bluuebunny/crossref_metadata_2025_split huggingface dataset:
investigating long-term outcomes and predictors of primary outcomes in patients treated for cardiac implantable electronic device infections
Authors: Bulat Z , Arslan S , Gecit M H , Gokce M E , Bilgin M E , Balcioglu S A , Ebeoglu A O , Uzunhasan I , Yildiz M 
Published: May 2024

Abstract

Background
The estimated current infection rate after cardiac implantable electronic devices (CIED) implantation ranges between 1% and 2%, with variations in the literature from 0.13% to 12.6% (2). The rise in CIED implantation rates over the years has led to an escalation in the frequency of device-related infections. This trend is compounded by the elongation of patient comorbidities and life expectancy (3).

Purpose
The study aimed to investigate the primary outcome rates (including death, myocardial infarction (MI), cerebrovascular accidents (CVA), and reinfection) and identify predictors of primary outcomes in patients receiving treatment for CIED infection.

Methods
A retrospective analysis was conducted at a single-center. The study encompassed 2322 patients who sought treatment at the arrhythmia clinic of our Institute between March 2011 and July 2020 and underwent CIED implantation. After excluding 20 patients with active infections and 3 patients postoperative cardiac arrest, 36 patients were diagnosed with CIED infection (1.55% incidence). Diagnosis was based on the Novel 2019 International CIED Infection Criteria. Patients were categorized into groups based on the occurrence of all-cause death, MI, CVA, and reinfection during the follow-up period.

Results
The median follow-up period post admission with CIED infection was 42.5 (7-141) months. Table 1 presents patient characteristics, procedure details, and management-related parameters in the groups stratified by the primary endpoint. Notably, 58.3% of the patients had previously undergone a replacement procedure. Among patients with CIED infection, reinfection was observed in 20.0% of those who had a de novo procedure and 38.1% of those who underwent a secondary procedure (p: 0.25). Cox regression analysis revealed that pre-procedure C-reactive protein (CRP) levels and CHA2DS2-VASc score were independent predictors of the primary outcome (OR: 1.03 (1.00-1.06); P: 0.035, OR: 1.34(1.03-1.88); P: 0.030, respectively) (Table 2).

Conclusion
Long-term outcomes in patients with CIED infection appear to be correlated with pre-procedure CRP levels, indicating the severity of infection, and the CHA2DS2-VASc score, providing valuable insights into patient comorbidities. These factors seem to outweigh the impact of the specific procedure and antibiotic regimens administered. Management should not only focus on the history of CIED infection during follow-up but also prioritize the management of existing comorbidities to improve outcomes. Given the study's limitations such as the small sample size and retrospective nature, further investigations are warranted to confirm these findings.Table 1Table 2
Very early fractures of the stylet-driven Biotronik Solia lead used for left bundle branch area pacing
Authors: Haeberlin A , Hofer D , Noti F , Reichlin T , Breitenstein A 
Published: May 2024

Abstract

Introduction
Left bundle branch area pacing (LBBAP) has become increasingly popular due to the relatively simple implantation procedure allowing for conduction system pacing (CSP). Initially, lumen-less leads have been used primarily for CSP. However, several authors have published encouraging results using conventional stylet-driven pacemaker (PM) leads as well and our centers have largely adopted this approach.

Methods
In our two tertiary referral centers, we assessed all patients, who underwent a LBBAP lead implantation using any lead. We observed several early lead fractures, exhibiting a unique failure mechanism, which we illustrate in this case-series.

Results
Between January 2022 and November 2023 343/393 patients (87.3%) were implanted with a Solia pacemaker lead, 46/393 (11.7%) received a SelectSecure 3830 lead, and 4/393 (1.0%) another stylet-driven lead. Three patients (0.8%) who initially were implanted with a Solia lead experienced very early intracardiac lead fractures within 1, 11 and 13 months after implantation despite good initial electrical performance values (Table shows initial values and values during the time of failure (bold)).
The first case was a 54 year-old woman with permanent 3d degree AV block receiving an LBBAP lead after lead extraction. Four weeks later, she presented with presyncope and exit block at maximum output in uni- and bipolar configuration.
The second case was a 72 year-old man with intermittent 3rd degree AV block in the context of an ischemic heart disease. He received a dual-chamber LBBAP PM. 13 months after the implantation, a bipolar impedance &gt; 2’500Ω and exit block were noted.
The third case was 65 year-old man suffering from sick sinus syndrome. He initially underwent a dual-chamber PM implantation in 2011 and due to ventricular sensing issues a transvenous lead extraction and implantation of a LBBAP lead in October 2022. During device follow-up after 11 months, a fractured LBBAP lead with bipolar impedance &gt;2’500Ω and exit block during threshold testing was noticed.
In all cases, X-rays and macroscopic analysis consistently showed a disintegration of the lead immediately distal to the ring electrode (Figure; site of fracture marked with an arrow). Most likely, this was caused by the repetitive shear stress at the hinge point of the lead where it is entering the septum.

Conclusion
No dedicated stylet-driven CSP lead is available to date. The implantation site and technique for LBBAP may exert higher mechanical stress on the distal part of the lead, making it more prone to fracture than in a conventional position. Currently, the use of conventional stylet-driven leads is still off-label and the performance of such leads should be monitored closely.TableFigure
Transvenous lead extraction: the jugular pull-through technique
Authors: Akhtar Z , Kontogiannis C , Leung L W M , Sohal M , Gallagher M M 
Published: May 2024

Abstract

Background
Transvenous lead extraction (TLE) is vital to the management of cardiac implantable electronic devices (CIEDs). Evolving tools and techniques have contributed to an improvement in procedural safety and efficacy. The jugular access is advantageous in TLE, providing a linear, direct path to the heart for extraction sheaths. However, transfer of a lead with a deployed locking stylet from the subclavian to the jugular carries risk of cardiovascular injury. A novel jugular pull-through technique has been described for safe transfer of the lead and locking stylet from the native site to the jugular access, to facilitate TLE using a powered sheath.

Purpose
We report our early experience of the novel jugular pull-through technique which transfers a locking stylet and lead unit, from the subclavian to the jugular access for completion of TLE.

Method
The jugular pull-through technique entailed transfer of the deployed locking stylet with the lead via a long-sheath from the subclavian access to the jugular. In brief: a long wire positioned in the Superior Vena Cava via the jugular is snared and pulled from the subclavian site, permitting a long 8.5-french sheath to be railroaded through the jugular to surface at the subclavian access. The deployed locking stylet was fed through this long sheath to emerge at the jugular access; the sheath, locking stylet and lead were then pulled as a single entity to transfer the locking stylet and lead from the subclavian to the jugular. The rotational dissecting sheath was then advanced over the lead via the jugular in linear fashion to complete the lead extraction. Data for consecutive jugular pull-through procedures performed between 1/7/2022 – 31/12/2022 in our high-volume TLE institute were collected and evaluated for safety and efficacy.

Results
Three male patients aged 69.8±12.5 years with a left ventricle ejection fraction of 46.7±14.4%, underwent TLE for infection (67%). Of the 7 targeted leads, 4 (57%) were extracted using the jugular pull-through technique, all from the right ventricle (50% ICD) with 128±131.8 months dwell time. Of these 3 cases, 1 suffered diabetes, 1 hypertension, 1 ischaemic cardiomyopathy and 1 hypertrophic obstructive cardiomyopathy. All procedures were performed in the cardiac catheterisation suite under general anaesthesia using a locking stylet, compression coil, Evolution RL (13-french), a Needle’s Eye Snare, a loop snare and a long 8.5-french sheath with its 0.032 guidewire. The jugular pull-through technique facilitated 100% complete procedural success and 100% clinical success in the absence of any complications or procedural mortality; there was no 30-day mortality.

Conclusion
The jugular-pull-through technique allows safe transfer of a fully deployed locking stylet and lead from the subclavian to the jugular access, to facilitate jugular TLE.The jugular pull-through technique
Relationship between ECG parameters and electrophysiological study in post-TAVI de novo left bundle branch block
Authors: Massoullie G , Bordachar P , Ploux S , Souteyrand G , Mondoly P , Amabile N , Jean F , Combaret N , Motreff P , Clerfond G , Eschalier R 
Published: May 2024

Abstract

Background
The measurement of the HV interval in post-TAVI has a determining place in the most recent recommendations. However, its value, in addition to the post-TAVI ECG, remains debated. To describe the correlation in post-TAVI ECG and HV in case of de novo left bundle branch block and his correlation to PR interval prolongation.

Methods
Prospective, open-label study with 12 months follow-up. From June 2015 to November 2018, TAVR recipients were included at 10 centers in the French Multicenter LBBB-TAVR study. 183 TAVR recipients (64% self-expanding valve) had a new-onset LBBB after TAVR persisting for more than 24 hours. HV interval was assessed by intracardiac EPS and compared to ECG parameter on the day of EPS.

Results
1631 ECGs were recovered and double-read. On the day of EPS the mean PR was 224±51 ms, the mean QRS duration was 148±18 ms. The PR increases after TAVI by a maximum of 60±43 ms to reach a mean maximum PR of 252±55 ms. It increases progressively in the post-procedure period from 25±37ms, until the 4th day (44±32ms, p&lt;0.001). The mean HV interval delay was 62±14 ms, the AH was 140±63 ms. The HV interval was weakly correlated with the duration of the PR interval (0.19), the AH interval had a correlation of 0.72. In logistic regression, PR ≥ 240 ms and QRS ≥ 150 ms were independent predictor of HV prolongation (HR 7.6 [3.0 - 12.2], p=0.001 and 5.9 [1.6 - 10.3], p=0.007). The rate of conduction disturbance at 1 year in case of prolonged HV, QRS ≥ 150 ms and PR ≥ 240 ms was 57% vs. 27% if HV &lt; 70 ms (p&lt;0.001).

Conclusions
In post-TAVI de novo left bundle branch block, PR interval prolongation is a dynamic, transient process driven by an alteration of atrioventricular node. The HV interval prolongation is poorly correlated to post-TAVI PR prolongation and LBBB duration.Correlation between ECG and EP studyConduction disorders after TAVR
Ventricular septal defect characteristics influence presence and properties of septal anatomical isthmuses in patients with repaired tetralogy of Fallot
Authors: Wallet J , Kimura Y , Blom N A , Hazekamp M G , Jongbloed M R M , Zeppenfeld K 
Published: May 2024

Abstract

Background
In repaired tetralogy of Fallot (rTOF), the septal anatomical isthmuses (AI), 3, between the ventricular septal defect (VSD) and pulmonary annulus, and 4, between the VSD and tricuspid annulus, are important ventricular tachycardia (VT) substrates when slow conducting. Patients with rTOF can have different VSD characteristics which may influence presence and properties of septal AIs.

Methods
This study included all consecutive patients with rTOF who underwent electroanatomical mapping (EAM) between 2005 and March 2023 for ventricular arrhythmias, risk stratification, or before pulmonary valve replacement and had a surgical report of initial repair available.

Results
In 130 of 154 (84%) patients a surgical report was available (35% female, median age at EAM 38 years [IQR 20-49]), with provided VSD details in 90 (69%). The majority of patients had an outlet perimembranous VSD (n=77, 86%), 7 (8%) a doubly-committed juxta-arterial (DC-JA) VSD, and 4 (4%) a muscular outlet VSD. All patients with a DC-JA VSD had a blocked/absent AI 3. Among patients with a DC-JA VSD with a muscular posteroinferior rim, 50% had AI 4, which was not observed in patients with a fibrous posteroinferior rim. In patients with a muscular VSD, AI 4 was present in 25%. In contrast, in patients with an outlet perimembranous VSD, an AI 4 or a blocked/absent AI 3 were rare findings (1% and 4%, respectively).

Conclusions
VSD characteristics influence presence and properties of septal AIs. In patients with DC-JA VSD septal VT substrates seem to be rare. Detailed surgical information is desirable for patient management.
Factors of unfavorable prognosis in patients with non-high risk pulmonary embolism
Authors: Tseluyko V , Askierov R 
Published: May 2024

Abstract

Introduction
Pulmonary embolism (PE) nowadays is the third leading cause of death in the structure of cardiovascular mortality after myocardial infarction and stroke. Most of patients (pts) with PE are with non-high risk. According to the latest guidelines PESI and sPESI scores are used to predict 30-day outcome of non-high-risk pts. Nevertheless, the question of additional factors which are not included in PESI and sPESI scores and which may be associated with prognosis in such pts remains poorly understood.

Purpose
To identify factors associated with in-hospital mortality in non-high-risk PE pts.

Methods
A retrospective analysis of 635 medical cards of pts with diagnosis "PE" hospitalized in our clinical hospital during 2017 – 2023 period. The diagnosis was verified by multispiral computed tomography angiography (CTPA) of pulmonary arteries and/or by autopsy. There were 530 non-high-risk pts (83,4%). Pts were divided into groups: І group - pts who were discharged from hospital with improved status (479 – 90,4%), II group - pts who died in hospital (51 – 9,6%). Clinical, anamnestic, laboratory and instrumental parameters were measured. Statistical analysis was performed.

Results
According to multivariate analysis of variance, independent factors, which were associated with in-hospital mortality in pts with non-high-risk PE, were: the presence of atrial fibrillation, obesity, age, history of venous thromboembolism, lower levels of O2 saturation, systolic blood pressure (SBP) and higher pulmonary artery pressure (PAP). ROC analysis was performed to determine the thresholds of factors that were associated with in-hospital mortality: SBP ≤124 mmHg, HR≥110 bpm, PAP ≥54 mmHg, age&gt;54 yo.

Conclusions
The factors which were associated with in-hospital mortality in pts with non-high-risk PE were: age, SBP, history of VTE, obesity, AF; blood saturation level, pulmonary artery pressure level.
ECG risk markers among premenopausal and postmenopausal SCD victims
Authors: Eskuri M A E , Holmstrom L , Vahatalo J , Kentta T V , Tikkanen J , Pakanen L , Perkiomaki J , Huikuri H V , Junttila M J 
Published: May 2024

Abstract

Background
Majority of the SCD victims aged 50 years or younger are male. On average menopause occurs at the age of 51.4 years and it has a substantial role in cardiovascular risk burden among women. The mechanisms and risk markers of SCD are not as well defined for women as they are for men possible due to difference in population burden, and electrocardiographic risk markers do not seem to make a difference in this matter.

Purpose
The aim of this study was to determine electrocardiographic findings among women at pre- and postmenopausal age in a large SCD population.

Methods
The Fingesture study has systematically collected clinical and autopsy data from SCD victims in Northern Finland between 1998 and 2017. The cohort consists of 5,869 SCD victims of which 1,238 are women (21.1%). Antemortem electrocardiograms (ECG) were recorded in 1,101 subjects (women 25.3%). Women aged ≥ 52 years were considered as postmenopausal and ≤ 51 years old as premenopausal as the direct information of the menopause lacked due to the retrospective nature of this autopsy-based data.

Results
Only 7.9% of the female subjects experienced SCD under age of 52 years (P&lt;0.001). No statistically significant differences in ECG abnormalities were found between pre- and postmenopausal women. However, almost one female SCD victim out of four lacked any ECG abnormalities in premortem ECG (26.3% of premenopausal and 24.2% of postmenopausal women, P=1.000). In general, ECG abnormalities were more prevalent in SCD victims at postmenopausal age. Though, fragmented QRS, particularly in the lateral ECG leads, was observed in 47.4% of women at premenopausal age group and in 42.1% of women at postmenopausal age even though statistical significance was not obtained (p=0.810). ECG-LVH, as per Cornell's criteria, was present in 4.8% of individuals in premenopausal age group whereas in postmenopausal age group, it was observed in 19.0% of subjects (P=0.140). ECG variables are presented in Table 1. When the analysis was repeated between the women &lt;55 years of age and ≥55 years of age, only left ventricular hypertrophy (LVH; Cornell) was statistically significant and more common in women ≥55 years old (19.5% vs. 3.6%, P=0.037).

Conclusion
Premenopausal SCDs are rare. Approximately one female SCD victim out of four did not have any ECG abnormalities prior to SCD. Only ECG-LVH remained statistically significant in analysis between younger and older women, and was clearly more prevalent finding among postmenopausal SCD victims.Table 1
Left atrial function and polygenic risk scores for predicting atrial fibrillation and related stroke/systemic embolism
Authors: Park H , Kim D H , Jang E S , Yu H T , Kim T H , Uhm J S , Sung J H , Pak H N , Lee M H , Yang P S , Joung B Y 
Published: May 2024

Abstract

Objective
To explore whether the addition of left atrial (LA) function, polygenic risk score (PRS), or both to clinical risk scores improves predictions of atrial fibrillation (AF) and related stroke/systemic embolism (SSE).

Methods
A total of 36,919 individuals without AF who were assessed for LA emptying fraction and AF-PRS were included from the UK Biobank imgaing enhancement. The primary aims were incident AF and AF-related SSE. AF-related SSE was ascertained when previously undiagnosed AF was identified at the time of an SSE or up to 1-year after an SSE.

Results
Among the 36,919 participants (median 64 years; 52.4% women), 535 incident AF and 27 AF-related SSE developed over a median follow-up of 2.9 years. Both LA emptying fraction and AF-PRS were associated with the risk of incident AF (hazard ratio [HR] per standard deviation [SD] decrease in LA emptying fraction; 2.13; 95% CI, 1.99-2.27 and HR per SD increase in AF-PRS [95% CI]; 1.65 [1.52-1.79]) and AF-related SSE (HR per SD decrease in LA emptying fraction [95% CI]; 3.52 [2.85-4.35] vs. HR per SD increase in AF-PRS [95% CI]; 1.86 [1.30-2.68]). The addition of LA emptying fraction to a clinical risk score was associated with a significant improvement in C-statistics for incident AF (C-index; 0.704 to 0.788, p for difference in C-index &lt;0.001) and AF-related SSE (C-index; 0.666 to 0.868, p&lt;0.001) but not for AF-PRS (p for difference in C-index &gt; 0.05). The addition of LA emptying fraction was associated with a net reclassification of 26.2% and 21.8% for incident AF and AF-related SSE whereas 11.5% and none with the addition of AF-PRS, respectively. There was limited additive predictive utility with the combination of the two markers over LA emptying fraction alone for both incident AF and AF-related SSE (p for difference in C-index &gt; 0.05).

Conclusions
Adding LA function to a clinical risk score was associated with statistically significant and clinically meaningful improvements in risk predictions of AF and AF-related SSE compared with adding AF-PRS. The addition of both LA function and AF-PRS to a clinical risk score had limited additive predictive utility compared with the addition of LA function alone.
Artificial intelligence-estimated electrocardiographic age as a recurrence predictor after atrial fibrillation catheter ablations
Authors: Park H , Kim D H , Park J W , Yu H T , Kim T H , Uhm J S , Joung B Y , Lee M H , Hwang C , Pak H N 
Published: May 2024

Abstract

Aims
The application of artificial intelligence (AI) algorithms to 12-lead electrocardiogram (ECG) provides promising age prediction models. We explored whether the gap between the pre-procedural AI-ECG age and chronological age can predict atrial fibrillation (AF) recurrence after catheter ablation.

Methods
We validated a pre-trained residual network (ResNet)-based model for age prediction on four independent multinational datasets: CODE-15%, PTB-XL, UK Biobank, and SaMi-Trop cohorts. Then, we evaluated AI-estimated ECG (AI-ECG) age for AF recurrence in a single-center AF catheter ablation (AFCA) cohort, which included 4,794 patients with de-novo AFCA and pre-procedural sinus rhythm ECGs. We categorized the AI-ECG age gap into two groups: aged-ECG (&gt;13 year) and normal age (≤13 year) groups based on the maximum log-likelihood for AF recurrence according to the difference between chronological age and AI-ECG age.

Results
The ResNet-based AI-ECG age model successfully reproduced the chronological age on the independent datasets (total ECG number=414,804): CODE-15% (r=0.83), PTB-XL (r=0.74), UK Biobank (r=0.53), and SaMi-Trop (r=0.60). During median 22 (9-47) months after AFCA, patients with aged-ECG had a significantly higher AF recurrence rate (adjusted hazard ratio 1.31, 95% confidence interval [1.17-1.48], p&lt;0.001) than normal age group. In the sub-group analyses, the aged-ECG affected more in patients with paroxysmal AF than in non-paroxysmal AF (P for interactions &lt;0.001) and after cryoballoon pulmonary vein isolation (Cryo-PVI) than radiofrequency PVI (P for interactions &lt;0.001).

Conclusions
Pre-procedural AI- ECG age has a prognostic value for AF recurrence after AF catheter ablation.