bluuebunny/crossref_metadata_2025_split huggingface dataset:
Usefulness of the physiological single chamber pacemaker VDD in elderly patients with normal sinus rhythm
Authors: Martinho A , Telo M , Antonio N , Almeida J , Elvas L , Goncalves L 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
In frail elderly patients or when atrioventricular block (AVB) is paroxysmal, and pacing anticipated to be infrequent, single chamber pacing (VVI or VDD) may be considered as it carries a lower complication rate compared with DDD devices. For sinus rhythm patients, the single lead VDD, by preserving atrial sensing, is a more physiological mode than VVI devices, with comparable time procedure and complication rates. However, there are few data assessing the performance of VDD pacemakers in elderly patients, with AVB and sinus rhythm.

Purpose
We want to evaluate the 3-years performance of VDD pacemakers (PM) in frailty elder patients with AVB.

Methods
We conducted a retrospective, observational study of 200 elderly (³75 years) patients with AVB and normal sinus rhythm who consecutively implanted VDD PM between 2016 and 2018. Baseline clinical characteristics were analyzed, and a 3-years follow-up was performed: atrial undersensing, atrial fibrillation (AF), heart failure (HF) hospitalization, cardiovascular (CV) and non-CV death.

Results
Mean age was 84±5 years and 55% were female. The study population presented several comorbidities: 74% had atrial hypertension, 49% dyslipidemia, 35% chronic kidney disease and 28% diabetes. After 3-years follow-up most of the patients (90%; n=162) were still programmed in their original mode with good atrial sensing. Due to permanent AF, 4%(n=8) patients had been switched to VVIR mode and 5.5% (n=11) due to P-wave undersensig. 0ne-third (n=65) died during follow-up, 89% (n=58) due to non-CV causes. Low amplitude P-wave (&lt;0.5mV) at baseline had a numerical, non-statistically significant association with atrial undersensig and AF at 3-years (p=0.14 and p=0.77, respectively). Atrial undersensing during follow-up didn’t relate with all-cause death and HF hospitalization (p=0.58 and p=0.64, respectively), but was associated with atrial fibrillation (12.7% vs 31.6%, p=0.038).

Conclusion
A significantly larger number of VDD-paced elderly patients maintain their original mode program with good atrial sensing. Moreover, atrial undersensing did not influence mortality or HF hospitalization rate. These results reinforce the benefit of VDD use among frail and elderly patients.
Fractured epicardial lead in paediatric patients: can they be safely repaired?
Authors: Silvetti M S , Campisi M , Silvetti G , Tamburri I , Saputo FA , Battista V , Albanese S , Drago F 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
Before bipolar epicardial leads became widely available and used by heart surgeons, unipolar epicardial leads were frequently implanted in small children requiring permanent pacing. Main complications are lead fractures causing pacing/sensing defect. Therefore, patients should undergo new epicardial or endocardial lead implantation with relevant procedural risks, especially in complex congenital heart disease (CHD). Proximal fractures, close to the generator, may be repaired using a dedicated Unipolar Lead Adapter and Extension, with reduced operative risks. Purpose of the study is the retrospective analysis of the outcome of the repair of unipolar epicardial leads in young patients (pts) in a single tertiary paediatric center.

Methods
Consecutive patients with proximal fracture underwent a trial of lead repair using the lead adapter/extension, during general anaesthesia, cefuroxime antibiotic profilaxis, from 2004 to 2020. Lead data (threshold, sensing, impedance) were compared before and after the repair procedure.

Results
18 patients with CHD (12pts, 10 of whom complex, 6 post-Fontan) or normal structural heart (6pts), who underwent pacemaker implantation at 2.5 (0.7-5.8)years of age for congenital/postoperative atrioventricular block (11pts) and sinus node dysfunction (7pts), showed lead (7 atrial, 11 ventricular) fractures after chronic pacing. At 13 (8-17)years of age, all leads were successfully repaired without any complications. Follow-up was 4 (2-6)years. Four pts (22%) showed again fractures of the repaired lead, after 1 month, 1and 3 years (2pts). Electrical lead parameters are shown in table 1: there were not significant differences between consecutive time of controls, also in the atrial and ventricular lead subgroups.
Table 1.-------------------Pre-repair;--intraprocedural;---1 month;----------1 year;-------------4 years.
Threshold (V/0.4 ms):--1.1 (0.7-1.4);--1.0 (0.8-1.6);-------1.2 (0.9-1.5);-----1.2 (0.9-2.1);-------1.5 (1.1-1.8).
Sensing (mV):--------- 7 (2.4-12);------5.4 (1.3-15);-------4 (1.5-11);----------5 (1.6-12);---------3 (2-10).
Impedance (ohm): 343 (289-407);---350 (246-415);--346 (250-432);--374 (250-589);--362 (220-470).

Conclusion
The repair of fractured unipolar epicardial leads in young patients is a safe and effective procedure, with few complications during follow-up. Effective repair can delay more aggressive procedures.
Transvenous lead advancement in paediatric pacing to overcome growth stretching
Authors: Silvetti M S , Tamburri I , Silvetti G , Campisi M , Saputo FA , Battista V , Drago F 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
One of the main complications of transvenous leads implanted in paediatric patients is the stretching of the lead caused by the somatic growth. It may cause pacing and sensing defects and lead dislodgement or even fracture. Absorbable lead ligature and atrial loop may reduce this risk. However, the loop may induce traction or may unroll too early and therefore impair lead function. Lead extraction and replacement is another solution, although it has some procedural risks in young patients. Lead advancement through pushing it from the pocket may solve growth-induced traction and spare the electrode throughout childhood until post-puberty.
Purpose of the study is the retrospective analysis of the outcome of the transvenous lead advancement in children with a pacemaker (PM) in a single tertiary paediatric center.

Methods
Consecutive patients with a VVIR PM implanted for isolated congenital complete atrioventricular block (no structural heart disease) in alternative right ventricular (RV) pacing sites, with lead stretching underwent a trial of lead advancement during general anaesthesia, cefuroxime antibiotic profilaxis, from 2014 to 2021. After venous angiography showed venous patency, the PM pocket was opened, the lead was released from subcutaneous adherences and with a stylet was gently advanced to create a semi-loop in the atrium without dislodging the tip. Lead data (threshold, sensing, impedance) were compared before and after the procedure. Data are expressed as median (25th-75th centiles) Results: 7 patients underwent PM implantation at 6.9 (5.5-8.0) years of age, 20 (18-21) kg, 116 (106-120) cm, with the lead positioned at parahisian(3)/mid-septum (4 pts) sites. During a follow-up of 3 (1-5) years, advancement procedures were 2 (1-4) per patient. Between procedures, delta age was 15 (12-19) months, height 7 (6-11) cm and weight 4 (2-6) kg. All leads were successfully advanced without any procedural complications. Procedure time (skin to skin) was 91 (69-105) minutes, fluoroscopy was 0.4 (0.2-1.2) mGy, 13 (9-35) microGy/m2. Electrical lead parameters did not showed significant differences between consecutive control times. In one parahisian pacing, chronic threshold increased after 3 years (2 advancement procedures) from 0.7V to 2.6 V/0.4 ms.

Conclusion
the advancement of transvenous leads in children is a safe and effective procedure, without significant procedural complications and during follow-up, and with low fluoroscopy exposure. This procedure may maintain a good function of transvenous leads until growth has completed.
Pacemaker choice optimization based on expected pacing requirement
Authors: Breeman KTN , Dijkshoorn LA , Wilde AAM , Tjong FVY , Knops RE 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Bradyarrhythmias are adequately treated with pacemakers. Currently, different pacing modes (single- and dual-chamber, cardiac resynchronization therapy and physiologic pacing) and types (leadless, transvenous) are available. Expected pacing requirement is an important factor in determining optimal pacing mode and type.

Purpose
To evaluate atrial (AP) and ventricular pacing percentages (VP) over time, stratified by pacemaker indication.

Methods
All consecutive patients ≥18 years with a DDD(R) transvenous pacemaker and ≥1 year follow-up at a tertiary center between January 2008 and January 2020 were retrospectively included. Baseline characteristics and AP and VP at yearly follow-up visits were assessed.

Results
714 patients were included, of which 210 (29%) with incomplete AV block (AVB), 261 (37%) complete AVB, 243 (34%) sinus node disease (SND). Mean age at implant was 72±13, 68±16, 67±14 years (p=0.005). AP and VP over time is shown in Figure. For incomplete AVB, median AP increased from 3% (1-24%) to 21% (1-49%) and VP from 37% (7-93%) to 91% (16-100%); for complete AVB, median AP increased from 3% (1-17%) to 10% (2-30%) and VP remained stable (98% [13-100%] to 99% [62-100%]); for SND, median AP increased from 26% (5-63%) to 55% (8-90%) and VP remained stable (3% [1-13%] to 5% [1-31%]).

Conclusion
These results confirm the pathophysiology of different pacemaker indications, resulting in clear differences in pacing requirement over time and expected battery longevity. These results can be used to help guide optimal pacing mode and suitability for leadless or physiologic pacing.
Left ventricular septal pacing: how deep is enough?
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 Institution(s). Main funding source(s): Charles University Research Program

Background
When pacing in the left septal area, it is not clear where the pacing lead needs to be implanted to obtain the most physiological ventricular activation during pure myocardial pacing.

Objective
To use UHF-ECG to compare ventricular activation between myocardial pacing of the left septum with and without the possibility to capture the left bundle branch by high output pacing.

Methods
This was a retrospective study of patients with bradycardia and deep septal myocardial pacing close to LBB (paraLBBP) or deep septal pacing more distant from LBB (DSTP), which both produced a pseudo-right bundle branch morphology in V1. During paraLBBP, left bundle branch capture was feasible during increasing pacing output up to 5V at 0.5 ms, but during DSTP, LBB capture was not possible during high output pacing. Only patients with both paraLBBP and DSTP were analyzed. Paced QRS morphology, presence of LBBpotential, QRSduration, R wave peak time (RWPT) in V5, lead depth in the septum and UHF-ECG parameters of dyssynchrony, i.e., e-DYS as the difference between the first and last ventricular activation and local depolarization durations in precordial leads (V1-V8d) were compared between them.

Results
From 119 consecutive bradycardia patients enrolled, we identified 23 with both paraLBBP and DSTP during an implant procedure. On X-ray, a lead tip was placed shallower during DSTP than paraLBBP (12 ± 3 vs. 15 ± 3 mm, p &lt; 0.001). A pseudo right bundle branch block morphology was present in all cases, but LBB potential was more frequently present in paraLBBP (17 of 23) than in DSTP (4 of 36; p &lt; 0.0001). QRSd was not significantly different (146 ± 14 vs. 142 ± 14 ms, p = 0.08), but DSTP had longer V5RWPT (86 ± 11 vs. 83 ± 9 ms; p = 0.03). paraLBBP resulted in larger interventricular dyssynchrony, e-DYS (-20 ± 15 vs. -12 ± 18 ms; p = 0.046), the same V1-6d, but its local depolarization durations in V7 and V8 (V7 and V8d) were shorter compared to DSTP (-5 and -7 ms; p &lt; 0.05).

Conclusion
Interventricular dyssynchrony and LV lateral wall depolarization during myocardial pacing of the left septum are dependent on the relation of the leads´ tip to the LBB. Pacing positions closer to the LBB are responsible for bigger interventricular dyssynchrony and more physiological LV lateral wall depolarization.
Six year follow-up data on a leadless pacing system real life experience in comparison to data of the prospective trial
Authors: Winter S , Sinning J-M , Nguyen D-Q , Duquoc B , Scheffer A , Fischer S , Farahati K , Fehske W , Tuscher T 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The Micra™ leadless intracardiac pacing system has been introduced and implemented into clinical routine in 2015, with its next generation MICRA AV ™ in 2020. Feasibility, implantation safety, and acute success have been proven in the setting of controlled studies. Even apart from controlled studies, this new technology was beneficial for the individual patient. We aimed to report our single center follow-up (FU) data with a follow-up of up to six years.

Methods
In 246 patients (134 men; age: 79±8 y), Micra™ implantation was performed.
Pacemaker interrogation was performed one to seven days after implantation and during FU (1; 3; 6, then every 6 month) up to 72 months. Data were assessed in a real-life setting and compared with existing data of a controlled prospective trial.

Results
The implantation was successful in all 246 attempts with only one pericardial effusion as major complication. During follow up there were two patients developing severe heart failure symptoms resulting in an implantation of a CRT-device and switching of the leadless pacemaker system.
The average acute thresholds, sensing and impedance after system release were: 0.62±0.45V@0.24ms; 10,55±3,61mV and 697±178Ohm. During follow up of up to 5 years neither, pacemaker failure, nor infections were reported. Measurements were reevaluated for long-term thresholds, sensing and impedance: 0.44 ± 0.07V @ 0.24 ms; 17,25 ±4,65 mV and 572 ± 80 Ohm. During five years, no significant changes from acute to long-term measurements were detectable. In comparison to the controlled trial, our measurements of this real-life cohort were very similar.

Conclusion
In a real-life setting, the implantation of the leadless Micra™ system demonstrates a high rate of implantation success without major complications. We were also able to show stable long-term system parameters in the clinical setting of up to six years of follow up with a very good battery longevity of about 12 years.
In-silico optimisation of ICD defibrillation efficacy by modifying lead/can configurations using a cohort of high-resolution whole-torso heart models
Authors: Qian S , Monaci S , Mendonca-Costa C , Campos F , Gemmell P , Zaidi S , Rajani R , Whitaker J , Rinaldi C , Bishop M 
Published: May 2022

Abstract

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

Background
ICD is an effective direct therapy against VT/VF by applying a strong electrical shock across the heart between the shocking coil and can. Conventionally, patients will have a shocking coil inside the right ventricle (RV) and a can at the upper left chest. However, due to infections or other conditions, the can may need to place towards the right chest. The placement of the RV coil may also vary in different cases, for example avoiding scar. However, it is unclear how defibrillation efficacy may be altered by these unavoidable modifications to conventional lead/can configurations and whether optimisation may be possible.

Purpose
To compare defibrillation efficacy of modifications of ICD configurations in a cohort of whole-torso models.

Methods
A cohort of 15 whole torso models was generated from high resolution CT data and contrast CT cardiac scans, including 5 dilated cardiomyopathy (DCM), 5 hypertrophic cardiomyopathy (HCM) and 5 structurally normal patients (Fig A). Transvenous ICDs were represented by a shocking coil inside the RV (near apex) and a (ground) can at the upper left chest as default settings. Configurations were then varied by moving the can to the right chest, moving the RV coil up the mid-septum or adding extra grounds (Superior Vena Cava (SVC) coil, coronary sinus (CS) coil (Fig A)). Defibrillation-strength shocks were applied to all models (Fig B). DFTs and mean electrical field were evaluated across the whole heart as well as specific LV, RV, RV insertion regions, along with overall impedance.

Results
Shifting the can from left to right significantly increased DFT for the whole heart (23 J vs 15 J, P=0.03) and LV (25 J vs 17 J, P=0.03) (Fig C) and reduced the mean electrical field. Moving the RV coil further up the septum did not significantly alter DFT (Fig D), but did reduce mean electrical field for all regions and reduce impedance significantly. Additional separate coils significantly reduced DFT for all regions (Fig D) by increasing mean electrical field, whilst adding both coils significantly reduced DFT the most (whole heart: 15 J vs 6 J, P=0.03) (Fig E). Impedance was increased significantly by adding SVC coil, but reduced significantly by adding CS coil. Adding both coils increased impedance slightly.

Conclusions
Although a right-sided can increases DFT by over 50%, additional leads (grounds) may mitigate this increase by increasing mean electrical field. Moving the RV coil closer to the mid-septum reduces DFT slightly, but also reduces mean electrical field and impedance significantly.
Ventricular arrhythmias and prognosis of patients after explantation of an infected ICD compared to patients with newly diagnosed heart failure using the wearable cardioverter-defibrillator
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
The wearable cardioverter-defibrillator (WCD) is a tool for temporary protection from sudden cardiac death (SCD). It is used in patients with newly diagnosed heart failure with reduced ejection fraction (HFrEF) as well as in patients with a preexisting ICD indication who need explantation of the device. There is no data on long-term prognosis after the WCD in this latter group of patients.

Methods
All patients receiving the WCD at a Medical School between 2012 and 2017 were analyzed. Patients with newly diagnosed HFrEF from the PROLONG-II study were compared to patients receiving the WCD after an ICD explantation. Follow-up (FU) data were analyzed after 3 months and at last available FU including WCD data, clinical status, medication, echocardiography and ECG.

Results
353 patients (69% male) with newly diagnosed HFrEF from the PROLONG-II study were compared to 29 patients (86% male) having received a WCD after explantation of an ICD (45% with secondary preventive indication). Mean baseline LVEF was 25±8% and 34±13% respectively (p&lt;0.001). Follow-up was 2.8±1.5 and 3.2±1.8 years. WCD shocks occurred in 14 (4%) of the patients with newly diagnosed HFrEF and in 3 (10%) patients after ICD explantation (2 with a secondary preventive indication). During long-term FU, patients with an explanted ICD had a poorer prognosis compared to patients with newly diagnosed HFrEF (p=0.02), and appropriate WCD shocks were associated with even higher mortality in patients after ICD explantation (p=0.045).

Conclusion
Patients after ICD explantation have an increased risk of ventricular arrhythmias and WCD shocks, but also show an increased risk of all-cause mortality despite wearing the WCD compared to patients with newly diagnosed HFrEF.
Ventricular arrhythmias and implantable cardioverter-defibrillator therapy in women: a propensity score-matched analysis
Authors: Maglia G , Giammaria M , Zanotto G , D’onofrio A , Della Bella P , Marini M , Rovaris G , Iacopino S , Calvi V , Pisano’ EC , Caravati F , Balestri G , Giacopelli D , Gargaro A , Biffi M 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The implantable cardioverter-defibrillator (ICD) is an established therapy for the prevention of sudden cardiac death in selected patients. Although current guidelines apply to both women and men, there is a growing awareness that the incidence of cardiac arrhythmias and device interventions is influenced by sex.

Purpose
To investigate sex-specific risk of sustained ventricular arrhythmias (SVAs) and device therapies, using remote monitoring data from ICDs and cardiac resynchronization therapy defibrillators (CRT-Ds).

Methods
Study endpoints were time to the first appropriate SVA, time to the first appropriate device therapy for SVA, and time to the first ICD shock. Appropriateness of device-detected SVAs was adjudicated by three expert electrophysiologists. Results were compared between women and a 1:1 propensity score (PS)-matched subgroup of men.

Results
In a cohort of 2,532 patients with an ICD or CRT-D (median age, 70 years), 488 patients (19.3%) were women. As compared to men, women more frequently had a CRT-D (51% vs. 40%, p&lt;0.001), and nonischemic cardiomyopathy (65% vs. 45%, p&lt;0.001). After a median follow-up of 2.1 years, SVAs occurred in 123 women (25.2%) and in 174 of the 488 PS-matched men (35.6%) with an adjusted hazard ratio (HR) of 0.65 (95% confidence interval [CI], 0.51-0.81; p&lt;0.001). Women also showed a reduced risk of any device therapy (HR, 0.59; CI, 0.45-0.76; p&lt;0.001) and shocks (HR, 0.66; CI, 0.47-0.94, p=0.021). Differences in sex-specific SVA risk profile were not confirmed in CRT-D patients (HR, 0.78; CI, 0.55-1.09; p=0.14) and in those with an ejection fraction &lt;30% (HR, 0.80; CI, 0.52-1.23; p=0.31).

Conclusion
In our analysis of remote monitoring data, women exhibited a lower SVA risk profile than PS-matched men in the subgroup of patients with an ICD or/and ejection fraction ≥30%.