bluuebunny/crossref_metadata_2025_split huggingface dataset:
AV synchronous pacing in patients implanted with leadless pacemakers: a real-world cohort study
Authors: Briongos Figuero S , Estevez Paniagua A , Sanchez Hernandez A , Gomez E , Jimenez S , Vaqueriza Cubillo D , Cortes Beringola A , Munoz-Aguilera R 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Backgroung
Leadless pacemakers (LPM) were developed to overcome complications related to endovenous devices. Devices carrying an accelerometer-based atrial sensing algorithm provided good AV synchrony in a 5-hours study.

Methods
Prospective study of patients implanted with LPM capable of AV synchronous pacing at our institution. We performed a close follow-up consisting of device check-ups 24 h after the implant and 1-3-6-12 months later. Changes in programming were guided by device counters and rate histograms. Once AV synchrony derived from counters (AM-VP + AM-VS) remained stable for at least two consecutive months, a 24 hours Holter monitoring was performed. ECG recordings were automatically and blindly analyzed with a delineation system based on the wavelet transform developed by Martinez et al.1 Cardiac cycles were defined as synchronous if a ventricular event followed the P-wave by ≤300 ms. AV synchrony was calculated by dividing the number of synchronous cycles by the total number of cardiac cycles.
Our aim was to describe AV synchrony in a real-world setting and to determine which echocardiographic and programming parameters were related to optimal AV synchrony (≥85% of total cardiac cycles).

Results
A total of 18 patients (12 males, mean age 82.6 ±8.1) were included. Indications for pacing were complete AV block (n=10) and second-degree AV block (n=8). Device reprogramming was needed in all patients at follow-up. The 24 h Holter monitoring was performed 118.8±43.8 days after the implant. Implant data and, device settings and programming at Holter date is displayed in Table 1. One patient was excluded from the analysis due to the development of severe sinus node disease. Total ECG recorded time was 386.8 hours and 1,537,995 cardiac cycles were analyzed.
Median AV synchrony, after Holter monitoring analysis, was 88.2% (interquartile range 79.9-95,1%) and 12 out of 17 patients showed an AV synchrony ≥85% of cardiac cycles. Optimal AV synchrony was related to smaller right atrium size (13.2±3.4 cm2 vs 15.6±1.2 cm2 for AV synchrony ≥85 and &lt;85%, respectively) but no association appeared between diastolic parameters (E, A, E/A ratio, E´, A´) and AV synchrony. Rate smoothing algorithm was associated with higher rates of optimal AV synchrony (81.8% of patients with algorithm OFF vs 50% of patients activated). Besides, higher A3 threshold (7.1±3.5 m/s2 vs 4.2 ± 1.1 m/s2) and longer A3 window (620.8±25.7 ms vs 600 ms for AV synchrony ≥85% and &lt;85%, respectively) were also linked to optimal AV synchrony. Multivariate analysis did not show any independent predictor of AV synchrony.

Conclusions
In our cohort of LPM patients we obtained high percentages of AV synchronous pacing in a real-life setting. Device reprogramming was often needed, and larger studies are desirable to confirm our data.
Safety of leadless pacemaker implantation in very eldery patients in a one-center study
Authors: Martinez-Sande JL , Gonzalez-Melchor L , Garcia-Seara J , Rodriguez-Manero M , Fernandez-Lopez XA , Minguito C , Gonzalez-Ferrero T , Gonzalez-Juanatey JR 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Leadless pacemakers (LPM) have demonstrated safety in patients with multiple commorbidities. Very elderly patients have multiple commorbidities and are more prone to develop complications in pacemaker implants.

Purpose
We present our experience with LPM in a subgroup of very elderly patients.

Methods
We present a prospective clinical trial that including all consecutive LPM implantation from June 1 2015 to December 25 2021. We divide the patients in two groups according to age: older or younger than 85 y/o. Clinical and electrical, characteristics, as well as related complications and electrical parameters were compared between the two groups according to age.

Results
A total of 300 LPM were implanted and divided in two groups: 231 patients of less than 85 y/o and 69 patients ≥85 y/o. Clinical and electrical characteristics were described in table 1. Mean follow-up was of 36 months. There were 7 complications, all during the implantation procedure and there were no significant differences in complications between both groups . Electrical performance had no differences between the patients and was stable at long-term follow-up. (Figure 2)

Conclusions
There were no significant differences in complications or electrical performance between both groups and LPM were safe at long-term follow-up in very elderly patients with multiple commorbidities.
Early experience with the second generation of leadless pacemakers and correlation with ecg parameters
Authors: Breitenstein A , Perucchini F , Gasperetti A , Hofer D , Schiavone M , Forleo GB , Algibbawi M , El-Chami MF , Steinwender C 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Leadless pacing has evolved as a safe and effective treatment option in selected patients. With the updated generation that allows sensing of atrial contraction, atrioventricular synchronized pacing is now possible in a VDD mode. Previous retrospective analyses have demonstrated that echocardiographic parameters may be helpful in selecting patients with a higher chance of good atrioventricular synchronous pacing behaviour.

Purpose
Analysis of the early experience with the second generation of leadless pacemaker and the role of ECG parameters to predict a good atrial contraction signal (so-called A4 amplitude) in patients who underwent leadless pacemaker implantation in four tertiary centres.

Methods and Results
In this retrospective analysis, a total of 136 patients were included. Mean age was 78.0 (64.7 - 84.2 years) years with 48.9 % being male. Coronary artery disease was the leading underlying heart disease with 27.1 % affected patients. 61.7 % of the population suffered from sinus rhythm with complete or intermittent atrioventricular block. The majority of devices were implanted at the mid-septal (61.2 %) or high-septal (25.6 %) right ventricle, respectively. Electrical parameters were optimal at implant (Table 1) and remained stable over time (Table 1). In addition, A4 signal amplitude remained stable too during follow-up compared to the value early after implantation (Table 1). From this entire cohort, patients with an ECG available at implant and those in which the device was working predominantly in the VDD mode were selected for further analyses (62 patients). PR interval measured from the ECG prior to implantation did not correlate with the A4 signal amplitude (Figure 1A; P = NS). Next, P wave amplitudes were measured in all 12 ECG leads. There was a correlation between P wave amplitude from lead V2 with the A4 amplitude (Figure 1B; P = 0.034, R2 = 0.09), whereas the other right-sided ECG leads (V1/aVR), either alone or in combination, did not correlate with the A4 signal amplitude (P = NS).

Conclusions
In our cohort of patients with the second generation of leadless pacemakers, offering VDD pacing, good electrical parameters can be achieved as it has been observed with the first generation. Also the A4 signal amplitude as a marker for atrial contraction remains stable over time. In regard to ECG parameters measured prior to device implantation, only the P wave amplitude in lead V2 correlated with a amplitude of the A4 signal.
Predictors of heart failure events detected by a multisensor implantable defibrillator algorithm
Authors: Santobuono V , Tavoletta V , Manzo M , Calo’ L , Bertini M , Santini L , Savarese G , Dello Russo A , Viscusi M , Lavalle C , Amellone C , La Greca C , Valsecchi S , Favale S 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiovascular and non-cardiovascular comorbidities are common in heart failure (HF) patients and determine disease severity and prognosis. Select modern implantable defibrillators (ICDs) are equipped with multisensor algorithms for HF monitoring. The HeartLogic index combines multiple ICD-based sensor data (heart rate, heart sounds, thoracic impedance, respiration, activity), and the associated alert has proved to be a sensitive and timely predictor of impending HF decompensation in cardiac resynchronization therapy (CRT) patients.

Purpose
This analysis aims to investigate the performance of the algorithm in non-CRT patients, as well as in relation to the presence of comorbidities.

Methods
The HeartLogic feature was activated in 568 ICD patients (410 with CRT) from 26 centers. The median follow-up was 25 months [25th–75th percentile: 15-35].

Results
We recorded 1200 HeartLogic alerts (0.71 alerts per patient-year) in 370 patients. Among patient characteristics, atrial fibrillation (AF) at implantation (HR: 1.62, 95%CI: 1.27-2.07, p&lt;0.001) and chronic kidney disease (CKD) (HR: 1.53, 95%CI: 1.21-1.93, p&lt;0.001) independently predicted alerts. HeartLogic alerts were not associated with CRT vs. non-CRT device implantation (HR: 1.03, 95%CI: 0.82-1.30, p=0.775). Comparing the combined index and all physiologic parameters during clinically stable periods we did not notice differences between CRT and non-CRT patients. Thoracic impedance was significantly lower in CKD than non-CKD patients. (46±11ohm versus 49±10ohm; p=0.047). We found a higher S3 amplitude (0.9±0.3mG versus 0.8±0.2mG; p=0.005) and nocturnal heart rate (72±9bpm versus 66±7bpm; p&lt;0.001), and lower S1 amplitude (2.0±0.8mG versus 2.4±0.9mG; p&lt;0.001) in AF patients vs non-AF. These differences persisted at the time of alerts (all p&lt;0.05). In the overall population, and in patients stratified by device type, CKD and AF, we measured significant changes of all contributing sensors (paired t-test; p&lt;0.05) from clinically stable periods to the time of alert.

Conclusions
The burden of HeartLogic alerts appears similar between CRT and non-CRT patients, while patients with AF and CKD seem more exposed to alerts. ICD-measured thoracic impedance is sensitive to the fluid overload that characterizes kidney disease, as well as the first and third heart sound amplitudes seem sensitive to the reduced ventricular efficiency during AF. Nonetheless, ICD sensors seem to equally contribute to the HeartLogic alerts in all patient subgroups.
Incidence of premature battery depletion in subcutaneous cardioverter-defibrillator patients. Insights from a multicenter registry
Authors: Luker J , Strik M , Raymond-Paquin A , Elrefai MH , Cano Perez O , Franqui-Rivera H , Pott A , Veltmann C , Schmitt J , Collinson J , Van Stipdonk AMW , Fluschnik N , Haeberiln A , Andrade J , Steven D 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
A subset of more than 35,000 S-ICD is under FDA advisory, warning of the potential of premature battery depletion (PBD), caused by a faulty low-voltage capacitor. Based on internal data, the manufacturer projects the incidence at 3.7% after 5 years. Data independent from the manufacturer is sparse.

Methods
This study was a multicenter effort of 14 centers in Europe, the US, and Canada. Consecutive patients who received a S-ICD at the participating centers were included in this retrospective analysis. Patients with the 1010 S-ICD generator model, and those without available follow-up information were excluded. Data was collected and managed using REDCap electronic data capture tools hosted at the University Hospital Cologne.
The primary endpoint in this registry was device explantation, generator replacement, or generator failure. Reasons for explantation, replacement, or failure were collected. Device longevity was defined in months. It was calculated as the time from device insertion to the time of replacement, or explantation, or failure, where applicable. Premature battery depletion was defined as the occurrence of battery depletion requiring generator replacement after 60 months or less.
The study complies with the Declaration of Helsinki. Ethics committee approval was obtained. This study is registered with Clinicaltrials.gov.

Results
Data of n=1,102 S-ICD devices was analyzed. The registry comprised of S-ICD generators implanted between 03/2015 and 09/2021 (43.4% A209 model and 56.6% A219 model). Of these, 611 devices (55.4%) were identified by the Boston Scientific serial number lookup tool as affected by the advisory. The mean and median follow-up duration was 2.43±1.66 and 2.29 years, respectively.
During follow-up, 110 devices (10%) were explanted after 2.9±1.7 years. Battery depletion was the indication in 52. The endpoint of PBD (battery depletion after less than 5 years) was met in 37 devices (6% of the devices under advisory), after 4.1±0.6 years.
In 58 cases, the S-ICD was explanted for reasons other than battery depletion.
Infection (16), system upgrade (20), heart transplant or LVAD therapy (7), and inappropriate shocks or inappropriate sensing (7) were the most common indications.

Discussion
This registry provides a systematic and manufacturer independent analysis of premature battery depletion in S-ICD patients. In the affected devices, the incidence of premature battery occurred in 6%. This is higher than what is projected by the manufacturer. The rate of PBD increases notably around the 4-year mark.

Conclusion
S-ICD generators under advisory suffer from PBD at a higher incidence than previously reported. Patients equipped with these devices should be closely monitored.
Septal flash correction with His-Purkinje pacing predicts echocardiographic response in resynchronization therapy
Authors: Pujol-Lopez M , Jimenez-Arjona R , Guasch E , Doltra A , Borras R , Roca-Luque I , Castel MA , Garre P , Ferro E , Niebla M , Carro E , Arbelo E , Sitges M , Tolosana JM , Mont L 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Grant of the Catalan Society of Cardiology, 2019; Research Grant Josep Font 2019, Hospital Clínic de Barcelona
His-Purkinje conduction system pacing (HPCSP) has been proposed as an alternative to cardiac resynchronization therapy (CRT); however, no predictors of echocardiographic response have been described. Septal flash (SF) is a marker of intraventricular dyssynchrony.

Methods
The study aimed to analyze whether HPCSP corrects SF in patients with CRT indication, and if correction of SF predicts echocardiographic response. Prospective observational study (n=30). Left ventricular ejection fraction (LVEF) was measured with echocardiography at baseline and at 6-month follow-up. Echocardiographic response was defined as increase in 5 points LVEF. ECG Imaging was performed in 2 patients to validate ventricular activation shortening and to study the basal and HPCSP activation pattern.

Results
HPCSP shortened QRS duration by 48±21ms and SF was significantly decreased (baseline 3.6±2.2mm vs HPCSP 1.5±1.5mm p&lt;0.0001) (Fig.1). At 6-months, mean LVEF improvement was 8.6% ± 8.7% and 64% of patients were responders. There was a significant correlation between SF correction and increased LVEF (r=0.61, p=0.004). A correction of &gt;1.5mm had 81% sensitivity and 80% specificity to predict echocardiographic response (area under curve 0.86, p=0.019).

Conclusion
HPCSP improves intraventricular dyssynchrony and results in 64% echocardiographic responders at 6-month follow-up. Dyssynchrony improvement with SF correction may predict echocardiographic response at 6-month follow-up (Fig.2.).
Apical versus septal pacing - can we chose the localization of ventricular lead in order to prevent upgrade to cardiac resynchronization therapy?
Authors: Silverio Antonio P , Couto Pereira S , Brito J , Valente Silva B , Alves Da Silva P , Garcia B , Simoes Oliveira C , Nunes-Ferreira A , Magalhaes A , Bernardes A , Lima Da Silva G , Carpinteiro L , J Pinto F , Marques P , De Sousa J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Right ventricular apical pacing (RVAp) may be deleterious to ventricular function and hemodynamics due to pacing induced dyssynchrony. In the last decades, some studies showed that RVAp has been associated with heart failure, deterioration of left ventricular function and high mortality. Some patients (pts) may need, during the follow up (FUP), an upgrade to cardiac resynchronizaon therapy (CRT). New techniques have emerged such as RV lead implantation in the high septum or outflow RV tract (RVOT) and, more recently, His bundle/LB pacing.

Purpose
To compare the need for upgrade to CRT in patients with RVAp versus septal/RVOT pacing.

Methods
Retrospective single-center study of consecutive pts that implanted pacemakers in a tertiary center between January 1995 and December 2020. We collected data regarding pacing indication, RV pacing site (apex versus septum/RVOT) and need for an upgrade to CRT during follow up (FUP).
Our primary endpoint was upgrade to CRT during the FU period. In the model, the impact of localization of the implanted lead on the survival free from upgrade was estimated assuming a neutral effect on mortality. Statistical analysis was performed using T-student test and logistic regression.

Results
We included 8761 pts, 60.2% (n=5275) were male, with a mean age of 76.5±10.7 years. The main indications for pacemaker implantation were (1) complete atrioventricular (AV) block (2239, 25.6%), (2) sick sinus syndrome (2211, 25.2%), (3) atrial fibrillation with AV block or bradycardia with significant pauses (17.4%) and (4) Mobitz II 2nd degree AV block (1467, 16.7%).
RVAp was performed in 1746 (20%) patients and RVOT/septal pacing in 6933 patients (80%; RVOT in 657 (9,5%)). During FUP, 26 (1,5%) RVAp pts and 52 (0,8%) RVOT/septal pacing pts underwent upgrade to CRT, in a total of 78 pts (CRT-P in 54 patients and CRT-D in 24 patients).
We observed that patients with RVAp had twice the risk of CRT upgrade during FUP (OR: 2,0 (IC 95% 1,25-3,21), p=0,004) when compared to patients with RVOT/septal pacing.

Conclusions
Patients with RVAp presented a 2-fold higher risk for upgrade to CRT when compared to patients with RVOT/septal pacing in our center. This retrospective analysis shows that lead implantation in the septum/RVOT should be preferred instead of the apex to reduce pacing induced dyssynchrony and need for CRT upgrade.
Endocardial pacing results in better electrical resynchronization and hemodynamic improvement than epicardial pacing in CRT
Authors: Ghossein MA , Salden FCWM , Van Stipdonk AMW , Janssen B , Luermans JGLM , Westra S , Prinzen FW , Vernooy K 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The original study was financially supported by Medtronic (Minneapolis, Minnesota). The investigation of the current abstract is unrelated to the original financial support.

Background
Cardiac resynchronization therapy (CRT) is conventionally applied by means of a transvenous epicardial left ventricular (LV) lead. Studies suggest that endocardial LV pacing may result in better resynchronization and LV function than epicardial LV pacing.

Purpose
To investigate whether endocardial pacing results in better electrical resynchronization and hemodynamic improvement compared to epicardial pacing.

Methods
Patients with an indication for CRT were prospectively included from two hospitals. In all patients, LV pacing was performed endocardially and epicardially in the postero-lateral region. QRS area was calculated from vectorcardiograms that were synthesized from 12-lead ECGs. Acute hemodynamic improvement was assessed as the change in maximum rate of rise of LV-pressure (%ΔLVdP/dtmax). We assessed the effects of endocardial and epicardial LV pacing on the change in QRS area (∆QRS area) and LVdP/dtmax (%ΔLVdP/dtmax).

Results
A total of 16 patients (age 66 ± 11 years, 56% male, 31% ischemic cardiomyopathy, QRS duration 166±18ms, LBBB in 88%) were included. Endocardial pacing resulted in greater ∆QRS area than epicardial pacing (-51 ± 34 µVs vs. -24 ± 37 µVs, p = 0.021, Panel A). In addition, endocardial pacing led to a larger %ΔLVdP/dtmax as compared to epicardial pacing (21 ± 12% vs. 18 ± 9%, p = 0.025, Panel B).

Conclusion
Compared to conventional epicardial LV pacing in CRT, endocardial LV pacing results in better electrical resynchronization and acute hemodynamic improvement.
Impact of the electrocardiographic pattern in V1, aVL and I following cardiac resynchronization therapy at 2 years
Authors: Asensio Nogueira J , Salgado Aranda R , Garcia Fernandez FJ , Martin Gonzalez FJ , Villagraz Tecedor L , Sanchez Corral E , Fernandez Gonzalez B , Gomez Llorente M , Alvarez Calderon M , Abella Vallina D , Aguilar Iglesias L , Hernando Gonzalez R , Margalejo Franco A , Perez Rivera JA 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
There is little evidence regarding if the electrocardiographic pattern following CRT has impact on morbidity and mortality. In a previous study, a specific group of patterns in three leads of the ECG (Rs in V1, Qr in aVL or rS in I) was associated with lower incidence of the composite endpoint of death from any cause and heart failure hospitalization at 1 year.

Purpose
In this historical cohort study we analyzed if the specific pattern (Rs in V1, Qr in aVL or rS in I) was associated with outcomes at 2 years follow up.

Methods
Patients with CRT devices were consecutively included from January 2012 to April 2019. The primary endpoint was a composite of death from any cause and heart failure hospitalization at 2 years. Secondary endpoints included the individual components of the primary endpoint at 2 years. Survival analysis was performed using Kaplan-Meier test, comparing survival graphics through Log-Rank test. For multivariate analysis, Cox regression was performed.

Results
We included 111 patients. Baseline characteristics are reported in Table 1. Presence of any of the three patterns was not significantly associated with the primary endpoint (p=0.182). Patients who presented any of these patterns had not a significantly lower incidence of death from any cause (p=0.303), but had a significantly lower incidence of HF hospitalization (4.7% vs. 17.6%, hazard ratio 0.207, 95% confidence interval 0.046-0.93, p=0.04). Previous atrial fibrillation was independently associated with a higher incidence of primary and secondary endpoints. QRS duration postimplantation was independently associated with incidence of the primary endpoint.

Conclusion
The presence of the patterns Rs in V1, Qr in aVL or rS in I is an independent predictor of reduced HF hospitalizations at 2 years in patients with CRT. Previous atrial fibrillation and QRS duration were also associated with outcomes.