bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical factors affecting survival in patients with D-transposition of the great arteries after atrial switch repair: a meta-analysis
Authors: Nartowicz S , Jakielska E , Cieplucha A , Ratajczak P , Grajek S N , Lesiak M , Trojnarska O 
Published: October 2022

Abstract

Background
Atrial switch repair (AtrSR) was the initial method of operation in patients with D-transposition of the great arteries (D-TGA) constituting the right ventricle as a systemic one. Currently, it has been replaced with arterial switch operation (ASO), but the cohort of adults after AtrSR is still large and requires strict cardiological management of late complications. For this reason, we aimed to evaluate potential long-term mortality risk factors in patients with D-TGA after AtrSR (either Mustard or Senning procedure)

Method
We searched MEDLINE database for suitable trials. We included 22 retrospective and prospective cohort studies of patients with D-TGA with at least 5 years mean/median follow-up time after Mustard or Senning procedure, with an end-point of non-sudden cardiac death (n-SCD) and sudden cardiac death (SCD) after at least 30 days after surgery.

Results
A total of 2912 patients were enrolled, of which 351 met the combined endpoint of n-SCD/SCD. The long-term mortality risk factors were: NYHA&gt;II/heart failure hospitalization (OR=7.25; p=0.0001), tricuspid valve regurgitation (OR=4.64; p=0.0005), Mustard procedure (OR=2.15; p=0.0008), complex D-TGA (OR=2.41; p=0.005), right ventricle dysfunction (OR=1.94; p=0.05). Supraventricular arrhythmia (SVT; OR=2.07; p=0.09) and pacemaker implantation (OR=2.37; p=0.29) did not affect long-term survival in this group of patients. In an additional analysis, SVT showed a statistically significant impact on SCD (OR=2.74; p=0.005) but not on n-SCD (OR=1.5; p=0.57).

Conclusions
This meta-analysis identified that at least moderate tricuspid valve regurgitation, NYHA class &gt; II/heart failure hospitalization, right ventricle dysfunction, complex D-TGA and Mustard procedure as risk factors of long-term mortality in patients after AtrSR.

Funding Acknowledgement
Type of funding sources: None.
Fibrosis inhibits ablation lesion formation in muscle tissue
Authors: Mayr M , Lewalter T , Keil A , Kaufmann Y , Tiemann K , Jilek C 
Published: October 2022

Abstract

Introduction
Myocardial fibrosis is a trigger for both atrial and ventricular arrhythmia. Ventricular fibrosis correlates with ventricular tachycardia, ventricular fibrillation, and sudden death. Besides medical therapy, radiofrequency (RF) ablation is an important therapeutical option to treat ventricular arrhythmia. Our study gains insights into effectivity of RF ablation depending on the degree of fibrosis.

Methods
Using a wet lab, we created with radiofrequency (RF) ablation lesions in parts of restructured beef with a defined, homogenous content of 0, 10, 20 and 50% fiber. We calculated the volume of ablation zones (called lesion volume below). Both common ablation modes low-power long-duration (LPLD: 30 W, 30 s) and high-power short-duration (HPSD: 70 W, 10 s) were tested. Lesion volumes of fibrotic beef were compared to lesion volumes of fibrotic-free beef using an ordinary ANOVA. The effect and interaction of fibrosis and ablation mode to the lesion volume was tested by a two-way ANOVA.

Results
Higher degrees of fibrosis create smaller lesion volumes (M = mean volume ablation zone): M (0%) = 322 mm3 (SD 187 mm3), M (10%) = 226 mm3 (SD 94.8), M (20%) = 217 mm3 (SD 103 mm3) and M (50%) = 186 mm3 (SD 92.7 mm2). Lesion volumes in fibrotic tissue differ significantly from lesion volumes in fibrotic-free tissue (F(3,124) = 6.94, p&lt;0.001). There is a significant difference in lesion volumes for all degrees of fibrosis compared to fibrosis-free tissue (MD = mean difference of ablation zone volumes between 0% fibrosis and 10, 20 and 50% fibrosis): MD (0, 10%) = 95.6 mm3 (95% confidence interval (20.8–170), p=0.008), MD (0, 20%) = 105 mm3 (95% confidence interval (30.4–180), p=0.003) and MD (0, 50%) = 135 mm3 (95% confidence interval (60.7–210), p&lt;0.001). We also found a significant difference in lesion volumes related to the content of fiber in a comparison of all groups (F(3,120) = 7,49, p≪0.001). There is no significant difference in lesion volumes related to the used ablation mode (F(1,120) = 2.89, p=0.09). There is also no significant difference in lesion volumes related to the interaction between the content of fiber and the ablation mode (F(3,120) = 1.23, p=0.3).

Conclusion
Lesions created by RF ablation are influenced by fibrosis. A higher content of fibrosis is associated with smaller lesion volumes. Neither LPLD nor HPSD ablation mode shows an advantage in fibrotic tissue.

Funding Acknowledgement
Type of funding sources: None.
Comparison of septal vs hisian ventricular synchrony in paediatric patients
Authors: Chavez Gutierrez C , Pasarin Tapia M M , Pacheco Lopez S L , Mariona Montero V A 
Published: October 2022

Abstract

Background
Long-term right ventricular stimulation is associated with left ventricular dysfunction and cardiomyopathy, particularly in pediatrics and congenital heart diseases. Research has shown that pacemaker-induced cardiomyopathy can be reversed with stimulation of the Bundle of His in-adult's, however the available information on it's use in pediatrics is scarce. In this study, pacemaker carriers were analyzed over a period of 26 months to set up a protocol for improving the quality of life of patients undergoing this type of procedure.

Introduction
Cardiac stimulation initially arose with the aim of correcting the hemodynamic instability caused by the low cardiac output resulting from complete atrioventricular block, the next objective sought was to obtain atrioventricular synchrony and with it a more physiological functioning. Stimulation in the Bundle of His and the hisian zone induces a physiologically normal sequence of activation and thus prevents damage associated with the asynchronous pattern.

Material and methods
We reviewed 21 pediatric patients with pacemakers of stimulation in the Bundle of His and right septal stimulation that had echocardiographic assessment of ventricular function, as well as the assessment of ventricular synchrony. The study period included was from June 2019 to August 2021.

Results
The total number of patients was 21 of whom 52.4% (11) were carriers of Hisiana stimulation pacemakers, 47.6% (10) with septal pacemakers. Ventricular function was correlated between both groups without obtaining significant relevance. We obtained significant relevance in the evaluation of atrioventricular asynchrony obtaining a P&lt;0.05 (P=0.01), as well as intraventricular synchrony with a P&lt;0. 05 (p=0. 07).

Conclusions
The site of ventricular stimulation is the major determinant of the presentation or deterioration of asynchrony and ventricular function in the pediatric population. With this study we can conclude that the pacemakers of hisian stimulation are the ones that are closest to cardiac physiological activation and maintain ventricular and intraventricular atrio synchrony for a better ventricular function.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Instituto Mexicano del Seguro Social- Centro Medico Nacional de Occidente - UMAE Pediatria.
Conventional single-chamber pacemakers versus transcatheter pacing systems at long-term follow-up
Authors: Gonzalez-Melchor L , Martinez-Sande J L , Garcia-Seara J , Rodriguez-Manero M , Fernandez-Lopez X A , Minguito-Carazo C , Gonzalez T , Gonzalez Juanatey J R 
Published: October 2022

Abstract

Background
Leadless pacemakers systems (LPM), have demonstrated safety and efficacy at mid-long term follow-up. There are still issues that cannot be completely avoided with conventional transvenous pacemaker (VVI) such as infectious or pocket related complications in which LPM are clearly superior.

Purpose
The aim of the study was to compare the clinical and device performance between LPM and VVI in a one-center long-term follow-up.

Methods
This was a prospective, observational, one-center study. We include all patients with a single chamber pacemaker implantation from June 1 2015 to March 1 2022 to complete a long-term follow-up. All clinical, electrical and echocardiographic characteristics, including electrical parameters, complications and mortality, were described.

Results
We included 245 patients with VVI pacemakers and 315 LPM. Mean age was 79.6±6.6 in LPM and 83.5±8.9 y/o in VVI pacemakers. All clinical, electrical and echocardiographic characteristics are described in Table 1. Electrical parameters of LPM were stable at long-term follow-up. There were a total of 7 complications in LPM and 17 in VVI pacemakers (p=0.006). There were no significant differences between major complications but there were in minor complications as shown in Table 2. There were no significant differences in mortality between both groups, but there was one death related to endocarditis in a VVI pacemaker patient during the follow-up (40,3±10 months).

Conclusions
In our study, there were no significant differences in terms of mortality and major complications between LMP and VVI at long-term follow-up. We consider our study supports the results in favor of the safety and effectiveness of LPM in the long-term.

Funding Acknowledgement
Type of funding sources: None.
Rates of implantable cardioverter defibrillator implantation and outcomes in octogenarians or older compared to non-octogenarians in a statewide cohort from 2009 to 2018
Authors: Vijayarajan V , Hsu A , Cheng Y Y , Wei M S S , Sy R , Chow V , Hyun K , Brieger D , Kritharides L , Ng A C C 
Published: October 2022

Abstract

Background
Octogenarians are underrepresented or excluded in major implantable cardioverter defibrillator (ICD) trials. The deployment of ICDs and their real-world outcomes in octogenarians is unclear.

Purpose
To investigate the prevalence and outcomes of ICD implantation in octogenarian or older vs non-octogenarian.

Methods
We extracted details of all ICD implanted statewide from 2009–2018 including patient's characteristics, in-hospital complications and mortality using the Centre-for-Health-Record-Linkage administrative datasets. Implantation rates were adjusted for the population size by sex, age-groups in decade and calendar-year. Analysis was stratified by age &lt;80 vs ≥80yo.

Results
There were 9304 admissions (12.1% ≥80yo) for de novo ICD implantation (mean±SD implantation: 1163±122 cases per-annum). The mean age for ≥80 vs &lt;80yo groups was 83.5±2.9yo vs 66.2±12.1yo respectively (overall cohort mean age 66.1±13.1yo). Total ICD implantations increased by 8.4±12.4% vs 1.8±8.4% per-annum for ≥80 vs &lt;80yo groups. The mean implantation rates were 52.7±10.8 vs 22.0±2.8 per-100,000-persons in ≥80yo compared to &lt;80yo, respectively, with rates increasing at 7.7±18.3% per-100,000-persons-per-annum in ≥80yo. In contrast, implantation rates declined slightly by 0.2±12.4% per-100,000-persons-per-annum in &lt;80yo groups. There was a non-significant trend towards more in-hospital non-fatal complications in ≥80yo compared to &lt;80yo (10.8% vs 9.0% respectively, p=0.054), with no difference in in-hospital mortality (0.6% vs 0.4% respectively, p=0.32). The 1-year mortality was 10.7% in ≥80yo compared to 4.7% in &lt;80yo (p&lt;0.001), and 2-year mortality was 20.2% vs 8.8% respectively (p&lt;0.001). The 1-yr and 2-yr mortality hazard ratio for ≥80yo was 2.0 (95% confidence interval [CI] 1.6–2.5, p&lt;0.001) and 2.2 (95% CI 1.8–2.5, p&lt;0.001) respectively after adjusting for sex, year of implantation, referral source, indications for ICD, and comorbidities. Overall, the annual rates of total in-hospital non-fatal complications and mortality did not alter significantly during the study period.

Conclusion
Despite limited clinical trials data on efficacy of ICD use in octogenarians or older, implantation rate was more than double that of &lt;80yo age-groups, with the implantation rate observed to be increasing in ≥80yo. There was no significant difference in in-hospital mortality between the two age-groups, however the 1-year and 2-year mortality rates were significantly higher in the ≥80yo.

Funding Acknowledgement
Type of funding sources: None.
The role of trigger factors in the occurrence of appropriate ICD shocks and their prognostic implications
Authors: Kleemann T , Lampropoulou E , Kouraki K , Strauss M , Fendt A , Mohammad O , Zahn R 
Published: October 2022

Abstract

Background
The role of triggers in the occurrence of appropriate ICD shocks due to ventricular tachyarrhythmias is not well known. The aim of the study was to assess the prevalence of trigger factors in appropriate ICD shocks and to analyze their prognostic impact on clinical outcome.

Methods
A total of 710 consecutive patients of a prospective single-centre ICD-registry who received a first appropriate ICD shock between 2000 and 9/2021 were analyzed.

Results
In 35% of ICD patients with first ICD shock, at least one of the following triggers was found: Ischemia (22%), Compliance (9%), Decompensation (38%), Stress (12%), Technical (5%), Electrolyte/endocrinological disorder (22%) and Medication intoxication (4%) (Table 1). The trigger factors can be summarized under the acronym ICD-STEMi. Patients with trigger associated ICD shocks had a more depressed ejection fraction and presented more often with ventricular fibrillation or electrical storm. The therapy after VT/VF shock in the trigger group comprised trigger optimization in 100% and heart failure optimization in 21% as compared to 0% respectively 10% in the no-trigger group (p&lt;0.001). The ventricular arrhythmia therapy (antiarrhythmics or VT ablation) was not different between both groups (35% in each group). Patients with triggered first ICD shock had an increased 5-year mortality rate (50% versus 38%, p&lt;0.001) (Figure 1).

Conclusions
In one third of ICD patients with first appropriate ICD shock, at least one trigger can be identified. Finding a trigger strongly influenced therapy after VT/VF shock. Patients with triggered ICD shock have a higher 5-year mortality rate. The evaluation of trigger factors after the occurrence of ICD shocks is mandatory and can be systematically evaluated using the acronym ICD-STEMi.

Funding Acknowledgement
Type of funding sources: None.
Predictors of all-cause mortality for patients undergoing transvenous lead extraction
Authors: Azari A , Kristjansdottir I , Gatti P , Gadler F 
Published: October 2022

Abstract

Background
Risk assessment of TLE patients may be challenging due to incomplete knowledge about possible risk factors for post-TLE outcomes. The aim of this study was to identify predictors of 30-days and 1-year all-cause mortality including the novel parameter frailty in a large retrospective series of patients undergoing TLE at a high-volume centre.

Methods
Medical journals of 893 consecutive patients undergoing TLE between January 1, 2010 and December 31, 2018 were retrogradely analysed. Univariate logistic regression and multivariate analyses were performed to identify risk factors.

Results
A total of 893 patients were identified. Local infection was the dominant indication (41.1%) and pacemaker was the most common device (49.4%). Mean age was 65±16 years and 73.0% were males. The median follow up was 3.9 years (IQR, 4.5 years). Within the systemic infection group, Staphylococcus aureus was the main microorganism in the positive blood cultures (44.4%) and 69.4% of the patients had vegetations. The 30-days and 1 year mortality rates were 2.5% and 9.7%, respectively. Per-procedural mortality occurred in 1 patient. Significant risk factors for 30-days all-cause mortality at univariate analysis were anaemia, systemic infection, clinical frailty scales (CFS) 5–7 and stage 5 chronic kidney disease (CKD). Age, CRT-P/D (vs ICD), reduced ejection fraction, anaemia, BMI &lt;25 kg/m2, CFS 4–7 and CKD stages 3–5 were identified as significant predictors of 1-year all-cause mortality. Within the systemic infection subgroup, leucocytosis and white blood cell count (WBC) 8.8–15x109/L were associated with significant 30-days and 1-year all-cause mortality and CRP 200–300 mg/L and low WBC count correlated with 1-year all-cause mortality. Local infection patients with CRP 100–150 mg/L had an elevated risk for 1-year all-cause mortality. Multivariate analysis identified CKD 5, CFS 5–7 and systemic infection for 30-days all-cause mortality and age, CKD 5, CFS 5–7, systemic infection and BMI &lt;25 kg/m2 for 1-year all-cause mortality as independent risk factors.

Conclusions
Patient-related characteristics, comorbidities and systemic infection independently predicted worse post-TLE prognosis. Several parameters need to be considered when assessing patients for TLE in order to risk stratify the patients and optimize the post-TLE care. Frailty is a novel parameter with significant influence on short and long-term outcome.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Internal funding
Effect of proton radiation therapy on cardiovascular implantable electronic devices [CIED]
Authors: Gumuser E , Sharif Z , Ho R , Allison J , Aitelli A , Bussiere M , Shih H , Mela T 
Published: October 2022

Abstract

Background
The number of cancer patients with CIED receiving radiotherapy has increased dramatically with improving life expectancy in both patients with cardiovascular disease and cancer. The advent of proton therapy adds new concern for potential malfunction in CIED devices, both due to significant neutron scatter and its use of strong magnets to focus radiation beams. Therefore, we aimed to assess the incidence of CIED malfunction secondary to proton therapy in this patient cohort.

Methods
We retrospectively analyzed patients with CIED undergoing proton therapy at our institute between 2011–2021. Each device was programmed pre-treatment and monitored post-treatment according to a special protocol developed in our centre. Treatments were prescribed to doses up to 70 Gy (RBE) and delivered using either passive-scattering or pencil beam techniques. Distances between the CIED and treated volumes ranged from 10–50 cm. We analyzed baseline patient demographics, CIED demographics, CIED outcomes pre-proton therapy as well as post-proton therapy including device reset and requirement for replacement, analyzing up to most recent check.

Results
Fifty-one patients with CIED underwent proton therapy during the study period. Estimated neutron dose ranged from 0.05–2.0 mSv/GyRBE for this patient cohort. Baseline demographics outlines in table 1. Of note 26/51 patients underwent proton therapy for ophthalmic malignancies, 6/51 for brain/skull malignancies. CIED comprised of 39 pacemakers and 12 implantable cardioverter defibrillators. Fourteen patients were pacemaker-dependent. Using 95% Confidence Interval, ventricular threshold, impedance, and amplitude, as well as atrial threshold and amplitude were unchanged, whereas atrial impedance measurements had a change pre- and post-proton therapy (Table 2). No patients had a device reset. One patient had a premature battery depletion three months post-radiotherapy for pancreatic cancer.

Conclusions
Our findings suggest that proton therapy does not significantly impact CIED function. Whilst caution remains as further data is accrued, close monitoring, particularly with the advent of remote monitoring, of these patients should be recommended.

Funding Acknowledgement
Type of funding sources: None.
Cardiac sodium/hydrogen exchanger (NHE11) as a novel potential target for SGLT2i in heart failure
Authors: Perez-Carrillo L , Gimenez-Escamilla I , Feijoo-Bandin S , Lago F , Gonzalez-Juanatey J R , Martinez-Dolz L , Portoles M , Tarazon E , Rosello-Lleti E 
Published: October 2022

Abstract

Background
Despite the cardiac benefits of sodium/glucose cotransporter 2 inhibitors (SGLT2i), their basic of action remains unclear. Sodium/hydrogen exchanger (NHE) has been proposed as mechanism of action of SGLT2i, but there are controversies related to its function and expression in heart failure (HF).

Purpose
We hypothesized that sodium transported-related molecules could be altered in human HF and they could be modulated through SGLT2i.

Methods
Transcriptome-level differences in genes involved in sodium transport between HF and control (CNT) were investigated in 36 heart samples with RNA-sequencing technology (HF, n=26; CNT, n=10). In addition, NHE11 and NHE1 protein levels were determined in 80 heart samples (HF, n=70; CNT, n=10) by ELISA assay. Furthermore, the effect of empagliflozin on NHE11 mRNA levels in rat left ventricular tissue (n=22) was studied through RT-qPCR.

Results
We observed alterations in several genes involved in sodium transport. Among them the overexpression in SLC9C2 (p=0.005) and SCL9A1 (p=0.020) genes, which encode the NHE11 and NHE1 proteins, respectively. In addition, cardiac protein levels of these molecules were determined. We found a significant increase in the concentration of NHE11 (p=0.042) and NHE1 (p=0.018) in HF. Moreover, NHE11 levels were correlated with left ventricular diameters. Due to the relevance of NHE11 changes observed, we studied the effect of SGLTi on its expression. NHE11 mRNA levels were reduced in rats treated with empagliflozin (p=0.010).

Conclusions
Our findings show alterations in several sodium transport, reinforce the importance of these channels in HF progression. We described upregulation in NHE11 and NHE1 in HF patients, but only NHE11 correlated with cardiac dysfunction. In addition, the most relevant finding is the change observed in the expression of the unknown NHE11 after treatment with empagliflozin. These results propose NHE11 as a potential target of SGLT2i in cardiac tissue.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute of Health Carlos III European Regional Development Fund (ERDF)