bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nationwide study of sudden cardiac death in young persons diagnosed with chronic kidney disease
Authors: Svane J , Nielsen JL , Feldt-Rasmussen B , Garcia R , Risgaard B , Gislason GH , Winkel BG , Lynge TH , Tfelt-Hansen J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): This work was supported by Novo Nordisk Foundation, Copenhagen, Denmark.

Background
Chronic kidney disease (CKD) is associated with increased risk of cardiovascular morbidity and mortality. The increased cardiovascular mortality is partly explained by an increased risk of sudden cardiac death (SCD) among patients with CKD.

Purpose
The purpose of this study was to compare short- and long-term risk of SCD in individuals with and without CKD aged 18-49 years.

Methods & Results
Using the Danish nationwide health registries, all persons aged 18-49 years diagnosed with non-failure stage CKD or kidney failure from 1st of July 1995 through 2009 were identified. Non-exposed subjects matched on sex and birth-year were included 50:1. All SCD in the Danish population aged 18-49 years in 2000-2009 have previously been identified by thoroughly examining the Danish Registries, the Danish death certificates, autopsy reports and discharge summaries. In total, 9,476 incident cases of non-failure stage CKD and 1,283 incident cases of kidney failure were included.
For patients with non-failure stage CKD and kidney failure, the absolute risk of all-cause mortality 10-year after diagnosis was 8.7% and 23.6%, respectively. Among patients with non-failure stage CKD, the absolute risk of SCD 1, 5 and 10 years after diagnosis was 0.14%, 0.37%, and 0.68%, respectively. Compared with age- and sex matched subjects the corresponding relative risk was 20 (95%-CI 8.4-48.8), 7.1 (95%-CI 4.2-12.0), and 6.1 (95%-CI 3.8-9.7), respectively. Among patients with kidney failure, the absolute 1, 5, and 10 year risk of SCD was 0.17%, 0.56% and 2.07%, respectively. The corresponding relative risk was 12.5 (95%-CI 1.4-111.6), 7.9 (95%-CI 2.3-27.0) and 10.1 (95%-CI 4.5-22.6), respectively.

Conclusions
Persons with non-failure stage CKD and kidney failure had increased risk of SCD compared with the background population with a 20- and 13-fold increased risk one year after diagnosis, respectively. These findings underline the importance of early cardiovascular risk monitoring and assessment in persons with CKD.
Failed shocks in hypertrophic cardiomyopathy patients: prevalence, predictors and outcome
Authors: Segev A , Fishman B , Wasserstrum Y , Beinart R , Arad M , Sabbag A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
An implantable cardioverter-defibrillator (ICD) is used in selected high-risk hypertrophic cardiomyopathy (HCM) patients in order to prevent sudden arrhythmic death. The unique features of this population raise concerns regarding the reliability of successful defibrillation.

Purpose
To describe the rate and discover potential predictors of failed shocks in HCM patients.

Methods
We retrospectively evaluated all HCM patients with an ICD from a single tertiary medical center. Clinical, electrocardiographic and echocardiographic data were collected and compared among patients with and without failed shocks.

Results
A total of 99 patients (77% male, 45±17 years old) were analyzed. Over a median follow up of 6.3 years (IQR 2.6-10.7), 20 patients developed sustained ventricular arrhythmia (VTA). Of those, 18 patients received appropriate shocks from their ICD. VTA was associated with younger age at diagnosis, history of syncope and thicker maximal LV width. Six patients experienced at least one failed shock. The likelihood of failed shocks was similar when single or dual coil electrodes were used (dual coils in 67% of patients with failed shocks and 50% in those without), and the only predictor was increased wall thickness [OR 1.2 (1.07-1.38) per 1 mm]. All-cause mortality was low and similar in patients with an without failed shocks (0% vs 8%, P=0.5)

Conclusions
Failed shocks are a rare entity in HCM patients. Increased maximal LV width was the only predictor of those events. Our findings support avoiding defibrillation threshold testing routinely, but may indicate its need in patients with extreme LV wall thickening (≥23 mm).
Very low event rate and few device implants in drug-induced brugada. A seven-year experience of ajmaline challenge at a district general hospital
Authors: Brown S , Furniss G , Dayer M , Bailey J , Kemp J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Patients with a drug-induced Brugada electrocardiogram (ECG) are thought to have a lower risk of sudden cardiac death than those with a spontaneous type 1 ECG. Despite having a Brugada ECG, most patients do not need an implantable cardioverter defibrillator (ICD).

Purpose
To report a district general hospital experience on referral and outcomes of ajmaline challenge (AC) with medium term follow up.

Methods
92 consecutive patients (50 males, mean age 41 ±17) had an AC in a single centre from 2014-2021. High ventricular leads were used from 2015. Ajmaline (1m/kg) was administered intravenously over 10-minutes. Data were collected from the electronic health record.

Results
The AC was positive in 18 (20%) patients. The yield from high leads was higher (7% vs 22%) p=0.28) but not statistically significant. There were no deaths or documented ventricular arrhythmias (VA) in AC positive patients during a median follow up of 3.2 years (1.7-4.9).
The resting ECG was normal in 46.7%. A type 1 pattern had been provoked by fever or electrolyte derangements in 3.3%, type 2 pattern in 8.7% and a type 3 pattern in 5.4%. An RSR pattern (not in keeping with a BrS ECG) was seen in 26.4%. The test was stopped prematurely due to QRS widening &gt;150ms in 1 patient. No adverse arrhythmic events occurred (table 1).
In our cohort, positive AC patients were older (48y vs 37y p= 0.05) and more likely to have a type 2 (28% vs 4% p=0.007) or type 3 ECG (17% vs 3% p=0.05). Asymptomatic patients were more likely to have a normal ECG (22% vs 78% p=0.05)
Of those with a positive AC, nine patients had symptoms of palpitations or syncope (table 2). A subcutaneous ICD (S-ICD) was implanted for syncope in two patients. No device therapies have occurred during a follow up of 2.5 years and 3.9 years respectively. Of those with a positive AC but asymptomatic, one S-ICD was initially implanted due to patient preference. A second S-ICD was implanted in a patient who experienced a collapse and brief seizure in the context of modest alcohol consumption.
In seven positive patients (39%) and 18 negative patients (23%) an ILR was implanted. 1 episode of complete heart block was detected in an ajmaline negative patient during a median follow up of 2.7 years (1.7-3.9).
There were no device related complications or adverse events.

Conclusion
AC is safe with a low number of device implants and ICD shocks. The yield from ILR implants was very low. A single patient had a potentially adverse outcome after consuming alcohol, a known trigger for VA in BrS. Our findings are in keeping with contemporary evidence that suggests the risk of adverse cardiac events in drug-induced BrS is low. However, time to first ICD shock may occur after ten years or more from diagnosis so long term follow up is required.
Access site bleeding complications comparing oral anticoagulation therapy with NOACs and VKAs in patients with atrial fibrillation undergoing cardiac implantable device intervention
Authors: Spinoni E , Ghiglieno C , Costantino S , Battistini E , Dell’era G , Porcellini S , Santagostino M , De Vecchi F , Patti G 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial fibrillation is frequent in patients undergoing cardiac implantable electronic device (CIED) intervention. Such population require oral anticoagulation therapy, which increases risk of procedure related bleeding. There is a lack on data on procedure-related bleeding outcome with non-vitamin K antagonist anticoagulants (NOACs) vs vitamin K antagonist anticoagulants (VKAs) in patients with AF undergoing CIED intervention.

Study purpose
Aim of the present stud was to evaluate whether NOACs have a safety benefit compared to VKAs in terms of fewer hemorrhagic complications at the site of CIED implant.

Methods
Consecutive AF patients receiving NOACs or VKAs at the time of CIED procedure were included in this observational, retrospective, monocentric investigation. Primary endpoint was the incidence of post-intervention clinically significant pocket hematoma. Multivariate analysis was performed to investigate the association between covariates and the primary endpoint.

Results
A total of 311 patients were enrolled, 146 on NOACs and 165 on VKAs. The incidence of pocket hematoma was 3.4% in the NOAC vs 13.3% in the VKA group (p=0.002) (Figure 1). Primary outcome-free survival at 30-days was 96.6 % in patients on NOACs and 86.0% in those on VKAs (p=0.019) (Figure 2). Multivariate analysis, adjusted by propensity-score calculation of inverse-probability-weighting, showed a significantly lower occurrence of pocket hematoma in patients receiving NOACs vs VKAs (HR 0.35, 95% CI 0.13-0.96, p=0.042). Such NOACs benefit was confirmed vs patients on VKAs without peri-procedural bridging with low-molecular weight heparin (HR 0.34, 95% CI 0.11-0.99, p=0.048). The incidence of pocket infection, surgical pocket evacuation, ischemic events and major bleeding complications at 30 days (secondary endpoints) was similar in the two groups.

Conclusion
Among patients with AF undergoing implantable cardiac defibrillator or pace-maker intervention, the use of NOACs vs VKAs is associated with significant reduction of post-procedural pocket hematoma, regardless of bridging with low molecular-weight heparin in the VKA group.
Impact of the use of cusp overlap projection technique in the incidence of post-TAVR permanent pacemaker implantation with self-expanding valves
Authors: Moura A , Rodrigues JA , Guerreiro C , Pires-Morais G , Santos L , Melica B , Braga P , Fontes-Carvalho R 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Current rates of new Permanent Pacemaker (PPM) Implantations in the context of Transcatheter Aortic Valve Replacement (TAVR) range from 2-36% and that necessity is related to worse prognosis. The use of self-expanding valves and a lower valve implantation depth are two factors associated with an increased risk of conduction disturbances post-TAVR. Theoretically, cusp overlap implantation technique has the potential to enable a higher valve deployment by eliminating parallax of the delivery catheter.

Aim
To compare the in-hospital incidence of PPM post-TARV using self-expandable valve according to the fluoroscopic guidance technique.

Methods
Retrospective, single-centre study, with evaluation of patients consecutively submitted to TAVR with self-expanding CoreValveTM between July 2020 and December 2021 dichotomized according to the use of cusp overlap implantation technique for fluoroscopic valve implantation guidance.

Results
138 patients were included, predominantly women (57.2%), with a mean age of 78.4±8.0 years old, with severe aortic stenosis of the native valve being the most common indication for TAVI (85.5%). Cusp overlap view technique was applied in 50.7% of the patients (n=70). Frailty and co-morbidities were the most common cause for surgical refusal (54.3%). There was a significantly higher percentage of hypertensive patients (92.9% vs. 77.9%), lower previous aortic valve surgery (2.9% vs. 16.2%) and lower percentage of patients previously medicated with b-blockers in the group of patients in whom was used the cusp overlap technique; there were no other relevant differences related to the baseline characteristics. First degree atrioventricular block was present in 19.6% and complete right bundle block in 13.6% of the patients. Incidence of in-hospital post-TAVR PPM implantation wasn’t significantly different between the two cohorts of patients (cusp overlap vs. standard approach: 24.3% vs. 26.5%, p=0.77) (71.4% implanted in the context of complete heart block). Likewise, there were similar proportions of in-hospital new-onset of complete left bundle branch block (35.8% vs. 37.3%, p=0.86), volume of contrast used (140.6±37.5 mL vs. 145.2±51.5 mL, p=0.12), fluoroscopy time (15.6±8.8 min vs. 19.6±8.9 min, p=0.40) and radiation dose (556.3±320.6 mGy vs. 859.4±531.2 mGy, p=0.06).

Conclusions
This study shows that using the cusp overlap view for self-expanding valve implantation does not seem to achieve a significant reduction in in-hospital PPM implantation rate in comparison with the traditional 3 cusp co-planar fluoroscopic view. A larger and probably randomized clinical trial is needed to confirm these results.
Learning curve of left bundle branch area pacing with standard stylet-driven pacing leads: a single center prospective observational study in Korea
Authors: Yu G , Kim TH , Yu HT , Joung BY , Pak HN , Lee MH 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Although cardiac pacing is an essential therapy for bradycardia, conventional right ventricular pacing (CRVP) can cause electrical-mechanical dyssynchrony. Left Bundle Branch Area Pacing (LBBAP) is a new conduction system pacing strategy that includes a normal conduction system and therefore maintains synchronous ventricular contraction. Most of the experience with LBBAP is done in a lumen-less lead with fixed helix design, and this device is not available in sometimes.

Purpose
This study aimed to evaluate the learning curve of LBBAP using standard stylet-driven lead with extendable helix design.

Methods
This study enrolled patients who underwent permanent cardiac pacemaker implantation at a University Hospital in South Korea from December 2020 to October 2021. LBBAP was performed with a 5.6Fr stylet-driven pacing lead with an extendable helix. The learning curve was assessed by analyzing fluoroscopy time and procedure time.

Results
In 65 patients who underwent LBBAP during the observation period, mean fluoroscopy time and procedural time were 17.1 ± 17.2 minutes and 64.2 ± 33.5 minutes, respectively in this study. The learning curve for achieving LBBAP appears to plateau after around 24th case with a progressive reduction in procedure time. This is a significantly shorter period of time when compared to the previously reported learning curves of his bundle pacing (30-50cases), previously developed conduction system pacing strategy.

Conclusion
During initial experience with LBBAP, fluoroscopy and procedural time continue to improve with operator experience. For physicians who are experienced at cardiac pacemaker implantation, the steepest part of the learning curve of LBBAP appears to be over the first 20-25 cases.
VDD leadless pacemaker: atrioventricular synchrony predictors
Authors: Estevez Paniagua A , Briongos Figuero S , Sanchez Hernandez A , Munoz Aguilera R 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Leadless pacemaker technology has shown a reduction of the complications associated with conventional pacemakers. The development of the VDD mode has allowed us to extend the use of leadless pacemakers to patients in need of pacing due to atrioventricular (AV) block. Maintaining AV synchrony (AVS) in cardiac pacing improves cardiac output and quality of life and reduces the risk of atrial fibrillation (AF) and pacemaker syndrome. In previous analyses, it was observed that the low amplitude of the A4 signal was associated with low AVS.

Methods
Prospective single-center study of consecutive patients who received a VDD leadless pacemaker (Micra AV), and who remained in VDD mode throughout the follow-up. Our purpose was to analyze the possible predictors of A4 signal amplitude and AVS in the first month of follow-up. We tested univariate association with A4 signal and AVS of echocardiographic data, clinical variables, implant parameters, and pacemaker function.

Results
We included data from the first 21 patients who received a VDD leadless pacemaker (Micra AV) between Jun/20 and Apr/21. 18 patients remained in VDD mode after the first month of follow-up. There was no significant association between ventricular filling waves (E and A) and Tissue-Doppler diastolic waves (E ’and A’) with the A4 signal and the percentage of AVS. Only the E / A ratio showed a trend of association with the percentage of AVS, although it did not reach statistical significance (p = 0.09), showing an inverse relationship (Pearson’s correlation coefficient of -0.396). None of the clinical variables analyzed showed an association with the A4 signal or with the percentage of AVS. Only the A4 signal was significantly associated with the percentage of AVS (Pearson´s correlation coefficient of 0.524, p = 0.02). Considering 85% as an adequate discriminator for correct AVS, the mean signal of A4 was significantly lower (p = 0.03) in those with AVS &lt; 85% (2.63 ± 1.73) compared with those with AVS≥85% (4.37± 1.34). Regarding implant factors, there seems to be a tendency to worse AVS with higher number of releases (p = 0.06, Pearson’s correlation coefficient of -0.460), as well as when implanting in positions further away from the atrium (medium interventrcular septum vs. high interventricular septum / proximal right ventricular outflow tract; p = 0.06, Pearson’s correlation coefficient of -0.463).

Conclusions
Although this is a short case series, our results are aligned with the data from the MARVEL2 AVS predictors substudy. It appears that the main predictor of higher AVS is the A4 signal. Device position, as well as the number of releases, could also play a role. Nevertheless, it is necessary to continue the analysis with the data of future patients to corroborate these preliminary findings.
Right ventricular lead sensing latency in pacemaker therapy
Authors: Zagkli F , Kalovrenti N , Patrinos P , Chronopoulos P , Chiladakis J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Pacemaker’s ventricular sensing function relies on the analysis of the intracardiac electrogram (EGM) including the timing of the intrinsic detection. The phenomenon of ventricular sensing latency refers to the gap of time by which the intrinsic signal gets delayed to be detected compared with the surface electrogram (ECG). A pacing system analyzer (PSA) unit is needed to record the EGM during pacemaker operation, which is expected to correspond to those taken following implantation.

Purpose
We sought to determine the latency period for sensing EGM by the right ventricular (RV) lead, either through the PSA or through the implanted pacemaker on the same patient.

Methods
Patients without significant heart disease and intrinsic atrioventricular conduction underwent conventional dual-chamber Medtronic or Abbott pacemaker implantation with the RV lead positioned on mid-septum. Real time sensing data was obtained through PSA and after pacemaker implantation. The RV lead sensing latency was defined as the time interval Q-VS measured from the beginning of QRS on ECG to the released ventricular sensed (VS) event marker on either device.

Results
Of 157 patients, 105 had narrow QRS (&lt;120 ms) and 52 had wide QRS (≥120 ms) of right bundle branch block (RBBB). Both narrow QRS and RBBB patients had longer sensing latency through PSA (50.9 ± 24.2 ms and 67.8 ± 32.9 ms, respectively) than through pacemaker (18.2 ± 12.8 ms and 31.2 ± 14.8 ms, respectively, both p&lt;0.001). RBBB patients had longer sensing latency compared with narrow QRS patients, either through PSA or through pacemaker (p&lt;0.001). The sensing latency of Medtronic recipients was longer than those of Abbott in narrow QRS, but not in RBBB (p=0.03 and p=0.08, respectively).

Conclusion
We demonstrated longer RV lead sensing latency (1) through PSA than through the implanted pacemaker, (2) in RBBB than in narrow QRS, (3) in Medtronic pacemakers compared with Abbott pacemakers. Knowledge of the RV lead sensing latency helps optimization of atrioventricular delay and reduces unnecessary ventricular pacing.
The subcutaneous ICD replacement in the clinical practice: preliminary observations from the multicentre RHYTHM DETECT
Authors: Bianchi V , Viani S , De Filippo P , Dello Russo A , Checchi L , Biffi M , Caravati F , Giammaria M , Pisano’ E , Papa A , Francia P , Bongiorni M , Valsecchi S , D’onofrio A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Experience with the subcutaneous implantable cardioverter-defibrillator (S-ICD) is expanding rapidly. However, few data on generator replacement exist.

Purpose
The aim of this analysis was to describe the procedural characteristics of the pulse generator replacement in the current Italian practice and to provide a preliminary insight in the possible acute complications associated with first elective S-ICD generator replacements.

Methods
We analyzed 106 consecutive patients enrolled in the Rhythm Detect registry who underwent elective replacement of the S-ICD generator from September 2019 to July 2021. Procedures were accomplished according to the local clinical practice. A chest X-ray was performed, and the PRAETORIAN score was assessed and compared with the one measured after the first implantation.

Results
All replacements were performed in electrophysiology laboratories, 50% in day-hospital regimen, by 1 or 2 expert operators. Procedures were performed using local (87%) or general anaesthesia (13%). The median procedure duration was 40 (30-45) min. The previous S-ICD generator was in a subcutaneous pocket in 58 (55%) patients, and in an intermuscular pocket in the remaining patients. The PRAETORIAN score of the previous system was low (&lt;90) in 93% of patients and intermediate in 7% of patients. In all patients with the device in an intermuscular pocket, the PRAETORIAN score was &lt;90. During the replacement procedure, 22 S-ICD (3 with PRAETORIAN ≥90 before replacement) were removed from the initial subcutaneous position and placed in an intermuscular pocket. After replacement all patients with intermuscular devices had a score &lt;90, and the overall proportion of patients with low-risk PRAETORIAN score raised to 97%. Defibrillation testing was performed only in 10% of patients, while testing was performed in 77% of patients at the first implantation procedure. No procedure-related complications occurred.

Conclusions
S-ICD replacements seem easy to perform with no peri-procedural complications. The adoption of an intermuscular pocket is associated with optimal positioning according to the PREATORIAN score, and seems preferred also in many cases of generators previously placed subcutaneously. In the Italian clinical practice conversion testing is rarely performed at device replacement.