Abstract
Aims
The aim of this study is to investigate determinants of left atrial (LA) reservoir and pump strain and if these parameters may serve as non-invasive markers of left ventricular (LV) ...filling pressure.
Methods and results
In a multicentre study of 322 patients with cardiovascular disease of different aetiologies, LA strain and other echocardiographic parameters were compared with invasively measured LV filling pressure. The strongest determinants of LA reservoir and pump strain were LV global longitudinal strain (GLS) (r-values 0.64 and 0.51, respectively) and LV filling pressure (r-values −0.52 and −0.57, respectively). Left atrial volume was another independent, but weaker determinant of both LA strains. For both LA strains, association with LV filling pressure was strongest in patients with reduced LV ejection fraction. Left atrial reservoir strain <18% and LA pump strain <8% predicted elevated LV filling pressure better (P < 0.05) than LA volume and conventional Doppler parameters. Accuracy to identify elevated LV filling pressure was 75% for LA reservoir strain alone and 72% for pump strain alone. When combined with conventional parameters, accuracy was 82% for both LA strains. In patients with normal LV systolic function by GLS, LA pump strain >14% identified normal LV filling pressure with 92% accuracy.
Conclusion
Left atrial reservoir and pump strain are determined predominantly by LV GLS and filling pressure. Accuracy of LA strains to identify elevated LV filling pressure was best in patients with reduced LV systolic function. High values of LA pump strain, however, identified normal LV filling pressure with good accuracy in patients with normal systolic function.
Graphical Abstract
Determinants and clinical application of LA reservoir and pump strain: Panel A: Apical 4-chamber image with colour coded region of interest for LA strain and the LA strain trace. Panel B: Relationship between LA reservoir strain and LV filling pressure in the total population. Panel C: Left atrial pump strain > 14% identifies normal LV filling pressure. Panel D: ROC curves for classification of LV filling pressure as normal or elevated. For comparison, curves are from the 235 patients where pump strain could be assessed. Panel E: Illustrates how LA strain may be incorporated in the decision algorithm for evaluation of LV filling pressure from the 2016 ASE/EACVI guideline (2).
Background
Conventional right ventricle (RV) pacemaker stimulation has been associated with worse clinical outcomes in patients with cardiac amyloidosis (CA). Left bundle branch area pacing (LABPP) ...has been suggested as a promising alternative. We sought to assess the safety, feasibility, and outcomes of LABPP in patients with CA.
Methods
We retrospectively analyzed echocardiography and pacing parameters and clinical outcomes in 23 consecutive patients with CA and LBBAP implanted from June 2020 to October 2022.
Results
LBBAP was successfully performed in 22 over 23 patients (19 male, 78.6 ± 11.7 years, 20 ATTR, mean LVEF 45.5 ± 16.2%). After the procedure, 9 patients showed Qr pattern and 11 a qR pattern in V1 on ECG. Average procedure time was 67 ± 28 min. After 7.7 ± 5.2 months follow‐up, no procedure‐related complications had occurred. Although, a significant reduction in QRS width (p = .001) was achieved, we did not observe significant changes in LVEF and Nt ProBNP at 6 months of follow‐up. Pacing parameters were stable during follow‐up: LBB capture threshold and R wave amplitude were 1.0 ± 0.5 V and 10.6 ± 6.0 mV versus 0.8 ± 0.1 V, p = .21 and 10.6 ± 5.1 mV (p = .985) at follow up.
Conclusion
LBBAP is safe and feasible pacing technique for patients with CA. LBBAP is associated with significant narrowing of QRSd without worsening in LVEF and Nt‐proBNP.
Background and Objectives
The common practice after atrial fibrillation ablation is to admit patients for an overnight stay. The aim of this study was to compare a strategy of vascular suture ...mediated closure system utilization and early discharge (strategy A) compared to traditional closure and overnight hospitalization (strategy B) regarding feasibility, safety, quality of life and health care cost effectiveness.
Methods and Results
Hundred patients were randomized to compare both strategies. No clinical differences were reported except diabetes mellitus. Six patients (6%) had and emergency visit or were admitted in the first 30 days after procedure. Three occurred in strategy A versus three in strategy B (p = 1) (p < .005 for non‐inferiority). Forty out of 50 patients (80%) were safely discharged in a time frame of 3 h and 42 patients (84%) were discharged in the same day of the procedure in strategy A. Time to discharge was shorter in strategy A compared to strategy B. (5.89 ± 7.47 h vs. 27.09 ± 2.29 p < .005). No differences were obtained in quality‐of‐life outcomes. Mean (95% CI) euros cost saving per patient in strategy A was 379.16 ± 93.55 p < .001. Ten acute complications (10% patients CI 95% 4.02%–15.98%) were reported during the trial. Seven (14% CI 95% 4.04%–23.96%) occurred in strategy A patients versus 3 (6% CI 95% 0.8%–12.8%) in strategy B. (p = .182)
Conclusion
A strategy of vascular suture mediated closure system utilization and early discharge was feasible, reduced time to discharge, saved costs and was not associated with more complications or admissions/emergency visits in a 30‐day time frame after procedure compared to a strategy of regular admission and discharge after overnight stay. There were no differences regarding quality‐of‐life parameters between both strategies.
Abstract
Background
Embolic cerebrovascular events that remain of unknown etiology after a thorough diagnostic evaluation, are known as Embolic Strokes of Undetermined Source (ESUS). Subclinical ...atrial fibrillation (AF) represents a significant underlying cause of ESUS. Our aims were to examine the overall diagnostic yield of a prolonged cardiac monitoring wearable system (PCMw) after an ESUS to detect AF and factors associated with it, including the time frame from the ESUS event to PCMw initiation. Additionally, to evaluate the frequency of unexpected arrhythmic events (UAE) and their prognostic implications.
Methods
We retrospectively analyzed 200 ECG recordings (3‐leads, 30 days duration) by means of a PCMw in patients with an ESUS to detect AF lasting longer than 30 s, between 2017 and 2021. UAE were defined as arrhythmia events that were not correlated to the main reason of prolonged cardiac monitoring.
Results
AF was detected in 21 patients (10.5%). Patients with AF had more left atrial enlargement (OR = 4.22 1.59–6.85;
p
= .01) and atrial arrythmias in the initial 24‐h Holter during hospitalization (OR = 5.73 2.03–16.49;
p
= .001). The detection of AF was significatively higher if the PCMw was worn within the first 30 days after the ESUS compared to beyond 30 days (17% vs. 10.3%;
p
= .002). Fifty three patients (26.5%) had UAE during PCMw. In six of them these findings led to targeted treatment.
Conclusion
PCMw represents a feasible non‐invasive device that could reliably detect subclinical AF episodes after an ESUS. Diagnostic yield was significatively higher when used within the first 30 days after the event, especially in selected patients. UAE were common, but did not impact prognosis.
We present the case of a 75‐year‐old woman with severe aortic stenosis and moderate left ventricular dysfunction, who underwent elective transcatheter aortic valve replacement. After the procedure, ...the patient developed a left bundle branch block and a long PR interval. For this reason, a dual chamber pacemaker with pacing in the left bundle branch area was implanted. On device interrogation, we confirmed the presence of functional atrial undersensing causing loss of ventricular electric resynchronization. This case highlights the importance of recognizing this problem and, by means of device reprogramming and pharmacological intervention, suggests a stepwise approach to solve it.
Anxiety is often present among patients with atrial fibrillation (AF). This condition has been associated with greater symptom severity and worse quality of life in these patients. However, the ...influence of anxiety on the risk of AF recurrence is not well known. We aimed to define the level of anxiety in patients with persistent AF undergoing elective cardioversion (EC) and determine whether there is an association between anxiety and the risk of early AF recurrence after EC.
Anxiety was measured before EC using the State-Trait Anxiety Inventory. Early AF recurrence was assessed with a control electrocardiogram at 30-day follow-up.
We included 107 patients undergoing effective EC. Early AF recurrence was diagnosed in 40 patients (37.4%). Compared with those who remained in sinus rhythm, individuals with early AF recurrence had significantly higher levels of trait anxiety (23.1 10.4 versus 17.9 9.5; p = .013) and larger left atrial volume index (45.8 12.3 versus 37.9 13.3 ml/m; p = .004). Both variables remained independently associated with early AF recurrence after multivariate analysis. A predictive model including trait anxiety score >20 and left atrial volume index >41 ml/m showed acceptable accuracy for the diagnosis of early AF recurrence (area under the curve = 0.733; 95% confidence interval = 0.634-0.832; p < .001).
Our study shows that trait anxiety is an independent risk factor for early AF recurrence after EC. Further studies are warranted to assess the beneficial role of anxiety-reducing strategies on the outcomes of patients with AF.
Dizziness in a patient with a permanent VVI pacemaker García-Izquierdo, Eusebio; Parra, Carolina; Toquero, Jorge
The American journal of emergency medicine,
March 2018, 2018-Mar, 2018-03-00, 20180301, Letnik:
36, Številka:
3
Journal Article
Recenzirano
A 83-year-old woman with a single-chamber pacemaker implanted 15 years earlier was brought to the ED due to symptomatic bradycardia. ECG continuous monitoring allowed the diagnosis of atrial ...fibrillation with complete atrioventricular block in the setting of a complete failure to capture. The differing timing cycles of pacing outputs can confirm that sensing is preserved in the absence of a pacemaker programmer.
Purpose
Implantable cardiac defibrillator (ICD) is the only definitive therapy for prevention of sudden cardiac death in hypertrophic cardiomyopathy (HCM). Conventional transvenous ICDs can provide ...cardiac pacing unlike new subcutaneous ICD, but the usefulness of cardiac pacing in HCM patients is not well defined. We sought to assess the usefulness of ICD pacing in HCM.
Methods
We retrospectively analyzed 93 HCM patients who had undergone ICD implantation at our center. Usefulness of pacing was defined as follows: 1) need of pacing due to bradycardia or AV conduction disturbances, 2) improvement of LV outflow tract obstruction by sequential AV pacing, 3) need for CRT pacing, or 4) successful antitachycardia pacing without a subsequent shock. Independent predictors of useful pacing were investigated by multivariable analysis.
Results
During a mean follow-up of 91.3 ± 5.5 months, 43 patients (46.2%) reached the composite endpoint. Independent predictors of pacing usefulness were older age (HR 1.36; 95%CI: 1.088–1.709;
p
=0.007) and NYHA functional class ≥ II (HR 2.15; 95%CI: 1.083–4.301; p=0.029). Twenty-eight (30.1%) patients had appropriate ICD interventions, triggered by a monomorphic ventricular tachycardia (MVT) in 22 of them (78.5%). In 17 individuals with MVT (77%), antitachycardia pacing successfully treated MVT.
Conclusions
In our HCM series of patients with ICD, 46% of individuals benefitted from cardiac pacing. MVT were documented in nearly 80% of the patients with ventricular arrhythmias and antitachycardia pacing successfully treated them in 77% of cases.
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