bluuebunny/crossref_metadata_2025_split huggingface dataset:
How to better identify patients at high risk of inappropriate shocks before S-ICD implantation: Results from a multicenter experience
Authors: Ben Kilani M , Jacon P , Badenco N , Marquie C , Ollitrault P , Behar N , Khattar P , Carabelli A , Venier S , Defaye P 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Despite the recent improvements, inappropriate shocks (IAS) in patients implanted with subcutaneous implantable cardioverter-defibrillator (S-ICD) remain a challenge in "real-life" practice. The purpose of this study was to assess the preoperative predictive factors of IAS with the latest generation of S-ICD, with a particular focus on data obtained during the screening procedure.

Methods
Between January 2017 and March 2020, 300 patients implanted with Generation 3 S-ICD system for primary and secondary prevention were included in this multicentric study. Follow-up (FU) of at least 6 months and preoperative screening procedure data were mandatory for all patients.

Results
After a mean follow-up of 22.8 (±11.4) months, appropriate therapies occurred in 12.3% patients; while 26 patients (8.7%) experienced inappropriate therapies (incidence 4.9 per 100 patient-years). The total number of inappropriate shock episodes was 48; 9 patients experienced multiple episodes. Causes of IAS were: supraventricular arrhythmias (34.6%), cardiac (30.7%) and extra-cardiac noise oversensing (38.4%). In univariate analysis, availability of all 3 sensing vectors during preoperative screening significantly reduced inappropriate therapies occurrence (hazard ratio [HR], 0.32; 95% confidence interval [CI], 0.12-0.89, P=0.028). Clinical preoperative S-ICD inappropriate shocks predictors were: history of Supraventricular Tachycardia (SVT)(HR, 4.42; 95% CI, 1.45-13.47; P=0.009); overweight (BMI&gt;25: HR, 1.93; 95% CI, 0.83-0.4.48; P=0.13); QRS duration (HR, 1.01; 95% CI, 0.1-1.03; P=0.14) and lower QRS/T wave ratio in lead I (for a threshold &lt; 3: HR, 4.44; 95% CI, 1.88-10.48; P=0.001). By multivariate analysis, independent factors associated with IAS were: the availability of less than 3 sensing vectors during preoperative screening (p&lt;0.05), a low QRS/T wave ratio in lead I (for a threshold &lt;3; p&lt;0.001), history of SVT (p&lt;0.001) and overweight (BMI&gt; 25; p&lt;0.05).

Conclusion
Automatic preoperative screening data is of high interest as a predictor of IAS with a quantitative value. ECG specificities in association with other clinical factors should be taken into consideration to identify patients at high risk for IAS.
Cardiac resynchronization therapy: long-term impact of echocardiographic non-progression
Authors: Monteiro E , Madeira M , Antonio N , Marinho V , Milner J , Sousa P , Ventura M , Cristovao J , Elvas L , Goncalves L 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
As heart failure (HF) is a progressive disease, there has been a raising idea that considering the absence of echocardiographic improvement as non-response to cardiac resynchronization therapy (CRT) may not be appropriate. In fact, in some classical echocardiographic non-responders, CRT might have prevented HF deterioration.

Purpose
Our aim was to compare the composite outcome of death and re-admissions due to HF according to a new classification of CRT response: responders, non-progressors and progressors.

Methods
We included 144 consecutive patients with HF, left ventricle (LV) ejection fraction &lt; 40% and QRS duration &gt; 120mseg submitted to CRT implantation. Patients were divided into 3 groups according to the variation of LV end-systolic volume (LVESV) at 6-month: ≥15% reduction in LVESV - responders (R); 0–15% reduction in LVESV – non-progressors (NPr); increase in LVESV – progressors (Pr). A long-term follow-up (4.9 ± 2.9 years) was performed targeting mortality and re-admissions due to HF.

Results
In our population, 78 patients (54.2%) were classified as R, 21 (14.5%) as NPr and 45 (31.3%) as Pr. Baseline comparison between groups is presented in table 1. Compared with R, N-Pr had ischemic aetiology more frequently. The prescription of digoxin was more common in Pr. The Kaplan-Meier curves (figure 1) demonstrate that the composite outcome of death and re-admission due to HF had a lower incidence in R, but was similar between N-Pr and Pr. After adjustment of possible confounders (ischemic aetiology and digoxin use), the type of response to CRT remained as the only predictor of outcomes (OR 0.61; CI 0.41-0.90). 144

Conclusion
In our population, patients without progression of HF had a similarly negative prognosis to the ones that deteriorated. Hence, positive LV remodelling, and not only stabilization seems to be necessary to improve long-term prognosis.
Evaluation of left ventricular dyssynchrony by ultra-high-frequency ECG in patients with non-LBBB conduction disorder treated with cardiac resynchronization therapy
Authors: Roubicek T , Hodbodova M , Pidhorodecky J , Bitmanova B , Cerny J , Morava J , Jurak P , Polasek R 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
LBBB is a reliable left ventricular (LV) electrical dyssynchrony indicator. Patients with RBBB/IVCD are a heterogeneous group, where even with "larger" QRS complex expansion, LV dyssynchrony may not be present. Ultra-high-frequency (UHF) 14-lead ECG is a non-invasive method based on signal averaging that allows better assessment of local electrical activation of the ventricles than standard ECG. Our study aims to test the hypothesis of the usefulness of UHF ECG to select non-LBBB patients for cardiac resynchronization therapy (CRT) based on evidence of electrical dyssynchrony.

Methods
Using UHF ECG we analysed patients who underwent CRT implantation. The groups of patients with RBBB, IVCD, and LBBB were compared and the presence of electrical dyssynchrony (e-DYS) as a parameter of global ventricular activation, and delayed activation of the left ventricular lateral wall (LVLWd) as a marker of LV intravenricular dyssynchrony was assessed.

Results
UHF ECG was recorded in 49 patients treated with CRT. IVCD patients had lower e-DYS compared to LBBB patients (26±17 ms vs. 86±20 ms; p&lt;0.0001) and lower LVLWd (26±16 ms vs. 83±22 ms; p&lt;0.0001). In RBBB patients, e-DYS was -52±22 ms, corresponding to right ventricular delay. Delayed left ventricular free wall activation ("RBBB masking LBBB" activation pattern) was not found in any RBBB patient.

Conclusion
UHF ECG appears to be a promising tool to detect LV electrical dyssynchrony in non-LBBB candidates for cardiac resynchronization therapy. Delayed left ventricular free wall activation was not found in any RBBB patient. Our findings are consistent with the lack of effect of CRT in this group of patients.
Heart failure medication and its effect on response to cardiac resynchronisation therapy in patients with pacing-induced cardiomyopathy: an UPGRADE post hoc analysis
Authors: Barbieri F , Spitaler P , Adukauskaite A , Rubatscher A , Schgoer W , Pfeifer B , Hintringer F , Dichtl W 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Austrian National Bank
Unlimited scientific grant from the Boston Scientific Investigator Sponsored Research (ISR) Committee

Background/Introduction
Current heart failure (HF) guidelines recommend optimal medical therapy (OMT) in patients with pacing-induced cardiomyopathy (PICM) prior upgrading to cardiac resynchronisation therapy (CRT). It is unknown, whether previous prescription of heart failure medication reduces the effect of CRT upgrading.

Purpose
To evaluate the effect of HF medication on CRT response in patients suffering from PICM receiving an upgrade to CRT.

Methods
The UPGRADE trial was a prospective investigator driven trial evaluating the effect of CRT upgrading in patients with PICM. Key inclusion criteria were symptomatic HF with left ventricular ejection fraction (LVEF) below 40% despite OMT and right ventricular pacing (RVP) above 40%. Device programming had to be adjusted to minimize RVP prior to enrolment. Echocardiographic examinations were performed prior to device implantation and 3-5 months after activation of CRT and were analyzed in blinded fashion. CRT response was defined by a reduction of &gt; 15% in left ventricular end systolic volume (LVESV). Heart failure medication was assessed at implantation of the device.

Results
Overall, 54 patients were enrolled in the UPGRADE trial between 2014 and 2018. Beta-blockers (BB) were prescribed in 43 (79.6%), mineralcorticoid receptor antagonists (MRA) in 29 (53.7%) and either an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin II receptor blockers (ARB) in 45 (83.3%) of the patients. Therapy with CRT has led to significant improvement in LVEF (mean delta: 12.8 ± 7.8%) and LVESV (delta: 30.7 ± 33.2ml), whereas CRT response was achieved in 30 (55.6%) patients. There was no statistically significant difference in patients with BB intake regarding increase of LVEF (12.4 ± 7.5% vs. 14.6 ± 9.4%, p=0.431), decrease of LVESV (42.8 ± 32.8ml vs. 27.8 ± 33.0ml, p=0.201) or CRT response (22 (53.7%) vs. 8 (80%), p=0.167). Similar results were found regarding ACE inhibitor/ARB [LVEF: 13.1 ± 6.8% vs. 11.5 ± 11.8%, p=0.705; LVESV: 32.6 ± 32.6ml vs. 21.7 ± 36.3ml, p=0.373; CRT response: 26 (61.9%) vs. 4 (44.4%), p=0.460] and MRA intake [LVEF: 13.7 ± 7.3% vs. 11.8 ± 8.4%, p=0.382; LVESV: 34.3 ± 36.8ml vs. 26.7 ± 28.8ml, p=0.423; CRT response: 15 (55.6%) vs. 15 (62.5%), p=0.777].

Conclusion
Previous prescription of heart failure medication did not reduce the effect of CRT upgrading in patients suffering from PICM. It remains to be proven, whether similar results may be observed for newer HF agents like sodium-glucose co-transporter 2 inhibitors or angiotensin receptor-neprilysin inhibitors as both were not available in clinical routine at the time of study conduct.
The effect of implantable cardioverter defibrillator in patients with cardiac resynchronizational therapy and diabetes mellitus
Authors: Masszi R , Merkel E , Schwertner W , Veres B , Behon A , Pinter A , Osztheimer I , Zima E , Geller L , Becker D , Kosztin A , Merkely B 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): (NKFIA; NVKP_16-1-2016-0017 National Heart Program).

Background
Heart failure (HF) and diabetes mellitus (DM) are common causes of death on their own, but the coexistance of these two diseases are especially fatal. 1 In DM, sudden cardiac death (SCD) is more common than in non-DM patients, however in many cases, implantable cardioverter defibrillator (ICD) could not prevent SCD. 2

Purpose
Our aim is to decide which device warrant higher life expectancy, cardiac resynchronizational therapy with or without defibrillator.

Methods
We examined retrospectively 2525 CRT implanted patients, with a mean follow-up time of 4.6 years. Implantaions were based on the current guidelines. The primary endpoint was all-cause mortality, while our composite end-point were all-cause mortality and heart failure hospitalization.

Results
In our population, 928 people (36%) had diabetes. We did not find statistical differences between age (68 vs. 68 years; p&lt;0.099), gender (26% women, 23% women; p&lt;0.08) LVEF (28% vs. 29% p&lt;0.1425), incidence of atrial fibrillation (37% vs. 38%; p&lt;0.76), implantation of an ICD (53% vs. 54%; p&lt;0.847), NT-proBNP median levels (2939 pg/ml vs. 2778 pg/ml; p&lt;0.35), and NYHA I (0,5% vs. 0,5%; p&lt;0.898), and NYHA IV stadium (11% vs. 11%; p&lt;0,82). However DM patients had higher BMI (28 kg/m2 vs. 26 kg/m2; p&lt;0.001), lower eGFR levels (57 ml/min/1,73m2 vs. 60 ml/min/1,73m2; p&lt;0.011) higher prevalence of hypertonia (82% vs. 66%; p&lt;0.001), NYHA III stadium (39% vs. 33%; p&lt;0,0008), ischemic etiology (56% vs. 44%; p&lt;0.001), previous acute myocardial infartion (42,9% vs. 36%; p&lt;0.001), a percutan coronaria intervention (35% vs. 25%; p&lt;0.001) compared to non-DM patients. Those patients with DM showed a 25% higher risk of all-cause mortality (HR 1.25; 95% CI 1.12-1.40; p‹0.01) then non-DM patientes, also observable after adjusting for relevant clinical covariates such as age, gender, atrial fibrillation and the addition of an ICD (HR 1.17; 95% CI 1.06-1.31; p‹0.01).

Conclusions
Adding an ICD for CRT patients with diabetes reduces the risk of all-cause mortality significantly by 32% (HR 0,68; CI 0,56-0,82; p‹0.001) during the first six years but diminished on longer follow-up time (HR 0,95; CI 0,80-1,12; p=0,54).
Effects of lockdown on physical activity and arrhythmia burden in patients with an implantable cardioverter-defibrillator: the Covid-19 Lockdown ICD-Carelink (CLIC) study
Authors: Ghossein MA , Linz DK , Van Kraaij D , De Melis M , Vernooy K , Heijman J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background: Both COVID-19 and the measures taken to control the pandemic may significantly affect cardiovascular health. The effects of a lockdown on physical activity and its potential consequences for arrhythmia burden remain largely unknown.
Purpose: In this study, we investigated the effect of the lockdown during the first COVID-19 wave on patients’ physical activity and arrhythmia burden.
Methods: All patients with an ICD connected to a Carelink home-monitoring system from two Dutch hospitals were included. Anonymized data on physical activity, heart rate, and occurrence of ventricular tachycardia/fibrillation (VT/VF), and atrial fibrillation/tachycardia (AF/AT) were obtained and were compared between March-April 2020 (lockdown) and March-April 2019 (reference) within each patient. The study was approved by the local ethics committee.
Results: The ICDs of 531 patients registered significantly less activity during de lockdown period compared to the reference period (21,895±12,394min vs 25,173±12,532min, p&lt;0.0001, panel a). Daytime and nighttime heart rates were significantly lower during lockdown compared to the reference period (71.3±9bpm vs 72.6±9bpm, p&lt;0.0001 and 63.4±9 vs 63.8±9, p=0.02, respectively). 94 patients with VT/VF during the reference period did not show any VT/VF during lockdown, while only 4 patients without VT/VF during the reference period showed VT/VF during lockdown (p&lt;0.0001, panel B). There was no significant difference in the occurrence of NSVT or AF/AT.
Conclusion: During the lockdown in the first COVID-19 wave, the Carelink system revealed significantly less activity and lower heart rates. Moreover, there was a significant reduction in the occurrence of VT/VF.
Diagnostic evaluation of implantable loop recorder devices associated with remote monitoring: a retrospective multicentric study
Authors: Ricciardi D , Aurino L , Sanasi L 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
It has been proven that Implantable Loop Recorders (ILRs) and remote monitoring could improve diagnostic rate, shorten time-to-diagnosis and thus better patient’s clinical outcome. Medical indications to ILRs have been lately extended, and many technical improvements have been achieved in the last few years. Nowadays many different ILRs are available, therefore choosing the best device, according to the patient’s clinical features, could help to reach an optimal patient management.
Aim of this retrospective multicentric study is to compare which is best between 2nd generation ILR Medtronic Reveal™ LINQ (MRL) or St. Jude Medical Confirm™ RX (SCX), both associated with remote monitoring, in terms of overall accuracy rate (OAR), true positive detection rate (TPDR) and arrhythmias-free survival (AFS).
Patients included in the study required an ILR implant for syncope, non-recurring heartbeat, suspect AF, Brugada Syndrome, post-ablation AF monitoring and non-stustained ventricular tachycardia. Medtronic Reveal™ LINQ (n=436, mean age 66±15, mean BMI 30±5) and St. Jude Medical Confirm™ RX (n=98, mean age 64±14, BMI 27.5±4) implanted patients underwent a weekly remote and a six-monthly outpatient follow-up. Every transmission was judged by two different cardiologists. The final diagnosis was set only in case of agreement, conversely, the transmission was discussed either considered non-diagnostic. Patients were studied for atrial fibrillation (AF), pauses (Ps), bradycardias (Bs) and tachycardias (Ts).
MRL transmitted 5585 times, SCX 7545 (monthly transmission/patient ratio 25.5±45.6 vs 0.9±1.1 respectively). MRL had statistically significant better OAR for AF (61% vs 14%, p&lt;0,001), Ps (20% vs 7%, p&lt;0.001) and Bs (72% vs 20%, p&lt;0.001). SCX had statistically better OAR for Ts (84% vs 56%, p&lt;0.001). MRL had statistically significant better TPDR for AF alone (82% vs 48%, p&lt;0.001) and non-statistically significant better TPDR for Ps (32% vs 28%, p=0.117), Bs (48% vs 38%, p=0.133) and Ts (69% vs 69%, p=0.505). Patient with MRL had better AFS at a six-months follow-up (72% vs 20%, p&lt;0.001). The overall accuracy rate for every arrhythmic episode was better in MRL implanted patients than in the SCX implanted ones (43% vs 16%, p=0.001).
Transmission rate was higher in SCX, even though MRL had a better accuracy in detecting real arrhythmic events. The overall accuracy rate of arrhythmic events in both groups is sub-optimal, therefore further engineering research is required to improve diagnostic accuracy of ILRs.
Temporal trend of QRS voltage amplitude on surface sensing in patients with arrhythmogenic cardiomyopathy implanted with a subcutaneous ICD
Authors: Casula M , De Toni C , Pignalosa L , Savastano S , Schintu B , Sanzo A , Scalone A , Tola G , Corda M , Vicentini A , Rordorf R 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Previous studies have reported a significant decrease in ventricular sensing amplitude during follow-up in patients with arrhythmogenic cardiomyopathy (ACM) implanted with trans-venous implantable cardioverter defibrillator (ICD). No data are yet available on sensing amplitudes values over time for subcutaneous ICD (S-ICD). Low QRS voltage on surface ECG is one of the diagnostic clues in ACM. This, together with the progressive nature of the disease and the not-negligible incidence of inappropriate shocks due to oversensing, raise safety concerns on the use of S-ICD in this population.

Aim
The aim of this study was to evaluate the trend of QRS amplitude on subcutaneous ECG (S-ECG) over time in patients with ACM implanted with S-ICD.

Methods
We conducted a retrospective analysis on a cohort of consecutive patients with ACM implanted with S-ICD in two tertiary centers, prospectively enrolled in the home-monitoring program. The S-ECGs recorded by the S-ICD at the time of first and last data transmission were analyzed. The voltage amplitude was estimated for each QRS complex available, and the values obtained were compared between the two time points (i.e. baseline and last follow-up available). The primary endpoint of our study was the proportion of patients in which the decrease of QRS amplitude during follow-up was statistically significant.

Results
Eleven patients (1 female, 9%) were enrolled in this study. The mean age was 43±10 years. An exclusive right ventricular involvement was reported in 5 patients (46%), 2 patients (18%) had an exclusive left ventricular, and 4 (36%) a biventricular involvement. Three patients (27%) were implanted in secondary prevention. During a median follow-up of 9 months (IQR 6-17), 6 patients (55%, 95%CI 24-84%) experienced a statistically significant reduction in the S-ECG QRS amplitude (Figure A). Considering these 6 patients, the mean absolute reduction was -0.46±0.32 mV corresponding to a relative reduction of -19%±11%. Moreover, we found a statistically significant correlation between follow-up duration and QRS amplitude relative reduction (r=-0.89, p=0.018, Figure B). No patients experienced inappropriate shocks.

Conclusions
In a cohort of ACM patients implanted with S-ICD the majority of patients experienced a significant reduction in the amplitude of QRS voltage during follow-up, confirming a potential safety concern on the use of S-ICD in this population. Further studies are needed to investigate this issue.
Leadless pacemakers as replacement for infected transvenous pacemakers: different strategies are feasible
Authors: Breeman KTN , Beurskens NEG , Wilde AAM , Tjong FVY , Knops RE 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Pacemaker infections have a high morbidity and mortality and are an indication for extraction. For reimplantation, leadless pacemakers (LPs) may be preferable due to a low chance of infection. Even more, early LP reimplantation in pacemaker-dependent patients would circumvent the need for temporary pacemakers.

Methods
We included all patients with LP implantation before, simultaneously with, or after transvenous pacemaker extraction due to infection, between January 2013 and December 2021. Outcomes were assessed during standard follow-up visits.

Results
30 patients (mean age 81±8 years) were included, of which 19 (63%) had a pocket infection, 10 (33%) endocarditis and 1 (3%) a systemic infection without endocarditis (Table). LP implantation was successful in all and was performed before extraction in 2 patients (7%; 3 and 5 days before), simultaneously in 6 (20%) and after extraction in 22 (73%). There were 3 procedural complications: 2 femoral artery bleedings and one LP dislocation. Also, one patient with complete AV block and an initially stable escape rhythm had an in-hospital cardiac arrest due to asystole after transvenous pacemaker extraction, but before LP implantation. During follow-up of median 21 months (IQR 7-53 months), no reinfection occurred. Six Nanostims were extracted due to early battery depletion, prophylactically after the battery advisory, or due to non-capture (median 36 months [range 0-67 months] after implantation); histopathologic examination of tissues around the devices showed no signs of infection. Two Nanostims were abandoned after which another device was implanted. No further device revisions were necessary during follow-up.

Conclusions
In case of transvenous pacemaker infection, LP implantation before, simultaneously with or after extraction is safe and effective.