bluuebunny/crossref_metadata_2025_split huggingface dataset:
Skeletal muscle index as a prognostic marker for sudden cardiac death in heart failure patients with reduced ejection fraction
Authors: Li X , Gao Y U A N , Chen K E P I N G , Niu H X , Zhang S H U 
Published: May 2024

Abstract

Background
The association between sarcopenia and sudden cardiac death remains unclear. Therefore, this study aimed to explore the association between sarcopenia, sudden cardiac death, and all-cause mortality in heart failure (HF) patients with reduced ejection fraction based on the skeletal muscle index (SMI) predicted by a formula.

Methods
A total of 300 patients with heart failure who were admitted to our Hospital, National Center for Cardiovascular Diseases, between March 2013 and November 2015 and met the inclusion criteria were retrospectively analyzed. Baseline SMI was divided into two groups: lower than or equal to the median (n=151) and higher than the median (n=149). The primary endpoints were a composite outcome of sudden cardiac death (SCD) or an equivalent event (sustained ventricular events, or appropriate implantable cardioverter-defibrillator (ICD) therapy).The secondary end point was all-cause mortality.

Results
The average follow-up period was 24.40 ± 14.07 months. Atotal of 42 patients (42/300,14.0%) experienced sudden cardiac death or an equivalent event, and 97 patients (97/300, 32.2%) experienced all-cause mortality. Analysis of the Kaplan–Meier survival curves showed that patients with an SMI lower than or equal to the median had a higher risk of sudden cardiac death (P=0.0015) and all-cause mortality (P&lt;0.0001). Multivariate Cox analysis showed that an SMI lower than the median was an independent risk factor for sudden cardiac death (hazard ratio (HR): 2.837, 95% confidence interval (CI): 1.009–7.980, P=0.048) and all-cause mortality (HR: 2.597, 95% CI: 1.384–4.871, P=0.003).

Conclusions
Decreased SMI significantly increased the risk of sudden cardiac death and all-cause mortality in patients with HF and reduced ejection fraction. In a HF population with reduced ejection fraction, attention should be paid to the effect of sarcopenia on prognosis, and active intervention is expected to improve the prognosis of patients.
Effectiveness of left bundle branch area pacing to restore narrow QRS in patients with right bundle branch block
Authors: Kupper J , Lejeune S , Garnir Q , Wauters A 
Published: May 2024

Abstract

Background/Introduction
Left bundle branch area pacing (LBBaP) is an innovative technique used to capture conduction tissue and maintain ventricular synchrony during pacing.
There are few data about the efficacy of LBBaP in right bundle branch block (RBBB).

Purpose
To compare the response to LBBaP, evaluated by the change in QRS duration (QRSd) after pacing, in patients with RBBB, left bundle branch block (LBBB) or without conduction disorder.

Methods
A total of 162 patients with pacemaker indication underwent LBBaP with stylet driven lead with dedicated sheaths, between November 2020 and April 2023. ECG characteristics were evaluated. Data are presented in mean ± standard deviation (SD) or n (%). Paired sample t-test was used to compare QRSd before and after pacing.

Results
Indications for pacing were atrioventricular block (AVB) 48,4 %, sinus node dysfunction (SND) 37,7 %, AVB and SND 10,7 % and cardiac resynchronization therapy 3,1 %. LBBaP was successfully performed in 98 % (159/162) of patients (78 ± 10 years, 62 % male). Overall, baseline QRSd was 113,2 ± 26,7 ms and paced QRSd was 112,3 ± 14,8 ms (p = 0,662), with left ventricular activation time (LVAT) of 69 ± 14 ms (table 1).
Baseline ECG showed 18 LBBB, 29 RBBB and 11 undetermined conduction disorder. In every kind of conduction disorder, paced QRSd was reduced to &lt; 120 ms (table 2).
Notably, paced QRSd was &lt; 120 ms, regardless of baseline QRSd. In patients with most important pre-existing conduction disorder (QRS ≥ 145 ms), an impressive reduction in QRSd was observed (Delta = -40,8 ms , table 1).

Conclusion
LBBaP with stylet driven lead is an effective approach to obtain short paced QRS regardless of baseline QRSd and of the nature of the initial conduction disorder. This opens new perspectives for cardiac resynchronization in patients with RBBB.
Oral flecainide therapy and myocardial pacing: preliminary data from a prospective multicenter registry
Authors: Niglio F , Santoro F , Palmisano P , Gianfrancesco D , Ragnatela I , Pellegrino P L , D'arienzo G , Coluccia G , Bartolomucci F , Brunetti N D 
Published: May 2024

Abstract

Background
Antiarrhythmic drugs, class I are widely used for prevention of atrial fibrillation recurrence. However, previous studies found that these drugs could affect pacing thresholds among pacemaker recipients.
Aim of the study: evaluate short -term effect on myocardial pacing following therapy with oral flecainide (200 mg/daily).

Methods
45 consecutive pacemaker recipients were prospectively enrolled in a multicenter registry. These patients had preserved left ventricular ejection fraction, a dual chamber pacemaker with symptomatic sustained high-rate atrial fibrillation episodes and stable output atrial and ventricular thresholds. Patients were followed with ambulatory and/or remote monitoring.

Results
mean age was 74±1 years, 48% pts were male and AF burden was 8±16%. Pacemaker implantation was performed 3.9±0.3 year before study enrollment.
Three (6%) out of 45 patients were excluded due to drug sided effects including dyspnea (n=1), diplopia
(n=1) and toxicity during acute renal insufficiency (n=1).
Flecainide treatment was associated with a significant reduction of atrial fibrillation burden (from 8±16% to 5±12%, p&lt;0.01).
At 30 days follow-up since Flecainide starting therapy both atrial and ventricular sensing significantly
decreased (3.6 ± 2.2 vs 3.4 ± 2.1mV p=0.01; 12.5±6.6 vs 11.8±6.3 mV p=0.01), while there was a slight
increase of both atrial and ventricular capture thresholds (0.77±0.61V@0.4ms vs 0.80±0.42V@0.4ms
p=0.01; 0.80±0.53V @0.4ms vs 0.83±0.33V @0.4ms p=0.01). No patient required pacemaker parameters reprogramming.

Conclusions
oral flecainide therapy among pacemaker recipients at 30 days follow-up seems to be safe
and do not affect device function. Further studies with additional follow-up data are warranted.
LV systolic function assessment in conventional cardiac pacing: a simple and forgotten parameter - MAPSE
Authors: Cirin L , Luca C T , Gaita D , Hocher A , Faur A , Cozgarea A , Gurgu A , Vacarescu C , Cozma D 
Published: May 2024

Abstract

Background
Mitral annular plane systolic excursion (MAPSE) was a widely used M-mode echocardiographic marker of left ventricular longitudinal systolic function. On the other hand, right ventricle (RV) apical pacing is associated with left ventricle (LV) dysfunction development due to dysynchronous activation, while non-apical pacing may provide a more physiological LV activation. The aim of this study is to ascertain the clinical usefulness of MAPSE in the assessment of LV contractile function in patients with permanent RV pacing.

Methods
Consecutive patients with indication for permanent cardiac pacing (with ventricular pacing percentages over 20% - Vp&gt;20%) were retrospectively enrolled from 2019 to 2023. All patients were assessed by echocardiography with MAPSE, left ventricule ejection fraction (LVEF) and diastolic filling patterns being measured at the time of implant and at subsequent follow-ups.

Results
359 patients (age range 41-80yo; mean age=60,5yo) were included, 244 men and 115 women, 173 implanted with single-chamber devices and 186 dual-chamber. 259 patients were paced from the RVA (right ventricle apex) and 62 had septal lead positioning. The mean follow-up period was 18±2 months. The results showed that a MAPSE cut off value of ≤10 mm was associated with a LVEF&lt;42±2%, while MAPSE values &gt;10mm were associated with LVEF&gt;45±3% (p&lt;0.01). RV septal pacing was associated with a higher average MAPSE value (14,28 mm) than RVA pacing (13,47).

Conclusions
MAPSE seems to corelate well with LVEF in RV conventional pacing. Younger patients with preserved LVEF and less than grade II diastolic dysfunction were not associated with a significant decrese in MAPSE value. However, older patients with HFmrEF and RVA pacing seem to have a more substantial reduction in MAPSE value, suggesting that non-apical or conduction system pacing might be beneficial in this subgroup. MAPSE seems to be a quick and reliable echocardiographic marker of LV systolic function in patients with permanent cardiac pacing. It may be used as an early predictive marker for heart failure in conventional RV paced patients.
Emergency leadless pacing implantation is feasible and safe out-of-hours
Authors: O'rourke F , Sevier L S , Elliot J E , Creta R H , Hunter R H , Sporton S S , Sawhney V S , Schilling R S , Finlay M F 
Published: May 2024

Abstract

Introduction
Leadless pacing is increasingly used in patients with contraindications to transvenous systems. However, a common presentation of life-threatening bradyarrhythmia is in the out-of-hours emergency setting. The perceived complexities of leadless implantation anecdotally inhibit their use as destination devices implanted in the acute setting. Our centre offers a 24-7 emergency pacing service, we examined our use of leadless pacemaker implantation for patients requiring out of hours emergency pacing at our centre from December 2021 to December 2023.

Purpose
The purpose of this study looking to examine the feasibility and safety of leadless pacing in out of hours emergency situations.

Methods
This is a single centre retrospective cohort study examining all patients (pts) undergoing leadless pacemaker implantation at 1 hospital. Out of hours (OOH) implantation was defined as being after 18:00 during the week and any time during the weekend. Clinical and procedural parameters were compared between in-hours and out of hours (OOH) implantation. Haemodynamic instability was defined as any patient requiring inotrope support.

Results
118 leadless pacing systems were implanted between 0/1/12/2021 and 01/12/2023; 95 being performed in-hours and 23 OOH. Pacing indication was high-degree AV block in 20 pts (87%) in the OOH group, with frailty (8pts), dialysis (4pts) and infection (3pts) being listed as the most common reasons for selection of a leadless system in the OOH group. OOH pts had greater haemodynamic instability [in-hours: 3pts (3.2%) vs OOH: 4pts (17.4%)]. Procedural time (mean ± Standard deviation, mins) was similar between groups [52.4 (±3.6) in-hours vs 59.7(+/- 6.4) OOH; p= 0.33] as was fluoroscopy time (mins) [in-hours: 4.9 (+/- 1.0) vs OOH: 5.1(+/- 2.3) p=0.97] and radiation dose (cGy*cm²) [in-hours: 56.73 (+/- 9.87) vs OOH: 53.8(+/- 14.1), p=0.89].
3 (3.1%) major complications occurred in the in-hours group [tamponade (2pts), infection (1pt)]. One pt in the OOH group had a significant post procedure access site bleed (4.3%), but no tamponade occurred in this group.
Four pts (4.2%) died before discharge in the in-hours group, four patients (17.4%) died in the OOH group, reflecting their poor premorbid condition.

Conclusions
Leadless pacemakers can be safely implanted in the emergency, out of hours setting. In selected patients, this technology can offer an immediate destination therapy as an important alternative to placing a temporary system.
Clinical impact of ICD implantation in octogenarians: a longitudinal cohort study
Authors: Spoladori M , Crocamo A , Capoccia F , Rizzello D , Vrenozaj R , Bettella A , Palumbo A A , Cavalli S , De Maria M , Zilioli C , Bearzot L , Gonzi G L , Niccoli G , Ardissino D , Notarangelo M F 
Published: May 2024

Abstract

Background
The implantation of defibrillators (ICDs) in patients over 80 years old is becoming increasingly common; however, evidence-based data regarding the actual clinical benefit in this population remain limited and contradictory. While age seems not to affect mortality and arrhythmia risk in octogenarians undergoing secondary prevention, the mortality reduction benefit given by ICD implantation for primary prevention appears to decrease with advancing age, likely due to the high number of non-arrhythmic deaths.

Purpose
This study aims to assess the long-term incidence of ventricular arrhythmias and mortality in a real-world cohort of octogenarian patients undergoing ICD implants.

Methods
This was an observational, retrospective, longitudinal cohort study. Demographic, clinical, and radiological data were collected for all patients undergoing ICD implantation between 2014 and 2021. Deaths from all causes and significant arrhythmic events (sustained ventricular tachycardias and ventricular fibrillation) detected during routine device controls and remote monitoring were recorded. Then was performed an univariate Kaplan-Meier analysis, stratifying the population by age in relation to the two study endpoints: ventricular arrhythmias and all-cause mortality.

Results
Out of a total of 700 patients, 512 underwent ICD implantation before the age of 80 (mean age at implantation 64±12), while 188 underwent ICD implantation after the age of 80 (mean age at implantation 82±3.2). No significant differences were found between these two groups in terms of gender (82% vs. 83% male; p 0.12), indication for implantation (74% vs. 75% primary prevention; p 0.79), and the presence of late gadolinium enhancement (LGE) on cardiac MRI (68% vs. 77%; p 0.14). Octogenarians were more frequently affected by ischemic heart disease (54% vs. 65%; p 0.01) and were more frequently treated with Amiodarone (17% vs. 24%; p 0.02). At the end of the average 8-year follow-up, octogenarians had significantly higher all-cause mortality than younger patients (HR=2.35 [1.88-3.16]; p&lt;0.05), with survival curves diverging from 3 years after implantation. However, ventricular arrhythmic events were significantly reduced in octogenarian patients (HR=0.88 [0.87-0.89]; p&lt;0.05).

Conclusions
In a real-world population of octogenarian patients, the clinical benefit of ICD implantation for primary prevention appears diminished, considering the trade-off between ventricular arrhythmias and mortality, in both ischemic and non-ischemic cardiomyopathy patients.
LVSP and LBBP result in similar or improved LV synchrony and hemodynamics compared to biventricular pacing
Authors: Poviser L , Stros P , Jurak P , Kautzner J , Whinnett Z , Jastrzebski M , Waldauf P , Hozman M , Osmancik P , Curila K 
Published: May 2024

Abstract

Background
The effect of left ventricular myocardial septal pacing (LVSP) and left bundle branch pacing (LBBP) on ventricular synchrony and LV hemodynamics is poorly understood in unselected cardiac resynchronization therapy (CRT) patients.

Aim
To investigate the impact of LBBP and LVSP on ultra-high-frequency ECG (UHF-ECG) ventricular synchrony and hemodynamics in CRT patients.

Methods
In consecutive CRT patients with LBBB, ventricular synchrony was assessed using UHF-ECG. LV hemodynamics was assessed using invasive systolic blood pressure measurement during multiple transitions between LBBP, LVSP, and biventricular pacing (BVP). LV synchrony was assessed by LV lateral wall delay (LVLWd) from the first to the last from V5-V8 activations. Hemodynamic effects were expressed as relative changes in systolic blood pressure.

Results
Thirty patients with an LVEF of 29 ± 6% and mean QRSd of 169 ± 24 ms were included. Twenty had non-ischemic cardiomyopathy. QRSd during BVP, LVSP, and LBBP was the same, but LBBP provided shorter LVLWd than BVP (-9 ms (-16; -4), p = 0.004); the difference between LVSP and BVP was not significant (-4 ms (-10;2), p = 0.2). LBBP was associated with higher systolic blood pressure than BVP (4% (2; 5) p &lt; 0.001), while LVSP was not (1% (1; 2), p = 0.1. LV hemodynamic improvements during LBBP and LVSP vs. BVP were more pronounced in non-ischemic than ischemic patients.

Conclusion
The differences in ventricular synchrony between LBBP, LVSP, and BVP were demonstrated using UHF-ECG but not QRSd. LBBP, but not LVSP, was associated with better LV synchrony and hemodynamics than BVP.Local activation times in V1–V8Ventricular dyssynchrony and hemodynamic
Cardiac resynchronization therapy using endocardial versus trans-coronary sinus, epicardial left ventricular pacing: the Epi-Endo study
Authors: Okafor O , Zegard A , Stegemann B , Kalla M , Lencioni M , De Bono J , Marshall H , Leyva F 
Published: May 2024

Abstract

Aims
Some studies have suggested that cardiac resynchronization therapy (CRT) using endocardial left ventricular (LV) pacing (Endo-CRT) is superior to a conventional transvenous, epicardial CRT (Epi-CRT). To determine whether, in CRT recipients, endocardial LV pacing is haemodynamically superior to trans-coronary vein (trans-CV) LV epicardial pacing.

Methods and results
At implantation patients (n=16; aged 68.9±8.32 years; 13 male) underwent Epi-CRT and Endo-CRT in basal, mid and apical myocardial segments, delivered using the trans-CS lead and an intra-cavitary, roving EP catheter to achieve juxtapositions of the epicardial and endocardial side of the LV free wall respectively. Myocardial scar was quantified using cardiovascular magnetic resonance. An acute haemodynamic response (AHR) was defined as a ≥10% increase in the maximal rate of rise of LV pressure (%LV dP/dtmax) in relation to RV pacing (DOO). When the 84 paired segments were taken together, the %ΔLV dP/dtmax was higher with Endo-CRT than with Epi-CRT (9.9±8,6% vs 7.9±8.3% respectively, p&lt;0.002; 52.3% vs 28.6% responders [p&lt;0.045). However, Endo-CRT was not always superior to epi-CRT in individual patients. For example, in basal segments, only 5/10 (50%) patients were converted from non-responders with epi-CRT to responders with endo-CRT whereas 1/4 (25%) epi-CRT responder was converted to a non-responder with endo-CRT (Figure). There was no difference in ΔLV dP/dtmax between Epi-CRT and endo-CRT in segments with myocardial scar.

Conclusions
On average, endo-CRT provides a better AHR than epi-CRT. Within patients, however, endo-CRT is not always better.Epicardial versus Endocardial CRT
Clinical and long term safety outcomes of conduction system pacing compared to biventricular pacing : a large retrospective cohort study
Authors: Lachance R , Ayala-Valani L , Pelchat L P , Badra M , Dussault C , Roux J F , Ayala-Paredes F A 
Published: May 2024

Abstract

Background
Biventricular pacing (BVP) is the gold standard for cardiac resynchronization therapy (CRT). Recently, studies have shown promising results for conduction system pacing (CSP) as an alternative to BVP. However, the small study samples and paucity of data concerning long term safety of these devices prevent CSP from being used as first line therapy.

Purpose
This study examines clinical outcomes and long term safety of CSP compared to BVP.

Methods
We conducted a retrospective cohort study from patients receiving CSP or BVP. All patients implanted with either CSP (N = 282) or BVP (N = 216) from 2018 to 2023 were included. Patients had to complete at least 3 months of follow-up and CSP patients had to pace at least 20% of time at first visit. The outcomes were defined as at least one heart failure hospitalization and the complication rates for both arms.

Results
Median [IQR] follow-up time was 1.64 years [0.73 – 2.80]. Heart failure admissions were numerically lower for CSP group but when adjusted to confounders the adjusted odds ratio was 0.75 in the CSP group compared to BVP ([95% CI, 0.43-1.31]; P = 0.32). Long term complication rates (infection, lead dysfunction, diaphragmatic stimulation requiring system revision, etc.) were lower in the CSP group (4 [1.4%] vs 10 [4.7%]; odds ratio, 0.21 [95% CI, 0.06-0.69]; P = 0.01). Short term complication rates (lead displacement, infection, pneumothorax, etc.) were however similar for both arms (16 [5.7%] vs 11 [5.1%]; odds ratio, 1.53 [95% CI, 0.64-3.65]; P = 0.33). In two patients, septal lead extraction after over a year was possible without any sequelae. The change in the QRS duration went from 150 ms to 149 ms for group (p=NS) and from 153ms to 144ms for comparable CSP group (P = 0,01). Left ventricular ejection fraction (LVEF) increased from 28% to 40% in the BVP group and from 32% to 40% in the CSP group with pre intervention LVEF less than 50% (P &lt; 0.0001 for both groups). Procedure duration was significantly shorter for CSP (82.3 minutes [32] vs 93.1[39.1]; P = .0002).

Conclusion
CSP approach achieves similar clinical results as BVP, with significantly less complications, shorter implant times, shorter QRS durations and comparable LVEF improvement. All these favorable results are obtained using less leads and simpler devices.
Multicenter hemodynamic assessment of the LOT-CRT strategy: when is one lead enough for resynchronization?
Authors: Jastrzebski M , Foley P , Vijayaraman P , Whinnett Z , Upadhyay G A , Schaller R D , Gardas R , Richardson T , Kudlik D , Stadler R W , Zimmerman P , Waxman R , Cornelussen R N , Lyne J , Herweg B 
Published: May 2024

Abstract

Background
Left bundle branch area pacing (LBBAP) has been postulated as an alternative to traditional cardiac resynchronization therapy via biventricular pacing (BiV) in heart failure patients with wide QRS. Limited data is available regarding the acute hemodynamic response of LBBAP and the combination of LBBAP and coronary venous (LVcv) pacing (LOT-CRT).

Purpose
We sought to compare the acute hemodynamic and ECG effects of traditional CRT (BiV or LV-only) versus LBBAP and LOT-CRT in CRT candidates with advanced conduction disease.

Methods
In this multi-centre study (5 EU and 7 US centres), 48 subjects (mean age 65.8 years, 67% males, LV ejection fraction 29.4%) with either nonspecific interventricular conduction delay (NIVCD, n = 29) or left bundle branch block (LBBB; n =19; based upon strict criteria AHA/ACC/HRS plus Strauss) underwent an acute hemodynamic study to determine the % change in +LV dP/dtmax from baseline atrial pacing versus BiV, LBBAP, or LOT-CRT. Each therapy pacing configuration was applied 4 times at 5 different atrioventricular (AV) delays. QRS shortening was assessed using standard 12-lead ECG.

Results
Successful LBBAP lead implantation was achieved in 27 patients (56%) using current EHRA criteria. Twenty-one patients (44%) were categorized as deep septal pacing (DSP), due to suboptimal lead penetration or advanced left conduction system disease with broad paced QRS complexes and absent V1-r-wave. The increase in AV-optimized dP/dtmax for the different pacing configurations is displayed in the Figure, left panel. LOT-CRT dP/dtmax % improvement was 25.8%, significantly higher than LBBAP configurations (p&lt;0.01), either unipolar-LBBAP (19.3%), or bipolar-LBBAP (16.4%), but not different from BiV (26.4%). QRS shortening was greater in LOT-CRT (29.5ms) vs. unipolar-LBBAP (11.9ms), bipolar-LBBAP (11.7ms), or BiV (18.5ms), all p&lt;0.01. Sub-group analysis indicated the hemodynamic benefit of adding LVcv pacing when LBBAP strategy was pursued (Figure, right panel) depended on obtaining LBBAP rather than DSP (p &lt; 0.01) and baseline QRS duration (p = 0.03). The largest benefit was observed among subjects with a baseline QRS wider than the observed cohort mean (171ms) and DSP only, where LOT-CRT provided 14.5% (5.0-24.1%) greater dP/dtmax improvement and 20.8ms (12.8-28.8ms) greater QRS duration shortening than unipolar DSP.

Conclusions
In a CRT cohort with advanced conduction disease, LOT-CRT provided greater acute hemodynamic benefit than LBBAP strategy (i.e. including also DSP cases). Patients with wider QRS or suboptimal outcome of LBBAP strategy (DSP) are more likely to benefit from addition of a LVcv lead to implement LOT-CRT.Figure 1