bluuebunny/crossref_metadata_2025_split huggingface dataset:
The safety and feasibility of same-day discharge after subcutaneous implantable cardioverter defibrillator implantation
Authors: Toon L T , Elrefai M , Bates A , Patil R , Hudson J , Zubair Z , Roberts P R 
Published: May 2024

Abstract

Introduction
Subcutaneous Implantable cardioverter defibrillators (S-ICDs) are now progressively administered as a day-case procedure. While existing data supports the feasibility and safety of same-day discharge after transvenous ICD implantation, comparable evidence for S-ICDs is not well established. This study addresses this by presenting data from the most extensive population documented in the medical literature. We seek to evaluate the feasibility and safety of same-day discharge after S-ICD implantation.

Purpose
To investigate the feasibility and safety of same-day discharge following S-ICD implantation.

Methods
A retrospective analysis was conducted, encompassing data from all patients who underwent S-ICD implantation at our institution between January 2011 to April 2023 (n=240). The cohort was stratified into two groups: those discharged on the same day of the procedure (SD, n=124) and those subject to at least overnight hospital observation (OD, n=116). The medical records were reviewed during this period aiming to identify potential complications. Complications were categorized as device-related complications or inappropriate shock. Specific events, such as inappropriate shocks; lead revision; infection necessitating lead or generator extraction; pocket hematoma requiring drainage, blood transfusion, or prolongation of hospitalization; and other complications related to the lead or generator prompting medical or surgical intervention were documented. An inappropriate shock was defined as one delivered for any rhythm other than ventricular fibrillation or ventricular tachycardia.

Results
Among the 240 patients included in the study, 123 were scheduled for a day case procedure, while the remaining 117 underwent S-ICD implantation as in-patients. Notably, 112(91%) out of 123 planned-day patients and 12 in-patients (SD, total n=124) were successfully discharged on the same day. A substantial proportion (84%) of SD group had undergone the procedure for primary prevention. Patients with congenital heart disease were predominantly observed overnight.
Defibrillation testing (DFT) is routine in our practice to ensure S-ICD integrity and was conducted in all S-ICD patients unless contraindicated. The success rate of DFT among attempted patients was high, standing at 72% and 78% in the SD and OD groups, respectively.
The incidence of device-related complications was comparable between the two groups. The SD group displayed a slightly higher superficial infection rate but the incidence of inappropriate shocks was lower in the SD groups.

Conclusion
Based on our findings, same-day discharge following S-ICD implantation emerges as an appropriate practice. Our data strongly supports the assertion that same-day discharge in this context is safe and feasible, offering valuable insights into the optimal post-procedural management of S-ICD patients.Table 1ComplicationsTable 2Defibrillation Test
Optimising electrical performance of leadless cardiac resynchronisation therapy and leadless LV septal pacing
Authors: Wijesuriya N , Strocchi M , Mehta V S , Elliott M K , De Vere F , Howell S , Sidhu B , Mannakkara N , Little I , Martic D , Carlisle L , Kwan J , Bosco P , Niederer S A , Rinaldi C A 
Published: May 2024

Abstract

Introduction
Leadless left ventricular (LV) endocardial pacing with the WiSE-CRT System is an emerging form of cardiac resynchronisation therapy (CRT). The system was designed to provide lateral wall LV pacing (LVP) via an endocardial receiver electrode in response to detection of a right ventricular pacing (RVP) stimulus from a co-implanted device, thereby delivering near-simultaneous biventricular pacing (BiVP). However, it is unclear whether BiVP generates the optimal electrical performance in this system, particularly in the context of leadless LV septal pacing, a novel use for leadless CRT.

Aim
We aimed to characterise the acute performance of leadless CRT at different pacing modalities using electrocardiographic imaging (ECGi).

Methods
Patients with the leadless CRT underwent an acute ECGi study. The following pacing modalities were tested: RVP; BiVP; LVP; and LVP with an electrically optimised atrioventricular delay (LV-OPT) in patients with sinus rhythm (SR). Reconstructed epicardial electrograms (Figure 1) were used to calculate BiV activation time (BIVAT-90), LV activation time (LVAT-90), RV activation time (RVAT-90), LV dyssynchrony index (LVDI), and BiV dyssynchrony index (BIVDI). For each metric, the improvement compared to baseline rhythm was calculated, and the optimal pacing modality (OPM) in each patient was determined.

Results
Ten patients were studied, 5 receiving septal LVP, and 5 receiving lateral LVP. The underlying rhythm in 4 patients was SR with left bundle branch block (LBBB), and atrial fibrillation (AF) with complete heart block (CHB) in the remaining 6. BiVP generated a 23.7% improvement in BiVAT-90 compared to baseline (p=0.002). An individualised OPM resulted in a 43.3% BiVAT-90 improvement compared to baseline (p=0.0001), thus a 19.6% improvement compared to BiVP (p=0.02, Figure 2A). Using an OPM, BiVAT-90 was significantly improved in both patients with lateral (43.3%, p=0.0001) and septal LVP (42.4%, p=0.009). The BiVAT-90 OPM varied between patients (Figure 2B). BiVP was the OPM in 4/10 patients, all of whom had AF with CHB. BiVP was the OPM in 1/5 patients receiving LV septal pacing, with LVP or LV-OPT performing best in the remaining 4. In 3/4 patients in SR, LV-OPT was the OPM. Choosing the OPM increased performance primarily through significant improvements in RVAT-90 compared to BiVP (36.5% versus -8.2%, p =0.002).

Conclusion
Leadless CRT, both with lateral and septal LVP, significantly reduces electrical activation times and improves electrical dyssynchrony. Individualised selection of the OPM may be required with leadless CRT to accommodate for varying conduction disease phenotypes and implant locations.
Short-term cost-utility analysis of biventricular cardiac resynchronization therapy in comparison with left bundle branch area pacing cardiac resynchronization therapy
Authors: Sanchez Moreno J , Fernandez Sanchez J A , Garrido-Arroquia Jurado T , Molina Lerma M , Gutierrez Ballesteros G , Frutos Lopez M , Pavon Jimenez R , Jimenez Jaimez J , Garcia Mochon L , Alvarez Lopez M 
Published: May 2024

Abstract

Background
Cardiac resynchronisation therapy (CRT) is a well-established form of treatment for patients with heart failure and cardiac dyssynchrony. Recently, left bundle branch area pacing (LBBAP) has emerged as a more physiological alternative for biventricular pacing (BiVP) cardiac resynchronization therapy (1,2).

Purpose
The purpose of this study was to conduct a cost-utility analysis for LBBAP CRT, compared to BiVP CRT in a cohort of patients with heart failure from the Spanish health system perspective.

Methods
A multicenter prospective quasi-experimental study in which 44 consecutive patients underwent CRT was conducted. According to the study protocol, the four centers would perform their usual clinical practice: two out of them would perform conventional BiVP-CRT while the other half LBBAP-CRT. Intention-to-treat analysis was carried-out. Health outcomes were quality-adjusted life years (QALYs), measured by the EuroQol-5D-5L questionnaire, which the patients were asked to complete at baseline and 12 weeks after the CRT device implantation. The total direct costs include device, leads, guidewires, introducer kits, sheats and operating theater time. The results were expressed as the incremental cost-utility ratio (ICUR). In order to analyze the uncertainty of ICUR results, we performed a non-parametric bootstrapping with 1000 replications.

Results
The LBBAP procedure was attempted for a total of 26 consecutive patients (1 patient underwent rescue BiVP), while BiVP was attempted for 18 patients (2 patients switched to LBBAP). Mean QALYs over 3 months were 0.1914 ± 0.009 in the LBBAP CRT group and 0.1904 ± 0.0112 in the BiVP CRT. Improvements from baseline were greater in the LBBA CRT group but not statistically significant. The total costs at the end of the intervention were 7546.6 €± 602.15€ in the LBBAP CRT group and 16064.56€ ± 723.7€ in the BiVP CRT group. When excluding from the analysis the cases in which ICD was implanted, the mean difference in QALYs is 0.002; 95% confidence interval [95%CI]: -0.03 to 0.036) and the mean saving is -3.510.38 €. The LBBAP CRT leads to cost savings for the health system and similar QALYs outcomes; 95%CI: -6.660 to -360.71. Based on 1000 bootstrapping replication, the cost savings of using LBBAP vs BiVP occur in 99% of the simulations.

Conclusion
LBBAP CRT is an efficient alternative to BiVP CRT for cardiac resynchronization in patients with heart failure with similar results in terms of QALYs but with significant average savings per patient.Cost-utility plane for 1000 bootstrappedBaseline characteristics of patients
Impact of non-typical LBBB on CRT response
Authors: Abrantes A , Joana Brito J B , Beatriz Silva B S , Beatriz Garcia B G , Margarida Martins M M , Miguel Azaredo Raposo M A R , Catarina Gregorio C G , Daniel Cazeiro D C , Diogo Ferreira D F , Pedro Silverio Antonio P S A , Sara Couto Pereira S C P , Ines Ricardo I R , Fausto J Pinto F J P , Joao De Sousa J S , Pedro Marques P M 
Published: May 2024

Abstract

Introduction
Cardiac resynchronization therapy (CRT) benefits have been established in patients with heart failure and reduced left ventricular ejection fraction (HFrEF) who have a broad QRS and remain symptomatic despite optimized medical therapy. Responders typically are female, with LBBB and broader QRS. It remains uncertain to what extent do patients with non-LBBB QRS complex morphology respond to CRT and also if there are differences among various types of intraventricular conduction delays.

Purpose
To evaluate the impact of non-typical left bundle branch block (LBBB) on reverser remodeling and clinical events.

Methods
Single center, observational, retrospective study including patients (pts) who implanted CRT in the context of HFrEF, from 2015 to 2020. Evaluation of QRS morphology analysis was conducted.
CRT response was defined by a reduction of LVESV≥15% or an increase in LVEF≥10%. Predictors of CRT response were evaluated with Chi-square and Mann- Whitney analysis. Impact on reverse remodeling and clinical outcomes was performed with Kaplan-Meyer analysis.

Results
A total of 361 pts were included for analysis, of which 184 had non-typical LBBB. Pts had a mean age of 71±9years old, the majority of pts were female (61%), and almost half were ischemic (47.8%).
EGC evaluation prior to CRT implantation, revealed an atypical LBBB in 83 (45.1%) pts, typical RBBB in 23 (12.5%) pts, atypical RBBB 94.(9%) pts and nonspecific intraventricular conduction delay in 69 (37.5%) pts.
During a mean time of follow-up of 2.9 ±2.4years, 33 pts (18%) had hospitalizations due to HF and 68 (37%) died. In this cohort, 78 pts (42.4%) were deemed as responders, who presented a better clinical outcome when compared to non-responders (p &lt; 0.001, HR 2.629 [95% CI 1.635-4.225].
There was no difference among the four types of intraventricular conduction analyzed in respect to degree of CRT response – figure 1. Regarding clinical events during follow-up, there was once again no significant difference among the different patterns of non-typical LBBB– figure 2.
In this subset population we found no independent predictors of CRT response, although non-responders were significantly older than responders (72±8 vs 69±10 years-old (p=0.016).

Conclusion
Although pts with non-typical LBBB morphology display a lower therapy response to CRT than reported for LBBB pts, the rate of response is not negligible and represents a protective factor for clinical outcomes. Different types of intraventricular conduction delay present no difference regarding long- term prognosis or reverse remodeling.Survival according to CRT response
Predictors of responders to cardiac resynchronization therapy in patients with non-left bundle branch block with mid-wide QRS duration
Authors: Takanashi Y , Kondo Y , Nakano M , Kajiyama T , Ito R , Chiba T , Ryuzaki S , Yoshino Y , Komai Y , Kobayashi Y 
Published: May 2024

Abstract

Background
Cardiac resynchronization therapy (CRT) is useful for patients with severe heart failure with dyssynchrony of left ventricular contraction, significantly reducing total mortality or heart failure rehospitalization. In patient with left bundle branch block (LBBB) or QRS duration (QRSd) ≥ 150 ms, CRT is a well-established therapy at guidelines in Japan and other countries. However, CRT may be more useful and effective in Asian patients with middle range wide QRSd, because of smaller body size than in the West. Few reports have shown the usefulness and efficacy of CRT in patients with non-LBBB and middle range wide QRS duration (mid-wide QRSd).

Purpose
To evaluate the predictors of CRT responders in heart failure patients with non LBBB and mid wide QRSd.

Methods
We retrospectively studied 174 consecutive patients who underwent a denovo CRT device implantation at two institutions between September 2013 and March 2023. Follow up echocardiography examination could be performed after 150 days postoperatively. CRT responders were defined as a decrease in left ventricular end systolic volume ≥15% on echocardiography. We plotted thereceiver operating characteristic (ROC) curve for predicting CRT responders. The area under the curve (AUC) was calculated to determine the best cut off value.

Results
A total of 34 patients with non LBBB and 120≤ QRSd &lt;150 ms were enrolled in this study. Sixteen of 34 (47%) patients were the responders for CRT. There was no significant difference in gender between the responder and non responder groups (p=0.274). Non ischemic cardiomyopathy was more prevalent in the responder group (p=0.046). The ROC curve analysis confirmed that 0.809 was the better optimal cut off value of QRSd/left ventricular end diastolic volume (LVEDV) for predicting CRT responders (AUC = 0.688). The multivariate analysis demonstrated that QRSd/LVEDV was significantly associated with CRT responders [odds ratio (OR) 9.88, 95% confidence interval 1.51 64.90, p = 0.017].

Conclusion
The corrected QRSd for heart size using LVEDV could be the independent predictor of CRT responders in Japanese patients with non LBBB and mid wide QRSd.
Thoracic impedance during national holidays
Authors: Olsson A , Rylance R , Borgqvist R , Erlinge D , Platonov P 
Published: May 2024

Abstract

Background
Several studies have observed increased incidence of myocardial infarctions during Christmas and national holidays. Emotional stress, overindulgence in food and alcohol have been suggested as potential underlying mechanisms. Monitoring of thoracic impedance (TI) by cardiac implantable electronic devices (CIED) has been proposed as a tool for detection of fluid accumulation. We aimed to assess the relationship between TI and national holidays in patients treated with CIED with and without reduced left ventricular ejection fraction (LVEF).

Method
Consecutive patients with CIED capable of TI monitoring enrolled in the remote monitoring program at a tertiary care hospital in Sweden were screened. Full disclosure remote CIED monitoring database containing daily measurements of TI and device therapy delivery was accessed as the source of information for this retrospective cohort study. Patients were included if they had the monitoring data for at least one holiday (Christmas, New Year or Midsummer) between June 2015 and January 2020. TI during the holiday was compared with baseline values, defined as a mean value of three days preceding Christmas Eve and Midsummer. Clinical characteristics, LVEF, medical treatment and possible contact with healthcare during the holidays or the following week were obtained from medical records. A linear mixed model was used since dependent observations existed.

Result
In total, 96 patients (82 % men, age 69±10 years, 92 % ICD, 78 % CRT, 72 % with LVEF&lt;40%) were included, which provided data for 255 patient-holidays. TI decreased by mean 1.3 Ohm (95% CI -1.9 to -0.6, p&lt; 0.001) on the Christmas Day, 0.6 Ohm (95 % CI -1.4 to 0.1, p = 0.08) on New Years Day and 1.0 Ohm (95 %CI -1.7 to -0.3, p=0.005) on Midsummer Day. These TI changes were not related to age and did not differ between men and women. Holiday-related TI drop was observed regardless of LVEF: mean decrease on Christmas Day 1,1 vs 1,4 Ohm, New Years Day 0,2 vs 0,4 Ohm and Midsummer Day 1,2 vs 1,0 Ohm for LVEF &lt;40% and &gt;40% respectively. By the third day after a holiday, TI had reached the baseline level. Only one ventricular tachycardia event requiring shock therapy and hospital admission was documented. No other patients were seeking care during the holidays or the days afterwards.

Conclusion
A significant transient decrease in thoracic impedance was evident during Christmas Day and Midsummer Day in CIED treated patients with reduced and preserved LVEF. These holidays are therefore associated with both decrease in thoracic impedance and incidence of myocardial infarction and it is possible that decrease in thoracic impedance could contribute to the increased incidence of myocardial infarction during holidays.
Incidence of infections related to cardiac implantable electronic devices in Germany
Authors: Baldauf B J , Bode K , Assadian O , Giaccardi M , Cemin R , Chevalier P , Vonthein R , Bonnemeier H 
Published: May 2024

Abstract

Background
Worldwide, the risk of cardiovascular implantable electronic device (CIED) infection is increasing. Publications of contemporary big data regarding CIED infections for Germany are lacking. This investigation is providing rates of CIED, hospital admission for CIED infection and related mortality in Germany.

Methods
Data from the biggest healthcare insurance fund was screened for CIED procedures, including placement, revision with aim to up- or downgrade, generator substitution, early revision and partial or complete extraction using specific procedure codes for reimbursement in Germany during 2015. Among the total population of beneficiaries with CIED placement in that year international Classification of Diseases, 10th revision German modification codes were used to identify CIED infections and lead related endocarditis.

Results
In 2015 altogether 60,296 patients (57.3% male) underwent a CIED procedure. 1129 (1.9%) patients underwent at least one procedure related to CIED infection and 466 (0.77%) participants underwent at least one procedure for treatment of a lead related endocarditis.
CIED infection was associated with a mortality rate of 8.4%. Lead related endocarditis was associated with a mortality rate of 15.4% in 2015.
Patients presenting with CIED infection and lead related endocarditis were younger (69.5 and 67.3 vs 73.5 years) and more often male (69.4 and 70.2 vs 57.3%) 2.22 procedures in case of hospital admission with CIED infection and 1.93 procedures in case of lead related endocarditis were conducted in 2015.

Conclusions
Our observational study shows that the rate of CIED infection is greater than has been reported by large randomised trials. Mortality rates for CIED infection and lead related endocarditis are in line with published rates. Younger age and male gender are host related risk factors for an increased risk for CIED infection and lead related endocarditis.
No lead left behind: procedural outcome of excimer laser powered extractions in patients with abandoned leads - a GALLERY subgroup analysis
Authors: Rexha E , Chung D , Schlichting A , Kaiser L , Hassan K , Gessler N , Reichenspurner H , Willems S , Pecha S , Hakmi S 
Published: May 2024

Abstract

Background
Lead dwell time &gt; 10 years, has been recognized as a predictive factor for procedural failure of transvenous lead extraction (TLE). However, there is a limited information concerning the specific outcomes of TLE for abandoned leads when employing the excimer laser-powered sheath.

Objective
The purpose of this study was to investigate the procedural outcomes of individuals with abandoned leads undergoing TLE with excimer laser-powered sheath as first tool strategy.

Methods
A subgroup analysis of patients with abandoned leads of the GALLERY (GermAn Laser Lead Extraction RegistrY) database was conducted. Patients were categorized into two groups based on the presence of abandoned leads at the time of extraction: Group 1 for those with abandoned leads, and Group 2 for those without abandoned leads.

Results
Among the 2524 patients, 749 individuals (29.7%) had abandoned leads (Group 1) at the time of the procedure. Patients in Group 1 were typically older (69.1±13 vs. 67.6±14.1 years; p=0.026) and 23.5% were female. Leading extraction indication was local infection (37.4% vs. 34.3%, p=0.145), systemic infection (33.2% vs. 26.6%, p=0.001) and lead dysfunction (24.3% vs. 33.5%, p&lt;0.001). Additionally, more patients in Group 1 presented with cardiac resynchronization therapy (CRT) devices (30.4% vs. 22.9%, p&lt;0.001). Significant differences were observed in the mean number of total leads (3.4±1.1 vs. 2.0±0.7, p&lt;0.001), median age of the oldest lead (117 vs. 87 months; p&lt;0.001), and the number of right-sided leads (41.7% vs. 29.5%, p&lt;0.001), all of which were higher in Group 1.
Median hospital stay (10 vs. 9 days; p=0.002), median procedural time (105 vs. 75 minutes; p&lt;0.001) and use of additional tools (11.2% vs. 4.7%, p&lt;0.001) were significantly higher in Group 1. There was no difference regarding clinical success (p=0.32) between the groups. However, complete procedural success was significantly higher in Group 2 (84.9% vs. 94.2%, p&lt;0.001).
All-cause mortality did not differ between the groups (p=0.111) but procedural-related mortality was higher in Group 1 (2.9% vs. 0.6%, p&lt;0.001). The overall complications rate was also significantly higher in Group 1 (5.7% vs. 3.7%, p=0.03).

Conclusion
Patients with abandoned leads presented an increased procedural complexity, less procedural and clinical success despite the use of multiple tools, longer hospital-stay and higher procedure-related mortality rates. Therefore, an extraction strategy should be considered before deciding to abandon non-functional or dysfunctional leads.