bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left ventricular afterload reduction by transcatheter aortic valve implantation acutely alleviates right ventricular pacing-induced left ventricular dysfunction in patients with aortic stenosis
Authors: Ruppert M , Lakatos B K , Osztheimer I , Molnar L , Zima E , Geller L , Kosztin A , Straub E , Papp R , Tarjanyi Z , Ladanyi Z S , Turschl T , Kovacs A , Merkely B 
Published: November 2023

Abstract

Introduction
In patients with left bundle branch block (LBBB) cardiac function has been found to be particularly sensitive to alterations in left ventricular (LV) afterload. Nevertheless, whether the detrimental hemodynamic effect of right ventricular pacing (RVP)-induced electromechanical dyssynchrony on LV function is also associated with afterload dependency, has not been investigated yet.

Purpose
Hence, in the current study we sought to examine the acute effect of RVP on LV function in patients with aortic stenosis (AS) before (with elevated afterload) and after (without elevated afterload) transcatheter aortic valve implantation (TAVI).

Methods
Patients with a previously implanted permanent pacemaker (PM) and significant AS referred for TAVI at our heart and vascular center university were screened for this observational study. Only those patients who had an intrinsic, regular, narrow QRS or right bundle branch block (RBBB) morphology rhythm were included. From 2022 March to 2023 February, nine patients with a DDD PM (with sick sinus syndrome and maintained AV conduction) and four patients with a VVI PM (with atrial fibrillation and complete AV block but stable junctional escape rhythm) were enrolled. Following TAVI, four patients were excluded due to the development of new-onset persistent LBBB. Transthoracic conventional and advanced echocardiography and non-invasive blood pressure monitoring were performed immediately before TAVI and on the second postoperative day. The measurements were carried out during intrinsic QRS rhythm and during frequency-matched RVP as well. Global longitudinal strain was determined by speckle-tracking echocardiography, then using LV pressure curves estimated from systolic blood pressure and mean aortic gradient, global myocardial work index (GMWI) was calculated to assess LV contractility.

Results
Mean aortic gradient was decreased after TAVI (40.2±3.6 vs. 6.7±1.3mmHg before vs. after TAVI, P&lt;0.001) indicating successful reduction of LV afterload. Compared to the intrinsic QRS rhythm, RVP decreased GMWI before TAVI (GMWI: 1967±206 vs. 1240±174mmHg% intrinsic QRS vs. RVP, P&lt;0.001) and after TAVI (GMWI: 1399±149 vs. 1020±121mmHg% intrinsic QRS vs. RVP, P=0.019) as well. Nevertheless, the extent of RVP-induced LV contractility impairment (expressed as ΔGMWI) was significantly alleviated after pressure unloading therapy (ΔGMWI: -37.1±6.6 vs. -24.5±7.8% before TAVI vs. after TAVI, P=0.024).

Conclusion
Our preliminary results indicate that RVP-induced LV dysfunction is afterload dependent. Hence, in patients with AS and a high percentage of RVP, TAVI might entail substantial functional improvement.
Impact of clinical frailty on the outcome of pacing for bradyarrhythmias in a district general hospital population
Authors: Warraich M , Haggag A , Ayyaz A , Sunni N 
Published: November 2023

Abstract

Background and Aims
There is good evidence for mortality with increasing age, heart disease, peripheral vascular disease, pulmonary disease and renal disease in implantable cardiac defibrillators. And while multimorbid states and fragility are considered in decision to offer for more complex cardiac electronic device implants1,2 we aimed to characterise how much frailty and co-morbidities impact mortality in patients receiving simple bradyarrhythmia cardiac pacing device implants.

Methods
Retrospective examination of 700 consecutive novel standard bradyarrhythmia cardiac device implants (DDD, VVI, AAI) at Walsall Manor Hospital between 01/01/2016 to 28/02/2021 was undertaken through the electronic patient record. Patients’ frailty was calculated with Rockwood Frailty Score (RFS) and comorbidities at the time of implant recorded.3 Prospective follow up until 14/02/2023 was conducted, allowing at least a 2 year follow-up for all surviving patients. Results were analysed with Kaplan-Meier survival curves and Hazard Ratios (HR) and Risk Ratios (RR).

Results
Mean age of implant was 78.4±10.3 with mortality rate of 87/700 (12.4%) at one year and total 282/700 (40.3%). Overall, a RFS of 5 or more was associated with death overall HR 2.05 (95% CI 1.61-2.60) and 3.42 (95% CI 2.23-5.24) within 1 year (Fig. 1).
Heart failure (OR 2.38, 95% CI 1.59-3.57), valvular heart disease (OR 3.19, 95% CI 2.08-4.89), atrial fibrillation/flutter (OR 1.44, 95% CI 1.09-1.91), chronic kidney disease (OR 1.89, 95% CI 1.296-1.72), malignancy (OR 1.91, 95% CI 1.08-3.36) were important co-morbidities of death within one year of implant. Ischemic heart disease and cognitive impairment including dementia demonstrated a trend towards worse mortality but did not reach significance (Fig. 2).

Conclusion
High frailty score as well as comorbidities including heart failure, valvular heart disease, atrial fibrillation, chronic kidney disease and malignancy indicate increased risk of early death after novel implant of bradycardia cardiac pacing device implants. Although advanced age alone is not a barrier to offer pacing, consideration should be given to advanced frailty and multimorbid states which may detract from any perceived benefit bradyarrhythmia correction may offer. These data have impacted our shared decision making during the consent process with our patients and in our multidisciplinary team discussions.Figure 1Figure 2
Development and validation of a nomogram predicting all-cause mortality for patients with an implantable cardioverter-defibrillator
Authors: Zhou B , Sun X , Zhao S , Chen K , Hua W , Su Y , Yang J , Liang Z , Xu W , Tang M , Yan H , Zhang S 
Published: November 2023

Abstract

Background
For patients with high risk of sudden cardiac death, despite the benefits of an implantable cardioverter defibrillator (ICD), some patients are still at a high risk of death. Death risk assessment of ICD patients is beneficial to the clinical management of such patients.

Purpose
The purpose of this study was to develop and validate a nomogram predicting all-cause mortality for patients with an ICD.

Methods
We retrospectively analyzed the data of multicenter ICD registration study (SUMMIT study) from 2010 to 2014 in China. A total of 617 ICD patients from regions where the enrollment ranked top five formed a development cohort. The physical activity monitored by ICD and clinical data were collected. Univariate and multivariate COX regression analyses were used to screen mortality predictors and construct the nomogram. The performance of nomogram was evaluated by the C index and the calibration curve. A total of 196 ICD patients from other regions formed a validation cohort, and the nomogram constructed by the development cohort was further evaluated in the verification cohort.

Results
In the development cohort, physical activity, diabetes and left ventricular end-diastolic diameter were selected as mortality predictors by univariate and multivariate proportional hazard model analysis. The nomogram was constructed by these three factors. The C index of the nomogram was 0.80 (95% confidence interval, 0.75-0.84). The calibration curve showed that the predicted survival probability of the nomogram was in good agreement with the actual survival probability. In the validation cohort, the C index of the nomogram was 0.74 (95% confidence interval, 0.64-0.84), and the calibration curve still maintained good consistency.

Conclusion
Our study develops and validates a nomogram predicting all-cause mortality for patients with an ICD by integrating the physical activity monitored by ICD and clinical data. The nomogram performs well and can provide personalized death risk assessment for ICD patients.Figure 1Figure 2
Chronic safety and performance of the extravascular ICD: results from the global EV ICD Pivotal study
Authors: Boersma L , Friedman P , Murgatroyd F , Manlucu J , Knight B P , Clementy N , Leclercq C , Amin A , Merkely B P , Birgersdotter-Green U M , Chan J Y S , Biffi M , Knops R E , Wiggenhorn C , Crozier I 
Published: November 2023

Abstract

Background
Implantable cardioverter defibrillators (ICDs) prevent sudden cardiac death in patients at high risk for ventricular arrhythmias, but conventional systems carry a risk of transvenous (TV) lead-related complications. The novel extravascular ICD (EV ICD) may reduce some of these complications, while offering anti-tachycardia pacing (ATP), pause prevention pacing, and a device of similar size and projected battery longevity as a TV ICD, by placing a lead substernally. The EV ICD Pivotal study demonstrated EV ICD safety and performance for termination of ventricular arrythmias at 6 months. Longer-term performance is unknown.

Purpose
To report the chronic safety and performance of the EV ICD system.

Methods
The extravascular implantable cardioverter defibrillator (EV ICD) Pivotal study was a prospective, international, single-arm, premarket clinical study. Patients with a class I or IIa indication for a single-chamber ICD per ESC or ACC/AHA/HRS guidelines were enrolled. Freedom from major system- and/or procedure-related complications at 18 mo was evaluated, as well as conversion of arrhythmias by anti-tachycardia pacing (ATP) or shock through all available follow up. Rates of ATP success were evaluated using the generalized estimating equation (GEE) and simple proportions.

Results
Implantation was attempted in 316 patients: 74.7% male, age 53.8±13.1 years, 82% primary prevention, left ventricular ejection fraction of 38.9%±15.4%, and New York Heart Association Class I (23.4%) or II/III (65.5%).
Of 299 implanted patients (average follow up 16.2±7.2 mo), 19 experienced 80 spontaneous, appropriately treated arrhythmic episodes: 37 treated by ATP, 15 by ATP and shock, and 28 by shock alone with a Kaplan-Meier (KM) estimated 6.8% of patients experiencing appropriate therapy by 18 mo (Figure). Of discrete episodes treated with shock, 21/21 (100%) were successfully terminated. ATP was delivered in 12 patients, successfully treating 35/52 episodes (67.3%; GEE adjusted 59.0%). Inappropriate shocks occurred in 35 patients through all follow up, with a rate of 10.2% at 1 year.
The KM estimate of freedom from major EV ICD system-or procedure-related complications rate through 18 mo was 91.9% (95% CI: 88.2% to 94.4%). The most common event was lead dislodgment (10 events in 9 patients) identified 0 to 120 days post-implant, predominantly due to anchoring technique.

Conclusion
The safety and effectiveness of a novel EV ICD system with a substernal lead extends through chronic follow up. Shocks were avoided in nearly half of all spontaneous episodes because of the availability of ATP.Figure
Marked differences in ICD therapy frequencies between phenotypes
Authors: Zheng C , Christensen A H , Joens C , Risum N , Bosselmann H S , Philbert B T , Frosted R , Bundgaard H 
Published: November 2023

Abstract

Background
Implantable cardioverter defibrillators (ICD) are implanted due to a broad range of cardiac conditions according to guidelines.

Purpose
The aim of this study was to compare the distribution of ICD therapies across different cardiac diseases.

Methods
In this descriptive study, we included patients from Eastern Denmark with an ICD implanted up until November 2021. Data was obtained from the national ICD registry and the diagnosis leading to implantation of the ICD was registered. ICD interrogations and number of episodes of appropriate ICD therapies (shock/anti-tachycardia pacing (ATP)) were obtained. End of follow-up was November 8, 2021 or date of death or heart transplantation. Cumulated numbers of therapies were calculated for each patient during the follow-up period (shock/ATP therapies per 1,000 patients per year).

Results
Data on 3,068 patients (median (IQR) age at implantation 65 years (56-72)) across 10 cardiac disorders was obtained (Figure). A total of 1,403 patients had the ICD implanted as primary prophylaxis and 1,554 as secondary prophylaxis and in 111 patients it was unclear. Mean follow-up time of 595 years per diagnostic subgroup (210-12,911 years). The median (IQR) shock/ATP rate per 1,000 patients per year was 1.47 (0.70-2.62). The numerically highest shock/ATP rate of 28.9 therapies per 1,000 patients per year was seen in patients with arrhythmogenic right ventricle cardiomyopathy and the lowest shock/ATP rate of 0.05 therapies per 1,000 patients per year was seen in patients with ischemic heart disease. In patients with ischemic heart disease, the shock/ATP rate per year was 0.06 in patients with an ICD implanted as primary prophylactic and 0.15 in patients with an ICD as secondary prophylactic.

Conclusion
The frequency of ICD shock/ATP therapy varies several-fold between cardiac disorders, with the highest rate in patient with arrhythmogenic right ventricle cardiomyopathy and the lowest rate in the major group of patients, i.e. patients with ischemic heart disease. These findings may indicate a need for adjustments of patient selection for ICD implantation.
Left ventricular anterolateral site is the preferable left ventricular lead position for an upgrade to biventricular pacing
Authors: Ogano M , Iwasaki Y , Okada T , Tanabe J , Shimizu W , Asai K 
Published: November 2023

Abstract

Background
Cardiac resynchronization therapy (CRT) is a well-established treatment for symptomatic heart failure with electrical dyssynchrony. The LV lead position in patients with left bundle branch block is usually recommended at the LV posterolateral to the lateral site, which is the latest electrical activation site. In contrast, the preferable LV lead position in patients who plan to upgrade from conventional RV apical pacing to CRT remains unclear.

Purpose
This study aimed to identify the preferable LV lead position for upgrading to CRT from conventional RV apical pacing.

Methods
An electrophysiological study was performed on patients who underwent ablation for atrial fibrillation. The electrode catheters were positioned at the RV apex, LV anterolateral, and LV posterolateral sites via the coronary sinus branches. During RV apical pacing, the activation time from the RV apex to the LV anterolateral and posterolateral sites was measured, and the activation time ratio to QRS duration was calculated. Biventricular pacing from both the RV apex and LV anterolateral or LV posterolateral sites was performed, and the difference in QRS duration and LV dP/dt compared to only the RV apical pacing state was measured.

Results
We enrolled 37 patients who exhibited anterolateral and posterolateral LV coronary sinus branches. During RV apical pacing, the average activation time ratio to QRS duration was higher at the LV anterolateral site than at the LV posterolateral site (0.89±0.07 vs. 0.71±0.11, P &lt;0.001). The shortening ratio of QRS duration during biventricular pacing compared to baseline RV apical pacing was greater at LV anterolateral site than at the LV posterolateral site (45.7±18.0% vs. 32.0±17.6%, P &lt;0.001). The improvement ratio of LV dP/dt during biventricular pacing was also better from the LV anterolateral site than from the LV posterolateral site (12.7±8.9% vs. 3.7±8.2%, P &lt;0.001).

Conclusion
LV lead position in patients who plan to upgrade to CRT from conventional RV apical pacing is preferably at the LV anterolateral site.
Biventricular or conduction system pacing for cardiac resynchronization therapy: a proposed treatment algorithm based on interventricular conduction delays
Authors: Landra F , Marallo C , Taddeucci S , Sisti N , Pica A , Stefanini A , Tavera M C , Pagliaro A , Baiocchi C , Santoro A 
Published: November 2023

Abstract

Background
Cardiac resynchronization therapy (CRT) is usually performed with biventricular pacing (BiVP), but recently conduction system pacing (CSP) has been proposed as an alternative in case of unsuccessful coronary sinus lead implantation. However , further evidence is needed to determine when CSP should be used in lieu of BiVP to improve clinical benefit.

Purpose
To assess the clinical benefit of a treatment algorithm based on interventricular conduction delays (IVCD) to choose between BiVP or CSP in candidates to CRT.

Methods
Consecutive patients presenting at our Institution from January 2018 to December 2020 with an indication to CRT were prospectively enrolled in the study group (delays-guided resynchronization group, DRG). IVCD were measured after left ventricle (LV) lead positioning in a lateral or posterior-lateral cardiac vein, when feasible, using endocavitary electrogram. Treatment algorithm based on IVCD was used to decide whether to leave LV lead to perform BiVP or pull it out and perform CSP. An historical cohort of patients who underwent CRT from January 2016 to December 2017 independently from IVCD was used as a control group (standard resynchronization group, SRG). The primary endpoint was a composite of cardiovascular mortality, heart failure (HF) hospitalization, or urgent unplanned clinic visits at 1 year after the date of intervention.

Results
Study population consisted in 292 patients, of which 160 (54.8%) in the DRG and 132 (45.2%) in the SRG. Age, sex, HF etiology, NYHA class, left ventricular ejection fraction and QRS duration and morphology did not differ between the two groups. In the DRG 41 of 160 patients underwent CSP based on treatment algorithm (25.6%). The primary endpoint was significantly reduced in the DRG (35/160, 21.8%) compared to SRG (48/132, 36.4%)(hazard ratio (HR): 1.72; 95% confidence interval (CI):1.12-2.65; p=0.013).

Conclusion
A treatment algorithm based on IVCD shifted 1 patient every 4 from BiVP to CSP, with consequent reduction in cardiovascular deaths, HF hospitalizations or urgent unplanned clinic visits after implantation. Therefore, its application could be useful to determine whether to perform BiVP or CSP in CRT candidates.Treatment Algorithm
Contemporary management and awareness of cardiac implantable electronic device infection: a European survey
Authors: Weil J , Atar D , Rao A 
Published: November 2023

Abstract

Background
Cardiac Implantable Electronic Device (CIED) infections pose a significant risk to patient health and can be life-threatening. Despite this, there exist significant disparities in knowledge and a lack of adherence to established guidelines regarding their management and prevention.

Purpose
In order to gather valuable insights into overall awareness of CIED infections and the current practice patterns in Europe, we conducted a survey aimed at evaluating the knowledge and skills of healthcare practitioners and identifying areas that require improvement.

Methods
A double-blinded online survey was conducted among General Cardiologists (GCs) and Electrophysiologists (EPs) in Europe who were not skilled in lead extraction, and in full-time, active practice between April and May, 2022. The survey collected key demographic data and used multiple-choice questions as well as two clinical vignettes to assess the skills and knowledge.

Results
In total, 240 physicians (120 EPs and 120 GCs) from four European countries (Germany, UK, Italy, and France) responded to the survey. About 83% of the physicians were affilicated with public hospitals. On average, EPs had 16 years and GCs had 17 years in practice, with experience managing 305 and 233 CIED patients, respectively. The majority of the respondents (87% EPs, 84% GCs) would replace the full device in the case of a system infection. However, when dealing with pocket infection with negative blood culture and no fever, only about 36% of EPs and 20% GCs would recommend complete system replacement, with GCs more likely to only replace the device without lead removal. Most EPs (92%) were familiar with EHRA/HRS guidelines for CIED lead management and extraction. Significantly more EPs in Germany (27%) were unfamiliar compared to EPs from other three countries (0%, 0% and 3% for UK, Italy and France, respectively). Overall, less GCs (89%) were familiar with guidelines, with significantly more UK GCs (27%) unfamiliar compared to GCs from Italy (7%) and France (0%). Majority of physicians (83% EPs and 82% GCs) believe that Class I indications for lead management are frequently adhered to in their facility, with more physicians in France (40%) believing that their facility always adheres as compared to those in other countries (7%, 7%, and 17% for Germany, UK and Italy, respectively).

Conclusions
Although there is a high familarty with guidelines for CIED lead management and extraction, gaps in adherence to infection management recommendations in practice still exist. There is a need of education to increase guideline awareness and understanding of the severity of pocket infection, especially among GCs and physicians in certain countries.
Cassandra speaks: a case series of unanticipated subcutaneous ICD premature battery depletion in a single-centre experience
Authors: Lazzeri M , Carecci A , Bertelli M , Quaranta A , Spadotto A , Bartoli L , Massaro G , Angeletti A , Frisoni J , Valzania C , Diemberger I , Martignani C , Ziacchi M , Galie' N , Biffi M 
Published: November 2023

Abstract

Background
Subcutaneous ICDs (S-ICD) are a valuable option in sudden cardiac death prevention. The main advantage over conventional transvenous ICDs is the absence of intravascular hardware for patients without the need for cardiac stimulation, resynchronization therapy or anti-tachycardia pacing. The claim of reduced lead-related complications has on the contrary been challenged by recent warnings of unexpected lead fracture. Moreover, concerns related to premature battery depletion (PBD) leading to unanticipated device replacement are increasing.

Purpose
To evaluate retrospectively the incidence of unanticipated S-ICD premature battery depletion in a single-centre experience.

Method
168 consecutive patients implanted with S-ICD from February 2015 to November 2022 in our tertiary cardiology centre were included in this study. 4 patients moved to other sites and were thus lost to follow-up, leaving a total of 164 patients. PBD was defined as the occurrence of battery depletion requiring generator replacement earlier than 60 months post-implantation in the absence of therapy being delivered, or as a result of manufacturer recommendations.

Results
Most patients were implanted for primary prevention (101 patients, 60%). The main aetiology was hypertrophic cardiomyopathy (47 patients, 28%), followed by arrhythmogenic (35, 21%) and dilated idiopathic cardiomyopathy (24, 14%). Mean age and left ventricular ejection fraction at baseline were 46±18yrs and 51±16%, respectively.
Over a total follow up period of 44±25 months, at 58±17 months following implantation 19 (11,6%) patients needed early replacement due to PBD, while 2 (1.2%) patients had lead fracture after respectively 41 and 26 months, for a total of 12,8% of patients with system-related complications. In addition to those patients requiring early replacement due to PBD or lead fracture, two underwent S-ICD extraction due to infection. Analysis of freedom from unanticipated PBD per year of implantation showed higher rates in years 2016 and 2017, with 67% and 27% of all implanted patients, respectively (Figure 1).

Conclusions
In this study, the incidence of PBDs appear to be higher than reported in literature though confined to a limited device series. However, if on the contrary the trend should remain remarkably high, that would not only endanger patients health due to repeated replacements, but also pose a huge economic burden to health systems.