Left bundle branch area pacing (LBBAP), a new pacing approach, lacks adequate evaluation.
To assess the feasibility, safety, and acute effect of permanent LBBAP in patients with atrioventricular ...block (AVB).
A total of 33 AVB patients with indications for ventricular pacing were recruited. Electrocardiograms, pacing parameters, echocardiographic measurements, and complications associated with LBBAP were evaluated perioperatively and at 3-month follow-up. Successful LBBAP was defined as a paced QRS morphology of right bundle branch block pattern in lead V
and QRS duration (QRSd) less than 130 ms.
LBBAP was successfully performed in 90.9% (30/33) of patients (mean age: 55.1 ± 18.5 years; 66.7% male). The mean capture threshold was similar during the procedure (0.76 ± 0.26 V at 0.4 ms) and at the 3-month follow-up (0.64 ± 0.20 V at 0.4 ms). The paced QRSd was 112.8 ± 10.9 ms during the procedure and 116.8 ± 10.4 ms at the 3-month follow-up. Baseline left or right bundle branch block was corrected (intrinsic QRSd 153.3 ± 27.8 ms vs paced QRSd 122.2 ± 9.9 ms) with a success rate of 68.7% (11/16). One ventricular septal lead perforation occurred soon after the procedure with characteristics of pacing failure, and lead revision was successful. Cardiac function and left ventricular synchronization by 2-dimensional echocardiographic strain imaging at the 3-month follow-up slightly improved compared with that at baseline.
Permanent LBBAP yielded a stable threshold, a narrow QRSd, and preserved left ventricular synchrony with few complications. Our preliminary results indicate that LBBAP holds promise as an attractive physiological pacing strategy for AVB.
Abstract
Background
The prognostic nutritional index (PNI) and geriatric nutritional risk index (GNRI) are well known indicators for adverse outcomes in various diseases, but there is no evidence on ...their association with the risk of left atrial thrombus (LAT) in patients with valvular atrial fibrillation (VAF).
Methods
A comparative cross-sectional analytical study was conducted on 433 VAF patients. Demographics, clinical characteristics and echocardiographic data were collected and analyzed. Patients were grouped by the presence of LAT detected by transesophageal echocardiography.
Results
LAT were identified in 142 patients (32.79%). The restricted cubic splines showed an L-shaped relationship between PNI and LAT. The dose-response curve flattened out near the horizontal line with OR = 1 at the level of 49.63, indicating the risk of LAT did not decrease if PNI was greater than 49.63. GNRI was negative with the risk of LAT and tended to be protective when greater than 106.78. The best cut-off values of PNI and GNRI calculated by receiver operating characteristics curve to predict LAT were 46.4 (area under these curve AUC: 0.600, 95% confidence interval CI:0.541–0.658, P = 0.001) and 105.7 (AUC: 0.629, 95% CI:0.574–0.684, P<0.001), respectively. Multivariable logistic regression analysis showed that PNI ≤ 46.4 (odds ratio: 2.457, 95% CI:1.333–4.526, P = 0.004) and GNRI ≤ 105.7 (odds ratio: 2.113, 95% CI:1.076–4.149, P = 0.030) were independent predictors of LAT, respectively.
Conclusions
Lower nutritional indices (GNRI and PNI) were associated with increased risk for LAT in patients with VAF.
Background: The coronavirus disease 2019 (COVID-19) pandemic has severely affected healthcare systems around the world. This study aimed to investigate the perceptions of cardiologists regarding how ...the COVID-19 pandemic has affected the clinical practice patterns for acute coronary syndrome (ACS). Methods: A multicenter clinician survey was sent to 300 cardiologists working in 22 provinces in China. The survey collected demographic information and inquired about their perceptions of how the COVID-19 pandemic has affected ACS clinical practice patterns. Results: The survey was completed by 211 (70.3%) cardiologists, 82.5% of whom were employed in tertiary hospitals, and 52.1% reported more than 10 years of clinical cardiology practice. Most respondents observed a reduction in ACS inpatients and outpatients in their hospitals during the pandemic. Only 29.9% of the respondents had access to a dedicated catheter room for the treatment of COVID-19-positive ACS patients. Most respondents stated that the COVID-19 pandemic had varying degrees of effect on the treatment of acute ST-segment elevation myocardial infarction (STEMI), acute non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina. Compared with the assumed non-pandemic period, in the designed clinical questions, the selection of coronary interventional therapy for STEMI, NSTEMI, and unstable angina during the COVID-19 pandemic was significantly decreased (all p < 0.05), and the selection of pharmacotherapy was increased (all p < 0.05). The selection of fibrinolytic therapy for STEMI during the pandemic was higher than in the assumed non-pandemic period (p < 0.05). Conclusions: The COVID-19 pandemic has profoundly affected ACS clinical practice patterns. The use of invasive therapies significantly decreased during the pandemic period, whereas pharmacotherapy was more often prescribed by the cardiologists.
Abstract
Background
Congenitally corrected transposition of great arteries (ccTGA) is a rare congenital cardiac defect with atrioventricular and ventriculoarterial discordance which leads to heart ...failure and limits patients’ lifespan. The extremely aberrant cardiac structure makes electrophysiological procedure and radiofrequency ablation very difficult to be performed in such patients. Until now, there were only sporadical cases that have reported the successful ablation of atrial flutter in ccTGA patients.
Case presentation
We report a case of a 36-year-old male who was diagnosed with dextrocardia, atrial septal defect and congenitally corrected transposition of great arteries (ccTGA) at a young age and received atrial septal defect repair and morphological tricuspid valve plasty in 2014. As for reasons of heart failure and atrial flutter, he frequently suffered from progressively worsening dyspnea and recurrent episodes of palpitations. Cardiac anatomic imaging reconstruction before electrophysiological test revealed an unusually huge left atrial appendage in this patient. After high-density mapping of both right atrium and left atrium, activation mapping showed reentry circuit loops were located in left atrium. Successful ablation strategy was performed under the guidance of high-density mapping and entrainment.
Conclusion
This is a clinical case showing high-density mapping and successful ablation of a complex dual-loop atrial flutter in a patient with ccTGA and aberrant left atrial appendage. The successful procedure corroborates clinical utility of high-density mapping approach in the treatment of the patients with complex congenital heart disease accompanied by rapid arrhythmia, can be simpler, safer and more effective.
Catheter ablation as first-line therapy for ventricular tachycardia (VT) at the time of implantable cardioverter defibrillator (ICD) implantation has not been adopted into clinical guidelines. Also, ...there is an unmet clinical need to prospectively examine the role of VT ablation in patients with non-ischemic cardiomyopathy (NICM), an increasingly prevalent population referred for advanced therapies globally.
We conducted an international, multi-center, randomized controlled trial enrolling 180 patients with cardiomyopathy and monomorphic VT with an indication for implantable cardioverter defibrillator (ICD) implantation to assess the role of early, first-line ablation therapy. A total of 121 patients were randomized (1:1) to ablation + an ICD versus conventional medical therapy + an ICD. Patients who refused ICD (n=47) were followed in a prospective registry after stand-alone ablation treatment. The primary outcome was a composite endpoint of VT recurrence, cardiovascular hospitalization, or death.
Randomized patients had a mean age of 55 years old (IQR 46-64) and left ventricular ejection fraction of 40 % (IQR 30-49 %); 81 % were male. The underlying heart disease was ischemic cardiomyopathy (ICM) in 35 %, NICM in 30 %, and arrhythmogenic cardiomyopathy (ARVC) in 35 %. Ablation was performed a median of 2 days prior to ICD implantation (IQR 5 days prior to 14 days after). At 31-months, the primary outcome occurred in 49.3 %of the ablation group and 65.5 % in the control group (HR 0.58, 95 % CI, 0.35-0.96; P=0.04). The observed difference was driven by a reduction in VT recurrence in the ablation arm (HR 0.51 95 %CI, 0.29-0.90 ; P=0.02). A statistically significant reduction in both ICD shocks (10.0 vs 24.6 %; p=0.03) and anti-tachycardia pacing (16.2 % vs 32.8 %; p=0.04) was observed in patients who underwent ablation compared with control. No differences in cardiovascular hospitalization (32.0 % vs. 33.7 %; HR 0.82 95 % CI, 0.43-1.56 ; P=0.55) or mortality (8.9% vs 8.8 %, HR 1.40 95 %CI, 0.38-5.22 ; P=0.62) were observed. Ablation-related complications occurred in 8.3 % of patients.
Among patients with cardiomyopathy of varied etiologies, early catheter ablation performed at the time of ICD implantation significantly reduced the composite primary outcome of VT recurrence, cardiovascular hospitalization, or death. These findings were driven by a reduction in ICD therapies.
Less is known about pregnancy in women with arrhythmogenic right ventricular cardiomyopathy (ARVC). From April 1995 to May 2018, 157 women with ARVC were retrospectively enrolled. Data on pregnancy ...and cardiac outcomes were analyzed. There were 224 pregnancies in 120 patients including 30 (13.4%) spontaneous and 2 (0.9%) medical abortions, 12 cardiac adverse events were recorded including new onset frequent premature ventricular contractions (PVC) in 3 (2.5%) patients, previous PVC numbers increased more than 100% in 5 (4.2%), syncope in 2 (1.7%), sustained ventricular tachycardia and heart failure required hospitalization each in one patient (0.8%). Women with cardiac events showed lower left ventricular ejection fraction (LVEF) (50.3 ± 2.7 vs 60.0 ± 7.3; p = 0.004). No significant change in cardiac structure and function was found at 1 year follow-up postpartum. At a median follow-up of 8 (1 to 32) years, 36 (22.9%) women died. Earlier symptom onset age (hazard ratio 1.046; 95% confidence interval 1.017 to 1.075; p = 0.002) and decreased LVEF (hazard ratio 1.127; 95% confidence interval 1.001 to 1.154; p = 0.041) increased the risk of all-cause mortality, pregnancy had no negative influence on survival. In all the 192 offsprings (mean age 26.3 ± 13.5 years), 2 died of sudden death, no definite ARVC was found. Pregnancy seemed to be acceptable in ARVC, decreased LVEF increased the risk of pregnancy and was associated with poorer long-term survival.
Aim
To assess the electrocardiogram patterns of paced QRS narrowing after successful left bundle branch area pacing (LBBAP) and echocardiographic measurements in patients with bradycardia and bundle ...branch block (BBB).
Methods
We prospectively enrolled 55 consecutive bradycardia patients with BBB and left ventricular ejection fraction ≥40% who had attempted LBBAP. Successful LBBAP was defined as paced QRS morphology of a right BBB (RBBB) pattern in lead V1 and a recording of abruptly shortened and then constant stimulus to peak left ventricular activation time with high and low output. Pacing characteristics and echocardiographic measurements were evaluated perioperatively and at 6‐month follow‐up.
Results
The success rate of LBBAP was 83.6% in patients with BBB, and median cumulative X‐ray dose‐area product was 100.5 µGym2 (60.0, 179.3). LBBAP was successful in 19 of 26 patients with left BBB (LBBB) (73.1%) and in 27 of 29 patients with RBBB (93.1%). The QRS duration (QRSd) was significantly shortened in patients with LBBB (QRSd 169.4 ± 22.6 to 119.6 ± 9.5 ms), and five forms of QRSd narrowing were observed in patients with RBBB with the mean QRSd shortened from 143.1 ± 16.6 ms to 119.5 ± 11.7 ms. The thresholds for narrowing of QRSd were higher in RBBB than LBBB (1.74 ± 0.36 V/0.4 ms vs 0.79 ± 0.17 V/0.4 ms, P < .001). During the 6‐month follow‐up, both left and right ventricular synchronies were improved, and narrow QRSd persisted in patients with BBB.
Conclusion
In most bradycardia patients, RBBB could be completely or partially narrowed by LBBAP at different pacing models in addition to the correction of LBBB with LBBAP.
Cardioneuroablation is an emerging and promising therapy to treat vasovagal syncope (VVS). The aim of this study was to assess the characteristics of vagal response (VR), heart rate (HR), and blood ...pressure (BP) during cardioneuroablation with different sequences of ganglionated plexus (GPs) catheter ablation and clarify the regulatory mechanism of cardiac GPs of the left atrium.
A total of 28 patients with VVS who underwent cardioneuroablation were prospectively enrolled and randomly assigned to 2 groups according to the ablation order of GPs. Group A: Left superior GP (LSGP) - Left inferior GP (LIGP) - Right inferior GP (RIGP) - Right anterior GP (RAGP); Group B: RAGP - LSGP - LIGP - RIGP.
In Group A, the VR in LSGP, LIGP, RIGP, and RAGP during ablation was observed in 11 (78.6%), 5 (35.7%), 4 (28.6%) and 2 (14.3%) cases, respectively. In contrast, in Group B, the VR in RAGP, LSGP, LIGP, and RIGP was observed in 2 (14.3%), 1 (7.1%), 0 (0%) and 0 (0%) cases, respectively. BP reduction during procedure was observed eight times in Group A and once in Group B (P = 0.013). In both groups, the HR increased significantly during ablation of the RAGP (all P < 0.001).
The sequence of GPs ablation during cardioneuroablation affected the occurrence rate of VR and BP reduction during cardioneuroablation. The RAGP was a critical target to increase HR and inhibit VR and BP reduction during procedure, indicating that it may be a key GP in regulation of the cardiac vagal activity.
Left atrial appendage (LAA) morphology is considered to be associated with ischemic stroke, non-Chicken Wing LAA morphology increases the risk of thromboembolic events. However, existing ...classification of LAA morphology remains not well quantifiable and therefore may leave room for substantial subjective interpretation. This study aimed to assess interobserver and intraobserver agreements in LAA morphology and its real value in stroke prediction. A total of 2,264 atrial fibrillation patients who underwent computed tomography to explore the LAA anatomy were enrolled. All computed tomography images were given to 3 reviewers to judge the LAA morphology independently. A consensus between all 3 reviewers was only reached in 655 cases (28.9%). In which, 86 patients had previous stroke. Poor intraobserver consistency was observed between 2 times of reading in all the 3 reviewers (Kappa = 0.368, p = 0.014; Kappa = 0.350, p = 0.014; Kappa = 0.333, p = 0.015). Multivariate analysis showed that persistent atrial fibrillation (odds ratio OR 1.679; 95% confidence interval CI 1.031 to 2.736; p = 0.037), female gender (OR 1.761; 95% CI 1.037 to 2.994; p = 0.036) and age (OR 1.029; 95% CI 1.004 to 1.056; p = 0.025) were associated with previous stroke. LAA morphology was not associated with previous stroke and non-Chicken Wing LAA morphology did not increase the risk of stroke (OR 1.392; 95% CI 0.847 to 2.288; p = 0.192). In conclusion, high interobserver and intraobserver variabilities suggested that existing classification of LAA morphology was unreliable, the interpretation of the relation between LAA morphology and stroke needs caution.
Objective: To examine whether spironolactone could reduce the severity of obstructive sleep apnea (OSA) and lower blood pressure in patients with resistant hypertension. Methods: This was a ...blank-controlled, single-center study. Patients with resistant hypertension and moderate-to-severe OSA (apnea-hypopnea index >15 events/h) were enrolled and randomly assigned to the therapy or control group. Patients in the therapy group were administered spironolactone 20 mg once daily (up to 40 mg once daily for 4 weeks, if required) in addition to original antihypertensive medication. Follow-up was 12 weeks. Results: Thirty patients were enrolled (n = 15 per group). After 12 weeks of follow-up, apnea-hypopnea index (21.8 ± 15.7 vs. 1.8 ± 12.8, p < 0.05), hypopnea index (9.8 ± 11.1 vs. −2.7 ± 16.8, p < 0.05), oxygen desaturation index (20.8 ± 15.0 vs. 0.3 ± 16.1, p < 0.05), clinical blood pressure, ambulatory blood pressure, and plasma aldosterone level (9.8 ± 6.3 vs. 2.9 ± 6.7, p < 0.05) were reduced significantly in the therapy group compared with the control group. No side effects were reported. Conclusions: Spironolactone reduced the severity of OSA and reduced blood pressure in resistant hypertension patients with moderate-to-severe OSA. These findings may assist in the treatment of OSA in patients with resistant hypertension.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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