bluuebunny/crossref_metadata_2025_split huggingface dataset:
A multicentric observational study of patients affected by advanced heart failure with implantable cardioverter defibrillator and left ventricular assist devices
Authors: Pignalosa L , Casula M , Rordorf R , Perna E , Baroni M , Garascia A , Guida S , Gazzoli F , Pini D , Cannata F , Pellegrino M , Vergara P , Della Bella P , Gulletta S 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Left ventricular assist device (LVAD) implantation is increasingly used in patients with end-stage heart failure. Most patients already have an implantable defibrillator (ICD) at the time of L-VAD implantation. Studies on this patient population are limited by the small sample size and the short duration of follow-up.

Purpose
The aim of this study was to retrospectively describe the real-world management of patients implanted with both ICD and LVAD. The main objective was to evaluate the incidence and predictors of appropriate and inappropriate therapies of the ICD and the incidence and predictors of ICD related complications.

Methods
212 patients were enrolled in four Centers in the period between July 2006 and November 2020. The inclusion criteria were age&gt; 18 years, advanced heart failure, patients with ICD and concomitant or subsequent continuous flow LVAD implantation. ICD therapy was defined as antitachycardia pacing therapy or shock.
The data available at the last visit with a median follow up of 21 months were analyzed.
Outcome predictors were assessed by univariate logistic regression and the variables of interest included in a multivariate model.

Results
The rate of appropriate ICD therapies was 29.7%, while the incidence of inappropriate therapies was 10.4%; in the multivariate analysis the presence of a zone therapy with low detection rate (VT zone with median detection rate of 164.5 bpm) was found to be an independent predictor of the composite of appropriate and inappropriate therapies (OR = 19.05; CI = 2.19-165.21; p = 0.007). Interference between ICD and LVAD occurred in 7.5% of cases; the incidence of infectious complications related to the ICD was 7.1% and bleeding complications of 5.2%; in the multivariate analysis, ICD generator replacement was an independent predictor of total complications related to the ICD (interference, infectious and bleeding; OR = 4.45; IC = 1.60-12.36; p = 0.004). 103 patients had CRT defibrillator (48,6%). At follow up there was no statistically significant difference in the incidence of appropriate therapies between those who had CRT-on (n=74) and those who had CRT-off (n=29; p = 0.61).

Conclusions
Patients with LVAD implanted with an ICD experience a high rate of appropriate and inappropriate ICD therapies. An active VT zone at low heart rate was found to be an independent predictor of ICD therapies. Of more, ICD generator replacement was found to be an independent predictor of total complications related to the ICD. Our findings suggest the importance of tailoring device programming in order to minimize the incidence of ICD therapies, thus sparing the need for generator replacement in this population.
Comparison between his-bundle pacing and biventricular pacing as cardiac resynchronization therapy for heart failure patients: a systematic review and meta-analysis
Authors: Toding Labi N , Rampengan D , Rampengan S 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiac resynchronization therapy (CRT) has demonstrated significant improvements in cardiovascular outcomes of selected heart failure patients. However, conventional biventricular CRT implantation can be challenging due to unfavorable coronary sinus anatomy, leads to lead instability, poor capture, and insufficient cardiac resynchronization. His-bundle pacing has gained interest as alternative strategy for patients underwent biventricular CRT implantation when coronary sinus lead implantation is unsuccesful or in non-responder cases.

Purpose
This study aims to compare the efficacy of his-bundle pacing and biventricular pacing in improving electrocardiographic, echocardiographic, and clinical parameters of heart failure patients that required resynchronization therapy.

Methods
A search for eligible studies was conducted until August 2021 on three databases (PubMed, ScienceDirect, ProQuest). Included studies were evaluated for risk of bias. Our primary outcomes of interest were mean difference in QRS duration, left ventricular ejection fraction (LVEF), and change in systolic blood pressure (SBP). We also investigated left ventricular activation time, left ventricular dyssynchrony index, left ventricular end-systolic volume (LVESV), New York Heart Association (NYHA) functional class, 6-minute walk test, quality of life, heart failure hospitalization and cardiovascular or all cause death. Review Manager (RevMan) 5.4 was utilized to compute mean differences.

Results
We identified five studies from 2010 to 2019, involving 95 heart failure patients underwent CRT implantation. Pooled analysis showed that his-bundle pacing resulted in significant narrowing of QRS duration compared to biventricular pacing [Mean Difference -23.17 ms (95% CI -36.10, -10.24; p=0.0004; I2=0.63)]. Left ventricular activation time and left ventricular dyssynchrony index were significantly improved in his bundle pacing. There were no significant differences of changes in LVEF, LVESV, and SBP. Clinical parameters such as NYHA functional class, 6-minute walk test, and quality of life were significantly improved in both pacing modality. No significant difference in heart failure hospitalization and cardiovascular or all cause mortality.

Conclusion
His-bundle pacing delivers better decrease of QRS duration, also reduction in left ventricular activation time and left ventricular dyssynchrony index compared to biventricular pacing. These suggests that his-bundle pacing is a reasonable alternative option for cardiac resynchronization therapy.
Feasibility, safety and outcomes of upgrading to left bundle branch pacing in patients with right ventricular pacing induced cardiomyopathy
Authors: Rademakers LMF , Bouwmeester S , Mast TP , Bracke FA 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Right ventricular pacing (RVP) induces abnormal electrical activation and asynchronous ventricular contraction and leads to pacing induced cardiomyopathy (PICM) in 10-20% of patients. Cardiac resynchronization therapy (CRT) utilizing biventricular pacing (BVP) is the recommended treatment. Left bundle branch pacing (LBBP) is a novel physiological pacing technique which may serve as an alternative to CRT. This study assessed feasibility and outcomes of LBBP delivered CRT in patients with PICM.

Methods
Twenty consecutive patients with PICM who received an upgrade of their pacemaker to LBBP were prospectively studied. Acute success rate, complications, functional and echocardiographic response and hospitalization for heart failure within six months from implantation were evaluated.

Results
LBBP was successfully delivered in all patients. Median duration of RVP before upgrade to LBBP was 3.8 years and the RVP percentage was 99. LBBP resulted in significant QRS narrowing (from 192 ± 18 to 131 ± 17 ms (p&lt;0.001)), improvement in LVEF (from 31 ± 6 percent to 44 ± 8 percent (p&lt;0.001)) and NYHA class (from 2.7 ± 0.5 to 1.4 ± 0.5 (p&lt;0.001)) at 6 months. No LBBP-related complications occurred and no hospitalization for heart failure or death occurred.

Conclusion
LBBP is feasible and safe in delivering CRT in PICM. Preliminary analyses demonstrated significant electrical resynchronization and favourable improvement in LV function and NYHA functional class at short term follow-up. Data need to be validated in large randomized controlled trials.
Impact of anticoagulation therapy on outcomes in patients undergoing transvenous lead extraction
Authors: Dias Ferreira Reis JP , Valente B , Portugal G , Lousinha A , Silva Cunha P , Oliveira M , Cruz Ferreira R 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Oral anticoagulation (OAC) is essential for patients (pts) at high risk for thromboembolism. However,uninterrupted anticoagulation and bridging with enoxaparin increases the risk of pocket hematoma (PH) andinfection (I).

Aim
To evaluate the impact of OAC in the rate of PH and outcomes in pts undergoing lead extraction (LE) usingthe Pisa Technique (PT).

Methods
A single centre prospective study of consecutive procedures (Pr) of LE using the PT between February2013 and October 2019. Demographic, clinical, device and procedure related variables, morbidity and mortality(M) data were compared between pts without OAC (O0) and pts with AC (O1).

Results
320 electrodes (E) were removed in a total 171 Pr in 159 pts (mean age - 67.7 years, mean LVEF - 48%,male - 72%). The LE were from the following implanted systems: pacemaker – 110 pts, cardiac resynchronizationtherapy – 29 pts, cardioverter-defibrillator – 20 pts. The radiological success rate was 91.2% and the clinicalsuccess rate was 98.3%. There were 14 cases of PH. During a mean follow-up (FU) of 33 months, 11 pts had toundergo a new Pr, 5 of them due to pocket I. 8 pts (5.0%) died during hospital stay, and 19 pts during the firstyear post-Pr. There were no deaths during the Pr. O1 included 56 pts (35.4%), of which 51.9% were under vitaminK antagonists (AVK) and 48.1% under direct oral anticoagulants (DOAC). 11 pts were receiving OAC due toprosthetic mechanical valve, and the remainder due to atrial fibrillation (AF). Pts in O1 were significantly older(p=0.026), presented a lower LVEF (p=0.001), a higher prevalence of valvular heart disease - VHD -(p=0.002),overt heart failure (p=0.006), AF (p&lt;0.001) and previous cardiac surgery - CS - (p&lt;0.001). OAC was associatedwith a higher rate of PH (OR 2,44, IC 95% 1.02-5,84, p=0.046) and pts with PH presented a significantlyprolonged hospital stay (22.7 vs 9.8 days, p=0.031). These pts also presented a higher hospitalization rate duringthe first year post-Pr (OR 2,48, IC95% 1.27-4.88, p=0.009). There was no difference in all-cause hospital M(p=0.522), all-cause M during first year of follow-up (p=0.551) or need for reintervention (p=0.375). Among pts inO1, pts under AVK presented a significantly higher rate of PH (OR 18,67, IC95% 2,23-156,17, p=0.007).

Conclusion
Pts receiving OAC, particularly pts under AVK, presented a higher rate of PH after LE. PerioperativeOAC management is crucial to reduce the morbidity rate in this population.
Procedural outcome and risk prediction in patients with implantable cardioverter-defibrillator (ICD) undergoing transvenous lead extraction: a GALLERY subgroup analysis
Authors: Chung D , Burger H , Kaiser L , Osswald B , Baersch V , Naegele H , Knaut M , Reichenspurner H , Willems S , Butter C , Pecha S , Hakmi S 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Device complications, such as infection or lead dysfunction necessitating transvenous lead extraction (TLE) are continuously rising amongst patients with indwelling transvenous implantable cardioverter-defibrillator (ICD).

Objectives
Aim of this study was to characterize the procedural outcome and risk factors of patients with indwelling 1- and 2-chamber ICD undergoing TLE.

Methods
We conducted a subgroup analysis of all 1- and 2-chamber ICD patients in the GALLERY (GermAn Laser Lead Extraction RegistrY) database. Predictors for procedural failure and all-cause mortality were assessed.

Results
A total of 854 patients with ICD undergoing TLE were identified, who were younger (62.9±13.8 vs. 70.7±13.0 years; p&lt;0.001), less likely to be female (20.8 vs. 27.1%; p&lt;0.001) and had a higher proportion of patients with coronary artery disease (51.5 vs. 38.6%; p&lt;0.001) and highly reduced ejection fraction (32.0 vs. 23.0%; p&gt;0.001), when compared to non-ICD patients. Leading extraction indication was lead dysfunction (48.0 vs. 21.9%; p&lt;0.001), followed by device-related infection (45.6 vs. 73.0%; p&lt;0.001). There were no differences in overall procedural complications (4.3 vs. 4.3%; p=0.980), clinical success rate (97.9 vs. 97.8%; p=0.861) or procedure-related (0.8 vs. 0.5%; p=0.292) and all-cause mortality (3.4 vs. 3.7%; 0.742) between groups. Multivariate analysis revealed lead age≥10 years (OR:5.75, 95%CI:2.0-16.2; p=0.001) as independent predictor for procedural failure. Systemic infection as extraction indication (OR:9.57, 95%CI:2.2-42.4; p=0.003) and procedural complications (OR:8.0, 95%CI:2.8-23.3; p&lt;0.001) were identified as risk factors for all-cause mortality. Predictors for systemic infection in ICD patients were atrial fibrillation (OR: 2.22, 95%CI: 1.51-3.27; p&lt;0.001), diabetes mellitus (OR: 2.28, 95%CI: 1.59-3.25; p&lt;0.001) and chronic kidney disease (OR: 2.0, 95%CI: 1.39-2.89; p&lt;0.001).

Conclusions
Transvenous lead extraction is safe and efficacious in patients with 1- and 2-chamber ICD. Although lead dysfunction is the leading indication for extraction, systemic device-related infection is the main driver of all-cause mortality for ICD patients undergoing TLE.
A head-to-head comparison of the first choice and crossover lead extraction tool: laser vs. mechanical
Authors: Vamos M , Zsigmond EJ , Benak A , Miklos M , Makai A , Hegedus Z , Alacs E , Agocs SZ , Saghy L 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
During transvenous lead extraction (TLE) longer dwelling time often requires the use of powered sheaths.

Purpose
This study aimed to compare outcomes with the laser and mechanical tools.

Methods
Single-center data from consecutive patients undergoing TLE between 2012 and 2021 were retrospectively analyzed. Efficacy and safety of the primary extraction tool were compared. Procedures requiring crossover between powered sheaths were also analyzed. Moreover, we examined the efficacy of each level of the stepwise approach.

Results
Out of 166 patients 142 (age 65.4±13.7 years) underwent TLE requiring advanced techniques with 245 leads (dwelling time 9.4±6.3 years). Laser sheaths were used in 64.9%, mechanical sheaths in 35.1% of the procedures as primary extraction tools. Procedural success rate was 85.5% with laser and 82.5% with mechanical sheaths (p=0.552). Minor and major complications were observed in similar rate. Procedural mortality occurred only in the laser group in case of 3 patients. Crossover was needed in 19.5% after laser and in 12.8% after mechanical extractions (p=0.187). Among crossover procedures only clinical success favored the secondary mechanical arm (87.1% vs. 54.5%, aOR: 0.09, 95%CI: 0.01-0.79, p=0.030). After step-by-step efficacy analysis, procedural success was 64.9% with the first-line extraction tool, 75.1% after crossover, 84.5% with bailout femoral snare, and 91.8% by non-emergency surgery (Figure).

Conclusion
The efficacy and safety of laser and mechanical sheaths were similar in our study, however in the subgroup of crossover procedures mechanical tools had better performance regarding clinical success. Device diversity seems to be indispensable in order to achieve the most optimal outcomes.
Occluded vein as a predictor for complications in non-infectious transvenous lead extraction
Authors: Milman A , Massalha E , Jia K , Meitus A , Kariv S , Shafir Y , Glikson M , Luria D , Sabbag A , Beinart R , Nof E , Leshem E 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiovascular implantable electronic device (CIED) use is steadily increasing, with subsequent need to solve lead failure issues and device upgrades with an occluded vein. Transvenous lead extraction (TLE) has inherent risks that must be carefully weighed. Currently there is lack of conclusive data regarding many non-infectious indications.

Methods
A retrospective study on indications and outcomes of TLE for non-infectious reasons at our medical center, between the years 2011 to 2020 was performed. Occluded vein (OV) presence was compared for characteristics, extraction methods and periprocedural complications and outcomes.

Results
A total of 88 patients underwent TLE for non-infectious reasons. The majority were referred due to lead malfunction (70.5%) and CIED upgrade with an OV (25%), while 4 patients had other TLE indication (intractable pain, heart transplant, severe Tricuspid regurgitation, and irradiation). fourteen patients referred due to lead malfunction had an OV observed during venography.
The OV group (36 patients) were significantly older (65.7±14.1 vs 53.8±15.9 respectively, p=0.001) and had more comorbidities. EF was significantly lower for the OV group (27.5% vs 57.5%, p=0.001) as was longer lead dwell time (3226±2324 vs 2191±1355 days, respectively, p=0.012).
Major complications were exclusive for the OV group (16.7% vs none, p=0.02), and most minor complications occurred in the OV group as well (38.9% vs 4.1% respectively, p&lt;0.001). Laser sheath and Mechanical tools for TLE were frequently used for OV as compared to the non-occluded group (94.4% vs 73.5% respectively, p=0.012). Procedure success was higher in the non-occluded group compared to the OV group (98% vs 83.3%, respectively, p=0.047). Despite these results, peri-procedural mortality was similar between groups.

Conclusions
Among TLE for non-infectious reasons, vein occlusion appears as a major predictor for complex TLE tools use, complications, and procedural success. Venography should be routinely performed prior to non-infectious TLE to identify high-risk patients.
Lead complications after cardiac surgery in danish patients with cardiac implantable electronic devices: a nationwide nested case-control study
Authors: Frausing MHJP , Nielsen JC , Johansen JB , Jorgensen OD , Kristensen J , Olsen T , Gerdes C , Kronborg MB 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Karen Elise Jensen’s Foundation

Background
Manipulation of the heart during cardiac surgery in patients with cardiac implantable electronic devices (CIEDs) may result in lead damage or -displacement, but whether cardiac surgery truly infers an excess risk of lead failure is not known.

Purpose
The objective of this study was to examine risk of lead complications as a result of cardiac surgery in CIED patients.

Methods
We conducted a nationwide nested case-control study. Our source population comprised all patients ≥18 of age who underwent a de novo CIED implantation in Denmark between 1998 and 2017. Only patients who were alive and event-free at six months after implantation were eligible for inclusion in the case-control study. Cases were defined as incident lead complications resulting in a revision procedure, and were matched 1:30 to controls using risk set sampling. We used conditional logistic regression to estimate incidence rate ratios (IRRs) for the association between cardiac surgery and lead complications.

Results
Our population consisted of 61,869 de novo CIED patient. We identified 1324 incident cases of lead complications and 39,708 time-matched controls. 1036 cases and controls underwent cardiac surgery during follow-up; 61 cases (4.5%) and 975 controls (2.5%). Risk of lead-related reoperation was highest within the first six months of cardiac surgery (IRR 10.1, 95% CI 6.5-15.6, adjusted IRR 11.0, 95% CI 7-17.4). At one year, we observed no association between cardiac surgery and lead complications (IRR: 1.0, 95% CI 0.7-1.5 and adjusted IRR: 1.1, 95% CI 0.7-1.6).

Conclusion
Cardiac surgery was associated with a substantial risk of lead complications in patients with de novo CIEDs. Manipulation of the heart including cannulation of the right atrium is a likely explanation for the subsequent lead problems.
Tunnelled dialysis catheter extraction: a cardiology experience
Authors: Akhtar Z , Gallagher MM , Leung LWM , Kontogiannis C , Elbatran AI , Zuberi Z , Sohal M 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Tunnelled dialysis catheters are integral to the management of patients with chronic kidney disease (CKD), providing a means to dialysis. They are prone to blockages necessitating removal. Most catheters are removed with manual traction without any sequalae by renal physicians whilst a small proportion require further intervention which may include interventional radiology or an ‘open’ surgical removal which carries additional risk. Cardiologists versed in transvenous lead extraction (TLE) provide an additional strategy.

Purpose
To evaluate the outcomes of tunnelled dialysis catheter ‘extractions’ performed by cardiologists at a high-volume TLE institute.

Method
All consecutive patients referred to cardiologists (1/10/2016 – 1/10/21) for extraction of tunnelled dialysis catheters following an unsuccessful attempt by the renal physicians and interventional radiology, were included in this series. Data of procedural outcomes was evaluated for safety and efficacy.

Results
Twelve patients (7 male) aged 64.15±15.04 years with a body mass index of 28.3 kg/m2 were referred for tunnelled catheter extraction for non-functioning lines (75%). Of these 12 CKD patients, the aetiology included focal segmental glomerulosclerosis (n=2), hypertension (n=2), diabetes (n=1) and sickle cell disease (n=1). In total, 12 tunnelled catheters (75%; n=9 right side) were completely removed (100%) using local anaesthesia (83.3%) in a procedure lasting 54.7±29.8 minutes and requiring 0.79±1.32 minutes of fluoroscopy. Eleven patients (91.7%) had their catheters successfully extracted with manual traction alone; 3 necessitated the use of a 0.035 stiff J-tip wire whilst one required the use of a rotational dissecting sheath Evolution (Cook Medical, USA). Of the 12 cases, 11 had a failed previous attempt including 1 patient who suffered a ventricular fibrillation cardiac arrest during the procedure and 1 was referred directly without an attempt as there was a concurrent pacemaker situated from the contralateral side; 4 patients had new lines placed and no significant complications occurred. There were no complications or procedural mortality.

Conclusion
Extraction of tunnelled dialysis catheter lines performed by cardiologists is safe and efficacious; experience in TLE is vital. This may provide an additional strategy for removal of these catheters when other percutaneous attempts fail.