bluuebunny/crossref_metadata_2025_split huggingface dataset:
A tertiary centre experience of routine exercise testing as part of subcutaneous ICD vector mapping
Authors: Hall P , Walton J , Patel P A , Leyva-Leon F 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The pre-implant patient screening process (vector mapping) for subcutaneous defibrillators (S-ICD) seeks to determine eligibility for implantation. It broadly requires at least one of three available vectors (primary, secondary or alternate) to pass under all conditions to mitigate risk of inappropriate device therapies. Vector mapping protocols currently require only supine and sitting/standing ECG. However, the standard operating procedure (SOP) in our centre also includes mapping at peak exercise, actioned after audit data highlighted an association between exercise and sensing complications (T and R wave changes, rate-related bundle branch block and noise/myopotential over-sensing).

Aim
To determine whether routine exercise testing during screening alters the outcome of vector mapping, and whether this correlates with inappropriate therapies post-implant.

Method
This was a single-centre retrospective study of 121 patients (79% male, mean BMI 29) who completed S-ICD vector mapping between October 2016 and August 2022. 10 patients were excluded as they were unable to tolerate exercise. Emblem automated screening tool (AST) and AST 2.0 was used to complete vector mapping and a revised SOP was devised in conjunction with their technical support team. Post- implant vector programming was based on device optimisation algorithms rather than exercise-inclusive screening recommendation, which provided additional observational data only.

Results
75% were primary prevention devices and the 3 most prevalent aetiologies were dilated (22%), ischaemic (20%) and hypertrophic (18%) cardiomyopathies. In 29.7% (33/111) of participant’s, inclusion of exercise screening altered vector mapping success: The alternate vector saw the largest decrease (23.2%) in successful mapping once exercise was incorporated (69 participants passed supine and sitting/standing, 16 of those failed post-exercise), followed by secondary 13.1% (13/99) then primary 3.9% (4/103) – see Figure 1.
Further retrospective analysis showed that in 16.2% (18/111) of patients, post-implant vector selection opposed screening recommendation. 6 of these patients experienced exercise-induced sensing complications with 4 leading to inappropriate shocks. After reprogramming in-line with screening, all but 1 patient have had no further issues.

Conclusions
Incorporation of exercise mapping into S-ICD screening protocols may improve vector selection to reduce inappropriate device therapies.
ICD patients with first appropriate ICD shock: new treatment concept is associated with better outcome
Authors: Kleemann T , Lampropoulou E , Kouraki K , Strauss M , Mohammad O , Wenz A , Zahn R 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Patients with implantable cardioverter defibrillator (ICD) receiving appropriate ICD-shocks are known to have a worse prognosis. We recently developed a new treatment concept for ICD-patients with appropriate ICD shock, the ToVAMI protocol consisting of the following three steps: Trigger optimization, Ventricular Arrhythmia treatment and Medical and Interventional prognostic heart failure treatment. This protocol was implemented into clinical practice since 9/2018. Aim of the study was to evaluate the impact of the ToVAMI protocol on the outcome of patients with first appropriate ICD shock.

Methods and Results
A total of 255 consecutive patients of a prospective single-centre ICD-registry who received a first appropriate ICD shock between 2012 and 8/2022 were analyzed. Patients with first ICD shock between 2012 and 8/2018 (control group, n = 175) were compared to patients with first ICD shock between 9/2018 and 6/2021 who were treated according to the ToVAMI protocol (ToVAMI group n = 80). Prospective use of the ToVAMI approach increased the rate of identified triggers (42% vs. 60%), VA therapy (34% vs. 51%), and tripled the rate of optimised heart failure treatment (Table 1). Patients treated according to the ToVAMI protocol had better survival without recurrent ICD shock (73% versus 55% at two years, p = 0.02) (Figure 1). The number of recurrent ICD shocks decreased from 48% to 25% after two years (p = 0.01), and all-cause mortality showed a trend towards lower mortality after two years (19% versus 10%, p = 0.32). In a multivariate analysis adjusting for 10 parameters, the ToVAMI approach was independently associated with a lower combined endpoint of mortality and repeated ICD shocks.

Conclusion
The use of ToVAMI in patients with first ICD shock is associated with a reduction of the combined endpoint of mortality and recurrence of appropriate ICD shocks.
Capsulectomy: a safe and effective way to lower shock impedance in S-ICD replacement procedures
Authors: Wuerfel S , Fastenrath F , Liebe V , Akin I , Borggrefe M , Duerschmied D , Kuschyk J , Rudic B 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The safety and efficacy of the subcutaneous implantable cardioverter-defibrillator (S-ICD) has been proven in various clinical trials. Due to intermuscular device placement, higher shock energy is required for effective treatment of ventricular tachyarrhythmia. High shock impedance is a risk marker for ineffective defibrillation. Previous studies have shown reduced shock efficacy in device replacement procedures, possibly due to fibrous encapsulation of the device associated with dwelling time of the system. Therefore, in case of significant capsulation, capsulectomy became part of device replacement procedure in our center. In this study we analyzed the results of intraoperative testing before and after capsulectomy measured by results of high-voltage impedance.

Purpose
Aim of our study was to show that removal of the fibrous capsulation can help to reduce high voltage impedance without relevant perioperative adverse events at the device replacement procedure.

Methods
Between January 2018 and November 2022, a total of 68 consecutive patients underwent S-ICD device replacement in our center. Pre-operative high-voltage impedance was determined either through recent therapy deliveries or by a 10J test shock immediately before device replacement. Device replacement was performed according to international standards. In case of significant capsulation, additional capsulectomy was performed. Defibrillation testing was routinely performed by the end of the procedure in the absence of contraindications.

Results
Of 68 patients, 81% were male, mean age at device replacement was 55 ± 17 years. Most patients were implanted for primary prevention (69%). Defibrillation testing with 65 J at initial device implantation was successful in 87% of patients. Mean dwelling time of the S-ICD System was 61 months (±19 months). Shock impedance increased significantly to 98±33 Ω vs. 80±20 Ω (p=0.013) at initial implantation. Capsulectomy of the S-ICD pocket resulted in a significant decrease of high-voltage impedance to 83±23 Ω as compared to measurement prior to replacement (p=0.03). Defibrillation testing was successful in all patients. First shock efficacy with 65 J was 92%. No acute complications (defined as significant bleeding, prolongation of hospital stay, etc.) were observed in short term follow-up and patients could be discharged as planned.

Conclusion
Capsulectomy of S-ICD pocket appears to be a safe and effective way to reduce shock impedance which has proven to be a predictor of successful defibrillation in testing as well as in spontaneous episodes. Despite the additional step during device replacement, no complications were observed in our study. Randomized trials regarding defibrillation testing during first implantation are ongoing. Trials addressing the optimal device replacement strategy however are warranted.
A 25-year single-center experience with transvenous and subcutaneous ICD patients under thirty years of age
Authors: Lewandowski M , Syska P 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Young implantable cardioverter-defibrillator (ICD) recipients present high rate of inappropriate shocks and complications. Some of them seem to be underestimated. The subcutaneous ICD(S-ICD) system was developed to eliminate lead-related complications and was proved to be effective, avoiding intracardiac and endovascular adhesions.
Aims To report on our clinical experience with transvenous (TV-ICD) and S-ICD therapy in patients under thirty years of age.

Methods
We reviewed database of ICD recipients in our institution between 1996 and 2022(25 years) and have chosen 125 pts consecutively implanted up to and including the age of 30 years. We retrospectively analyzed the rate of appropriate(AI) and inappropriate interventions(IS), lead complications rate, infection rate, mortality and treatment options.

Results
The study group: 84 TV-ICD(age: 6-30, BMI: 16,3-22,2) and 41 S-ICD( age: 15-30, BMI; 15,6-31,1) patients. The mean follow-up in analyzed groups was 159±48 and 40± 2 months respectively. Abnormal ventricular function: EF≤30 occurred in compared groups: 12/84(14%) and 5/41(12%) respectively, p=0,3. 24/84pts(28%) received ≥1 AI for VT/VF(ATP or shock) in TV-ICD and 4/40pts(10%) in S-ICD groups. 25/84 pts(30%) received one or multiple (IS) and 1/40pts(2,5%) in compared groups respectively, p=0,02. There were 18/84 (21.5%) ventricular lead dysfunctions(reimplantation of a new system) in TV-ICD and 0% in S-ICD groups, p=0,025. An infection rate (endocarditis or device pocket )was 8/84 (10%) in TV-ICD group with complete system removal and 1 pts (2,5%) wound infection(staphylococcus aureus) in S-ICD group successfully treated with antibiotics. 1 left ventricular assist device was implanted in end-stage heart failure S-ICD patient with good result. There were 2 S-ICD implantations as a concomitant device i.e. conversion of TV-ICD(with therapy OFF) to S-ICD due to ventricular lead dysfunction. 4(10%) pts required generator elective replacement due to early battery depletion in S-ICD group. In 2(5%)pts right sternal lead location was chosen due to better sensing results. Mortality rate was 6/84 pts (7%), caused by ventricular lead dysfunction, end-stage heart failure or heart transplantation fatal result in TV-ICD group. There was no death in S-ICD group.

Conclusions
TV- ICD implantation in children and young adults is a feasible and effective procedure in a 25-year follow-up but the rate of complications is high in this population. S-ICD recipients did not experienced lead failures or systematic infections. S-ICD appears to be a good therapy option and an alternative to TV-ICD in pediatric and young patients population, preventing from some serious lead complications and tricuspid valve regurgitation. The method and follow-up period effect is present between the TV-ICD and S-ICD in analyzed groups.
Trends in adoption of extravascular devices compared to conventional devices: real-world data from the Netherlands Heart Registration
Authors: Breeman K T N , Van Der Stoel M D , Van Dijk V F , Yap S C , Van Erven L , Maass A H , Boersma L V A , Wilde A A M , Knops R E , Tjong F V Y 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Extravascular devices (EVD), such as the subcutaneous ICD (S-ICD) and leadless pacemaker (LP), have been developed to circumvent pocket- and lead-related device complications. Knowledge on trends in adoption of these devices among patient categories and hospital types is mainly derived from industry-initiated studies or selected populations.

Purpose
To assess the real-world nationwide trends in adoption of EVDs in the Netherlands.

Methods
Using real-world data registered at the Netherlands Heart Registration from 72 Dutch device-implanting hospitals, all consecutive patients were included with an EVD implantation (de novo or replacement) from 2012-2020. To describe the relative adoption of EVDs, all consecutive patients with a single-chamber conventional ICD or pacemaker were also included (pacemakers from 2014, the first LP registration). Trends in EVD adoption are described for different patient (age, gender, and BMI) and hospital (tertiles of device-implanting volume and implanting center [general , intervention, or thorax]) characteristics. Differences in adoption were tested using Chi-square and Fisher’s exact tests.

Results
From 2012-2020, 2862 S-ICDs and 15806 single-chamber conventional ICDs were implanted, while from 2014-2020, 785 LPs and 16530 single-chamber conventional pacemakers were implanted. S-ICD use among single-chamber ICD recipients increased from 7% to 22% and LP use among single-chamber pacemaker recipients increased from 1% to 8%, although utilization has levelled off in recent years (Fig. 1). The relative use of S-ICDs was largest in patients aged 10-30 years and declined with higher age (p&lt;0.001); LP use ranged between 0 and 6% among age groups, with no specific preference at older age (p=0.002)(Fig. 2A). S-ICDs were used more in female than male ICD recipients (p=0.005); LPs more in male than female pacemaker recipients (p=0.002)(Fig. 2B). EVD utilization was largest in patients with a BMI &lt;25 kg/m2 (S-ICDs p&lt;0.001; LPs p=0.02)(Fig. 2C). EVDs were mostly implanted in high-volume centers (S-ICDs p=0.03; LPs p&lt;0.001). S-ICDs were implanted mostly in thorax centers (p&lt;0.001); LPs in thorax centers only.

Conclusions
Although EVDs have been adopted early in the Netherlands, their utilization has levelled off in recent years, possibly driven by higher cost, battery issues, or the COVID-19 pandemic. Utilization of S-ICDs is highest among younger patients while utilization of LPs was not specifically high in certain age groups. The effects of gender and BMI were smaller. EVDs were mainly implanted in high-volume thorax centers.
Stepwise application of ECG and electrogram based criteria to ensure left bundle branch pacing
Authors: Pujol-Lopez M , Ferro E , Borras R , Garre P , Guasch E , Niebla M , Carro E , Roca-Luque I , Guichard J B , Uribe L , Arbelo E , Porta-Sanchez A , Sitges M , Tolosana J M , Mont L 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): MPL received the Catalan Society of Cardiology Research Grant in 2019 and 2020 (Catalonia, Spain); the Josep Font Grant (2019-2022) from Hospital Clínic Barcelona (Catalonia, Spain).

Background
Left bundle branch pacing (LBBP) has emerged as an alternative to biventricular pacing. However, lack of a systematic stepwise application of the left bundle branch (LBB) capture criteria complicates implantation.

Objective
To define a stepwise application of LBBP capture criteria that will simplify implantation and ensure LBB capture.

Methods
A cohort of 24 patients from the LEVEL-AT trial who received LBBP and had electrocardiographic imaging (ECGI) at 45 days post-implant were included. The usefulness of ECG and electrogram based criteria to predict accurate LBB capture were analyzed. A two-step approach was developed to ensure LBB capture. The gold standard used to confirm LBB capture was the change in ventricular activation pattern and shortening in left ventricular activation time, assessed by ECGI.

Results
Twenty-two (91.6%) patients showed LBBP capture on ECGI. All patients fulfilled pre-screwing requisites: lead in septal position in left-oblique projection and W paced morphology in V1. In the first step, presence of either right bundle branch conduction delay pattern (qR or rSR in V1) or left bundle branch capture Plus (QRS ≤120ms) resulted in 95% sensitivity and 100% specificity to predict LBB capture, with an accuracy of 95.8%. In the second step, the presence of selective capture (100% specificity, only 41% sensitivity) or a spike-R&lt;80ms (100% specificity, sensitivity 46%) ensured 100% accuracy to predict LBBP capture.

Conclusions
Stepwise application of ECG and electrogram criteria ensured an accurate assessment of left conduction system capture.
Left ventricular global strain and duration of QRS complex as predictors of prognosis after cardiac resynchronization therapy
Authors: Mashal A , Soltan G , Samy N , Soliman A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): National heart institute and Menoufia university, Egypt.

Background
cardiac resynchronization therapy is effective for patients with chronic heart failure with reduced left ventricular ejection fraction and wide QRS (≥120 ms). We aimed to verify that a baseline left ventricular global longitudinal strain(LVGLS) and qrs duration may be beneficial as predictors of prognosis of CRT response.

purpose
We aimed to evaluate if LVGLS & QRS duration may be of additive prognostic value in CRT response.

Methods
Transthoracic echocardiography was performed prior to and 6 months after CRT implantation. Echocardiography was performed to assess left ventricular function as LVGLS. The response to CRT was defined as improvement in NYHA functional class (at least one class) and ≥ 15% reduction in the left ventricular end-systolic volume or improvement in left ventricular ejection fraction &gt; 10. Comparison between responders and not responders was done using the appropriate test, and ROC analyses were done for QRS duration and LVGLS to predict CRT response.

Results
fifty-five HF patients (age 58 ±8 years, LVEF 23 ±5%, QRS duration 159 ±8ms, 30.9% ischemic aetiology of HF) underwent CRT implantation. The percentage of responders was 72.72% (Table). Baseline LVGLS differed significantly according to CRT response (P &lt; 0.019). The best cutoff for LVGLS to predict response was 6.2, at which sensitivity and specificity were 70% and 73.3%, respectively with AUC of 0.793, with a 95% confidence interval (CI) of 0.651 - 0.936 (P = 0.001). Also, there was a statistically significant difference of the baseline QRS duration between the patients who had and hadn’t CRT response (P &lt;0.001). The best cutoff was &gt;154 ms,at which sensitivity and specificity were 87.5% and 86.7%, respectively. (AUC was of 0.793, with a 95% CI ranging from 0.651 - 0.936 (P = 0.001).

Conclusion
Baseline LVGLS and QRS duration may have a prognostic value in prediction CRT response. Baseline LVGLS (&gt;6.2) and QRS duration (&gt;154ms) may help to select CRT responders.
Left-bundle branch block, an alert for cardiac resynchronization therapy
Authors: Gatti P , Kristjansdottir I , Azari A , Anselmino M , Lind S , Savarese G , Linde C , Gadler F 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Medtronic.

Background
Left bundle branch block (LBBB) might be the first finding of cardiovascular diseases but it is also the target of cardiac resynchronization therapy (CRT) in heart failure (HF) with reduced ejection fraction (HFrEF). LBBB prognosis and the implication of CRT in an unselected real-world setting are of great potential clinical impact.

Methods
A central ECG database together with national registries has been screened to identify LBBB patients. Cox models were fitted to assess the hazard ratio (HR) of death, cardiovascular death (CVD) and HF hospitalization (HFH) according to gender and CRT use. A subdistribution of the hazard ratio (SHR) was used to account for non-cardiovascular death as a competing risk. Logistic regression was fitted to investigate characteristics associated with CRT use.

Results
Of 5359 patients with LBBB and QRS duration over 150ms, 36% were female. The median age was 76 years and males had a significantly higher risk of death after 5 years from the LBBB diagnosis. CRT, when indicated, has a large benefit on all-causes of death (HR: 0.53, 95% confidence intervals (CI): 0.42-0.67), CVD (HR: 0.53 CI: 0.39-0.71) and HFH (HR: 0.71 CI: 0.60-0.82), especially in the first 5 years after the indication. These results are consistent with the competing risk analysis.

Conclusion
In an unselected LBBB population, CRT is underused but extremely beneficial. Therefore it’s crucial to find ways of better implementing and understanding CRT utilization, focusing on characteristics that influence recommendations.
Long term conservation of electrical synchrony by multipoint pacing with dynamic atrioventricular delays
Authors: Thibault B , Chow A , Mangual J , Badie N , Waddingham P , Mcspadden L , Betts T , Calo L , Leyva F 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Abbott.

Introduction
Automatic adjustment of atrioventricular delay (AVD) with SyncAV has been shown to improve electrical synchronization. However, the long term effects of SyncAV optimization on electrical synchrony are unknown.

Purpose
Evaluate the effect of SyncAV programming on 6-month (6mo) QRS duration during biventricular (BiV) and left ventricle only MultiPoint Pacing (MPP).

Methods
Patients with LBBB and QRS duration (QRSd) ≥ 150 ms scheduled for CRT-P/D device implantation with quadripolar LV lead were enrolled in this prospective study. QRSd was measured post-implant from 12-lead surface ECG by blinded experts during the following pacing modes: intrinsic conduction, MPP (MPP=RV+LV1+LV2) and LV-only MPP (LVMPP=LV1+LV2). For each mode, SyncAV was enabled (e.g. MPP+SyncAV) with the patient-tailored SyncAV offset that minimized QRSd. Patients were then randomized 1:1 to receive MPP+SyncAV or LVMPP+SyncAV with the optimal offset identified at implant, and QRSd was re-evaluated at the 6mo follow-up.

Results
Fifty-nine patients (72% male, 41% ischemic, 26% ejection fraction, 166 ms intrinsic QRSd) completed device implant and QRSd assessment. Relative to intrinsic conduction at implant, the MPP+SyncAV group (n=30) had a QRSd reduction of 26% at implant (162 to 122 ms, p&lt;0.001), and 20% at 6mo (162 to 130 ms, p&lt;0.001). The LVMPP+SyncAV group (n=29) had a QRSd reduction of 24% at implant (165 to 128 ms, p&lt;0.001), and 15% at 6mo (165 to 140 ms, p&lt;0.001). In the MPP+SyncAV group, 28/30 (93%) of patients had more than 10% reduction in QRSd with respect to intrinsic at implant, with 27/30 (90%) maintaining this trend at 6 mo follow up. With LVMPP+SyncAV pacing, only 25/29 (86%) of patients had more than 10% reduction in QRSd with respect to intrinsic at implant, and this reduced to 18/29 (62%) maintaining this trend at 6 mo follow up.

Conclusion
MPP combined with SyncAV significantly improved acute electrical synchrony at implant in CRT patients with LBBB, as assessed by QRSd reduction. Significant QRSd reduction was maintained at 6 months post-implant by both biventricular and LV-only MPP configurations.