bluuebunny/crossref_metadata_2025_split huggingface dataset:
A new window on subcutaneous ICD system performance: Z-lead impedance change over time in devices with and without extracellular matrix envelope use
Authors: Liu K , Stahl W K , Riebman J B , Speakman B , Wu J E , Elayi C S , Deering T F , Catanzaro J N 
Published: October 2022

Abstract

Background
Device impedance for subcutaneous ICDs (S-ICDs) may rise over time reflecting changes in tissue electrical conduction due to fibrosis from the natural foreign body response, increasing the risk of defibrillation failure. A biologic envelope optimized for S-ICDs may mitigate fibrosis and encourages angiogenesis around the device possibly decreasing impedance rise over time. The S-ICD system performs routine low-voltage Z-lead (LVZ) impedance testing (impedance between shocking coil and can) that may provide insight into the impedance changes on device functionality and efficacy over time.

Purpose
Explore early and late impedance changes over time in S-ICDs implanted with and without envelopes using periodic LVZ measurements.

Methods
30 patients received S-ICDs (15 with envelope) between 1/2017 and 3/2021, after excluding those with device complications, uncontrolled comorbidities, or recent cardiac surgery. Impedance data was recorded at initial implantation. LVZ impedance data was extracted from the wireless remote monitoring system, trended over 0–4 years post implant, and analyzed blinded to patient information.

Results
24 patients (12 envelope) had evaluable implant and chronic data sets. Baseline clinical characteristics were similar between groups. Impedance in general was higher in the envelope group at initial implantation (LVZ mean 89 Ω vs 74 Ω) and throughout the first year. Comparing envelope to no envelope, the initial average shock impedance was 87.3±30.50 vs 66.7±10.40, followed by an average low-V impedance drop of 29 Ω vs 17 Ω during the first month, with a recovery to 109 Ω vs 91 Ω at 30 months post implant. After 30 months, impedance trends demonstrated a modest linear increase up to 48 months in the no envelope group in comparison with a modest decrease in the envelope group (sample sizes too small to determine significance) (Figure 1).

Conclusion
The results demonstrate periodic LVZ testing in the S-ICD monitoring system can reliably trend changes in system impedance over time. Impedance measurements within the first 6–7 months (and most markedly within the first 3 months) appear to be transiently lower than the values seen after this timepoint suggesting that early impedance measurements may not predict steady-state impedance. Further studies are needed to explore the impact of envelope use and the S-ICD impedance changes beyond 30 months.

Funding Acknowledgement
Type of funding sources: None.
The case against premature treatment of heart failure patients with implantable cardioverter-defibrillators: results from an institutional registry
Authors: Prepolec I , Pasara V , Bogdanic J E , Nekic A , Putric Posavec J , Pezo Nikolic B , Matasic R , Krpan M , Lovric-Bencic M , Percin L , Puljevic M , Puljevic D , Milicic D , Velagic V 
Published: October 2022

Abstract

Introduction
Implantable cardioverter-defibrillators (ICD) are gold-standard therapy for primary prevention (PP) of sudden cardiac death (SCD) in patients with heart failure with reduced ejection fraction (HFrEF). According to relevant guidelines, ICDs should be implanted only after patients have been treated with revascularization procedures and/or optimal medical therapy (OMT) [1]. Due to perceived high risk of SCD and low chance of improvement some patients receive ICDs “too early” in the course of the disease [2].

Purpose
To investigate adherence to guidelines in our institution with emphasis on premature ICD implantation and early ICD activation.

Methods
We analysed all ICDs newly implanted for PP in patients with HFrEF in our institution between 2011 and 2017. Follow-up data was collected from hospital medical records.

Results
Total number of 307 ICDs were implanted during the analysed interval, 147 (47.9%) in ischemic cardiomyopathy (ICM) and 160 (52.1%) in non-ischemic dilated cardiomyopathy (DCM) patients. Only 57.8% of ICM patients have been treated with OMT at least 3 months before implantation. The proportion was similar in DCM patients (60.0%). However, DCM patients were more commonly implanted at the time of diagnosis (13.8% vs. 0.7% in ICM). It is worth noting that OMT was up-titrated after implantation in 35.2% of patients. In 9 cases patients were treated with ICDs less than 3 months after revascularization procedures or less than 6 weeks after STEMI (6 and 3 cases respectively). Follow-up data revealed that among all the patients who prematurely received an ICD, a device activated to deliver appropriate therapy within 3 months of implantation only in 1 ICM patient (0.7% of ICM patients). That patient had established ICM and was suffering from recurrent unexplained syncopes. One DCM patient with prematurely implanted ICD had early inappropriate ICD activation that was due to supraventricular tachycardia. Early ICD activations were generally uncommon even among patients who were treated according to guidelines (1 ICM and 1 DCM patient).

Conclusion
Results from our institutional ICD registry show that a significant number of patients with HFrEF received premature ICD implants before being treated with OMT. This is even more common in patients newly diagnosed with DCM. Our follow-up data suggests that early ICD activation is extremely rare in all comers and hardly ever happens in patients who received ICD immediately after diagnosis, revascularization or without 3 months of OMT. This data can help improve our future practice and encourage clinicians to follow relevant guidelines when faced with these important decisions.

Funding Acknowledgement
Type of funding sources: None.
Effect of defibrillator on long term all-cause mortality in patients with chronic kidney disease: an updated meta-analysis
Authors: Aslam F , Al-Sadawi M , Aleem S , Alsaiqali M , Almasry I , Singh A , Rashba E , Fan R 
Published: October 2022

Abstract

Background
The beneficial role of implantable defibrillator (ICD) in patients with chronic kidney disease (CKD) is less understood as this population is often not well represented in clinical trials.

Purpose
Evaluate the effect of ICD use in patients with CKD on long term outcomes.

Methods
Literature search was conducted for studies reporting the effect of ICD on all-cause mortality in patients with CKD, which is defined as glomerular filtration rate (GFR) &lt;60 mL/min. The search was not restricted to time or publication status. The search included the following databases: Ovid MEDLINE, EMBASE, Scopus, Web of Science, Google Scholar, and EBSCO CINAHL. The minimum duration of follow-up required for inclusion was one year.

Results
The literature search identified 834 studies, of which 14 studies with 70,661 patients were included. Mean follow up was 39 months (12–81 months). For all patients with CKD, ICD was associated with lower all-cause mortality (log HR −0.247, SE 0.101, p=0.015); Heterogeneity: df=13 (P&lt;0.01), I2=97.057; Test for overall effect: Z=−2.431 (Figure 1). When further stratified based on dialysis, CKD patients without the need for dialysis had favorable outcome (log HR −0.211, SE 0.095, p=0.026); Heterogeneity: df=6 (P&lt;0.01), I2=70.146; Test for overall effect: Z=−2.225, whereas ICD implantation in CKD patients requiring dialysis was not associated with mortality benefit (log HR −0.262, SE 0.134, p=0.051) (Figure 2A, B).

Conclusion
ICD implantation is associated with mortality benefit in patients with CKD, but this association is not present for patients requiring dialysis.

Funding Acknowledgement
Type of funding sources: None.
Mechanical dyssynchrony, a novel marker to predict long-term survival in patients with cardiac resynchronization
Authors: Ahmed M A , Sohns C , Rudolph V , Dumitrescu D , Faber L , Fox H 
Published: October 2022

Abstract

Background
Cardiac resynchronization therapy (CRT) is an established therapy in patients with symptomatic heart failure with reduced left ventricular ejection fraction (LVEF &lt;35%) (HFrEF) that have conduction disturbances as measured by prolonged QRS duration of &gt;130 ms. Mechanical dyssynchrony (MD) in echocardiography has not proven benefit to determine CRT indication, but is hypothesized to be of predictive value. Both MD aspects of “apical rocking” (AR) but also “septal flash” (SF) have been shown to be a predictive value in short- and medium-term follow-up in CRT, but no trial has tested long-term effects yet.

Purpose
This study investigated the impact of AR and SF on long-term survival in CRT recipients.

Methods and results
425 HFrEF patients (mean age: 63.0±10.6 years, 72.3% male, 60.7% non-ischemic etiology) with ESC guideline-derived CRT indication have been implanted and additionally investigated for MD markers at baseline as well as after a 11.5±8.0 months follow-up including long-term survival. Herein AR and/or SF were identified in 307 (72,2%) participants at baseline. During follow-up both AR and/or SF disappeared in 256 (83.4%) patients through CRT use. The overall mean survival was 95.9±52.9 months. Univariable analysis showed beneficial survival for women over men (109.1±52.4 vs. 90.9±52.4 months; p&lt;0.001). Moreover, younger (&lt;60 years) patients profit more than older patients (110.6±53.7 vs. 88.6±51.1 months; p&lt;0.001). Interestingly, patients with MD markers at baseline generally had an improved overall survival (106.2±52.0 vs. 68.9±45.4 months; p&lt;0.001), and in addition to that we found the best survival in patients with disappeared over persisting mechanical dyssynchrony echocardiography parameters in CRT (111.6±51.2 vs. 79.7±47.6 months p&lt;0.001). Multivariate analysis shows age and presence of MD at baseline to be powerful predictors for long-term survival in CRT HFrEF patients (Figures 1 and 2).

Conclusion
Novel echocardiography MD parameters before CRT implantation predict long-term survival. Moreover, long-term survival even further improves when AR and/or SF disappear through CRT in HFrEF. Our results encourage a prospective, randomized, controlled, multicenter trial to study clinical implementation of MD in CRT patients.

Funding Acknowledgement
Type of funding sources: None.
Electromechanical factors associated with response to cardiac resynchronization therapy
Authors: Jadczyk T , Maffessanti F , Wilczek J , Conte G , Caputo M L , Golba K S , Biernat J , Cybulska M , Caluori G , Regoli F , Krause R , Wojakowski W , Prinzen F W , Auricchio A 
Published: October 2022

Abstract

Background
Cardiac resynchronization therapy (CRT) is clinically proven in patients with heart failure (HF) and left bundle branch block (LBBB). However, approximately 30% of CRT individuals are non responsive to the therapy while factors affecting electromechanical coupling remain not fully understood.

Objective
To determine the optimal combination of electromechanical parameters associated with responsiveness to CRT.

Methods
Sixty-two patients with HF/LBBB underwent invasive anatomo-electromechanical mapping (AEMM) of the left ventricle using NOGA XP system (Biosense Webster), cardiac magnetic resonance (cMR), transthoracic echocardiography and 12-lead ECG. Remodeling was quantified based on the end-systolic volume (ΔESV) decrease at 6-month follow-up. Response to CRT was defined as ΔESV ≤−15%. QRS duration (QRSd) was measured from a surface ECG. Area strain was obtained from AEMM and used to calculate systolic stretch index (SSI) and total left ventricular mechanical time (TLVMT). Total left ventricular activation time (TLVAT) and transeptal time (TST) were derived from AEMM and ECG. Scar burden was evaluated from cMR late gadolinium enhancement imaging.

Results
Significant correlations were observed between ΔESV and TST (rho=0.42; responder: 50 [20–58] vs non-responder: 33 [8–44] ms), TLVAT (−0.68; 81 [73–97] vs 112 [96–127] ms), scar burden (−0.27; 0.0 [0.0–1.2] vs 8.7 [0.0 19.1]%) and SSI (0.41; 10.7 [7.1–16.8] vs 4.2 [2.9–5.5]), but not QRSd (0.11; 155 [140–176] vs 167 [155–177] ms). TLVAT and SSI had a high predictive value for CRT response (AUC&gt;0.80). TLVAT (OR=1.50), scar burden (0.91) and SSI (0.04) were independent factors associated with a positive response to CRT. Individuals with SSI &gt;7.9% and TLVAT &lt;91 ms all responded to CRT, while low SSI and prolonged TLVAT were more common in non-responders.

Conclusion
Electromechanical parameters show better correlation with CRT response than traditional surface ECG measurements. The absence of scar combined with high SSI and low TLVAT ensures effectiveness of CRT.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Swiss National Science Foundation, Statutory funds of the Medical University of Silesia
Acute hemodynamic effects of biventricular pacing studied during cardiovascular magnetic resonance imaging: the PICARIA Trial
Authors: Hopman L H G , Zweerink A , Van Der Lingen A C J , Mulder M J , Robbers L F H , Van Halm V P , Van Rossum A C , Gotte M J W , Allaart C P 
Published: October 2022

Abstract

Background
Cardiac resynchronization therapy (CRT) is hampered by a relative high rate of non-response whereby device optimization could aid in improving benefit from CRT. Nonetheless, a non-invasive and reproducible clinical tool for device optimization is currently lacking. Recently introduced cardiovascular magnetic resonance (CMR) compatible CRT devices may allow for patient follow-up and device optimization as biventricular (BIV) pacing can be performed during the CMR exam. However, to date, CMR evaluation of acute pump function changes during CRT is limited.

Purpose
To assess the effects of BIV-pacing on change in left ventricular (LV) function and contraction patterns using CMR.

Methods
Ten patients were included in this prospective pilot study. All patients underwent CMR imaging (1.5T system) prior to device implantation (baseline), and 6 weeks after device implantation (CRT-on and CRT-off). LV end systolic volume (ESV), end diastolic volume (EDV), ejection fraction (LVEF), and measures of LV dyssynchrony and dyscoordination (septal systolic rebound stretch (SRSseptal)) were assessed on cine images.

Results
LV function and contraction patterns before and after device implantation are compared and displayed in the figure. LV ESV and EDV decreased in all patients during BIV-pacing as compared to intrinsic rhythm (CRT-off) (ESV; 161.4±36.3ml vs. 194.9±37.1ml, p&lt;0.01 and EDV; 236.2±31.8ml vs. 268.1±42.3ml, p&lt;0.01). A significant improvement in LVEF was observed during BIV-pacing (32.2±8.7% vs. 27.4±5.9%, p&lt;0.01). Both, regional dyssynchrony and regional dyscoordination significantly improved during CRT-on compared to CRT-off (peakseptal-peaklateral; 57±46ms vs. 183±86ms, p&lt;0.01 and SRSseptal; 2.1±2.6% vs. 6.0±3.0%, p&lt;0.01).

Conclusions
Post-CRT implantation CMR assessing acute pump function changes to different CRT pacing settings is feasible and provides important insights in the effects of BIV-pacing on cardiac function and contraction patterns. LV assessment using CMR, potentially in combination with non-invasive pressure measurements, may constitute a future CRT optimization strategy.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Biotronik (Berlin, Germany)
Long-term outcome in patients with heart failure after cardiac surgery other than coronary artery bypass grafting treated with cardiac resynchronization therapy
Authors: Jedrzejczyk-Patej E , Mazurek M , Lenarczyk R , Sokal A , Kotalczyk A , Kowalska W , Gumprecht J , Kowalski O , Kalarus Z 
Published: October 2022

Abstract

Background
Cardiac resynchronization therapy (CRT) has been proven therapy in patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF). However, little is known about the prognosis, and the risk of cardiac device-related infective endocarditis (CDRIE) in patients with HF after cardiac surgery other than coronary artery bypass grafting (CABG) treated with CRT.

Aim
To assess the long-term outcome, mortality predictors, and the risk of CDRIE in patients with HF after cardiac surgery other than CABG treated with CRT.

Methods
The study population consisted of 1059 consecutive patients with CRT implanted between 2002 and 2019 in a tertiary care university hospital in a densely inhabited, urban region of Poland (949 subjects [89.6%] with CRT-D; 110 patients with CRT-P [10.4%]).

Results
The studied population was divided into two groups according to be or not after cardiac surgery other than CABG (n=74 patients [6.9%] vs. n=985 patients [93.1%]). During the median follow-up of 1661 days (10th and 90th percentile: 323–3995), all-cause mortality in patients after cardiac surgery other than CABG did not differ significantly in comparison to other CRT recipients (50% vs. 54.4%, P=0.46). Also, the risk of CDRIE was not statistically significant differ (2.7% vs. 5.7%, P=0.28). On multivariable regression analysis, only older age (HR 1.04, 95% CI 1.01–1.07, P=0.02) was identified as independent predictor of higher mortality in patients after cardiac surgery treated with CRT.
Kaplan-Meier curves of survival of patients after cardiac surgery other than CABG treated with cardiac resynchronization therapy in comparison to other CRT recipients are presented on Picture 1.

Conclusions
The mortality rate in patients after cardiac surgery other than CABG is similar to other subjects treated with CRT and reaches 50% within 4.5 years. The risk of device-related infective endocarditis is not higher than in other patients treated with CRT. Advanced age is an independent mortality predictor in subjects after cardiac surgery other than CABG undergoing CRT.

Funding Acknowledgement
Type of funding sources: None.
His-pacing and biventricular pacing show similar efficiency in resynchronization and improvements in longitudinal contractile function
Authors: Hoejgaard E V , Philbert B , Svendsen J H , Vinther M , Risum N 
Published: October 2022

Abstract

Background
The clinical role for HIS-pacing in cardiac resynchronization therapy (HIS-CRT) is promising but is yet to be established. The randomised His-alternative study showed better remodelling with HIS-CRT compared to patients receiving conventional biventricular pacing (BIV-CRT) in the per-protocol-analysis.

Purpose
In this substudy we investigated whether HIS-pacing was more efficient compared to BIV-CRT in improving mechanical synchrony and longitudinal contractile function.

Methods
In the His-Alternative study 50 patients with symptomatic heart failure, left ventricular ejection fraction (LVEF) ≤35% and Left bundle branch block were randomized 1:1 to His-CRT or BiV-CRT and followed for 6 months. At implantation, 7 patients crossed over from His-pacing to LV-pacing in the His-CRT group and 1 patient crossed over from LV-pacing to His-pacing in the BiV-CRT group. All patients had echocardiography performed including 2D-strain echocardiography to asses global systolic longitudinal deformation (GLS) at baseline and 6 months. Mechanical dyssynchrony was measured as SD of time-to-peak in all 12 segments of the left ventricle (TPS-SD).

Results
There were no significant differences in baseline characteristics between patients receiving HIS-CRT and BIV-CRT with regard to dyssynchrony and longitudinal systolic strain. LVEF was significantly higher at 6 months (48±8% vs. 42±8%; p&lt;0.05) in the HIS-CRT group. However, GLS did not significantly improve more with HIS-CRT compared to BIV-CRT, (−8.7ms ± 2.0 to −11.1 ms ± 2.0 vs −9.1 ms ± 2.7 to −10.8±2.5 ms ± 2.8, P = ns for difference) and regarding resynchronization measured as TPS-SD there was no significant difference either (110 ms ± 51 to 47 ms ± 10 vs. 115 ms ± 42 to 60 ms ± 21, P = ns for difference).

Conclusion
In this substudy, HIS-pacing did not prove more efficient than BIV-CRT in resynchronizing the left ventricle, nor did the observed improvement in longitudinal function differ significantly between methods. However, the number of included patients was rather small and larger studies are needed to fully assess the possible benefits of HIS-CRT.

Funding Acknowledgement
Type of funding sources: None.
Long-term lead and mortality following pacemaker and defibrillator implantation in adult congenital heart disease
Authors: Stokes A , Karadakhy O , Lui C , Argyriou A , Almansoor Z , Adegboye O , Biswas S , Raj Krishna G , Agrawal D , Shah A , Kirkwood G , Morris G 
Published: October 2022

Abstract

Background
Adult congenital heart disease (ACHD) survival has dramatically improved in recent decades. As such, clinicians now face the complex long-term interactions of congenital and chronic heart diseases. One area of continuing mortality in this group is arrhythmias, especially in those with cardiovascular implantable electronic devices (CIEDs). With these developments in survival, the long-term outcomes of the CIED systems and their effects on mortality are beginning to be elucidated.

Aims
This study aims to compare the effects of system location, surgical history, patient demographics and congenital disease complexity on lead survival, complication distributions and patient mortality in ACHD CIED patients.

Methods
A retrospective cohort of 250 ACHD CIED patients with follow up at a heart centre was collated from clinical correspondence letters and CEID records. Data was collected on demographics, mortality and lead survival and complications. Survival data was analysed with Kaplan-Meier (KM) curves and hazard ratio tests.

Results
Complex ADHD patient survival was less than the non-complex cohort (HR 0.38, 95% CI 0.22–0.67, p&lt;0.01). Lead survival was longer in non-surgical patients (HR 1.42, 95% CI 1.13–1.78, p&lt;0.01) and longer in female patients (HR 1.35, 95% CI 1.07–1.69, p&lt;0.01) (Figure 1). No significant differences in mortality or lead survival were seen between epicardial and transvenous systems.

Conclusions
Complex ACHD is associated with worse patient mortality in CEID patients. Surgical history and male gender are associated with worsened lead survival.

Funding Acknowledgement
Type of funding sources: None.