bluuebunny/crossref_metadata_2025_split huggingface dataset:
Feasibility and outcomes of ultrasound-guided transcutaneous access to the axillary vein for implantation, revision, and upgrade of cardiac electronic devices
Authors: Nikorowitsch J , Uectas T , Borof K , Metzner A , Wenzel J P , Winkelmann S J , Pecha S , Reichenspurner H , Kirchhof P , Toennis T , Becher N 
Published: May 2024

Abstract

Background
Implanting leads for cardiac implantable electronic devices (CIED) requires venous access. Venous access is commonly established through the cephalic and subclavian vein. For CIED upgrades or revisions, the preferred cephalic vein access is often not viable. Several reports suggest that fluoroscopy-guided axillary vein puncture may reduce thoracic complications.

Purpose
This study reports on procedural outcomes of ultrasound-guided axillary vein access for CIED implantation, revision, or upgrade in a large tertiary care centre. Outcomes were compared to the traditional subclavian vein approach.

Methods
This retrospective, single-center non-randomized study, conducted from January 2021 to August 2023, analyzed patients undergoing CIED implantation, revision, or upgrade. Axillary access, initially introduced by one operator, was increasingly adapted by additional operators. The axillary access was obtained by ultrasound-guided visualization of the axillary vein at the deltopectoral groove (Figure 1A and B). Subsequently, the wire(s) were transcutaneously inserted. An adjacent skin incision allowed for threading the wire(s) followed by standard lead implantation (Figure 1C). The study evaluated the acute success of each venous access method and the incidence of adverse events. Those were defined as pneumothorax, hemothorax, and pocket hematoma. An intention-to-treat analysis was performed. A p-value assessed the comparative outcomes between the axillary and subclavian access methods.

Results
In this study, 986 patients (mean age 74, IQR 64-82 years, 35% women) underwent CIED implantation, revision, or upgrade with 1636 lead implants. Axillary access was used in 578 patients with 532 (92%) successful implantations. Subclavian access yielded a higher success rate with 394/408 patients (97%) (p=0.003). For device upgrades or revisions specifically, axillary access was successful in 68/79 patients (86%), versus 44/47 patients (94%) with subclavian access (p=0.193). Acute complications were less frequent with axillary access (0.3%, 2/578 patients) and consisting of two cases of pneumothorax requiring intervention. In CIED implantations via subclavian access, complications occurred in 17/408 patients (4.2%) (p&lt;0.001) including pneumothorax in 12 patients (2.9%, with 2% requiring intervention), hemothorax in three patients (0.7%), and pocket hematoma in two patients (0.5%). No additional complications were observed in the axillary group.

Conclusion
The implementation of transcutaneous, ultrasound-guided axillary access for CIED implantations, revisions and upgrades in a major CIED training centre is feasible. Complication rates were low compared to subclavian venous access.Figure 1
Primary vs. secondary wound closure following transvenous system explantation in CIED infection
Authors: Tran Q , Richter U , Bair J , Richter S , Albert A , Gaspar T 
Published: May 2024

Abstract

Background & Introduction
Patients undergoing an explantation of cardiac implantable electronic devices (CIED) receive either a primary or secondary wound closure or open wound treatment depending on departmental practice. To date, there is limited data on whether secondary wound closure or open wound treatment has any benefit in terms of future complications although it requires a more intensive wound care.

Material & Methods
Patients who underwent CIED explantation for system infection at our institution between 2016 and 2022 were retrospectively reviewed. From this cohort, patients diagnosed with pocket infection were isolated and divided into two groups:
(i) Patients who underwent primary wound closure with or without temporary use of a drain (PG), and
(ii) patients who underwent secondary wound closure or open wound management (SG).
Patients were followed up by telephone contact for short and long term complications.

Results
387 patients underwent CIED explantation due to local or system infection at a heart centre. Of this cohort, 205 patients (135 female; 74.4 ±11.4 y.o.) had a pocket infection. In addition to local infection, 25.9% of all patients presented with a pocket perforation. The onset of infection was early (within 28 days) in 16.1%, intermediate (29 days - 1 year) in 50.2% and late (after 1 year) in 33.2%. Wound swabs and blood cultures were positive for pathogens in 61.0% and 14.1% respectively.
136 (65.9%) underwent primary wound closure, 69 (34.1%) underwent secondary wound closure or open wound management. Post-operative (p.o.) hematoma was present in 12.2% of the cases (6.6% of PG and 24.6% of SG). The risk of developing a p.o. hematoma was significantly more likely in the SG (OR=4.61; IC95%: 1.93 − 11.01).
Re-implantation occurred in 70.2%, including 25.7% of leadless pacemakers an 1.5% subcutaneous defibrillators. In 13.7% re-implantation was not indicated, 4.4% refused and 1.0% had contraindications.
Mean length of hospitalization was 12.4 ±8.9 days in the PG and 15.7 ±9.6 days in the SG (ρ = 0.0083). A total of 24 (34.8%) patients were discharged with an open wound with or without vacuum treatment (0.74% of PG; 34.8% of SG).
Mean telephonic follow-up was 27 ±18 months in 147 cases (n1 = 99; n2 = 48). 91.8% of the cases had no pathological findings at follow-up. 2.7% developed a wound healing disorder (WHD) which was treated conservatively, 4.1% required revision, 0.7% explantation and 0.7% endocarditis. No statistical difference of complication risk between both groups was found (OR=1.8; IC95%: 0.51 - 6.17).

Summary & Conclusions
Management of CIED pocket infection with primary wound closure compared to secondary wound closure showed a statistically significant shorter hospital stay and reduced likelihood of post-operative hematoma, with no increase in long-term complication rates.
Permanent epicardial pacing : a first line strategy in children
Authors: Zeriouh S , Koutbi L , Mancini J , Maille B , Hourdain J , Franceschi F , Deharo J C 
Published: May 2024

Abstract

Background
Permanent cardiac pacing in paediatric patients remains a challenge. According to the European Paediatric and Congenital Society (AEPC) recommendations, below 20 kg epicardial implantation is preferred, while above 20 kg endocardial implantation is given priority unless specific contraindication. In the literature, a weight at 15 kg is also found to be the minimal weight above which an endovascular implantation is considered. However, endovascular systems have been reported to be associated with a high risk of complications. Recent improvements in epicardial leads technology have significantly improved pacing thresholds (1-3), battery life and reduced the risk of re-intervention for epicardial lead dysfunction (4,5).

Purpose
The aim of the study is to evaluate the long-term results and efficacy of epicardial pacing in children and to investigate risk factors for epicardial lead dysfunction.

Method
We performed a retrospective, single-centre analysis of consecutive patients aged ˂18 years implanted with an epicardial PM between 2004 and 2020. The data collection included initial pacing parameters, at 1 month, 1 year, 2 years, and at last follow-up, as well as occurrence of early and late complications.

Results
A total of 101 patients (93 atrial and 131 ventricular epicardial) were analysed. The mean follow-up time was 6.2 years (range 2 days to 16.9 years). Median age at implantation was 4.2 years (IQ 0.3-8.8 years), median weight was 15.2 kg (IQ 5.2-28.0 kg). Congenital heart disease (CHD) was recorded in 59,4% of patients. Reasons for implantation were postoperative complete atrioventricular block (AVB) (40.6%), congenital AVB (37.6%), sinus dysfunction (7.9%), complete AVB with heart disease without surgery (7.9%), others (4%). Four patients had a system infection resulting in device extraction and reimplantation. The mortality rate was 15.8%, but no deaths was directly related to PM implantation or dysfunction. Detection values, impedances were stable over time, and the and average pacing thresholds remained ˂0,98±0,81 volt in the atrium and ˂ 1.57±0,89 volt in the ventricle. Lead survival was 96,7%, 90,7%, 82,3%, 74,5% at 1, 5, 8 and 10 years. The presence of CHD, weight ˂15kg, dual chamber implantation, implantation for postoperative BAV were not significant risk factors for lead dysfunction. In the group of patients implanted above 15kg the presence of a CHD significantly increased the risk of lead dysfunction (p=0.037) and all-cause reimplantation (p=0.010). In the group implanted above 15kg without any cardiopathy, the survival rate without lead dysfunction at 5 and 10 years was 100% and 90.9% respectively.

Conclusion
Epicardial pacing in children with steroid-eluting leads shows good long-term results with stable pacing parameters and good survival from lead dysfunction. For children implanted at a weight above 15 kg and without cardiopathy results with epicardial stimulation were excellent.Epicardial lead survival
Recording of chest leads via mobile ECG and quantitative correlation with Wilson leads in a patient with monomorphic PVCs
Authors: Mueller-Leisse J , Hillmann H A K , Eiringhaus J , Hohmann S , Karfoul N , Duncker D 
Published: May 2024

Abstract

Introduction
Mobile ECGs using handy smartphone-based devices such as the KardiaMobile (AliveCor) are increasingly used as diagnostic tool for arrhythmias. They can be especially useful in cases of non-permanent arrhythmia. However, they were designed to record limb leads and few experience exists with the recording of modified chest leads. However chest leads provide important diagnostic information in many forms of arrhythmias including premature ventricular contractions (PVCs). We hypothesized that chest lead recordings using the 6-lead enabled KardiaMobile 6L device in a novel way would closely resemble the Wilson chest leads.

Methods
A patient with monomorphic idiopathic PVCs was identified. A standard 12- lead ECG was then taken in a supine position, and the exact same electrode positions were then used to record a mobile ECG in the supine position in the following manner: right finger and left finger positioned at the right and left sensor of the KardiaMobile 6L device respectively; back sensor positioned on the chest wall at the former positions of the chest electrodes, in a sequential manner (figure 1). The QRS morphologies of the 12-lead ECG Wilson leads and the reconstructed chest-leads with the mobile device were then overlied using Adobe illustrator and photoshop. The 12-lead ECG was also compared to a second 12-lead ECG of the patient that had been taken on the day before.

Results
QRS-morphologies of the chest leads derived from the 12-lead ECG and mobile ECG device resembled closely considering both regularly conducted beats and PVCs (figure 2 left and middle ECGs). Transition scores (TZ) of the sinus beats (3,5) and the PVCs (4) were identical. Overlaying two representative QRS-complexes of leads V1-6 of the Wilson leads and the mobile tracings showed a mean correlation of 73% for sinus beats and 78% for PVCs. In comparison, correlation of the QRS-complexes between the two 12-lead ECGs taken on consecutive days was 60% and 68% respectively (figure 2 left and right ECGs).

Conclusion
QRS-morphologies of the chest-leads taken with the KardiaMobile closely resembled the Wilson leads of the 12-lead ECG, and correlated better than did another 12-lead ECG that was taken the day before. The techniques could be useful for self-recording of arrhythmias including PVCs by patients to guide clinical decision-making in cases where no 12-lead ECG can be achieved due to intermittent arrhythmia occurrence.
Electrocardiographic features in the early differential diagnosis of cardiac amyloidosis from cardiac sarcoidosis
Authors: Hachisuka M , Murata H , Yodogawa K , Toida Y , Okajima S , Ito N , Arai T , Kobayashi S , Fujimoto Y , Hagiwara K , Aizawa Y , Shimizu W , Asai K , Iwasaki Y 
Published: May 2024

Abstract

Introduction
Amyloidosis and sarcoidosis are both systemic infiltrative diseases which can cause cardiac involvement. Differentiating early-stage cardiac amyloidosis (CA) from cardiac sarcoidosis (CS) is still challenging, although hypertrophy for CA and septal thinning for CS are characteristic echocardiographic findings in each late-stage. The diagnosis is a time-sensitive issue, given the therapies for CA and CS likely to be effective at early disease stages.

Purpose
We aimed to evaluate the utility of electrocardiography (ECG) for distinguishing CA from CS before or early in the course of cardiomyopathy.

Methods
This study enrolled 36 consecutive patients (20 male, 75±13 years) diagnosed with transthyretin-CA in 25 (CA group) and isolated CS in 11 patients (CS group) according to accepted criteria at our institute from July 2014 to July 2023. We retrospectively reviewed electrocardiographic characteristics and clinical outcomes of early-stage CA and CS.

Results
The CS group were younger than the CA group at the time of diagnosis (59±9 vs 83±7 years, P&lt;0.01) and had a shorter period between the date of their first ECG recording at our institute and the date of diagnosis (18±3 vs 62±67 months, P=0.012). Furthermore, the CA group showed specific P-waves with longer duration (142±19 vs 126±8 ms, P=0.003) and more notches and/or fragmentation (91% vs 33%, P=0.003) in the limb leads on the initial ECG than the CS group, although prolonged PR-interval is common in both CA and CS (191±44 vs. 208±43 ms, P=0.359). Unexpectedly, the CA group had a shorter QRS duration (103±25 vs 123±31 ms, P=0.047) and a higher R-wave in V5 (2.0±0.9 vs 1.3±1.1 mV, P=0.039) than the CS group. In addition, the low voltage in all limb leads, pseudoinfarct pattern and bundle branch block morphology characteristic of CA patients did not differ between diagnosis and initial examination. There were also no differences in atrial and ventricular arrhythmias. During the follow-up period, 5 patients (20%) in the CA group, but no patients in the CS group died.

Conclusion
CA and CS shares several electrocardiographic features. Prolonged P-wave with notches and fragmentation, suggesting atrial conduction disturbance, may be associated with amyloid deposition in CA. This finding might be useful in the early differential diagnosis for CA from CS.
Association of spontaneous coronary artery dissection with bradycardia - a novel observational study
Authors: Raj K , Jyotheeswara Pillai K E E R T H , Rangadham N A G A R A 
Published: May 2024

Abstract

Introduction
Spontaneous coronary artery dissection (SCAD) is a common cause of Myocardial infarction (MI) in women less than 50 years of age (1). SCAD has a high recurrent rate, and beta blockers are the only drug shown to reduce the recurrence of SCAD. However, in our clinical practice, we could not use beta-blockers in some of our patients due to sinus bradycardia of unclear cause. Therefore, we planned to study if SCAD could cause Bradycardia.

Purpose
To determine if Bradycardia is associated with SCAD.

Methodology
Utilising the National Inpatient Sample (NIS) from 2016 to 2020, we performed a multivariable logistic regression analysis to determine if SCAD was independently associated with Bradycardia (ICD-10 code R0.01) among adults. SCAD was defined as coronary artery dissection (ICD-10 code I25.42) after excluding patients who had PCI.

Results
A- A total of 2,561,434 (95% CI 2,526,646-2,596,222) weighted hospitalisations with Bradycardia and 18,049 (95% CI 17,288-18,811) with SCAD was included. Bradycardia was present in 5.2% (95% CI 4.6-6) of patients with SCAD and 1.7% (95% 1.7-1.7) in patients without SCAD. After adjusting for relevant causes of Bradycardia, SCAD was highly associated with Bradycardia (OR 3.04, 95% CI 2.61-3.55). Among all the risk factors studied, SCAD showed the 2nd highest strength of association (Table 1).

Discussion
We report the first described association of SCAD with Bradycardia in literature. Although the prevalence of Bradycardia with SCAD in our study is only 5.2%, Bradycardia is frequently not coded, and we suspect the true frequency of Bradycardia in SCAD is much higher. The exact mechanism for this association is unclear. Although the frequency of beta-blocker use is not available in our study, several other conditions, such as ischemic heart disease and cardiomyopathy, which involve more frequent beta-blocker use, did not show a degree of association as strong as SCAD with bradycardia. Therefore, we hypothesize Bradycardia could be from SCAD itself, and the current ongoing BA-SCAD (Beta-blockers and Antiplatelet agents in patients with Spontaneous Coronary Artery Dissection) trial could shed light on this association (2).
Electrophysiological assessment of atrial tachycardia substrates in patients with repaired tetralogy of Fallot
Authors: Mirizzi G , Tamborrino P , Rossi A , Startari U , Panchetti L , Garibaldi S , Nesti M , Festa P , Ait-Ali L , Marrone C , Ridolfi L , Santoro G , Assanta N , Piacenti M 
Published: May 2024

Abstract

Introduction
Adults with repaired tetralogy of Fallot (rToF) are most often referred to Adult Congenital Heart Disease centers for atrial tachycardia (AT) and radiofrequency catheter ablation (RFCA) is often required. A systematic evaluation of the mechanisms and recurrences of arrhythmias in these patients is lacking.

Methods
28 patients with rToF referred for catheter ablation to the Interventional Electrophysiology Unit of our center between January 2013 and January 2023 were evaluated. Pts underwent electrophysiologic study (EPS) with 3D electroanatomic high density mapping. Evaluation of right atrial bipolar voltage and activation mapping of the AT was performed. Intra-atrial re-entrant tachycardias (IART), focal AT (FAT), other. Activation mapping was performed to identify the critical isthmus for IART. FATs were localized according to the earliest unipolar signal. Whenever possible, all the induced tachycardias were treated besides the arrhythmia which represented the clinical indication to EPS. RFCA was aimed at the earliest activation point for FAT and at the critical isthmus for IART, anchoring lesion to fixed obstacles (valve annuli or atriotomy scar). All patients provided written informed consent for participating in the study.

Results
Among 28 adult (age 47±13 years) patients (females n=14, 50%), 53 AT were documented: 34 (64%) IART, 11 (21%) FAT and 8 (15%) atrial fibrillation (AF). Mean tachycardia cycle length (excluding AF) was 307±95 ms. At least 2 ATs were induced in 12 pts during index EPS. Among IARTs, incisional IART (IARTinc, atriotomy and superior and inferior vena cava orifices, SVC and IVC, respectively) was the prevalent critical part of the circuit (n=22, 52%), while CTI was the second mechanism (n=20, 48%). In three pts, due to non-inducibility, a pre-emptive lesion set comprising in one case CTI and in two cases CTI+SVC-atriotomy-IVC line was performed. 2 patient underwent scheduled pulmonary veins isolation and CTI ablation. Among FAT, in 3 cases the AT was mapped in the coronary sinus, in two at the tricuspid annulus, in the remaining at the crista terminalis, at the right appendage base, at the posterolateral incision scar or between atriotomy and SVC. In 6 patients AF was induced but not ablated. During a median follow up of 23 months (interquartile range, 6-37) recurrence occurred in 8 pts (18% of pts, 15% of tachycardias). Patients with recurrences were younger (43±7 vs. 48±17 y, p=0.04); no differences were found according to critical isthmus location (4 CTI and 4 IARTinc, 50%, p=ns).

Conclusions
Among rToF pts with AT, IART is the prevalent mechanism and atriotomy scar is the prevalent critical isthmus. FAT location is much more variable. Atrial fibrillation burden is not negligible. Long-term freedom from AT in this clinical setting is encouraging.
Coexistence of cardiac sarcoidosis and genetic cardiomyopathies: a conundrum
Authors: Rossi V A , Palazzini M , Gasperetti A , Brunckhorst C B , Manka R , Giannopoulos A A , Tanner F C , Medeiros-Domingo A , Gentile P , Gruebler M R , Ammirati E , Flammer A J , Ruschitzka F , Duru F , Saguner A M 
Published: May 2024

Abstract

Introduction
Cardiac sarcoidosis (CS) is a chronic inflammatory disease characterized histologically by the formation of non-caseating granuloma in the myocardium, however, causes remain largely unknown. Genetic arrhythmogenic cardiomyopathy (ACM) is an important differential diagnosis of CS. Until now, few data are available about the coexistence of CS in a patient with genetic ACM harboring a desmoglein-2 (DSG2) variant.

Purpose
We report a case series of patients who demonstrate coexistence of histologically proven CS and genetic ACM.

Methods
This is a multicentric study, which included patients from four high-volume cardiology referral centres for heart failure and ACM in Switzerland, Italy, and Austria. Patients with both a biopsy-proven diagnosis of sarcoidosis with cardiac involvement (according to the 2014 HRS criteria) also harboring a pathogenic/likely pathogenic (P/LP) variant for cardiomyopathy-associated genes were 1:1 matched for age, gender and genetic variant with patients with genetic ACM without CS (Gen-only). Clinical and imaging data (echocardiography (TTE), cardiac magnetic resonance (CMR) and positron-emission tomography (18FFDG-PET/CT) were collected.

Results
Each group included 5 patients (Gen+CS: age 48 ± 11 years, Gen only: age 52 ± 13.7 years, n=3 (60%) female in both groups). For each group, the following genes with P/LP variants were found: PKP2: n=2 (40%), DSG2: n=1 (20%), DSP: n=1 (20%), TTN: n=1 (20%). In patients with Gen+CS, atrio-ventricular block (AVB) I° (80% vs 20%, p=0.05) and paroxysmal atrial fibrillation (80% vs 0%, p=0.004) were more frequent, and median NT-proBNP levels (1346ng/l, IQR:103-4276 vs. 214ng/l, IQR:131-326, p=0.046), as well as high-sensitive C-reactive protein levels were higher (3.1g/dl, IQR:1.1-24.2 vs. 0.7g/dl, IQR:0.3-0.95, p=0.016). On imaging, Gen+CS patients were more likely to have septal involvement (60% vs 0%, p=0.021), as highlighted by positive late-gadolinium enhancement on CMR, metabolic activity on PET, or focal wall motion anomalies on TTE.

Conclusions
CS and genetic ACM can coexist. Hence, detection of a P/LP genetic variant associated with ACM should not lead to exclusion of CS, which more frequently presents with AVB, septal involvement, heart failure, and metabolic activity on imaging. On the contrary, CS can be associated with genetic variants in cardiomyopathy-associated genes.FDG-PET/CT