bluuebunny/crossref_metadata_2025_split huggingface dataset:
595 LOW INCIDENCE OF ARRHYTHMIC SYNCOPE AND PACEMAKER IMPLANTATION IN OLDER PATIENTS WITH BIFASCICULAR BLOCK AND IMPLANTABLE CARDIAC MONITOR
Authors: Gambardella Marco , Fumagalli Carlo , Rafanelli Martina , Brignole Michele , Guarducci Caterina , Bettoni Niccolò , Pieragnoli Paolo , Casolaro Flavia , Paolisso Giuseppe , Marfella Raffaele , Sardu Celestino , Ungar Andrea 
Published: December 2022

Abstract

Background
In patients with unexplained syncope, bifascicular block (BFB) is considered associated with syncope due to either heart block or sinus arrest. Immediate or delayed pacemaker (PM) implantation after ECG documentation of syncopal recurrence by means of implantable cardiac monitors (ICM) is still debated. We aimed to assess the incidence of recurrent syncope and guideline-based PM implantation in patients with syncope and BFB implanted with ICM.

Methods
Consecutive patients with syncope and BFB followed at two tertiary care syncope units and implanted with ICM from 2012 to 2020 were retrospectively reviewed. Only patients with &gt;2 clinical visits and &gt;18 years of age were included. Incidence of a Class I indication for PM implantation was the primary outcome.

Results
Of 635 syncope patients implanted with an ICM, 55 (8.7%) had a BFB and were included. Median age at implantation was 75 [interquartile range, IQR:64-81] years, and 28(49.1%) were women. At 26 [IQR:12-41] months follow-up, 20 (36.3%,16.3%/year) patients experienced syncope: in 6(10.9%) patients syncope was classified ‘arrhythmic’ with a higher prevalence in older individuals (p=0.048). PM implantation (N=14,25.5%) was more frequent in patients &gt;75 years (p=0.024). At survival analysis, patients &gt;75 years were at highest risk of arrhythmic syncope and guideline directed PM implantation (Hazard Ratio: 4.5, 95% Confidence Intervals 1.5-13.3).

Conclusions
Most older patients with syncope who received an ICM didn't have events during follow-up. Only one-in-three experienced syncope, and an even smaller number had an arrhythmic syncope with indication for PM implantation. Older age was strongly associated with PM implantation.
984 ARRHYTHMOGENIC DYSPLASIA: JUST A PROBLEM OF THE YOUNG?
Authors: Giacalone Giuseppe , Cadeddu Dessalvi Christian 
Published: December 2022

Abstract
Arrhythmogenic dysplasia is a disease of genetic aetiology characterised by the progressive replacement of functioning myocardium by fibro-adipose tissue with high arrhythmogenic potential, as well as by morpho-functional impairment. Molecular genetic studies have revealed a deficiency of demosomal proteins such as placoglobin, desmoglein, desmoplazine, placophylline and desmocollin. It usually begins at a young age and in sports subjects. It mainly affects the right ventricle, although over time it can also affect the left sections due to a biventricular alteration of the heart pump. Forms with major left-sided involvement have been described in the literature, but these are rare.
A 73-year-old man, a sportsman with over 40 marathons, presented with an episode of sustained VT during exercise in 2011. Admitted to our hospital, he was diagnosed with arrhythmogenic cardiomyopathy and was subsequently implanted with an ICD-DR mod.Teligen 100F. After 3 months, however, there was a new episode of VT, so it was decided to subject the patient to transcatheter ablation with radiofrequency, using an endocardial approach, which proved ineffective. Two months later, a new attempt at radioablation with an endocardial approach. Due to the persistence of arrhythmic symptoms, sustained VT episodes, in February 2012 it was decided to proceed with a third ablation, but adopting an endo-epicardial approach, with apparent resolution of the symptomatology. After severals episodes of atrial fibrillation, he underwent a new ablation with pulmonary vein isolation and ablation line at the level of the cavo-tricuspid isthmus in August 2020. On echocardiogram, the left ventricle had normal dimensions with upper limit thicknesses, diffuse parietal hypokinesis with markedly reduced EF (30%), dilated right ventricle (DTD 48 mm) with parietal hypertrabeculature and free wall hypokinesis (TAPSE 1.4) and dilated right atrium. In May 2020 new relapse of atrial fibrillation successfully cardioverted, maintenance therapy set up with sotalol.
In the literature, mainly forms of arrhythmogenic dysplasia in youth (30 years) have been described, whereas older forms appear to be rare. A search of the Medline database (National Library of Medicine, Bethesda, MD) found 5 cases of ARVD among the elderly; all these patients had died and were diagnosed by histology. The diagnosis is multi-parametric and the main aim of therapy is the prevention of sudden cardiac death. Currently, ICD defibrillator implantation is the only effective therapy for the prevention of sudden death. New drug therapies, radiofrequency ablation and defibrillators are likely to have a favourable impact on the survival of these patients and make it not unlikely that elderly patients with ARVD will be present. The possibility of a late onset of the disease should also be suspected.
352 PROGNOSTIC VALUE OF THE TPEAK-TEND INTERVAL FOR IN-HOSPITAL SUBACUTE VENTRICULAR ARRHYTHMIAS IN TAKOTSUBO SYNDROME
Authors: Rosa Giulio La , Pelargonio Gemma , Lucia Narducci Maria , Pinnacchio Gaetano , Bencardino Gianluigi , Perna Francesco , Follesa Federico , Galiuto Leonarda , Crea Filippo 
Published: December 2022

Abstract

Introduction and objectives
The clinical value of ECG repolarization parameters associated with ventricular arrhythmias (VAs) in Takotsubo syndrome is still under debate. We aimed to evaluate ECG predictors of subacute VAs, defined as those occurring after the first 48 hours from admission.

Methods
This is a single-center observational study enrolling patients admitted to the Cardiology Department between 2012 and 2018 with confirmed diagnosis of Takotsubo syndrome. Data collection included a 12-lead ECG on admission and at 48 hours, continuous telemetry monitoring, blood testing, transthoracic echocardiography and coronary angiography during hospitalization. VAs events were defined as: premature ventricular contractions ≥2000 within a 24-hour window of telemetry monitoring, ventricular fibrillation, sustained ventricular tachycardia (VT), polymorphic VT and non-sustained VT.

Results
A total of 87 patients (age 72±12 years old) were enrolled. During an average of 16±14 days of hospitalization, subacute VAs were documented in 22 patients (25%) after 127±75 hours from admission. Subacute VAs were associated with an increased in-hospital mortality (p=0.030). The corrected global (mean of the 12-lead ECG values) Tpeak-Tend interval at 48 hours from admission was an independent predictor of subacute VAs. The corrected global Tpeak-Tend was statistically superior to the standard corrected QT interval to predict subacute VAs (Z test, p=0.040). A cut-off of 108 msec for the corrected global Tpeak-Tend yielded a 71% sensitivity and 72% specificity for subacute VAs.

Conclusions
In patients with Takotsubo syndrome subacute VAs are associated with repolarization alterations that can be identified on the conventional ECG using the Tpeak-Tend interval.
281 CARDIAC RESYNCHRONIZATION TERHAPY IN PERSISTENT LEFT SUPERIOR VENA CAVA WITH A BRIDGING INNOMINATE VEIN
Authors: Liccardo Mattia , Pilato Giovanni , Vittoria Domenico , Rea Maria , Ciardiello Carmine , Cipolletta Ersilia 
Published: December 2022

Abstract

Background
The Persistent Left (PL) Superior Vena Cava (SVC) is a congenital malformation of the thoracic venous return that has an incidence of 0.2-3% in the general population and an incidence of about 0.5% in patients undergoing cardiac implantable electronic device. In this case, the placement of the leads, especially for the Right Ventricle (RV) and Left Ventricle (LV) through one of the branches could be challenging.

Methods
A 66-year-old man with hypertension, diabetes and dyslipidemia, in optimal pharmacologic therapy for congestive heart failure (NYHA II), hospitalized for recurrent syncopal episodes, with extreme sinus bradycardia, first-degree AV block and Left Bundle Branch Block, The patient had a LV hypertrophy and mild global systolic function (LV ejection fraction of 40%) for these we opted for a pacemaker CRT device implantation.

Results
Isolation of left cephalic vein was used as venous access for right atrium (RA) and RV leads while Seldinger technique via subclavian vein was used as venous access for LV lead. The guidewire through the subclavian vein pointed out the presence of PLSVC. Left subclavian venogram confirmed PLSVC and revealed a bridging innominate vein. To pass through the innominate vein and reach the SVC, a 0.035-inch hydrophilic guidewire was used. A 6Fr-sheath was advanced through the hydrophilic guidewire, subsequently a second metallic guidewire was advanced through the same introducer by removing the dilator. The RV and RA leads were placed respectively on low right interventricular septum and RA appendage passing through bridging innominate vein. Electrical parameters were normal. For the placement of the LV lead a 9.5Fr sheath introducer was advanced over the guidewire through the PLSVC. A venogram showed a lateral and a postero-lateral branch of the coronary sinus with acute angulation. With a 6Fr quadripolar Josephson catheter the postero-lateral branch was entered, eventually a 9Fr peelable outer guide catheter was advanced through the electrophysiology catheter becoming selective with the interested branch. A quadripolar S shaped lead was used, it was advanced into the targeted vein through a 0,014fr hydrophilic guidewire. Adequate electrical parameters and stability were achieved.

Conclusion
Lead implantation in patient with PLSVC is challenging. Placing the RA and RV leads through SVC ensure a better stability along time. The cannulation of CS is easily achieved by approach via PLSVC while selective vein cannulation can be difficult due to the modified acute angulation.
805 FAILURE OF RYTHMIQ, AN ALGORITHM FAVOURING INTRINSIC CONDUCTION: WHEN IS TOO MUCH OF A GOOD THING?
Authors: LoSavio Armando , Vetta Giampaolo , Caminiti Rodolfo , Parlavecchio Antonio , Luongo Alfredo , La Cognata Olga Mariarita , Crea Pasquale , Dattilo Giuseppe , Luzza Francesco , Carerj Scipione , Micari Antonio , Di Bella Gianluca 
Published: December 2022

Abstract
An 80-year-old woman received a dual chamber pacemaker (Boston Scientific Accolade MRI DR) for pre-syncopal episodes associated with transient type 1 and 2:1 II degree atrioventricular block, recorded in 24-hour Holter monitoring. Due to residual AV conduction, pacemaker was set with RYTHMIQ algorithm, in order to reduce inappropriate ventricular pacing. A month later, the patient began to complain of severe asthenia and bradycardia (46-48 bpm). Telemetry-supported pacemaker control revealed III degree AV block with junctional escape rhythm, unmasking failing to switch of RYTHMIQ algorithm.
Why did it happen?
The RythmIQ algorithm has been designed to promote intrinsic conduction in Boston Scientific devices. With RythmIQ the device provides AAI(R)[i] at the lower rate limit and/or sensor indicated rate. It provides backup VVI pacing at a rate 15 bpm slower than the programmed lower rate limit, with backup VVI pacing rate limited to no slower than 30 bpm and no faster than 60 bpm. If 3 slow ventricular beats are detected in a window of 11 beats, the device automatically switches to DDD(R) mode. A slow beat is defined as a ventricular paced or ventricular sensed event that is at least 150 ms slower than the AAI(R) pacing rate. Slow ventricular beats are any of the following: - V paced event- V sensed event &gt; AAI lower rate limit + 150 ms- V sensed event &gt; AAI(R) sensor indicated rate + 150 ms
In our case LRL was set at 50 bpm (1200 ms). During III degree AV block, patient's ventricular rate was always about 46-48 bpm, due to stable junctional escape rhythm. Thus no ventricular sensed event occurred with a V-V cycle greater than AAI lower rate limit + 150 ms, namely 1350 ms (around 44 bpm). Moreover the device didn't provide backup VVI pacing at a rate 15 bpm slower, namely 35 bpm. This two conditions impaired Rhythm IQ switching from AAI with VVI backup to DDD.
The device was set manually in DDD with restoring of AV synchrony and adequate ventricular rate followed by complete resolution of symptoms.
Rhythm-IQ algorithm doesn't check for AV synchrony, providing switch from AAI with VVI backup to DDD just in case of sudden and marked bradycardia. Loss of AV synchrony doesn't represent a switching criteria and moreover it is not recognized by the device. This condition could be dangerous failing to correct AV conduction disturbances in pacemaker recipient, especially if LRL was set ≤ 50 bpm. For this reason, adequate knowledge of the algorithm would indicate greater caution in using RythmIQ in certain categories of patients, such as the one in the case just described.
197 INTERMUSCULAR TWO-INCISION TECHNIQUE FOR IMPLANTATION OF THE SUBCUTANEOUS IMPLANTABLE DEFIBRILLATOR: 3-YEAR FOLLOW-UP
Authors: Pittorru Raimondo , Giacomin Enrico , Dall´aglio Pietro Bernardo , Falzone Pasquale Valerio , Bertaglia Emanuele , Lazzari Manuel De , Iliceto Sabino , Corrado Domenico , Migliore Federico 
Published: December 2022

Abstract

Background
The aim of the present study was to evaluate the outcome of patients underwent subcutaneous implantable cardioverter defibrillator (S-ICD) implantation with the intermuscular (IM) two-incision technique during 3-year follow-up.

Methods
the study population consisted of 105 consecutive patients (79 male; median 50 [13-77] years) underwent S-ICD implantation with the IM two-incision technique.

Results
according to the PRAETORIAN score, the risk of conversion failure was classified as low in 99 patients (94.3%), intermediate in 6 (5.7%). Ventricular fibrillation was successfully converted at ≤65 J in 97.4% of patients. During a median follow-up of 39 (16-53) months, 10 patients (9.5%) experienced device-related complications and 9 (8.5%) patients reported shocks (IAS). Lead-associated complications were the most common (3.8%), including 2 cases of lead failure (1.9%). Pocket complications were reported in 2 patients (1.9%). Extra-cardiac oversensing (3.8%) represented the leading cause of IAS. No T-wave oversensing episodes were recorded. Twelve patients (11.4%) experienced appropriate shocks. Eight patients (7.6%) died during follow-up. IAS or device-related complications did not impact on mortality (HR 0.5;95%CI 0-4.3;P=0.5; HR 0.7;95%CI 0.1-6.0;P=0.8, respectively).

Conclusions
according to our findings, the IM two-incision technique allows for optimal positioning of the device achieving a low PRAETORIAN score with a high conversion rate. IM two-incision technique allows low incidence of pocket complications, shifting the type of complications towards lead-related complications, which represent the most common complications. The IM two- incision technique would not seem to impact the occurrence of IAS. Management of complications are safe without impact on the outcome.
929 LEADLESS PACEMAKER IMPLANTATION FOLLOWING TRANSVENOUS LEAD EXTRACTION: DATA FROM HIGH-VOLUME REFERRAL CENTERS
Authors: Mitacchione Gianfranco , Schiavone Marco , Arabia Gianmarco , Gasperetti Alessio , Denora Marialessia , Arosio Roberto , Palmisano Pietro , Montemerlo Elisabetta , Manuel Cerini , Russo Giulia , Mazzone Patrizio , Ziacchi Matteo , Pisanò Ennio , Rovaris Giovanni , Gulletta Simone , Steffel Jan , De Asmundis Carlo , Breitenstein Alexander , Biffi Mauro , Battista Chierchia Giovanni , Dello Russo Antonio , Bella Paolo Della , Claudio Tondo , Battista Forleo Giovanni , Curnis Antonio 
Published: December 2022

Abstract

Background
limited data on real-world safety and efficacy of leadless pacemakers (LPMs) in patients who underwent transvenous lead extraction (TLE) are currently available. The present study aims to assess long-term safety and efficacy of LPMs implantation following TLE, compared with LPM de novo implant patients.

Methods
consecutive patients who underwent LPM implantation in 12 centers joining the International LEAdless PacemakEr (i-LEAPER) registry were enrolled end retrospectively considered. Patients receiving LPM following TLE (n=184) were compared with patients with de novo implant (n=995). The primary endpoint was LPM-related complications rate at implant and during follow-up (FU). Additionally, differences in electrical performance were assessed between the two groups.

Results
1179 patients were enrolled in this study and followed for a median of 33 months. LPM related major complications and all-cause mortality did not differ among the two groups (1.6% TLE group vs. 2.2% de novo group, p=0.785, and 5.4% TLE group vs. 7.8% de novo group, p=0.288, respectively). Pacing threshold (PT) resulted higher in the TLE group throughout the whole follow-up (FU) (Figure 1). Higher PTs were recorded in LPMs implanted at same location from where the previous transvenous lead was removed, as far as 24-months postimplant (Figure 2), with a higher proportion of patients with high PT (&gt;1 to 2V @0.24ms) in the first group at implant, 1-month, and 12-month FU (Figure 3).

Conclusion
In this real-world registry, LPMs showed a satisfactory safety and efficacy profile after TLE. In the post-TLE cohort, better electrical parameters were obtained when LPMs were implanted at a different location from where the previous transvenous lead was extracted.
365 ANALYSIS OF PIVOT POINTS AND SLOW CONDUCTION AREAS IN PATIENTS UNDERGOING ATRIAL FIBRILLATION ABLATION
Authors: Pinna Gabriele Diego , Ceriotti Carlo , Poggio Luca , Latini Alessia Chiara , Battaglia Vincenzo , Mincione Gianluca , Del Monaco Guido , Taormina Antonio , Galimberti Paola , Frontera Antonio 
Published: December 2022

Abstract

Introduction
Little is known about progression of atrial fibrillation (AF) from paroxysmal to persistent form. Electrical remodeling may play a pivotal role in the arrhythmia transition. The aim of the study was the characterization of the atrial electrical substrate in patients suffering from AF.

Methods
Twenty-seven patients were included in the study (14 with paroxysmal AF and 13 with persistent AF). Two simultaneous electroanatomical maps of the left atrium were collected using PentaRay catheter using the parallel mapping feature [first map during sinus rhythm and a second one with an extrastimulus from coronary sinus (CS)]. We analyzed the propagation of the wavefront and we identified zones of abnormal conduction: slow conduction (SC) corridors and pivot points (PP). SC corridors were defined by the slowing of conduction velocity; pivot points were zones in which propagation pattern changed the direction of 90° or more. Maximum delay between the recording dipoles located at the extremities of the PentaRay splines was calculated. At each of these sites, EGMs were collected and analyzed in terms of amplitude and duration. We checked if areas of abnormal conduction during sinus rhythm were present or they disappeared by delivering an extrastimulus from the coronary sinus.

Results
The average number of collected EGMs per map was 4790 ± 1333 (PAF 4829 ± 1407; PsAF 4745 ± 1402).
Total abnormal conduction areas in the 27 patients were 62, 65% of which were slow conduction. Pivot points and slow conduction manifested a trend to cluster in some areas: both of them were mostly present at the ostia of pulmonary veins, in a specific segment between LAA ostium and mitral annulus and in the posterior wall. During sinus rhythm, pivot points were 29, while pacing from distal CS catheter the same zones showed normal conduction in 14 cases: they were still present in 60% in PAF group and 50% in PsAF. Slow conduction corridors, instead, show a trend to remain while pacing from CS: 76% in the first group and 78% in the second one.

Conclusions
SC corridors are fixed alterations of atrial substrate, while pivot sites may be more dynamic entities: both of them may have a key role in remodeling atrial structures and atrial fibrillation progression and maintenance. These may represent future targets for AF therapy and prevention.
452 ONE-YEAR OUTCOMES OF DIFFERENT ANTITHROMBOTIC STRATEGIES IN OLDEST OLD STEMI PATIENTS WITH NEW ONSET ATRIAL FIBRILLATION
Authors: Ruzzarin Alessandro , Unterhuber Matthias , Baessato Francesca , Donazzan Luca 
Published: December 2022

Abstract

Introduction
Management of antithrombotic therapy (ATT) in oldest old STEMI patients undergoing percutaneous coronary intervention (PCI) with new onset atrial fibrillation (NOAF) is a clinical conundrum given the gamut of possible ATT strategies and the lack of studies in this population.
We sought to evaluate ATT patterns at discharge and 1-year outcomes in our center.

Methods
A retrospective cohort study of all consecutive oldest old (i.e. over 85 years) STEMI patients undergoing primary PCI (pPCI) was performed at our institution. NOAF was defined according to its documentation within 48 hours of STEMI diagnosis.
Primary outcomes were 1-year major adverse cardiac or cerebrovascular events (MACCE: composite of death, myocardial infarction, stroke, heart failure hospitalization) and major bleeding events (Bleeding Academic Research Consortium 3 or 5).

Results
Among the 248 patients studied, NOAF was detected in 25.4% of patients (mean patient age 88.9±2.4 years, 56.5% females). At logistic regression analysis, baseline chronic kidney disease (eGFR&lt;60 ml/min) was associated to nAF (OR: 2.38, 95% CI: 1.3 to 4.2; p&lt;0.05).The development of heart failure during hospitalization was statistically higher in patients with nAF compared to patients without nAF (p=0.05). At discharge, triple therapy (TT: 1 anticoagulant and 2 antiplatelet agents) was prescribed in 11.5%, dual antiplatelet therapy (DAPT) in 77% and dual therapy (1 anticoagulant plus 1 antiplatelet agent) in 11.5% of patients.
No group differences by ATT strategy were observed in 1-year MACCE (TT 32% vs dual therapy 27.2% vs DAPT 25.7%; p=0.81), or BARC 3,5 (TT 8% vs dual therapy 12.8% vs DAPT 9%; p=0.74).

Conclusions
The high incidence of NOAF in oldest old STEMI patients highlights the need of an adequate calibration between ischaemic and bleeding risk.
Despite differences in the choice of ATT strategy, there were no significant differences in clinical outcomes up to 1 year.