bluuebunny/crossref_metadata_2025_split huggingface dataset:
Microelectrode voltage mapping for substrate assessment in catheter ablation of ventricular tachycardia: a dual-center experience
Authors: Compagnucci P , Dello Russo A , Bergonti M , Cipolletta L , Parisi Q , Volpato G , Colonnelli M , Saenen J , Valeri Y , Carboni L , Marchese P , Marini M , Sarkozy A , Natale A , Casella M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The assessment of the ventricular myocardial substrate critically depends on the size of mapping electrodes, their orientation with respect to wavefront propagation, and interelectrode distance.

Objective
we conducted a dual-center study to evaluate the impact of microelectrode mapping in patients undergoing catheter ablation (CA) of ventricular tachycardia (VT).

Methods
We included 21 consecutive patients (median age, 68 [12], 95% male) with structural heart disease undergoing CA for electrical storm (n=14) or recurrent VT (n=7) using the QDOT Micro catheter and a multipolar catheter (PentaRay, n=9). The associations of peak-to-peak maximum standard bipolar (BVc) and minibipolar (PentaRay, BVp) with microbipolar (BVμMax) voltages were respectively tested in sinus rhythm with mixed effect models. Furthermore, we compared the features of standard bipolar (BE) and microbipolar (μBE) electrograms in sinus rhythm at sites of termination with radiofrequency energy.

Results
BVμMax was moderately associated with both BVc (β=0.85, p&lt;0.01) and BVp (β=0.56, p&lt;0.01). BVμMax was 0.98 (95% CI, 0.93-1.04, p&lt;0.01) mV larger than corresponding BVc, and 0.27 (95% CI, 0.16-0.37, p&lt;0.01) mV larger than matching BVp in sinus rhythm, with higher percentage differences in low voltage regions, leading to smaller endocardial dense scar (2.3 [2.7] vs. 12.1 [17] cm2, p&lt;0.01) and border zone (3.2 [7.4] vs. 4.8 [20.1] cm2, p=0.03) regions in microbipolar maps compared to standard bipolar maps. At sites of VT termination (n=14), μBE were of higher amplitude (0.9 [0.8] mV versus 0.4 [0.2] mV, p&lt;0.01), longer duration (117 [66] ms versus 74 [38] ms, p&lt;0.01), and with greater number of peaks (4 [2] versus 2 [1], p&lt;0.01) in sinus rhythm compared to BE.

Conclusions
Microelectrode mapping is more sensitive than standard bipolar mapping in the identification of viable myocytes in SR, and may facilitate recognition of targets for catheter ablation.
Clinical outcomes and procedural characteristics of ventricular tachycardia ablation in patients with or without electrical storm
Authors: Nagy Z , Szonyi M , Csakany L , Major T , Mladoniczky S , Kassa K , Som Z , Foldesi C , Kardos A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Electrical storm (ES) is a life-threatening clinical condition characterized by the recurrence of three or more episodes of ventricular tachycardia (VT) and/or ventricular fibrillation within 24 hours, leading to ICD therapy. Catheter ablation of VT in patients with ES is a high-risk procedure but has been shown to reduce VT recurrence and the number of appropriate ICD therapies in patients with structural heart disease.

Purpose
Our study aimed to compare the characteristics and outcomes of VT ablation in patients with or without ES.

Methods
Our single-center study included a cohort of 39 consecutive patients (31 men, mean age=60.9±18.4 years) who underwent VT ablation between January 2020 and January 2022, 21 of them (53.8%) due to ES and 18 patients (46.2%) had an elective procedure. Clinical and procedural characteristics, VT recurrence, and mortality rates were compared between the two groups.

Results
Patients with ES were older than patients without ES (67.8 vs 54.2 years, p=0.004), they were mainly presented with ischaemic cardiomyopathy (85.7% vs 27.8%, p&lt;0.0001), had a higher prevalence of congestive heart failure (90.5% vs 44.4%, p=0.001) and a more severe left ventricular dysfunction (LVEF: 30.8% vs 46.9%, p=0.002). During the procedure, in the ES group, all of the patients had left-sided ablation (transaortic: 80.9%, transseptal: 19.1%), while in patients without ES, 72.2% of the procedures were left-sided (p=0.04). In 8/39 patients (20.5%) endo-epicardial access was needed. The number of RF ablation points was significantly higher in the ES group (64.1 vs 36.1 points, p=0.01). Complications were detected only in the ES group: intraprocedural death occurred in one case due to an ES and consequently cardiogenic shock, and one patient had a dissection of the right femoral artery. There was no significant difference regarding procedure time, fluoroscopy time, and radiation exposure. The in-hospital 30-day mortality was 8/21 (28.6%) in patients with ES, while no patients died in the non-ES group. During longer clinical follow-up, there was no significant difference in the recurrence of VT episodes and mortality.

Conclusion
Patients presented with ES are a more vulnerable population with many comorbidities. Catheter ablation of VT in patients with ES is a more complex procedure with a higher complication rate and these patients have a higher risk of in-hospital mortality. Further studies are needed to determine the optimal timing of VT ablation in this patient population.
Omnipolar mapping in ventricular tachycardia: will it be a game changer?
Authors: Ascione C , Kowalewski C , Bouyer B , Tixier R , Chauvel R , Yokoyama M , Cohet H , Duchateau J , Pambrun T , Derval N , Tondo C , Hocini M , Haissaguerre M , Jais P , Sacher F 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Ventricular tachycardias(VT) are life-theatening cardiac arrhythmias. Catheter ablation, the standard approach to VT is relying heavily on maps depicting intracardiac signals. The current mapping approach was based on bipolar electrograms, which are massively influenced by the direction of the underlying tissue activation. The omnipolar (OT) electrogram method was recently proposed to generate orientation-independent electrograms and has shown improved results in recent publications (1-2). We describe the first cohort of patients ablated for VT with the help of an OT-enabled catheter.

Purpose
To evaluate acute and mid-term follow-up of patients ablated for VT using an OT enabled mapping system.

Methods
Eighteen patients (age 65 ± 19; 2 females, 32% nonischemic, median ejection fraction 40), underwent catheter ablation for scar-related VT. 50% (9) n patients had previous ablation, 4 of which underwent epicardial access. High-density omnipolar maps were obtained with an HD-grid catheter after which ablation was performed with an irrigated-tip catheter. In all patients the ablation was primarily substrate-based with the support of CT scan scar visualization. In 18 patients local abnormal ventricular activities (LAVA) ablation was performed (3), while one patient showed no LAVA. In 7 patients VT mapping was possible due to stable blood pressure during the tachycardia. The median radiofrequency application duration was 36 min. While all patients except one were inducible at the beginning of the procedure, only 3 patients were inducible at the end with a protocol using up to 3 extrastimuli. Follow-up was available in 13 patients (7.1 ± 2.5 months) with 66% freedom from VT recurrence (60% in redo cases and 71% in first procedures).

Conclusion
OT is a reliable method to visualize signals and perform a substrate-based ablation in with good acute and mid-term outcomes. Future studies will evaluate the impact on long term outcomes.
The phospholamban (PLN) p.Arg14del risk model; Longitudinal validation and reevaluation of predictors regarding sudden cardiac death (SCD)
Authors: Van Der Heide M Y C , Verstraelen T E , Van Lint F H M , Bosman L P , De Brouwer R , Proost V M , Germans T , Dickhoff C , Schoonderwoerd B A , Houweling A C , Gimeno-Blanes J R , De Boer R A , Cox M G P J , Van Tintelen P , Wilde A A M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): PSIDER (ZOn-MW)
PREDICT2 (Hartstichting)

Background
The PLN p.Arg14del risk model is a mutation-specific risk model developed to predict individual malignant ventricular arrhythmia (VA) risk to inform decision-making for primary prevention implantable cardioverter defibrillator (ICD) implantation. While the risk model has proven to be valid, two main points of criticisms remain to be discussed: first, the risk model is only validated at baseline and second, appropriate ICD therapy and sustained ventricular tachycardia (VT) &lt;250 bpm is an imperfect surrogate outcome for SCD.

Purpose
To evaluate the diagnostic performance of the PLN p.Arg14del risk model longitudinal at 3 year follow-up and to reevaluate the predictors regarding SCD.

Methods
Clinical data of 278 PLN p.Arg14del mutation carriers with no history of malignant VA at both baseline and 3 year follow-up were collected. During a median follow-up of 4 years (Interquartile range (IQR) 1.8-6.5), 31 (11%) carriers experienced malignant VA, defined as sustained VA, appropriate ICD intervention, or (aborted) SCD. The reevaluation of the predictors with the 3 year follow up data revealed hazard ratio’s (HR) that were similar to the baseline PLN p.Arg14del risk model for left ventricular ejection fraction (HR 1.10 [95% CI, 1.06-1.12], p&lt;0.001), low-voltage ECG (HR 12.24 [95% CI, 5.21-28.8], p&lt;0.001) and the PVC count per 24h (HR 1.51 [1.15-1.98], p=0.003). The 5-year malignant VA risk was divided into tertiles of predicted risk. The tertiles clearly demonstrated good discrimination between risk group as shown in figure 1 and this resulted in an C-statistic of 0.85 (95% CI 0.78-0.92).
To reevaluate the predictive performance of the PLN p.Arg14del risk model for a more strict surrogate of SCD we redefined the outcome as VT &gt;250 beats per minute sustained (lasting ≥30 seconds) or terminated by ICD, ventricular fibrillation, aborted SCD and SCD. We included 669 PLN p.Arg14del carriers with no presentation or history of sustained VA or (aborted) SCD. During a median follow-up of 4.75 years (IQR 1.9-7.9), 33 (5%) carriers experienced the outcome. Results of the univariable analysis are shown in table 1. The PLN p.Arg14del risk model yielded a C-statistic of 0.75 (95% CI 0.70-0.80). Adding risk factors sex, age and sustained VT &lt;250 bpm did not change its performance.

Conclusion
The PLN p.Arg14del risk model was validated longitudinal at 3 year follow-up and it held its performance with a more strict definition of SCD.
Biventricular strain dyssynchrony analysis of left bundle branch area pacing: a prospective, observational study
Authors: Dell'era G , Ghiglieno C , Degiovanni A , De Vecchi F , Porcellini S , Santagostino M , Veroli A , D'amico A , Spinoni E G , Patti G 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Left bundle branch pacing (LBBAP) seems to carry advantages compared to His bundle pacing, such as superior electrical performances and less steep learning curve. Aim of this study was to evaluate technical feasibility, safety, electrical parameters and ventricular synchrony with LBBAP.

Methods
We prospectively enrolled patients receiving LBBAP, such as those with preserved (&gt;50%) left ventricular ejection fraction (LVEF) and narrow QRS, with preserved LVEF and wide QRS, and with LVEF &lt;50%. Electrocardiogram and electrical parameters were evaluated at implant, 24 hours and 3 months. Echocardiographic evaluation was carried out at baseline and after 3 months. Ventricular synchrony was analyzed by time-to-peak-standard-deviation (TPSD) of strain curves of both ventricles.

Results
We enrolled a total of 58 patients, in whom, according to currently validated criteria, LBBAP was successful in 56 (97%) patients. In the overall population mean baseline QRS duration was 124.1±30.7 msec, while paced QRS duration was 107.7±13.6 msec (p &lt; 0.001). LVEF improved from 52.9±10.5% to 56.9±8.4%, (p=0.004). Improvement was also observed for interventricular synchrony, by reduction of TPSD difference between LV and RV from 27.9 (10.2–41.5) to 13.9 (4.3-28.7) (p=0.001), and for LV synchrony, by decrease of TPSD delta between LV segments from 38.2 (13.6–53.9) to 15.1 (8.3–31.5) (p &lt;0.001). Ameliorations were consistent in all patient subgroups, irrespective of QRS duration or LVEF.

Conclusion
LBBAP improves LVEF and both intraventricular (LV) and interventricular (LV-RV) synchronization, irrespective of pacing indication, baseline QRS duration and LV function.
Depolarization-repolarization synchrony after right ventricular and left bundle branch area pacing
Authors: Sales Belles C , Melero Polo J , Cabrera Ramos M , 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
Left bundle branch area pacing (LBBAP) has been recently proposed to overcome the limitations associated with right ventricular pacing (RVP) and has been suggested as a new physiological pacing form with high feasibility and safety. A greater difference between QRS complex and T-wave angle directions has been proposed as a marker of abnormal electrical activity in several patient populations, but a comparison between these two pacing modalities has never been performed. The total cosine R to T (TCRT) is an ECG descriptor that accounts for depolarization-repolarization synchrony by measuring the difference between their directions. The purpose of this study was to compare TCRT in patients referred for RVP and LBBAP pacing as anti-bradycardia therapy.

Methods
ECG recordings from 134 patients (82 LBBAP, 52 RVP) were classified into two groups, narrow QRS and wide QRS, depending on the patient’s QRS duration prior to implantation. In the post-implantation state, the TCRT index was calculated from a median beat calculated for each patient. Singular value decomposition was applied to the median beat in the eight independent ECG leads (I, II, V1, V2, V3, V4, V5, V6). The QRS complex and T wave loops in a three-dimensional space were determined from the first three components of the decomposition. TCRT was computed as the average of the cosines of the angles between the QRS complex directions and the maximum T wave direction. More positive values corresponded to more synchronized depolarization and repolarization processes while more negative values indicated larger differences in the orientation of the QRS and T wave loops and, therefore, greater dyssynchronization.

Results
showed that TCRT took negative values for both techniques, RVP and LBBAP, and both groups, narrow and wide QRS, indicating that pacing generated dyssynchronization between ventricular depolarization and repolarization. Nevertheless, TCRT values for both groups were significantly more negative (p&lt;0.01) for RVP than for LBBAP. We hypothesize that cardiac memory induced by pacing could account for these negative TCRT values. In any case, LBBAP did not increase the difference in the QRS complex and T wave loop orientations as much as RVP.

Conclusion
LBBAP induces less dyssynchrony than RVP in the depolarization-repolarization process.
Amiodarone does not significantly affect the success rate of ventricular fibrillation induction tests performed during or after ICD implantation. Insights from the German DEVICE registry
Authors: Wiedmann F , Ince H , Stellbrink C , Kleemann T , Eckardt L , Brachmann J , Gonska B D , Kaab S , Perings C A , Jung W , Lugenbiel P , Hochadel M , Senges J , Frey N , Schmidt C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): The DEVICE registries were financed by “Stiftung Institut für Herzinfarktforschung (IHF)”, with additional support by grants from Biotronik, Medtronic, and St. Jude Medical.

Background
Experimental data and early clinical trials suggested that amiodarone may alter the defibrillation threshold of ICD systems. However, because of its potent antiarrhythmic effect and lack of alternatives, amiodarone is frequently used for antiarrhythmic therapy in ICD or CRT-D patients, leading to the question of whether ICD testing with ventricular fibrillation induction should be repeated in these patients after starting amiodarone.

Objective
This study was designed to assess the impact of amiodarone therapy on the success of ventricular fibrillation induction tests in this "real life" cohort of ICD recipients of the German DEVICE registry.

Methods
3,680 patients who underwent ICD implantation, revision, or upgrade in 49 centers participating in the German DEVICE Registry were enrolled 03/2007-02/2014.

Results
Intraoperative defibrillation testing was conducted in 2,705 patients receiving only beta-blockes as antiarrhythmic therapy and in 422 patients under betablocker plus amiodarone therapy. With regard to ineffective defibrillation tests, no difference could be described between the two groups (0.6% vs. 0.5%; p=0.77). In a similar fashion 488 patients receiving beta-blockers only and 65 patients under beta-blocker plus amiodarone therapy who were scheduled for postoperative defibrillation testing showed comparable rates of ineffective testing (14.5% vs. 15.4%; p=0.86).

Conclusions
Based on 3,127 intraoperative and 553 postoperative defibrillator testings, our study failed to show a significant association of amiodarone therapy and ineffective defibrillator testings in this "real life" cohort of ICD recipients of the German DEVICE registry. Our results thus underline that, apart from special situations such as right-sided implantation, HCM, extravenous ICD systems, etc., it might not be necessary to perform a DFT test after the start of an amiodarone therapy in ICD patients.
Prediction of all-cause mortality using a multisensor implantable defibrillator algorithm for HF monitoring
Authors: D'onofrio A , Manzo M , Bertini M , Santini L , Savarese G , Dello Russo A , Santobuono V E , Lavalle C , Viscusi M , Amellone C , Calvanese R , Santoro A , Ziacchi M , Valsecchi S , Calo L 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The HeartLogic algorithm combines multiple implantable defibrillator (ICD) sensor data and has proved to be a sensitive and timely predictor of impending heart failure (HF) decompensation.

Purpose
We determined if remotely monitored data from this algorithm can be used to identify patients at high risk of mortality.

Methods
The HeartLogic feature was activated in 568 ICD patients from 26 centers.

Results
During a median follow-up of 26 months [25th–75th percentile: 16-37], 1200 HeartLogic alerts were recorded in 370 (65%) patients. Overall, the time IN the alert state was 13% of the total observation period (151 out of 1159 years) and 20% of the follow-up period of the 370 patients with alerts. During follow-up, 55 patients died (37 in the group with alerts). Experiencing any alert episode was associated with a substantially increased risk of death [hazard ratio (HR): 2.08, 95% confidence interval (CI): 1.16–3.73, P = 0.039]. Additionally, a time IN alert ≥20% was associated with death (HR: 4.07, 95%CI: 2.19-7.54, p&lt;0.001, Figure), even after multivariate correction for age, atrial fibrillation on implantation, chronic kidney disease, ischemic cardiomyopathy (HR: 3.26, 95%CI:1.87-5.70, p&lt;0.001). The rate of death was 0.25/patient-year (95%CI: 0.17-0.34) with the HeartLogic IN the alert state and 0.02/patient-year (95%CI: 0.01-0.03) OUT of the alert state, with an incidence rate ratio of 13.72 (95%CI: 7.62-25.60, p&lt;0.001).

Conclusions
The HeartLogic algorithm provides an index that can be used to identify patients at higher risk of all-cause mortality. The index status identifies periods of significantly increased risk of death.
Device-related infection in a large tertiary center-Benefit of the antibacterial envelope
Authors: Hofer D , Avdi D , Ruegg P , Saguner A M , Molitor N , Breitenstein A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiac implantable electronic device (CIED) infection carry a high morbidity and mortality. According to current data, the risk for a device-related infection is in a range of 0.6-3.4 % due to the latest EHRA consensus practical guide (reference 1). The use of an antibacterial envelope was associated with a reduced risk for infection in a large randomized trial (reference 2).

Methods
Retrospective analysis of the one-year risk of device-related infections in a large tertiary center in Switzerland during the time period of 2014-2019 (period A where the antibacterial envelope used only occasionally) in comparison to the risk of infection during the year 2020 (Period B, one year where in all device-interventions an antibacterial envelope was used). The presence of a local or systemic, device-related infection was counted as an infection event.

Results
In this retrospective analysis from two large Swiss implantation centres, a total of 1776 patients were included from the time period 2014-2020. 1’457 derived from period A (2014-2019) where the antibacterial envelope was only used in 2.6 % of the interventions compared to period B with 319 patients where in all interventions the envelope was present. There were no demographic or baseline characteristic differences between the two groups (table 1) except for the presence of a larger population of patients suffering from valvular heart disease (30.3 % during period A versus 10.8 % during period B) but without an relevant difference in the use of anticoagulation. The risk for device-related infection during period A was 0.96 % (N=14) versus only 0.63 % (N=2) during time period B which equals a relative risk reduction of 34.8 %.

Conclusions
The use of the antibacterial envelope during device-interventions was associated with a 34.5% relative risk reduction in a large tertiary Swiss center. Keeping in mind the potential additional burden of device-infection related treatment, it is of paramount importance to reduce the risk for device-associated infections.