bluuebunny/crossref_metadata_2025_split huggingface dataset:
Catheter ablation of ventricular arrhythmias in arrhythmogenic cardiomyopathy - comparison of different approaches and results of genetic testing
Authors: Rafaj A , Peichl P , Wichterle D , Stojadinovic P , Cihak R , Krebsova A , Kautzner J 
Published: November 2023

Abstract

Introduction
Arrhythmogenic cardiomyopathy (ACM) is a disease characterized by fatty-fibrous remodeling of the myocardium and a high risk of ventricular tachycardia (VT). Catheter ablation is an effective method that prevents VT recurrences. Although the arrhythmogenic substrate in ACM is located dominantly in the epicardium, in some patients VT can be effectively suppressed only by endocardial ablation.

Purpose
Retrospective analysis of catheter ablation results of VT in patients with ACM and right ventricular involvement.

Methods
Between 2001-2021, catheter ablation of VT was performed in 51 patients (mean age 43±18 years, 9 women) with a clinical diagnosis of ACM and right ventricular involvement. Pathogenic/likely pathogenic mutation was detected during the genetic testing in 80% of patients. Repeated ablation procedures were necessary to suppress VT (a total of 1.9±1.3 procedures/patient). According to the approach, patients were divided into three groups: A - endocardial ablation only (n=20); B - endocardial ablation first, followed by epicardial approach (n=15); C- primary epicardial approach (n=16).

Results
The primary epicardial approach (group C) compared to the endocardial approach (group A+B) was associated with better VT free survival (Figure 1, p&lt;0.02) and significantly fewer procedures needed to suppress arrhythmia recurrences (1.1±0.2 vs 2.3±1.5 procedures/patient; p&lt;0.005). Patients in whom an endocardial approach (group A) was sufficient to control arrhythmias were significantly older than patients in whom an epicardial approach (group B) had to be used (52.9±15.1 vs 36.0±16.0 years; p&lt;0.001). The frequency of pathogenic mutations did not differ among groups (A - 83% vs B - 71% vs C - 86%; p=n.s.). The most commonly found mutation was in the gene for plakophilin 2 (51% of all patients).

Conclusion
Epicardial VT ablation in ACM patients with right ventricular involvement leads to the most effective control of arrhythmias. Endocardial ablation alone may be sufficient to control VT in older patients. The identification of a pathogenic/likely pathogenic mutation does not seem to be relevant for choice of ablation approach.Figure 1
The benefit of a double ventricular extra stimuli protocol to improve functional substrate mapping during ablation of ventricular tachycardia. - The S3-VT-FREE project
Authors: Regany M , Guichard J B , Vazquez S , Pellicer B , Serrano J , Roca I 
Published: November 2023

Abstract

Introduction
Ablation of ventricular tachycardia (VT) based on substrate-based mapping has been proposed to itemize areas of interest identifying areas of low-voltage, late potentials (LPs), and deceleration zones (DZs). However, partial delineation of targets for ablation is likely responsible for a suboptimal long-term success rate.
The abnormal electrograms (EGMs), featuring low-voltage near-field components may be hidden within the high-amplitude far-field signal. We hypothesized that the acquisition of functional mapping after double ventricular extrastimuli (S3 protocol) would uncover relevant areas of functional substrate that could be missed during sinus or S1 map.
We aim to evaluate the potential benefit and the feasibility of functional substrate mapping using an S3 protocol for VT ablation and to assess its colocalization with detected corridors using late gadolinium enhancement magnetic resonance imaging (LGE-MRI).

Methods
We included consecutively 29 patients with structural cardiomypathy who underwent a VT ablation. The S3 protocol included: (1) assessment of the ventricular effective refractory period (ERP), (2) pacing protocol from the apex of the right ventricle with S1 x 6 (cycle length: 600ms) followed by S2 (ERP+30ms) and S3 (ERP+50ms). Electroanatomical mapping was acquired with the EnsiteX system (Abbott, IL) using HD Grid catheter and omnipolar signals. ILAMs were used to identify deceleration zones and areas of late potentials were identified for all maps. A non-invasive substrate assessment was done with LGE-MRI and post-processing with a commercially available system (ADAS3D, Spain) with automated identification of corridors.

Results
The S3 protocol was completed in 25 of the 29 procedures (86.2%). The repeated induction of ventricular arrhythmias did not allow for full protocol of the S3 protocol in 4 patients (13.8%).
The functional substrate identified during the S3 activation mapping was significantly more extensive than the one identified using S1 and S2 activation mappings (p&lt;0.05) (Table). The S3 protocol unmasked a higher number of DZs (p&lt;0.01), a wider area of LPs (p&lt;0.01), and a longer duration of the DZs (p=0.01).
All DZ maps were compared with preprocedural cardiac magnetic resonance. The number of DZs matching with conduction corridors identified by LGE-MRI was higher in the activation mapping of S3 compared with the S1 and S2 ones (p=0.02).
After VT ablation based on an S3 protocol, 88% of patients have been VT free during a median follow-up of 9 months.

Conclusions
This novel substrate-based protocol to assess the ventricular functional substrate is feasible in the majority of patients (86.2%) and allows for a better identification of targets for ablation and could facilitate VT ablation, and improve the prognosis of the patients after ablation.
Effect of ICD on patients with improved EF in idiopathic dilated cardiomyopathy
Authors: Dhaliwal S , Al-Sadawi M , Aslam F , Kim P , Gier C , Henriques M , Tao M 
Published: November 2023

Abstract

Background
The efficacy of implantable cardioverter defibrillator (ICD) therapy in patients who had heart failure with improved ejection fraction (HFimpEF) above guidelines indication for ICD (&gt;35%) during generator change is still controversial. This meta-analysis assesses the impact of ICD therapy in patients with HFimpEF with EF &gt;35% and patient with NICM.

Methods
Databases were searched for studies reporting the association between ICD in patients with NICM and HFimpEF and ventricular arrhythmias (VA) and sudden cardiac death (SCD); including Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. The minimal follow up duration was one year.

Results
A total of 38 studies and 13,538 patients (5,829 with improved EF vs 7,709 with EF &lt;35% during follow up) were included; mean follow up was 43 months (ranging between 12 to 74 months). Mean age was 63.5 and 75% were males. Patients with HFimpEF with ICD, wither alone or as part of CRT therapy, was associated with lower risk of VA and SCD (OR 0.39, 95% CI 0.32-0.47; P&lt;0.01; annual rate 4.1 vs. 8%). Sub-analysis for patients with ICD for patient with NICM was associated with lower risk of VA and SCD (OR 0.25, 95% CI 0.1-0.62; P&lt;0.01; annual rate 2.9 vs. 10.2%). (Figure)

Conclusion
Improved EF is associated with reduced VA but with still elevated risk in HFimpEF especially in NICM.
Time for a new destination: foregoing surgical sympathectomy after successful stellate ganglion block in patients with refractory ventricular tachycardia
Authors: Dye C , Larsen T , Patel P , Huang H , Sharma P 
Published: November 2023

Abstract

Background
Electrical storm (ES) is defined as &gt;3 episodes of sustained ventricular arrhythmias in 24 hours and is associated with increased mortality. ES portends a poor prognosis with limited effective treatment options. Stellate ganglion block (STGB) can be used in patients with ES for temporary control of VT. When STGB is successful, patients can be referred for surgical sympathectomy for longer term management. We postulated that STGB can be used as a bridge to other treatments for refractory VT.

Purpose
To evaluate the efficacy of STGB as a bridge to interventions other than surgical sympathectomy in patients with refractory VT. Additionally, we assessed STGB as an adjunctive therapy to medical optimization when the cause for ES is temporary (e.g., QT prolonging medications, acute ischemia) foregoing the need for long term interventions.

Methods
This is a single center retrospective study. We enrolled 12 consecutive patients admitted from July 2018 to September 2022 for ES that received a STGB. The primary clinical outcome was cessation of VT for 24 hours beginning 1 hour after STGB was performed. Secondary clinical outcome of the study was freedom from VT until discharge after STGB. Primary safety outcomes were major procedural complications or death within 48 hours after STGB.

Results
Sixty-seven percent of the patients were male, with a mean age of 58 years and an average left ventricular ejection fraction of 32%. Two-thirds of the patients had ischemic VT of which half were status post CABG and the other half were status post PCI. In the first 24 hours after STGB, 91% of patients were without recurrent VT. Fifty percent of patients did not have recurrent VT from 24 hours after SGB was performed until discharge. Three patients were referred for catheter ablation. No patients received surgical sympathectomy. There were no major complications or deaths within 48 hours of STGB.

Conclusion
STGB is a safe and effective procedure that can be utilized as a bridge to VT interventions other than surgical sympathectomy. For patients with ES, STGB is also effective at temporarily suppressing VT allowing time for medical optimization and the withdrawal of provoking agents which perpetuate ES. Further research is necessary to determine optimal timing and patient selection for STGB when used as a bridge for alternative VT therapies.Clinical Impact of VT after STGBElectrical Storm Characteristics
Lower intercostal spaces depicted better final r wave than V1 at left bundle branch pacing implant attempts
Authors: Ayala Valani F G , Mardigyan V , Ayala Valani L M , Ayala Paredes F 
Published: November 2023

Abstract

Background
Left bundle pacing lead positioning implies screwing the lead until a final ‘r’ wave is seen in V1 ECG lead (unipolar pacing), depicting the left part of the septum has been reached. That final vector should be better seen if V1 is placed parallel rather than perpendicular to the lead tip, so we used lower intercostal spaces for V1, to test this hypothesis. Failure to see the 'r' wave could increase the screwing efforts owing to perforation.

Methods
Leads V1 to V5 were positioned from 2nd to 6th right sided intercostal spaces during implants. Fluoroscopy was used to ascertain the lead most parallel to the final tip position. Inferior leads were used to confirm anterior, mid or posterior implants. A ratio between the ‘r’ wave amplitude and the QRS amplitude was used to compare the intercostal space depicting better the final ‘r’ wave.

Results
19 patients were implanted using this new set-up of precordial leads (see figure 1); 32% were female; mean age at implant was 77,6 +/-8,04 years (range 58,3-90,6 years old); all but two were Medtronic 3830 leads. Regarding the position 26%, 32% and 42% of the leads ended in the posterior, mid or anterior septum respectively. Mean unipolar pacing QRS was 126ms +/- 18,2ms and mead LVAT was 76ms +/-19ms. Only 31% of patients had the lead placed parallel to the 4th intercostal space; 13% had the lead parallel between the 4th and the 5th space; and 56% of implants, had the 5th or 6th space as the most parallel to the lead tip. Finally in a consistent way, mean ratios of ‘r’/QRS amplitude were increasing at every intercostal space from: 0,12/2nd; 0,24/3rd; 0,3/4th; 0,35/5th and 0,45/6th (except for most posterior implanted leads where ratios varied less); this finding was even greater for anterior implanted leads (see figure 2).

Conclusion
Final ‘r’ wave is better depicted when V1 is lowered to 5th or 6th intercostal space, as the leads are mostly implanted parallel to these observation sites; but the septum is also a 3-D structure and when the leads are implanted too anterior, there is almost no way to see the final ‘r’ wave in usual 4th space V1, as the vector is directed mostly in the opposite direction (posteriorly and downward), while a lower placed V1 allows some of that vector to be depicted anyways. Placing V1-V3 leads in 4th-6th intercostal spaces could prevent excessive screwing and reduced perforation rates specially in anterior implanted leads.LAO: V1 to V5 placed 2-6 R intercostal'r' not seen until 5th-6th R intercostal
Reevaluation of the indications for permanent pacemaker implantation after cardioneuroablation
Authors: Wileczek A , Stodolkiewicz-Nowarska E , Reichert A , Kustron A , Sledz J , Biernikiewicz W , Hering D , Stec S 
Published: November 2023

Abstract

Background
Cardioneuroablation(CNA) is promising and innovative method to cure vagally mediated bradycardia.However, according to current ESC2021 guidelines patients may have indications for permanent pacing. CNA is still referred to patients as an experimental and alternative method,not being recommended in guidelines due to too small amount of evidence.The study sought to validate criteria for permanent pacemaker(PPM) implantation,discontinuation of PPM therapy(PPMT) and risk of PPM implantation after CNA in a large population of patients qualified for electrophysiologic study(EPS),Extracardiac vagal nerve stimulation(ECVS) and CNA.

Methods
Data were collected from POLish prospective multicentre CardioneuroAblation registry(POLCA) with comprehensive management, interdisciplinary consultations, state-of-art autonomic tests, atropine tests, EPS as well as ECVS. Shared-decision making was used to developed patient-oriented therapy with clear declaration of fulfilling indications for PPMT according to ESC guidelines,(when applicable) and CNA only as alternative and developing technique.

Results
A total of 195 consecutive adult patients(mean age:55,6+/-14,3 years; min 20,0 Q1 44,96-Q2 58,4 - Q3 67,2; max 82;107(54%)females,) underwent first CNA. Out of them, 17(8,2%) had already PPM. According to current guidelines 100/178(51%) patients had de novo indications for PPM implantation prior to CNA including: SND(n=88,45%), AVB(n=21, 10%), TBS (n=26, 13%), CI-VVS(n=41; 21%),M-VVS(n=1;0,5%), CI-CCS(n=41;21%) or mixed etiologies (n=45;23%). Indications for de novo PMT were present in 32(37%) patients above age 60. During moderate-term (23,7+/-10,3 months), no patient died, and only 10 had syncope (which was diagnosed as orthostatic or vasodepressive). Despite preprocedural positive atropine test and positive ECVS, 6 out of 195 patients (had early and elective PPM implantation due to coexistence of functional and structural bradycardia(n=3) or bradycardia recurrences(n=2) or severe sinus chronotropic incompetence(n=1).
There were 7(3,5%) major complications (tamponade (n=2), pericarditis(n=2), pericardial effusion(n=1), femoral aneurysm(n=1), pneumothorax(n=1) of CNA. Only 4 of patients with indications for PPM implantation before CNA still had those indications during follow-up. Out of 6 patients with late PPM implantations after CNA, 1 patient had syncope due to development of AVB.

Conclusions
About 51%patients referred for CNA had indications for PPM therapy. CNA in subgroup of patients with functional bradycardia is becoming alternative choice to PPMT and allowed to give up PPM implantation at least temporarily in 96%patients without prior PPMT. However some patients require PMT due to failed CNA or reinnervation,but also co-existence or development of complex structural bradyarrhythmias.
Intermuscular placement and defibrillation with the extravascular ICD: a single-centre experience
Authors: Carecci A , Lazzeri M , Quaranta A , Bertelli M , Spadotto A , Angeletti A , Massaro G , Bartoli L , Frisoni J , Martignani C , Valzania C , Diemberger I , Ziacchi M , Galie' N , Biffi M 
Published: November 2023

Abstract

Background
Extravascular (EV) implantable cardiac defibrillators (ICD) with substernal lead have recently proved to be a safe and effective alternative to conventional transvenous (TV) and subcutaneous defibrillators (S-ICD), owing to the possibility to deliver antitachycardia and asystole pacing while saving intravascular hardware. The proposed implantation technique for EV-ICDs is a subcutaneous pocket along the mid axillary line, although an intermuscular ICD placement can potentially reduce the risk of pocket complications, device migration and improve patient comfort and aesthetic outcomes.

Purpose
exploring the safety and feasibility of extravascular ICDs implantation with a substernal coil and an intermuscular generator placement.

Methods
Seventeen patients with a class I or IIa ICD indication either for primary (14/17) or secondary (3/17) prevention underwent EV-ICD implantation in our centre as part of the EV ICD Pivotal Study from May 2021 to November 2022. Access and tunnelling along the retrosternal space were performed based on current standard recommendations for EV-ICDs implantation. An intermuscular pocket for generator placement was obtained between the latissimus dorsi and the serratus anterior muscles beyond the left mid-axillary line.

Results
Mean age, BMI, NYHA class and left ventricular ejection fraction (LVEF) were respectively 53±9yrs, 25.3 ±6 kg/m2, 2 ±0.7, and 39±14%. The main aetiology was non ischemic cardiomyopathy (12/17), including 3 arrhythmogenic cardiomyopathy patients and one with hypertrophic cardiomyopathy.
The implantation was successful in 16 (6 females) out of 17 patients, with one implant failure due to inadequate sensing (0,5 mV); the median sensing amplitude was 2,3 mV (min = 1,3 mV; max = 5,8 mV), with R1R2 being the final sensing vector chosen for 14/16 and R2-Can for 2/16. Defibrillation Testing (DFT) was performed in all patients: a 15 J shock terminated induced ventricular fibrillation (VF) in 12/16 patients, 20 J terminated VF in 3, a single patient had VF terminated at 30 J. No patient had infection or skin erosion or complained pain/discomfort at the pocket site along an 18±4 months follow-up. Only 1/16 patients had ventricular tachycardia at follow-up, successfully treated by the device.

Conclusions
Intermuscular placement of the EV ICD may be a feasible and reliable alternative to a subcutaneous one in terms of defibrillation efficacy, enabling patient comfort and aesthetic acceptance in thin-habit or young patients. Additional long-term data and larger patient cohorts are required to confirm its advantage compared to the subcutaneous placement.
Local anesthesia during S-ICD implantation gives similar post procedural pain perception as sedation
Authors: De Veld J , Smeding L , El-Chami M F , Marquie C , Nordbeck P , Tilz R R , Lambiase P D , Quast A B E , Brouwer T F , Cassidy C , Boersma L V A , Betts T R , Burke M C , Wilde A A M , Knops R E 
Published: November 2023

Abstract

Introduction
The PRAETORIAN-DFT trial hypothesises that subcutaneous implantable cardioverter defibrillator (S-ICD) implant without defibrillation test (DFT) but with PRAETORIAN score is non-inferior to S-ICD implant with DFT with regard to first shock efficacy in spontaneous events. Various anesthesia protocols are used for S-ICD implant, ranging from local to general anesthesia. Sedation of the patient during S-ICD implantation is required because of DFT. Without the need for DFT, local anesthesia may suffice, thereby reducing the logistical burden associated with sedation and general anesthesia. However, data comparing the effects of various anesthesia methods are lacking.

Purpose
This prespecified analysis of the PRAETORIAN-DFT trial aims to investigate the effect of three different anesthesia methods on (post-)operative pain during S-ICD implant.

Methods
In the PRAETORIAN-DFT trial (NCT03495297), 965 patients were randomised to DFT (N=483) or no DFT with PRAETORIAN Score calculation (N=482). Choice of anesthesia protocol was per local routine and physician discretion and was listed as local anesthesia (LA), monitored anesthesia care (MAC) or general anesthesia (GA). Patients under LA who underwent DFT, had MAC or GA during the test. Pain scores were assessed using the Numerical Rating Scale (NRS), prior to implant (baseline) and at 1-3 hours, 5-7 hours and 1 day post implant. Mean change in NRS compared to baseline was calculated at every time point. Exact pain scores as well as mean change in NRS were compared between anesthesia methods using a Kruskal Wallis Test.

Results
Pre-implant pain questionnaires were completed by 97% of patients. In the complete study cohort, 149/965 (15%) of implants were performed under LA, 327/965 (34%) under MAC and 489/965 (51%) under GA. This distribution did not differ between the randomised arms (p=0.301). There was no difference in NRS or mean change compared to baseline between the groups at any time post implant. The mean change in NRS compared to baseline was highest at 5-7 hours post implant in all groups (Figure). Analysis with patients under LA and MAC or GA during DFT as independent group showed similar results.

Conclusion
There was no difference in pain perception after S-ICD implantation between implant under local anesthesia, MAC and general anesthesia. These results confirm that S-ICD implantation under local anesthesia is feasible and sedation may be no longer necessary if defibrillation testing becomes redundant.Mean changes in NRS compared to baseline