bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety of pulsed-field ablation in patients with cardiac implantable electronic devices. A single-center pilot study
Authors: Winkelmann SJ , Lemoine MD , Wuerger T , Schleberger R , Rottner L , Dinshaw L , Moser JM , Muenkler P , Nikorowitsch J , Reissmann B , Ouyang F , Toennis T , Kirchhof P , Metzner A , Rillig A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Pulsed-field ablation (PFA) is a novel energy source to perform pulmonary vein isolation (PVI) in patients with atrial fibrillation or cavo-tricuspid isthmus ablation (CTI) in patients with atrial flutter. Whether strong electrical fields generated by PFA could change the function and integrity of cardiac implantable electronic devices (CIED) is not known.

Aim
To assess the function and integrity of implanted devices before and after pulsed-field ablation.

Methods
This study included consecutive patients with CIED undergoing PFA at a large single center. Real-time CIED electrograms were recorded during PFA applications. CIED were interrogated before and after PFA assessing function (threshold, sensing), integrity (impedance), and arrhythmia episodes.

Results
We performed PFA in six patients (age 69±12 years, 1/6 female, left atrial diameter was 44±3 mm, left-ventricular ejection fraction 40±14%) for PVI in five patients with atrial fibrillation and CTI ablation in one patient with atrial flutter. All patients had CIEDs (one cardiac resynchronization device, two implantable cardioverter-defibrillators, three two-chamber pacemakers). Each patient undergoing PVI received 32 PFA applications of 2.5 s. (4x basket configuration and 4x flower configuration at each pulmonary vein), amounting to a total ablation time of 80 s and resulting in complete PVI in all five patients. For CTI ablation we applied 8 PFA applications of 2.5 s (20 s total ablation time) resulting in CTI blockade. Real-time intracardiac electrograms (iEGM) during PFA applications revealed sensing of single PFA application impulses in three patients and blanking of the iEGM in three patients. Postinterventional device testing revealed no changes in impedance, stimulation threshold or sensing. No leads were dislocated or damaged. No other device malfunctions occurred during the procedure, as well as no other major periprocedural complications occurred.

Conclusion
The function and integrity of pacemakers and defibrillators is not affected by PFA in our patient sample. Larger series are needed to confirm the apparent safety of PFA in patients with CIED.
Gastrointestinal bleeding preceding new-onset atrial fibrillation - results from the nationwide FinACAF study
Authors: Jolkkonen S , Aro A , Haukka J , Halminen O , Putaala J , Linna M , Mustonen P , Hartikainen J , Airaksinen J , Lehto M 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Helsinki and Uusimaa Hospital District Funding The Finnish Foundation of Cardiovascular Research

Introduction
Initiation of oral anticoagulation (OAC) in case of a new-onset atrial fibrillation (AF) requires assessment of bleeding history. Gastrointestinal (GI) bleedings are among the most common bleeding events.

Purpose
We aimed to assess clinical characteristics and initiation of OAC in patients with new-onset AF and a history of previous GI bleeding.

Methods
The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) study is a nationwide study among AF patients conducted as a retrospective register-based linkage study combining data from several Finnish health care registers. The study population consists of all patients diagnosed with AF between the years 2010-2018 and with laboratory data available. Patients were identified from nationwide primary care and reimbursement registries and hospitalization records. OAC purchases at 90 days from cohort entry were obtained from the National Prescription Register upheld by the Social Insurance Institution of Finland.

Results
134 242 patients from the initial FinACAF cohort were included in this substudy. Of these, 6543 (4.9%) patients had a history of GI bleeding. Those with GI bleeding were more often male (52.6%), older (mean age 76.6 ± 11.4 vs 72.4 ± 13.1 years), and had more comorbidities. They also had lower blood hemoglobin (mean 124.9 ± 21.3 vs 135.8 ± 18.4 g/l) and higher serum creatinine (mean 99.7 ± 75.8 vs 87.5 ± 52.7 µmol/l) levels than patiens without preceding GI bleeding. Furthermore, initiation of OAC medication was less frequent in the GI bleeding group (46.9% vs 58.6%).
Patient characteristics of the study population including age, sex, comorbidities, OAC medication and laboratory findings are shown in Figures 1 and 2.

Conclusions
Patients with AF and preceding GI bleeding are vulnerable to rebleeding events. This may affect decision-making of clinicians, leading to more infrequent initiation of OAC medications.
First clinical experience with cardiac magnetic resonance guided typical atrial flutter ablation with the integration of active catheter tracking and electro-anatomical mapping
Authors: Bijvoet GP , Nies HMJM , Holtackers RJ , Vernooy K , Wildberger JE , Linz D , Mihl C , Chaldoupi SM 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
In our university hospital, we previously implemented cardiac magnetic resonance (CMR) guided typical atrial flutter ablation in a pre-existing MRI suite which was transformed into an interventional cardiac MRI (iCMR) suite.

Purpose
To describe our first clinical experience with integration of active catheter tracking and dedicated electro-anatomical mapping (EAM) system for the treatment of typical atrial flutter in a transformed pre-existing MRI suite.

Methods
Between February 2021 and December 2021, all consecutive patients planned for CMR guided typical atrial flutter ablation were included in this analysis. The procedure was performed under general anaesthesia. Feasibility and safety of active catheter tracking and the integration with a dedicated EAM was evaluated. All patients provided written informed consent.

Results
In total, nine patients underwent CMR guided atrial flutter ablation. Procedural characteristics are presented in Table 1. In all patients, both active catheter tracking and the integration with EAM were performed successfully. Bidirectional cavo-tricuspid isthmus block was achieved in eight out of nine patients and confirmed by differential pacing using intracardiac electrograms and EAM. In one of these eight patients, the registration of intracardiac electrograms was not possible due to technical problems and the patient was transferred to a conventional electrophysiology lab to complete the ablation following our predefined bailout procedure. Seven out of nine patients were in sinus rhythm at the start of the procedure, one in nodal rhythm with atrial bigeminy, one patient required electrical cardioversion for atrial fibrillation prior to the procedure. No periprocedural complications occurred.

Conclusion
CMR guided typical atrial flutter ablation in a transformed pre-existing MRI suite using active catheter tracking and a dedicated EAM system is feasible and safe based on this small population. It allows for detailed visualisation of catheters and individual patients anatomy. Further studies in larger patient populations are required to evaluate whether iCMR is cost effective and can improve clinical outcome of typical atrial flutter ablation and other arrhythmias.
Procedural safety, short and long-term follow up after pacemaker implantation in nonagenarians
Authors: Meynet I , Tricomi L , Ferraro A , Maggio R , Mazza A , Ceci R , Minniti D , Varbella F 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Permanent cardiac stimulation is increasingly necessary in very old patients, due to the augmented life expectancy. This raise concerns in physicians, patients and caregivers, because pacemaker (PM) implantation can be perceived as too invasive for frail patients with significant comorbidities.

Purpose
The aim of the present study is to provide data about peri-operative complications, short and long-term survival and their predictors in this specific setting.

Materials and methods
All consecutive patients aged ≥90 years undergoing pacemaker implantation in our Centre from 2008 to 2020 were enrolled in the registry. Their baseline and follow up data were recorded in a specific database.

Results
Among the 2437 patients undergoing PM implantation in a 13-year period, 153 were nonagenarians (6.3%). Mean age was 92.7±2.3 years. Most of the patients (66.7%) received a ventricular single chamber PM. High-degree atrio-ventricular block was the first indication for implant (59.5%), followed by sick sinus syndrome or atrial fibrillation with slow ventricular response (30.1%). 15.7% patients needed temporary pacing at presentation. 4 patients (2.6%) experienced acute complications: 3 pneumothorax, 1 ventricular lead displacement with need of repositioning. Mean follow up duration was 2.5±2.0 years. 117 patients (78.5%) died during the follow up. Death occurred after a mean of 2.47 years after PM implantation (range 1-3272 days). Survival rates were 70.0%, 35.3% and 10.0% at 1, 3 and 5 years respectively. No pacemaker-related long-term complication was recorded during the follow up. 2 patients underwent generator replacement due to battery end of life. Chronic kidney insufficiency (p = 0.030) and congestive heart failure (p = 0.021) but not age were predictors of precocious mortality (within 1 month). Age at implant and longer length of hospital stay before PM implantation were predictors of long-term death (p = 0.001 and p = 0.043 respectively).

Conclusions
Extremely old age should not discourage PM implantation, when indicated; age is obviously predictor of long-term death but is not predictor of precocious mortality. Acute periprocedural complication rate is low and generally comparable to that of younger populations.
Recurrences after stereotactic arrhythmia radioablation for refractory ventricular tachycardia
Authors: Herrera Siklody C , Schiappacasse L , Jumeau R , Le Bloa M , Ozsahin M , Teres Castillo C , Moeckli R , Porretta AP , Pascale P , Domenichini G , Bourhis J , Pruvot E 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Stereotactic arrhythmia radioablation (STAR) has been recently introduced for the management of ventricular tachycardia (VT) refractory to antiarrhythmic drugs and catheter ablation (CA). VT recurrences have been reported after STAR but the mechanisms remain poorly known. We analyzed recurrences in our patients (pts) after STAR for refractory VT.

Methods
From 09.2017 to 01.2020, 12 pts (66±8y, LVEF 40±14%) suffering from refractory VT were enrolled. The underlying cardiopathy was ischemic in 3, inflammatory in 3 and idiopathic in 6 pts. Nine out of 12 pts had a history of at least 1 electrical storm. Before STAR, an invasive electro-anatomical mapping of the VT substrate (VT-sub) was performed. A mean dose of 22±2Gy was delivered to the VT-sub using the Cyberknife system.

Results
The ablation volume was 24±7cc and involved the basal interventricular septum (IVS) in 10 pts. During the first 6 months after STAR, VT burden decreased by 95% (mean value, from 930 to 46 VT/semester). After a median follow-up of 14±10 months, 10/12 (83%) developed a recurrence as a sustained VT and underwent a redo CA. VT recurrence was located at the border zone (BZ) of the treated VT-sub in 6 cases, involved both the BZ and a larger substrate in 2 cases, and occurred remote from the VT-sub in 2 cases (see Table). The dose delivered at sites of VT recurrence was 9.9±8.6 Gy with a large heterogeneity ranging from 0.11 to 28.37 Gy, for some patients due to dose constraints near critical structures. Importantly no pts developed an AV block after STAR.

Conclusion
STAR appears to be an efficient tool for the management of IVS refractory VT, leading to a strong VT burden reduction and no AV block. Recurrences were nevertheless common, often at the border zone of the irradiated volume.
Determinants of mortality after stereotactic radio-ablation for ventricular tachycardia. Results from the international MUSIC consortium
Authors: Cochet H , Maury P , Whitaker J , Woods C , Gandjbakhch E , Bredfeldt J , Mak R , Sauer W , Juhoor M , Sermesant M , Sacher F , Bogun F , Zei P , Jais P , Tedrow U 
Published: May 2022

Abstract

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

Background
SBRT is currently restrained to the most severe patients with drug- and catheter ablation-refractory VT, often associated with advanced heart failure.

Purpose
To analyze the determinants of mortality after SBRT for VT.

Methods
Patients with drug- and catheter ablation-refractory VT underwent imaging prior to SBRT. The inHEART technology was used to create image-based 3D models of substrate, cardiac anatomy, and organs at risk (coronaries, phrenic nerve, GI tract, AV node). In MUSIC software (IHU Liryc-Inria), 3D models were fused with prior EP maps, and SBRT targets were interactively drawn in 3D by the referring EP cardiologist. Transmural target volumes and organs at risk were fused with a 4D planning CT and used to plan SBRT in Eclipse (Varian). SBRT was delivered with either Truebeam or Edge systems (Varian), at a total dose of 25 Gy in a single session. The determinants of adverse outcomes after SBRT were analyzed.

Results
30 pts from 7 centers were included (age 70±10, 90% men). Mean LVEF was 26±9%. The VT etiology was ischemic in 67%, and non-ischemic or mixed in 47%. Patients had undergone a mean of 1.7±1.2 prior failed catheter ablation procedures. SBRT was delivered on median planning treatment volumes (PTVs) of 96[63-149] mL. Complications attributed to SBRT were observed in 2/30 (7%), none of which were fatal (heart failure and pneumonitis, both managed with steroids). Over a median FU of 4[2-8] months, death or heart transplant occurred in 11(37%) pts, attributed to VT recurrence in 4(13%), and heart failure in 7(23%). On univariate analysis, patients experiencing death or transplant after SBRT were older (77±6 vs. 66±9 years, P=0.001) and showed lower LVEF (22±6 vs. 29±10%, P=0.03). In contrast, mortality or transplant did not relate to the underlying VT etiology (P=0.30), the number of prior catheter ablations (P=0.20), the pre-SBRT VT burden (P=0.20) and the SBRT treatment volume (P=0.18).

Conclusion
In patients with severe drug- and catheter ablation-refractory VT undergoing cardiac SBRT, mortality is most often due to non-arrhythmic causes, and is more driven by age and LV dysfunction than by the VT substrate, pre-SBRT arrhythmia burden, and SBRT treatment volume.
Implantable cardioverter defibrillator in arrhythmogenic cardiomyopathy: which role for antitachycardia pacing?
Authors: Spadotto A , Toniolo S , Bartoli L , Statuto G , Angeletti A , Massaro G , Martignani C , Ziacchi M , Diemberger I , Galie N , Biffi M 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Arrhythmogenic Cardiomyopathy (ACM) is an inherited cardiomyopathy characterized by ventricular arrhythmias and sudden cardiac death. Implantable cardioverter defibrillator (ICD) remains the only proven therapy to reduce mortality in ACM.

Purpose
The objective of this study was to identify characteristics of ventricular arrhythmias and treatment in patients with ACM.

Method
Retrospective analysis of the data of consecutives patients with confirmed diagnosis of ACM based on the proposed Padua Criteria, who underwent implantation of transvenous ICD from January 1992 and October 2021. The clinical data and information about appropriate and inappropriate ICD therapies were obtained from medical records with the review of the available intra-cardiac electrograms (EGMs).

Results
We enrolled 52 patients (69% males, mean age at implant 48.9 ±14.8 years), 27 (52%) were implanted for primary prevention, 25 (48%) for secondary prevention. After a median follow-up of 7.52 years [IQR: 4.37 - 12.0], 32 patients (61.5%) had 914 sustained episodes of ventricular arrhythmias (VA). 25 patients (48%) had 309 episodes of life-threatening arrhythmias (LT-VA), defined as sustained ventricular tachycardia ≥200 beats/min. In 29/32 patients (91%) ATP treated at least one episode of VA and in 14/25 (56%) at least one episode of LT-VA. Ventricular tachycardia (VT) detection was programmed at least 20 seconds, while VF detection was at least 7 seconds. Among patients with appropriate ICD activation, the first treated episode was a LT-VA in 50% of cases. Out of 914 VA episodes, 735 (80.4%) were treated with ATP and 179 (19.6%) with shocks. Considering LT-VA (cycle length 248 ± 25 ms), 201/309 (65%) and 108/309 (35%) episodes were treated with ATP and shocks, respectively. In 13 patients (25%) there was an inappropriate ICD activation, mostly caused by atrial fibrillation, while in 8 patients (15%) there was a complication needing reintervention (in 3 cases there was a loss of ventricular sensing dictating lead revision).

Conclusions
ACM patients are at risk of VA and LT-VA. The majority of VA at follow-up are monomorphic at rate &lt;200 beats/minute, however the first treated VA episode is a LT-VA in half of cases. ATP is highly successful in terminating VT and even LT-VA, which questions the use of non-transvenous ICD in this young patient population. Nevertheless, transvenous ICDs are burdened by a relevant rate of lead complications which should be weighed in the choice of the ICD type.
Leadless pacemaker implantation in patients with a previous transvenous device
Authors: Jelisejevas J , Regoli F , Hofer D , Conte G , Saguner AM , Caputo ML , Grazioli L , Steffel J , Auricchio A , Breitenstein A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Leadless pacing has been established as an alternative approach to transvenous devices for selected patients suffering from bradycardias. While in the majority of cases leadless pacemaker implantation represents a de novo procedure, in an increasing number of patients such a device is used after a previously implanted transvenous pacemaker.

Purpose
Retrospective analysis of the efficacy and safety outcome in patients who underwent leadless pacemaker implantation in the context of a previously implanted conventional pacemaker.

Methods and Results
In this retrospective analysis from two large Swiss implantation centres, 257 consecutive patients undergoing leadless pacemaker implantation were included. Of the total cohort, 233 patients were diagnosed with new-onset bradycardias, while in 24 patients a prior transvenous device was present. Out of these 24 patients, 20 subjects required lead extraction of the previous system due to infection (70%, 14 patients), malfunction or other reasons (Table 1). In 3 patients with device-related infection, lead extraction and leadless pacemaker implantation were performed as a single procedure, while in the remaining 11 cases a time window between the two procedures was present (median of 11.5 days with a range of 2 to 186 days). In the population with a previous device, mean age at implantation was 81 ± 9 years which did not differ compared to the de novo cohort. Mean implantation duration was 57 ± 31 minutes in the cohort with a previous device versus 48 ± 191 minutes in the de novo population without a significant difference (P=NS) and with a successful implantation rate of 100% versus 98.7% in the de novo population (P=NS). Electrical device parameters (sensing, impedance, threshold) at implantation and during follow-up (mean 12.5 ± 9.3 months) were similar between the two groups. Eight major periprocedural complications (3.1%) were encountered (4 pericardial effusions, 3 femoral bleedings and 1 intra-abdominal bleeding) in the entire cohort within a 30 days period, of which the majority occurred in the de novo cohort (75 %, 6 of 8). A total of 4 pericardial effusions occurred, which could be managed without the need for cardiac surgery. The were no reinfections registered after leadless pacemaker implantation during follow-up.

Conclusions
Implantation of a leadless pacemaker in patients with a prior conventional system (with or without extraction of the previous device) was effective and safe in our population of patients.
Leadless pacemaker implantation after transcatheter aortic valve replacement
Authors: Jelisejevas J , Regoli F , Hofer D , Conte G , Saguner AM , Caputo ML , Grazioli L , Steffel J , Auricchio A , Breitenstein A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Impairment of the conduction system may occur in 9-30 % of patients undergoing transcatheter aortic valve replacement (TAVR). Since this is typically an elderly and frail patient population, leadless pacing potentially offers benefits over conventional transvenous pacemaker devices. However, available efficacy and safety outcome data of leadless pacing in a population who underwent a TAVR procedure is still limited.

Purpose
Retrospective analysis of efficacy and safety outcome data in patients who underwent leadless pacemaker implantation after TAVR due to relevant bradycardias.

Methods and Results
In this retrospective analysis from two large Swiss implantation centres, 257 consecutive patients undergoing leadless pacemaker were included. Of the total cohort, 26 subjects had a previous TAVR complicated by early (within 30 days)- or late-onset (after 30 days) bradycardias (Table 1). The TAVR group did not differ compared to the non-TAVR with regard to age, gender and left-ventricular ejection fraction (LVEF). Median duration between valve intervention and leadless pacemaker implantation was 8 days (range 0 to 368 days). After a TAVR procedure, left femoral access was chosen in 30.8% (8 of 26 of cases) for the leadless pacemaker implantation as compared to 5.2% (12 of 231 of the cases) in the remaining population (P &lt; 0.01). Mean implantation duration was 56 ± 22 min in the TAVR group compared to 48 ± 20 min (P = NS) and a successful implantation rate of 100.0 % in the TAVR group vs 98.7% in the remaining population (P = NS). There were no significant differences in pacing parameters (sensing, impedance and threshold, respectively) between the two groups. A total of eight major periprocedural complications (3.1%) were encountered in the entire cohort within 30 days, of which one (pericardial effusion) occurred in the TAVR population (P = 0.04), which was managed conservatively with pericardiocentesis.

Conclusions
Leadless pacemaker implantation appears to be safe and effective in patients after TAVR in need of antibradycardia pacing.