients with a post-CRT mean QRS-T angle above median had a higher risk of reaching the endpoint (log-rank p=0.002, Figure 1).

Conclusion
Our results show that a larger magnitude of the post-CRT spatial peak and mean QRS-T angles, and a larger reduction of the latter, are associated with long-term heart failure hospitalisation and death. These findings suggest that spatial QRS-T angle may have a potential role in refined risk stratification of CRT patients.Figure 1.K-M curve spatial mean QRS-T