bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient characteristics, predictors and outcome of pacemaker patients upgraded to an implantable cardioverter defibrillator
Authors: Baldinger SH , Burren D , Noti F , Servatius H , Seiler J , Madaffari A , Asatryan B , Tanner H , Reichlin T , Haeberlin A , Roten L 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Pacemaker (PM) patients may require a later upgrade to an implantable cardioverter-defibrillator (ICD). Limited data exists on this patient population. We sought to characterize this population, to assess predictors for ICD upgrade, and to report the outcome.

Methods
From our prospective PM and ICD implantation registry, all patients who underwent PM and/or ICD implantations at our center were analyzed. Patient characteristics and outcome of PM patients with subsequent ICD upgrade were compared to age- and sex-matched patients with de novo ICD implantation, and to PM patients without later upgrade.

Results
Of 1’301 ICD implantations, 60 (5%) were upgrades from PMs. Median time from PM implantation to ICD upgrade was 2.6 years (IQR 1.3-5.4) Of 2’195 PM patients, 28 patients underwent subsequent ICD upgrade, corresponding to an estimated annual incidence of an ICD upgrade of at least 0.33%. Lower LVEF (p=0.05) and male sex (p=0.038) were independent predictors for ICD upgrade. Transplant- and LVAD-free survival was worse both for upgraded ICD patients compared to matched patients with de novo ICD implantation (p=0.05; Figure, panel A), as well as for PM patients with later upgrade compared to matched PM patients not requiring an upgrade (p=0.036; Figure, panel B).

Conclusions
One of twenty ICD implantations are upgrades of patients with a PM. At least one of 30 PM patients will require an ICD upgrade in the following 10 years. Predictors for ICD upgrade are male sex and lower LVEF at PM implantation. Upgraded patients have worse outcome.
Left bundle branch pacing with normal paced QRS axis produce more physiological left ventricular lateral wall depolarization than its pacing resulting in heart axis deviation
Authors: Curila K , Jurak P , Jastrzebski M , Sussenbek O , Waldauf P , Halamek J , Stros P , Smisek R , Znojilova L , Plesinger F , Leinveber P , Viscor I , Herman D , Osmancik P 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health of the Czech Republic

Background
Left bundle branch pacing is defined as the pacing of the trunk or its proximal fascicles, usually with septal myocardial pacing at low output. It preserves physiological left ventricular activation; however, it is unknown if there is a difference between captures with normal or deviated axes and pacing in proximal vs. distal locations.

Objective
To study ventricular activation during nonselective LBB pacing (nsLBBp) resulting in different paced QRS axes and proximal vs. distal pacing positions using ultra-high-frequency ECG (UHF-ECG).

Methods
This was a retrospective analysis of patients with bradycardia in which nsLBBp was archived during an implant procedure, and UHF-ECG analysis of ventricular activation was performed. nsLBBp captures were classified according to paced QRS axis as with superior (-30°;-90°), normal (-29°;60°), or inferior (61°;120°) axis deviation and proximal (LBbpo to ventricular EGM signal distance ≥ 26 ms) vs. distal (LBBpo to ventricular EGM signal distance &lt; 26 ms). UHF-ECG electrical dyssynchrony parameters – e-DYS (difference between the first and last ventricular activation), local depolarization durations in precordial leads (V1-V8d), and their mean value (Vdmean) were calculated.

Results
We have studied 79 nsLBBp, of which 35 had superior, 28 normal, and 16 had inferior paced QRS axes. There was no difference in LBBpo to V distance, QRSduration, V5 RWPT, or e-DYS (-27 ms vs. – 22 ms vs. -25 ms for superior vs. normal vs. inferior axes; p = NS) between them. However, nsLBBp with normal paced QRS axis had shorter Vdmean (43 ±6 ms) compared to captures with superior (48 ± 7 ms) and inferior axis deviation (48 ± 6 ms); p &lt; 0.05. It was mainly due to shorter V7-8d during nsLBBp with normal axis (mean difference of - 10 ms; p &lt; 0.05) than in captures with superior or inferior axes. No difference in any of the studied parameters was noted when comparing proximal vs. distal pacing locations.

Conclusion
Nonselective capture of the left bundle branch resulting in normal paced QRS axis produces more physiological LV activation compared to captures with superior or inferior axes deviations.
Pacemaker upgrade to Cardiac Resynchronization Therapy-defibrillator or Cardiac Resynchronization Therapy-pacemaker without prior ventricular arrhythmias
Authors: Schwertner W R , Tokodi M , Behon A , Veres B , Merkel E , Kuthi L , Masszi R , Kovacs A , Zima E , Geller L , Osztheimer I , Kosztin A , Merkely B 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by the ÚNKP-21-3-II-SE-47, ÚNKP-20-3-I-SE-43 New National Excellence Program if the Ministry for Innovation and Technology in Hungary. Project no. NVKP_16-1–2016-0017 (’National Heart Program’) has been implemented with the support provided by the National Research, Development and Innovation Fund of Hungary, funded under the NVKP_16 funding scheme. The research was financed by the Thematic Excellence Programme (2020-4.1.1.-TKP2020) of the Ministry for Innovation and Technology in Hungary, within the framework of the Therapeutic Development and Bioimaging thematic programmes of the Semmelweis University. This work was also supported by the Semmelweis 250+ Excellence PhD Scholarship (EFOP-3.6.3-VEKOP-16-2017-00009).

Background
Cardiac Resynchronization Therapy (CRT) can reverse the harmful effects of right ventricular pacing (RVP). Data are scarce on comparing long-term survival among patients who undergone CRT-defibrillator (CRT-D) or CRT-pacemaker (CRT-P) upgrade from pacemakers (PM) without prior ventricular arrhythmias (VAs).

Purpose
We compared the differences in long-term all-cause mortality among PM patients receiving CRT-D or CRT-P upgrade.

Methods
Patients with conventional PMs developing heart failure despite optimal medical treatment and a high rate of RVP with no prior VAs were included. Altogether 326 patients were investigated, 117 (36%) upgraded to CRT-D, 209 (64%) to CRT-P in our retrospective registry. The primary endpoint was all-cause mortality. Subgroup analyses were performed by comorbidities and CRT device types. Using topological data analysis, we identified risk groups based on the primary endpoint.

Results
During the median follow-up time of 3.6 years, 33 (28%) CRT-D and 145 (69%) of CRT-P upgrade patients reached the primary endpoint. The CRT-D upgrade group showed a lower risk of all-cause mortality in the total cohort (HR: 0.55; 95% CI: 0.38-0.81; p=0.002) and by ischaemic aetiology (HR: 0.47; 95% CI: 0.29-0.76; p=0.002) compared to CRT-P. After adjustment, CRT-D, male gender and loop diuretics proved as independent predictors of all-cause mortality. Patients upgraded with CRT-D demonstrated favourable survival in the high-risk group over CRT-P.

Conclusions
Patients had survival benefit after CRT-D upgrade, compared to CRT-P, in the high-risk group and with ischaemic heart failre aetiology. However, no difference could be observed between the two groups among low- and intermediate-risk patients.
Improvement in ECG parameters predictive of sudden death in patients with ventricular dysfunction and left bundle branch block after cardiac resynchronization through His Bundle pacing
Authors: Lopez-Masjuan Rios A , Esteve-Ruiz I , Moraleda Salas M , Arce-Leon A , Venegas-Gamero J , Fernandez-Gomez JM , Morina-Vazquez P 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Electrocardiographic (ECG) parameters predictive of sudden death have been described in patients with ventricular dysfunction. Cardiac resynchronization therapy (CRT) in patients with left bundle branch block (LBBB), in addition to improve the left ventricular ejection fraction (LVEF), can correct part of them, which could have an important impact prognostic at follow-up. Repolarization changes in patients resynchronized via permanent His Bundle pacing (p-HBP) have not been described yet.

Methods
We designed a prospective descriptive study of patients with LBBB and CRT indication proposed for CRT by p-HBP. We analyzed different ECG patterns of sudden death (QT interval, corrected QT interval, QT interval dispersion, Tpeak-Tend, Tpeak-Tend dispersion, Tp-Te/QT ratio, rdT / JT index, T wave voltage, T wave duration) and the changes of them at 6-month follow-up after His resynchronization.

Results
We included 21 patients (57.1% male, 70 [63.5-80] years). 90.5% had hypertension, 57.1% diabetes mellitus and 66.7% dyslipidemia. 90.5% had structural heart disease (median LVEF 38 [30-52.5] %); 52.9 % had non-ischemic cardiomyopathy, being the principal cause of the dysfunction in these patients the dyssynchronipathy caused by LBBB. Other causes of cardiomyopathy were hypertensive cardiomyopathy (5.9%), valvulopathy (11.8%) and pacing induced cardiomyopathy (11.8%). 66.7% were resynchronized with dual chamber pacemakers, 28.6% with tricameral defibrillator and 4.8% with tricameral pacemaker. ECG parameters predictive of sudden death basally and at 6-month follow-up are summarized in table 1. All predictors improved in the follow-up with statically significant differences. Fig 1 shows basal (A) and 6-month follow-up (B) changes in repolarization parameters.

Conclusion
There is an improvement in the ECG parameters predictive of sudden death in patients with LBBB resynchronized via p-HBP. CRT through p-HBP could improve the risk of sudden death.
The patient perspective on remote monitoring of cardiac devices: a german patient survey
Authors: Hillmann HAK , Hansen C , Przibille O , Duncker D 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Current guidelines recommend remote monitoring for patients with implanted cardiac devices. Nevertheless, data regarding patients’ attitude using remote monitoring is lacking. This study aims to analyze the patient perspective on remote monitoring of cardiac devices in Germany.

Methods
Patients with an implanted cardiac device and remote monitoring (continuous device follow-up and remote device follow-up) of all current manufacturers in three German centers were asked to participate in the study filling in a patient questionnaire between 07-11/2021. The questionnaire consisted of 37 questions regarding patient’s baseline characteristics, individual use and judgement on remote monitoring, as well as the patient’s opinion regarding future remote monitoring perspectives. Survey participation was anonymous and on a voluntary basis.

Results
617 patients (28.4 % women) out of three cardiac centers in Germany participated. Implanted cardiac devices were pacemakers ± cardiac resynchronization therapy (CRT) (11.9%), implantable defibrillators ± CRT (70.3%) and implantable loop recorders (17.8%). Technical problems with remote monitoring transmitter were reported to occur: never (60.3%), seldomly (25.5%), sometimes (12.0%) and all the time (2.2%). The majority of patients (84.9%) take part in remote monitoring without the help of others. After starting remote monitoring, patients reported a significant prolongation of the intervals (p&lt;0.001) of their in-person follow-up visits (figure 1). 44.0% of the participating patients answered to have a better, 1.2% a worse and 54.8% an equal disease management since participating in remote monitoring. Regarding possible future perspectives using remote monitoring, 73.0% patients answered to own a smartphone. 48.3% of the patients would prefer a smartphone-based application for remote monitoring. 15.0% had no opinion on that question, whereas 36.7% would prefer the use of a transmitter in their bedroom.

Conclusion
In this patient survey, remote monitoring was a widely accepted tool for patients with implanted cardiac devices. Patients perceive an improvement of their disease management through telemonitoring. Furthermore, patients answered that intervals of outpatient visits could be prolonged by the use of remote monitoring. Most patients would appreciate a smartphone-based remote monitoring of their cardiac device.
Lead extraction with the "pisa technique" - experience of a portuguese tertiary care center
Authors: Dias Ferreira Reis JP , Valente B , Portugal G , Lousinha A , Silva Cunha P , Oliveira M , Cruz Ferreira R 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The "Pisa Technique" (PT) is an increasingly used method of lead extraction (LE) that has shown excellent results in terms of clinical (Cs) and radiological success (Rs) associated with the lowest rate of complications reported in ELECTRa Registry.

Purpose
To characterize the adult population submitted to LE with the PT and evaluate its short-term results.

Methods
A single-center prospective study of consecutive procedures (P) of LE using the PT between February 2013 and October 2019. Demographic, clinical, and P related variables, mortality (M) and reimplantation (R) data were assessed.

Results
320 electrodes (E) were removed in a total of 171 Ps and 159 patients (pts). 80.7% of these P’s were due to CIED infection (55.1% due to pocket site infection, 18.8% to occult bacteremia with probable CIED infection and 26.1% due to both local and systemic infection, with 44% of pts presenting with valvular/ lead vegetation) and the remainder due to E dysfunction or venous occlusion. Pts averaged 67.7 years of age, 71.9% were male with a mean left ventricular ejection fraction of 47.8%.
19.3% presented coronary artery disease, 42.1% overt heart failure and 43.9% atrial fibrillation. 29 pts had cardiac resynchronization devices, 20 pts implantable cardioverter-defibrillator devices and 110 pts pacemaker systems (mostly DDD). The mean "age" of the extracted E’s was 83.2 months, 244 of which were atrial or ventricular pacing, 26 pacing E’s via the coronary sinus and 50 shock E’s. In 31.0% of the cases, the E’s were of active fixation, with 42.7% of the pts being pacing dependent. 14% of pts had a previous attempt of LE, 37.4% had already been submitted to generator replacement and a third to CIED upgrade. In 66.7% of pts, a new contralateral CIED was implanted during the hospital stay - H -(mean time for R of 6 days) and in 19% of R’s an antibacterial envelope was used. The Rs and Cs rates were 91.2% and 98.3%, respectively. There was 1 case of cardiac tamponade during LE, which was stabilized by pericardiocentesis and 2 pocket site hematomas requiring surgical drainage. There were no deaths during the P. During a mean follow-up (FU) of 33 months, 11 pts had to undergo a new P, 5 of them due to pocket reinfections. The M rate during FU was 24.2% (37 pts), with 8 pts (5.0%) dying during H, mostly due to septic shock, and 19 pts during the first year post-P.

Conclusion
Our center’s experience with the PT confirms the method’s high efficacy and safety in the percutaneous extraction of E’s in pts with CIED.
Risk factors of mortality after secondary procedures during the world-wide randomized antibiotic envelope infection prevention trial (WRAP-IT)
Authors: Mittal S , Poole J , Kennergren C , Birgersdotter-Green U , Lustgarten DL , Tomassoni GF , Hilleren G , Lande J , Lensing C , Wilkoff B , Tarakji K 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Medtronic

Background
Previous analysis of WRAP-IT (World-wide Randomized Antibiotic Envelope Infection Prevention trial) data identified both patient and procedural characteristics as risk factors for cardiac implantable electronic device (CIED) infection. In the current analysis, we sought to similarly use prospectively collected WRAP-IT data to assess risk factors of all-cause mortality. Understanding if mortality risk can be modified and identifying baseline characteristics associated with high risk can help guide physician decision making.

Purpose
To identify modifiable and non-modifiable risk factors for 1-year all-cause mortality after a secondary (replacement, revision, or upgrade) CIED procedure.

Methods
This analysis included 5,461 secondary procedure patients from the WRAP-IT study. Included as candidate factors were patient and procedural characteristics. Patients with more than one year follow-up were censored at one year. A multivariate Cox Proportional Hazards model was reached by stepwise selection to minimize Akaike Information Criterion.

Results
The overall one-year mortality rate was 5.2% after secondary procedures. Of the 26 patient and 18 procedural characteristics analyzed, the following variables best predicted risk of a 1-year all-cause mortality: age, NYHA class, renal dysfunction, anticoagulant use, ischemic cardiomyopathy, diabetes, BMI, procedure time, myocardial infarction, valve surgery, and hypertrophic cardiomyopathy (Table).

Conclusion
In WRAP-IT patients undergoing secondary procedures, the only procedure characteristics that had any association with all-cause 1-year mortality risk was procedure time suggesting that most of the risk factors of mortality are non-modifiable. Baseline patient characteristics and co-morbidities were the principal risk factors of all-cause 1-year mortality. Specifically, increasing age, NYHA class, and a history of renal dysfunction were strongly associated with mortality.
Studying the relation between post-infarction ventricular arrhythmia and left ventricular myocardium thinning on computed tomography images using explainable deep learning
Authors: Ly B , Finsterbach S , Nunez Garcia M , Bacoyannis T , Cedilnik N , Sridi S , Jais P , Sermesant M , Cochet H 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): National Research Agency, 3IA Côte d’Azur (ANR-19-P3IA-0002),
IHU Liryc (ANR- 10-IAHU-04)

Background
Infarct heterogeneity plays a critical role in the development of scar-related ventricular arrhythmias (VA). Wall thickness (WT) from CT was shown to correlate with arrhythmogenic sites in the context of ablation.

Purpose
To analyze the relationship between WT distribution and the presence VAs in patients with history of myocardial infarction (MI).

Methods
From 2010 to 2020, we retrospectively included consecutive patients who underwent CT more than 1 year after MI.Automated LV wall segmentation, reorientation, WT computation and flattening methods were applied to obtain 2D WT bullseye maps.The population was divided into a training set (3/4) and a testing set (1/4). On the training set, a conditional variational autoencoder (CVAE) model was trained to encode the WT map in its latent representation,which was then used by a classifier model to predict VA. For each prediction, a gradient back-projection method was used to generate attention maps highlighting the bullseye region most influential in the model’s decision. The ability of the trained CVAE to identify patients with VA was then assessed on the test population, and compared to that of other clinical variables (age, gender, LVEF, scar size).

Results
641 patients were included (age 73±7 years, 83% males, LVEF 46±10%), including 166 (26%) with history of VA. From original CT images, automated processing methods allowed for the obtention of a WT bullseye, a VA prediction and an attention map in less than 2 min. On the testing population, univariable correlates of VA were LVEF (P&lt;0.001), scar size defined as WT area (P&lt;0.001), CVAE prediction (P&lt;0.001), and male gender (P=0.007). Multivariable analysis identified CVAE prediction and male gender as independent VA correlates (P&lt;0.001 and P=0.01, R2=0.364), while LVEF and scar size were not (P=0.052 and P=0.60). The CVAE model identified patients with VA with a sensitivity/specificity of 0.87/0.74. The analysis of attention maps confirmed that the CVAE actually used the MI region to predict VA, and showed that the CVAE was filtering out areas of physiological WT, thereby outperforming simple WT thresholding.

Conclusions
Fully automated analysis of WT from CT images is feasible in patients with MI, and allows for the extraction of robust markers of VA, outperforming conventional risk stratifiers
The effect of sacubitril/valsartan on device detected heart failure status
Authors: Giordano F , Striuli L , Pollina AV , Mumoli N , Spaziani D 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Sacubitril/Valsartan (S/V) improves survival in symptomatic patients with heart failure with reduced ejection function (HFrEF) when compared to standard treatment guidelines. The mechanism by which S/V further reduces mortality is not utterly clear: a favorable left ventricular reverse remodeling connected with a reduction of the arrhythmic burden, seems to play a key role in this setting. The HeartLogic multiparametric algorithm combines multiple cardioverter-defibrillator sensor and has emerged as a powerful and well-validated tool to follow patients with HF.

Purpose
To evaluate the effect of S/V on a device based algorithm to predict heart failure (HeartLogic) in HFrEF patients with an implantable cardioverter-defibrillator (ICD).

Methods
ICD patients with HFrEF and with at least an HeartLogic alert (HL index &gt;16) were enrolled in this single-centre prospective observational study. S/V was added on top of medical therapy. All patients underwent device interrogation at baseline, before S/V administration, and at 12 months follow-up. Serum levels of NT-proBNP (pg/mL) were measured at baseline and at follow-up. The primary endpoint was the number of HeartLogic alerts after 12 months from the beginning of S/V. The secondary endpoint was the total number of ventricular arrhythmias recorded on the ICD controls.

Results
36 ICD patients (83% male, age 69±6) with HFrEF (LVEF ≤ 35%) and at least an HL alert, were consecutively enrolled and treated with S/V on top of standard therapy. At 12 months follow-up, HeartLogic alerts were significantly reduced (HL 38 vs 24; p=0,024) consistently with the reduction in NT-proBNP serum levels (2358 vs 1134 pg/mL; p=0,019). Both sustained and nonsustained ventricular tachycardia episodes decreased (3 vs 0.7; p =0,05 and 15.7 vs 2.2; p=0,04) irrespective of S/V dose.

Conclusion
The administration of S/V effectively reduced HeartLogic index and NT-proBNP values supporting the favourable impact of this drug in HFrEF patients. The results confirm the reliability of HeartLogic algorithm for heart failure management. Thus, an alert-based follow-up approach can be used for therapy optimization in this population.