bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of 1st and 2nd generation leadless pacemaker in sinus rhythm patients with chronic ventricular pacing for complete atrioventricular block
Authors: Clementy N , Lenormand T , Bodin A , Bisson A , Babuty D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Leadless pacemakers (LPMs) represent a seductive alternative to conventional pacing. First generation of Micra transcatheter pacing system was able to provide single-chamber VVI(R) pacing mode only, with a potential risk of pacemaker syndrome in sinus rhythm patients. A 2nd generation system (AV) now provides atrioventricular synchrony through atrial mechanical sensing capability (VDD mode).

Purpose
We sought to compare VR and AV systems in patients with sinus rhythm and chronic ventricular pacing for complete atrioventricular block.

Methods
All consecutive patients implanted with an LPM in our department for complete atrioventricular block were retrospectively screened. Patients with atrial fibrillation, sinus dysfunction, or ventricular pacing burden &lt;20% at 1-month post-implantation were excluded.

Results
A total of 80 patients – 35 VR (2015-2020) and 45 AV (2020-2021) – were included. VR and AV patients had similar baseline characteristics, except for that VR patients being older (82±8 versus 77±9 years, p=0.01). Mean ventricular pacing burden was 75% in the VR and 79% in the AV group (p=0.63). In AV patients, median atrioventricular synchronous beats rate was 77%, 67% having a &gt;66% rate. An E/A ratio &lt;1 as measured on echocardiography was the only independent predictor of accurate atrial mechanical tracking (adjusted OR=13, p=0.006). One-year survival rate was 86% in the VR group and 95% in the AV group (adjusted p=0.21). Two patients in the VR and 0 in the AV group eventually developed pacemaker syndrome in the 1st year post-implantation (p=0.07).

Conclusion
In sinus rhythm patients with chronic ventricular pacing for complete atrioventricular block implanted with an LPM, atrial mechanical sensing algorithm allowed significant atrioventricular synchrony in most patients, and was associated with no occurrence of – otherwise rare – pacemaker syndrome.
Radiotherapy and cardiac implantable electronic devices: a nurse-based protocol in a single centre experience
Authors: Quintarelli S , Marini M , Agostini R , Demozzi M , Pellizzari S , Guarracini F , Coser A , Vanoni V , Magri E , Lisimberti R , Delana A , Menegotti L , Trianni A , Bonmassari R 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
An increasing number of patients need cardiac implantable electronic devices (CIED) for bradycardia or to prevent sudden cardiac death. At the same time many patients require radiotherapy for oncologic reasons. Interaction between CIEDs and ionizing radiations may cause several dysfunctions: electromagnetic interferences due to oversensing, CIED reset, drainage of the battery, hardware damage to the pulse generator and to the lead-tissue interface.

Purpose
An adequate planning is expected to guarantee the safety of CIED patients, reducing the potential complications. We describe our protocol in use and its application.

Methods
In 2016 an internal protocol was written to standardize the approach to CIED patients undergoing radiotherapy. Cardiology Department, Radiotherapy Unit and Medical Physics were involved in the draft. We stratified patients in high and low risk groups according to the CIED characteristics (ICD vs pacemaker), electro-dependency (yes vs no), and the estimated radiation dose (&lt; 2 Gy: 2-10 Gy, &gt; 10 Gy).
Low risk group:
- Non pacemaker (PM) dependent patients, estimated dose &lt; 10 Gy
- PM dependent patients, estimated dose &lt; 2 Gy
High risk group:
- PM dependent patients, estimated dose &gt; 2 Gy
- Non-PM dependent patients estimated dose &gt;10 Gy
- ICD patients
Two EHRA certificated nurses followed up the patients before, during and after the radiotherapy. Low risk patients received weekly in office evaluation during radiotherapy course. High risk patients were scheduled for daily in office check plus monitoring during each radiotherapy session, ICD therapy was temporarily switched off during each radiotherapy session.
An in office evaluation was planned 1, 3, 6 and 12 months after the end of radiotherapy course until 2019, since 2020 all patients were given remote monitoring for accurate follow up.

Results
Between 2016 and November 2022 101 patients with CIED underwent radiotherapy in our facility. Clinical characteristics of the patients are described in Table 1. EHRA certificated nurses managed 1282 radiotherapy sessions without any complication. A transient underestimation of ICD longevity was the only software error occurred.

Conclusions
The reported protocol assured a safe radiotherapy course for all our CIED patients. Given the limited data available about the interaction between the newest CIEDs and radiotherapy, we opted for a high safety profile. The EHRA certified nurse’s involvement allowed to optimize personnel resources.
Feasibility and short-term outcomes of left bundle pacing in paediatric patients: a case series
Authors: Chiramel S , Shenthar J , Reddy S , Banavalikar B , Padmanabhan D , Krishnappa D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Government

Background
Chronic RV apical pacing in pediatric patients can lead to LV dysfunction. Left bundle pacing has been shown to preserve LV function in adults. The feasibility and outcomes of left bundle pacing in pediatric patients are unknown.

Objectives
To study the feasibility, safety, and short-term outcomes of pediatric left bundle branch pacing (LBBp).

Methods
Patients &lt; 18 years with class I or II indication for pacing were the study subjects. All patients had dual-chamber pacemaker implantation from the right or left side.
We did the device implantation either under conscious sedation, or general anesthesia, after 6 hours of fasting and intravenous hydration with normal saline at 1 ml/kg/min. A venogram was performed on the ipsilateral to the implantation site from the cubital venous access with 5-10 ml of non-ionic contrast side to delineate the venous anatomy before the procedure. Venous access was obtained through two separate punctures of the extrathoracic axillary vein using an 18 G puncture needle and a 0.025 glide wire. The vein was sequentially SelectSecure 3830 4F lead, and C315HIS sheath was used for LBBp. An additional loop was added to the ventricular lead to account for the growth of the patient. The primary outcomes were successful, stable LBBp. The secondary outcomes were lead stability over three months with no implant-related complications or death.

Result
This case series has six patients of whom 2 were males and with a mean age of 9.5 years, and a mean body weight of 25.5 Kgs. All patients but one had undergone intracardiac repair (4 VSD, 1 ASD). The pacing indication was symptomatic AV block in five and sick sinus syndrome in one patient. At implant, the mean R wave was 12.83±4.8 mV, mean ventricular threshold was 0.6 ± 0.1 V at 0.5 ms pulse width, mean ventricular impedance of 737.3W ±131.5 ohms. The mean procedure time was 65± 20min, the mean fluoroscopy time was 14.63±13.3 min and the mean contrast volume was 30±20ml and the mean paced QRS duration was 98.5±16.5 ms and V5 LVAT 62.66±22.33ms. During follow follow-up of 4±3 months, the lead parameters were stable with a ventricular threshold of 0.8±0.1V at 0.5ms pulse width impedance of 689±130.2 ohms. There was no lead perforation, dislodgement, or death.

Conclusion
LBBp in the pediatric population is feasible and safe with good -lead stability and no complications in the near term.
Dyssynchrony assessment by ultra-high-frequency electrocardiography: a single numerical parameter to identify the relationship between right and left ventricular depolarization
Authors: Jurak P , Halamek J , Leinveber P , Plesinger F , Smisek R , Viscor I , Vondra V , Nguyen U C , Prinzen F , Curila K 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): grant number NU21-02-00584, the CAS project RVO:68081731, the project National Institute for Research of Metabolic and Cardiovascular Diseases (Programme EXCELES, ID Project No. LX22NPO5104) - Funded by the European Union – Next Generation EU.

Background
The common criterion for assessing synchronous activation during single and biventricular pacing is QRS duration (QRSd). The novel conduction system pacing (CSP) techniques provide more physiological ventricular activation but less clear effects on QRSd. In these circumstances, a more detailed and visual assessment of ventricular synchrony than QRSd alone can be insightful.

Purpose
To investigate whether differences between various modes of CSP can be better differentiated by ultra-high-frequency ECG (UHF-ECG) than by QRSd.

Methods
UHF-ECG recordings were acquired in 199 bradycardia patients with narrow QRS complex during intrinsic rhythm, selective (sHBP) and non-selective His bundle (nHBP), selective (sLBBP) and non-selective left bundle branch (nsLBBP) pacing, and left (LVSP) and right ventricular septal pacing (RVSP). Lead positions were certified using X-ray and QRS morphology. Electrical dyssynchrony (e-DYS) was calculated from UHF-ECG activation times as the maximal time difference between the peaks of ECG leads V1-V6. Positive e-DYS indicates delayed left ventricular (LV) activation, whereas negative e-DYS means delayed right ventricular (RV) activation.

Results
The Figure shows the relationship between QRSd and e-DYS for individual types of stimulation on an intrinsic background (black). All pacing, except sHBP, modes significantly increased QRSd. QRSd was significantly larger during RVSP than all other pacing modes, but QRSd was not able to differentiate between nsHBP, sLBBP, nsLBBP and LVsp. In contrast to QRSd, e-DYS was positive during nsHBP and RVSP and negative during sLBBP, nsLBBP and LVSP (p&lt;0.001).

Conclusion
e-DYS assessed with UHF-ECG provides more detailed information on the ventricular activation and is more superior in differentiating between CSP pacing modes, compared to standard QRSd. sHBP, nsHBP, nsLBBp, and LVSP create activation patterns closest to normal ventricular activation.
Implant failures in conduction system pacing: single centre experience
Authors: Marcantoni L , Deluca F , Pastore G , Baracca E , Marsiglia S , Cappato E , Fornasaro M , Manzato E , Tiribello A , Raffagnato P , Pigaiani C , Zanon F 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Conduction system pacing (CSP) ensures physiological ventricular activation and avoids the dyssynchrony associated with traditional myocardial pacing. New dedicated tools makes it possible to increase procedural success but not yet comparable to myocardial pacing.

Objective
Retrospective analysis of 3-years CSP implants, focusing on implant failures.

Methods
From January 2019 to June 2022, 639 CSP implant were performed (91% PMs and 9% ICDs). Single-chamber ICDs implants and devices replacements were excluded from the analysis because the conduction system pacing could not be an option in those cases. Pacing indications were standard with prevalence of AV block (51%); AF with slow ventricular rate 14.5%; sick sinus syndrome 14.5%; ablate&pace 4%; heart failure or cardiomyopathy 14.5%, re-interventions after malfunction of a previous implant 1.5%. Mean age was 78±9 years; 62% were males.

Results
CSP was successfully achieved in 605 cases (94.6%). In 34 cases lead implant failed. Reasons for failure were "anatomical" in 15 cases (5 due to excessive right atrial enlargement, 5 due to severe pulmonary hypertension; 3 due to scar in the septum and 2 due to stenosis of the venous axis in upgrading procedure) and "technical" in 19 cases (5 due to unacceptable high thresholds, 10 due to uncorrected bundle branch block, 4 due to dislodgment during cutting without reposition). In 52% of the CSP implant failures, an underlying cardiomyopathy or heart failure were documented. Considering CSP failure, the implant was concluded with standard biventricular pacing in 18 cases (in 4 cases the coronary sinus implantation also failed) while 16 implants were concluded with the lead implanted in the septum or apex.

Conclusions
conduction system pacing is feasible in daily clinical practice; available tools allow to achieve high procedural success rate (94.8% implant success rate in our experience). Procedural failures were 5.2% and were caused by anatomical (44%) or technical reason (56%).
Characterization of the effects of right ventricular and left bundle branch area pacing on the QRS complex
Authors: Sales Belles C , Melero Polo J , Cabrera Ramos M , Vadillo Martin P , Mayo Carlos V , Palacios Rosales S , Martinez Cortes J P , Minchole Lapuente A , Pueyo Paules E , Ramos Maqueda J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): TED2021-130459B-I00 LMP94_21

Introduction
Right ventricular pacing (RVP) has been the treatment of choice for patients with atrioventricular block and sinus node disease for the last decades . It is well known that RVP ventricular may cause ventricular dyssynchrony and could lead to left ventricular dysfunction in 20% of patients, and therefore could increase the risk of heart failure, atrial fibrillation and cardiovascular mortality. Left bundle branch area pacing (LBBAP) has recently emerged as a new physiological pacing modality that can circumvent the limitations of RVP. The purpose of this study was to compare changes induced by RVP and LBBAP in the standard 12-lead ECG by the analysis of QRS complex characteristics in order to asses ventricular dyssynchrony.

Methods
ECG recordings from 134 patients (82 LBBAP, 52 RVP) with indication for anti-bradycardia therapy were acquired before and after pacemaker implantation. Patients were grouped into narrow and wide baseline QRS using a threshold for the QRS duration of 120 ms. Median beats were calculated at baseline and 24 hours post-implantation states for each patient. ECG markers describing ventricular activation were measured, including: 1) QRS duration (QRSd) from QRS onset to QRS end; 2) QRS area (QRSa), computed from the individual areas in orthogonal X, Y and Z leads calculated using the Kors conversion matrix; 3) a new index QRS50 proposed to estimate the ventricular activation time from the first three components of the singular value decomposition of the median QRS complex.

Results
Note that the QRS characteristics showed similar values in baseline for both pacing techniques. In patients with narrow QRS, we found that paced QRS characteristics remained similar from the basal QRS in LBBAP group whereas in RVP group they worsened. The three markers, QRSd, QRSa and QRS50, increased after RVP by 34 ms, 68 uVs and 22 ms, respectively (p&lt;0,001). In patients with wide QRS, LBBAP significantly reduced QRSd, QRSa and QRS50 while RVP increased QRSa and QRS50 and left QRSd unchanged.

Conclusion
In patients receiving a pacemaker for anti-bradycardia therapy, LBBAP led to more synchronized ventricular activation than RVP measured from QRS duration- and area-related characteristics.
Screw-in attempts and success rates in left bundle branch area pacing lead implantation
Authors: Haeberlin A , Seiler J , Kozhuharov N , Baldinger S H , Servatius H , Madaffari A , Thalmann G , Kueffer T , Muehl A , Tanner H , Roten L , Reichlin T , Noti F 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Left bundle branch area pacing (LBBAP) represents a novel cardiac pacing approach that overcomes limitations of conventional right ventricular (septo-) apical pacing. Feasibility and early safety have been shown previously. However, technical limitations (non-dedicated leads, limited availability of suitable implantation sheats) still may preclude successful conduction system pacing (CSP) lead implantation. So-called drilling and entanglement effects can prevent lead implantation at a suitable site and multiple screw-in attempts may be required. However, lead implantation may ultimately still be unsuccessful.

Purpose
To evaluate the number of total screw-in attempts until abandonment of LBBAP lead implantation during the procedure.

Methods
We prospectively assessed 170 consecutive LBBAP lead implantation attempts at our center from 09/2021 to 11/2022. All implanters had previous experience with His-bundle pacing lead implantation. Successful conduction system pacing was established according to standard criteria (R-wave peak time in V6, V1-V6-interpeak interval, programmed stimulation or visibility of a left bundle potential) and pacing thresholds &lt;2V/0.5ms. The number of screw-in attempts and decision of LBBAP lead implantation abandonment was at the operator’s discretion.

Results
Patient baseline characteristics and procedural outcomes are shown in the table (percentages and median values with interquartile range in brackets). Overall CSP lead implantation success rate was 91%. Two patients (1%) experienced complications (one atrial lead dislodgement, one pneumothorax). Median number of screw-in attempts in all interventions was 2 (interquartile range [IQR] 1-4, maximum 12). If implantation was successful, a maximum of four attempts provided already 90% of the overall chance of success (figure). Additional lead implantation attempts rarely provided an additional benefit but prolonged overall implantation duration.

Conclusion
To balance implantation success rates with procedure duration, the number of screw-in attempts during LBBAP lead implantation may be limited to 4-5 attempts. Bail-out strategies (implantation of a cardiac resynchronization pacemaker or a conventional pacemaker) may be considered if CSP lead implantation is unsuccessful after 4-5 attempts.
Isolated PR prolongation in patients undergoing transcatheter aortic valve implantation
Authors: Perel N , Tovia-Brodie O , Schnur A , Glikson M , Michowitz Y 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
New conduction disturbances are common complications following transcatheter aortic valve implantation (TAVI). The last ESC guidelines recommended electrophysiological study (EPS) or long-term monitoring for patients with new LBBB above 150 ms or one that is associated with PR prolongation (IIa indication). For patients with preexisting conduction abnormality and further PR or QRS prolongation EPS or long-term monitoring are also recommended but with a IIb recommendation. The data regarding the prognosis and management of patients with isolated PR prolongation is limited.

Purpose
Evaluate the need for permanant pacmaker implantation, occurance of syncope and mortality during the 1st year following Transcatheter aortic valve implantation

Methods
All patients undergoing TAVI at Shaare Zedek Medical Center were retrospectively reviewed. All patients underwent at least 1 ECG prior and daily post the procedure. Patients with isolated PR prolongation &gt; 20 ms compared to baseline ECG were included. While patients with preexisting permanent pacemaker (PPM), complete AV block or any peri or post procedural QRS widening &gt; 20 ms were excluded. Patient were followed for 1 year for the occurrence of syncope, PPM or death.

Results
Excluding patients with preprocedural PPM, 1028 patients were reviewed. Compared to baseline ECG, 124 (12%) patients had isolated PR prolongation, of whom 88 (71%) and 36 (29%) had baseline narrow and wide QRS respectively. During follow-up none of these 88 patients with baseline narrow QRS required in hospital PPM, while only 2 patients with baseline wide QRS required in hospital PPM. During 1 year follow-up, 6 patients (4.8%) died and no one had syncopal episode or need for PPM.

Conclusion
Post TAVI, isolated new PR prolongation is not associated with an adverse outcome including syncope or progression to complete heart block and need for PPM at 1 year post the procedure. These finding may be considered when evaluating these patients post the procedure.
Learning curve for left bundle branch area pacing with standard stylet-driven pacing leads
Authors: Yu G , Kim H T , Yu H T , Joung B Y , Pak H N , Lee M H 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
His bundle pacing (HBP) was developed as a physiological conduction system pacing to complement the problem of conventional right ventricular pacing (RVP) related to dyssynchrony. Recently, left bundle branch area pacing (LBBAP), which overcomes the shortcomings of HBP, has been implemented. Most studies on initial experiences with LBBAP have reported that it was achieved through a lumen-less pacing lead (LLL) with a fixed helix design; however, there are situations in which LLL cannot be used. This study aimed to evaluate the initial experience and learning curve of LBBAP using a standard stylet-driven lead with an extendable helix design.

Methods
The study included 265 patients who underwent LBBAP or conventional RVP performed by operators without previous LBBAP experience at our hospital in Korea between December 2020 and October 2021. LBBAP was performed using a stylet-driven pacing lead with an extendable helix. The learning curve was evaluated by analyzing fluoroscopy and procedure times.

Results
LBBAP was successful in 65 of 69 (94.2%) patients during the observation period. In 65 patients who underwent LBBAP, mean fluoroscopy and procedural times were 17.1 ± 17.2 minutes and 64.2 ± 33.5 minutes, respectively. The learning curve for achieving LBBAP plateaued after the 24th case, with a gradually shortening procedure time.

Conclusion
During the initial experience with LBBAP, fluoroscopy and procedural times improved with increasing operator experience. For operators who were experienced in cardiac pacemaker implantation, the steepest part of the learning curve was over the first 20-25 cases. It is shorter than the previously reported learning curves of HBP.