bluuebunny/crossref_metadata_2025_split huggingface dataset:
Termination without global capture: electrocardiographic and anatomical characteristics using 3D-electroanatomical mapping system in reentrant ventricular tachycardia
Authors: Katsume Y , Hasegawa K , Ikewaki H , Mohri T , Tashiro M , Nonoguchi N , Hoshida K , Togashi I , Ueda A , Matsuo S , Sato T , Soejima K , Stevenson W G 
Published: May 2024

Abstract

Background
Termination without global capture (TWGC) is the phenomenon which a pacing stimulus applied during ventricular tachycardia (VT) terminates the tachycardia without generating a QRS complex, and is considered as an indicator for the critical component of the circuit. The details of the electrocardiographic and anatomical characteristics of the site using a 3D-electroanatomical mapping system (3D-EAM) remain unknown.

Purpose
This study aimed to retrospectively analyze the cases that showed TWGC during VT mapping and ablation, and to investigate the electrocardiographic characteristics and relationship with the substrate identified by 3D-EAM.

Methods
Of 632 cases of VT associated with structural heart disease from July, 2019 to July, 2023 at a university hospital and a university medical center, cases with TWGC were analyzed.

Results
TWGC was observed in 10 patients (median age 61 years, 9 males, 5 ischemic cardiomyopathy, median LVEF 31%) at least once (12 times) in 11 locations. Local capture was observed in 6. The QRS morphology generated by continued pacing after TWGC matched the clinical VT in only 5 VTs (42%). Five showed decremental conduction of stimulus to QRS interval following the TWGC. In 11 locations, 4 corresponded to scar area (&lt;0.1 mV) in the voltage map, 6 to border zone (0.1-1.5 mV), and 1 had no information on 3D-EAM. Of 12 times of TWGC, 3 were at the entrance, 1 at the central isthmus, and 1 at the exit. Acute elimination of clinical VT was successful in 7 of 10.

Conclusions
More than half of the sites with TWGC were located at the border zone in 3D-EAM. TWGC also occurred in the central or exit area, and local capture was observed frequently.Termination without global capture
Left and right ventricular function measured by strain analysis predicts one-year mortality in ventricular tachycardia ablation patients with structural heart disease
Authors: Szakal I , Beke S , Komlosi F , Toth P , Vamosi P , Arnoth B , Bohus G Y , Szegedi N , Sallo Z , Perge P , Osztheimer I , Kovacs A , Merkely B , Geller L , Nagy K V 
Published: May 2024

Abstract

Introduction
Radiofrequency catheter ablation has become increasingly important in the management of scar-related ventricular tachycardia (VT). Wide range of clinical and procedural predictors of VT recurrence and mortality are described by previous studies. However, currently known echocardiographic predictors are mainly limited to conventional echo parameters. Speckle tracking echocardiography (STE) is a novel and promising method to evaluate systolic and diastolic function. STE derived parameters, such as global longitudinal strain (GLS), are proven predictors of mortality and arrhythmic events in heart diseases.

Aims
The aim of the present study was to assess whether STE derived parameters could be considered predictors of VT recurrence and mortality after catheter ablation of ventricular tachycardia in patients with structural heart disease.

Methods
We measured pre-ablation strain and strain rate parameters with speckle tracking. Left ventricular four-chamber longitudinal strain (LV4CLS), early diastolic strain rate (e’-sr), right ventricular free wall longitudinal strain (RVFWLS) and right ventricular four-chamber longitudinal strain (RV4CLS) were assessed in 73 cases. Patients were followed up for one year. Endpoints were VT recurrence, which was defined as either ICD recording of a sustained VT episode requiring therapy or an episode of sustained VT recorded on 12-lead ECG or CIED, and all-cause mortality.

Results
Univariate analysis using the Cox proportional hazard model revealed that only lower LVEF (HR: 0.52 [0.31-0.88], p=0.02) was associated with higher VT recurrence in the first year among the echocardiographic parameters. High LVEDD (HR: 3.9 [1.31-11.65], p=0.02), low TAPSE (HR: 0.52 [0.28-0.98], p=0.04), low LV4CLS (HR: 0.4 [0.19-0.83], p=0.01) and low RV4CLS (HR: 0.31 [0.13-0.72], p&lt;0.01) were the predictors of 1-year mortality.

Conclusion
Strain parameters, especially right ventricular four-chamber longitudinal strain may supplement conventional echocardiographic parameters in the prediction of one-year mortality after catheter ablation in patients with structural heart disease. Further prospective clinical studies are necessary to verify the significance of strain parameters.
Cardiac tumors with life threatening arrhythmia, an eight year single centre experience
Authors: Kamel O , El Husseny M W , Hammouda T , Hosny H H , Ahmed E A , Nasr A N , Abdelfattah M A , Shaaban M S , Elguindy A E , Afify A A , Yacoub M Y 
Published: May 2024

Abstract

Background
Cardiac tumors are rare cardiac disorders which occur either as primary or secondary tumors. They have a wide variety of clinical presentations from accidental discovery till sudden cardiac death. Manifestations are mainly due to mass effect, local invasion, embolization, or constitutional symptoms. (1) Cardiac tumor related arrhythmias are more often incessant, especially in younger children, and the mechanism can be reentry or triggered automaticity. (2)
Arrhythmia management depends on its clinical impact as well as tumor size, site, and nature. Surgical resection is preferred in life threating arrhythmias however, the decision should be tailored.

Purpose
To describe our institution’s tailored approach in treatment of cardiac tumors presenting with life threatening ventricular arrhythmias (VAs), including surgical resection, coiling of feeding vessels or even ICD implantation with long term rhythm monitoring.

Methods
We reviewed patients with primary cardiac tumors presenting to our center from 2015 to 2023 with emphasis on those with life threatening VAs. Patient records were examined for clinical presentation, ECGs, imaging modalities, histopathological analysis of the resected tumors and interrogation data for those with cardiac implantable electronic devices (CIEDS).

Results
Over 8 years, 64 patients were diagnosed to have primary cardiac tumors. Of those, 3.8% (6 patients) presented with life threatening monomorphic VT, half of them were pediatrics. Tissue characterization by CMR and histopathological analysis for the resected tumors revealed: 4 fibromas, one lipoma and one hemangioma. Surface ECGs during VT showed exit at, or close to, the site of the tumor (Table). Total surgical resection was performed in four cases (3 fibromas and one lipoma), one of them (the youngest, 6 months old) died during the postoperative period due to refractory heart failure. Partial resection was done in one patient with fibroma as the tumor involved the majority of RV free wall while the patient with hemangioma underwent coiling of the feeding vessels twice with marked decrease in the tumor size however he had one further episode of VT, so ICD was implanted. Over a mean follow up period of 3 years, four patients had no recurrence of tachycardia as confirmed with implantable loop recorders (ILRs) while the patient with ICD had infrequent episodes.

Conclusion
Total surgical resection, albeit risky, is highly effective in eliminating life threatening VAs caused by cardiac tumors. Other modalities like partial resection or coiling of the feeding vessels could be effective in high-risk patients. Devascularization, in our hemangioma case was not totally protective. Finally, ILRs were highly beneficial in confirming long-term freedom of arrhythmia after resection.Table: VT exit, tumor site and typeECG, CMR, angiogram& surgical view
Cardiac magnetic resonance to predict appropriate therapies in secondary prevention
Authors: Castrillo Golvano L C , Vazquez-Calvo S , Ventosa-Blazquez O , Thomsen A F , Forado I , Garre-Beng P , Borras R , Guasch E , Tolosana J M , Arbelo E , Porta-Sanchez A , Sitges M , Brugada J , Mont L , Roca-Luque I 
Published: May 2024

Abstract

Introduction
Implantable cardioverter-defibrillator (ICD) therapy plays a pivotal role in the management of patient’s survivors of life-threatening ventricular arrhythmias (secondary prevention). Risk of recurrence may be related to presence of myocardial scar and its components (including core mass, border zone (BZ) mass, and BZ channels) assessed with late gadolinium enhancement cardiac magnetic resonance (LGE-CMR).

Purpose
Our study aims to analyze the role of imaging in predicting the risk of recurrent ventricular arrhythmias and improving the risk stratification for appropriate ICD therapy in patients receiving an ICD for secondary prevention.

Methods
From 2015 to 2020, a total of 111 patients with LGE-CMR before ICD implantation for secondary prevention. Scar tissue including core, BZ and BZ channels were automatically detected by specialized investigational software in patients with LGE-CMR. Patients were followed until a new event was detected.

Results
The mean age was 65.4 ± 11.4 years; 87% were men; 55% had ischemic cardiomyopathy. The mean left ventricular ejection fraction was 37.8 % ± 14.31%. Patients were followed for a median of 3.26 years (IQR 1.4-4.9). Within the first year of follow-up 22% of patients had received an appropriate therapy, 39% within 3 years and 53% within 6 years.
Chronic kidney disease and New York Heart Association (NYHA) class were associated with the primary endpoint [HR 1.94(1.06-3.55), P-value 0.032)] and [HR 1.86 (1.19-2.91), P-value 0.006)], respectively. Regarding CMR characteristics, BZ percentage was also associated with appropriate ICD therapy in the follow up [HR 1.04(1-1.08), P-value 0.048)]. Other CMR parameter, such as BZ mass, BZ core %, BZ core mass and core mass showed a trend to predict ICD therapies during follow-up. ROC curve analysis with Youden’s index defined an optimal BZ percentage cutoff value for recurrence prediction of 9.5% [HR 0.49 (0.28-0.85)].

Conclusion
In patients receiving an ICD for secondary prevention, chronic kidney disease, NYHA class and BZ percentage analyzed by LGE-CMR were predictors of recurrent ventricular arrhythmia. A cutoff of BZ of 9.5% could be used to select patients with high risk of recurrence.
Stereotactic arrhythmia radioablation for refractory ventricular tachycardia. A retrospective analysis and optimisation of the planning phase
Authors: Solana Munoz J , Luca A , Herrera-Siklody C , Van Der Ree M , Postema P , Teres C , Le Bloa M , Domenichini G , Pascale P , Blanck O , Verfhoff J , Schiappacasse L , Pruvot E 
Published: May 2024

Abstract

Introduction
Stereotactic arrhythmia radioablation (STAR) is used as a rescue treatment for refractory ventricular tachycardia (VT). However, the planning phase to accurately delineate the clinical target volume (CTV) still suffers from limitations due to the incompatibility of data formats between 3D electro-anatomical mapping systems (EAM) used for VT ablation and STAR planning software. The concordance between the CTVs as defined by the planning software (CTVSTAR) and the CTV based on EAM data (CTVEAM) remains unknown.

Purpose
Within the STOPSTORM European consortium, we compared the concordance between CTVSTAR and CTVEAM in our series of 13 patients (pts) treated by STAR for refractory VT. We also evaluated need for redo ablation of VT after STAR.

Method
Using the software Slicer3D, two protocols were retrospectively compared: Protocol 1 comprised the manual contouring of the CTVSTAR based on 4D-CT SCAN drawn side-by-side using EAM (Carto3, Biosense Webster) screenshots and diagnostic reports. Protocol 2 comprised semiautomatic segmentation of CTVEAM based on 4D-CT SCAN using imported EAMs annotated with landmarks for VT substrate delimitation. The delineation of CTVEAM included 3 steps: (1) semiautomatic segmentation of ventricular myocardium (VM), the blood-pool of the concerned ventricle and at least 2 additional cardiac cavities; (2) 3D-alignment of EAM with the segmented cavities; and (3), 3D-delineation of CTVSTAR identified as the transmural section of VM segment surrounding the EAM’s VT substrate delimited by STAR tags (Figure 1). Volume overlap (Dice coefficient, 100% meaning complete overlap) and volume absolute difference (VAD, 0% meaning similar volumes) between CTVs were compared. The following cumulative averages were computed over time: redo ablation (RedoA) and CTV.

Results
Figure 1 illustrates the last treated patient (#13) in whom the delineated volumes, CTVSTAR (red) and CTVEAM (blue), displayed good matching (Dice 72% and VAD 4. Figure 2 shows the comparison between CTVSTAR and CTVEAM for the 13 pts (65±7 yo) treated with STAR, resulting in a mean Dice of 47±17% and mean VAD of 40±51%. Figure 3 shows the cumulative RedoA and the cumulative averaged CTVSTAR and CTVEAM over time. Interestingly, the need for redo ablation decreased with increasing CTVs.

Conclusion
Our study demonstrates the efficacy of STAR treatment for refractory VT. Our confidence in STAR led to higher CTVs and lower RedoA over time. The high variability of CTV delineation using two different protocols suggests that STAR planning phase can be optimised by appointing intraprocedural anatomical landmarks to the VT substrate.
Clinical significance and prognostic value of right bundle branch block in permanent pacemaker patients
Authors: Mazza A , Bendini M G , Leggio M , Valsecchi S , Boriani G 
Published: May 2024

Abstract

Aim
In patients undergoing pacemaker implantation with no prior history of heart failure (HF), the presence of left bundle branch block (LBBB) has been identified as an independent predictor of HF-related death or hospitalization, while the prognostic significance of right bundle branch block (RBBB) remains uncertain. We aimed to assess the long-term risk of all-cause mortality in patients with a standard indication for permanent pacing and normal or moderately depressed left ventricular function when RBBB is detected at the time of implantation.

Methods
We retrospectively enrolled 1348 consecutive patients who had undergone single- or dual-chamber pacemaker implantation at the study center, from January 1990 to December 2022. Patients with a left ventricular ejection fraction ≤35% or a prior diagnosis of HF were excluded.

Results
The baseline 12-lead electrocardiogram revealed an RBBB in 241 (18%) and an LBBB in 98 (7%) patients. During a median follow-up of 65 [25th-75th percentile: 32-117] months, 704 (52%) patients died. The combined endpoint of cardiovascular death or HF hospitalization was reached by 173 (13%) patients. On multivariate analysis, RBBB was confirmed as independent predictor of death (Hazard Ratio, 1.33; 95% CI, 1.09–1.63; P=0.005). However, when considering the combined endpoint of cardiovascular death and HF hospitalization, this endpoint was independently associated with LBBB (Hazard Ratio, 2.13; 95% CI, 1.38–3.29; P&lt;0.001), but not with RBBB.

Conclusions
In patients with standard pacemaker indications and normal or moderately depressed LV function the presence of basal RBBB was an independent predictor of mortality. However, it was not associated with the combined endpoint of cardiovascular death and HF hospitalization.Time to event
The impact of clinical audits on patient radiation exposure for device procedures
Authors: Sazgary L , Theano Samara E , Stuessi A , Guckenberger M , Ruschitzka F , Wolber T , Molitor N , Fu G , Suna G , Hofer D , Breitenstein A , Brunckhorst C B , Duru F , Saguner A 
Published: May 2024

Abstract

Background
Clinical audits aim to ensure ideal use of ionizing radiation in clinical practice. Since it became mandatory by Swiss law in 2018, such an audit also took place in our Cardiac Pacing and Electrophysiology Division at the University Heart Center.

Purpose
To establish local diagnostic reference levels (DRLs) for specific procedures and to examine if patient radiation exposure was reduced after the clinical audit.

Methods
Retrospective cohort study including patients from October 2018 to October 2020 who underwent device implantation, including pacemakers, implantable cardioverter defibrillators (ICD), cardiac resynchronization therapy (CRT), or lead extraction / device explantation. Main measures to reduce radiation exposure after the audit were lower pulsed fluoroscopy frame rates and dose characteristics at baseline. Patient radiation exposure was evaluated with the dose-area product (DAP), cumulative dose, fluoroscopy time, and the number of cine acquisitions. Secondary endpoints included the effective dose, the acute procedural success rate and 30-day complications. Data were collected from a dose management system and cross-checked for accuracy with the patient information system. The third quartiles were set as local DRLs. Data before and after the clinical audit were compared.

Results
A total of 541 patients (45.7 % before the audit, 54.3% after the audit) were included. 28.3% had a conventional pacemaker, 22.0% a leadless pacemaker, 21.1% an ICD, and 17.2% a CRT implantation. Lead extraction / device explantation was undergone by 11.5% of patients. The local DRLs (including all procedures before and after the audit) for the DAP were significantly lower as compared to national DRLs (6.2 dGy.cm2 versus 300 dGy.cm2 for conventional pacemakers; 7.6 dGy.cm2 versus 200 dGy.cm2 for ICDs, 203 dGy.cm2 versus 570 dGy.cm2 for CRTs). After the audit, DAP (Figure 1), cumulative dose, effective dose and the number of cine acquisition significantly decreased for conventional pacemakers (p-value ≤ 0.04), whereas no significant differences were observed for the other procedures. The acute procedural success rate (98.4 vs 98.9%) and the 30-day complications (4.0 vs 7.8%) were not significantly different before and after the audit.

Conclusions
The clinical audit in our institution led to a significant reduction of radiation exposure for patients during pacemaker implantations. Regarding DRLs, local values were far below national DRLs, which suggests that national DRLs need to be updated more regularly. Our study highlights the importance of clinical audits and the need for more research in this field.
Prognostic impact of permanent pacemaker implantation after cardiac surgery
Authors: David A D , Taha A T , Thorleifsson S T , Jeppsson A J , Martinsson A M 
Published: May 2024

Abstract

Introduction
Brady-arrhythmias with subsequent need for permanent pacemaker implantation is after cardiac surgery. It is not known whether the need of a permanent pacemaker influences long-term prognosis after cardiac surgery.

Methods
This large, nationwide study included all patients who underwent cardiac surgery in Sweden 2006-2020. Data was obtained from the Swedish Cardiac Surgery Registry, The Swedish ICD and Pacemaker Registry, The Swedish National Patient Register, and the Swedish Cause of Death Register. Patients who received a permanent pacemaker within 30 days were compared to those who did not. Exclusion criteria were previous pacemaker or implantable cardioverter defibrillator implantation and death within 30 days. Missing data were handled by multiple imputation. Cox regressions models were used to obtain hazard ratios (HR) with 95% confidence intervals (95%CI). The model was adjusted for age at operation, sex, left ventricular ejection fraction (EF), type of surgery, previous myocardial infarction, diabetes, peripheral artery disease, chronic respiratory disease, hypertension and atrial fibrillation.

Results
In total, 74 606 patients were included out of which 2 150 (2.9%) received a pacemaker within the first 30 days after cardiac surgery. Those who had a pacemaker implanted were older, more often female, had lower EF and significantly more often atrial fibrillation and peripheral artery disease. These patients were less likely to have diabetes, hypertension and previous myocardial infarction. Pacemaker implantation was associated with a higher risk of all-cause mortality (adjusted HR: 1.09 (95%CI=1.00-1.19), p=0.035, Figure 1) and heart failure hospitalization (adjusted HR: 1.45 (95%CI=1.30-1.62), p&lt;0.001). Cardiovascular mortality had similar estimates but did not reach statistical significance (HR: 1.09 (95%CI=0.99-1.24), p=0.15).

Conclusions
The presence of brady-arrhythmias requiring permanent pacemaker implantation after cardiac surgery is associated with a higher risk of mortality and heart failure hospitalization. Measures should be taken to minimize the risk of injury to the conduction system leading to brady-arrhythmias during cardiac surgery.
Permanent pacemaker at the time of coronary artery bypass grafting and long-term outcome: a nationwide study from the SWEDEHEART registry
Authors: Taha A , David A , Bene O , Jeppsson A , Martinsson A 
Published: May 2024

Abstract

Introduction
A permanent pacemaker is not rare in patients who undergo coronary artery bypass grafting (CABG). It is unknown if the presence of a pacemaker influences the long-term prognosis after surgery.

Purpose
To investigate if patients with permanent pacemaker have a higher risk for severe complications after CABG.

Methods
All patients who underwent CABG in Sweden 2006-2020 were included in a nationwide observational study based on prospectively collected data. Exclusion criteria were implantation of a cardioverter defibrillator at any time (prior to or after surgery) and death within 30 days. Individual patient data was merged from SWEDEHEART, The Swedish ICD- and pacemaker registry, the Cause of Death Register and the National Patient Register. Multivariable Cox regressions models were used to obtain hazard ratios (HR) with 95% confidence intervals (95%CI). The model was adjusted for age at operation, sex, left ventricular ejection fraction, heart failure, previous myocardial infarction, diabetes, peripheral artery disease, chronic respiratory disease, hypertension and atrial fibrillation.

Results
In total 41,722 patients underwent CABG during the study period, 555 (1.3%) of these had a previously implanted permanent pacemaker. Patients with a previous pacemaker were older, more often male, and had more often reduced left ventricular ejection fraction heart failure, atrial fibrillation, diabetes, hypertension and peripheral artery disease. Permanent pacemaker was not associated with higher risk for all-cause mortality (adjusted HR (aHR) 1.09 (95%CI=0.96-1.26), p=0.30, Figure 1), myocardial infarction (aHR: 1.01 (95%CI=0.73-1.41), p=0.94), or cardiovascular mortality (HR: 1.19 (95%CI=0.98-1.44), p=0.082). However, permanent pacemaker implantation was associated with increased risk for heart failure hospitalization (HR: 2.16 (95%CI=1.84-2.53), p&lt;0.001).

Conclusions
A permanent pacemaker before CABG is not associated with increased mortality, cardiovascular mortality nor new myocardial infarction, but an increased risk for heart failure hospitalization after CABG. These patients could benefit from increased surveillance for heart failure symptoms after surgery to prevent hospitalizations.