bluuebunny/crossref_metadata_2025_split huggingface dataset:
Midterm results of bipolar ablation in patients with intramural substrate and recurrent VTs based on a single center experience
Authors: Ene E , Nentwich K , Deaconu A , Berkovitz A , Halbfass P H , Sonne K , Deneke T 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Catheter ablation of VTs and intramyocardial substrate (IS) remains a challenge that may require alternative mapping and ablation strategies such as bipolar ablation (BA) to achieve VT non inducibility. However, the long-term success of these alternative strategies is still uncertain.

Purpose
The aim of this study was to report the midterm center experience success of BA RF ablation of VT in patients with documented intramyocardial scar in cardiac imaging.

Methods
19 patients with documented intramyocardial substrate on cardiac imaging (cardiac MRI or cardio CT with delayed enhancement) and VT recurrences after at least one conventional catheter ablation were retrospectively included. The intraprocedural success (i.e. VT non inducibility at the end of procedure) respectively midterm success (i.e VT recurrence after 6 months from BA) were investigated. The ablation was performed using a special RF generator which permits bipolar RF ablation between 2 irrigated catheters.

Results
A total number of 19 patients were included (100 % men, mean age 66,7 ± 9,16 y/o). The mean LVEF was 39,5 ± 5,7. The distribution of underlying structural heart disease was as follow: 21 % ischemic cardiomyopathy (4 out of 19 patients), 52 % dilative cardiomyopathy (10 out of 19 patients) respectively 26 % other etiologies (5 out of 19 patients). A mean number of 2 ± 1 conventional VT ablation were previously performed. In almost all patients (94 %, 18 out of 19 patients) the clinical VT was induced before the BA (mean CL 342 ± 91ms). The BA was performed predominantly septal (84%, 16 out of 19 patients). In 3 patients an endo/epicardial BA was performed. No VT was inducible any more at the end of procedure in 15 patients (79 %). At a mean follow up of 1 ± 0,5 years no recurrence of clinical VT was noted but non-clinical VT recurrence was seen in 9 patients (47 %) exclusively in patients with septal substrate.

Conclusion
BA represents a good alternative strategy for CA in patients with IS and failed conventional VT ablation with good acute success but high VT recurrence rate in patients with septal IS.
Feasibility of novel atrial mechanical sensing method for leadless atrioventricular synchronous pacing
Authors: Kazawa S , Murakami H , Sakaida T , Okano T , Takada Y , Yazaki Y , Tanaka N , Satomi K 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
A novel leadless pacemaker enables atrioventricular synchronous pacing. However, there have been still difficulties to obtain high atrioventricular (AV) synchrony due to a mechanical sensing algorithm. We’ve reported a new sensing method for acquiring high AV synchrony regardless of heart rate. Our hypothesis is that this novel sensing method might facilitate better AV synchrony.

Purpose
The purpose of this study is to investigate the feasibility of our novel sensing method for the patients that ventricular activity completely depends on the ventricular pacing.

Methods
This study is a retrospective study conducted by 2 centers. From the 1st December, 2021 to the 31th October, 2022, leadless pacemakers with atrioventricular synchronous pacing were implanted to 32 patients in 2 centers. Among the 20 patients with sinus rhythm and complete AV block were analyzed. Two groups were compared in this study. Novel sensing setting was programmed during the hospitalization in Group 1, composed by 9 patients. Auto A3 threshold and auto A3 window end are turned off. An intentionally prolonged A3 window end and a low A3 threshold are programmed in a novel sensing method. Conventional setting (auto A3 threshold, auto A3 window end and auto A4 threshold were turned on) was programmed during the hospitalization in Group 2, composed by 11 patients. Device check was performed at the first outpatient clinic within 3 months after the implantation.

Results
Overall, 20 patients were analyzed. Baseline characters are described in Table 1. BMI (23.5±0.9 vs 20.4±0.8, p&lt;0.05), BNP at the hospitalization (130.7±143.6 pg/ml vs 686.9±129.9 pg/ml, p&lt;0.05) were different between 2 groups. Mean age, sex, past history of atrial fibrillation, hypertension, diabetes mellitus, dyslipidemia, past history of coronary artery disease, eGFR, previous cardiac surgery, left ventricular ejection fraction, E/A, left atrial diameter were no significant differences between 2 groups. Table 2 shows the comparison of the device parameters between 2 groups. In Group 1, AV synchrony (%AMVp) was significantly higher at the first outpatient clinic (81.0 ± 4.2 % vs 63.0 ± 5.7 %, p=0.03). A3 window end was significantly longer in Group 1 (883.3 ± 34.0 ms vs 757.0 ± 45.5 ms, p&lt;0.05). A3 threshold was significantly lower in Group 1 (2.3 ± 0.5 m/s² vs 5.9 ± 0.7 m/s², p&lt;0.05). There were no significant differences about A4 amplitude (1.8 ± 0.4 m/s² vs 1.0 ± 0.6 m/s², p=0.34) and A4 threshold (2.3 ± 0.3 m/s² vs 1.5 ± 0.4 m/s², p=0.12).

Conclusion
Novel sensing method might be a feasible sensing method to obtain higher AV synchrony than conventional algorithm. Further prospective studies will be required.
Axillary vein puncture versus cephalic vein cutdown for cardiac implantable electronic device implantation: a meta-analysis
Authors: Vetta G , Magnocavallo M , Parlavecchio A , Caminiti R , Polselli M , Sorgente A , Crea P , Pannone L , Lo Savio A , Pistelli L , Chierchia G B , Rossi P , Natale A , De Asmundis C , Della Rocca D G 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Cephalic vein cutdown (CVC) and axillary vein puncture (AVP) are both recommended for transvenous implantation of leads for cardiac implantable electronic devices (CIEDs). Nonetheless, it is still debated which of the two techniques has a better safety and efficacy profile.

Methods
We systematically searched Medline, Embase and Cochrane electronic databases up to September 5th, 2022, for studies that evaluated the efficacy and safety of AVP and CVC reporting at least one clinical outcome of interest. The primary endpoint was acute procedural success. The effect size was estimated using a random-effect model as Risk Ratio (RR) and relative 95% Confidence Interval (CI).

Results
Overall, 8 studies were included, which enrolled 1926 patients and 3532 transvenous lead implants [66.3% (n=1277) males with an average age of 72.3±14.8 years]. Compared to CVC, AVP showed a significant increase in the primary endpoint (95.7 % vs 76.1 %; RR: 1.24; 95% CI: 1.09-1.40; p=0.001) (Figure 1). Total procedural time (Mean Difference [MD]: -8.25 min; 95%CI: -10.23- -6.27; p&lt;0.0001; I2 =0%) and venous access time (MD: -6.24 min; 95%CI: -7.01- -5.47; p&lt;0.0001; I2 =0%) were significantly shorter with AVP compared to CVC. No differences were found between AVP and CVC for incidence of pneumothorax (RR: 0.72; 95% CI: 0.13 - 4.0; p=0.71), lead failure (RR: 0.58; 95% CI: 0.23-1.48; p=0.26), pocket hematoma/bleeding (RR: 0.58; 95% CI: 0.15- 2.23; p=0.43), device infection (RR: 0.95; 95% CI: 0.14- 6.60; p=0.96) and fluoroscopy time (MD: -0.24 min; 95%CI: -0.75- 0.28; p=0.36).

Conclusion
Our meta-analysis suggests that AVP may improve procedural success and reduce total procedural time and venous access time compared to CVC.
Afterload dependence of right ventricular pacing-induced left ventricular dysfunction in patients with aortic stenosis undergoing transcatheter aortic valve implantation
Authors: Ruppert M , Lakatos B K , Osztheimer I , Molnar L , Zima E , Geller L , Kosztin A , Straub E , Papp R , Tarjanyi Z , Ladanyi Z S , Turschl T , Kovacs A , Merkely B 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): TKP2021-EGA-23
János Bolyai Research Scholarship of the Hungarian Academy of Sciences.

Introduction
Recent experimental data indicates that patients with left bundle branch block are particularly sensitive to increased arterial afterload. Nevertheless, whether the detrimental hemodynamic consequence of right ventricular pacing (RVP) is also associated with afterload dependency has not been investigated yet.

Purpose
Hence, the present preliminary study aimed to examine the acute effect of RVP on left ventricular (LV) function in patients with aortic stenosis before (with elevated arterial afterload) and after (without elevated arterial afterload) transcatheter aortic valve implantation (TAVI).

Methods
Patients with a previously implanted permanent pacemaker (PM) and significant aortic stenosis referred for TAVI at the Heart and Vascular Center of our university were screened for this observational study. Only those patients who had an intrinsic, regular, narrow QRS rhythm (including junctional escape rhythm) were included. Four patients with a DDD PM (with sick sinus syndrome and maintained AV conduction) and two patients with a VVI PM (with atrial fibrillation and AV block) were enrolled. Echocardiography was performed immediately before TAVI and on the second postoperative day. The ultrasound measurements were carried out during intrinsic, narrow QRS rhythm (80/min AAI pacing in patients with DDD PM and 30/min backup VVI pacing to allow the narrow QRS escape rhythm in patients with VVI PM) and during frequency-matched RVP with wide QRS (&gt;150ms) (DDD pacing with a short AV interval ensuring ventricular capture or VVI pacing, respectively). From the sonographic recordings, speckle-tracking echocardiography-derived global myocardial work index (GMWI) was calculated by commercially available software to assess LV function.

Results
TAVI resulted in decreased mean aortic gradient (35.4±3.6 mmHg vs. 5.3±1.4 mmHg before vs. after TAVI, P&lt;0.001) indicating successful alleviation of the increased arterial afterload. Compared to the intrinsic, narrow QRS rhythm, RVP reduced GMWI before and after TAVI as well. Nevertheless, a significant reduction was only noted when the increased afterload was present (pre-TAVI GMWI: 1710±169 vs. 1170±199mmHg%, P=0.008), while following pressure unloading only a strong tendency could be observed (post-TAVI GMWI: 1127±76 vs. 865±83mmHg%, P=0.065).

Conclusion
Our preliminary results indicate that RVP-induced LV dysfunction might be afterload dependent. Hence, in patients with aortic stenosis and a high percentage of ventricular pacing, afterload reduction could entail a great clinical benefit.
Long-term impact of pacemaker implantation after TAVI: a subgroup analysis according to previous intraventricular conduction disturbances
Authors: Lacerda Teixeira B , Grazina A , Castelo A , Mendonca T , Rodrigues I , Ramos R , Fiarresga A , Osorio P , Portugal G , Valente B , Silva Cunha P , Lousinha A , Cruz Ferreira R , Cacela D , Oliveira M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Transcatheter aortic valve implantation (TAVI) is a worldwide accepted treatment for severe aortic stenosis (AS). Conduction system disturbances, frequently requiring permanent pacemaker (PM) implantation, remain one of the most common procedural complication. Whether the permanent ventricular pacing has a deleterious impact on the prognosis of this population remains unclear.

Objectives
To assess the long-term impact of permanent PM implantation in clinical outcomes after TAVI.

Methods
We performed a retrospective analysis of consecutive patients (P) who underwent TAVI between 2009 and 2021 in a single tertiary center.P with a PM implanted before TAVI or with in-hospital mortality were excluded from the analysis. PM implantation post-TAVI was defined as an implant during hospital stay after TAVI or in the first month after discharge. Kaplan Meier survival curves were used to estimate the impact of permanent PM after TAVI, regarding the composite endpoint of all-cause mortality and heart failure (HF) hospitalization during a 4 years follow-up period, and a comparison performed according to the presence or absence of baseline intraventricular conduction disturbances.

Results
549 P (82±6.6 years, 56.8% female, left ventricular ejection fraction 53±10%, peak gradient 51±15.6 mmHg, aortic valve area 0.7± 0.2 cm2) were included. At baseline, 108 P (20%) had intraventricular conduction disturbances on ECG (50 P with right bundle branch block [RBBB] and 58 P with left bundle branch block [LBBB]). 127 P (23%) required PM implantation after TAVI. Baseline characteristics were similar between P with and without PM implantation, except for age, gender, previous valvular surgery and RBBB (Table 1). At 48 months follow-up, 35% (n=193) met the composite endpoint, that was similar between both groups (35.8% vs. 34.1%, p=0.731). Kaplan-Meier survival curves revealed no difference in the composite endpoint between the two groups (log-rank p=0.170). Further analysis of subgroups according to the presence or absence of baseline intraventricular conduction disturbances revealed a significant difference among the subgroup of P without previous intraventricular conduction disturbances that underwent PM implantation after TAVI (log rank p=0.02) (Fig 1). This difference in the composite endpoint after PM was not found in the subgroups of P with RBBB (log rank p=0.656) or LBBB (log rank p=0.975) at baseline (Fig 2).*

Conclusions
Permanent PM implant after TAVI does not have an impact on long-term HF hospitalization and mortality. However, in the specific subgroup of P without previous intraventricular conduction disturbances, PM implantation seems to be associated with worse prognosis.
Left ventricular size may predict a better CRT response
Authors: La Greca C , Prezioso A , Zanchi S , Pecora D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
We know that women have better responses to cardiac resynchronization therapy (CRT) (1). A possible explanation for this greater benefit has been attributed to sex difference in left ventricular (LV) size: sex-specific differences disappear when we normalize QRS duration to left ventricular end-diastolic volume (LVEDV) (2). QRS narrowing index (QI) has been showed predicting reverse left ventricular remodelling following CRT (3; 4).

Purpose
We sought to analyse the relationship between LV dimensions pre-CRT and QRS narrowing index, as a predictor of LV remodelling, and the relationship between LV dimensions pre-CRT and echocardiographic response 1 year after CRT.

Methods
We collected data from our Cardiovascular Implantable Electronic Device (CIED) outpatients’ database, selecting patients who underwent CRT, with analysable echocardiographic images in our local PACS, and with clinical, electrocardiographic, and echocardiographic data pre-CRT and at 1-year follow-up.

Results
We reviewed electrocardiograms and echocardiograms of 203 patients (M=120, 59,11%) who underwent CRT from 2015 to 2020. A higher QRS/LVEDV ratio and a higher QRS/LV mass ratio were associated with higher QI (p=0.03 and p&lt;0.001, respectively). A higher QRS/LVEDV ratio was associated with higher LVEF (p&lt;0.001), lower LVEDV (p&lt;0.001) and lower LVESV (p&lt;0.001) at follow up. Similarly, a higher QRS/LV mass ratio was associated with higher LVEF (p=0.04), lower LVEDV (p=0.02) and lower LVESV (p=0.01) at follow up.

Conclusions
LV size seems to have a role in prediction of a better response to CRT. Both the QRS/LVEDV ratio that the QRS/LV mass ratio may predict better electrocardiographic an echocardiographic response.
Repolarization changes following left bundle branch area pacing versus conventional biventricular pacing in patients with dyssynchronous heart failure
Authors: Smits K C , Nguyen U C , Rijks J , Stipdonk A M W , Hermans B J M , Bressi E , Grieco D , Luermans J G L M , Vernooy K , Prinzen F W 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Dutch Heart Foundation.

Background
Biventricular pacing (BiVP) is the standard treatment for patients with dyssynchronous heart failure. Despite the effectiveness of BiVP, 6% of patients develop ventricular tachyarrhythmia’s (VTAs) within one year following implantation. The relationship between BiVP and the development of VTAs is still under debate. The left-sided epicardium-to-endocardium activation during BiVP creates a nonphysiological activation and repolarization and might provoke VTAs. A relatively new treatment option is left bundle branch area pacing (LBBAP), in which the physiological activation of the left ventricle is restored. We hypothesize that LBBAP leads to a more homogenous repolarization compared to conventional BiVP.

Purpose
To compare time-dependent repolarization changes in patients with dyssynchronous heart failure receiving LBBAP versus BiVP.

Methods
Patients with dyssynchronous heart failure eligible for cardiac resynchronization therapy who underwent LBBAP (n=13) or BiVP (n=28) were retrospectively included. Standard 12-lead electrocardiograms (ECG) obtained prior to implantation [baseline], shortly following implantation (0-2 days,[acute]) and during follow-up (31-180 days, [FU]) were analyzed. The QT interval and Tpeak to Tend interval (Tpeak-Tend) were calculated using a semi-automatic approach in MATLAB. Repolarization differences between LBBAP and BiVP patients were determined using the Mann-Whitney U-test. Time-dependent changes within groups were determined using the Wilcoxon signed rank tests. Significance was defined as a p-value ≤0.05.

Results
The QT interval did not significantly change over time in BiVP patients, but it decreased immediately following implantation and during FU in LBBAP patients. At FU, QT interval was significantly lower in LBBAP than in BiVP patients (Figure 1, left panel). A slight increase in Tpeak-Tend interval over time in BiVP patients, while it tends to decrease over time in LBBAP patients can be seen in the right panel. Acutely and long term after implantation, Tpeak-Tend was significantly lower in LBBAP than in BiVP patients.

Conclusion
LBBAP is associated with lower QT and Tpeak-Tend intervals compared to BiVP during FU, suggesting that LBBAP leads to less heterogeneity of repolarization over time. These findings suggest a more physiological repolarization pattern in LBBAP compared to BiVP, which may decrease the risk of developing VTAs.
Analysis of the effects of atrial pacing on the timing of left ventricular pressure rise in normal conduction and left bundle branch block
Authors: Marciniak M , Albatat M , Hammersboen L , Stugaard M , Finstad E , Frostelid V C , Remme E , Odland H 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Norwegian Research Council.

Background/Introduction
The timing of left ventricular pressure rise (Td) relative to QRS-onset is associated with dispersion of regional work distribution and prolongs with dyssynchrony and dyssynergistic contractions. Td is short in normal conduction and shortening of Td can be achieved with effective biventricular pacing (BIVP). The effect of atrial pacing on Td is unknown and could be important for the interpretation of Td when utilized for cardiac resynchronization therapy.

Purpose
We wanted to test the effects from atrial pacing (AP) compared to sinus rhythm (SR) on Td in animals with narrow QRS (nQRS) complexes and after the creation of LBBB.

Methods
9 mongrel dogs were included in the study and handled according to ethics committee approved protocol/GLP. Pacing electrodes were placed epicardial on the left atrial appendage. Pressure was measured with a Micro-tip pressure sensor (Millar Inc.) in the LV and sampled at 1000Hz. LBBB was created with a retrograde placed 7F standard ablation catheter and confirmed by surface ECG and four endocardial electrodes. Td was measured from 10 consecutive beats. Mixed models were utilized for the repeated measurements.

Results
Analysis of the marginal means in pooled data showed that the average Td with AP was 96.7ms (95% CI: -195.7, 388.7), and in SR 96.5ms (95% CI: - 195.5, 389.0). The analysis with the Bonferroni correction for multiple comparisons revealed that the differences between pacing configurations were not statistically significant (p=0.80). The analysis revealed that AP on average lengthens Td by 0.3ms (95% confidence interval (CI): - 1.7, 2.2, p=0.8), compared to no pacing. The difference in Td in nQRS between AP and SR was 82.4ms (95% CI: 76.8, 88.1) and 82.1ms (95% CI: 76.4, 87.8) respectively (p=0.02) while the difference in Td in LBBB between AP and SR was 111.1ms (95% CI: 104.8, 117.4) and 110.9ms (95% CI: 104.581, 117.197) respectively (p=0.48). Standard deviation within 10 consecutive beats was 1.0ms (max 3.7ms, min 0.4ms, median 0.95ms), and AP did not influence Td measurement variability (p=0.53).

Conclusion(s)
We did not find any influence from atrial pacing in Td in this study. The significant difference between AP and SR in nQRS was extremely small and less than the sample interval of 1ms. The significance of this difference is attributed to the robustness of the Td measurement and does not represent a meaningful clinical significance. Td can be measured without being influenced by atrial pacing in both native conduction and with LBBB.
Low incidence rate of infections associated with cardiac implantable electronic device procedures in a large real-world patient cohort
Authors: Imberti J F , Vitolo M , Mei D A , Bonini N , Fontanesi R , Muto F , Gerra L , Sbarra F , Turco V , Casali E , Boriani G 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The incidence of death and infections in patients implanted with cardiac implantable electronic devices (CIEDs) are not fully known yet (1,2).

Purpose
To describe the incidence of death and device’s infection and its potential predictors in a contemporary cohort of CIED patients.

Methods
All consecutive patients implanted with a CIED at our tertiary institution were prospectively enrolled. Follow-up was performed every six months and clinical events recorded by expert electrophysiologists. For the purpose of the present analysis, we considered patients with a potential follow-up of at least 24 months.

Results
Between 01/09/2018 and 01/09/2020, a total of 838 patients were enrolled (34.6% female; age 77 [70-84]; PADIT score 2 [2-4]). Pacemaker (PM) and implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy and defibrillator (CRT-D) were implanted in 569 (68%) and 269 (32%) patients respectively. All patients had pre-implant antibiotic prophylaxis and 5.5% had an antibiotic-eluting envelope. Follow-up data were available for 832 (99.2%) patients. After a median follow-up of 42.3 (30.2-56.4) months, 212 (25.5%) patients died and 5 (0.6%) had a CIED infection. Four out of five patients required CIED extraction, while 1 patient antibiotics only. At multivariate Cox-regression analysis, age (hazard ratio [HR] 1.08; 95% confidence interval [CI] 1.05-1.10) and dialysis (HR 6.18; 95%CI 3.40-11.25) were independently associated with death, while first implant was associated with a lower risk as compared to subsequent procedures (HR 0.63; 95%CI 0.46-0.85) (Figure 1).

Conclusions
In large contemporary cohort of CIED patients, mortality was substantially high and associated with clinical factors depicting a population at risk. On the other hand, the incidence of CIED infections was low.