bluuebunny/crossref_metadata_2025_split huggingface dataset:
The added value of abnormal regional myocardial function for risk prediction in arrhythmogenic right ventricular cardiomyopathy
Authors: Kirkels F P , Rootwelt-Norberg C , Bosman L P , Aabel E W , Muller S , Taha K , Van Osta N , Lie Ø H , Asselbergs F W , Lumens J , Te Riele A S J M , Hasselberg N E , Cramer M J , Haugaa K H , Teske A J 
Published: November 2023

Abstract

Background & aims
A risk calculator for individualized prediction of first-time sustained ventricular arrhythmia (VA) in arrhythmogenic right ventricular cardiomyopathy (ARVC) patients has recently been developed and validated. This study aimed to investigate whether regional functional abnormalities, measured by echocardiographic deformation imaging, can provide additional prognostic value.

Methods & results
From two referral centres, 150 consecutive patients with a definite ARVC diagnosis, no prior sustained VA and an echocardiogram suitable for deformation analysis were included (aged 41 ± 17 years, 50% female). During a median follow-up of 6.3 (IQR 3.1-9.8) years, 37 (25%) experienced a first-time sustained VA. All tested left and right ventricular (LV, RV) deformation parameters were univariate predictors for first-time VA. While LV function did not add predictive value in multivariate analysis, two RV deformation parameters did; RV free wall longitudinal strain and regional RV deformation patterns remained independent predictors after adjusting for the calculator-predicted risk (HR 1.07 [1.02-1.11]; p = 0.004 and 4.45 [1.07-18.57]; p = 0.040, respectively) and improved its discriminative value (from C-statistic 0.78 to 0.82 in both. Akaike information criterion change &gt;2). Importantly, all patients who experienced VA within 5 years from the echocardiographic assessment had abnormal regional RV deformation patterns at baseline.

Conclusions
This study showed that regional functional abnormalities measured by echocardiographic deformation imaging can further refine personalized arrhythmic risk prediction when added to the ARVC risk calculator. The excellent negative predictive value of normal RV deformation could support a watchful waiting strategy regarding ICD implantation in intermediate risk patients.Added value of functional abnormalities
Arrhythmic risk stratification of filamin C truncating variants carriers
Authors: Gigli M , Stolfo D , Barbati G , Sinagra G , Mestroni L 
Published: November 2023

Abstract

Background
Truncating variants in Filamin C (FLNCtv) are a rare cause of cardiomyopathy with heterogeneous phenotypic presentation and high incidence of life-threatening ventricular arrhythmias, including sudden cardiac death (SCD). Nevertheless, there is a residual gap in the definition of solid risk markers for the stratification of arrhythmic risk and the significance of conventional predictors (i.e. left ventricular ejection fraction [LVEF]) remains extremely controversial.

Purpose
The aim of this study was to analyze the risk profile and to identify the factors associated with increased risk of life-threatening arrhythmias in an international multicenter cohort of FLNCtv carriers.

Methods
Patients were retrospectively collected from 19 international tertiary care centers for genetic cardiomyopathies. Primary endpoint was SCD/major ventricular arrhythmias (MVA, i.e. sustained ventricular tachycardia and appropriate implantable cardioverter defibrillator [ICD] shocks). Multivariate Cox regression analysis was performed to identify the predictors of SCD/MVA, taking into account non-sudden cardiac death/heart transplant/destination left ventricle assist device as competing event and including family clusters in the model as clustering factor.

Results
Among the 326 included carriers (median age 45 years, IQR 33-57; 51% males), 120 (37%) were probands. 100 (31%) carriers had no clinical signs of overt disease; for the others, phenotypic presentation was heterogeneous (36% dilated cardiomyopathy, 17% arrhythmogenic left dominant cardiomyopathy, 4% arrhythmogenic right or biventricular cardiomyopathy, 11% minor phenotype). Median LVEF was 51% (IQR 35%-59%, 41% had LVEF&lt;50%), 16% had right ventricle dysfunction. During a median follow-up of 32 months (IQR 8-63), 60 carriers (18%) experienced SCD/MVA (65% probands, 97% with overt disease, median age at event 48 years, IQR 38-64, min-max 18-78). Among variables associated with the risk of SCD/MVA at univariable analysis, male sex, previous syncope and non-sustained ventricular tachycardia maintained a significant association with the primary outcome at multivariable analysis (Table), whereas there was no significant association between LVEF and the risk of SCD/MVA neither as a continuous nor categorical (i.e. LVEF&lt;50%) variable. In the subgroup of 175 patients with available cardiac magnetic resonance, 57% had late gadolinium enhancement with no significant association with the outcome.

Conclusions
In the largest worldwide cohort of FLNCtv carriers the high risk of SCD/MVA was confirmed. Three important factors emerged to be associated with higher arrhythmic risk and should be considered for decisions on ICD implantation. Remarkably, LVEF was not significantly associated with SCD/MVA risk. The higher risk observed in males compared with females advocates for prompt investigations on the influence of sex-related factors on the disease expression in genetic cardiomyopathies.
No association between COVID-19 vaccination and sudden cardiac death
Authors: Paratz E , Stub D , La Gerche A 
Published: November 2023

Abstract

Background
Global concerns regarding potential cardiac side effects of COVID-19 vaccination have been raised, particularly with regards to sudden cardiac death (SCD) in young people.

Methods
Data from April 2019 to March 2022 was obtained from a state-wide registry investigating all OHCAs aged 1-50 years old. Vaccination and COVID-19 rates for people aged 1-50 years old were derived from publicly-available data. The primary outcome was comparison of vaccination availability against young OHCA rates, unascertained causes of arrest or myocarditis. The secondary outcome was causes of young sudden death within thirty days of COVID-19 vaccination, with reference to age-matched normative data.

Results
2,242 people experienced OHCA during the study period (unascertained causes = 223, myocarditis = 13). No variation was seen in monthly rates of OHCA (p=0.7481), rates of myocarditis (p=0.7378) or unascertained cause of arrest (p=0.2323) according to vaccine availability. 38 people experienced sudden death within thirty days of vaccination and were referred for forensic assessment (vaccine types: BNT162b2=22, ChAdOx1 nCoV-19= 9, mRNA-1273=2, vaccination type not documented =5). No difference was seen in underlying causes of the sudden death compared to previously-published age-matched data (p=0.235).

Conclusion
A state-wide analysis of OHCA in the young did not show any increase in rates of overall OHCA, myocarditis causing OHCA or unascertained OHCA during the COVID pandemic or following the introduction of COVID-19 vaccination. Causes of death in young people experiencing fatal OHCA within 30 days of their COVID-19 vaccination were consistent with pre-pandemic causative profiles.
Risk factors and prognostic implications for new-onset heart failure with ventricular pacing - a nationwide study
Authors: Maiwand F , Rorsman C , Marinko S , Mortsell D , Chaudhry U , Wang L , Platonov P , Borgquist R 
Published: November 2023

Abstract

Background
Studies have shown that the incidence of new-onset heart failure (HF) is higher for patients receiving pacemaker therapy with traditional right ventricular pacing, compared to age matched controls. Conduction system pacing may overcome this, but is more expensive and technically challenging.

Objectives
To investigate risk factors and implications for long-term prognosis of new-onset HF in patients after pacemaker-implant, with the aim of identifying patients at high risk already prior to device implant.

Methods
All patients without preexisting HF, who received a pacemaker with a right ventricular lead in Sweden during the period 2005-2020, were identified via the nationwide Pacemaker Registry. Data was crossmatched with the population registry and national disease registries. Outcome was new-onset HF within 5 years post-implant, HF hospitalization and all-cause mortality.

Results
In all, 65579 patients met the inclusion criteria (10351 single chamber ventricular and 55228 dual chamber pacemakers). 13792 (21.0%) patients were diagnosed with HF within five years post-implant. Of these, 6244 (45.3%) were hospitalized for HF (see Figure 1). Patients with heart failure were older (80.6 vs. 76.7 years, p&lt;0.001), had a higher burden of comorbidities, and were more likely to die within five years compared to those without HF (41.2% vs. 19.7%, p&lt;0.001). Independent risk factors with more than 25% increased odds ratio for developing heart failure within 5 years included increasing age, diabetes, atrial fibrillation, chronic lung- and kidney disease, ischemic heart disease, and AV block. A combined score using these variables was strongly associated with increased risk of both HF-hospitalization (OR 1.48 [1.46-1.51], p&lt;0.0001) and 5-year mortality (OR 1.81[1.77-1.98], p&lt;0.0001). There was a progressively increasing risk proportional to the summed score. Patients with at least five points on the score had &gt;25% risk of new-onset heart failure within five years, and patients with at least seven points had &gt;25% risk of new-onset heart failure within two years. In figure 2 we present a suggested score model, based on the results.

Conclusions
Pacemaker therapy with a lead in the right ventricle was associated with &gt;20% risk of new-onset HF within five years. This in turn was associated with higher risk of death. Based on clinical risk factors, our proposed score can be used to identify patients at high risk for new-onset heart failure. These patients may be eligible for conduction system pacing or resynchronisation therapy. Randomized trials are needed to determine if a score-based pacing strategy (right ventricular or conduction system pacing) approach results in better clinical outcome, and if it is cost-effective.Included patients and risk of HF hosp.Decision algorithm based on results
Leadless vs. transvenous single-chamber pacing - propensity-matched comparison of outcomes
Authors: Amador R , Presume J , Carmo P , Carmo J , Santos A R R , Matos D , Rodrigues G , Santos P G , Costa F M , Carvalho M S , Cavaco D , Morgado F , Adragao P 
Published: November 2023

Abstract

Background
Clinical Trials have demonstrated the safety and efficacy of the leadless pacemaker. However, real-world outcome comparisons between patients receiving conventional VVI and leadless pacemakers are still scarce. The aim of this study was to evaluate short and long-term complications of patients receiving leadless pacemakers in comparison to a population of conventional VVI.

Methods
We conducted a single-centre retrospective study of patients receiving the leadless or a conventional VVI between 2014 and 2022. Propensity score matching was performed on 725 patients (156 leadless and 569 conventional) and according to age, sex, coronary artery disease (CAD), chronic kidney disease (CKD), haemodialysis and AF, with a 1:1 matching protocol without replacement (matching tolerance 5%).
Complications that occurred up to one month after implantation were considered acute and included access site BARC ≥ 3 bleeding events, pacemaker pocket hematoma requiring medical intervention (either drainage o antibiotic therapy), femoral access infection, pneumothorax, pericardial effusion, cardiac tamponade, and dysfunction of the implanted device. Long-term complications were defined as those occurring at least one month after implantation and included device infection, need for reintervention, and device upgrades due to left ventricular dysfunction. The primary outcome was a composite of acute and long-term complications.

Results
A total of 312 patients (80 [73 - 86] years, 63% male, 79% with AF and 7% on dialysis) were included, 156 within each group. The main indication for PM implantation was AF with low ventricular rate (48%), followed by atrioventricular block (31%) and sick sinus syndrome (13%). In total, 19 patients (16%) had a previously implanted device, and 14 (4%) had previously been submitted to lead extraction, of which 10 (71%) were due to device-related infection. All of these were more frequent in patients receiving the leadless pacemaker (p = 0.001).
During a median follow-up of 26 [11 - 47] months, a total of 32 patients (10%) had a complication related to the implantation of the device – table 1. While intra-hospital complications showed only a tendency towards higher incidence in the VVI group (5% vs 3%; p = 0.124), overall complications (16% vs 5%) and long-term complications (12% vs 2%) were higher in the VVI group (p &lt; 0.001 for both).
The Kaplan-Meier curves for the primary outcome showed a significantly lower event-rate for patients receiving the leadless pacemaker – Figure 1.

Conclusions
In this propensity-matched study, leadless pacemaker implantation was associated with a lower incidence of complications during follow-up, in comparison to conventional VVI pacemaker.
Mortality and appropriate therapies in ischaemic ICD recipients according to the electrophysiological study
Authors: Teodorovich N , Swissa M S , Diamante R , Jaber M , Cuciuc V , George J , Swissa M 
Published: November 2023

Abstract

Aims
Current guidelines recommend ICD implantation for primary prevention in patients with ischaemic heart disease and LVEF ≤35%. We aimed to access the value of the EP study in prediction of the arrhythmic events in ischaemic patients with reduced EF (≤35%) who underwent EPS and ICD implantation and do address the impact of ICD implantation on the all-cause mortality.

Methods
We compared the risk for all-cause mortality in ischaemic patients with negative and positive EPS with and without ICD implantation and compared the risk for appropriate therapy according to the results of the EP study of patients who underwent ICD implantation in our institution. The median follow-up was 84 months.

Results
Of 235 patients, who underwent EPS, 115 were negative (noninducible to VT). These patients were more likely to be female and did not differ in age, presence of diabetes, hypertension, atrial fibrillation or ejection fraction.
Kaplan-Meier survival analysis showed that there was no difference in mortality between the 2 groups (49.6% vs 44.2%, p=0.419). ICD was implanted in 168 patients: there was no difference in mortality between them (47%) and patients without implanted ICD (46.6%), p=0.861. This was true for patients with negative and positive EPS (p=0.136 and p=0.554, respectively)
Of 167 patients who underwent ICD implantation, 66 had negative EPS. Kaplan-Meier analysis showed that these patients were significantly less likely to receive appropriate therapy (7.6% vs 25.7%, p=0.003) and appropriate shock (0% vs 10.9%, p=0.004. The time to first appropriate ICD therapy was significantly longer in EPS negative patients (112 vs 93 months, p&lt;0.001). The incidence of inappropriate therapies was similar in both groups (2.6% vs 5.8%, p=0.221).

Conclusion
ICD implantation does not reduce mortality in ischaemic patients with reduced EF and both positive and negative EPS. Patients with negative EPS and implanted ICD had much lower incidence of appropriate ICD therapies and no appropriate shocks. The policy of implanting ICDs to all ischaemic patients with EF&lt;35% should be reconsidered.ICD shocks according to the EPS resultsMortality with and without ICD
Lead extraction of very old leads using the PISA technique - experience of a portuguese tertiary care center
Authors: Ferreira A , Valente B T , Cunha P S , Portugal G , Lousinha A , Ferreira R C , Oliveira M 
Published: November 2023

Abstract

Background
The "Pisa Technique" (PT) is an increasingly used method of lead extraction (LE) that is associated with the lowest rate of complications reported in the ELECTRa Registry. Lead dwell time has been recognized as the highest risk factor for extraction failure and procedure-related complications.

Purpose
To investigate the safety and efficacy of LE, using the PISA technique, of very old cardiac implantable electronic devices (CIED) leads.

Methods
Patients submitted to LE of very old leads (with an implant duration of more than 10 years) between February 2013 and October 2022 (Old group), were compared with a contemporary cohort of patients subjected to LE of leads with a shorter implant duration (New group). The PT was used in all patients. Demographic, clinical, and patient-related variables, complications, mortality, and reimplantation data were assessed.

Results
A total of 150 very old leads were removed from 86 patients in the Old group, and a total of 305 leads were removed from 171 patients in the New group during the study period. Regarding the baseline characteristics, patient mean age was 69.5±16.9 years, 82.6% were male. Nine patients (10.5%) had cardiac resynchronization devices, 11 (12.8%) implantable cardioverter-defibrillator devices, and 66 (76.4%) pacemaker systems (mostly DDD). Of the total LE in the Old group, 88.4% were due to CIED infection (44.1% with valvular or lead endocarditis) vs 75.9% (p=0.464) vs the New group. The mean "age" of the extracted leads was 163.7±53.4 vs 46.6±34.9 months, and there were more of active fixation in the New group 35.2% vs 58.9%, p&lt;0.01. A previous attempt of LE had been done in 5.8% vs 11.1% (p=0.172) of the patients, there were more previous generator replacements in the Old group 67.4% vs 23.7% (p&lt;0.01). The radiographic success rate of the attempted lead extractions was similar between both groups 90.7% vs 96.5% (p=0.063). The clinical success rate was slightly lower in the Old group 95.3% vs 99.4% (p=0.031). The procedure major complications rate in the Old group was 2.3% (there were 2 cases of cardiac tamponade that required sternotomy with no laceration of the SVC observed) vs 1.2% (p=0.294) in the New group. Minor complications occurred in 11.6% vs 8.8% (p=0.466) of the LE (mostly comprised of infected pocket hematomas). No deaths occurred during the procedures, and there was no extraction-related mortality in both groups.

Conclusion
Our center’s experience with the PISA technique confirms the method’s safety and feasibility for the percutaneous extraction of very old CIED leads.
Complications according to intrathoracic versus extrathoracic venous access for cardiac device implantation: results from the PLACE (Planning Lead Access for Cardiac Electrostimulation) study
Authors: Dell'era G , Ghiglieno C , Palmisano P , Floris R , Pimpini L , Coluccia G , Fais L M , Colombo C , Malacrida M , D'amico A , Mazzoleni F , Antonicelli R , Delogu G , Accogli M , Patti G 
Published: November 2023

Abstract

Background and Aims
The choice of the vascular access for cardiac pacing devices (CIED) implant may impact on patients outcome. Recent studies and consensus documents encourage the use of an extra-thoracic access to prevent adverse events. In this large, multicenter, retrospective study we report the impact of leads access on post-procedural outcome.

Methods
Consecutive patients receiving a CIED from 2008 to 2019 in 4 high-volume Italian hospitals were enrolled. Short- and long-term complications (i.e. pneumothorax, cardiac tamponade, pocket decubitus, pocket hematoma, lead dislodgement, lead failure) were collected and their relationship with the type of vascular access (extra- vs intra-thoracic, i.e. cephalic vein/extra-thoracic axillary vein vs subclavian vein puncture) was analyzed. Primary endpoint was the occurrence of at least one complication during follow-up.

Results
A total of 4,443 patients were enrolled; 3,374 (75.9%) received a pacemaker (PM) and 1,069 (24.1%) an implantable cardioverter defibrillator (ICD). Mean follow-up was 1,630±1,010 days. At least one complication occurred in 7.6% of patients. At multivariate Cox regression analysis, adjusted for baseline confounders, the presence of structural heart disease (HR 1.59, 95%CI 1.21-2.10; p=0.001), anticoagulant therapy at implantation [HR 1.31, 95%CI 1.0004-1.71; p=0.05) and female gender (HR 0.78, 95%CI 0.63-0.98; p=0.03) were associated with the primary outcome measure. Extra-thoracic access did not reduce the risk of complications compared to intra-thoracic access (HR 0.97, 95%CI 0.76-1.25 p=0.81). The use of both accesses in the same patient conferred a significant increase in the risk of complications (HR vs single approach:1.95, 95%CI 1.41-2.69; p &lt;0.001).

Conclusions
The choice of a different vascular access (intra- vs extra-thoracic) does not impact on post-procedural complications in patients receiving CIED. In particular, the intra-thoracic subclavian vein puncture by experienced operators is not related to a poorer outcome. The need for both types of access in the same patient (i.e. increased procedure complexity) increases the risk of post-procedural complications.Graphical abstract
Social and clinical predictors of 90-day readmission after hospitalization for pacemaker implantation in patients with dementia: insight from the National Readmissions Database
Authors: Kodali M , Atluri R , Vallabaneni M , Yalamanchili S , Shoura S , Vardar U 
Published: November 2023

Abstract

Background
Patients with dementia are one of the most common subpopulations that are at risk for readmission and are responsible for a significant burden on American healthcare resources. In addition to this, many studies have shown poor outcomes with dementia patients undergoing invasive procedures. Nonetheless, dementia patients presenting with conditions such as high degree heart block and sinus node dysfunction still require pacemaker implantation (PMI).

Purpose
We aimed to analyze social and clinical predictors of readmission in those with Dementia who were admitted for PMI.

Methods
We utilized the National Readmission Database (NRD) from 2018 to identify adults hospitalized for pacemaker implantation (PMI) who also had dementia. We included those who were readmitted within 90 days after the index admission. We excluded elective and traumatic admissions. A multivariate cox regression model was used to identify independent predictors of readmission.

Results
In our study, 7,529 patients with dementia who were hospitalized for pacemaker implantation (PMI) were discharged alive. Within 90-days from discharge, 1,250 (16.6%) were readmitted. The top three causes of readmission were heart failure (12.2%), sepsis (8%), and acute kidney injury (5%). Readmitted patients had more comorbidities (≥3; 64.4% vs 57.3%; p&lt;0.001), higher rates of intubation (4.9% vs 1.59%; p&lt;0.001) and annual income &lt; $44,000 (29.39% vs 25.7%; p=0.03). In-hospital mortality (3.9% vs 1.27%; p&lt;0.001) was higher during readmission. Figure 1 shows the Forrest plot of multivariate analysis of independent factors associated with readmissions.

Conclusion
We identified predictors of readmission after hospitalization for PMI in dementia patients such as household income, leaving against medical advice, federal insurance, heart failure, atrial flutter, and liver disease during their index admission. Healthcare systems should use this data to have an open discussion with caregivers and family members to weigh the prognosis on a case by case basis prior to pacemaker implantation in this population.