bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical accuracy of a 3-dimensional multielectrode non-invasive ECG mapping vest in premature ventricular contraction ablation procedures
Authors: Besiroglu F , Pluta S , Lenarczyk R , Hunuk B , Sokal A , Kowalski O , Kalarus Z 
Published: May 2024

Abstract

Background
Invasive 3D mapping is the current gold standard in determining premature ventricular contraction (PVC) localization. However, given its invasive nature, unawareness of PVC origin beforehand may lead to prolonged procedure times and increased complications risk.

Purpose
In this study, we compared the diagnostic accuracy of a non-invasive 3-dimensional mapping ECG vest (MECGV) with invasive 3D mapping and ablation successful points as a reference. We also evaluated 12-lead ECG based pre-procedural PVC localization accuracy of 2 expert operators blinded to clinical findings.

Methods
In 15 consecutive adult patients between the ages of 35 to 69 (male n: 9, median age: 48), MECGV and subsequently a 3D mapping with uneventful successful PVC RF catheter ablation were performed and included in the study. PVC localization estimations of MECGV method and the EP experts' locatization predictions were compared separately with invasive 3D ablation results using the Cohen's kappa method and with the help of a 16-segmentation model we created for the ease of the analyses .

Results
Results were presented on Table-1. MECGV was found to be highly compatible (Cohen's kappa 0.968, p&lt;0.001) with the RF ablation results. However operators assessments were found to be less coherent with invasive 3D mapping (Operator 1 Cohen's kappa 0.571, p 0.033, Operator 2 Cohen's kappa 0.618, p: 0.019, respectively). MECGV accuracy was %87 in pinpointing the PVC focus. The only 2 localizations that MECGV failed were on the septal aspects of the heart (Picture-2 Failure of defining the focus on LVOT septal instead of RVOT septal)

Conclusion
MECGV method seems to be highly compatible with invasive 3D mapping techniques in detection of PVC localization and bests EP expert estimates in this regard. However, it also seem to have some pitfalls especially on septal aspects of the heart.Table-1 and segmentation schemePicture-1
Ventricular tachycardia initiation patterns on electrograms of implantable defibrillator devices
Authors: Ganeswaran T , Monkhouse C , Orini M , Walker A , Srithar K 
Published: May 2024

Abstract

Introduction
Sudden cardiac death is an unexpected death from a cardiac origin attributed by arrhythmias such as ventricular fibrillation (VF) and ventricular tachycardia (VT). The predominant treatment to terminate VT and VF is the implantation of an implantable cardioverter defibrillator (ICD). Currently, VT initiation in specific and small cohorts such as structural heart disease and reduced left ventricular ejection fraction patients have been explored. However, there is limited literature comparing the association between VT initiation patterns and defibrillators therapy outcome. This study aimed to investigate the most prevalent type of VT initiation from stored electrograms on ICDs and to explore the association between VT initiation pattern and therapy outcome (i.e., the ability to terminate VT).

Method
344 stored electrograms amongst 65 patients from an existing database were visually inspected to classify VT initiation pattern as sudden onset (not preceded by premature ventricular complexes), non-sudden onset (preceded by premature ventricular complexes) and pacing-induced (device induced). Wilcoxon rank sum and Fisher’s Exact tests were used to assess differences between these groups. Mixed-effect logistic regression models accounting for multiple events occurring in individual patients were used to investigate association between the VT initiation pattern and therapy outcome.

Results
The mean age for the study group was 53±20 years and 54 (83%) subjects were males. Aetiology includes: 29 ischemic heart disease (45%), 10 hypertrophic cardiomyopathy (15%), 8 dilated cardiomyopathy (12%) and 18 other conditions (28%). Non-sudden onset VT (51%) was the most prevalent type of VT initiation pattern on defibrillators followed by sudden onset (44%) and pacing induced (5%). Non-sudden onset was 3 times more likely than the other 2 groups combined to be associated with unsuccessful therapies with an OR: 3.05 (95% confidence interval: 1.14, 8.15); p =0.03. There was no association between pacing-induced onset and unsuccessful therapies with an OR: 0.33 (95% confidence interval: 0.03, 3.33); p = 0.35. No association was identified for any of the three initiation patterns versus the other two combined and unsuccessful therapies when mixed-effect models were constructed.
Discussion/ Conclusion: This study is consistent with other findings showing that non-sudden onset (51%) is the most prevalent VT onset. Pacing-induced VT accounted for 5% of VT with the predominant reason for initiation being undersensing of R-waves leading to pacing on the T-wave. This study reiterates the importance of programming strategies to prevent pacing induced VT. No associations were found with VT initiation and therapy outcome with mixed-effect models, possibly due to pseudo-replication being a limitation of this study. Prospective studies should be carried out in future to attempt to maximise success rate and establish the most effective treatment in ICDs.
Short- and long-term patient-reported outcomes of subcutaneous implantable cardioverter-defibrillator therapy
Authors: Bisignani A , Bisignani G , Palmisano P , Bianchi V , La Greca C , Tola G , Nigro G , Caravati F , Mascia G , Rordorf R , Notarstefano P , Valsecchi S , Lovecchio M , Bianchi S 
Published: May 2024

Abstract

Background
The safety and efficacy of subcutaneous implantable cardioverter-defibrillator (S-ICD) therapy are well-established. However, there is a paucity of patient-reported outcome data, despite the increasing emphasis on incorporating patients' perspectives into quality care assessments. Current guidelines also recommend evaluating psychological status and addressing distress in defibrillator patients.

Purpose
This study aims to assess perioperative and postoperative pain during S-ICD implantation, along with patient acceptance during follow-up. We also explore associations between these outcomes, clinical characteristics, and implantation variables.

Methods
A total of 149 consecutive patients (87% male, mean age 53±13 years, body mass index 27±4 Kg/m², ejection fraction 39±14%) who underwent S-ICD implantation across 11 centers were analyzed. Short-term endpoints included pain during and 6 hours after the procedure. Pain intensity was rated on a 10-point visual analogue scale. Long-term endpoint was S-ICD patient acceptance measured (on a 0-to-100 point scale) by the Florida Patients Acceptance Survey (FPAS) score and its components: Return to Function (RTF), Device-Related Distress (DRD), Positive Appraisal (PA), and Body Image Concerns (BIC). The survey was administered 12 months post-implantation.

Results
The S-ICD generator was positioned in an intermuscular pocket in 140 (94%) patients. Serratus anterior plane block (SAPB) was performed in 103 (69%) patients. 72 (48%) patients underwent the defibrillation testing. Implantation success was reported in all patients without operative complications. Overall, pain intensity during implantation was 2 [25th-75th percentile: 1-4], and 1 [1-2] for static pain and 2 [1-3] for dynamic pain, 6 hours post-procedure. SAPB was associated with significantly lower pain intensity during implantation (2 [1-3] vs. 4 [2-5], p&lt;0.001) and non-significantly lower values of dynamic pain intensity 6 hours post-procedure (1 [1-2] versus 2 [1-3], p=0.076). The other tested variables, i.e. age, sex, body habitus, ejection fraction, omission of defibrillation testing, were not associated with different pain levels. S-ICD acceptance scores were favorable overall (total FPAS 77 [63-87], RTF 69 [56-88], DRD 25 [10-45], PA 88 [75-100], BIC 13 [0-38]). Patients who underwent SAPB exhibited better RTF (75 [56-88] versus 63 [50-69], p=0.002) and PA (88 [75-100] versus 75 [69-94], p=0.004).

Conclusions
S-ICD implantation resulted in minimal discomfort, especially with novel anesthetic techniques. Overall, patients reported good acceptance of the S-ICD. Improved acceptance was observed in patients who underwent SAPB, highlighting the significance of enhanced patient implantation experience for long-term outcomes.
When to implant an ICD in patients with heart failure and reduced ejection fraction? Insights from the HF-OPT trial
Authors: Veltmann C , Duncker D , Doering M , Gummadi S , Robertson M , Wittlinger T , Colley B J , Perings C , Jonsson O , Bauersachs J , Sanchez R , Maier L 
Published: May 2024

Abstract

Background
In patients with de novo heart failure with reduced ejection fraction (HFrEF) improvement of left ventricular ejection fraction (LVEF) is expected to occur when started on guideline-recommended medical therapy (GRMT). However, the period of time, when LVEF improvement is completed, is unknown.

Purpose
Evaluation of improvement of LVEF &gt;35% within the first year after de novo diagnosis of HFrEF with severely reduced LVEF &lt;35%.

Methods
In the prospective HF-OPT-trial, patients with de novo HFrEF and LVEF ≤35% prescribed the wearable cardioverter defibrillator (WCD) were enrolled and followed up to one year. GRMT was initiated and uptitrated according current guidelines. LVEF improvement &gt;35% under GRMT was echocardiographically assessed at day 0, day 90, day 180 and day 360.

Results
A total of 487 patients (59 years (IQR: 51-68), 27% women) were followed until day 180. Out of 487 patients 392 patients were followed additionally to day 360. Dosages of GRMT were significantly increased during follow-up (p&lt;0.001) At 90 days, 46% (CI: 41%-50%) of the patients had LVEF improvement &gt;35%. About half of those with persistently LVEF&lt;35% at day 90 (46%, CI: 40%-52%) had LVEF improvement &gt;35% by day 180, increasing the total rate of improvement &gt;35% to 68% (CI: 63% - 72%). Until day 360 the rate of LVEF improvement &gt;35% increased to 78%.

Conclusions
78% of patients with de novo HFrEF showed improvement in LVEF &gt;35% during the first year after diagnosis following GRMT. This finding impacts decision making for primary preventive ICD implantation.Development of LVEF.
Outcomes of leadless pacemaker in chronic kidney disease patients: real-world data from the i-LEAPER registry
Authors: Mitacchione G , Schiavone M , Arabia G , Gasperetti A , Palmisano P , Mazzone P , Rovaris G , Dello Russo A , Biffi M , Di Biase L , Chierchia G B , Della Bella P , Tondo C , Curnis A , Forleo G B 
Published: May 2024

Abstract

Background
Chronic kidney disease (CKD) represents a major risk factor for patients requiring transvenous pacemaker (TV-PM), resulting in a high rate of operative complications and PM-related infection rate (21.9% and 12.5%, respectively), with both complications parallels to severity of CKD. Moreover, TV leads represent an important concern for end-stage CKD patients, often needing vascular access patency for renal replacement therapy. In this setting leadless pacemakers (LPMs) represent an attractive alternative to TV-PM for their lower device-related infection rate and the absence of TV leads. To date, limited data on LPM safety and efficacy profile in CKD patients are available.

Purpose
to assess operative and long-term safety and efficacy of LPMs implantation in patients with different stages of CKD in the real-world setting.

Methods
Consecutive patients who underwent LPM implantation in 12 European centers joining the i-LEAPER registry were retrospectively enrolled. CKD stage was assessed according to CKD-EPI equation for eGFR. Patients with CKD stage G3a/b (N=245) and stage G4/G5 (N=67) were compared with patients with normal kidney function (NKF) (N=867). Primary safety endpoint was LPM-related major complications rate at implant and during follow-up (FU). Additionally, the rate of patients showing sub-optimal electrical performance (pacing threshold [PT] &gt;1V@0.24ms) was compared between groups.

Results
1179 patients were enrolled and followed for a median of 33 [IQR 24-47] months. When compared with the NKF group, patients with CKD stage G3a/b and stage G4/G5 showed a higher burden of cardiovascular comorbidities (Table 1). The choice of a LPM was mainly due to vascular concern in the CKD stage G4/G5 group, while a perceived highest infective risk was reported in CKD stage G3a/b group (Table 1). Major complication rate at implant and during FU did not differ between groups, regardless of renal impairment stage (Table 2). All-cause mortality incidence resulted higher in CKD stage G4/G5 group when compared with NKF group (17.9% vs 6.8%; HR 4.24; 95%CI 4.25-7.94, p&lt;0.001) (Figure A). The rate of patients with PT&gt;V1@0.24ms during FU did not differ between groups, not exceeding 13.8%, and therefore remaining consistent with historical data for LPM (Figure B).

Conclusion
In the real-world setting, LPM showed a remarkable safety and efficacy profile in CKD patients regardless of renal impairment stage that was comparable to NKF population. LPM should be considered as first choice in CKD patients requiring a PM.
Serial GLS assessments over time in patients with preserved ejection fraction undergoing permanent cardiac pacemaker placement
Authors: Sung Soo K I M , Hyung Ki J , Hyun Kuk K I M , In Young C H O I , Young Jae K I , Dong Hyun C H O I , Keun Ho P A R K 
Published: May 2024

Abstract

Background
Chronic right-ventricular (RV) pacing can exacerbate heart failure in patients with a low ejection fraction (EF), but little is known about pacing-induced cardiomyopathy (PICM) in patients with preserved EF. We aimed to investigate risk factors of PICM in these patients during long-term follow-up.

Methods
The prospective registry at our University Hospital, South Korea, included de novo patients with preserved EF undergoing transvenous permanent pacemaker (PPM) implantation for atrioventricular blockage from 2018 to 2022. Patients with EF &gt; 50% and expected ventricular pacing &gt; 40% were included. All patients were followed with serial echocardiography (preimplant, post implant, 12 months). All patients enrolled in this study were seen as outpatients every 3–6 months. Composite outcomes were cardiac death (pump failure), hospitalization because of heart failure, PICM, and biventricular pacing (BVP) upgrade.

Results
71 patients (28 men, 73.1 ± 9.5 years) were included. After PPM implantation, EF and GLS were significantly decreased. During three years of follow-up, 2 patient died, 6 were hospitalized, 7 suffered PICM, and 3 underwent BVP upgrade. Cox regression analysis identified reduced post-implant global longitudinal strain (GLS) (HR, 1.524; 95% CI, 1.149–2.021; P = 0.003) as independent predictors of PICM. Post-implant GLS showed high predictive accuracy for PICM, with an area under the curve of 0.92 (95% CI 0.829–0.971; P &lt; 0.001)
Conclusion Post-implant GLS, rather than pre-implant GLS could help identify individuals at high risk of PICM. After PPM implantation, it is important to measure GLS, and patients with reduced GLS should be monitored more frequently and echocardiographic surveillance, with a view to an upgrade to BVP.Serial EF and GLS assessmentGLS ROC curve
Reduction in pacemaker rates post-heart transplantation with use of organ preservation systems
Authors: Cherrett C , Adonopulos A , Phan J , Lee W , Walker B , Jansz P , Subbiah R , Macdonald P 
Published: May 2024

Abstract

Background
Approximately 10% of heart transplant recipients require permanent pacemaker (PPM) implantation. (1) Prolonged graft ischaemic time may contribute to conduction system injury and PPM requirement. (2) Ex-vivo preservation of heart allografts at the time of organ retrieval, using either normothermic or hypothermic organ preservation systems (OPS), allows for the reduction of graft ischaemic time which can facilitate long-distance procurements and use of marginal donors including donation after circulatory death (DCD) donors. (3)

Purpose
We sought to determine if the use of organ preservation systems reduced PPM implantation in heart transplant recipients.

Methods
This was a single-centre retrospective study of 405 consecutive heart transplant recipients between July 2014 and March 2023. Baseline demographics, utilisation of organ preservation systems, donor ischaemic times, history of graft dysfunction, rejection and chronic allograft vasculopathy were obtained from the medical records. The primary outcome was PPM implantation.

Results
Of 405 heart transplants performed, an organ preservation system (OPS) was utilised in 118 (29.1%) patients. Normothermic OPS was used in 93/405 (23%) transplants, 90 of which were DCD transplants. Twenty-five of 405 (6.2%) transplants were performed using a hypothermic OPS to facilitate donation after brain death (DBD). The remaining 287 (70.9%) organs underwent cold ischaemic storage (CIS) from retrieval until transplant. Apart from male sex (81% in OPS group versus 69% in the CIS group), there were no significant differences in baseline demographics between the two groups (table 1).
Two of 118 (1.7%) patients in the OPS group required PPM implantation, compared to 27/287 (9.4%) in the cold ischaemic storage group (Chi-Square 7.5, p = 0.006). Kaplan-Meier analysis (figure 1) demonstrates a significantly lower rate of PPM implantation in the OPS arm (Log Rank 6.975, p = 0.008). Of the 29 patients who required pacing, 12/29 (41.4%) had AV block and 17/29 (58.6%) had sinus node dysfunction. Thirteen of 29 patients (44.8%) required PPM implantation within 30 days of transplant. Six of 29 patients (20.7%) were pacing dependent at last follow up.

Conclusion
Heart transplants performed utilising an organ preservation system were associated with lower PPM rates.Table 1.Figure 1.
Electrocardiogram predictors of leadless pacemaker implantation in the right ventricular free wall
Authors: Goto K , Miyazaki S , Negishi M , Ikenouchi T , Yamamoto T , Kawamura I , Nishimura T , Takamiya T , Tao S , Takigawa M , Sasano T 
Published: May 2024

Abstract

Background
Leadless pacemakers (LLP) carry the potential risk of cardiac injury, especially when implanted in the free wall of the right ventricle.

Purpose
To investigate the ECG criteria for distinguishing free wall implantation of LLP, further clarification is needed.

Methods
We conducted a retrospective study involving 17 patients who underwent LLP implantation, followed by chest computed tomography to confirm the implantation site. Patients were categorized into three groups based on the location of implantation (septum [Sep], apex [Apex], and free wall [FW]), and we compared the morphology of the 12-lead ECG during LLP pacing.

Results
Among the implantation sites, nine were in the Sep (52.9%), five in the Apex (29.4%), and three in the FW (15.8%). In terms of pacing QRS morphology, the FW group exhibited significantly longer QRS duration (Sep: 145.6±15.2 vs. Apex: 161.6±3.6 vs. FW: 175.3±16.6, P&lt;0.01), a notched QRS complex in lead III (Sep: 0.0% vs. Apex: 0.0% vs. FW: 100.0%, P&lt;0.01), and a shorter peak deflection index (PDI) in lead V1 (Sep: 0.59±0.07 vs. Apex: 0.55±0.06 vs. FW: 0.40±0.02, P&lt;0.01) than the other two groups. Receiver operating curve analysis to predict FW implantation revealed that a PDI of 0.42 in lead V1 (Area under the curve [AUC]=1.00, specificity=100.0%, sensitivity=100.0%, P&lt;0.01) and a QRS duration of 173 msec (AUC=0.89, specificity=100%, sensitivity=66.7%, P&lt;0.01) were the optimal cutoff values.

Conclusion
The LLP FW implantation group had a longer QRS duration, a notched QRS complex in lead III, and a shorter PDI in lead V1 compared to the other pacing sites.
Feasibility and safety of permanent left bundle branch area pacing in pediatric patients
Authors: Bakytzhanuly A , Turubayev E , Bagibayev S , Esilbayev Z H , Talgatova S , Yuldashev S , Nuralinov O 
Published: May 2024

Abstract

Introduction
Left bundle branch area pacing (LBBAP) is a promising pacing strategy with a low and stable pacing threshold. It maintains electrical and mechanical synchronization of the ventricles. Conduction system pacing (CSP) has evolved rapidly to become the pacing method of choice for many adult and pediatric patients. Recent studies have begun to demonstrate the feasibility and efficacy of CSP in pediatric patients. Nowadays, research articles about LBBAP in children are comparatively rare, therefore, research in this area is preferred. Limited data on LBBAP in pediatric patients (≤ 18 years old) are available.

Purpose
This study aims to describe the feasibility and safety of LBBAP in pediatric patients.

Methods
This study includes 4 patients: 1 male, and 3 females, respectively. The average age of the patients was 15.5±1.9 years and the weight was 51,5±17,6 kg. All patients were diagnosed with 3rd-degree atrioventricular (AV) block, in one case the total AV block occurred after previous radiofrequency ablation of the parahisian and right lateral accessory pathway. One patient had previously been implanted with an epicardial pacemaker and presented to our clinic with ventricular lead dysfunction. Pacing parameters were assessed during implantation, the next day after the procedure, and 1, 3 months follow-up. Echocardiography was performed to evaluate LV function and assess the approximate lead location and impact on tricuspid valve function.

Results
LBBAP was successfully achieved in all patients resulting in narrow QRS complexes (102±12.7ms) and right bundle branch block QRS morphology. To confirm left bundle branch area capture, peak left ventricular activation time (pLVAT) (84.5±4.1ms), V6-V1 (43.5±2.5ms) inter-peak interval, presence of left bundle potential, transition from non-selective to selective capture were recorded at during the implantation. The mean paced QRS duration was (108±13 ms). Pacing threshold and impedance remain stable (0.75±0.25V, and 615±50 Ohm, respectively). There was no major complication during the implanting process and follow-up.

Conclusions
LBBAP can be performed safely in children with narrow QRS complexes and can achieve stable pacing parameters.
Leadless pacemaker implantation following tricuspid interventions: multicenter collaboration of feasibility and safety
Authors: Gul E , Waldmann V W , Baudinaud P B , Sabbag A S , Jubeh Y J , Clementy N C , Bisson A B , Ollitraut P O , Conti S C , Carabelli A C 
Published: May 2024

Abstract

Background
Permanent pacing is often required following valve intervention (either surgical or percutaneous), however tricuspid interventions pose specific challenges to conventional pacing.
Therefore, leadless pacemaker (LP) implantation may be the preferred strategy when permanent pacing is required after tricuspid valve intervention.

Objective
To report periprocedural outcomes and follow-up of patients undergoing implantation of a LP system following tricuspid valve interventions.

Methods
Consecutive patients with previous tricuspid valve intervention at the time of attempted implantation of a LP were included.

Results
Between 2019 and 2022, 40 patients underwent LP implantations following tricuspid interventions in 5 large tertiary centers. The mean age was 68.9 ± 13.7 years, and 48 % patients were male. The indication for pacing was as following: AVB in 27 (68%) patients, AF with slow ventricular response in 10 (25%) patients, and refractory rapid atrial fibrillation (AF) referred to AV junction ablation in 3 (7%) patients. Most of the patients received Micra VR (78 %). Procedure was successful in all patients. Mean procedural time of 58 ± 32 min and median fluoroscopy time of 7.5 min. Electrical parameters were within normal range (threshold: 1.35 ± 1.2 V@0.24 ms, impedance: 772 ± 245 Ohm, R-wave: 6.9 ± 5.4 mV). No acute complications were observed. During a mean follow-up of 10 months, electrical parameters remained stable, and 4 deaths were occurred (not related to the procedure).

Conclusion
A LP is safe and efficient option following tricuspid valve interventions.Micra LP in a patient with bioprostheticMicra LP in a patient with tricuspid rin