bluuebunny/crossref_metadata_2025_split huggingface dataset:
An incremental energy stimulation test to predict success in left bundle branch capture
Authors: Chavez Ortiz I , Vangrieken J , Sanchez Vallejo C , Martinez Gomez E , Bello E , Goni Blanco L , Calvao J , Salgado Aranda R , Canadas Godoy V , Gonzalez Ferrer J J , Filgueiras Rama D , Perez Castellano N , Perez Villacastin J , Calvo D 
Published: May 2024

Abstract

Introduction
Left bundle branch (LBB) stimulation is guided by fluoroscopic projections and electrocardiographic criteria limited by positional variations.

Purpose
To evaluate an incremental energy stimulation test (IEST) to optimize success.

Methods
Prospective, non-randomized experimental study for proof-of-concept analysis (N=23), consisting on: (i) stimulation at three locations at the high, middle and low right mid-ventricular septum (right oblique 30o); and (ii) continuous unipolar stimulation (lumenless fixed helix electrode) at each location with increasing outputs (2 volt x 0.5 ms up to 10 vol x 1.5 ms). The final position for lead penetration was made by the operator blinded to the results of the IEST.

Results
IEST shortened the S-LVAT (δ-S-LVAT) up to 6.4±5 ms (range 0 to 18 ms), 8±8 ms (range 0 to 36 ms) and 5.5±5 ms (range 0 to 20 ms) respectively for high, mid, and low sites (Figure, panel A and B). There was not observed any paired correlation between the magnitude of the δ-S-LVAT at the three different positions (Pearson 0.36, 0.12 and 0.22; p= 0.1, 0.6 and 0.4 respectively), suggesting that the δ-S-LVAT is site specific. The final position for lead penetration was medium in 17 cases vs low in 6 cases. The low-output S-LVAT interval at the final position before lead penetration was positively correlated with the final S-LVAT achieved after lead penetration (Pearson 0.44; p=0.04), but the magnitude of the correlation increased with the high-output S-LVAT interval (Pearson 0.57; p=0.006) suggesting a better prediction performance (Figure, panel C). A complex relationship was observed where higher δ-S-LVAT values were associated with shorter S-LVAT after penetration and final position of the lead. In fact, for cases with low-output S-LVAT interval &gt; 100 ms, the δ-S-LVAT significantly correlated with S-LVAT after penetration and final position of the lead (Pearson -0.61; p=0.026).

Conclusions
IEST lead to a site-specific shortening of the S-LVAT, pointing to optimized positions for LBB pacing. The technique provides with additional diagnostic criteria to determine the better site for lead penetration.
Conduction system pacing: procedural success and failures over the years
Authors: Marcantoni L , Deluca F , Valenza S , Pastore G , Bejko A , Diaferio A , Porcelli G , Follesa A , Zanon F 
Published: May 2024

Abstract

Background
Conduction system pacing (CSP) ensures physiological ventricular activation and avoids the dyssynchrony. New tools (sheaths and leads) can better assist the implant thus increasing procedural successes.

Objective
Retrospective analysis of CSP implants from the last 4 years, analyzing procedural success and failures.

Methods
From 2019 to 2022, 820 CSP implant were performed, being 66% of the overall implants (excluding SR and DR ICDs). 89% were PMs and 11% were ICDs. 32.6% were styled-driven leads while 67.4% were lumenless. Pacing indications were standard with prevalence of AV block (53.6%); AF with slow ventricular rate 14.8%; sinus node disease 12.9%; ablate&pace 3.7%; heart failure 12.8%, re-interventions after malfunction of a previous implant 2.2%. Mean age was 78±9 years; 61.8% were males.

Results
From 2019 to 2022, CSP was successfully achieved in 756 cases (92.2%) considering all indications. In 64 (7.8%) cases, CSP lead implant failed (17 lumenless leads; 47 stylet driven leads) and the lead was then implanted in RV septum or coronary sinus. Reasons for failure were: 2.7% suboptimal electrical parameters (mainly high threshold); 1.1% uncorrected BBB; 0.9% intraprocedural lead dislodgement; 1.4% impossibility to penetrate the septum; 1.4% severe right atrial enlargement; 0.3% unavailable venous access. Heart failure and left ventricular dysfunction (EF&lt;45%) were found more frequently in the failed implant subgroup. Procedural failures were more frequently associated with more than 1 sheath and more than 1 lead utilization during the procedure. Interestingly, in 12.8 % of successful procedures the sheath was changed intraprocedurally; and in the 5.4% of successful procedures the lead was changed (from lumenless to styled-driven or viceversa). No predictors of procedural failure were found in the logistic regression analysis. IInterestingly, failed implants have not decreased over the years.

Conclusions
conduction system pacing is feasible in daily clinical practice. Both lumenless and stylet-driven lead can be utilized. Different sheaths allow to customize the procedure based on the anatomy. During a 4-year experience, the overall procedural success rate was 92.2% while 7.8% of the procedures failed. Interestingly the failure rate has not decreased over the years, likely being related to increasingly complex cardiac conditions where CSP has been attempted.CSP implant success and failures
Near-zero fluoroscopy technique for cardiac electronic device implantation: long-term outcomes
Authors: Creta A , Finlay M , Providencia R , Schilling R J , Monkhouse C , Dhinoja M 
Published: May 2024

Abstract

Introduction
Radiation hazards are a major concern for both patients and staff. We have previously described a near-zero fluoroscopy technique for cardiac electronic device implantation. In this study, we aimed to investigate the long-term safety of this technique and compare outcomes and procedural metrics with a conventional approach in a larger population.

Methods
Low-dose fluoroscopy technique.
Radiation exposure during fluoroscopy is directly proportional to the time the unit is activated. Typically, the pedal switch is depressed for at least a few seconds per imaging sequence in order to visualize "live" movements of either the leads during their positioning or the needle during a fluoroscopy-guided puncture of the subclavian vein. Our technique consists of setting a low frame rate per second (0.5-3.75fps) and momentarily triggering the foot pedal switch only to obtain screenshots of the position of the leads/needle. Use of live electrograms to assist spatial awareness of lead position (e.g. Atrial, Coronary Sinus, Ventricular signals) acts as an adjunct to guidance.

Study design
We included consecutive patients undergoing permanent pacemaker (PPM) or cardiac defibrillator (ICD) implant at our center from July 2018 to December 2022 using the near-zero fluoroscopy technique. Procedures were performed by three operators (AC, MD, MF). Cumulative radiation dose was measured using dose-area product (DAP). We assessed procedure success and complication rate during long-term follow-up. We compared the procedural metrics and outcomes with a cohort of patients with PPM or ICD implanted in our centre by senior operators, using a traditional fluoroscopic approach. Propensity score was adopted to match baseline characteristics between the study and control group.

Results
The total population consisted of 412 patients (74.2±13.9 years, 60.9% male). We included 206 who underwent PPM or ICD implantation using the low-dose fluoroscopy technique, and 206 matched-control. A PPM or ICD was successfully implanted in all patients. Fluoroscopy time and DAP were significantly lower in the low-dose fluoroscopy group, mean 2.3±2.0 seconds versus 258.4±252.1 seconds (P&lt;0.001) and 3.4±3.5 µGym2 versus 29.8±55.4 µGym2 (P&lt;0.001), respectively. Mean procedure time was 49.0±20.8 minutes in the low fluoroscopy group and 65.7±26.8 minutes in the control group (P&lt;0.001). Median frame per second setting was 0.5 in the low-dose cohort. After a mean follow-up of 441±470 days, the rate of complications was identical across groups (2.4%, p = 1.0).

Conclusion
This near-zero dose fluoroscopy technique is effective and safe, enabling a 10x reduction in radiation exposure during device implant. Modification of traditional implant and imaging techniques can provide material reductions in fluoroscopy dose to even below that for a standard PA chest radiograph.
Comparison of long-term risk of device-related complications between left bundle branch area pacing and biventricular pacing in candidates for resynchronization therapy
Authors: Coluccia G , Ziacchi M , Dell'era G , Donateo P , Ammendola E , Aspromonte V , Guido A , Ghiglieno C , Parlavecchio A , Nigro G , Senes J , Patti G , Biffi M , Accogli M , Palmisano P 
Published: May 2024

Abstract

Introduction
Cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) is a well established therapy in patients with reduced left ventricular ejection fraction (LVEF), heart failure, and wide QRS. Left bundle branch area pacing (LBBAP) has recently been shown to be a feasible and effective alternative to BVP. Comparative data on the risk of complications between LBBAP and BVP among CRT candidates are lacking.

Purpose
The aim of this study was to compare the long-term risk of device-related complications between LBBAP and BVP in a cohort of patients undergoing CRT.

Methods
Prospective, multicenter, observational study enrolling 668 consecutive patients (71.2±10.0 years, 52.2% male, 59.4% NYHA class &gt;II), with LVEF ≤35% (mean 33.4±4.3%) who underwent BVP (n=560) or LBBAP (n=108) for the first time for Class I or II indications for CRT from January 2020 to June 2023 at 6 Italian centers. Propensity matching for baseline characteristics yielded 90 matched pairs. Rate and nature of device-related complications occurring during follow-up were prospectively collected and compared between the two groups.

Results
During a mean follow-up of 18 months, device-related complications were observed in 14 patients: 11 in BVP (12.2%), and in 3 in LBBAP (3.3%) (p=0.026). Compared to BVP patients, LBBAP patients showed a higher cumulative survival free from first device–related complication (Figure). Complications related to coronary sinus lead were most frequently observed in BVP patients (36.4% of all complications). The rate of overall lead-related complications was 6.7 and 2.2% in BVP and LBBAP patients, respectively (p=0.149).

Conclusion
LBBAP was associated with a lower long-term risk of device-related complications compared with BVP in patients with CRT indications.
Left ventricule remodeling with improvement of mitral regurgitation after resynchronization therapy
Authors: Carias M , Almeida A , Paralta M , Viana R , Bento A , Trinca M 
Published: May 2024

Abstract

Introduction
Moderate or severe mitral regurgitation is common in patients with dilated cardiomyopathy who are candidates for resynchronization therapy (CRT). In many patients there is no improvement in mitral regurgitation (MR), and this factor may be associated with a lower response to CRT and worse prognosis.

Purpose
This study seeks to evaluate the association between MR reduction with left ventricular remodeling (LVR), left ventricular ejection fraction (LVEF) and mortality after CRT implantation.

Methods
This is a 4-year retrospective observational study. Patients who had CRT implantation according to the indications in the guidelines with moderate or severe MR were selected. A pre-implantation transthoracic echocardiogram and another at 12-month follow-up were performed. The LVEF, the left ventricle end-systolic volume (LVESV) and the severity of MR were evaluated, which was categorized into without, mild, moderate or severe, according to vena contracta and quantitative method of proximal isovelocity surface area. Patients with a reduction greater or equal to 15% in LVESV or an increase greater or equal to 5% in LVEF were considered responders to CRT.

Results
86 patients had moderate or severe MR pre-CRT, with a mean age of 71.9±9.8 years and 62.2% were female. In 51.2% of the patients there was a reduction in the severity of the MR to without or mild. LVEF recovery was significantly greater in patients with MR reduction (13.1% vs 6.3%, p=0.01). Although not statistically significant, reverse remodeling was more frequent among patients with MR reduction (DLVESV 13.1% vs 6.3%, p=0.119) and mortality was also lower in patients with MR reduction (56% vs 44%, p=0.395).

Conclusion
Improvement in RM severity after CRT implantation appears to be associated with better response to this therapy and better prognosis at 1-year follow-up.
QRS length/left ventricular mass index: a novel predictive factor of response to cardiac resynchronization therapy
Authors: Sanhueza S , Velasquez L , Flores P , Paredes A , Castillo J , Vergara I , Bittner A 
Published: May 2024

Abstract

Introduction
The length of QRS interval is an extensively studied predictor of response to CRT. There is little evidence of the probability of response in patients with QRS between 130 and 150 ms and its relationship with LV mass. (1,2)

Objective
Evaluation of the QRS length/LV mass index (QRS/LVMi) as a "relative dyssynchrony" marker and its correlation to response after CRT implantation.

Methods
Retrospective study that included patients over 18 years of age with HFrEF (LVEF ≤ 35%) and CRT implantation between years 2018 – 2022 (n = 92). QRS length (ms) was measured with CardioLab 3.0 Software and divided by LV mass (g), according to Deveraux equation using echocardiography measurements. Primary outcome was response to CRT defined by: Improvement of at least 1-point in NYHA functional class + (i) increase of at least 5% in LVEF or (ii) decrease of at least 15% in LVESD.

Results
QRS/LVMi value ≥ 0.6 was associated with a higher frequency of response to CRT than values &lt; 0.6 (83% responders vs 17% non responders; OR 5.1; CI 2.7–12.1, p &lt; 0.05). There was no difference in response to CRT between QRS &gt; 150 ms and 130 – 150 ms in patients with QRS/LVMi ≥ 0.6 (80% vs 82% of responders, p = 0.8). A multivariate analysis showed a significantly higher probability of response to CRT in patients with QRS/LVMi ≥ 0.6 compared to other known predictive factors (OR 4.1; CI 1.2–12, p &lt; 0.05).

Conclusions
The use of QRS/LVMi was associated with a better prediction of response to CRT than other traditional factors. There was no difference in response between QRS &gt; 150 ms and 130 - 150 ms in patients with QRS/LVMi ≥ 0.6, suggesting the efficacy of CRT in patients with shorter QRS interval length and less LV mass, highlighting the importance of the concept of relative dyssynchrony.Total Response according QRS/LMViMultivariate analysis
Early vs. late lead extraction in CIED infections: evaluating the interplay of infection type, timing, and comorbidities
Authors: Tamborrino P P , Segreti L , Barletta V , Fiorentini F , Torre M , Di Cori A , De Lucia R , Viani S M , Paperini L , Grifoni G , Soldati E , Parollo M , Bongiorni M G , Zucchelli G 
Published: May 2024

Abstract

Background
Cardiovascular Implantable Electronic Devices (CIEDs) may be associated with peri- and post-procedural complications like device-related infection, one of the most serious challenge of CIEDs therapy associated with significant morbidity, mortality, and financial healthcare burden. Despite a routine use of antibiotics, recent studies reported an increase in CIEDs infections, with or without systemic involvement, that often require surgical interventions like transvenous lead extraction.

Purpose
This study evaluates the outcomes of transvenous lead extraction in patients with infected CIEDs, focusing on the impact of early versus delayed extraction timing on patient outcomes.

Methods
A retrospective analysis of 165 patients who underwent transvenous lead extraction for CIED infections between 2019 and 2022 was conducted. Patients were categorized into systemic (n=64) or local (n=101) infection groups and further into early (within 7 days from admission, n=102) or delayed (after 7 days, n=63) extraction groups. Post-procedural outcomes, including septic shock, complications, and mortality rates were described.

Results
The majority of patients were male (75%) with a median age of 73 (IQR 64-80) years. In the early extraction group, the 1-year mortality rate was significantly lower at 6.4%, compared to 25% in the delayed group. Patients with systemic infections had higher 1-month and 1-year mortality rates compared to those with local infections. The success rates of complete device removal were similar across groups. However, the delayed extraction group exhibited higher rates of comorbidities like anemia, chronic kidney disease, and elevated C-reactive protein levels, which were prevalent in 70% of these patients, compared to 45% in the early extraction group.

Conclusions
Timely management of CIED infections is crucial for improving patient outcomes. Early extraction within 7 days from hospital admission is associated with significantly lower mortality, regardless of local or systemic infection. Patients undergoing delayed extraction often present with greater comorbidity, which may contribute to their higher mortality rates. This underscores the importance of considering patient comorbidities and prompt intervention in managing CIED infections.
Incidence and prognosis of subclinical cardiac perforation after leadless pacemaker implantation
Authors: Lee Y , Uhm J S , Kim M H , Park J W , Kim D , Yu H T , Kim T H , J B , Pak H N , Lee M H 
Published: May 2024

Abstract

Introduction
Subclinical cardiac perforation, a known complication of cardiac implantable electronic device leads, occurs in 6–20% of cases. While leadless pacemakers are advised to be placed in the septum to mitigate perforation risk, limited studies exist on lead positioning and perforation incidence.

Objectives
This retrospective observational study aimed to assess leadless pacemaker lead positions, determine the incidence of subclinical cardiac perforation, and evaluate associated prognoses through computed tomography (CT) in post-implantation patients.

Methods
Thirty-one patients underwent CT after leadless pacemaker implantation. Two cardiologists and a radiologist analyzed CT scans to categorize lead positions (septum, free wall, or septum-free wall junction) and identify subclinical perforation (defined as tine transversal beyond the outer myocardial contour without symptoms, hemodynamic instability, or pacemaker issues).

Results
Mean age at implantation was 70.5 ± 12.7 years; 35.5% were male, and 41.9% had atrial fibrillation. Twenty patients (64.5%) were on anticoagulants or antiplatelet agents. Twenty-four patients (77.4%) were positioned at the septum-free wall junction. Subclinical perforation occurred in 12 patients (38.7%), with a higher proportion in patients on non-vitamin K antagonist oral anticoagulants. Two patients had moderate amount of pericardial effusion; the remaining ten with subclinical perforation were stable during follow-up.

Conclusions
The most common leadless pacemaker implantation site was the septum-free wall junction with 38.7% of subclinical perforation.
Electrophysiological characteristics of tachyarrhythmia and effects of catheter ablation in patients with Fontan circulation
Authors: Uhm J S 
Published: May 2024

Abstract

Introduction
Incidence of arrhythmia in complex congenital heart disease is higher than general population. Characteristics of arrhythmia in patients with functional single ventricle is not known.

Methods
Total 18 patients (age, 22.1 8.5 years, 9 men) with Fontan circulation who had undergone catheter ablation for tachyarrhythmia were retrospectively consecutively included. Characteristics of congenital heart disease, mechanisms of tachyarrhythmia, and efficacy and safety of catheter ablation were analyzed.

Results
Congenital heart diseases of the patients were as follows: double outlet right ventricle, 9; common atrioventricular septal defect, 5; and pulmonary atresia, 4. Fontan types were as follows: lateral tunnel Fontan, 9; extracardiac conduit Fontan 9. Fontan conduit puncture was successful in all patients. Mechanisms of tachyarrhythmia were as follows: intraatrial macroreentrant tachycardia, 8; focal atrial tachycardia, 4; atrioventricular nodal reentrant tachycardia, 3; twin atrioventricular nodal reciprocating tachycardia, 2; unknown, 2. Success rate of catheter ablation, recurrence rate, and complication rate were 16 of 18 patients, 2 of 18 patients, and 0 of 18 patients, respectively.

Conclusion
Intraatrial macroreentrant tachycardia is the most common tachycardia mechanism in patients with Fontan circulation. Catheter ablation for tachyarrhythmia is effective and safe in these population.
Phenotypes and outcomes in patients with atrial fibrillation: a global unsupervised cluster analysis from Phase II/III of the GLORIA-AF registry
Authors: Bisson A , Fawzy A M , Calvert P , Romiti G F , Proietti M , Angoulvant D , El-Bouri W , Fauchier L , Lip G Y H 
Published: May 2024

Abstract

Background
Atrial fibrillation (AF) patients are characterized by a great clinical heterogeneity and complexity across the world. Usual classifications may not adequately characterize this population. Data-driven cluster analysis reveals different possible classifications of patients.

Purpose
To identify different clusters of AF patients who share similar clinical phenotypes and evaluate the association between identified clusters and clinical outcomes using cluster analysis.

Methods
An agglomerative hierarchical cluster analysis was performed in patients from phase II/III of the GLORIA-AF registry. Associations between clusters and a composite outcome composed of all-cause death, stroke and major bleeding were evaluated using Cox regression analyses.

Results
The study included 26,045 AF patients (mean±SD age 70.1±10; 44.8% female) with a median [IQR] follow-up of 3 years [2.3-3.1]. Five clusters were identified: Cluster 1 was composed of young males from North America with morbid obesity and cardiovascular (CV) risk factors; Cluster 2 included older Asian patients with lower body mass index (BMI), fewer CV risk factors, lower anticoagulation rate but the highest AF ablation rate; Cluster 3 identified European males with CV comorbidities and behavioral disorders (smoking, alcohol abuse); Cluster 4 was characterized by patients with the highest rate of permanent AF, cancer, anticoagulant therapy prescription ; Cluster 5 included older women from Europe with high CHA2DS2-VASc and HAS-BLED scores, the highest heart rate, lower BMI and high rate of previous stroke and transient ischemic attack. The incidence of the composite outcome increased a stepwise fashion among clusters from 3.2% patient-years (95% confidence interval (CI): 2.4-4.1) for Cluster 1 to 6% patient-years (95% CI: 5.6-6.4) for Cluster 5 (p&lt;0.0001): Cluster 1 versus 2 hazard ratio (HR): 0.85 (95% CI 0.65–1.11); 2 versus 3 HR: 0.84 (95% CI 0.76–0.93); 3 versus 4 HR: 0.9 (95% CI 0.82–0.99) and 4 versus 5 HR: 0.82 (95% CI 0.74–0.91).

Conclusion
Cluster analysis identified five statistically-driven groups of AF patients, with distinct phenotype characteristics and associated with different risks for major clinical adverse events.Baseline characteristics.Dendrogram and Kaplan Meier-curves.