bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of the quality of life of patients with leadless pacing system during 1 year follow-up period
Authors: Baimbetov A , Bizhanov K , Yakupova I , Jukenova A 
Published: May 2024

Abstract

Background
Leadless pacemakers (LesPM) are a new safe alternative technology for pacing the right ventricle. However, not enough information is available on their potential benefits for quality of life (QoL) in patients with LesPM. The purpose of the study was the quality of life comparison of patients with LesPM and conventional pacemakers (ConvPM).

Methods
The study included patients who underwent implantation of a single-chamber pacemaker from December 2018 to March 2023. We used the SF-36 Questionnaire to assess quality of life at baseline and after 12 and 24 months of follow-up. We also used a questionnaire consisting of 10 specific questions related to the implantation procedure.

Results
Total of 50 patients were included (25 LesPM; 25 ConvPM). There were no differences in baseline characteristics between groups (LesPM vs. ConvPM), except for age (47.5 vs. 57.3 years; P = 0.012) and diabetes 28% vs. 21%; P = 0.021). Baseline SF-36 did not differ between groups. After 6 months of follow-up, patients in the LesPM group showed significantly higher scores on physical function (47 vs 32; P&lt;0.001), physical role (53 vs 37; P=0.004) and mental health (67 vs 52; P=0.017), even after adjusting for covariates. Pacemaker-related discomfort and physical limitations were significantly lower in the LesPM group.

Conclusion
LesPM is associated with a better quality of life than ConvPM, both in terms of physical and mental health. Patients who underwent LesPM implantation reported less procedure-related discomfort, physical limitations, and anxiety.
Anatomical considerations for the subcutaneous implantable cardioverter-defibrillator (SICD) implantation: a cadaver-based analysis
Authors: Khalil P , Hossein M , Barremkala M , Grogan J , Williamson B 
Published: May 2024

Abstract

Background
Subcutaneous implantable cardioverter-defibrillators (SICDs) offer primary and secondary prevention of sudden death without transvenous leads in individuals not requiring pacing therapy. Intermuscular placement of the SICD generator between the latissimus dorsi (LDM) and serratus anterior (SAM) muscles is often recommended. This specific technique results in reduced defibrillation impedance and subsequently optimal defibrillation thresholds, reduced risk of pocket complications and infections, reduced device migration, and enhanced patient comfort and cosmetic outcomes.
Despite the recommendation for an intermuscular implant technique utilizing a mid-axillary incision line, there is limited research describing this anatomical space to avoid complications. In this anatomic study, we examined this anatomical space. Our aim was to provide a better understanding of the interplay between the involved muscles and a proper location of an incision line. We also defined the location of the long thoracic nerve (LTN) relative to this space, which if transected, would lead to a winged scapula.

Methods
We examined 18 cadavers; 12 (66.7%) were female donors and 6 (33.3%) were males. We measured the distance from the anterior border of the LDM in relation to the cadaver back (A) and in relation to the anterior-posterior diameter of the chest (B). We performed these measurements at the 5th and 7th rib levels, and then averaged these measurements. We also measured the distance from the back to where the LTN enters SAM at the 4th, 5th, and 6th ribs.

Results
Analysis of the obtained data showed that the mean distance from the back to the anterior border of LDM at the 5th rib was 7.55 cm (5.65 – 10.85 cm) and at the 7th rib was 7.60 cm (5.35– 10.35 cm). Mean distance from the back to the anterior LDM border in both 5th and 7th ribs combined was 7.58 cm (5.50 – 1.06 cm). The mean anterior-posterior diameter of the chest wall at the fifth rib was 21.45 cm (18.55 – 24.75 cm). The mean A/B ratio (that is the ratio between the distance from the back to the anterior LDM border in comparison to the anterior-posterior chest diameter) was 0.4 with a standard deviation of +/- 0.1 (range 0.27-0.45).
The LTN was running anterior to the LDM border at the 4th rib level, and posterior to the LDM border at the 5th and 6th ribs level. The LTN entered the SAM at the 4th rib level in 6.6%, at the 5th rib in 46.6% and at the 6th rib in 46.6% of cadavers.

Discussion
Intermuscular technique for S-ICD implantation is recommended as the preferred procedural approach. In our postmortem study, the anterior LDM border was variable but posterior to the mid-axillary line with a variable A/B ratio of 0.27 – 0.45.
Our study also demonstrates the proximity of the long thoracic nerve (LTN) in comparison to the anterior LDM border. Caution should be taken when implanting S-ICD devices to avoid LTN injury.
Implant failure predictors of left bundle branch pacing used as cardiac resynchronization therapy: importance of left ventricular diameter and QRS morphology
Authors: Graterol F R , Pujol-Lopez M , Borras R , Ayala B , Guasch E , Regany-Closa M , Guichard J B , Castel M A , Arbelo E , Porta-Sanchez A , Sitges M , Roca-Luque I , Doltra A , Mont L , Tolosana J M 
Published: May 2024

Abstract

Background
Left bundle branch pacing (LBBP) is considered an alternative to cardiac resynchronization therapy (CRT). However, LBBP is not suitable for all heart failure patients.

Purpose
The aim of our study was to identify predictors of unsuccessful LBBP implantation in CRT candidates.

Methods
A cohort of consecutive patients with indications for CRT were included. Clinical, echocardiography and electrocardiographic variables were prospectively recorded.

Results
A total of 157 patients were included in the analysis. The LBBP implant was successful in 129/157 (82.2%) patients, and the implant failed in 28/157 patients (17.8%). The causes of failed implantation were as follows: unsatisfactory paced QRS (21/28; 75%); impossibility of screwing the helix (4/28; 14.3%); lead instability (2/28; 7.1%); and high pacing thresholds (1/28; 3.6%). Left ventricular end diastolic diameter (LVEDD), nonspecific intraventricular conduction delay morphology (IVCD), and QRS width were predictors of failed implants according to the univariate analysis. In a multivariable regression analysis, LVEDD [OR 1.44 per 5 mm increase (95% CI 1.13, 1.82) p=0.003] and IVCD [OR 2.96 (95% CI 0.74, 11.84) p=0.09] were independent predictors of unsuccessful LBBP implantation. An LVEDD of 60 mm has 75% sensitivity and 67% specificity to predict LBBP implant failure.

Conclusions
When LBBP was used as CRT, LVEDD and IVCD predicted unsuccessful implantation. IVCD triples the possibility of failed implantation independently of LVEDD. Caution should be exercised when considering these parameters to plan the best pacing strategy in patients.
Effectiveness of dynamic atrioventricular optimization during patient exercise in cardiac resynchronization therapy
Authors: Covino G , Iuliano A , Sollazzo V , Leccisotti S , Calvanese R , Tavoletta V , Canciello M , Caroli G , Di Renzo A , Medico A , Vittoria D , Spiniello G , Simonetti A , Bianchi V 
Published: May 2024

Abstract

Background
Cardiac resynchronization therapy (CRT) is considered the standard treatment for patients with heart failure and prolonged QRS duration. Recent studies suggest that atrioventricular delay (AVD) optimization can play a key role in QRS narrowing, thus improving CRT outcomes. For this purpose, device-based algorithms have been developed. In particular, the SyncAV algorithm continuously monitors the patient’s intrinsic AVD and dynamically adjusts the pacing AVD to allow fusion of the left ventricle pacing with intrinsic right ventricle depolarization. SyncAV optimization is usually performed in a single patient condition, i.e. at rest, and in a single operating scenario of the device, i.e. during atrial sensing.

Purpose
This study aims to compare QRS narrowing after AVD optimization using SyncAV in CRT-treated patients at rest, during moderate exertion, and during an increase in the atrial pacing rate.

Methods
This is a prospective, non-randomized, non-blinded, multicenter study. The study population consisted of patients in sinus rhythm, PR interval &lt; 350 ms, and rest ventricular rate &lt; 100 bpm. Within one month from the implant, patients were assessed for AVD optimization with SyncAV, selecting the offset (i.e. 10 to 40% AVD) that resulted in the shortest QRS duration (QRSd). Subsequently, patients performed moderate physical activity using a bicycle ergo-meter while a surface ECG was collected. QRSd was assessed once patients achieved a heart rate over 20 bpm to baseline heart rate, up to 100 bpm. Finally, QRSd narrowing was evaluated during a programmed increase in atrial pacing (i.e. &gt;20 bpm of baseline atrial rate).

Results
Nine patients were treated with CRT and enrolled (age 67,3 ± 13,2 years; 66% male; LV ejection fraction 33,7±2,9 %; intrinsic QRSd 155,6 ± 12,7 ms) with intact atrioventricular conduction (PR interval 170,6±25,8 ms). The median SyncAV offset that provided the best QRSd reduction was 20 % (10 - 35%). Intrinsic QRSd was reduced to 132,7 ± 10,0 ms (-14,2±9,4%) with standard biventricular pacing and to 122,0 ± 11,2 ms (-21,2±8,5%) with SyncAV optimization. During exercise the mean heart rate was 88,1 bpm, the QRSd was reduced to 132,7 ± 10,0 ms (-14,2±9,4%) with standard biventricular pacing and to 124,9 ± 14,9 ms (-19,3±10,8 %) with SyncAV optimization. The mean heart rate during atrial pacing was 90 bpm with paced QRSd of 126,0 ±13,9 ms (-18,9±7,3% from baseline) with SyncAV optimization and paced PR interval of 198,2±22,7ms.

Conclusion
We evaluated the effectiveness of SyncAV for AVD optimization in out-of-clinic. This study demonstrates the possibility of narrowing the QRSd using SyncAV at several activity levels. Nevertheless, a deeper evaluation is needed to confirm our findings, investigating the SyncAV role in a larger population of patients.
Conduction system pacing improved cardiac functions and functional capacity in heart failure with reduced ejection fraction and right bundle branch block
Authors: Nagy L , Toth A , Sandorfi G , Csanadi Z 
Published: May 2024

Abstract
Conduction system pacing (CSP) is increasingly accepted as an alternative to biventricular pacing in heart failure (HF) patients with left bundle branch block (LBBB) and non-LBBB. However, its efficiency in right bundle branch block (RBBB) is ill-defined. Herein, we report on the clinical outcomes of CSP in HFrEF patients with wide QRS complex and RBBB morphology.
His-bundle (HBP) or LBB-area pacing (LBBAP) was attempted as a primary strategy in patients with RBBB, QRS duration ≥130 ms and left ventricular ejection fraction (LV EF) &lt;35% and NYHA class II to IV HF despite optimized medical treatment for at least 6 months. Data on functional status, NT-pro-BNP levels and echocardiographic parameters were collected during follow-up and expressed as mean ± SEM, Statistical significance was calculated with Student’s paired t-test and chi square distribution.
CSP was performed in 12 RBBB-HF patients (age 64.3±2.9 years) with mean QRS duration of 150±4 msec and baseline LV EF of 25.4±2.3%. The aetiology of HF was ischaemic (6 patients) and non-ischaemic cardiomyopathy (6 patients). During the procedure, HBP was achieved in 7 and LBBAP in 5 patients, resulting in a significant reduction in the QRS-duration (115±2.6 msec, P&lt;0.0001) as compared with baseline value. CSP improved LV function (LV EF= 31.8±2.8%, P=0.009) as well as NYHA functional class (25% of the patients with NYHA II and 75% with NYHA III before vs. 33% with NYHA I, 33% with NYHA II and 33% with NYHA III after CSP, P=0.048) as compared to what was obtained prior to the procedure. A numerical decrease was also found in NT-proBNP levels (4735±2606 ng/ml before CSP vs. 3972±1883 ng/ml after CSP) which did not reach the level of statistical significance (P=0.45).
In conclusion, CSP improved both quality of life and LV function in HFrEF patients with RBBB. Our results support the use of CSP in HFrEF patients with QRS width&gt;130msec and RBBB morphology.
Enhancing heart failure management: a comprehensive analysis of continuous remote monitoring vs. standard care in patients with cardiac implantable electronic devices
Authors: Veres B , Kiss B , Fehervari P , Engh M , Hegyi P , Zima E , Schwertner W , Masszi R , Merkel E , Behon A , Kuthi L , Osztheimer I , Kosztin A , Merkely B 
Published: May 2024

Abstract

Background
Utilizing remote monitoring (RM) in patients with heart failure (HF) who have cardiac implantable electronic devices (CIED) proves to be a dependable method for closely adhering to device-specific and heart failure-related parameters. While there is some favorable outcome data, the results remain incomplete.

Aims
We aimed to evaluate the advantages of continuous RM compared to the standard of care (SoC) in reducing all-cause mortality, cardiovascular-related death (CV), sudden cardiac death, and ICD shocks.

Methods
A systematic review and meta-analysis of randomized controlled trials (RCT) testing RM vs. SoC for the management of HF patients were performed. Endpoints were all-cause mortality, CV mortality, sudden cardiac death, ICD shocks. Odds ratios (ORs), Hazard ratios (HRs) and 95% confidence intervals (CI) were calculated. CENTRAL, EMBASE and MEDLINE were searched up, and only randomized controlled studies were included.

Results
Sixteen RCTs that enrolled a total of 11,140 patients were identified to evaluate all-cause mortality, resulting in an HR 0.83 (95% CI 0.72 to 0.96). When CV mortality was assessed, there was a significant difference between the RM group and SoC group, and the HR was 0.81 (95% CI 0.67 to 0.97) Moreover RM did not have an effect on the rate of sudden cardiac death and ICD shocks.

Conclusions
RM proved to be superior in reducing all-cause mortality and CV mortality compared to SoC despite of the heterogeneous study cohorts and unstandardized alert actions. However, the use of RM did not influence the occurrence of sudden cardiac death and ICD shocks.
Evaluation of CHA2DS2VASc scale as a tool of prognosis of death in transvenous lead extraction patients in long term follow-up
Authors: Wojciechowska C , Jachec W , Polewczyk A , Nowosielecka D , Tulecki L , Kutarski A 
Published: May 2024

Abstract

Background
CHA2DS2VASc scale is commonly used to risk stratification of stroke in atrial fibrillation patients. With the exception of female gender, the remaining components of the scale are also risk factors for long-term prognosis.

Aim
Assessment of the usefulness of the CHA2DS2VASc scale for predicting the short and long term risk of death in the population of transvenous lead extraction (TLE) patients.

Methods
Retrospective analysis of data of 3822 consecutive patients underwent TLE followed by to 6239 days: median (Q1-Q3) 1846 (852 – 3146).

Results
The strong corelation between number of CHA2DS2VASc scale points and mortality was detected both in 30-days, 1-year, 3-year and all time of follow-up (Spearman r for all follow-up = 0.983, p&lt;0.001). In all TLE population multivariable Cox regression shown that number of points of CHA2DS2VASc scale is independent predictor of death [HR=1.181; 95%CI (1.104-1.264), p&lt;0.001], alongside Carlson index, atrial fibrillation, infective TLE indications and renal dysfunction. A scale value higher by 1 point is associated with an increase in the risk of death by 18.1%. In female group the risk increased by 37.5% [HR=1.375; 95%CI(1.193-1.584), p&lt;0.001)] and in male group the risk increased by 22.00% [HR=1.220; 95%CI 1.110-1.342), p&lt;0.001)].

Conclusion
The commonly known stroke risk CHA2DS2VASc scale may be a useful tool for predicting the risk of death both in short and long-term observation in the group of patients after transvenous lead extraction.Table 1
Temporal order of atrial fibrillation and acute myocardial infarction and associated prognosis in the Danish Diet, Cancer, and Health cohort
Authors: Frederiksen T C , Christiansen M K , Benjamin E J , Olsen A , Jensen H K , Dahm C C 
Published: May 2024

Abstract

Background
Atrial fibrillation (AF) and acute myocardial infarction (AMI) share risk factors and are bidirectionally associated. Several studies found higher risks of outcomes in individuals with both conditions. Whether the risks of outcomes differ according to temporal order of AF and AMI is unclear.

Purpose
We aimed to assess the risks of heart failure (HF), ischemic stroke (IS) and all-cause mortality in individuals with both AF and AMI compared to only one. In addition, we assessed risks of outcome according to the temporal order of AF and AMI in individuals with both conditions.

Methods
The study was based on the Danish Diet, Cancer and Health cohort in which 57,053 men and women aged 50-64 years, with no diagnosis of cancer, participated. Assessment of AF, AMI and outcomes were based on diagnosis codes from the Danish National Patient Registry. We examined the risks of HF, IS and all-cause mortality during 10 years of follow-up in participants with both AF and AMI compared to only one and according to the temporal order of AF and AMI in participants with both conditions using Cox regression models.

Results
We identified 5,816 participants with newly diagnosed AF only, 3,448 with first AMI only, 348 with AF before AMI and 721 participants with AMI before AF. The multivariable-adjusted risks of HF, IS and all-cause mortality were higher among participants with both AF and AMI compared to participants with only AF or AMI (Figure 1). In participants with both AF and AMI, there was no difference in risk of HF (HR=0.92, 95% CI 0.72-1.17) or IS (HR=1.12, 95% CI 0.76-1.66) between participants with AF before AMI compared to AMI before AF. AMI before AF was associated with lower all-cause mortality compared to AF before AMI (HR=0.70, 95% CI 0.54-0.90) (Figure 2).

Conclusions
Risks of adverse outcomes were higher among participants with both AF and AMI compared to only AF or AMI. All-cause mortality, but not risk of HF or IS, differed according to temporal order with a lower mortality among participants with AMI before AF.Figure 1Figure 2
Cardiovascular mortality in patients with atrial fibrillation and physical activity intensity: delineating the threshold of vigorous activity
Authors: Lin Y , Chen Y Y , Ling L C , Hsieh Y C , Chien K L , Ling C H , Chen S A 
Published: May 2024

Abstract

Background/Introduction
There is a correlation between light-to-moderate physical activity and reduced atrial fibrillation (AF) incidence and cardiovascular risk. Vigorous activities reduced the benefits and increased the risk of AF. The exact threshold at which physical activity increases the risk of cardiovascular death (CVD) in patients with AF remains to be determined.

Purpose
To determine the threshold of vigorous activity in patients with AF.

Methods
In this study, data from 23856 individuals from the Taiwan Biobank (2017) were analyzed. Physical activity levels were quantified in metabolic equivalent task (MET) hours/week and categorized into four groups based on 20 MET-hour increments. The study employed Kaplan-Meier survival analysis and an adjusted generalized additive model (GAM) to assess the impact of physical activity on CVD risk (adjusting for age, sex, diabetes, hypertension, chronic obstructive pulmonary disease, and chronic kidney disease), with follow-up data from 2017 to 2022.

Results
Over a median 5.51-year follow-up, 238 AF cases (cumulative rate of AF: 0.998%) were identified (48.7% female, mean age 61.7 years). The linear model indicated a lower CVD risk in participants engaging in moderate physical activity (20-40 MET-hours/week; adjusted hazard ratio [HR]: 0.38, 95% CI: 0.16-0.95) compared to the reference group (0-20 MET-hours/week). Notably, the GAM model demonstrated a significant increase in CVD risk for activities exceeding 40 MET-hours/week after multivariable adjustment.

Conclusions
Physical activity levels and CVD risk in AF patients are correlated in a J-shaped manner. The CVD risk of AF decreased with mild to moderate physical activity. For AF patients, it establishes a critical threshold of 40 MET-hours/week beyond which there is an increased risk of CVD, thus clarifying safe physical activity limits.Figure 1:KM sruvival curveFigure 2:Smooth model of GAM
Heart failure events prediction algorithm for patients implanted with multi-brand CIED
Authors: Varma N , Boveda S , Ibnouhsein I , Faedda G , Rosier A , Singh J 
Published: May 2024

Abstract

Background
Heart failure (HF) hospitalizations are associated with poor patient outcomes and generate a large burden on healthcare systems. Mitigation is a priority. Among HF patients with CIEDs, existing HF algorithm-based management solutions are manufacturer and device-specific, which imposes limitations. The SignalHF universal algorithm was developed to democratize access to HF management solutions by enabling prediction of HF decompensation based on CIED sensors data agnostic to manufacturer.

Objective
FORESEE-HF study aims to validate the SignalHF machine learning score and alerting system by matching alerts generated by SignalHF from CIED-related stored data in a universal platform (Implicity™) with HF events available in the French national health database containing medico-administrative data on patients’ characteristics, hospitalizations and deaths across 10 years.

Methods
The study cohort consisted of 19,013 patients (pacemaker (PM) 7,711, ICD 6,022, CRT-D 4,367 and CRT-P 913; age 70.0 ± 13.3, male 70.7%). Co-primary endpoints were sensitivity of HF hospitalizations detection with HF as primary diagnosis, the unexplained alert rate per patient-year defined as alert states not followed within 30 days by a hospitalization with HF as primary or secondary diagnosis (UAR PPY), and the lower quartile on alerting time defined as the lower bound on the time-to-event of 75% of true alert states (see Table 1).

Results
SignalHF for ICD/CRT-Ds demonstrated a sensitivity of 60%, a UAR PPY of 0.66 and a lower quartile on alerting time of 35 days. For PM/CRT-Ps, SignalHF demonstrated a sensitivity of 46%, a UAR PPY of 0.47 and a lower quartile on alerting time of 37 days.

Conclusion
FORESEE-HF demonstrates that SignalHF is an improvement over existing HF monitors for ICD/CRT-Ds, while also providing the same capability for PM/CRT-Ps. Being an algorithm that can be easily activated through a universal CIED remote monitoring platform, SignalHF widens the pool of patients that can benefit from HF monitoring solutions.Table 1:Study coprimary endpointsTable 2:Study results per device type