bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epicardial catheter ablation of ventricular tachycardia in patients of acm - from a university hospital report in switzerland
Authors: Guan F U , Brunckhorst C , Duru F , Feifan O Y , Saguner A M 
Published: May 2024

Abstract

Background
Arrhythmogenic left ventricular cardiomyopathy (ALVC) as a subtype of arrhythmogenic cardiomyopathy (ACM) is increasingly being recognized. Cardiac magnetic resonance (CMR) has emerged as the primary imaging modality for the diagnosis of ACM. In patients with right-dominant ACM (ARVC) and recurrent sustained ventricular tachycardia (VT), endocardial +/-epicardial ablation yields good clinical outcomes in the long-term. However, studies on VT ablation in ACM with LV involvement are scarce.

Purpose
We sought to investigate clinical outcomes of VT ablation in ACM patients with LV involvement.

Methods
The study included patients from the Zurich ACM Registry who met 2020 "Padua Criteria" for ACM and underwent VT ablation between January 2018 and July 2023. Epicardial ablation was performed in patients with recurrent sustained VT despite endocardial ablation, those lacking and endocardial substrate or if the ECG of the VT / substrate on CMR was suggestive of an epicardial origin. Catheter ablation was guided by activation/entrainment mapping for mappable VT, and pace mapping/voltage mapping during sinus rhythm for unmappable VT. Consecutive follow-up of all patients was performed according to our protocol.

Results
Twenty-one ACM patients underwent n=24 VT ablation procedures. Of those 20 patients, 6 patients (30%) had LV involvement on CMR. Eight (33%) patients underwent epicardial +/- endocardial ablation. Among patients receiving epicardial ablation, 3 patients (38%) had LV involvement. These three underwent a single ablation procedure, which was epicardial only. Total follow-up was 30 months (range 4-43). Three-month sustained VT/VF recurrence rates were 12% in the ACM group with LV involvement vs 25% in ACM without LV involvement. All patients with sustained VT/VF recurrence underwent repeat ablation via an epicardial approach within 3 months and were free of sustained VT/VF thereafter during a median follow-up of 12 months. One-year recurrence rate did not differ between ACM patients with LV involvement vs. without LV involvement (7.7% vs 8.3%, P＝0.117). Seven out of eight epicardial ablations achieved freedom from VT/VF after one-year follow-up. One ARVC patient with previous endocardial ablation had recurrent VT one month after epicardial ablation, which was free of VT after Flecainide combined with beta-blocker. No significant differences were found in the use of beta-blockers and antiarrhythmic drugs between both groups (ACM with LV involvement vs. without LV involvement) at baseline and during one-year follow-up.

Conclusions
Single or adjuvant epicardial substrate ablation of VT in arrhythmogenic cardiomyopathy is promising in terms of postprocedural VT free survival, especially in patients with left ventricular involvement demonstrated by CMR.Figure 1Figure 2
Clinical practice and outcome of S-ICD replacement: results from the multicenter rhythm detect registry
Authors: Palmisano P I E T R O , Pieragnoli P , Viani S , Nigro G , Francia P , Biffi M , De Filippo P , Pisano E , Bisignani G , Giammaria M , Ottaviano L , Tordini A , Migliore F , Valsecchi S , Bianchi V 
Published: May 2024

Abstract

Background
Subcutaneous implantable cardioverter-defibrillator (S-ICD) therapy is expanding rapidly. However, there are few data on the S-ICD replacement procedure.

Objective
The aim of this analysis was to describe the procedure and outcome of S-ICD replacement in clinical practice.

Methods
From 2013 to 2022, consecutive patients undergoing de-novo implantation of an S-ICD were enrolled at 66 Italian centers of the Rhythm Detect Registry. We analyzed consecutive patients who required S-ICD replacement.

Results
319 S-ICD generators (49 Cameron, 270 Emblem) were replaced for battery depletion. All the procedures were performed in electrophysiology laboratories, by one or two expert operators. In 118 (37%) cases, the replacement was performed as outpatient procedure. The procedure was performed under local anesthesia with or without conscious sedation in 297 patients (93%). The previous S-ICD generator was in an intermuscular pocket in 195 (61%) patients, and in a subcutaneous pocket in the remaining 124 (39%). 39 (31%) generators were shifted from subcutaneous to intermuscular pocket, and their PRAETORIAN score improved from 43±20 to 34±13 (p=0.007). In most cases (308 (97%)), the defibrillation test was not performed after replacement, but the overall PRAETORIAN score was very low (37±28). The S-ICD system was successfully replaced in all patients and no complications were reported; the procedure duration was 39±16 min and was comparable in the case of generator re-implanted in the same pocket or in case of shift to a new pocket.

Conclusions
S-ICD replacement was safe and easy to perform, with no peri-operative complications. In clinical practice the replacement procedure is often an opportunity to optimize the position of the generator
Safety and feasibility concerns of radiotherapy in the presence of subcutaneous implantable cardioverter-defibrillator
Authors: Tajstra M , Dyrbus M , Stapor-Fudzinska M , Rutkowski T , Gasior M , Blamek S 
Published: May 2024

Abstract

Introduction
Radiotherapy (RT) in patients with cardiac implantable electronic devices (CIED) is performed increasingly more frequently. Currently, there is no evidence, whether RT in patients with subcutaneous implantable cardioverter-defibrillator (sICD) is feasible and safe.

Purpose
To perform the first in-vitro analyses using a model of left lung cancer treated with stereotactic body radiotherapy (SBRT) with the presence of an sICD.

Methods
Three functional sICDs explanted from patients following the heart transplant underwent RT. In one device (No º3), the lead had to be cut during explantation at ~ 3 cm from the tip. A computed tomography-based SBRT plan was calculated for a left lung tumor (located 3.5 cm from the sICD). Three fractions of 18 Gy with a nominal energy of 6 MV were delivered, and the maximum dose calculated for the sICD was 3.5 Gy. Each sICD and lead were placed on an anthropomorphic phantom in the nominal location. The intervals between fractions were 7 days. The next step was a direct irradiation of the sICD with an open-field RT with 25 fractions of 2 Gy, then 2 of 20 Gy, 1 of 40 Gy, and a final fraction of 100 Gy. Before and after each fraction, the devices were interrogated, and to verify whether RT affects the devices in the possibly least optimistic clinical scenario, high-voltage therapies were turned on for each fraction and off for the intervals between them.

Results
A major depletion in the battery percentage (from 88% to 16%) between the first and second fraction of RT in device No. 2 was observed, while in two other devices, major reductions in the device battery longevity were observed after the third fraction of RT (from 38% to 14% and from 60% to 15%, respectively). The estimated doses for sICDs in those stages of RT were respectively 1.2 Gy, 3.5 Gy, and 3.5 Gy. Due to a significant drop of the battery longevity in device No 2º, only two remaining sICD underwent the open-field RT.
During the direct irradiation, an unannounced shock was delivered during the interrogation directly after the 14th fraction of 2 Gy, in a device with a macroscopically intact lead. An external interference was demonstrated, which was interpreted as an arrhythmia in the ventricular fibrillation zone. The complete device reset occurred in both devices after having received approximately 195 Gy.

Conclusions
The presented findings strongly indicate an association between RT and the malfunction of the sICD occurring in the anthropomorphic phantom model of left lung tumor, as well as the risk of inappropriate shocks during the open-beam direct radiation on the devices.Battery longevities before and after RT
Feasibility and effectiveness of left bundle branch area pacing after TAVR: the single center experience
Authors: Bakytzhanuly A , Turubayev E , Esilbayev Z H , Bagibayev S , Nuralinov O 
Published: May 2024

Abstract

Introduction
Transcatheter aortic valve replacement (TAVR) is a safe alternative to open-heart surgery in patients with symptomatic severe aortic stenosis and high surgical risk due to multiple comorbidities, advanced age, and severe left ventricle dysfunction. Due to anatomical considerations of the atrioventricular node, conduction abnormalities requiring the implantation of a pacemaker are common findings after TAVR. High-grade atrioventricular block and new-onset left bundle branch block (LBBB) are the most commonly reported conduction abnormalities after TAVR.

Purpose
The aim of our study was to assess the feasibility, success rates, and effectiveness of LBBAP in patients requiring pacing after TAVR.

Methods
A total of 302 patients underwent the TAVR procedure in our institution in the period from January 2022 to November 2023. In this cohort, 38 patients required ventricular pacing in the postoperative period. 16 patients who underwent permanent pacing using LBBAP were included in this observational study. Patients undergoing traditional right ventricular pacing biventricular pacing or leadless pacemaker implantation were excluded from the study.

Results
LBBAP was successfully performed in 16 patients (89%). 2 patients underwent conventional CRT implantation (1 cardiac resynchronization therapy pacemaker and 1 cardiac resynchronization therapy defibrillator) in order to severe calcification and presence of fibrotic tissue in the target area. The mean age was 60.5±2.74 years, and 10 patients (62.5%) were women. According to the patient’s medical history, 14 patients (84%) had hypertension; coronary artery disease – 2 (12.5%), 2 (12.5%) patients had atrial fibrillation and atrial flutter, and 7 (43.5%) patients had diabetes mellitus. The mean left ventricle ejection fraction (LVEF) was 46.2±14.7%. Interventricular septal thickness 11.8 ± 1.9 mm. Type of conduction diseases: Infranodal AV block and LBBB were present in 9 (56.5%) patients. 5 (31,25%) patients had persistent complete AV block and 2 (12,25%) had Mobitz II AV block. In 2 patients we observed congestive heart failure combined with LBBB. Pre-TAVR QRS morphology was normal in 15 (93%), and RBBB morphology in 1 (7%). The mean QRS duration at baseline was 105±20 ms. Pre-implant QRS duration 135±52 ms. The single-chamber pacemaker was implanted in 1 patient, dual-chamber pacemaker - 13 patients, and cardiac resynchronization therapy defibrillators in 2 patients. Procedural duration and fluoroscopy times were 105. ± 31.9 min and 18 ± 11 min, respectively.

Conclusion
Complete AV block and new-onset LBBB after TAVR is still an important issue. LBBB correction using conduction system pacing technology is an effective strategy for this type of patient. LBBAP is one of the most exciting developments in pacing therapy over the last few years. Long-term clinical outcomes and safety of physiological pacing data are limited and require further investigations
Efficacy and safety of lumenless leads compared with stylet-driven leads for left bundle branch area pacing
Authors: Melero Polo J , Murciano Marques E , Sales Belles C , Vadillo Martin P , Ramos Maqueda J 
Published: May 2024

Abstract

Introduction
Left Bundle Branch Area Pacing (LBBAP) was initially performed with lumenless leads (LLLs). In the last years, stylet-driven leads (SDLs) have emerged as an alternative. However, we are still lacking data comparing these two different approaches.

Purpose
To compare the efficacy and safety of LLLs Vs SDLs for LBBAP.

Methods
116 patients who underwent LBBAP attempt in our institution were prospectively included (mean age 74 ± 9 years, 40 (34%) female). We recorded and analyzed baseline characteristics, procedural findings, LBB capture criteria, lead parameters, success rates and complications. A 6-month remote follow-up data was programmed in every patient.

Results
We analyzed 75 patients who received LLLs and 41 patients with SDLs. Baseline characteristics were similar in both groups (table 1). There were no significant differences regarding Paced QRS (114 ± 18 ms Vs 117 ± 19 ms, p = 0.36), presence of a LB potential (16 (21%) Vs 9 (22%), p = 0.93), V6 R-wave peak time (V6RWPT) (83 ± 15 ms Vs 82 ± 16 ms, p = 0.71) or V6–V1 inter-peak interval (40 ± 17 ms Vs 37 ± 13 ms, p = 0.37). Time to lead implant was also similar (37 ± 18 minutes Vs 37 minutes ± 13 minutes, p = 0.87). Mean pacing voltage threshold was higher for SDLs after implantation (0.71 ± 0.33 V Vs 0.86 ± 0.30 V, p = 0.02) and also at the 6-month remote follow-up (0.75 ± 0.28 V Vs 0.9 ± 0.34 V, p = 0,04). R-wave amplitude and impedance were also higher in SDLs (table 1).
According to 2023 EHRA clinical consensus statement on conduction system pacing, we achieved confirmed LBBP in 63 patients (54%), likely LBBP in 30 patients (26%) and Left Ventricular Septal Pacing (LVSP) in 21 patients (18 %), with no differences between groups (table 1). After the 6-month follow-up, a higher probability of lead dislodgement was appreciated in the SDLs group (3 (7%) Vs 0 (0%), p = 0,01).

Conclusions
LLLs and SDLs are effective tools to perform LBBAP, achieving similar paced QRS and and success rates. SDLs were associated with slightly higher pacing threshold. After the 6-month follow-up, a higher probability of lead dislodgement was appreciated in the SDLs group.
Impact of age on patient selection in leadless pacemaker implant: experience with the micra transcatheter pacemaker
Authors: Iacopino S , Roberts P R , Rao A , Johansen J B , Marijon E , Piccini J P , El-Chami M F , Stromberg K , Fagan D , Garweg C 
Published: May 2024

Abstract

Background
The safety and efficacy of the Micra AV leadless pacemaker has been demonstrated in the real-world setting. However, whether the patient profile and outcomes differ based upon patient age is not known.

Purpose
To report age-stratified peri-procedural outcomes and intermediate-term follow-up of patients undergoing Micra implant.

Methods
Patients (n=801) from the Micra AV Post-Approval Registry were included and divided into age groups: ≤40 (n=40), 41-&lt;65 (n=110), 65-80 (n=332), and &gt;80 (n=319). Baseline characteristics were summarized. A Fine-Gray competing risk model was used to compare risk for major complication through 12 months. Pacing burden and projected longevity were summarized.

Results
Among 801 included patients, 40 (5.0%) were ≤40 years of age with a mean age of 29.2 ± 6.6 years (range: 16-40) and 60.0% were female. Among patients ≤40, 20.0% had a prior CIED while 27.5% were precluded from transvenous pacing. Patients ≤40 had lower BMI and lower co-morbidity burden compared with older patients. The most common indication for implant was AV block in all age groups, however 35.0% of patients ≤40 had a syncope indication compared to ≤15.5% for older groups. Micra was successfully implanted in 100% of patients ≤40 years. The major complication rate at 12 months was 2.7% in patients ≤40 and did not significantly differ across age groups (P=0.82, Figure). Median pacing percentage was lowest in the ≤40 group (n=17, median= 1.0%) and was highest in the &gt;80 group (n=127, median 88.0%). Median projected longevity across all patients was 10.9 years and was 14.8 years among patients ≤40 with 82.3% having longevity ≥10 years.

Conclusion
Micra was successfully implanted across a broad range of age groups. Younger patients tended to be healthier and had a low median percentage pacing. The rate of major complications was low and did not differ across age groups.Major complication rate by age subgroup
Leadless pacemaker implantation via the internal jugular vein a promising access for an established intervention
Authors: Molitor N , Breitenstein A 
Published: May 2024

Abstract

Background
Leadless pacemaker therapy was introduced in 2013 to overcome lead- and pocket-related complications in conventional transvenous pacemaker therapy. These leadless devices are self-contained right ventricular single-chamber pacemakers implanted via a femoral percutaneous approach. However, the femoral route is not always possible due to various reasons. The aim of this analysis is to share our first experience using a jugulary approach for the implantation procedure.

Purpose
To evaluate safety and feasibility of leadless pacemaker implantation via the internal jugulary vein.

Methods
The records of the first 34 patients who underwent leadless pacemaker implantation via the right internal jugular venous route at our center were analyzed prospectively. Follow-up period was 3 months. Safety as well as efficacy including electrical parameters of the jugular approach were compared with the data of the first 100 patients who underwent a femoral leadless pacemaker implantation at our center (implanted from 2015-2019).

Results
Thirty-four patients underwent internal jugular vein leadless pacemaker implantation (mean age, 82.37 ± 7.58, 58.8% males). All leadless pacemakers were implanted successfully. The jugular approach was well tolerated by all patients. Mean procedure time was 33.29 ± 8.81 min with a mean fluoroscopy time of 3.66 ± 2.07 min. The device was positioned at the inferior septum in 11 patients, at the high septum in two and midseptal in 21 patients. The mean pacing threshold was 0.52 ± 0.22 V at 0.24 ms pulse width with a sensed amplitude of 9.13 ± 4.08 mV. There were no complications during the procedure as well as during 3-month follow-up. At follow-up, electrical parameters remained stable in all patients.

Conclusion
Implantation of a leadless pacemaker via the right internal jugulary vein is a safe and effective alternative to the femoral approach.Patient demographics/device parameterDevice value development over time.
Accelerated pacing reduces left heart filling pressures: a novel therapy for heart failure with preserved ejection fraction?
Authors: Van Loon T , Wolffs J , Rijks J , Cornelussen R , Van Osta N , Luermans J , Prinzen F , Schotten U , Linz D , Van Empel V , Delhaas T , Vernooy K , Lumens J 
Published: May 2024

Abstract

Background
The recent MyPACE trial demonstrated significant improvement of quality-of-life, physical activity, and atrial fibrillation (AF) burden with accelerated pacing as compared to the standard 60bpm back-up rate setting in patients with heart failure with preserved ejection fraction (HFpEF) and indication for pacemaker therapy. We hypothesized that a potential working mechanism underlying these improved outcomes lies in the reduction of left heart filling pressures during accelerated pacing, reducing congestion and atrial stretch.

Aim
To assess the acute effects of accelerated atrial pacing on left heart filling pressures in consecutive AF patients undergoing catheter ablation.

Methods
Fifty AF patients undergoing catheter ablation were prospectively enrolled for accelerated atrial pacing. As illustrated in Figure 1, pacing was performed proximally in coronary sinus (CS). Pacing rate was increased incrementally from resting heart rate by 10-bpm increments up to Wenckebach rhythm, with 30-sec intervals of pacing on and off for hemodynamic stabilization. Left atrial pressure (LAP) was continuously monitored via a fluid-filled transseptal sheath (SL0 sheath, Abbott). Acute pacing-induced changes in mean LAP and PR-interval were evaluated at each pacing rate and compared between resting heart rate, the patient-specific optimal heart rate (i.e., the rate resulting in the lowest mean LAP), and the maximum pacing rate.

Results
Atrial pacing acutely decreased mean LAP from 14.8[9.8; 18.4] to 12.8[8.5; 15.8]mmHg (median[IQR], p&lt;0.001) as heart rate increased from 51[47; 61] to 90[70; 100]bpm (p&lt;0.001) (Figure 2, resting versus optimal category). Among the 50 patients included, only 4 did not exhibit a decrease in LAP. Further increasing pacing rate to a maximum of 130[100; 140]bpm resulted in an acute LAP increase to 16.2[12.7; 19.9]mmHg (p&lt;0.001) to values above resting mean LAP. Accelerated pacing induced negative AV dromotropy, i.e., lengthening of the PR-interval from 169[150; 185] to 186[164; 209]ms (p=0.003) and 270[217; 310]ms (p&lt;0.001).

Conclusion
Our study demonstrated that moderately accelerated atrial pacing reduced mean LAP in AF patients undergoing catheter ablation. While our primary focus was on acute response in AF patients, the reduction in mean LAP during moderate pacing rates may suggest a promising therapeutic approach for managing HFpEF patients. However, caution is warranted as pacing rates beyond the optimal range led to a marked increase in LAP. Additionally, increasing pacing rates were observed to induce varying degrees of AV-node dromotropy, which potentially modulates therapy response.Fig 1. Overview of clinical protocolFig 2. Response to accelerated pacing
Long-term time-course of atrial sensing and incidence of atrial fibrillation in patients with VDD versus DDD pacemakers
Authors: Quesada Ocete B , Robles Musso M M , Quesada Ocete F J , Robles Musso E , Carrion A , Cardona Mulet S , Luengo S , Jimenez Bello J , Montes Valverde I , Alonso Marin A , Paya Chaume A , Paya Serrano R , Quesada Dorador A 
Published: May 2024

Abstract

Introduction
VDD pacemakers (PM) theoretically have the same advantages with respect to maintaining atrioventricular (AV) synchrony as dual-chamber (DDD) pacemakers, with lower costs and simpler implantation procedure. However, their use is often limited by concerns about the maintenance of atrial sensing (AS) and the occurrence of atrial fibrillation (AF).

Purpose
We aimed to compare long-term atrial sensing stability, the incidence of AF and complications in VDD and DDD systems.

Methods
We retrospectively enrolled patients who underwent VDD or DDD PM implantation for AV block between 2014 and 2021 from 2 centers. Clinical, analytical and electrical variables at implantation, their evolution and events at follow-up (25.2±16.2 months) were collected, comparing the groups by Kaplan-Meier and Cox multivariate analysis.

Results
487 patients who underwent PM implantation were included, 189 (38,8%) received a VDD PM and 298 (61,2%) a DDD PM. Patients with VDD were older and had a higher prevalence of risk factors and lower atrial voltage at implantation (Table). Complications at implantation and early complications were scarce and without significant differences in both groups. During follow-up, there was a reduction in atrial voltage in the VDD group (implant 1.4+0.8 mV; follow-up 1.2+0.9 mV; p&lt;0.01), with stability in the DDD group (3.8+2.1 vs 3.9+2.2 mV). Total percentages of AS loss were 23.2% (VDD) vs 2.3% (DDD); p&lt;0.01) (Figure 1). In the Cox multivariate analysis the risk of late AS loss was higher in the VDD group (HR=7.6; 95% CI 2.86-20.3; p&lt;0.001) together with the AS values at implant (HR=0.72; 95% CI 0.52-1.00; p=0.052). AS loss was corrected with reprogramming in 23 patients, reintervention was needed in 1 (2%) and VVI was abandoned in 27 (53%). The risk of AF occurrence was lower in the VDD group (HR=0.39 CI 95% 0.18-0.87; p=0.021) (Figure 2).

Conclusions
In the long term, AS is significantly reduced in VDD MPs, leading to its loss in a quarter of VDD patients. It is usually correctable with reprogramming, rarely requiring abandonment to VVI. AS at implantation is crucial as it is directed related to the AS during follow-up. DDD PMs were independently associated with a higher incidence of AF, with no differences in the remaining complications.TableFigure