bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing the field of view of multisize electrodes in ischemic cardiomyopathy by validating against ex-vivo high resolution cardiac magnetic resonance
Authors: Omara S , Glashan CA , Tofig BJ , Tao Q , Blom SA , Nielsen JC , Lukac P , Kristiansen SB , Van Der Geest RJ , Zeppenfeld K 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Leiden University Medical Centre

Background
Substrate identification after myocardial infarction (MI) relies on voltage mapping. Early reperfusion results in non-transmural scar (NTS). Narrow-spaced microelectrodes (ME) are thought to have a limited field of view (FOV). The role of ME for delineation of NTS is unclear.

Purpose
To evaluate mapping with multi-size electrodes for identifying NTS, validated against high-resolution ex-vivo cardiac magnetic resonance imaging (HR-LGE-CMR).

Methods
Nine swine with early reperfusion MI underwent endocardial electroanatomical voltage mapping (EAVM) with the QDOT catheter which incorporates three ME in the 3.5mm tip electrode. HR-LGE-CMR (0.3mm slices) were obtained and merged with EAVM. At each EAVM point a transmural cylinder (5mm radius) was projected on the CMR and the volume of viable myocardium (VM) in the cylinder quantified (Otsu method). Unipolar (UV) and bipolar (BV) voltages from conventional (c) and microelectrodes (µ) were related to VM. Cut-off values for normal myocardium were based on 5th percentiles of areas without fibrosis.

Results
In each swine 220 (IQR 216-260) mapping points were collected (total 2322 points). Cut-off for normal myocardium were 3.18 mV, 0.85 mV, 3.28mV and 1.93 mV for UVc, BVc, UVµ and BVµ, respectively. Wall thickness (WT) was reduced in areas with fibrosis vs. no fibrosis (5.4mm, IQR 3.2- 6.9 vs. 7.4mm, IQR 5.3 - 9.6). All voltages were reduced at sites with fibrosis vs. no fibrosis (UVs 4.4mV vs. 6.8mV; BVc 1.2mV vs. 2.1mV; UVµ 2.5mV vs. 5.5mV, and BVµ 2.9mV vs. 5.4mV, all p&lt;0.001).
For areas with any fibrosis, all voltages increased with increasing WT up to the maximal WT of 13mm (fig. 1). Similarly, all voltages increased with an increase in VM volumes from &gt;200mm3 to &gt;600 mm3 (equivalent to a cylinder with h=7.64mm) (fig. 2) with the strongest correlation for UVµ (r=0.47). Below a volume of 200mm3 VM voltages did not correlate significantly with VM.

Conclusion
In NTS, UVc, BVc, and, notably, BVµ and UVµ increase with increasing WT and increasing transmural volume of VM, with the biggest role perhaps laid out for UVµ to estimate transmural VM. EAVM cannot accurately delineate areas with the lowest amount of VM, potentially due to insufficient far field cancellation in NTS. Both these findings argue against a limited FOV of ME.
Multimodality planning of stereotactic radio-ablation for ventricular tachycardia. Results from the international MUSIC consortium
Authors: Cochet H , Tedrow U , Maury P , Whitaker J , Woods C , Gandjbakhch E , Khalifa J , Bredfeldt J , Mak R , Sauer W , Sermesant M , Sacher F , Bogun F , Jais P , Zei P 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Research Council

Background
Optimal SBRT planning methods for VT ablation are yet to be defined.

Purpose
To evaluate a multimodal approach for SBRT planning.

Methods
30 pts (age 70±10, 90% men, LVEF 26±9%, 67% ICM, 47% NICM or mixed, 1.7±1.2 prior catheter ablations) with drug-refractory VT underwent imaging prior to SBRT. The inHEART technology was used to create image-based 3D models of substrate, cardiac anatomy, and organs at risk (coronaries, phrenic nerve, GI tract, AV node). In MUSIC software (IHU Liryc-Inria), 3D models were fused with prior EP maps, and SBRT targets were interactively drawn in 3D by the referring EP cardiologist. Transmural target volumes and organs at risk were fused with a 4D planning CT and used to plan SBRT in Eclipse (Varian).

Results
SBRT was delivered on median PTVs of 96[63-149] mL (total dose 25 Gy) with either Truebeam or Edge systems (Varian). Over a median FU of 4[2-8] months, death occurred in 11(37%) pts, due to arrhythmia recurrence in 4(13%). FU at 6 months was available in 14 pts. In these, the median numbers of VT episodes and ICD shocks over the 6 months preceding SBRT were 20[9-27] and 8[5-15], respectively. In the 6 months following SBRT, these decreased to 0[0-30] and 0[0-0], respectively (P&lt;0.001 for both). 8/14(57%) pts were free from any VT recurrence, and 11/14(79%) were free from any ICD shock. In the total cohort, complications attributed to SBRT were observed in 2/30 (7%), none of which were fatal (heart failure and pneumonitis, both managed with steroids).

Conclusion
In patients with severe drug- and catheter ablation-refractory VT, SBRT planning based on 3D image-based models fused with prior EP maps is feasible, and associated with favorable efficacy and safety profiles.
Myocardial fibrosis predicts ventricular arrhythmias and sudden death after cardiac electronic device implantation
Authors: Zegard A , Okafor O , Foley P , Umar F , Taylor R , Marshall H , Stegemann B , Moody W , Steeds R , Halliday B , Hammersley D , Jones R , Prasad S , Qiu T , Leyva F 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Unrestricted educational grants

Background
Increasing evidence supports a link between myocardial fibrosis (MF) and ventricular arrhythmias. We sought to determine whether presence of MF on visual assessment (MFVA) and gray zone fibrosis (GZF) mass predicts SCD and ventricular fibrillation / sustained ventricular tachycardia after cardiac implantable electronic device (CIED) implantation.

Methods
In this prospective study, total fibrosis and GZF mass, quantified using cardiovascular magnetic resonance, was assessed in relation to the primary endpoint of sudden cardiac death (SCD) and the secondary, arrhythmic endpoint of SCD or ventricular arrhythmias after CIED implantation.

Results
Among 700 patients (age 68.0 ± 12.0yrs [mean ± SD]), 27 (3.85%) experienced a SCD and 121 (17.3%) met the arrhythmic endpoint over 6.93 yrs (median; interquartile range 5.82-9.32). MFVA predicted SCD (hazard ratio [HR]: HR:26.3 [95% confidence interval [CI] 3.70-3337]; negative predictive value: 100%). In competing risks analyses, MFVA also predicted the arrhythmic endpoint (subdistribution [sHR]: 19.9 [95% CI 6.40-61.9]; negative predictive value:98.6%). Compared with no MFVA, a GZF mass measured with the 5SD method (GZF5SD) &gt; 17 g was associated with highest risk of SCD (HR: 44.6;95% CI 6.12-5685) and the arrhythmic endpoint (sHR: 30.3 [95% CI 9.60-95.8]). Adding GZF5SD mass to MFVA led to reclassification of 39% for SCD and 50.2% for the arrhythmic endpoint. In contrast, LVEF did not predict either endpoint.

Conclusions
In CIED recipients, MFVA excluded patients at risk of SCD and virtually excluded ventricular arrhythmias. Quantified GZF5SD mass added predictive value in relation to SCD and the arrhythmic endpoint.
Prevention of early sudden cardiac death after myocardial infarction using the wearable cardioverter defibrillator - results from a real-life cohort
Authors: Rohrer U , Manninger M , Odeneg T , Ebner C , Moertl D , Keller H , Dirninger A , Stix G , Alber H , Steinwender C , Binder R , Stuehlinger M , Zweiker D , Zirlik A , Scherr D 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Patients are at elevated risk of sudden cardiac death (SCD) after acute myocardial infarction (MI). The VEST trial failed to show a significant reduction in arrhythmic mortality in patients prescribed with a wearable converter-defibrillator (WCD), having a lower than expected wearing compliance. We aimed to investigate the incidence of WCD treatments and outcomes of all patients with acute MI and LVEF ≤35% in a real life and well-compliant cohort in Austria.

Methods
We performed a retrospective analysis of all patients meeting the in- and exclusion criteria of the original VEST trial within the Austrian WCD registry between 2010 and 2021.

Results
105/896 patients (12%) with an average age of 64±11 years (12% female; LVEF 28±6%) registered in the Austrian WCD registry met the VEST in- and exclusion criteria. 104/105 patients were revascularized and prescribed with a WCD prescription for 69 (1;277) days, the median wearing duration was 23.5 (0;24) hours/day. 4/105 (3.8%) patients received 9 appropriate WCD shocks, the per patient shock rate was 2 (1;5). No inappropriate shock was delivered. During follow-up, 46/105 patients (44%) received an ICD after the WCD period, 4/105 (3.8%) patients died during follow-up. Arrhythmic mortality (1.9% Austria vs. 1.6% VEST, p=ns), as well as all-cause mortality (3.8% vs. 3.1%, p=ns) in the Austrian cohort were comparable to the VEST cohort.

Conclusion
The WCD is a safe treatment option in a highly selected cohort of patients with a LVEF ≤35% after acute myocardial infarction. However, despite excellent WCD compliance as opposed to the VEST study, only 3.8% of patients receive appropriate WCD shocks and the arrhythmic mortality rate was not significantly improved.
Programmed ventricular stimulation for risk stratification in patients with myocardial scarring and an ejection fraction above or equal to 40%
Authors: Soris A , Herrera-Siklody C , Lebloa M , Domenichini G , Teres C , Porretta A , Haddad C , Pruvot E , Pascale P 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Sudden cardiac death (SCD) is one of the leading causes of death, particularly among patients with myocardial scars. Implantable cardioverter defibrillators (ICD) are recommended in patients with a left ventricular ejection fraction (LVEF) ≤ 35%. Another recognised indication is the induction of sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) during programmed ventricular stimulation (PVS) in post-myocardial infarction patients with non-sustained VT and a LVEF between 35% and 40%. However, no recommendation exists to guide the use of prophylactic ICD implantation in patients with less altered LVEF, even though they represent the majority of SCDs.

Purpose
We aimed to evaluate the prognostic value of PVS in patients with myocardial scars and a relatively preserved LVEF (≥ 40%).

Methods
Patients with evidence of a chronic myocardial scar and a LVEF ≥ 40%, who underwent PVS at two hospital centers were considered for inclusion. Ischemic and non-ischemic myocardial scars were included. The primary endpoint was the occurrence of a Major Arrhythmic Event (MAE), namely SCD, clinical VT/ventricular fibrillation, or appropriate ICD therapy.

Results
134 patients were included (mean age 62.4 ± 12.5 years, LVEF 54.7 ± 8.6 %). Indication for PVS was mostly non-sustained VT and/or syncope (84%). Post-myocardial infarction patients represented about half of the cases (53%). Inducibility during PVS was observed in 17 patients (13%). There was a nonsignificant trend towards higher inducibility rates in ischemic versus nonischemic scars (17% and 8%, respectively; p-value = 0.1). Of these patients, 15 received an ICD (88%). Over a mean follow-up of 49 (±42) months, a MAE occurred in 7 patients (41.2%) with positive PVS, versus 4 patients (3.4%) with negative PVS. MAE-free survival at 10 years was 91% and 43% in PVS-negative and PVS-positive patients, respectively (p-value &lt; 0.001). One SCD occurred in a PVS-positive patient who denied prophylactic ICD implantation. Inducibility during PVS provided a 64% sensitivity and a 97% negative predictive value (PV) to predict the occurrence of MAE (specificity 92%, positive PV 41%).

Conclusion
PVS is a useful tool to discriminate patients with myocardial scars and LVEF ≥ 40% at increased arrhythmic risk. Effective utilisation of ICD may be anticipated in case of positive PVS, while non-inducible patients are at lower MAE risk.
Permanent his bundle pacing in suprahisian versus infrahisian atrioventricular block . A single center experience
Authors: Pestrea CG , Gherghina AI , Ortan FO 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Permanent His bundle pacing is currently considered the most physiological form of cardiac pacing. The main benefit of the procedure, compared to right ventricular pacing, is encountered in atrioventricular block, where a high burden of ventricular pacing is expected. One of the limits of His bundle pacing is a distal conduction abnormality in the His-Purkinje system. Nevertheless, there is published data that shows the possibility of conduction system capture even in these patients. This retrospective study evaluated the feasibility of permanent His bundle pacing in patients with second or third degree AV block, taking into account the level of block : suprahisian vs. infrahisian.

Material and methods
45 patients with second or third degree AV block with an attempt at permanent His bundle pacing and an available intraprocedural hisian electrogram for review were included. The procedure went as follows: a lead delivery system including a preformed 3D shaped sheath and a lumenless lead with a fixed exposed helix was placed at the septal atrioventricular junction. Careful mapping was performed until a His bundle signal was recorded. At that site, the pacing response was evaluated at variable pacing outputs. The procedural criteria for success was conduction system capture (selective or non-selective) with an amplitude of less than 2,5V/1ms. If the criteria was met, the lead was fixed, an atrial lead was placed and both connected to a dual-chamber pacemaker. The periprocedural characteristics and those at the three-months follow-up were noted.

Results
28 patients (62,2%) were diagnosed with suprahisian block, with a procedural success rate of 89 % and 17 (37,8%) with infrahisian block, with a procedural success rate of 59%. QRS duration was 96,4±21,6 ms in those with suprahisian block vs. 119,4±23,8 ms in those with infrahisian block (p=0,0027). There was no significant statistical difference regarding acute His bundle pacing thresholds (1,13±0,63 V/1ms vs. 1,25±0,76 V/1ms, p= 0,66), ventricular sensing (3,46±1,5 mV vs. 3,21±1,6 mV, p= 0,68) and fluoroscopy time (12,75±8,3 min vs. 10,78±9,5 min, p= 0,57) between suprahisian and infrahisian block. Also, the paced QRS duration was similar between the two groups (86,9±13,4 ms vs. 82±14,7 ms, p= 0,38) and narrower than the baseline complex. The three-months follow-up showed stable pacing and sensing parameters, without other procedural or lead related complications.

Conclusions
In atrioventricular block, permanent His bundle pacing achieves atrioventricular resynchronization, while maintaining rapid and synchronous biventricular depolarization. As expected, in suprahisian blocks the success rate is superior to infrahisian blocks. Nevertheless, in a significant proportion of the latter cases, His bundle pacing can recrute the intrinsic conduction system.
Tricuspid valve complications during leadless pacemaker implantation
Authors: Hauser R , Casey S , Sengupta J 
Published: May 2022

Abstract

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

Background
The implantation of a leadless right ventricular pacemaker (LPM) may be complicated by tricuspid valve injury or interference with tricuspid valve function.

Purpose
Characterize the nature, causes, and outcomes of tricuspid valve injury and functional interference due to LPM implantation.

Methods
The Food and Drug Administration’s Manufacturers and User Facility Device Experience (MAUDE) database was queried for tricuspid valve adverse events involving the Medtronic Micra LPM that were reported by the manufacturer.

Results
From 2016-October 2021, 19 patients suffered a tricuspid valve adverse event, including damage to the leaflets, papillary muscle, or chordae tendineae (n=14; 74%); interference with valve closure (n=3; 16%); and 2 LPMs were irretrievably wedged in the tricuspid valve apparatus. Damaged valves included: 1) torn leaflet or chordal tissue found in the delivery system (n=6) after complicated or failed LPM recapture that necessitated removal without the LPM retracted into the delivery system; all patients developed tricuspid regurgitation, and one patient died. 2) valve damage by the delivery system either directly (n=6) or during LPM recapture (n=1) or removal by a snare (n=1); all patients had new or worsening tricuspid regurgitation; one patient died, 2 had valve repair, and one valve was replaced. In three patients the LPM interfered with valve closure; one patient had valve replacement, one underwent LPM removal, and one was treated medically. Of the 2 LPMs wedged in the tricuspid valve apparatus, one required surgical removal and one was abandoned.

Conclusion
Tricuspid valve trauma during LPM implantation may cause significant regurgitation that results in poor outcomes and requires medical or surgical intervention. Mechanisms include direct valve injury by the delivery system, complications of difficult or unsuccessful LPM recapture, and LPM interference with valve function.
Ultrasounds versus fluoroscopy guidance for axillary vein puncture for cardiac devices implantation : a multicenter randomized comparison
Authors: Bun S-S , Taghji P , Massoure PL , Roche N , Squara F , Scarlatti D , Moceri P , Deharo JC , Ferrari E 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Axillary vein (AV) puncture, an emerging route for cardiac implantable electronic devices (CIED), can be performed under ultrasounds (US) or fluoroscopic (Fluo) guidance.

Objective
To compare US to fluroroscopy-guided AV puncture in a multicenter randomized controlled trial.

Methods
Consecutive patients admitted for CIED (first implant or upgrade, including resynchronization therapy) intervention were prospectively randomized between US or Fluo guidance for AV puncture in the three participating centers. Access performances, radiation exposure and complications were compared in both groups.

Results
102 patients were included (n = 51 patients per group). The two groups had similar characteristics concerning age (79.4 ± 10 years), and LVEF (47 ± 17%). 92 leads were implanted in both groups. AV catheterization was successful in 50/51 (98 %) in the US group versus 49/51 in the Fluo group (96 %, p = 0.56). AV access time and procedure time were not different between the two groups, respectively (156 ± 274 in the US group versus 137 ± 151 sec, p = 0.66; 54 ± 24 versus 61 ± 26 min; p = 0.13). Total fluoroscopy time (FT) and dose-area product were respectively lower in the US group, but without reaching significance: 197 ± 231 versus 247 ± 293 sec, p = 0.32; 0.39 ± 0.95 versus 0.75 ± 1.58 mGy.m², p = 0.14. FT for AV access was significantly higher in the Fluo group (51 ± 55 sec versus 0, p &lt; 0.0001). There were two complications in each group during the 9 ± 6 months follow-up.

Conclusion
Our study demonstrates that both US and fluoroscopy-guided AV catheterization for CIED are highly effective and safe techniques. Despite similar AV access time, compared to fluo guidance, US reduce time radiation exposure by 20 %.
Echocardiographic outcomes of left bundle branch versus deep septal pacing
Authors: Ramos Jimenez J , Marco Del Castillo A , Paredes Hurtado N , Borrego Bernabe L , Fontenla A , Rodriguez Munoz DA , Salguero Bodes R , Lopez Gil M , Arribas Ynsaurriaga F 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Left bundle branch area pacing (LBBAP) is a rising technique that aims to preserve physiologic activation of the left ventricle. However, left bundle branch capture (LBBC) is not always achieved despite good progression of the lead into the interventricular septum, leading to what has been called deep septal pacing (DSP). In the latter, the conduction system is not captured, whose consequences on systolic function are not well known. The goal of the present work is to evaluate the repercussion on transthoracic echocardiogram (TTE) of capturing or not the left bundle branch.

Methods
Unicentric prospective study where patients in whom LBBAP was performed were consecutively included if:
Previous TTE was available with a left ventricular ejection fraction (LVEF) &gt; 40%
A follow-up TTE performed &gt;30 days after the implant was available
Ventricular pacing was &gt;40% of the time at the device follow-up
LBBC was accepted if any of the following were present:
Sudden change of QRS morphology during ventricular threshold test
Left bundle potential was registered with an interval to left ventricular activation time (LVAT) equal to stimulus-LVAT time.
T-test was used to compare means between continuous variables and chi-squared to test differences between groups in the categorical ones. Two-tailed p value &lt;0.05 was considered statistically significant.

Results
20 patients were included, 12 (60%) males, with a mean age of 74.4±10.6 years. Half of the patients (n=10) fulfilled LBBC criteria whereas the rest received DSP. Image 1 summarizes baseline characteristics and differences observed in the control TTE. After a median follow-up of 322 (interquartile range 114-325) days, LVEF increased in LBBC group whereas it decreased in DSP patients. Image 2 shows a slopegraph of the evolution of LVEF by type of stimulation. Indexed LVEDV increased in DSP group, but it was diminished in LBBC patients (p=0.03). Control TTE showed no significant differences in other parameters.

Conclusions
In non-selected patients with comparable pre-implant baseline characteristics, deep septal pacing was associated with a decrease in LVEF and an increase in LVEDV, while LBB capture showed better outcomes in these two parameters.