bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy and safety of catheter ablation of VT using the QDOT Micro catheter: a propensity-matched dual-center comparison with the thermocool SmartTouch catheter
Authors: Compagnucci P , Dello Russo A , Bergonti M , Cipolletta L , Parisi Q , Volpato G , Santarelli G , Valeri Y , Carboni L , Stronati G , Guerra F , Marini M , Sarkozy A , Natale A , Casella M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Catheter ablation is an increasingly used treatment option for patients with recurrent ventricular tachycardia (VT) or electrical storm (ES). The QDOT Micro (QDOT) Catheter (Biosense Webster) is a novel radiofrequency ablation catheter that was found to allow rapid and effective pulmonary vein isolation among patients with atrial fibrillation. There is no published data on the safety and efficacy of catheter ablation for VT using the QDOT catheter, and few data allow a direct comparison of different technologies in this setting.

Purpose
to assess outcomes of CA for VT among patients with structural heart disease using the QDOT catheter, and compare them to those observed with the Thermocool Smarttouch (TC-ST, Biosense Webster) catheter.

Methods
we conducted a dual-center, observational, prospective study enrolling patients with structural heart disease and recurrent VT/ES undergoing catheter ablation with the QDOT catheter. For comparison, we performed a 1:1 propensity score matching to identify patients who underwent VT CA with the TC-ST catheter, using the nearest neighbor method. Propensity score was based on gender, age, etiology of structural heart disease, left ventricular ejection fraction, electrical storm, and number of previous CAs for VT. The primary efficacy outcome was freedom from recurrent VT, as assessed by implantable defibrillator (ICD) interrogation; the primary safety outcome was in-hospital complications.

Results
Forty propensity-matched patients were included in the analysis (QDOT, n=20; TC-ST, n=20); baseline clinical characteristics are resumed in Table. After a median follow-up of 7 months, survival free from any recurrent VT measured 74 (95% CI, 57-97)% and 69 (95% CI, 51-93)% in the QDOT and TC-ST groups, respectively (log-rank p=0.54, Figure A), while survival free from ICD shocks was 95 (95% CI, 86-100)% versus 84 (95% CI, 69-100)% (log-rank p=0.26, Figure B). There were no major complications in the QDOT group, while three patients (15%) in the TC-ST had a primary safety event (p=0.23; femoral pseudoaneurysm, n=1; cardiac tamponade, n=1; aortic cusp perforation, n=1).

Conclusion
In a cohort of patients with structural heart disease and recurrent VT or ES, the novel QDOT ablation catheter had similar efficacy and safety compared to the TC-ST catheter. Interestingly, no major procedural complications were observed with the QDOT catheter, suggesting that this device may be safe even in most challenging patients.
Safety and efficacy of bipolar radiofrequency catheter ablation in ventricular arrhythmias of mural vs non-mural origin
Authors: Caixal G , Waight M , Pinto A , O Neill C , Grimster A , Li A , Saba M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Bipolar radiofrequency catheter ablation (B-RFA) has shown promising results in refractory ventricular arrhythmia (VA) of septal origin and underlying non-ischemic cardiomyopathy (NICM). However, its efficacy and safety in other locations such as the free wall and papillary muscles (PM) has not yet been fully determined.

Purpose
To describe and analyse the procedural data, safety and efficacy results of B-RFA in a cohort of patients with VA of different locations and underlying substrate.

Methods
We enrolled 21 patients with recurrent VA after prior failed ablation into this study, of whom 16 patients required B-RFA for effective ablation. Seven of the patients had ventricular ectopy (VE) and 9 presented with ventricular tachycardia (VT). During B-RFA, a contact-force-sensing, saline-irrigated catheter was connected to the ablation catheter connection on the radiofrequency generator and a second ablation catheter (saline-irrigated in 6 of the cases) was connected to the ground patch terminal through a custom-made switch box. This allowed visualization of both catheters on the 3D mapping system and acquisition of electrograms from both simultaneously. Procedure data, related complications and acute and long-term outcomes during follow-up were assessed.

Results
The VA distribution was septal (31.3%, n=5), PM (31.3%, n=5), right ventricle free wall (18.8%, n=3), left ventricle (LV) free wall (12.5%, n=2) and LV summit (6.3%, n=1). Compared to septal ablation, contact force obtained during B-RFA ablation was significantly lower in PM ablation (p=0.01), as was the impedance drop (p=0.03). There were no significant differences in the number of energy applications, their mean duration, the total ablation time, the power and the temperature among locations. Acute success was achieved in 15 patients (93.6%). Long-term success, defined as no recurrence of sustained VT or less than 1% VE burden on 24-hour Holter at 12-month follow up, was achieved in 11 patients (68.8%), and another 2 patients (12.5%) had partial success. Papillary muscle VA had lower acute and long-term success (80% and 60%, respectively) after B-RFA. On the other hand, patients with NICM appeared to have superior outcomes (figure 1). No steam pops or major peri-procedural complications were observed. However, the use of a non-irrigated indifferent electrode resulted in char formation.

Conclusions
B-RFA can be used successfully and safely in NICM involving the septum and free walls but has limited use for PM arrhythmias. This could be related to a lack of catheter stability and reduced energy transfer. In addition, when using B-RFA, any catheter in the circulatory system should be irrigated.
Audit of urgent pacing therapy in nonagenarian patients and their follow up over one year
Authors: Saint-Joy V , Dagher-Hayeck Y , Bellemain-Appaix A , Frattini F , Jacq L 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction and objectives
The aging of the population in the world and particularly in developed countries is changing the panorama of patients who are treated both on the socio-demographic level and on the indications for the care of elderly subjects. Antibes is the sixth region in France with the most nonagenarians. A study had already been carried out in our center on the management of coronary emergencies in people over 90 years old and this time we are interested in the management of rhythmic emergencies in the latter with a focus on permanent cardiac stimulation in emergency.

Methods
This 5-year retrospective descriptive study runs from 2016 to 2020 and analyzes the records of 156 nonagenarians hospitalized in the intensive care unit and 1322 planned visits of patients over 90 years old to the electrophysiology unit.

Results
Nonagenarians represent 16.6% of patients admitted for cardiac arrhythmias requiring intensive and / or invasive management. 65% of patients hospitalized in cardiac critical care unit (CCU) benefited from the implantation of a pacemaker, with 13% of them presenting non-severe complications related to the procedure. 2% died in the CCU. After their hospital stay 60% came for follow-up at 3 months and only 19.6% at 1 year.

Conclusion
This study highlights the need to make invasive cardiology practitioners aware of the growing proportion of this geriatric subgroup of very old patients (&gt;90). There were no serious complications limiting the eligibility of nonagenarians. It seems necessary to develop a close collaboration of cardio-geriatricians and telecardiology in this subset of frail patients.
Autocapture algorithm behaviour in left bundle branch pacing
Authors: Sola Garcia E , Molina Lerma M , Tercedor L , Alvarez M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Autocapture algorithms allow remote monitoring of patients, reducing the need for face-to-face hospital consultations and increasing patient safety. These algorithms are widely validated in patients with conventional pacing and are not recommended in His bundle pacing, but there is no information on its behaviour in left bundle branch pacing (LBBP).

Purpose
The objective was to analyse the autocapture algorithm behaviour in LBBP and its differences with conventional pacing and manual thresholds during device first programming (acute phase), after 1-7 days (subacute phase) and 1-3 months later (chronic phase).

Methods
Prospective non-randomised single-centre comparative study. Consecutive patients with an indication for cardiac pacing were included. The implant was performed in the left bundle branch area or in the right ventricle endocardium (outflow tract or apex) at the discretion of the operator. LBBP was considered according to published criteria. Autocapture algorithm was activated in both groups whenever allowed by the device. The thresholds manual measurement was performed with the intracavitary electrogram and the surface electrocardiogram.

Results
Sixty patients were included, 40 with LBBP and 20 with conventional pacing. Baseline characteristics of patients are shown in Figure 1. The feasibility of the autocapture algorithm was more frequent in late phases, with a favourable trend toward bipolar pacing (Figure 2A). The failures in the activation of the algorithm were mainly due to the absence of adequate safety margins (90.9% in conventional pacing and 86.6% in LBBP), the rest were attributable to atrial tachyarrhythmias (9.1 and 6.7%, respectively) and electrical noise (remaining 6.7% in LBBP). In LBBP group, there were not statistically significant differences between manual and automatic thresholds except in subacute phase (unipolar) (Figure 2B), and both remained stable during follow-up (average increase of 0.46V).

Conclusions
Autocapture algorithm is feasible in LBBP, with a favourable trend toward bipolar pacing. Automatic thresholds are similar to manual in patients with LBBP, and they remain stable during follow-up.
Conduction system pacing guided by 3d-electroanatomic mapping system preserves systolic function in paediatric patients
Authors: Silvetti M S , Saputo F A , Mizzon C , Tamburri I , Campisi M , Battista V , Silvetti G , Cazzoli I , Raimondo C , Drago F 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
Paediatric transvenous permanent pacing from alternative ventricular sites including conduction system pacing may prevent ventricular dyssynchrony and systolic dysfunction. These procedures may be difficult and require higher fluoroscopic exposures. The use of three-dimensional-electroanatomic mapping system (3D-EAM) may guide lead implantation toward these alternative sites and reduce fluoroscopic exposure.

Purpose
of this study is the outcome of 3D-EAM-guided alternative sites pacing in paediatric patients.

Methods
Retrospective analysis of children and young patients with congenital or acquired complete atrioventricular block (CAVB) with or without other congenital heart disease (CHD) who underwent 3D-EAM-guided transvenous pacing in alternative sites of the subpulmonary ventricle, to perform non-selective His bundle pacing (NSHBP), pacing of ventricular septum close to conduction system (VS-CSP) or outflow tract (OT). 3D-pacing map guided stylet-directed screw-in lead implantation toward septal sites with narrower paced QRS. Procedure and follow-up data were recorded. Parameters of ECG (QRS duration, left ventricular activation time, LVAT), echocardiogram (3D ejection fraction, EF, global longitudinal strain, GLS, of the systemic ventricle) and lead (threshold, sensing) were registered and compared at baseline (pre-implantation) and during follow-up (1-3-year). Data are reported as median (25th-75th centiles). P&lt;0.05 was significant.

Results
64 patients (47 females) with CAVB, of whom 11 with CHD, underwent 3D EAM-guided pacing (31 VVIR, 33 DDD) at age 12 (8-15) years, weight 44 (27-57) kg. Prior pacing (RV apex, RV and LV free wall, also biventricular) was present in 27 patients. Pacing sites were: 10 NSHBP, 5 RVOT, 49 VS-CSP (Figure 1). Procedure time was 175 (146-200) min, fluoroscopy exposure was: 3.0 (1.2-5.0) mGy and 90 (33-146) microGy/m2. Echographic parameters at baseline and follow-up are reported in Table 1. Baseline QRS duration 85 (80-130) ms, increased after implantation, 115 (100-120) ms (P=0.002), with LVAT 80 (70-81) ms (Figure 1). In patients with prior pacing, QRS shortened post-implantation: QRS 130 (120-160) vs. 120 (110-125)ms (P=0.004). Lead parameters were good post-implantation and at 3-year follow-up: threshold 0.5 (0.4-0.7) vs. 0.9 (0.7-1.2)V/0.5 ms; R-wave sensing 9 (6-12) vs. 7 (4-9)mV. Four NSHBP patients showed lead dislodgement requiring lead repositioning.

Conclusions
3D-EAM-guided alternative site pacing was accomplished with low fluoroscopic exposure. Paced QRS duration was significantly broader than in junctional rhythm but it was significantly narrower than prior epi/conventional site endo pacing. This pacing approach preserved ventricular systolic function in paediatric patients with CAVB at mid-term follow-up.
Intermuscular two-incision technique for implantation of the subcutaneous implantable defibrillator: 3-year follow-up
Authors: Migliore F , Pittorru R , Dall'aglio P , Falzone P , Bertaglia E , De Lazzari M , Iliceto S , Corrado D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
data on long-term outcome of the intermuscular (IM) two-incision implantation technique for the subcutaneous implantable cardioverted defibrillator (S-ICD) are lacking.

Purpose
the aim of the present study was to evaluate the outcome of patients underwent S-ICD implantation with the IM two-incision technique during 3-year follow-up.

Methods
the study population consisted of 105 consecutive patients (79 male; median 50 [13-77] years) underwent S-ICD implantation with the IM two-incision technique.

Results
according to the PRAETORIAN score, the risk of conversion failure was classified as low in 99 patients (94.3%), intermediate in 6 (5.7%).Ventricular fibrillation was successfully converted at ≤65 J in 97.4% of patients. During a median follow-up of 39 (16-53) months, 10 patients (9.5%) experienced device-related complications and 9 (8.5%) patients reported inappropriate shocks (IAS). Lead-associated complications were the most common (4.7%), including 2 cases of lead failure (1.9%). Pocket complications were reported in 2 patients (1.9%). Extra-cardiac oversensing (3.8%) represented the leading cause of IAS. No T-wave oversensing episodes were recorded. Twelve patients (11.4%) experienced appropriate shocks. Eight patients (7.6%) died during follow-up. IAS or device-related complications did not impact on mortality (HR 0.5; 95%CI 0-4.3; P=0.5; HR 0.7; 95%CI 0.1-6.0; P=0.8, respectively).

Conclusions
according to our findings, the IM two-incision technique allows for optimal positioning of the device achieving a low PRAETORIAN score with a high conversion rate. IM two-incision technique allows low incidence of pocket complications, shifting the type of complications towards lead-related complications, which represent the most common complications. The IM two-incision technique would not seem to impact the occurrence of IAS. Management of complications are safe without impact on the outcome.
Beneficial effects of high output His bundle pacing in patients with heart failure, narrow QRS
Authors: Katsouras G , Stavrakis S , Guida P , Duni N , Dentamaro I , Perniciaro V , Sgarra L , Quadrini F , Galgano G , Grimaldi M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiac Resynchronization Therapy (CRT) decreases heart failure (HF) hospitalizations and mortality and increases left ventricular Ejection Fraction (EF) in patients with dilated cardiomyopathy, left bundle branch block and QRS&gt;130msec1. However, CRT is not beneficial in HF patients with narrow QRS3.

Purpose
We performed His Bundle Pacing (HBP) with high output (3.5V/1msec) in HF patients with dilated or ischemic cardiomyopathy and narrow QRS to prove hemodynamic benefit independently of the QRS duration or AV delay shortening.

Methods
9 male patients with dilated cardiomyopathy (EF&lt;35%) and narrow QRS (&lt;110ms) were referred for implantation of a defibrillator. We implanted an ICD- HBP system, and we collected clinical, echocardiographic, and electrocardiographic data.

Results
We obtained HBP in all 9 patients successfully. Basal mean EF was 31±4% and increased to 43±6% (P&lt;0.001) after a median follow-up of 116 days. Left ventricular end-diastolic diameter and left ventricular end-diastolic volume decreased from 62±5 to 59±6ml (P=0.014) and from 188±87 to 144±35ml (P=0.095), respectively. Left ventricular end-systolic volume decreased from 139±78 to 85±29 (P=0.035). NYHA class decreased by one class in every patient after only one month. Baseline QRS duration remained stable after pacing from 107±7 to 118±15ms. In one patient an iatrogenic right bundle branch block was created which was corrected partially by His bundle pacing. PQ after implantation was shorter (from 167±23 to 121±14 (P=0.030) so as to pace the ventricle. HBP threshold was 1.24V±0.50/1msec, the impedance was 529±116 Ohms while R-wave was 3.8±1.7mV. In one out of 9 patients, threshold increased from 1 to 2V/1msec in 6months and then remained stable. In the other eight patients, threshold remained stable.

Conclusions
HBP in HF patients with dilated cardiomyopathy and narrow QRS improves hemodynamic function and decreases NYHA class. This benefit appears to be produced by a higher stimulation output. We cannot exclude that a very short AV delay could be favorable. To our knowledge these are the first cases of beneficial HBP in HF patients with narrow QRS. There is urgent need for large, randomized clinical trials.
Biventricular or conduction system pacing for cardiac resynchronization therapy: a proposed treatment algorithm based on interventricular conduction delays
Authors: Carmine Marallo C M , Federico Landra F L , Claudia Baiocchi C B , Maria Barilli M B , Nicolo Sisti N S , Antonio Pagliaro A P , Cristina Tavera C T , Andrea Stefanini A S , Andrea Pica A P , Matteo Cameli M C , Santoro A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

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. CSP was performed as His Bundle pacing or Left bundle branch pacing(1). 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(figure1).

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(2). Treatment algorithm based on IVCD was used to decide whether to leave LV lead to perform BiVP or pull it out and perform CSP. Outcomes from the DRG group were compared to a historical cohort of CRT patients (resynchronization standard guide group,SRG). The primary endpoint was a composite of cardiovascular mortality, heart failure (HF) hospitalization, or HF event 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. 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)(figure2).

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 HF event after implantation. Therefore, its application could be useful to determine whether to perform BiVP or CSP in CRT candidates.
Baseline creatinine level and long-term outcomes in patients with heart failure undergoing cardiac resynchronization therapy
Authors: Mazurek M , Jedrzejczyk-Patej E , Kotalczyk A , Gumprecht J , Lenarczyk R , Sokal A , Pruszkowska P , Szulik M , Kowalski O , Kowlaczyk J , Kalarus Z 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Renal dysfunction has been shown as an independent predictor of mortality in patients with heart failure (HF). However, data on the long-term outcomes of cardiac resynchronization therapy (CRT) in patients with chronic kidney disease is scarce due to underrepresentation of such patients in clinical trials on CRT.

Aim
To determine outcome and mortality predictors in patients with HF and elevated creatinine level treated with cardiac resynchronization therapy.

Methods
Study population consisted of 1059 consecutive patients with CRT implanted between 2002 and 2019 in a tertiary care university hospital, in a densely inhabited, urban region of Poland (949 subjects [89.6%] with CRT-D; 110 patients with CRT-P [10.4%]; 832 men [78.6%]).

Results
The median creatinine level before CRT implantation was 96 umol/L (10th and 90th percentile: 67-160). We divided all CRT patients into quartiles per creatinine level: I &lt;79 umol/L, II 79 to less than 96 umol/L, III 96 to less than 118 umol/L, and IV ≥118 umol/L. During the median follow-up of 1661 days (10th and 90th percentile: 323-3995), mortality rates for quartiles I-IV were 36.8, 44.9, 60.1, and 71.7%, respectively (P&lt;0.05) [Figure 1]. The creatinine level ≥118 umol/L (quartile IV) appeared to be an independent risk factor for death (HR 1.004, 95%CI 1.003-1.006, P&lt;0.001). On multivariable analysis, lower left ventricular ejection fraction (HR 0.97, 95%CI 0.95-0.99, P=0.04), higher NT-proBNP level (HR 1.00, 95%CI 1.0001-1.0005, P=0.04), and diabetes treated with insulin (HR 1.64, 95%CI 1.07-2.53, P=0.02) were independent risk factors for death in quartile IV. The mortality rate in those with creatinine level ≥118 umol/L and left ventricular ejection fraction ≤ 20% was 88% during the observation.

Conclusions
Compared to patients without renal dysfunction prior to CRT implantation, mortality rates of those with creatinine level ≥118 umol/L are significantly higher and reach 70% in 4.5 years of median observation. Almost 9 out of 10 CRT recipients with creatinine level ≥118 umol/L and left ventricular ejection fraction ≤ 20% die within 4.5 years since CRT implantation.
Figure 1. Kaplan-Meier curves for survival of patients treated with cardiac resynchronization therapy as a function of creatinine level