bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence and autopsy rates of sudden cardiac death in Northern Finland
Authors: Mantyniemi L , Pakanen L , Holmstrom L , Hamalainen J , Ruuska L , Vahatalo J , Haukilahti A , Perkiomaki J , Huikuri H , Junttila J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Sigrid Juselius foundation. Finnish foundation for cardiovascular research.

Background/Introduction
Sudden cardiac death (SCD) is one of the most common modes of death in Western societies. The exact incidence and etiological background of SCD is somewhat unknown due to the low number of autopsies performed in sudden death victims. In prior autopsy studies approximately 40% of sudden death victims have other than cardiac cause for the event and in most countries autopsy rates are between 5-25%.

Purpose
Determine the incidence of SCD and autopsy rates for sudden death in Northern Finland.

Methods
We performed a death certificate review of all out of hospital or hospice deaths in 2016 in Northern Finland. Death was determined to be sudden if it occurred within one hour of occurrence of symptoms or if the victim was found dead. Information on autopsy, cause of death, and demographical data were collected.

Results
From a total of 6620 deaths 1412 occurred out of hospital/hospice. Death was classified as sudden in 1067 (16.1%) victims. Mean age was 70.1 yrs (±16.5 yrs) and 66.9% were male. Autopsy rate for all sudden deaths was 73.7%. Among victims under 70yrs autopsy rate was 90.8% and in under 50 yrs 96.2%. In all 785 autopsied sudden deaths 421 (53.6%) were SCD i.e. cardiac cause for death. In a population of 740 000 out of hospital/hospice sudden death incidence in 2016 was 144/100 000 and SCD incidence on 2016 was 77/100 000. Autopsied sudden cardiac death (N=421) was caused by ischemic heart disease (310, 73.6%), hypertensive heart disease (48, 11.4%), cardiomyopathy (50, 11.9%) or other cardiac causes (13, 3.1%).

Conclusions
Autopsy rates of sudden death in Northern Finland are high. The utilization of autopsies in sudden death provide the premises for accurate SCD incidence calculations. The results confirm the assumption that a large part of sudden deaths are non-cardiac and common cardiac diseases are the most frequent cause of SCD in unselected general population.
Management of cardiac arrhythmias in paediatric patients with TANGO2-deficiency disorder
Authors: Sarquella Brugada G 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
TANGO2-deficiency disorder (TDD) is a rare paediatric condition caused by bi-allelic mutations in the TANGO2 gene. TDD is characterised by susceptibility to metabolic crises with rhabdomyolysis, encephalopathy, lactic acidosis, hypothyroidism and difficult to manage tachyarrhythmias.

Aim
We describe the electrocardiographic (ECG) findings at baseline and during metabolic crises in patients with TDD.

Methods
Retrospective, single-centre, case series study of patients with TDD (&lt;18 years), with ECG and subcutaneous Holter monitoring, both during metabolic crises and compensated phases.

Results
During the period 2013-2021, 12 patients with TDD were found (median age 6.8 years, IQR 2-11.5 years). In the inter-crisis period, bradyarrhythmias were evidenced: 2/12 patients presented sinus bradycardia, 2/12 pauses of 4 and 10 seconds, 1/12 Wenckebach type block; and tachyarrhythmias: 1/12 presented paroxysmal supraventricular tachycardia and 1/12 flutter. 25% had long QT during non-acute phases (median QTc max 476 ms, IQR 456ms-530ms). There were 14 hospitalisations for metabolic crises. 57.1% had QTc interval prolongation, 35.7% ventricular tachycardias (4/14 monomorphic VT, 1/14 torsade de prongs) and 1/14 Brugada type 3 pattern. Three patients died in the context of severe metabolic acidosis and multi-organ involvement (2/12 due to VT and 1/12 due to cardiogenic shock, bradycardia associated with QTc of 635ms and severe ventricular dysfunction).

Conclusions
In paediatric patients with TDD, the most frequent ECG abnormality was QTc interval prolongation with or without metabolic crises. There is a high risk of tachyarrhythmias, mainly VT, being the main cause of death in children with TDD. Subcutaneous Holter monitoring is recommended. During metabolic crises, there should be close ECG monitoring.
Left bundle branch area pacing compared to right ventricular outflow tract pacing: mid-term results and learning curve
Authors: Cabrera Ramos M , Melero Polo J , Vadillo Martin P , Mayo Carlos G V A , Ruiz Arroyo J R , Ramos Maqueda J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The aim was to evaluate efficacy and feasibility of left bundle branch area pacing (LBBAP) with right ventricle outflow tract pacing(RVOP), as well as describing the learning curve.

Methods
Prospective single-center observational study, including 200 patients that required pacemaker implantation. Two groups: LBBAP and RVOP with 100 patients each. Our aim was to compare safety and efficacy as well as the procedure and fluoroscopy times and to describe the LBBAP-learning curve.

Results
Success and acute complication rate were similar in both groups(p=0.56,p=0.65). Time for ventricular lead placement was higher in LBBAP group(18 [13-28] vs 11[7-17]min, p&lt;0.001). Fluoroscopy time was lower in LBBAP, (2.8[1.3-3.7] vs 3.1[2-5.9]min, p=0.02). Paced-QRS was narrower in LBBAP group (122.9±13.7ms vs 145.7±17.6ms, p=0.002). There were no differences related to pacing parameters. In LBBAP group, procedure time was lower in the last quartile (Q4) compared to the first quartile (12 [10.5-15] vs 32[28.5-38.5]min, p&lt;0.001) as well as fluoroscopy time (2[1-4.6] vs 5.1[3.4-12]min, p&lt;0.01). Procedure time was similar between LBBAP-Q4 and RVOP (12[10.5-15] vs 11[7-17]min, p=0.33).

Conclusions
LBBAP is as safe as RVOP and it achieved a narrower paced-QRS than RVOP. It requires a longer procedure time and a shorter fluoroscopy time, with a rapid learning curve.
Marked first-degree AV block may lead to complete AV block development
Authors: Zupan Meznar A , Mrak M , Stublar J , Zizek D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
First-degree atrioventricular (AV) block (PR interval &gt;200 ms) is considered a benign condition with rare progression to a higher degree AV block. The site of block is determined with electrophysiological (EP) study and measurement of His-ventricular (HV) interval, with normal values below 55 ms. Prolonged HV interval &gt; 70 ms is predictive of higher-grade AV block development.
Marked first-degree AV block with a PR &gt; 300 ms may lead to symptoms such as fatigue, poor exercise tolerance and palpitations. When symptoms are correlated to the conduction delay, permanent pacemaker (PPM) implantation to restore AV synchrony should be considered.
In the Framingham heart study, patients with first-degree AV block had a threefold higher risk of PPM implantation. However, there is no data on the HV intervals and the rate of progression of conduction disorder in patients with marked first-degree AV block.

Purpose
To assess the predictive value of HV interval measurement in patients with marked first-degree AV block for progression to a higher-degree conduction disorder.

Methods
We prospectively evaluated consecutive patients with symptomatic marked first-degree AV block that underwent a PPM implantation. His electrograms were recorded during the implantation, and HV intervals were measured from the first deflection of the His signal to the earliest onset of ventricular activation on a 12-lead surface ECG. Patients were followed for 6 months with three out-patient visits, during which the PPM was temporarily inhibited to check for intrinsic AV conduction.

Results
Seventeen patients were evaluated between January 2020 and September 2022. Ten patients (59%) were male, and 7 (41%) were female, with an average age of 61 ± 19 years. All patients had markedly prolonged PR interval (383 ± 47 ms) and narrow QRS complex (100 ± 16 ms). Three patients (17%) had intermittent type 1 second-degree AV block, right bundle branch block was recorded in two (12%) and left anterior fascicular block in four (24%) patients. Except for one patient with a corrected atrial septal defect, there were no echocardiographic signs of structural heart disease with a left ventricular ejection fraction of 61 ± 5%. The HV intervals were on the upper limit of normal values at 54 ± 6ms and no patient had an HV interval above 70 ms. Two patients (12%) developed complete AV block during follow-up: one female, and one male, 28 and 83 years old, respectively, with a PR interval 392 and 363 ms, QRS 104 and 94 ms, and HV 57 and 48 ms. None of the two had any additional conduction blocks at the time of PPM implant.

Conclusion
In our cohort of patients with symptomatic first-degree AV block (PR&gt;300 ms), two patients (12%) developed complete AV block despite normal HV intervals at the time of implant. Closer monitoring, beyond only EP measurements, of patients with markedly prolonged PR intervals is warranted for the potential progression of conduction disorder.
Left bundle branch area pacing versus biventricular pacing for cardiac resynchronisation therapy
Authors: Gomes D , Moscoso Costa F , Rodrigues G , Matos D , Carmo J , Bem G , Santos I , Galvao Santos P , Carvalho P , De Sousa M , Carmo P , Belo Morgado F , Cavaco D , Adragao P 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Conventional right ventricular pacing induces dyssynchrony and 20% of patients may need upgrade for resynchronisation therapy (CRT). Currently, left bundle branch area pacing (LBBAP) is growing as an alternative for conventional pacing, preserving left ventricular function.

Purpose
We aimed to describe procedural characteristics of a group of consecutive patients submitted to LBBAP, and to compare the final QRS duration to a group of consecutive idiopathic LBB patients submitted to conventional CRT.

Methods
Single-centre cohort including consecutive patients submitted to LBBAP or CRT since November 2021. Feasibility, procedure and fluoroscopy times, final QRS duration during pacing immediately after implantation, and periprocedural complications were assessed. Successful implantation of LBBA pacing was defined as a left ventricular activation time (LVAT) &lt; 90ms plus right bundle branch block pattern in V1.

Results
A total of 91 patients (mean age 75±11 years, 70.3% male, and 43 [47.3%] with LBBAP) were included. Total procedure (63min [50-76] vs. 91min [71-131], p&lt;0.001) and fluoroscopy times (4.1min [2.4-6.4] vs. 13.4min [8.3-23.1], p&lt;0.001) were significantly lower in the LBBAP vs. CRT group, respectively. In the LBBA pacing group, median LVAT was 86ms (IQR 81-94) and no cases of electrode dislocation or perforation at discharge were reported. Final QRS duration was 112ms (IQR 105-125) vs 127ms (IQR 115-143) in the LBBAP vs CRT groups respectively (p&lt;0.001).

Conclusion
When compared to a group of idiopathic LBB block patients submitted to CRT, LBBAP was faster, required less fluoroscopy time and was associated with final narrower QRS. Further studies are necessary to understand its role in patients with LV dysfunction and indication for resynchronisation therapy.
Defibrillation testing during S-ICD implantation: How relevant? Results from a multicenter study
Authors: Ben Kilani M , Jacon P , Badenco N , Marquie C , Ollitrault P , Behar N , Khattar P , Carabelli A , Venier S , Defaye P 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Defibrillation testing (DFT) is still recommended in patients with subcutaneous implantable cardioverter-defibrillator (S-ICD) to ensure proper detection of ventricular fibrillation and confirm effective defibrillation. Given the significant risk of complications, recent studies, are reconsidering the interest of the DFT in S-ICD. The purpose of this study was to assess the clinical "real-life" outcomes of DFT over a mid-term follow-up period after third-generation S-ICD implantation.

Methods and Results
368 patients (pts) (47.9 ± 15.5 years old; male 72.8%) implanted with Generation 3 S-ICD system were included in this retrospective multicenter registry-based study. Mean left ventricular ejection fraction (LVEF) was 40.8% (primary prevention 56.1%). For 99.2% pts, S-ICD implantation was performed using the two-incision technique and intermuscular positioning of the generator was performed for all pts. 81% pts underwent ICD testing during implantation. Reasons for not performing DFT were: very low LVEF (3.5%), intracardiac thrombus (2.4%) and VF induction failure. In 2.2% (8 pts) DFT was unsuccessful, causes were: induction of ventricular tachycardias with rates falling below the shock zone for 3 pts while shocks were ineffective for 5 pts. One patient required revision for contralateral lead implantation, while sensing vector reprogramming and shock polarity modification were efficient for the others. The mean impedance was 68.4 (±14.7) Ω and time to shock therapy ranged from 10 to 33 s, with a mean of 16.7 (±4) s. A total of 36 appropriate shocks (10.1%) have been observed after a FU period of 11.02±8.8 months (1.8 shocks per patient, several shocks for 12pts, failure of the first shock for 5 patients). 17 patients (4.6%) underwent S-ICD system extraction. The reasons were pocket site complication (7 pts), pacing indication for cardiac resynchronization therapy or bradycardia (3 pts), and S-ICD lead dysfunction (4 pts). Extraction after heart transplant was needed in 3 pts. Among the 4 pts explanted for system dysfunction, only one patient had a DFT during implantation. After a mean follow-up of 19±12.1 months, the mortality rate was 3.8% (no S-ICD-related deaths were reported). There was no significant difference between the 2 groups of pts with and without DFT testing (p=0.629).

Conclusion
The DFT remains for the moment highly recommended during S-ICD implantations. Results from randomized studies are still needed to confirm the relevance of DFT during S-ICD implantation.
The prevalence and importance of frailty in cardiac resynchronization therapy patients
Authors: Kuthi L , Behon A , Merkel E , Schwertner W R , Masszi R , Veres B , Kovacs A , Osztheimer I , Zima E , Molnar L , Geller L , Kosztin A , Merkely B 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Nemzeti Kardiovaszkuláris Laboratórium RRF-2.3.1-21-2022-00003.

Background
Frailty, characterized by loss of homeostatic reserves and increased vulnerability to physiological decompensation, results from an aggregation of insults across multiple organ systems. Frailty can be quantified by counting the number of ‘health deficits’ across a range of domains.

Aims
We assessed the frequency of, and outcomes related to frailty in patients with heart failure and reduced ejection fraction who previously underwent cardiac resynchronization therapy (CRT) implantation.

Methods
We used a cumulative deficits approach to construct a 30-item frailty index (FI) and applied it to identify frail patients enrolled in our CRT registry. The 30 items were derived from medical history, other patient characteristics and laboratory results, covering a range of body systems. In keeping with previous studies, patients with FI ≤0.210 were classified as non-frail and those with higher scores were divided into two categories using score increments of 0.100. Our primary endpoint was all-cause mortality.

Results
Among 1004 included patients, 75 (7%) were considered Non-frail, while 271 (27%) and 658 (66%) participants were categorized as Frail in groups 1- and 2. Patients in Frail group 2 were older, had a less favorable renal function, and generally had more comorbidities (i.e. atrial fibrillation, hypertension, ischemic cardiovascular disease) than patients categorized in the Non-frail or Frail group 1. During the median follow-up time of 4.4 (2.3-6.9) years, 17 (22%) patients in the Non-frail group, 103 (38%) in Frail group 1, and 479 (73%) in the Frail group 2 reached the primary endpoint. Non-frail patient group showed the most beneficial survival with a 70% (HR 0.31; 95% CI: 0.23-0.41; p&lt;0.001) lower all-cause mortality risk compared to Frail group 2. Adjusting for relevant covariates, NYHA class, creatinine, and TAPSE were identified as independent predictors for all-cause mortality.

Conclusion
Based on our results, CRT candidates are exceedingly vulnerable with a high prevalence of frailty. The calculated frailty index was associated with the primary outcome of death from any cause. FI proved to be prevalent in individual risk stratification and can predict the outcome.
Response to cardiac resynchronization therapy and treatment with ARNi and iSGLT2
Authors: Fonderico C , Faccenda D , Pergola V , Marrese A , Comparone G , Meola M , Salucci A , Cocchiara L , Addeo L , Ammirati G , Rapacciuolo A , Strisciuglio T 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Heart failure with reduced ejection fraction (HFrEF) is associated in about one third of patients with abnormal conduction of the cardiac electrical impulse, resulting in asynchronous activation of the ventricles and worsening of cardiac pump function. Cardiac resynchronization therapy via biventricular pacing (CRT) has demonstrated improvement in cardiac mechanical function. The pharmacological treatment of HFrEF with sacubitril/valsartan (ARNi) and glyphozines (iSGLT2) have been shown to significantly reduce mortality.

Purpose
The objective of our study was 1) to evaluate the effect of therapy with ARNi and iSGLT2 on the recovery of left ventricular ejection fraction (LVEF %) in a population affected by HFrEF and with CRT 2) to evaluate whether there are any differences in terms of improvement in LVEF among patients who introduced these drugs into therapy before CRT implantation and those who introduced them after.

Methods
This single-center retrospective study analyzed patients with HFrEF and CRTD. These patients in our center undergo regular follow-up with cardiology visit, ECG and echocardiography every 6 months. We analyzed clinical features, drug therapy, and echocardiographic data including LVEF. Patients were considered responders they had an increase in LVEF ≥ 5% or a decrease in end-systolic volume of 15% at 6 months. The data analysis was performed with the R software.

Results
258 patients were included, 202 males (78%) with a mean age of 69.4 years, and 67.4% of them with ischemic HFrEF. Diabetes mellitus (68%), dyslipidemia (87%) and arterial hypertension (73%) were the most frequent comorbidities. Fifty-two percent of patients (133) were CRT responders and there was no difference in the proportion of responders between patients receiving ARNi and/or iSGLT2 therapy and those without (55% vs 47%; p=ns). The mean increase of LVEF was also similar between the two groups (+7.7% vs +10.3%; p=ns). In the group of patients taking ARNi or iSGLT2, no significant differences were found between patients taking these drugs already before CRT compared to those who started after.

Conclusions
In this population, HFrEF patients with CRT, therapy with ARNi or iSGLT2 does not affect the response to CRT.
Safety and efficacy of Laser lead extraction in octo- and nonagenarians. A Subgroup Analysis from the GALLERY registry
Authors: Pecha S , Chung D , Burger H , Moeller V , Osswald B , Naegele H , Baersch V , Ghaffari N , Knaut M , Reichenspurner H , Willems S , Butter C , Hakmi S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
In an aging population with cardiac implantable electronic devices (CIED), an increasing number of octogenarians and even nonagenarians present for lead extraction procedures. Those patients are considered as having an increased risk for surgical procedures including lead extraction.

Purpose
We here investigated in a large patient cohort safety and efficacy of transvenous lead extraction with powered extraction sheaths in octo- and nonagenerians.

Methods
A subgroup analysis of the German Laser Lead Extraction Registry (GALLERY) registry was performed. 499 patients were aged ≥80 years and included in this analysis. Primary extraction method was Laser lead extraction, with additional use of mechanical rotational sheaths or femoral snares, if necessary. Predictors for complications and mortality were evaluated in multivariate analysis.

Results
Mean patients age was 84.3±3.7 years, 27.1% were female. 1196 leads were treated. The median lead dwell time was 118.0 (78;167) months. Clinical procedural success rate was achieved in 97.6% of the cases. Procedural failure was observed in 2.1%. Overall complication rate was 4.4%, including 1.8% major- and 2.6% minor complications. BMI&lt;20, was the only statistically significant predictor for procedure related complications. Procedure-related mortality was 0.8%, all-cause in-hospital mortality was 5.4%. Predictors for in-hospital mortality were systemic infection, BMI≤20 kg/m2, procedural complications and chronic kidney disease.

Conclusion
Laser lead extraction in octo- and nonagenarians, is safe and effective. BMI BMI≤20 kg/m2 was the only statistically significant predictor for procedural complications. According to our data, advanced age should not be considered as contraindication for laser lead extraction.