bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stereotactic arrhythmia radioablation in europe: treatment planning benchmark results of the STOPSTORM consortium
Authors: Trojani V , Botti A , Grehn M , Balgobind B , Savini A , Pruvot E , Verhoeff J , Iori M , Blanck O 
Published: May 2022

Abstract

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

Background
In patients with refractory ventricular tachycardia (VT), STereotactic Arrhythmia Radioablation (STAR) showed promising results for otherwise untreatable patients [1]. The STOPSTORM.eu project coordinates European efforts to clinically validate STAR and to refine protocols and guidelines to ensure treatment harmonization.

Purpose
The aim of this work is to present the current clinical STAR practise in Europe based on three examples as baseline for further optimization.

Methods
Target Volumes (TV) and Organs-at-Risk (OAR) were generated from previous consortium benchmarks and consensus definitions for three well-selected STAR cases [1]. Planning Target Volumes (PTV) were generated based on three different compensation strategies for cardiac and respiratory motion [2] and overlapped close OAR like coronary arteries or stomach in some areas. The STOPSTORM.eu members were asked to generate single fraction treatment plans with 25 Gy dose prescription based on ICRU report 91 for each case based on their clinical practise and preferences for STAR including multi-disciplinary discussion and plan approval. Resulting dose distributions were analysed independently using a customized platform for multi-center treatment planning studies [3].

Results
Twenty centers submitted 22, 23 and 22 treatment plans for case 1, 2 and 3, respectively, mostly (75% of all plans) using Intensity Modulated Arc Therapy (IMAT) with 6 MeV FFF beams (73% of the IMAT plans) among other commonly used techniques for stereotactic radiotherapy. At this current stage, used guidelines for STAR treatment planning and OAR dose limits vary greatly and are mostly based on the AAPM TG-101 report or the RAVENTA trial publication [4]. As a major finding, 73% of all plans submitted preferred close OAR sparing over achieving high PTV coverage arguing that lower doses down to 20 Gy may also result in clinical efficiency as recently suggested [5]. As a minor finding, 80% of the centers chose to override strong artifact regions originating from e.g. left ventricular assist devices.

Conclusion
From this first STOPSTORM.eu multi-center multi-platform treatment planning benchmark study we obtained important information concerning current clinical preference and practise from major European centers performing STereotactic Arrhythmia Radioablation for VT. Using the individual and strongly varying approaches of the centers, the key task for the STOPSTORM.eu project is now to find consensus in order to harmonize and optimize STAR practise in Europe.
Reversed U-curve mapping and ablation of the left pulmonic cusp for treatment of the left ventricular summit arrhythmias
Authors: Futyma P , Zarebski L , Futyma M , Santangeli P , Kulakowski P 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Catheter ablation (CA) of the left ventricular summit (LVS) arrhythmias can be challenging. Close proximity of the left pulmonic cusp (LPC) offers a unique opportunity for targeting the LVS region. Whether LPC can serve as a vantage point for mapping and CA of LVS premature ventricular contractions (PVC) and ventricular tachycardia (VT) has not yet been systematically evaluated.

Methods
This is a retrospective analysis of consecutive patients who underwent CA of LVS PVC/VT and concomitant mapping and/or ablation within the LPC using reversed U-curve technique. PVC/VT activation precocity was determined and CA (unipolar, sequential unipolar and/or bipolar ablation) was performed involving LPC when necessary.

Results
A total number of 18 patients (age 59±15 years, 10 females) were included in this study. LPC mapping using reversed U-curve was successful in 17 (94%) patients. An earliest PVC/VT activation was recorded in LPC in 7 (39%). No early activation in the LPC was found in 5 (28%) patients. Selective LPC ablation (24W, 206s) led to acute suppression with late VT recurrence in one patient, whereas LPC served as an additional ablation target for sequential CA (37±4W, 416±252s) in 11 (61%) patients. 6 (33%) patients required combined sequential unipolar and bipolar CA (37±8W, 690±248s) between LPC and adjacent LVOT and this approach led to PVC/VT elimination in 5 patients. There were no procedure-related complications. During follow up 4 (22%) patients required redo ablation. Ultimately clinical success was achieved in 14 (78%) patients.

Conclusions
LPC mapping of LVS PVC/VT using reversed U-curve is safe and can be helpful for determination of LVS arrhythmia site of origin. While LPC ablation alone is rarely successful in eliminating LVS arrhythmias, it can serve as an anatomical vantage point for additional ablation of LVS PVC/VT as a part of sequential unipolar or bipolar CA.
Left bundle branch pacing preserves ventricular mechanical synchrony better than right ventricular pacing-a two-center study
Authors: Mao YK , Yang Y , Garweg C , Sheng X , Zhang JF , Yang Y , Wang M , Yang Y , Duchenne J , Voros G , Sun YX , Ma MM , Fu GS , Voigt JU 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Left bundle branch pacing (LBBP) has emerged as a novel pacing method. We sought to evaluate left ventricular (LV) mechanical synchrony under permanent LBBP and compare it with conventional and leadless right ventricular pacing (CRVP, LRVP).

Methods
Sixty-four patients with pacing indication for bradycardia were prospectively enrolled. Twenty-two patients received LBBP in the basal ventricular septum. Twenty-three patients received CRVP and 19 LRVP. All patients underwent echocardiography before and after device implantation. Myocardial work was estimated by pressure-strain analysis. Regional work in the septum (SEP) and lateral wall (LW) was calculated as the average from the respective basal and mid-ventricular segments in the apical four-chamber and three-chamber view. The absolute difference between work in LW and SEP (LW-S-work difference) was used as a measure of asymmetry in workload.

Results
Baseline characteristics were similar among the three groups. The electrocardiogram during LBBP showed a right bundle branch block pattern; during CRVP and LRVP a left bundle branch block pattern. The paced QRS duration was 114.27±9.9 ms in the LBBP group, significantly shorter than that in the CRVP and LRVP groups (153.9±25.26 ms and 159.1±13.99ms, respectively, both p&lt;0.001). The SEP work decreased in all groups during ventricular pacing (all P&lt;0.05), while the LW work remained similar. The paced LW-S work difference and work difference change between pacing on and off were more significant in the CRVP (1012.9±566.0mmHg*%) and LRVP group (1066.1±472.6mmHg*%) than the LBBP group (260.5±239.8mmHg*%, both P&lt;0.001). In addition, LW-S work difference during ventricular pacing and work difference change between pacing and baseline were comparable in CRVP and LRVP group.

Conclusion
LBBP causes less LV dyssynchrony than CRVP and LRVP as it preserves a more physiologic conduction pattern. CRVP and LRVP did not differ in this respect. Further studies need to prove that LBBP has advantages over RVP with regards to preservation of LV synchrony and contractility.
Paced P-wave duration as a significant predictor for atrial high-rate episodes in patients with cardiac implantable electronic devices
Authors: Rubio Campal JM , Garcia Talavera C , Bravo Calero L , Lazaro Rivera C , Diaz Cortegana FA , Castellanos Olmedilla A , Sanchez Arjona A , Tunon Fernandez J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial pacing can unmask or aggravate a preexisting interatrial block (IAB).

Purpose
The purpose of our study was to determine whether atrial pacing is associated with the development of atrial high-rate episodes (AHRE) during follow-up.

Methods
Patients with cardiac implantable electronic devices (CIED), no previous documented atrial fibrillation, and with a 6-month minimum follow-up were included. Sinus and paced P-wave duration were measured. AHRE was defined as an episode of atrial rate ≥ 225 bpm with a minimum duration of 5 min, excluding those documented during the first three months after implantation.

Results
Two hundred twenty patients were included (75 ± 10 years, 61% male). After a mean follow-up of 59±25 months, 46% of patients presented AHRE. Mean paced P-wave duration was significantly longer than sinus P-wave duration (154±27 vs 115±18 ms; p &lt; 0.001). Sinus and paced P-waves were significantly longer in those who developed AHRE (sinus: 119±20 vs 112±16; p = 0.006; paced: 161±29 vs 148±23; p &lt; 0.001). A paced P-wave ≥160 ms was the best predictor of AHRE, especially those lasting &gt;24 h (OR 4.2 (95% CI) [1.6-11.4]; p = 0.004). In a multivariate analysis, a paced P-wave ≥160 ms (OR: 1.84; 95% CI [1.03–3.28]; p = 0.038), a CHA2DS2-VASc score ≥4 (OR: 2.01; 95% CI [1.13–3.55]; p = 0.016), and a LA SI dimension ≥ 55 mm (OR 2.69; 95% CI [1.48–4.90]; p = 0.001) were independent predictors augmenting AHRE.

Conclusion
Atrial pacing significantly prolongs P-wave duration and is associated with further development of AHRE. A paced P-wave ≥160 ms is a strong predictor of AHRE and should be taken into consideration as a new definition of IAB in the presence of atrial pacing.
Comparative of stylet-driven versus lumenless technique for left bundle branch pacing: implant results and follow-up outcomes
Authors: Ramos Jimenez J , Marco Del Castillo A , Paredes Hurtado N , Rodriguez Munoz DA , Fontenla A , Borrego Bernabe L , Lopez Gil M , Salguero Bodes R , Arribas Ynsaurriaga F 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Left bundle branch pacing (LBBP) has traditionally been performed with fixed helix lumenless leads. The aim of this work is to compare feasibility and results with an extendable helix stylet-driven lead.

Methods
Unicenter and prospective registry of consecutive cases where LBBP was attempted using 2 different systems:
-B: stylet-driven extendable helix lead guided with preshaped delivery sheath.
-M: lumenless and fixed helix lead guided with preshaped delivery sheath.
Anthropometric, echocardiographic, procedural variables and long-term performance were compared using T-test for continuous variables, and chi-squared for categorical ones. A two-tailed p value &lt;0.05 was considered statistically significant.

Results
134 patients were included. 44% (n=59) underwent the B technique and 56% (n=75) the M technique. Table 1 summarizes baseline, procedural and follow-up results. Implant failed in 4 (6.8%) patients in the B group: 2 because of repetitive entanglement of the helix with the endocardial surface, and 2 because of dislodgment of the lead after slitting the sheath. In the M group only 1 (1.3%) implant failed due to endocardial entanglement precluding correct penetration into the septum. Of the successfully implanted leads, 78.2% (n=43) in the B group vs. 70.3% (n=52) of the M group fulfilled strict LBB capture criteria (p=0.31). Baseline characteristics, fluoroscopy and procedure time showed no differences. After a median device follow-up time of 66 (interquartile range 36-184) days, slightly inferior capture threshold was seen in M group. 2 patients (3.8%) of the B group showed a threshold increase &gt;2.0V, one of them needing intervention due to lack of capture. All M leads performed well during follow-up.

Conclusions
In consecutive patients with comparable baseline characteristics, both B and M technique are equally feasible, with similar LBBP success, procedural outcomes and long-term performance. Larger registries are needed to assess whether implant and long-term failure are also comparable.
Bilateral bundle branch capture during deep septal myocardial and nonselective left bundle branch pacing preserves interventricular synchrony
Authors: Curila K , Jurak P , Waldauf P , Halamek J , Stros P , Smisek R , Plesinger F , Znojilova L , Leinveber P , Viscor I , Herman D , Osmancik P , Prinzen FW 
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
Both left bundle branch pacing (LBBP) and deep septal myocardial pacing (LVSP) are less physiological than His bundle pacing. However, pacing both anode and cathode of the lead that is positioned in the interventricular septum may provide bilateral bundle branch capture, which may result in better interventricular synchrony.

Objective
To use UHF-ECG to compare ventricular activation between HBp and bilateral bundle branch capture during left bundle branch (LBBPbi) and deep septal myocardial pacing (LVSPbi).

Methods
Studies were performed in consecutive bradycardia patients. Bipolar pacing was performed with the lead in the LBBP (pseudo right bundle branch block morphology in V1 + proved LBB capture) and LVSP (pseudo right bundle branch block morphology in V1 without proved LBB capture) positions, with the pacing output leading to bilateral bundle branch capture. QRS duration was measured from the first to the last deflection of the QRS in any lead. UHF-ECG electrical dyssynchrony parameters – e-DYS (difference between the first and last ventricular activation) and local depolarization durations in precordial leads (V1-V8d) were calculated.

Results
In 94 consecutive patients, measurements were performed during HBp (n = 75) and LVSPbi (n = 37) and LBBPbi (n = 64). The average pacing threshold leading to bilateral bundle branch capture was 2.6 V at 0.5 ms. nsHBp led to the shortest QRSd compared to sLBBPbi and LVSPbi (98 vs. 103 vs. 110 ms; p &lt; 0.01). LVSPbi showed smallest e-DYS -2 ms vs. -8 ms during LBBPbi and 11 ms during nsHBp; p &lt; 0.05, but V5-8d were during LVSPbi longer than during nsHBp and LBBPbi (absolute difference 4-9 ms); p &lt; 0.05. No statistical difference in V5-V8d were observed between LBBPbi and nsHBp.

Conclusion
Bilateral bundle branch capture during LVSP and nsLBBp preserves interventricular synchrony at the same level as HBp and thus leads to more physiological ventricular activation in patients with bradycardia.
Impact of generic ICD programming on clinical outcomes
Authors: Khan P , Jahagirdar N , Laybourn M , Harding I , Cannata A , Bromage D , Shabeeh H , Kabunga P , Petzer E , Murgatroyd F , Scott P A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Generic ICD programming, where shock-reduction programming is extrapolated from trials of one manufacturer to another, may reduce non-essential ICD therapies beyond that seen in randomised trials. The purpose of this retrospective cohort study was to evaluate the impact of a standardised programming protocol, based on generic programming, across manufacturers. We also evalutated the impact of combining different detection rates and detection times.

Methods
We included all new ICDs in a single centre (2009-2019). In 2013 a standardised programming protocol based on generic programming was introduced. Patients were classified into three groups: pre-guideline (PS), post-guideline and guideline compliant (GC) and post-guideline but not guideline compliant (NGC). The end-points were the first occurrence of any device therapy (ATP or shock), ICD shock, syncope and all-cause mortality. Survival analysis was used to evaluate outcomes. A ’’programming score’’ was composed based on detection rate and time. The relationship between this composite "programming score’’ and study end-points was evaluated in multivariable cox proportional hazards models

Results
1003 patients were included (mean follow-up 1519 +/- 1005 days). In primary prevention patients freedom from ICD therapy (91.5% vs. 73.6%, p&lt;0.001) or shock (94.7% vs 84.8%, p=0.02) were significantly higher in GC compared to PS patients, without significant increase in syncope or mortality. In secondary prevention patients freedom from any ICD therapy or any shock were non-significantly higher in GC compared to PS patients. Among primary prevention patients with the highest ’programming score’ (longest detection time and highest detection rates), there was a 82% reduction in risk of any ICD therapy (p&lt;0.001) and a 70% reduction in risk of ICD shock (p&lt;0.001)

Conclusion
A standardised programming protocol, incorporating generic programming, reduced the burden of ICD therapy without an increase in adverse outcomes.
Device-detected sleep-disordered breathing predicts implantable defibrillator therapy in patients with heart failure
Authors: Mazza A , Bendini M , Bianchi V , Esposito C , Calo’ L , Andreoli C , Santobuono V , Dello Russo A , Chianese R , La Greca C , Santoro A , Giubilato G , Strisciuglio T , Valsecchi S , Boriani G 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Sleep-disordered breathing is highly prevalent in heart failure (HF) and it has been suggested as a risk factor for malignant ventricular arrhythmias. The Respiratory Disturbance Index (RDI) algorithm computed by select implantable cardioverter defibrillators (ICDs) can identify severe sleep apnea (SA).

Purpose
In the present analysis we evaluated the association between ICD-detected SA and the incidence of appropriate ICD therapy in patients with HF.

Methods
We enrolled 411 HF patients (age 69±10years, 77% male, ejection fraction 32±8%), implanted with an ICD endowed with an algorithm (ApneaScan, Boston Scientific) that calculates the RDI each night. In this analysis the weekly mean RDI value was considered. The endpoint was the first appropriate ICD shock. The median follow-up was 26 months [25th–75th percentile: 16-35].

Results
During follow-up, one or more ICD shocks were documented in 58 (14%) patients.
Patients with shocks were younger (66±13years versus 70±10years, p=0.038), and more frequently implanted for secondary prevention (21% versus 10%, p=0.026). The maximum RDI value calculated during the entire follow-up period did not differ between patients with and without shocks (55±15episodes/h versus 54±14episodes/h, p=0.539). However, the ICD-detected RDI showed a considerable variability during follow-up. The overall median of the weekly RDI was 33episodes/h [25th–75th percentile: 24-45]. Using a time-dependent Cox regression model, the continuously measured weekly mean RDI≥45episodes/h was independently associated with shock occurrence (HR:4.63, 95%CI:2.54-8.43, p&lt;0.001), after correction for baseline confounders (age, secondary prevention).

Conclusions
In HF patients, patients were more likely to receive appropriate ICD shocks during periods of time when they exhibited more sleep-disordered breathing.
Depressive symptoms and quality of life in patients with heart failure and an implantable cardioverter-defibrillator
Authors: Zormpas C , Kahl K G , Hohmann S , Oswald H , Stiel C , Veltmann C , Bauersachs J , Duncker D 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Heart failure (HF) is associated with development of depressive symptoms and reduced quality of life (QoL). Patients with HF and an implantable cardioverter-defibrillator (ICD) were evaluated regarding depressive symptoms and QoL.

Purpose
Patients with HF and an ICD were prospectively evaluated regarding depressive symptoms and QoL with the intention to elucidate the prevalence of depressive symptoms in this patient cohort and to assess how QoL evolves in the course of the underlying disease. Aim of the analysis is to identify patients in need for supportive care intervention and/or antidepressant therapy.

Methods
The present study included 446 patients with HF and an ICD. Depressive symptoms were assessed using the Patient Health Questionnaire 9 (PHQ-9), QoL was evaluated using the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Functional ability and exercise tolerance were assessed at inclusion and after 6 months with help of the 6-minute walking test (6MWT).

Results
Patients included in the study had a mean age of 65.8 years and were predominantly male (83.6%), with mostly ischemic (n = 277; 62.1%) or dilated (n = 150; 33.6%) cardiomyopathy. 193 (43.2%) patients had depressive symptoms, of whom 75 patients (16.8%) were classified as moderate to severe depression according to the PHQ-9 at baseline. Depressive symptoms were associated with low QoL independent of NYHA functional class. High NYHA functional class, high PHQ-9 score, age and body mass index (BMI) were associated with a lower 6MWT at enrollment, while depressive symptoms (expressed as higher PHQ-9 score) and age were associated with a lower 6MWT after 6 months. Patients with history of smoking and a higher BMI showed higher PHQ-9 scores after 6 months. Patients under antidepressant medication showed improved PHQ-9 score after 6 months, indicating controlled/treated depression. However, patients with low QoL at inclusion remained with low QoL after 6 months.

Conclusion
Depressive symptoms correlate with low QoL and lower long-term functional status in patients with HF and an ICD. Depressive symptoms are associated with smoking and obesity, which themselves are risk factors for a poor prognosis in HF. Only a small fraction of patients with HF and ICD showing depressive symptoms receives appropriate treatment. Assessing depressive symptoms and lifestyle factors should be part of a multimodal treatment plan in patients with HF and an ICD.
Potential for delayed improvement of left ventricular ejection fraction in newly diagnosed heart failure under optimized therapy depends on etiology - data from the PROLONG-II study
Authors: Mueller-Leisse J , Brunn J , Zormpas C , Hohmann S , Hillmann HAK , Eiringhaus J , Bauersachs J , Veltmann C , Duncker D 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Patients with a first diagnosis of heart failure with reduced ejection (HFrEF) have potential for improvement under appropriate therapy. We and others have previously suggested to extend the time of therapy optimization beyond 3 months before considering implantation of a primary preventive implantable cardioverter-defibrillator (ICD), in order to avoid unnecessary ICD implantations. This sub-analysis of the PROLONG-II study sought to investigate which patients show recovery of left ventricular ejection fraction (LVEF) beyond 3 months under optimized therapy.

Methods
Patients with newly diagnosed HFrEF with either ischemic cardiomyopathy (ICM), dilated cardiomyopathy (DCM), peripartum cardiomyopathy (PPCM) or myocarditis at our center between 2012 and 2017 were included. All patients received a wearable cardioverter defibrillator (WCD) for temporary protection from sudden cardiac death. Follow-up (FU) data were analyzed after 3 months and at last available FU, and included WCD data, clinical status, medication, echocardiography and ECG.

Results
353 patients (69% male) with newly diagnosed HFrEF (LVEF 25±8%) were followed for 2.8±1.5 years: 126 patients with ICM (35%), 169 patients with DCM (48%), 27 patients with PPCM (7%), 24 patients with myocarditis (7%) and 7 patients with other diagnoses (2%). LVEF improvement within the first 3 months was observed in all subgroups but was more pronounced in patients with DCM (9±9%) compared to ICM (5±8%) and in PPCM (20±10%) and myocarditis (15±9%) compared to both DCM and ICM. In patients with DCM and PPCM, LVEF continued to improve significantly beyond 3 months (another 10% each).

Conclusion
Potential for delayed LVEF improvement in newly diagnosed HFrEF under optimized therapy depends on etiology. Patients with PPCM and DCM seem to be particularly eligible for an extended period of therapy optimization and risk stratification before considering an ICD.