Journal: Heart Rhythm

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<div><h4>Radiotherapy-induced Malfunctions of Cardiac Implantable Electronic Devices: a Meta-analysis.</h4><i>Xu B, Wang Y, Tse G, Chen J, ... Korantzopoulos P, Liu T</i><br /><b>Background</b><br />Radiation therapy (RT) may pose acute and long-term risks for patients with cardiac implantable electronic devices (CIEDs), including pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs).<br /><b>Objective</b><br />We conducted a systematic review and meta-analysis to examine the association between RT and PMs/ ICDs malfunctions in cancer patients.<br /><b>Methods</b><br />We searched the literature using the PubMed, the Cochrane clinical trials database, and the Web of Science and Embase, for relative publications until April 2022. Of the 550 initially identified studies, 17 retrospective observational studies including 2,454 patients were finally analyzed.<br /><b>Results</b><br />The meta-analysis showed that RT was associated with an increased risk of ICDs malfunctions (OR 2.75, 95%CI 1.74-4.33). Five studies were included in the subgroup analysis regarding photon beam energy showing that radiation induced CIEDs failure was more likely to occur in ICDs when beam energy was ≥10MV (OR 5.28, 95%CI 2.14-13.03). Neutron-generating RT significantly increased the risk of CIEDs malfunctions (OR 3.97, 95%CI 1.70-9.26), especially the risk of reset (OR 5.79, 95%CI 2.37-14.12, p=0.0001). We did not find significant differences in the risk of CIEDs failure between chest RT and other RT sites (OR 1.09, 95%CI 0.63-1.88).<br /><b>Conclusion</b><br />Our meta-analysis suggests that ICDs are more likely to be affected by RT than PMs. These adverse events, especially reset, in cancer patients were associated with neutron-generating RT and beam energy ≥10MV. Given the increasing requirement for RT in several cancer patients as well as the increasing implantation rates of CIEDs, a better risk stratification is needed in this setting.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 25 Jan 2023; epub ahead of print</small></div>
Xu B, Wang Y, Tse G, Chen J, ... Korantzopoulos P, Liu T
Heart Rhythm: 25 Jan 2023; epub ahead of print | PMID: 36708909
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<div><h4>Right bundle branch pacing: criteria, characteristics and outcomes.</h4><i>Jastrzębski M, Kiełbasa G, Moskal P, Bednarek A, ... Burri H, Vijayaraman P</i><br /><b>Background</b><br />Targets for right-sided conduction system pacing (CSP) include His bundle and right bundle branch. ECG patterns, diagnostic criteria and outcomes of right bundle branch pacing (RBBP) are not known.<br /><b>Objective</b><br />Our aims were to delineate electrocardiographic and electrophysiological characteristics of RBBP and to compare outcomes between RBBP and His bundle pacing (HBP).<br /><b>Methods</b><br />Patients with confirmed right CSP were divided according to the conduction system potential to QRS interval at the pacing lead implantation site. Six hypothesized RBBP criteria as well as pacing parameters, echocardiographic outcomes and all-cause mortality were analyzed.<br /><b>Results</b><br />All analyzed criteria discriminated between HBP and RBBP: double QRS transition during threshold test, selective paced QRS different from conducted QRS, stimulus to selective QRS > potential-QRS, small increase in V<sub>6</sub>RWPT during QRS transition, equal capture thresholds of CSP and myocardium, and stimulus-V<sub>6</sub> R-wave peak time (V<sub>6</sub>RWPT) > potential-V<sub>6</sub>RWPT (adopted as diagnostic standard). Per this last criterion, RBBP was observed in 19.2% (64/326) patients who had been targeted for HBP, present mainly among patients with potential to QRS < 35 ms (90.6%, 48/53) and occasionally in the remaining patients (5.6%, 16/273). RBBP was characterized by longer QRS (by 10.5 ms), longer V<sub>6</sub>RWPT (by 11.6 ms) and better sensing (by 2.6 mV) compared to HBP. During median follow-up of 29 months, no differences in capture threshold, echocardiographic outcomes or mortality were found.<br /><b>Conclusions</b><br />RBBP has distinct features that separate it from HBP and is observed in approximately a fifth of patients in whom HBP is intended.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 23 Jan 2023; epub ahead of print</small></div>
Jastrzębski M, Kiełbasa G, Moskal P, Bednarek A, ... Burri H, Vijayaraman P
Heart Rhythm: 23 Jan 2023; epub ahead of print | PMID: 36702391
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<div><h4>Pre-clinical Evaluation of a Third Generation Absorbable Antibacterial Envelope.</h4><i>Love CJ, Hanna I, Thomas G, Greenspon AJ, ... Kirchhof N, Sohail MR</i><br /><b>Background</b><br />The TYRX absorbable antibacterial envelope has been shown to stabilize implantable cardiac devices and reduce infection. A third-generation envelope was developed to reduce surface roughness with a redesigned multifilament mesh and enhanced form-factor but identical polymer coating and antibiotic concentrations as the currently available second-generation envelope.<br /><b>Objective</b><br />To compare drug elution, bacterial challenge efficacy, stabilization, and absorption of second- vs. third-generation envelopes.<br /><b>Methods</b><br />Antibiotic elution was assessed in vitro and in vivo. For efficacy against gram+/gram- bacteria, 40 rabbits underwent device insertions with or without third-generation envelopes. For stabilization (migration, rotation), 5 sheep were implanted with 6 devices each in second- or third-generation envelopes. Pre-specified acceptance criteria were <83 mm migration and <90 degrees rotation. Absorption was assessed via gross pathology.<br /><b>Results</b><br />Elution curves were equivalent (similarity factors ≥50 per FDA guidance). Third-generation envelopes eluted antibiotics above minimal inhibitory concentration (MIC) in vivo at 2hr post-implant through 7d, consistent with second-generation envelopes. Bacterial challenge showed reductions (p<0.05) in infection with second- and third-generation envelopes. Device migration was 5.5±3.5 (third-generation) vs. 9.9±7.9 mm (second-generation) (p<0.05). Device rotation was 18.9±11.4 (third-generation) vs. 17.6±15.1 degrees (second-generation) and did not differ (p=0.79). Gross pathology confirmed absence of luminal mesh remainders and no differences in peri-device fibrosis at 9 or 12wks.<br /><b>Conclusion</b><br />The third-generation TYRX absorbable antibacterial envelope demonstrated equivalent pre-clinical performance to the second-generation envelope: antibiotic elution curves were similar, elution was above MIC for 7d, infections were reduced compared to no envelope, and acceptance criteria for migration, rotation, and absorption were met.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 21 Jan 2023; epub ahead of print</small></div>
Love CJ, Hanna I, Thomas G, Greenspon AJ, ... Kirchhof N, Sohail MR
Heart Rhythm: 21 Jan 2023; epub ahead of print | PMID: 36693614
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<div><h4>miR-448 regulates potassium voltage-gated channel subfamily A member 4 (KCNA4) in ischemia and heart failure.</h4><i>Kang GJ, Xie A, Kim E, Dudley SC</i><br /><b>Background</b><br />MicroRNA ,miR-448, mediates some of the effects of ischemia on arrhythmic risk. Potassium Voltage-gated Channel Subfamily A Member 4 (KCNA4) encodes a K<sub>v</sub>1.4 current that opens in response to membrane depolarization and is essential for regulating action potential duration in heart. KCNA4 has a miR-448 binding site.<br /><b>Objective</b><br />Therefore, we investigated whether miR-448 was involved in the regulation of KCNA4 mRNA expression in ischemia.<br /><b>Methods</b><br />Quantitative real-time reverse-transcriptase polymerase chain reaction was used to investigate the expression of KCNA4 and miR-448. Pull-down assays were used to examine the interaction between miR-448 and KCNA4. A miR-448 decoy and binding site mutation were used to examine specificity of the effect for KCNA4.<br /><b>Results</b><br />The expression of KCNA4 is diminished in ischemia and human HF tissues with ventricular tachycardia. Previously, we have shown miR-448 is upregulated in ischemia, and inhibition can prevent arrhythmic risk after myocardial infarction. The 3\'-UTR of KCNA4 has a conserved miR-448 binding site. MiR-448 bound to this site directly and reduced KCNA4 expression and the transient outward potassium current (Ito). Inhibition of miR-448 restored KCNA4.<br /><b>Conclusion</b><br />These findings showed a link between K<sub>v</sub>1.4 downregulation and miR-448-mediated upregulation in ischemia, suggesting a new mechanism for the antiarrhythmic effect of miR-448 inhibition.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 21 Jan 2023; epub ahead of print</small></div>
Kang GJ, Xie A, Kim E, Dudley SC
Heart Rhythm: 21 Jan 2023; epub ahead of print | PMID: 36693615
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<div><h4>Incidence and Management of Atrio-Ventricular Conduction Disorders in New-Onset Left Bundle Branch Block After TAVI A Prospective Multicenter Study.</h4><i>Massoullié G, Ploux S, Souteyrand G, Mondoly P, ... Bordachar P, Eschalier R</i><br /><b>Background</b><br />New-onset left bundle branch block (LBBB) is one of the most frequent complications after transcatheter aortic valve implantation (TAVI) and is associated with delayed high degree atrio-ventricular block (AVB).<br /><b>Objective</b><br />The objective of this study was to determine the incidence of AVB in such a population and to assess the performance and safety of a risk stratification algorithm based on electrophysiological study (EPS) followed by implantation of pacemaker or implantable loop recorder (ILR).<br /><b>Methods</b><br />Prospective, open-label study with 12 months follow-up. From June 2015 to November 2018, 183 TAVI recipients (mean age 82.3±5.9 years) were included at 10 centers. New-onset LBBB after TAVI persisting for more than 24 hours was assessed by EPS during initial hospitalisation. High-risk patients (His-ventricle interval≥70 ms) were implanted with a dual-chamber pacemaker recording AV conduction disturbance episodes. Patients at lower risk were implanted with an ILR with automatic remote monitoring.<br /><b>Results</b><br />High-grade AV conduction disorder was identified in 56 subjects (30.6%) at 12 months. Four subjects were symptomatic, all in the ILR group. No complications were associated with the stratification procedure. Patients with His-ventricle interval ≥70 ms displayed more high-grade AV conduction disorders [53.2%(25/47) vs. 22.8%(31/136), p<0.001]. In a multivariate analysis, His-ventricle interval ≥70 ms was independently associated with the occurrence of a high-grade conduction disorder: subdistribution hazard ratio 2.4(95%CI 1.2-4.8), p=0.010.<br /><b>Conclusion</b><br />New-onset LBBB after TAVI were associated with high rates of high-grade AV conduction disturbances. The stratification algorithm provided safe and valuable aid to management decisions and reliable guidance on pacemaker implantation.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 13 Jan 2023; epub ahead of print</small></div>
Massoullié G, Ploux S, Souteyrand G, Mondoly P, ... Bordachar P, Eschalier R
Heart Rhythm: 13 Jan 2023; epub ahead of print | PMID: 36646235
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<div><h4>Anterior mitral line in patients with persistent AF and anterior scar: a multicenter matched comparison. The MiLine Study.</h4><i>Bergonti M, Spera FR, Ferrero TG, Nsahlai M, ... Rodríguez-Mañero M, Sarkozy A</i><br /><b>Background</b><br />The benefit of an anterior mitral line (AML) in patients with persistent atrial fibrillation (AF) and anterior atrial scar undergoing ablation has never been investigated.<br /><b>Objective</b><br />To evaluate the outcomes of AML on top of standard treatment, compared to standard treatment alone (no-AML), in this subset of patients.<br /><b>Methods</b><br />Patients with persistent AF and anterior low voltage zone (LVZ) treated with AML in three Centers were retrospectively enrolled. These patients were matched in a 1:1 fashion with patients with persistent AF and anterior LVZ, who underwent conventional ablation, in the same centers. Matching parameters were: age, LVZ burden, and repeated ablation. Primary endpoint was AF/atrial tachycardia (AT) recurrence.<br /><b>Results</b><br />186 patients (66±9 years, 34% women) were selected and included into two matched groups. Bidirectional conduction block was achieved in 95% of AML. After a median follow-up of 2 years, AF/AT recurrence occurred in 29% of the patients in the AML-group, vs. 48% in the No-AML-group (log-Rank p=0.024). At Cox-regression multivariate-analysis left atrial volume (HR 1.03, p=0.006) and AML (HR 0.46, p=0.003) were significantly associated with the primary endpoint. At univariate logistic-regression, lower BMI, older age, extensive anterior LVZ and the position of the left atrial activation breakthrough away from the AML, were associated with first-pass AML block.<br /><b>Conclusion</b><br />In this retrospective matched analysis of patients with persistent AF and anterior scar, AML on top of standard treatment was associated with improved AF/AT-free survival compared with matched patients treated with standard treatment alone.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 11 Jan 2023; epub ahead of print</small></div>
Bergonti M, Spera FR, Ferrero TG, Nsahlai M, ... Rodríguez-Mañero M, Sarkozy A
Heart Rhythm: 11 Jan 2023; epub ahead of print | PMID: 36640853
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<div><h4>A systematic review of global autopsy rates in all-cause mortality and young sudden death.</h4><i>Paratz ED, Rowe SJ, Stub D, Pflaumer A, La Gerche A</i><br /><AbstractText>Autopsy is the gold-standard method for determining cause of death. Young sudden death (SD) is a prototype condition in which autopsy is universally recommended. The aim of this review was to quantify real-world global rates of autopsy in either all-cause death or young SD. A systematic review was conducted. Rates of autopsy in all-cause death and in young SD were determined in each country using scientific and commercial search engines. 59/195 countries (30.3%) reported autopsy rates in all-cause death, with rates varying from 0.01-83.9%. Almost all of these figures derived from academic publications rather than governmental statistics. Only 16/195 countries (8.2%) reported autopsy rates in the context of young SD, with reported rates ranging from 5-100%. The definition of \'young\' was heterogeneous. No governmental statistics reported autopsy rates in young SD. Risks of bias included inability to verify reported figures, heterogeneity in reporting of clinical vs medicolegal autopsies, and the small number of studies identified overall, resulting in the consistent exclusion of low and middle-income countries. In conclusion, most countries globally do not report autopsy rates in either all-cause death (69.7%) or in sudden death (92.8%). Without transparent reporting of autopsy rates, global burdens of disease and rates of sudden cardiac death cannot be reliably calculated.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 11 Jan 2023; epub ahead of print</small></div>
Paratz ED, Rowe SJ, Stub D, Pflaumer A, La Gerche A
Heart Rhythm: 11 Jan 2023; epub ahead of print | PMID: 36640854
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<div><h4>New insights in AV nodal anatomy, physiology and immunochemistry: a comprehensive review and a proposed model of the slow-fast AVNRT circuit in agreement with direct potential recordings in the Koch\'s triangle area.</h4><i>Pandozi C, Matteucci A, Galeazzi M, Russo M, ... Malacrida M, Colivicchi F</i><br /><AbstractText>Atrioventricular nodal re-entrant tachycardia (AVNRT) is humans\' most frequent regular tachycardia. In this review, we describe the most recent discoveries regarding the anatomical, physiological and molecular biological features of the AV junction that could underlie the typical slow-fast AVNRT mechanisms, as these insights could lead to the proposal of a new theory concerning the circuit of this arrhythmia. Despite several models have been proposed over the years, the precise anatomical site of the re-entrant circuit and the pathway involved in the slow-fast AVNRT have not been conclusively defined. One possible way to evaluate all the hypotheses regarding the nodal tachycardia circuit in humans is to map this circuit. Thus, we tried to identify the slow potential of nodal and inferior extension structures by using automated mapping of atrial activation during both sinus rhythm and typical slow-fast AVNRT. This constitutes a first step towards the definition of nodal area activation in sinus rhythm and during slow-fast AVNRT. Further studies and technical improvements in recording the potentials of the AVN structures are necessary to confirm our initial results.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 09 Jan 2023; epub ahead of print</small></div>
Pandozi C, Matteucci A, Galeazzi M, Russo M, ... Malacrida M, Colivicchi F
Heart Rhythm: 09 Jan 2023; epub ahead of print | PMID: 36634901
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<div><h4>Electrocardiographic and electrophysiological characteristics of ventricular arrhythmias from right bundle branch of the moderator band.</h4><i>Zhang T, Liang Z, Liu X, Ren X, ... Chen L, Wang Y</i><br /><b>Background</b><br />There are little data on ventricular arrhythmias (VAs) originating from the right bundle branch (RBB) of the moderator band (MB) (MB-RBB VAs) in a cohort of patients.<br /><b>Objective</b><br />To investigate electrocardiographic and electrophysiological characteristics of MB-RBB VAs.<br /><b>Methods</b><br />Sixteen patients with MB-RBB VAs and 5 patients with right ventricular (RV) anterior papillary muscle (APM) VAs (RV-APM VAs) were studied under the guidance of intracardiac echocardiography.<br /><b>Results</b><br />The MB-RBB VAs group demonstrated a typical left bundle branch block pattern with left superior axis deviation and a narrower QRS complex during VAs (P < 0.001), compared with the RV-APM VAs group. Furthermore, the MB-RBB VAs group also had a shorter rS interval, a sharper slope of the S wave downstroke without notching in leads V1 and V2, and a shorter r wave duration in lead V2. A leading RBB potential at the target during VAs was observed for all patients in the MB-RBB VAs group, which was also present during sinus rhythm for all patients, except for 2 with RBB block at baseline. Ablation of the leading RBB potential effectively eliminated the arrhythmia. In the RV-APM VAs group, no Purkinje potential at the target was identified in any patients during VAs.<br /><b>Conclusion</b><br />QRS morphology of MB-RBB VAs is characterized by a typical left bundle branch block pattern with a relatively narrow QRS complex, short r wave and rS durations, and a sharp S wave downstroke without notching in leads V1 and V2. Mapping and ablation of the leading RBB potential are effective for eliminating VAs.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 09 Jan 2023; epub ahead of print</small></div>
Zhang T, Liang Z, Liu X, Ren X, ... Chen L, Wang Y
Heart Rhythm: 09 Jan 2023; epub ahead of print | PMID: 36634903
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<div><h4>SGK1 Inhibition Attenuates the Action Potential Duration in Re-Engineered Heart Cell Models of Drug-Induced QT Prolongation.</h4><i>Kim M, Sager PT, Tester DJ, Pradhananga S, ... Das S, Ackerman MJ</i><br /><b>Background</b><br />Drug-induced QT prolongation (DI-QTP) is a clinical entity in which administration of a HERG/I<sub>Kr</sub> blocker such as dofetilide prolongs the cardiac action potential duration (APD) and the QT interval on the electrocardiogram. Inhibition of serum and glucocorticoid regulated kinase-1 (SGK1) reduces the APD90 in induced pluripotent stem cell derived cardiomyocytes (iPSC-CMs) derived from patients with congenital long QT syndrome.<br /><b>Objective</b><br />Here, we test the efficacy of 2 novel SGK1 inhibitors in iPSC-CM models of dofetilide-induced APD prolongation.<br /><b>Methods</b><br />Normal iPSC-CMs were treated with dofetilide to produce a DI-QTP iPSC-CM model. SGK1-I1\'s and SGK1-I2\'s therapeutic efficacy for shortening the dofetilide-induced APD90 prolongation was compared to mexiletine. The APD90 values were recorded 4 hours after treatment using FluoVolt.<br /><b>Results</b><br />The APD90 was prolonged in normal iPSC-CMs treated with dofetilide (673 ± 8 ms vs 436 ± 4 ms, p<0.0001). While 10 μM mexiletine shortened the APD90 of dofetilide-treated iPSC-CMs from 673 ± 4 ms to 563 ± 8 ms (46% attenuation, p<0.0001), 30 nM of SGK1-I1 shortened the APD90 from 673 ± 8 ms to 502 ± 7 ms (72% attenuation, p<0.0001). Additionally, 300 nM SGK1-I2 shortened the APD90 of dofetilide-treated iPSC-CMs from 673 ± 8 ms to 460 ± 7 ms (90% attenuation, p<0.0001).<br /><b>Conclusions</b><br />These novel SGK1 inhibitors substantially attenuated the pathological APD prolongation in a human heart cell model of DI-QTP. This pre-clinical data supports development of this therapeutic strategy to counter and neutralize DI-QTP thereby increasing the safety profile for patients receiving drugs with a torsadogenic potential.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 04 Jan 2023; epub ahead of print</small></div>
Kim M, Sager PT, Tester DJ, Pradhananga S, ... Das S, Ackerman MJ
Heart Rhythm: 04 Jan 2023; epub ahead of print | PMID: 36610526
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<div><h4>Increased vulnerability to atrial and ventricular arrhythmias caused by different types of inhaled tobacco or marijuana products.</h4><i>Qiu H, Zhang H, Han DD, Derakhshandeh R, ... Olgin JE, Springer ML</i><br /><b>Background</b><br />The emergence of a plethora of new tobacco products marketed as being less harmful than smoking, such as electronic cigarettes and heated tobacco products, and the increased popularity of recreational marijuana have raised concerns about the potential cardiovascular risk associated with their use.<br /><b>Objective</b><br />The purpose of this study was to investigate whether the use of novel tobacco products or marijuana can cause the development of proarrhythmic substrate and eventually lead to arrhythmias.<br /><b>Methods</b><br />Rats were exposed to smoke from tobacco, marijuana, or cannabinoid-depleted marijuana, to aerosol from electronic cigarettes or heated tobacco products, or to clean air once per day for 8 weeks, following by assays for blood pressure, cardiac function, ex vivo electrophysiology, and histochemistry.<br /><b>Results</b><br />The rats exposed to tobacco or marijuana products exhibited progressively increased systolic blood pressure, decreased cardiac systolic function with chamber dilation, and reduced overall heart rate variability, relative to the clean air negative control group. Atrial fibrillation and ventricular tachycardia testing by ex vivo optical mapping revealed a significantly higher susceptibility to each, with a shortened effective refractory period and prolonged calcium transient duration. Histological analysis indicated that in all exposure conditions except for air, exposure to smoke or aerosol from tobacco or marijuana products caused severe fibrosis with decreased microvessel density and higher level of sympathetic nerve innervation.<br /><b>Conclusion</b><br />These pathophysiological results indicate that tobacco and marijuana products can induce arrhythmogenic substrates involved in cardiac electrical, structural, and neural remodeling, facilitating the development of arrhythmias.<br /><br />Copyright © 2022 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.<br /><br /><small>Heart Rhythm: 01 Jan 2023; 20:76-86</small></div>
Qiu H, Zhang H, Han DD, Derakhshandeh R, ... Olgin JE, Springer ML
Heart Rhythm: 01 Jan 2023; 20:76-86 | PMID: 36603937
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<div><h4>Cardiovascular Implantable Electronic Device Lead Safety: Harnessing Real-World Remote Monitoring Data for Medical Device Evaluation.</h4><i>Caughron H, Bowman H, Raitt MH, Whooley MA, ... Odobasic H, Dhruva SS</i><br /><b>Background</b><br />Current methods to identify cardiac implantable electronic devices (CIED) lead failure include post-approval studies, which may be limited in scope, participant numbers, and attrition; studies relying on administrative codes, which lack specificity; and voluntary adverse event reporting, which cannot determine incidence or attribution to the lead.<br /><b>Objective</b><br />To determine whether adjudicated remote monitoring (RM) data can address these limitations and augment lead safety evaluation.<br /><b>Methods</b><br />Among 48,191 actively monitored patients with CIEDs, we identified RM transmissions signifying incident lead abnormalities and, separately, identified all leads abandoned or extracted between 4/1/19-4/1/21. We queried electronic health record (EHR) and Medicare fee-for-service claims data to determine if patients had administrative codes for lead failure. We verified lead failure through manual EHR review.<br /><b>Results</b><br />Of 48,191 patients, 1170 (2.4%) had incident lead abnormalities detected on RM. Of these, 409 patients had administrative codes for lead failure, and 233 (57.0%) of these patients had structural lead failure verified through chart review. Among the 761 patients without administrative codes, 167 (21.9%) had structural lead failure verified through chart review. Thus, 400 (66.7%) total patients with RM transmissions suggestive of lead abnormalities had structural lead failure. In addition, 200 patients without preceding abnormal remote transmissions had leads abandoned or extracted for structural failure. Patients with isolated right atrial or left ventricular lead failure were less likely to have lead replacement and administrative codes reflective of lead failure.<br /><b>Conclusion</b><br />Remote monitoring may strengthen real-world assessment of lead failure, particularly for leads where patients do not undergo replacement.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 28 Dec 2022; epub ahead of print</small></div>
Caughron H, Bowman H, Raitt MH, Whooley MA, ... Odobasic H, Dhruva SS
Heart Rhythm: 28 Dec 2022; epub ahead of print | PMID: 36586706
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<div><h4>Curcumin, a Dietary Natural Supplement, Prolongs the Action Potential Duration of KCNE1-D85N Induced Pluripotent Stem Cell-Derived Cardiomyocytes.</h4><i>Martinez K, Smith A, Ye D, Zhou W, Tester DJ, Ackerman MJ</i><br /><b>Background</b><br />Curcumin, a polyphenolic dietary natural compound and active ingredient in turmeric, exerts antioxidant, anti-inflammatory, antidiabetic, anti-cancer, and antiarrhythmic properties. KCNE1-D85N, present in approximately 1% of Caucasians, is a common, potentially pro-arrhythmic variant that predisposes individuals to drug-induced QT prolongation under certain conditions.<br /><b>Objective</b><br />To test the hypothesize that curcumin might cause action potential duration (APD) prolongation in KCNE1-D85N derived human induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs).<br /><b>Methods</b><br />Gene-edited/variant-corrected isogenic control and patient-specific, KCNE1-D85N containing iPSC-CMs were generated previously. Fluovolt, multielectrode array (MEA), and whole-cell patch clamp were performed to measure APD without and with 4-hour incubation of 10 nM Curcumin.<br /><b>Results</b><br />KCNE1-D85N derived iPSC-CMs demonstrated significant APD prolongation with treatment of 10 nM curcumin. Using Fluovolt, the APD90 was 578 ± 7 ms (n=39) at baseline and was prolonged to 658 ± 13 ms (n=35, p<0.0001) with curcumin incubation. Using MEA, the APD90 at baseline was 237 ± 6 ms (n=24), compared to 280 ± 6 ms (n=12, p=0.0002) with curcumin incubation. Whole-cell patch clamp confirmed these results with the APD90 of 544 ± 37 ms at baseline and 664 ± 40 ms (p < 0.005) with treatment of curcumin. However, the APD from isogenic control iPSC-CMs remained unchanged with curcumin treatment.<br /><b>Conclusions</b><br />This study provides pharmacological and functional evidence to suggest that curcumin, a dietary natural supplement, might cause APD prolongation in the patients with common, potentially pro-arrhythmic functional variants such as KCNE1-D85N. Whether this supplement is potentially dangerous for the Caucasian sub-population who possess this variant warrants further investigation.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 28 Dec 2022; epub ahead of print</small></div>
Martinez K, Smith A, Ye D, Zhou W, Tester DJ, Ackerman MJ
Heart Rhythm: 28 Dec 2022; epub ahead of print | PMID: 36586707
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<div><h4>Heart sound-derived systolic time intervals for atrioventricular delay optimization in cardiac resynchronization therapy.</h4><i>Luo H, Westphal P, Shahmohammadi M, Heckman LIB, ... Delhaas T, Prinzen FW</i><br /><b>Background</b><br />Phonocardiography (PCG) can be used to determine systolic time intervals (STIs) from ventricular pacing spike to first heart sound (VS1) and from first to second heart sounds (S1S2).<br /><b>Objective</b><br />To investigate the relations between STIs and hemodynamics during atrioventricular (AV) delay optimization of biventricular pacing (BiVP) in animals and patients.<br /><b>Methods</b><br />Five pigs with AV block underwent BiVP while PCG was collected from an epicardial accelerometer. In 21 patients undergoing CRT implantation, PCG was measured with a pulse generator-embedded microphone. Optimal AV delays derived from shortest VS1 and longest S1S2 were compared with AV delays derived from highest left ventricular pressure (LVP), maximal rate of rise of left ventricular pressure (LV dP/dtmax) and stroke work.<br /><b>Results</b><br />In the pigs, VS1 and S1S2 predicted the AV delays with optimal hemodynamics (highest LVP, LV dP/dtmax and stroke work) by a median error of 2 - 28 ms, resulting in a median loss of < 2% of pump function. In the patients, VS1 and S1S2 predicted the optimal AV delay by errors of 32.5 ms and 37.5 ms, respectively, resulting in 0.2% - 0.9% lower LVP and stroke work, which were reduced to 21 ms and 24 ms in the 8 patients with a full-capture AV delay longer than 180 ms.<br /><b>Conclusion</b><br />During BiVP with varying AV delays, close relations exist between PCG-derived STIs and hemodynamic parameters. AV delays advised by PCG-derived STIs cause only a minimal loss in pump function compared with those based on invasive hemodynamic measurements.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 24 Dec 2022; epub ahead of print</small></div>
Luo H, Westphal P, Shahmohammadi M, Heckman LIB, ... Delhaas T, Prinzen FW
Heart Rhythm: 24 Dec 2022; epub ahead of print | PMID: 36574867
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<div><h4>Cardiopulmonary capacity is reduced in children with ventricular arrhythmia.</h4><i>Pietrzak R, Łuczak-Woźniak K, Książczyk TM, Werner B</i><br /><b>Background</b><br />Premature ventricular contractions (PVCs) are frequently seen in children and are considered benign. A substantial group of adolescents with PVCs complain about a broad range of clinical symptoms, including low exertion tolerance OBJECTIVES: The study sought to evaluate prospectively if ventricular arrhythmia affects physical performance in adolescents with normal left ventricular function, using a cardiopulmonary exercise test (CPET) and evaluating the electrocardiographic characteristics of patients with PVCs concerning exercise capacity.<br /><b>Methods</b><br />The study group consisted of 49 children with PVCs and normal left ventricular function. The control group consisted of 36 healthy volunteers. Standard ECG, 24-hour-Holter-ECG, and CPET were performed. PVCs were analyzed regarding QRS duration, bundle branch block pattern, the axis of the QRS, and coupling interval (CInt). In the CPET, heart rate (HR), oxygen uptake (VO<sub>2max</sub>), predicted VO<sub>2max</sub>, and VO2max expressed as a percentage of the predicted value (%VO<sub>2</sub>) were measured.<br /><b>Results</b><br />In 37(76%) patients, arrhythmia subsided during exercise. Patients achieved lower VO2max (32.9±6.3ml/min/kg) than controls (40.4±6.7ml/min/kg); p<0.01. %VO2 was 71.0±13.7 in patients and 79.3±12.2 in controls; p<0.01. The exercise HR at which the PVCs subsided correlated with the VO2max (r=0.3; p=0.07). Patients with persisting arrhythmia performed worse than those in whom arrhythmia subsided during exercise: VO2max(p<0.01), %VO2 (p < 0.01). We did not observe any correlation between the QRS and CInt parameters and VO2max.<br /><b>Conclusion</b><br />Patients with premature ventricular contractions have lower aerobic capacity compared to their healthy peers. Further worsening of exercise capacity is present when premature ventricular contractions are preserved during effort.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 22 Dec 2022; epub ahead of print</small></div>
Pietrzak R, Łuczak-Woźniak K, Książczyk TM, Werner B
Heart Rhythm: 22 Dec 2022; epub ahead of print | PMID: 36566888
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Abstract
<div><h4>Systematic review of long QT syndrome identified during fetal life.</h4><i>Chivers S, Ovadia C, Regan W, Zidere V, ... Simpson JM, Williamson C</i><br /><AbstractText>Fetal long-QT syndrome (LQTS) may present with sinus bradycardia, functional 2:1 atrioventricular block (2:1AVB), and ventricular arrhythmias (VT/TdP) and lead to fetal or postnatal death. We performed a systematic review and individual participant data meta-analysis of 83 studies reporting outcomes of 265 fetuses where suspected LQTS was confirmed postnatally and determined risk of adverse peri/postnatal outcomes using logistic, and stepwise logistic regression. A longer fetal QTc was more predictive of death than any other antenatal factor (ROC area under curve (AUC), 0·85 (95% confidence interval (CI) 0·66-1·00)); risk of death was significantly increased with fetal QTc greater than 600ms. Neither fetal heart rate nor heart rate z-score predicted death (ROC AUC 0·51 (95%CI 0·31-0·71) and 0·59 (95%CI 0·37-0·80), respectively). The combination of antenatal VT/TdP or functional 2:1AVB and a lack of family history of LQTS was also highly predictive of death (ROC AUC 0·82(95%CI 0·76 to 0·88). Our data provide clinical screening tools to enable prediction and intervention for fetuses with LQTS at risk of death.</AbstractText><br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 22 Dec 2022; epub ahead of print</small></div>
Chivers S, Ovadia C, Regan W, Zidere V, ... Simpson JM, Williamson C
Heart Rhythm: 22 Dec 2022; epub ahead of print | PMID: 36566891
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Abstract
<div><h4>Increased risk of incident atrial fibrillation in young adults with mental disorders: a nationwide population-based study.</h4><i>Ahn HJ, Lee SR, Choi EK, Bae NY, ... Oh S, Lip GYH</i><br /><b>Background</b><br />Mental disorders and cardiovascular diseases are closely related. However, a paucity of information exists regarding the risk of incident atrial fibrillation (AF) in patients with mental disorders.<br /><b>Objectives</b><br />We aimed to assess the association between mental disorders and the risk of AF, particularly among young adults.<br /><b>Methods</b><br />Using the Korean National Health Insurance database between 2009 and 2012, we identified adults aged 20 to 39 years without a history of AF and who have been diagnosed with mental disorders. Mental disorders were defined as having one of the following diagnoses: depression, insomnia, anxiety disorder, bipolar disorder, or schizophrenia. The primary outcome was new-onset AF during follow-up.<br /><b>Results</b><br />A total of 6,576,582 subjects (mean age, 30.9±5.0 years; men, 59.6%) were included. Among the total population, 10% had mental disorders. During the follow-up period, 8,932 incident AF events occurred. Participants with mental disorders showed a higher AF incidence than did those without (25.4 vs. 17.7 per 100,000 person-years). After multivariable adjustment, mental disorders were associated with a significantly higher risk of AF (adjusted HR, 1.526; 95% CI, 1.436-1.621). Patients with bipolar disorder or schizophrenia had a two-fold higher risk of AF, and those with depression, insomnia, and anxiety disorder had 1.5 to 1.7-fold higher risk of AF compared to those without mental disorders.<br /><b>Conclusion</b><br />Young adults diagnosed with mental disorders have a higher risk of incident AF. Awareness for AF in high-risk populations should thus be considered.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 20 Dec 2022; epub ahead of print</small></div>
Ahn HJ, Lee SR, Choi EK, Bae NY, ... Oh S, Lip GYH
Heart Rhythm: 20 Dec 2022; epub ahead of print | PMID: 36563829
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Abstract
<div><h4>Tumescent Local Anesthesia Versus General Anesthesia for Subcutaneous Implantable Cardioverter Defibrillator Implantation: A Cost-Effectiveness Analysis.</h4><i>Romero J, Rodriguez-Taveras J, Diaz JC, Lorente-Ros M, ... Natale A, Di Biase L</i><br /><b>Background</b><br />General anesthesia (GA) is the standard sedation approach for subcutaneous cardioverter-defibrillator (S-ICD) implantation. Nonetheless, GA is expensive and can be associated with adverse events. Tumescent local anesthesia (TLA) has been shown to reduce in-room and procedural times, and to decrease post-procedural pain, all of which could result in a reduction in procedure-related costs.<br /><b>Objective</b><br />To compare the cost-effectiveness of GA and TLA in patients undergoing S-ICD implantation.<br /><b>Methods</b><br />Prospective, controlled study of patients who underwent S-ICD implantation between 2019 and 2022. Patients were allocated to either TLA or GA group. We performed a cost analysis for each intervention. As an effectiveness measure, the 0-10 point pain numerical rating scale at 1-, 12- and 24-hours post-implantation was analyzed and compared between groups. A score of 0 was considered no pain; 1 to 5: mild pain; 6 to 7: moderate pain and 8 to 10: severe pain. Cost-effectiveness was calculated using incremental cost-effectiveness ratios.<br /><b>Results</b><br />70 patients underwent successful S-ICD implantation. The total cost of the electrophysiology laboratory was higher in the GA group compared to the TLA group (median±IQR of $55,824±29,411 vs. $37,222±24,293, p<0.001), with a net savings of $20,821 when compared with GA for each S-ICD implantation. There was a significant decrease in post-procedural pain scores within the TLA group when compared to the GA group (repeated measures ANOVA p=0.009, median±IQR of 0±3 vs. 0±5 at 1hr, p=0.058; 3±4 vs. 6±8 at 12hrs, p=0.030; 0±4 vs. 2±6 at 24hrs, p=0.040).<br /><b>Conclusion</b><br />TLA is a more cost-effective alternative to GA for S-ICD implantation, with both direct and indirect cost reductions. Importantly, these reduced costs are associated with reduced post-procedural pain.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 20 Dec 2022; epub ahead of print</small></div>
Romero J, Rodriguez-Taveras J, Diaz JC, Lorente-Ros M, ... Natale A, Di Biase L
Heart Rhythm: 20 Dec 2022; epub ahead of print | PMID: 36563830
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Abstract
<div><h4>His Bundle Pacing and AV nodal ablation for non-controlled atrial arrhythmia: a technical challenge with major clinical benefits.</h4><i>Chaumont C, Auquier N, Milhem A, Mirolo A, ... Eltchaninoff H, Anselme F</i><br /><b>Background</b><br />His bundle pacing (HBP) is an appealing alternative to right ventricular pacing in patients referred for permanent ventricular pacing and AV nodal ablation (AVNA) as it preserves physiological ventricular activation. Only limited amount of data is available in the literature regarding HBP combined with AVNA.<br /><b>Objective</b><br />To provide further evidence on the feasibility and efficacy of this therapeutic approach in patients with uncontrolled atrial arrhythmia.<br /><b>Methods</b><br />We prospectively included all patients who underwent AVNA after HBP in three different hospitals between 2017 and 2022.<br /><b>Results</b><br />AVNA following HBP lead implantation was performed in 75 patients. A complete AV block was obtained in 58 patients (77%) whereas significant modulation of the AV node conduction (heart rate < 60bpm) was obtained in 12 (16%). AVNA failure was observed in 5 (7%). The recording of an atrial signal by the HBP lead was more frequently observed in patients with AVNA modulation/failure compared to patients with complete AV block (11/17 vs 5/58; p<0.001). There was no lead dislodgment during the AVNA procedures. Acute HB capture threshold increase>1V occurred in 11 patients (15%) with return to baseline value at day one in 9. NYHA class and LVEF significantly improved from baseline to last follow-up (3.0±0.7 vs 1.6±0.5, p<0.001; 47±14% vs 60±9%; p<0.0001, respectively), <br /><b>Conclusion:</b><br/>AVNA combined with HBP for non-controlled atrial arrhythmia was feasible and clinically efficient. Implanting the HB lead on the ventricular aspect of the tricuspid annulus avoiding atrial signal recording can facilitate AVNA.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 19 Dec 2022; epub ahead of print</small></div>
Chaumont C, Auquier N, Milhem A, Mirolo A, ... Eltchaninoff H, Anselme F
Heart Rhythm: 19 Dec 2022; epub ahead of print | PMID: 36549630
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Abstract
<div><h4>Remote interrogation and reprogramming of cardiac implantable electronic devices using a custom multi-vendor solution.</h4><i>Ploux S, Strik M, Demonière F, Rakotoarimanana D, ... Varma N, Bordachar P</i><br /><b>Background</b><br />Until recently, remote interrogation and reprogramming of therapeutic cardiac implantable electronic devices (CIEDs) has been virtually nonexistent due to technical challenges and safety concerns. It could be extremely useful, in particular in case of emergencies, when patients live far from CIED professionals or during enforced physical distancing.<br /><b>Objective</b><br />We investigated the feasibility and safety of a custom solution for remote interrogation and reprogramming of CIEDs from various manufacturers in various clinically relevant situations.<br /><b>Methods</b><br />Our solution consists of remote controlling CIED programmers through screen capture and remote cursor control. In this multi-center feasibility study the primary outcome was technical feasibility (% of success) and safety (absence of complication) of interrogations and reprogramming when indicated in clinically-driven encounters.<br /><b>Results</b><br />A total of 115 remote interrogations were performed in 110 patients; within the hospital (N=73), medium-range (50 to 100 km; N=22), and long-range (>5000 km; N=20). Implanted devices were pacemakers (N=85) and ICDs (N=25) from Abbott™ (N=13), Biotronik™ (N=65) and Microport™ (N=32). Patients were located in the outpatient clinic, cardiology department, radiology department (MRI), operating room (per-implantation), intensive care unit. Teleworking was performed in 39 cases. Complete CIED interrogations succeeded in all patients with reprogramming in 56/115 (49%) sessions. No clinical or technical complications occurred. Time lag for screen interaction was below 1 second.<br /><b>Conclusions</b><br />Remote interrogation and reprogramming of CIEDs are feasible and safe across disparate clinical contexts and distances. This strategy may enhance health care access and facilitate medical training, tele-expertise and tele-work worldwide.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 13 Dec 2022; epub ahead of print</small></div>
Ploux S, Strik M, Demonière F, Rakotoarimanana D, ... Varma N, Bordachar P
Heart Rhythm: 13 Dec 2022; epub ahead of print | PMID: 36526165
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<div><h4>A Panel of Blood Biomarkers Unique to Sudden Cardiac Arrest.</h4><i>Norby FL, Nakamura K, Fu Q, Venkatraman V, ... Van Eyk JE, Chugh SS</i><br /><b>Background</b><br />The identification of circulating biomarkers specific for sudden cardiac arrest (SCA) could enhance risk prediction. Of particular interest are biomarkers specific to SCA, independent of coronary artery disease (CAD).<br /><b>Objective</b><br />To identify biomarkers of SCA obtained close to the SCA event.<br /><b>Methods</b><br />20 cases (survivors of SCA) and 40 age and sex-matched controls were compared, with a replication analysis of 29 cases matched to 57 controls. A secondary analysis compared 20 SCA cases to 20 controls with CAD. Blood samples were obtained from SCA survivors at a median of 11 months following the SCA event. Proteins were analyzed on a TripleTOF® 6600 mass spectrometer using data-independent acquisition, a subset of cytokines were analyzed using immunoassays, and 1153 lipids (13 classes) were analyzed. A false-discovery rate p-value of <0.05 identified associated proteins.<br /><b>Results</b><br />Subjects had a mean age of 58 years (range 25-87) and 70% were male. A total of 26 protein biomarkers associated with SCA when cases were compared to controls, of which 20 differentiated SCA from CAD. The replication analysis identified 8 of 26 biomarkers, of which 6 were not overlapping with CAD. The top identified biological processes involved the extracellular matrix, coagulation cascades, and platelet activation. Lipids in the Lysophosphatidylcholine class were implicated in SCA through the CAD pathway.<br /><b>Conclusion</b><br />We identified a panel of novel blood biomarkers specifically associated with SCA, including several that may be involved outside the CAD pathway. These biomarkers could have mechanistic significance, and the potential to enhance clinical prediction of SCA.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 12 Dec 2022; epub ahead of print</small></div>
Norby FL, Nakamura K, Fu Q, Venkatraman V, ... Van Eyk JE, Chugh SS
Heart Rhythm: 12 Dec 2022; epub ahead of print | PMID: 36521734
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Abstract
<div><h4>Pharmacological Prevention of Recurrent Vasovagal Syncope: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.</h4><i>Behnoush AH, Yazdani K, Khalaji A, Tavolinejad H, ... Jalali A, Tajdini M</i><br /><AbstractText>Vasovagal syncope (VVS) is a transient loss of consciousness, currently posing a high burden on healthcare systems with limited evidence on the comparative efficacy of available pharmacological interventions. This study aims to compare all pharmacologic therapies suggested in randomized controlled trials (RCTs) through systematic review and network meta-analysis. A systematic search in PubMed, Embase, Web of Science, and Cochrane Library was conducted to identify RCTs evaluating pharmacological therapies for patients with VVS. The primary outcome was spontaneous VVS recurrence. The secondary outcome was a positive head-up tilt test (HUTT) after receiving intervention, regarded as a lower level of evidence. Pooled risk ratio (RR) along with 95% confidence interval (CI) were calculated using random-effect network meta-analysis. Pairwise meta-analysis was also performed when applicable. The surface under the cumulative ranking curve analysis (SUCRA) was conducted to rank the treatments in each outcome. Twenty-eight studies with 1,744 patients allocated to different medications or placebo were included. The network meta-analysis for the reduction in the primary outcome showed efficacy for midodrine (RR (95% CI): 0.55 (0.35-0.85)), and for fluoxetine (especially in patients with concomitant anxiety; RR (95% CI): 0.36 (0.16-0.84)). Additionally, midodrine and atomoxetine were superior to other treatment options, considering positive HUTT (RR (95% CI): 0.37 (0.23-0.59) and 0.49 (0.28-0.86), respectively). In conclusion, midodrine was the only agent shown to reduce spontaneous syncopal events, while fluoxetine also seems beneficial but should be studied further in RCTs. Our network meta-analysis did not find evidence for the efficacy of any other medication.</AbstractText><br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 09 Dec 2022; epub ahead of print</small></div>
Behnoush AH, Yazdani K, Khalaji A, Tavolinejad H, ... Jalali A, Tajdini M
Heart Rhythm: 09 Dec 2022; epub ahead of print | PMID: 36509319
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<div><h4>Blocking nerves and saving lives. Left Stellate Ganglion Block for Electrical Storms.</h4><i>Savastano S, Schwartz PJ</i><br /><AbstractText>Patients presenting with electrical storms (ES), due to rapid recurrence of ventricular tachycardia/fibrillation, represent a major emergency without easy solutions. Indeed, antiarrhythmic drugs have limited value, while ES need to be stopped quickly to avoid irreversible patient deterioration and death. Since the mid-70\'s we have provided the rationale for the interruption of cardiac sympathetic nerves and the evidence of its antifibrillatory action in different clinical settings. Slowly but progressively, from isolated clinical reports to small case series, evidence has been built indicating that pharmacological stellate ganglion block (SGB) is highly effective in interrupting ES. However, medical guidelines have largely ignored SGB and very few centers are ready to perform SGB in actual emergency. Our own experience shows that a direct anatomical approach, not requiring echo assistance, can be very rapidly performed saving time also in highly critical patients. Here, we retrace the evolution in the understanding of the mechanism of action of SGB, discuss the current approaches with their limitations, review the correct indications which overcome some still existing bias. Furthermore, we propose a practical solution to increase the availability of SGB to many more patients by extending the number of centers where this approach could be rapidly implemented.</AbstractText><br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 09 Dec 2022; epub ahead of print</small></div>
Savastano S, Schwartz PJ
Heart Rhythm: 09 Dec 2022; epub ahead of print | PMID: 36509320
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<div><h4>Single beta-blocker or combined amiodarone therapy in implantable cardioverter-defibrillator and cardiac resynchronization therapy defibrillator patients - insights from the German DEVICE-registry.</h4><i>Wiedmann F, Ince H, Stellbrink C, Kleemann T, ... Frey N, Schmidt C</i><br /><b>Background</b><br />Because of its antiarrhythmic potency and due to the lack of alternatives, amiodarone is often used for antiarrhythmic therapy in patients with ICD or CRT-D systems. To date, robust data on the safety and clinical benefit of amiodarone therapy in these patients are missing OBJECTIVE: This study was designed to assess the periprocedural and post-procedural outcome of combined therapy with beta-blockers plus amiodarone compared to treatment with single beta-blockers in this \"real life\" cohort of ICD recipients of the German DEVICE registry.<br /><b>Methods</b><br />4,499 patients who underwent ICD implantation, revision, or upgrade in 49 centers participating in the German DEVICE Registry were enrolled 03/2007-02/2014.<br /><b>Results</b><br />Amiodarone had no significant effect on the success of defibrillation testing. Early implantation-associated complications were similar between the groups. One-year overall mortality was, however, significantly higher in the beta-blocker plus amiodarone cohort (adjusted HR 2.09; p<0.001). Interestingly, amongst the surviving patients, amiodarone was not associated with a significantly reduced risk of ICD discharges, syncopal events. Further, the occurrence of VT storm or incessant VTs and the number of patients scheduled for intracardiac ablation did not differ among both groups while the rate of rehospitalization was lower in the cohort with sole beta-blockers.<br /><b>Conclusions</b><br />While amiodarone has no adverse effect on the success of defibrillation testing, our data suggest an increased all-cause mortality under amiodarone therapy, especially in the subgroups of patients with sinus rhythm or severely reduced left ventricular function. In surviving patients, rates of arrhythmic events were comparable.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 09 Dec 2022; epub ahead of print</small></div>
Wiedmann F, Ince H, Stellbrink C, Kleemann T, ... Frey N, Schmidt C
Heart Rhythm: 09 Dec 2022; epub ahead of print | PMID: 36509321
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<div><h4>Alert-driven versus scheduled remote monitoring of implantable cardiac defibrillators: A Cost-Consequence Analysis from the TRUST Trial.</h4><i>Chew DS, Piccini JP, Au F, Frazier-Mills CG, ... Varma N, TRUST Investigators</i><br /><b>Background</b><br />Alert-driven remote patient monitoring (RPM) or fully virtual care without routine evaluations may reduce clinic workload and promote more efficient resource allocation, principally by diminishing non-actionable patient encounters.<br /><b>Objective</b><br />The study objective was to conduct a cost-consequence analysis to compare three post-implant ICD follow-up strategies: (a) in-person evaluations (IPE) only, (b) RPM-conventional (hybrid of IPE and RPM), and (c) RPM-alert (alert-based ICD follow up).<br /><b>Methods</b><br />We constructed a decision-analytic Markov model to estimate the costs and benefits of these three strategies over a two-year time horizon from the perspective of the US Medicare payer. Aggregate and patient-level data from the TRUST (Lumos-T Safely RedUceS RouTine Office Device Follow-up) randomized clinical trial informed clinical effectiveness model inputs. TRUST randomized 1,339 patients 2:1 to conventional RPM or IPE alone, and found that RPM was safe and reduced the number of non-actionable encounters. Cost data was obtained from the published literature. The primary outcome was incremental cost.<br /><b>Results</b><br />The mean cumulative follow-up costs per patient were $12,688 in the IPE group, $12,001 in the RPM-conventional group, and $11,011 in the RPM-alert group. Compared to the IPE group, both the RPM-conventional and RPM-alert groups were associated with lower incremental costs of -$687 (95% confidence interval [CI]-$2,138 to +$638) and -$1,677 (95% CI -$3,134 to -$304), respectively. Therefore, the RPM-alert strategy was most cost-effective with an estimated cost-savings in 99% of simulations.<br /><b>Conclusions</b><br />Alert-driven RPM was economically attractive and, if patient outcomes and safety are comparable to conventional RPM, may be the preferred strategy of ICD follow up.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 08 Dec 2022; epub ahead of print</small></div>
Chew DS, Piccini JP, Au F, Frazier-Mills CG, ... Varma N, TRUST Investigators
Heart Rhythm: 08 Dec 2022; epub ahead of print | PMID: 36503177
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<div><h4>Programming more ATP sequences is not a case of no harm, no foul.</h4><i>van der Stuijt W, Smeding L, Knops RE</i><br /><AbstractText>We strongly recommend to limit ATP therapy to a single sequence and first observe the efficacy in the individual patient. After a positive effect of ATP is established, ATP programming may be safely extended.</AbstractText><br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 08 Dec 2022; epub ahead of print</small></div>
van der Stuijt W, Smeding L, Knops RE
Heart Rhythm: 08 Dec 2022; epub ahead of print | PMID: 36503179
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<div><h4>Outcomes of Leadless Pacemaker implantation following transvenous lead extraction in high-volume referral centers: real-world data from a large international registry.</h4><i>Mitacchione G, Schiavone M, Gasperetti A, Arabia G, ... Forleo GB, Antonio C</i><br /><b>Background</b><br />Limited data concerning real-world safety and efficacy of leadless pacemakers (LPMs) post-transvenous lead extraction (TLE) are available.<br /><b>Objective</b><br />To assess long-term safety and effectiveness of LPMs following TLE, compared with LPMs de novo implantations.<br /><b>Methods</b><br />Consecutive patients who underwent LPM implantation in 12 European centers joining the International LEAdless PacemakEr (i-LEAPER) registry were enrolled. The primary endpoint was the comparison of LPM-related complication rate at implant and during follow-up (FU) among groups. Differences in electrical performance were deemed secondary outcomes.<br /><b>Results</b><br />Among 1179 patients enrolled, 15.6% underwent a previous TLE. During a median FU of 33 [IQR 24-47] months, LPM related major complications and all-cause mortality did not differ among groups (TLE group: 1.6% and 5.4% vs. de novo group: 2.2% and 7.8%, p=0.785 and p=0.288, respectively). Pacing threshold (PT) resulted higher in the TLE group at implant and during FU, with very high PTs (>2V@0.24ms) patients being more represented than in de novo implantation group (5.4% vs. 1.6 %; p=0.004). When the LPM was deployed at a different right ventricular (RV) location than the one where previous transvenous-RV lead was extracted, a lower prevalence of high PT (>1 to 2V@0.24ms) patients at implant, 1-, and 12-month FU (5.9% vs 18.2%, p=0.012; 3.4% vs. 12.9%, p=0.026; 4.3% vs. 14.5%, p=0.037, respectively) was found.<br /><b>Conclusion</b><br />LPMs showed a satisfactory safety and efficacy profile after TLE. Better electrical parameters were obtained when LPMs were implanted at a different RV location than the one where previous transvenous-RV lead was extracted.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 07 Dec 2022; epub ahead of print</small></div>
Mitacchione G, Schiavone M, Gasperetti A, Arabia G, ... Forleo GB, Antonio C
Heart Rhythm: 07 Dec 2022; epub ahead of print | PMID: 36496135
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<div><h4>Timing of ICD implantation in patients with cardiac laminopathies - external validation of the LMNA-risk VTA calculator.</h4><i>Rootwelt-Norberg C, Christensen AH, Skjølsvik ET, Chivulescu M, ... Lie ØH, Haugaa KH</i><br /><b>Background</b><br />LMNA genotype positive patients have high risk of experiencing life-threatening ventricular tachyarrhythmia (VTA). The LMNA-risk VTA calculator published in 2019 has not been externally validated.<br /><b>Objective</b><br />To validate the LMNA-risk VTA calculator.<br /><b>Methods</b><br />We included LMNA genotype positive patients without previous VTA from two large Scandinavian centers. Patients underwent electrocardiogram, 24-hour Holter monitoring and echocardiographic examinations at baseline and repeatedly during follow-up. Validation of the LMNA-risk VTA calculator was performed by Harrell\'s C-statistic derived from multivariable Cox regression analysis.<br /><b>Results</b><br />We included 118 patients (age 37 years, 33% probands, 55% females, 85% with non-missense LMNA variants). Twenty-three (19%) patients experienced VTA during 6.1 (IQR 3.0-9.1) years follow-up, resulting in 3.0% (95% CI 2.0-4.5%) yearly incidence rate. Atrioventricular block and reduced left ventricular ejection fraction were independent predictors of VTA, while non-sustained ventricular tachycardia, male sex and non-missense LMNA variants were not. The LMNA-risk VTA calculator showed 83% sensitivity and 26% specificity for identifying patients with VTA during the coming 5 years, and a Harrell\'s C statistic of 0.85, when applying ≥7% predicted 5-year VTA risk as threshold. The sensitivity increased to 100% when re-evaluating risk at last consultation prior to VTA. The calculator overestimated arrhythmic risk in patients with mild and moderate phenotype, particularly among males.<br /><b>Conclusions</b><br />Validation of the LMNA-risk VTA calculator showed high sensitivity for subsequent VTA, but overestimated arrhythmic risk when using ≥7% predicted 5-year risk as threshold. Frequent re-evaluation of risk was necessary to maintain the sensitivity of the model.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 06 Dec 2022; epub ahead of print</small></div>
Rootwelt-Norberg C, Christensen AH, Skjølsvik ET, Chivulescu M, ... Lie ØH, Haugaa KH
Heart Rhythm: 06 Dec 2022; epub ahead of print | PMID: 36494026
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<div><h4>A Comparison of Data Quality and Monitoring Completion Rates Between Clinic and Self-Applied ECG Patches.</h4><i>Goergen JA, Peigh G, Hsu M, Wilk A, ... Knight BP, Passman R</i><br /><b>Background</b><br />Since the onset of the COVID-19 pandemic, direct-to-patient, self-applied ECG patch use has substantially increased. There are limited data comparing clinic versus self-applied ECG patches.<br /><b>Objectives</b><br />To compare rates of ECG patch return, percentages of time patches yielded analyzable data (analyzable time), and percentages of prescribed time ECG patches were worn between clinic and self-applied ECG patches prior to and during COVID-19.<br /><b>Methods</b><br />A retrospective analysis of patients prescribed an ECG patch during \"pre-COVID\" (3/1/2019-3/1/2020) and \"COVID\" (4/1/2020-4/1/2021) years was conducted. ECG patch return rates, mean percentages of analyzable time, and mean percentages of prescribed wear time were compared between clinic and self-applied groups.<br /><b>Results</b><br />Of 29,093 ECG patch prescriptions (19% COVID self-applied), the COVID self-applied group had a lower return rate (90.8%) than both clinic-applied groups (COVID; 97.1%; pre-COVID; 98.1%; p<0.001). Among the 28,048 ECG patches (17.5% self-applied) returned for analysis, the COVID self-applied group demonstrated a lower mean percentage of analyzable time (95.9 + 8.2%) than both clinic-applied groups (COVID: 96.6 + 6.6%; pre-COVID 96.6 + 7.4%; p<0.001). There were no differences in mean percentage of prescribed wear time between groups (pre-COVID clinic-applied: 96.7 + 34.3%; COVID clinic-applied 97.4 + 39.8%; COVID self-applied 98.1 + 52.1%, p=0.09).<br /><b>Conclusions</b><br />Self-applied ECG patches were returned at a lower rate and had a statistically lower percentage of analyzable time than clinic-applied patches. However, there were no differences between groups in mean percentages of prescribed wear time, and mean percentages of analyzable time were >95% in all groups.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 01 Dec 2022; epub ahead of print</small></div>
Goergen JA, Peigh G, Hsu M, Wilk A, ... Knight BP, Passman R
Heart Rhythm: 01 Dec 2022; epub ahead of print | PMID: 36464126
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<div><h4>Electrocardiogram Belt Guidance for Left Ventricular Lead Placement and Biventricular Pacing Optimization.</h4><i>Rickard J, Jackson K, Gold M, Biffi M, ... Vernooy K, ECG Belt for CRT Response Study Group</i><br /><b>Background</b><br />Patients with ischemic cardiomyopathy, non-left bundle branch block (LBBB), or QRS duration <150msec have a lower response rate to CRT than other indicated patients. The EBS is a novel surface mapping system designed to measure electrical dyssynchrony via the standard deviation of the activation times (SDAT) of the left ventricle.<br /><b>Objective</b><br />To evaluate the efficacy of the ECG Belt System (EBS) in patients less likely to respond to cardiac resynchronization therapy (CRT) and determine whether EBS use in lead placement guidance and device programming was superior compared with standard CRT care.<br /><b>Methods</b><br />This was a prospective, randomized trial of heart failure patients with EBS-guided CRT implant and programming vs. standard CRT care. The primary endpoint was relative change in LV end-systolic volume from baseline to 6 months post-implant.<br /><b>Results</b><br />A total of 408 subjects from centers in Europe and North America were randomized. Although both EBS and control patients had a mean improvement in LVESV, there was no significant difference in relative change from baseline (p=0.26). While patients with a higher baseline SDAT derived greater LV reverse remodeling, improvement in electrical dyssynchrony did not correlate with the extent of reverse remodeling.<br /><b>Conclusion</b><br />The findings of the present study do not support EBS-guided therapy for CRT management of heart failure with reduced ejection fraction.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 25 Nov 2022; epub ahead of print</small></div>
Rickard J, Jackson K, Gold M, Biffi M, ... Vernooy K, ECG Belt for CRT Response Study Group
Heart Rhythm: 25 Nov 2022; epub ahead of print | PMID: 36442824
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<div><h4>The Association of Left Ventricular Remodeling with CRT Outcomes.</h4><i>Gold MR, Rickard J, Daubert JC, Cerkvenik J, Linde C</i><br /><b>Background</b><br />Cardiac resynchronization therapy (CRT) response stratified by left ventricular (LV) remodeling revealed differing mortality profiles for distinct patient cohorts. Measuring functional endpoints, as well as mortality, may better assess CRT efficacy and inform patient management. However, the association between LV remodeling and functional outcomes after CRT is not well understood.<br /><b>Objective</b><br />To evaluate long-term CRT outcomes by extent of LV remodeling.<br /><b>Methods</b><br />REsynchronization reVErses Remodeling in Systolic Left vEntricular Dysfunction (NCT00271154) was a prospective, double-blind, randomized CRT trial. Patients were classified based on LV end-systolic volume (LVESV) change from baseline to 6-months post-CRT: Worsened (increase); Stabilized (0 to ≤15% reduction); Responder (>15 to < 30% reduction); and Super-responder (≥30% reduction). Subjects were evaluated annually for 5 years.<br /><b>Results</b><br />The analyses included 353 patients randomized to CRT-ON arm. All-cause mortality was higher in the worsened group compared with the 3 other response groups (29.8% vs 8.0%, p<0.0001), with no difference in survival among those groups (p=0.87). A significant interaction between LVESV group and time was observed for health status and quality of life (both p=0.02). The interaction was not significant for 6-minute hall walk (p=0.79); however, super-responders had increased walk distance compared to the 3 other response groups (p=0.03).<br /><b>Conclusion</b><br />Preventing further increase in LVESV with CRT was associated with reduced mortality, whereas functional measure improvement was associated with LV remodeling magnitude. These results support consideration of functional and mortality endpoints to assess CRT efficacy and provide further evidence the dichotomous \'responder and non-responder\' classification should be modified.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 25 Nov 2022; epub ahead of print</small></div>
Gold MR, Rickard J, Daubert JC, Cerkvenik J, Linde C
Heart Rhythm: 25 Nov 2022; epub ahead of print | PMID: 36442825
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<div><h4>The Association of Interventricular Activation Delay With Clinical Outcomes in Cardiac Resynchronization Therapy.</h4><i>Haqqani HM, Burri H, Kayser T, Carter N, Gold MR</i><br /><b>Background</b><br />Pacing at sites of longest interventricular delay has been associated with greater reverse remodeling in cardiac resynchronization therapy (CRT). However, the effects of pacing at such sites on clinical outcomes is less well studied.<br /><b>Objective</b><br />To assess the association between interventricular delay and clinical outcomes in CRT patients implanted with quadripolar left ventricular (LV) leads.<br /><b>Methods</b><br />RALLY-X4 was a registry study of the Acuity X4 quadripolar LV leads. Interventricular delay was measured during unpaced basal rhythm from the right ventricular (RV) lead to the LV lead electrode (E1 to E4) chosen for CRT pacing. Patients were stratified by median RV-LV delay (80 ms) into short and long delay groups, and they were also analysed by multivariable modelling. The primary composite outcome measure was all-cause mortality and heart failure hospitalization (HFH) at 18 months.<br /><b>Results</b><br />There were 581 patients with complete RV-LV delay data. The mean LV ejection fraction (EF) was 27% and 73% had a typical left bundle branch block. Predictors of long RV-LV delay included female sex, LBBB and QRS duration >150ms. Survival free of the primary outcome at 18 months follow up was 87% in the long activation delay group compared with 77% in the short delay group (p=0.0042). Multivariate analysis showed that RV-LV delay was a, independent predictor of survival free of HFH (p=0.028).<br /><b>Conclusions</b><br />Among CRT patients with quadripolar LV pacing leads, longer baseline interventricular activation delay was significantly associated with the composite endpoint of all-cause mortality and heart failure hospitalization.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 24 Nov 2022; epub ahead of print</small></div>
Haqqani HM, Burri H, Kayser T, Carter N, Gold MR
Heart Rhythm: 24 Nov 2022; epub ahead of print | PMID: 36436813
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<div><h4>Effects of Pulsed Field Ablation on Autonomic Nervous System in Paroxysmal Atrial Fibrillation: A Pilot Study.</h4><i>Guo F, Wang J, Deng Q, Feng H, ... Jiang H, Yu L</i><br /><b>Background</b><br />Vagal responses and phrenic activation are commonly observed during pulsed field ablation (PFA). However, it is unclear whether the vagal responses and phrenic activations are nerve damage or a neurological stress response due to electrical stimulation.<br /><b>Objective</b><br />The purpose of this study was to evaluate the effect of a PFA system for performing pulmonary vein isolation on the autonomic nervous system.<br /><b>Methods</b><br />Patients with paroxysmal atrial fibrillation (AF) who underwent the PFA between August 2021 and November 2021 were included. Nerve injury biomarkers and heart rate variability were obtained pre- and postablation. Patients were scheduled to undergo magnetic resonance imaging and diffusion-weighted imaging to evaluate cerebral microembolus formation postablation.<br /><b>Results</b><br />Acute electrical isolation was achieved in 100% of pulmonary veins (n = 72) in the 18 patients. The mean total procedure time was 64.1 ± 18.2 min, with a mean fluoroscopy time of 12.3 ± 3.5 min. Serum nerve injury biomarkers did not show any changes among the pre- and immediately postablation and 24h after ablation (all P>0.05). Pre- and 30 days postablation heart rate variability did not differ (all P>0.05). Postablation diffusion-weighted imaging revealed no acute cerebral microembolus events. Moreover, there were no other procedure-related complications. The 8-month Kaplan-Meier estimate of freedom from arrhythmia was 83 ± 9%.<br /><b>Conclusions</b><br />PFA does not induce nerve injury during pulmonary vein isolation for paroxysmal AF.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 23 Nov 2022; epub ahead of print</small></div>
Guo F, Wang J, Deng Q, Feng H, ... Jiang H, Yu L
Heart Rhythm: 23 Nov 2022; epub ahead of print | PMID: 36435350
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<div><h4>The Electrocardiographic P Terminal Force in Lead V1, Its Components and the Association with Stroke and Atrial Fibrillation or Flutter.</h4><i>Wolder LD, Graff C, Baadsgaard KH, Langgaard ML, ... Sogaard P, Kragholm KH</i><br /><b>Background</b><br />ECG marker P Terminal Force V1 (PTFV1) is generally perceived as a marker of left atrial pathology and has been associated with atrial fibrillation or flutter (AF).<br /><b>Objective</b><br />To determine the association between PTFV1 components (duration and amplitude) and incident AF and stroke/TIA.<br /><b>Methods</b><br />We included patients with an ECG recorded in the Copenhagen General Practitioners Laboratory in 2001-2011. PTFV1 of ≥ 4 mV·ms was considered abnormal. Patients with abnormal PTFV1 were stratified into tertiles based on duration (PTDV1) and amplitude (PTAV1) values. Cox regressions adjusted for age, sex and relevant comorbidities were used to investigate associations between abnormal PTFV1 components and AF and stroke/TIA.<br /><b>Results</b><br />Of 267,636 patients, 5,803 had AF and 18,176 had stroke/TIA (follow-up time 6.5 years). Abnormal PTFV1 was present in 44,549 (16.7%) subjects and was associated with an increased risk of AF and stroke/TIA. Among patients with abnormal PTFV1, the highest tertile of PTDV1 (78 ms to 97 ms) was associated with the highest risk of AF (hazard ratio (HR) 1.37 (95% CI: 1.23-1.52)) and highest risk of stroke/TIA (HR 1.13 (95% CI: 1.05 -1.20)). For PTAV1, the highest tertile (78 μV to 126 μV) conferred the highest risk of AF and stroke/TIA, with a HR of 1.20 (95% CI: 1.09-1.32) and 1.21 (95% CI:1.14-1.25), respectively.<br /><b>Conclusion</b><br />Abnormal PTFV1 was associated with an increased risk of AF and stroke/TIA. Increasing PTDV1 showed a dose-response relationship with the development of AF and stroke/TIA, while the association between PTAV1 and AF was less apparent.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 23 Nov 2022; epub ahead of print</small></div>
Wolder LD, Graff C, Baadsgaard KH, Langgaard ML, ... Sogaard P, Kragholm KH
Heart Rhythm: 23 Nov 2022; epub ahead of print | PMID: 36435351
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<div><h4>Epicardial Ablation of Refractory Focal Atrial Tachycardia After a Failed Endocardial Approach.</h4><i>Zhang J, Ju W, Yang G, Tang C, ... Xu J, Chen M</i><br /><b>Background</b><br />Endocardial ablation is effective for most focal atrial tachycardias (FATs). In rare circumstances, the FAT can originate from the epicardial side of atrium.<br /><b>Objective</b><br />In the present study, we retrospectively assessed the percutaneous approach for epicardial ablation of FAT when standard endocardial ablation had failed.<br /><b>Methods</b><br />Among a consecutive 186 patients undergoing ablation for 198 FATs, epicardial mapping and ablation via a percutaneous subxiphoid approach were attempted in ten patients due to failed endocardial ablation.<br /><b>Results</b><br />In three cases, the origin of FAT was at the epicardial side of the junction of the right atrial appendage (RAA) and superior vena cava (SVC). In three cases, the origin of FAT was located in the epicardial region of the LA insertion of Bachmann\'s bundle (BB). In two cases, the FAT originated from the epicardial side of right atrial free wall. In one case, the FAT was successfully ablated from the epicardial side of the RAA, and in the remaining case, the origin of FAT was located in the epicardial region of the vein of Marshall (VOM). All FATs were successfully eliminated by ablation at the epicardial earliest activation site (EAS).<br /><b>Conclusions</b><br />Epicardial mapping and ablation can be considered as an effective and safe option for FAT resistant to endocardial ablation.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 18 Nov 2022; epub ahead of print</small></div>
Zhang J, Ju W, Yang G, Tang C, ... Xu J, Chen M
Heart Rhythm: 18 Nov 2022; epub ahead of print | PMID: 36410677
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<div><h4>Ultra-microhistological study of Non-thermal Irreversible Electroporation on Esophagus.</h4><i>Song Y, Yang L, He J, Zhao X, Zheng J, Fan L</i><br /><b>Background</b><br />Esophageal ulceration and even fistula are severe complications of pulmonary vein isolation using traditional thermal ablation. Non-thermal irreversible electroporation (NTIRE) is a new technique for pulmonary vein isolation in patients with atrial fibrillation. NTIRE has been shown to be a safe method for pulsed electroporation near the esophagus. NTIRE preserves the structural framework of the esophagus and allows for rapid recovery of the whole layers of the esophagus.<br /><b>Objective</b><br />The purpose of this study is to elucidate the ultrastructural changes and cytological mechanisms of cell regeneration and tissue repair after esophageal electroporation.<br /><b>Methods</b><br />The parameter combination of 2000 V/cm multiplied by 90 pulses output was directly applied to esophagus in 60 New Zealand rabbits, and ultrastructure analysis of the esophagus was implemented subsequently.<br /><b>Results</b><br />NTIRE predominantly triggered apoptosis of esophageal cells shortly after electroporation. Since the tissue structural framework was preserved, esophageal cells could regenerate through self-replication within four weeks. Complete anatomical repair can eventually be achieved through structural remodeling, and no lumen stenosis, ulcer, or fistula was observed in the ablated segment.<br /><b>Conclusion</b><br />Monophasic, bipolar NTIRE pulses delivered using plate electrodes in an esophageal model demonstrates no irreversible ultra-micropathological changes to the esophagus after four weeks.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 10 Nov 2022; epub ahead of print</small></div>
Song Y, Yang L, He J, Zhao X, Zheng J, Fan L
Heart Rhythm: 10 Nov 2022; epub ahead of print | PMID: 36372314
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<div><h4>High-resolution mapping of reentrant atrial tachycardias: relevance of low bipolar voltage.</h4><i>Ramirez FD, Meo M, Dallet C, Krisai P, ... Dubois R, Derval N</i><br /><b>Background</b><br />Bipolar voltage is widely used to characterize the atrial substrate but has been poorly validated, particularly during clinical tachycardias.<br /><b>Objective</b><br />To evaluate the diagnostic performance of voltage thresholds for identifying regions of slow conduction during reentrant atrial tachycardias (ATs).<br /><b>Methods</b><br />Thirty bipolar voltage and activation maps created during reentrant ATs were analyzed to (1) examine the relationship between voltage amplitude and conduction velocity (CV); (2) measure the diagnostic ability of voltage thresholds to predict CV; and (3) identify determinants of AT circuit dimensions. Voltage amplitude was categorized as \"normal\" (>0.50 mV), \"abnormal\" (0.05-0.50 mV), or \"scar\" (<0.05 mV); slow conduction was defined as <30 cm/s.<br /><b>Results</b><br />266,457 corresponding voltage and CV data points were included for analysis. Voltage and CV were moderately correlated (r=0.407, P<0.001). Bipolar voltage predicted regions of slow conduction with an area under the receiver operating characteristic curve of 0.733 (95% CI 0.731-0.735). A threshold of 0.50 mV had 91% sensitivity and 35% specificity for identifying slow conduction whereas 0.05 mV had 36% sensitivity and 87% specificity, with an optimal voltage threshold of 0.15 mV. Analyses restricted to the AT circuits identified weaker associations between voltage and CV and an optimal voltage threshold of 0.25 mV.<br /><b>Conclusion</b><br />Widely used bipolar voltage amplitude thresholds to define \'abnormal\' and \'scar\' tissue in the atria are respectively sensitive and specific for identifying regions of slow conduction during reentrant ATs. However, overall, the association of voltage with CV is modest. No clinical predictors of AT circuit dimensions were identified.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 08 Nov 2022; epub ahead of print</small></div>
Ramirez FD, Meo M, Dallet C, Krisai P, ... Dubois R, Derval N
Heart Rhythm: 08 Nov 2022; epub ahead of print | PMID: 36368515
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<div><h4>Long Term Outcomes Amongst Non-Progressors to Cardiac Resynchronization Therapy.</h4><i>Rickard J, Gold MR, Patel D, Wilkoff BL, ... Marine J, Spragg D</i><br /><b>Background</b><br />In patients with heart failure undergoing CRT, patients with a minimal change in LVEF have recently been defined as \"non-progressors\" rather than as \"non-responders\". Little is known regarding long term outcomes of non-progressors.<br /><b>Objectives</b><br />We sought to evaluate outcomes in patients undergoing CRT based on echocardiographically determined response status.<br /><b>Methods</b><br />We reviewed the medical charts on patients with an LVEF ≤35% and a QRSd ≥ 120ms undergoing CRT at the Cleveland Clinic, Johns Hopkins Hospital, and Johns Hopkins Bayview Medical Center between 2003 and 2014. Response to CRT was defined based on LVEF change as follows: super-responders≥20%, responders6-19%, non-progressors0-5%, and progressors<0%. Survival free of left LVAD and heart transplant was compared based on response classification.<br /><b>Results</b><br />1058 patients were included and had a mean follow up 8.7 ±5.4 years over which time there were 606 end-points (37 LVADs, 32 heart transplants and 537 deaths). Survival free of LVAD and heart transplant differed significantly between response groups following CRT both in the mid-term (4 years) and long term (8.7 ±5.4 years) with super-responders achieving the best outcomes and progressors the worst (p<0.001). In multivariate analysis, non-progressors had superior outcomes compared to progressors (p=0.02) at 4 years of follow up. Over the duration of follow up (8.7 5.4 years) there was no significant difference in survival between those two groups (p=0.18).<br /><b>Conclusions</b><br />Non-progressors to CRT have superior medium-term outcomes but similar long term outcomes compared to progressors and inferior outcomes compared to responders and super-responders.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 07 Nov 2022; epub ahead of print</small></div>
Rickard J, Gold MR, Patel D, Wilkoff BL, ... Marine J, Spragg D
Heart Rhythm: 07 Nov 2022; epub ahead of print | PMID: 36356725
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<div><h4>The distance between the lead-implanted site and tricuspid valve annulus in patients with left bundle branch pacing: effects on postoperative tricuspid regurgitation deterioration.</h4><i>Hu Q, You H, Chen K, Dai Y, ... Chen R, Zhang S</i><br /><b>Background</b><br />Left bundle branch pacing (LBBP) is an alternative strategy for His bundle pacing (HBP), however little is known about tricuspid regurgitation (TR) deterioration after LBBP implantation.<br /><b>Objectives</b><br />This study aimed to characterize the incidence of post-LBBP TR deterioration and identify predicting factors, especially lead position parameters.<br /><b>Methods</b><br />Patients who received LBBP were continuously enrolled from January 2018 to August 2020. The progression of TR and the anatomic position of LBBP characterized by echocardiography.<br /><b>Results</b><br />A total of 89 patients were enrolled and assigned to two sub-groups based on the degree of TR before LBBP implantation. 58 (65.2%) patients with relatively normal TV function (Grade0/1 subgroup: with none/trivial or mild TR) and 31 (34.8%) with more severe TR (Grade2/3 subgroup: with moderate or severe TR). With 19.0±6.5 months of follow-up time, 29 (32.6%) patients had TR deterioration and 23 of them were in Grade 0/1 subgroup. In Grade 0/1 subgroup, patients with TR deterioration had a shorter distance between the lead-implanted site and tricuspid valve (Lead-TA-dist) than those without TR (19.0±7.6 vs 23.9±5.4, P=0.006). The receiver operating characteristic (ROC) curve (AUC=0.721, 95%CI 0.575 to 0.867, P=0.005) indicated the favorable efficacy of Lead-TA-dist for predicting TR deterioration after LBBP. The lead-TA-dist ≤ 16.1mm was independently associated with TR deterioration after LBBP (HR 0.20, 95% CI 0.06 - 0.76, P = 0.017).<br /><b>Conclusion</b><br />TR was a common complication of LBBP implantation. In patients with none/trivial or mild TR, lead-TA-dist ≤ 16.1mm was an independent predictor of TR deterioration after LBBP implantation.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 05 Nov 2022; epub ahead of print</small></div>

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