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Lan Z, Cheng S, Han Y, Jiang L, Li CW, Guo J. Predictive value of fine fibrillatory wave for declining eGFR in patients with persistent atrial fibrillation: Long-term follow-up study. Int J Cardiol 2024; 417:132521. [PMID: 39244098 DOI: 10.1016/j.ijcard.2024.132521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 08/29/2024] [Accepted: 09/04/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Renal dysfunction has been identified as a risk factor for both stroke and bleeding events in atrial fibrillation (AF) patients, yet the mechanisms remain unclear. We examines the connection between fine fibrillatory wave and estimated glomerular filtration rate (eGFR) decline, alongside chronic kidney disease (CKD). METHODS Persistent AF patients admitted to Jinan University's First Affiliated Hospital from January 2019 to June 2023 were enrolled. Kaplan-Meier analysis explored kidney endpoints for coarse and fine fibrillatory wave. A multivariate Cox model estimated adjusted hazard ratios (HR) and 95 % confidence intervals (95 % CI) to determine the correlation between fine fibrillatory wave and eGFR decline, as well as CKD. RESULTS Of the 3521 AF patients, 229 were ultimately included in the analysis of this study. The median age of these patients was 75 years, with 58 % being male. The median follow-up time was 23 months, and the mean eGFR was 70 ± 19 mL/min/1.73 m2. Multivariate COX regression analysis revealed fine fibrillatory wave (HR = 8.311, 95 % CI 3.418-20.211, p < 0.001) as an independent risk factor associated with a ≥ 30 % decline in eGFR. Among 166 AF patients with eGFR >60 mL/min/1.73 m2, 40 cases (24 %) experienced a decline to <60 mL/min/1.73 m2. In comparison to coarse fibrillatory wave, the risk of fine fibrillatory wave causing eGFR decline to <60 mL/min/1.73 m2 was approximately 4.6 times higher (HR = 4.645, 95 % CI 2.127-10.142, p<0.001). CONCLUSIONS Fine fibrillatory wave was independently associated with the risk of eGFR decline ≥30 % and eGFR decline to <60 mL/min/1.73 m2.
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Affiliation(s)
- Ziyin Lan
- Department of Cardiology, The First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Siyuan Cheng
- Department of Cardiology, The First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Yuchen Han
- Department of Cardiology, The First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Lie Jiang
- Department of Cardiology, The First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Chun Wai Li
- Department of Cardiology, The First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Jun Guo
- Department of Cardiology, The First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
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2
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Tuqan AR, Barabrah AM, Zaben BA, Shehadeh MH, Adas MM. Deficiency of adenosine deaminase 2 (DADA2) with bilateral renal subcapsular hematoma: a case report and literature review. Ann Med Surg (Lond) 2024; 86:5476-5480. [PMID: 39239002 PMCID: PMC11374158 DOI: 10.1097/ms9.0000000000001812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 01/30/2024] [Indexed: 09/07/2024] Open
Abstract
Introduction and importance Deficiency of adenosine deaminase 2 (DADA2) is a rare autosomal recessive genetic disorder caused by loss-of-function mutations in the adenosine deaminase 2 (ADA2) gene. This condition primarily manifests in pediatric cases before the age of 10 years, with sporadic cases reported in adults. ADA2 is a critical enzyme involved in macrophage differentiation and immune homeostasis. The clinical manifestations of DADA2 vary widely and can affect multiple organ systems. Our case uniquely highlights an infrequent DADA2 manifestation. Case presentation An 18-year-old female presented with right flank pain, fever, and a history of joint pain, Raynaud's phenomenon, livedo-like rash, and chronic abdominal pain. Physical examination revealed subcapsular hematoma in the right kidney. Further evaluation showed positive serologic tests for rheumatoid factor and antinuclear antibody (ANA). Genetic testing confirmed DADA2 homozygosity. The patient was discharged on the appropriate medications. Clinical discussion DADA2 is associated with vascular dysfunction and systemic vasculopathy. The clinical manifestations of DADA2 encompass a spectrum of organ involvement, including the skin, nervous system, gastrointestinal system, renal system, and the cardiovascular system. Early recognition and diagnosis are crucial for appropriate management. Conclusion This case report highlights the diverse clinical presentations of ADA2 deficiency, specifically focusing on bilateral renal subcapsular hematoma. This finding emphasizes the importance of considering DADA2 as a differential diagnosis in patients presenting with unexplained renal manifestations. Increased awareness of the varied clinical presentations of DADA2 will contribute to earlier diagnosis, appropriate management, and improved outcomes in patients affected by this rare genetic disorder.
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Affiliation(s)
- Anas R Tuqan
- Faculty of Medicine, Al-Quds University, Jerusalem
| | | | | | | | - Motaz M Adas
- Department of Internal Medicine, Palestine Medical Complex, Ramallah, Palestine
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Dong M, Liang C, Cheng G. The Loop Technique in Cardiac Resynchronization Therapy: A Prospective Cohort Study. Int J Gen Med 2024; 17:3711-3717. [PMID: 39219670 PMCID: PMC11363949 DOI: 10.2147/ijgm.s482227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024] Open
Abstract
Objective A new approach called the loop technique has been proven safe and effective for repeated intraoperative transvenous left ventricular (LV) lead dislocations during cardiac resynchronization therapy (CRT) in a 3-year follow-up. This study aimed to report on the 5-year safety and effectiveness of the loop technique. Methods This study was a prospective cohort study. Forty-four patients who underwent CRT device implantation at the Cardiology Department of Shaanxi Provincial People's Hospital between January 2013 and June 2019 were included. Data on patient demographics, medical history, laboratory test results, and echocardiography images at admission were collected. The loop technique was performed with repeated intraoperative dislocations of the LV lead. The intraoperative CRT parameters were also recorded. All patients were followed for 5 years. Several auxiliary examinations were performed during follow-up. Results The 44 patients were divided into the traditional operation group (n=36, 81.8%) and loop technique group (n=8, 18.2%). The baseline patient characteristics were almost balanced. During the 5-year follow-up, 8 (22.2%) patients in the traditional operation group and 2 (25.0%) patients in the loop technique group died. No lead dislocation or other complications related to CRT were observed. There were no significant differences in mortality rate (P=0.87), cardiac function (P=0.56), echocardiographic indices, threshold (P=0.58), or impedance (P=0.22) of the LV lead. There were no significant differences in the threshold and impedance between postoperative, 3-year, and 5-year follow-ups in the loop technique group (P=0.53). Conclusion The loop technique is an ideal solution for repeated intraoperative LV lead dislocation during CRT implantation.
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Affiliation(s)
- Mengya Dong
- Department of Cardiovascular Medicine, Shaanxi Provincial People’s Hospital, Xi’an, People’s Republic of China
| | - Chenyuan Liang
- Department of Cardiovascular Medicine, Shaanxi Provincial People’s Hospital, Xi’an, People’s Republic of China
| | - Gong Cheng
- Department of Cardiovascular Medicine, Honghui Hospital, Xi’an Jiaotong University, Xi’an, People’s Republic of China
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4
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Bhaiyya M, Panigrahi D, Rewatkar P, Haick H. Role of Machine Learning Assisted Biosensors in Point-of-Care-Testing For Clinical Decisions. ACS Sens 2024. [PMID: 39145721 DOI: 10.1021/acssensors.4c01582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Point-of-Care-Testing (PoCT) has emerged as an essential component of modern healthcare, providing rapid, low-cost, and simple diagnostic options. The integration of Machine Learning (ML) into biosensors has ushered in a new era of innovation in the field of PoCT. This article investigates the numerous uses and transformational possibilities of ML in improving biosensors for PoCT. ML algorithms, which are capable of processing and interpreting complicated biological data, have transformed the accuracy, sensitivity, and speed of diagnostic procedures in a variety of healthcare contexts. This review explores the multifaceted applications of ML models, including classification and regression, displaying how they contribute to improving the diagnostic capabilities of biosensors. The roles of ML-assisted electrochemical sensors, lab-on-a-chip sensors, electrochemiluminescence/chemiluminescence sensors, colorimetric sensors, and wearable sensors in diagnosis are explained in detail. Given the increasingly important role of ML in biosensors for PoCT, this study serves as a valuable reference for researchers, clinicians, and policymakers interested in understanding the emerging landscape of ML in point-of-care diagnostics.
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Affiliation(s)
- Manish Bhaiyya
- Department of Chemical Engineering and the Russell Berrie Nanotechnology Institute, Technion, Israel Institute of Technology, Haifa 3200003, Israel
- School of Electrical and Electronics Engineering, Ramdeobaba University, Nagpur 440013, India
| | - Debdatta Panigrahi
- Department of Chemical Engineering and the Russell Berrie Nanotechnology Institute, Technion, Israel Institute of Technology, Haifa 3200003, Israel
| | - Prakash Rewatkar
- Department of Mechanical Engineering, Israel Institute of Technology, Haifa 3200003, Israel
| | - Hossam Haick
- Department of Chemical Engineering and the Russell Berrie Nanotechnology Institute, Technion, Israel Institute of Technology, Haifa 3200003, Israel
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Zweibel SL. Switching to exclusive remote follow-up of CIEDs: Further proof of feasibility and safety. J Cardiovasc Electrophysiol 2024; 35:1559-1560. [PMID: 38923130 DOI: 10.1111/jce.16353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Steven L Zweibel
- Hartford HealthCare, Heart & Vascular Institute, Hartford, Connecticut, USA
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6
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de Graaf G, Timmermans I, Meine M, Alings M, Pedersen SS, Mabo P, Zitron E, Redekop K, Versteeg H. Economic evaluation of remote monitoring of patients with an implantable cardiac defibrillator (REMOTE-CIED study). J Telemed Telecare 2024; 30:1173-1185. [PMID: 36245363 DOI: 10.1177/1357633x221129176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Remote patient monitoring (RPM) of heart failure patients has the potential to reduce healthcare resource use and costs, but current evidence has been inconclusive. This study aims assess the impact of RPM of heart failure patients with an implantable cardioverter defibrillator on medical resource use, direct medical costs, quality-adjusted life years (QALYs), and travel time of patients, and to estimate its commercial headroom in the Netherlands and Germany. METHODS Data from the REMOTE-CIED randomized controlled trial were used to calculate differences in length of hospital stay, outpatient clinic visits, telephone consults, emergency room visits, and travel time between patients on in-clinic follow-up and RPM in the Netherlands, Germany, and France. Incremental cardiac-related healthcare costs and QALYs were calculated and used to calculate the commercial headroom of RPM in the Netherlands and Germany. The impact of imputation, parameter, and case-mix uncertainty on these outcomes was explored using probabilistic analysis. RESULTS Length of hospitalization, number of unscheduled admissions, and number of outpatient visits were lower in the remote monitoring group in all three countries. Number of hospital admissions was higher, and number of calls was lower in the Netherlands and Germany but not in France. Costs were lower in both the Netherlands (-€1041, 95% confidence interval (CI): -€3308, €1005) and Germany (-€2865, 95% CI: -€7619, €1105), while incremental effectiveness differed: -0.003 (95% CI: -0.114, 0.107) QALY in the Netherlands and +0.086 (95% CI: -0.083, 0.256) in Germany. Commercial headroom was estimated at €881 (95% CI: -€5430, €7208) in the Netherlands and €5005 (95% CI: -€1339, €11,960) in Germany. DISCUSSION RPM was found to result in reduced medical resource use and travel time. Whether it is cost saving or cost effective strongly depends on the costs of remote monitoring. TRIAL REGISTRATION NUMBER AND TRIAL REGISTER ClinicalTrials.gov: NCT01691586.
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Affiliation(s)
- Gimon de Graaf
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Ivy Timmermans
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
- Department of Medical and Clinical Psychology, CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, the Netherlands
| | - Mathias Meine
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Marco Alings
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Philippe Mabo
- Department of Cardiology, Centre Hospitalier Universitaire, Rennes, France
| | - Edgar Zitron
- Department of Cardiology, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Ken Redekop
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Henneke Versteeg
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
- Department of Medical and Clinical Psychology, CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, the Netherlands
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Higuchi K, Manne M, Tchou P, Baranowski B, Bhargava M, Callahan T, Chung M, Dresing T, Hussein A, Kanj M, Mayuga K, Nakhla S, Saliba W, Rickard J, Wazni O, Santangeli P, Sroubek J, Varma N. Left ventricular mass as a modulator of ventricular arrhythmia risk and sex differences after CRT for nonischemic cardiomyopathy and LBBB. Heart Rhythm 2024:S1547-5271(24)03084-4. [PMID: 39084586 DOI: 10.1016/j.hrthm.2024.07.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 07/01/2024] [Accepted: 07/13/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND The risk of ventricular arrhythmias (VAs) after cardiac resynchronization therapy (CRT) has been associated with ischemic disease/scar, sex, and possibly left ventricular mass (LVM). OBJECTIVE The purpose of this study was to evaluate sex differences and baseline/postimplant change in LVM on VA risk after CRT implantation in patients with nonischemic cardiomyopathy and left bundle branch block. METHODS In patients meeting the criteria, baseline and follow-up echocardiographic images were obtained for LVM assessment. VA events were reported from device diagnostics and therapies. VA risk was stratified by receiver operating characteristic (Youden index cutoff point) for baseline LVM and baseline/postimplant change in LVM, and baseline patient characteristics by using a multivariable Cox regression model. RESULTS One hundred eighteen patients (71 female [60.2%]; mean age 60.5 ± 11.3 years; left ventricular ejection fraction 19.2% ± 7.0%; QRS duration 165.6 ± 20 ms; LVM 313.9 ± 108.8 g) were enrolled and followed up for a median of 90 months (interquartile range 44-158 months). Thirty-five patients (29.6%) received appropriate shocks or antitachycardia pacing at a median of 73.5 months (interquartile range 25-130 months) postimplantation. Males had a higher VA incidence (male 18 of 47 [38.3%] vs female 17 of 71 [23.9%]; P = .02). Baseline LVM > 308.9 g separated patients with higher VA risk (P = .001). Less than a 20% decrease in LVM increased VA risk (P < .001). Baseline LVM was the only baseline characteristic predicting VA events in the Cox regression model (hazard ratio 1.01; 95% confidence interval 1.001-1.009; log-rank, P = .003). Sex differences in VA risk were eliminated by the baseline LVM parameters. CONCLUSION VA risk after CRT in nonischemic cardiomyopathy was associated with baseline LV > 308.9 g and a decrease in LVM ≤ 20%, without sex differences.
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Affiliation(s)
- Koji Higuchi
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
| | - Mahesh Manne
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Patrick Tchou
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Bryan Baranowski
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Mandeep Bhargava
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Thomas Callahan
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Mina Chung
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Thomas Dresing
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Ayman Hussein
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Mohamed Kanj
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Kenneth Mayuga
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Shady Nakhla
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Walid Saliba
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - John Rickard
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Oussama Wazni
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Pasquale Santangeli
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Jakub Sroubek
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Niraj Varma
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
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8
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Tan SY, Sumner J, Wang Y, Wenjun Yip A. A systematic review of the impacts of remote patient monitoring (RPM) interventions on safety, adherence, quality-of-life and cost-related outcomes. NPJ Digit Med 2024; 7:192. [PMID: 39025937 PMCID: PMC11258279 DOI: 10.1038/s41746-024-01182-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 07/01/2024] [Indexed: 07/20/2024] Open
Abstract
Due to rapid technological advancements, remote patient monitoring (RPM) technology has gained traction in recent years. While the effects of specific RPM interventions are known, few published reviews examine RPM in the context of care transitions from an inpatient hospital setting to a home environment. In this systematic review, we addressed this gap by examining the impacts of RPM interventions on patient safety, adherence, clinical and quality of life outcomes and cost-related outcomes during care transition from inpatient care to a home setting. We searched five academic databases (PubMed, CINAHL, PsycINFO, Embase and SCOPUS), screened 2606 articles, and included 29 studies from 16 countries. These studies examined seven types of RPM interventions (communication tools, computer-based systems, smartphone applications, web portals, augmented clinical devices with monitoring capabilities, wearables and standard clinical tools for intermittent monitoring). RPM interventions demonstrated positive outcomes in patient safety and adherence. RPM interventions also improved patients' mobility and functional statuses, but the impact on other clinical and quality-of-life measures, such as physical and mental health symptoms, remains inconclusive. In terms of cost-related outcomes, there was a clear downward trend in the risks of hospital admission/readmission, length of stay, number of outpatient visits and non-hospitalisation costs. Future research should explore whether incorporating intervention components with a strong human element alongside the deployment of technology enhances the effectiveness of RPM. The review highlights the need for more economic evaluations and implementation studies that shed light on the facilitators and barriers to adopting RPM interventions in different care settings.
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Affiliation(s)
- Si Ying Tan
- Alexandra Research Centre for Healthcare In The Virtual Environment (ARCHIVE), Alexandra Hospital, National University Health System, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jennifer Sumner
- Alexandra Research Centre for Healthcare In The Virtual Environment (ARCHIVE), Alexandra Hospital, National University Health System, Singapore, Singapore.
| | - Yuchen Wang
- School of Computing, National University of Singapore, Singapore, Singapore
| | - Alexander Wenjun Yip
- Alexandra Research Centre for Healthcare In The Virtual Environment (ARCHIVE), Alexandra Hospital, National University Health System, Singapore, Singapore
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9
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Keene D, Kaza N, Srinivasan D, Ali N, Tanner M, Foley P, Chandrasekaran B, Moore P, Adhya S, Qureshi N, Muthumala A, Lane R, Rinaldi A, Agarwal S, Leyva F, Behar J, Bassi S, Ng A, Scott P, Prasad R, Swinburn J, Tomson J, Sethi A, Shah J, Lim PB, Kyriacou A, Thomas D, Chuen J, Kamdar R, Kanagaratnam P, Mariveles M, Johnson N, Falaschetti E, Howard JP, Arnold A, Cleland JGF, Francis DP, Whinnett Z, Shun-Shin M. Predictors of the efficacy of His bundle pacing in patients with a prolonged PR interval: A stratified analysis of the HOPE-HF randomized controlled trial. Eur J Heart Fail 2024. [PMID: 39023285 DOI: 10.1002/ejhf.3367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 06/02/2024] [Accepted: 06/19/2024] [Indexed: 07/20/2024] Open
Abstract
AIMS The randomized, double-blind, placebo-controlled HOPE-HF trial assessed the benefit of atrio-ventricular (AV) delay optimization delivered using His bundle pacing. It recruited patients with left ventricular ejection fraction ≤40%, PR interval ≥200 ms, and baseline QRS ≤140 ms or right bundle branch block. Overall, there was no significant increase in peak oxygen uptake (VO2max) but there was significant improvement in heart failure specific quality of life. In this pre-specified secondary analysis, we evaluated the impact of baseline PR interval, echocardiographic E-A fusion, and the magnitude of acute high-precision haemodynamic response to pacing, on outcomes. METHODS AND RESULTS All 167 randomized participants underwent measurement of PR interval, acute haemodynamic response at optimized AV delay, and assessment of presence of E-A fusion. We tested the impact of these baseline parameters using a Bayesian ordinal model on VO2max, quality of life and activity measures. There was strong evidence of a beneficial interaction between the baseline acute haemodynamic response and the blinded benefit of pacing for VO2 (Pr 99.9%), Minnesota Living With Heart Failure (MLWHF) (Pr 99.8%), MLWHF physical limitation score (Pr 98.9%), EQ-5D visual analogue scale (Pr 99.6%), and exercise time (Pr 99.4%). The baseline PR interval and the presence of baseline E-A fusion did not have this reliable ability to predict the clinical benefit of pacing over placebo across multiple endpoints. CONCLUSIONS In the HOPE-HF trial, the acute haemodynamic response to pacing reliably identified patients who obtained clinical benefit. Patients with a long PR interval (≥200 ms) and left ventricular impairment who obtained acute haemodynamic improvement with AV-optimized His bundle pacing were likely to obtain clinical benefit, consistent across multiple endpoints. Importantly, this gradation can be reliably tested for before randomization, but does require high-precision AV-optimized haemodynamic assessment to be performed.
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Affiliation(s)
- Daniel Keene
- National Heart and Lung Institute, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Nandita Kaza
- National Heart and Lung Institute, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Nadine Ali
- National Heart and Lung Institute, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Mark Tanner
- West Sussex Hospitals NHS Trust, West Sussex, UK
| | - Paul Foley
- Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | | | - Philip Moore
- West Hertfordshire Hospitals NHS Trust, Hertfordshire, UK
- Barts Health NHS Trust, London, UK
| | | | | | - Amal Muthumala
- Barts Health NHS Trust, London, UK
- North Middlesex University Hospital, London, UK
| | - Rebecca Lane
- Royal Brompton and Harefield NHS Trust, London, UK
| | - Aldo Rinaldi
- Guy's and St. Thomas's NHS Foundation Trust, London, UK
| | - Sharad Agarwal
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | | | - Sukh Bassi
- Sherwood Forest Hospitals NHS Foundation Trust, Mansfield, UK
| | - Andre Ng
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | | | | | - Jon Swinburn
- Royal Berkshire NHS Foundation Trust, Reading, UK
| | | | - Amarjit Sethi
- London North West University Healthcare NHS Trust, London, UK
| | - Jaymin Shah
- London North West University Healthcare NHS Trust, London, UK
| | - Phang Boon Lim
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Andreas Kyriacou
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Dewi Thomas
- Morriston Hospital Regional Cardiac Centre, Swansea, UK
| | - Jenny Chuen
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | | | | | - Nicholas Johnson
- Imperial College Trials Unit, Imperial College London, London, UK
| | | | - James P Howard
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Ahran Arnold
- National Heart and Lung Institute, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - John G F Cleland
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Darrel P Francis
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Zachary Whinnett
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Matthew Shun-Shin
- National Heart and Lung Institute, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
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10
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Puvrez A, Duchenne J, Donal E, Gorcsan J, Patel HC, Marwick TH, Smiseth OA, Søgaard P, Stankovic I, Diogo PG, Vörös G, Voigt JU. Mechanical dyssynchrony as a selection criterion for cardiac resynchronization therapy: Design of the AMEND-CRT trial. ESC Heart Fail 2024. [PMID: 38984947 DOI: 10.1002/ehf2.14932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/25/2024] [Accepted: 06/14/2024] [Indexed: 07/11/2024] Open
Abstract
AIMS One third of patients do not improve after cardiac resynchronization therapy (CRT). Septal flash (SF) and apical rocking (ApRock) are deformation patterns observed on echocardiography in most patients eligible for CRT. These markers of mechanical dyssynchrony have been associated to improved outcome after CRT in observational studies and may be useful to better select patients. The aim of this trial is to investigate whether the current guideline criteria for selecting patients for CRT should be modified and include SF and ApRock to improve therapy success rate, reduce excessive costs and prevent exposure to device-related complications in patients who would not benefit from CRT. METHODS The AMEND-CRT trial is a multicentre, randomized, parallel-group, double-blind, sham-controlled trial with a non-inferiority design. The trial will include 578 patients scheduled for CRT according to the 2021 ESC guidelines who satisfy all inclusion criteria. The randomization is performed 1:1 to an active control arm ('guideline arm') or an experimental arm ('echo arm'). All participants receive a device, but in the echo arm, CRT is activated only when SF or ApRock or both are present. The outcome of both arms will be compared after 1 year. The primary outcome measures are the average change in left ventricular end-systolic volume and patient outcome assessed using a modified Packer Clinical Composite Score. CONCLUSIONS The findings of this trial will redefine the role of echocardiography in CRT and potentially determine which patients with heart failure and a prolonged QRS duration should receive CRT, especially in patients who currently have a class IIa or class IIb recommendation.
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Affiliation(s)
- Alexis Puvrez
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Jürgen Duchenne
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Erwan Donal
- LTSI, Inserm 1099, LTSI, University of Rennes, Rennes, France
- Department of Cardiology, CHU Rennes, Rennes, France
| | - John Gorcsan
- Heart and Vascular Institute, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Hitesh C Patel
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | | | - Otto A Smiseth
- Institute for Surgical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital and University of Aalborg, Aalborg, Denmark
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Ivan Stankovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Cardiology, Clinical Hospital Centre Zemun, Belgrade, Serbia
| | - Pedro G Diogo
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Gábor Vörös
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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11
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Scacciavillani R, Koliastasis L, Doundoulakis I, Chiotis S, Kordalis A, Narducci ML, Kotoulas S, Pinnacchio G, Bencardino G, Perna F, Comerci G, Gatzoulis KA, Tsiachris D, Pelargonio G. Remote Monitoring of Cardiac Implantable Electronic Devices in Very Elderly Patients: Advantages and Specific Problems. J Cardiovasc Dev Dis 2024; 11:209. [PMID: 39057629 PMCID: PMC11277150 DOI: 10.3390/jcdd11070209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/24/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
Cardiac implantable electronic devices (CIEDs) offer the benefit of remote monitoring and decision making and find particular applications in special populations such as the elderly. Less transportation, reduced costs, prompt diagnosis, a sense of security, and continuous real-time monitoring are the main advantages. On the other hand, less physician-patient interactions and the technology barrier in the elderly pose specific problems in remote monitoring. CIEDs nowadays are abundant and are mostly represented by rhythm control/monitoring devices, whereas hemodynamic remote monitoring devices are gaining popularity and are evolving and becoming refined. Future directions include the involvement of artificial intelligence, yet disparities of availability, lack of follow-up data, and insufficient patient education are still areas to be improved. This review aims to describe the role of CIED in the very elderly and highlight the merits and possible drawbacks.
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Affiliation(s)
- Roberto Scacciavillani
- Department of Cardiovascular & Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy; (R.S.); (G.P.)
| | - Leonidas Koliastasis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (L.K.); (S.C.); (A.K.); (S.K.); (K.A.G.); (D.T.)
| | - Ioannis Doundoulakis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (L.K.); (S.C.); (A.K.); (S.K.); (K.A.G.); (D.T.)
| | - Sotirios Chiotis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (L.K.); (S.C.); (A.K.); (S.K.); (K.A.G.); (D.T.)
| | - Athanasios Kordalis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (L.K.); (S.C.); (A.K.); (S.K.); (K.A.G.); (D.T.)
| | - Maria Lucia Narducci
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.L.N.); (G.P.); (G.B.); (F.P.); (G.C.)
- Cardiology Unit, Cardiothoracic Department, Azienda Ospedaliera Universitaria Santa Maria della Misericordia, 33100 Udine, Italy
| | - Sotiris Kotoulas
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (L.K.); (S.C.); (A.K.); (S.K.); (K.A.G.); (D.T.)
| | - Gaetano Pinnacchio
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.L.N.); (G.P.); (G.B.); (F.P.); (G.C.)
| | - Gianluigi Bencardino
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.L.N.); (G.P.); (G.B.); (F.P.); (G.C.)
| | - Francesco Perna
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.L.N.); (G.P.); (G.B.); (F.P.); (G.C.)
| | - Gianluca Comerci
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.L.N.); (G.P.); (G.B.); (F.P.); (G.C.)
| | - Konstantinos A. Gatzoulis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (L.K.); (S.C.); (A.K.); (S.K.); (K.A.G.); (D.T.)
| | - Dimitris Tsiachris
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (L.K.); (S.C.); (A.K.); (S.K.); (K.A.G.); (D.T.)
| | - Gemma Pelargonio
- Department of Cardiovascular & Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy; (R.S.); (G.P.)
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.L.N.); (G.P.); (G.B.); (F.P.); (G.C.)
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12
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Pagano M, Corallo F, Anselmo A, Giambò FM, Micali G, Duca A, D’Aleo P, Bramanti A, Garofano M, Bramanti P, Cappadona I. Optimisation of Remote Monitoring Programmes in Heart Failure: Evaluation of Patient Drop-Out Behaviour and Healthcare Professionals' Perspectives. Healthcare (Basel) 2024; 12:1271. [PMID: 38998806 PMCID: PMC11241166 DOI: 10.3390/healthcare12131271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/12/2024] [Accepted: 06/25/2024] [Indexed: 07/14/2024] Open
Abstract
Heart failure (HF) is a growing epidemic, affecting millions of people worldwide, and is a major cause of mortality, morbidity, and impaired quality of life. Traditional cardiac rehabilitation is a valuable approach to the physical and quality-of-life recovery of patients with cardiovascular disease. The innovative approach of remote monitoring through telemedicine offers a solution based on modern technologies, enabling continuous collection of health data outside the hospital environment. Remote monitoring devices present challenges that could adversely affect patient adherence, resulting in the risk of dropout. By applying a cognitive-behavioral model, we aim to identify the antecedents of dropout behavior among patients adhering to traditional cardiac rehabilitation programs and remote monitoring in order to improve the latter. Our study was conducted from October 2023 to January 2024. In the first stage, we used data from literature consultation. Subsequently, data were collected from the direct experience of 49 health workers related to both remote monitoring and traditional treatment, recruited from the authors' workplace. Results indicate that patients with cardiovascular disease tend to abandon remote monitoring programs more frequently than traditional cardiac rehabilitation therapies. It is critical to design approaches that take these barriers into account to improve adherence and patient satisfaction. This analysis identified specific antecedents to address, helping to improve current monitoring models. This is crucial to promote care continuity and to achieve self-management by patients in the future.
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Affiliation(s)
- Maria Pagano
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo, S.S. 113, C.da Casazza, 98124 Messina, Italy
| | - Francesco Corallo
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo, S.S. 113, C.da Casazza, 98124 Messina, Italy
| | - Anna Anselmo
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo, S.S. 113, C.da Casazza, 98124 Messina, Italy
| | - Fabio Mauro Giambò
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo, S.S. 113, C.da Casazza, 98124 Messina, Italy
| | - Giuseppe Micali
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo, S.S. 113, C.da Casazza, 98124 Messina, Italy
| | - Antonio Duca
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo, S.S. 113, C.da Casazza, 98124 Messina, Italy
| | - Piercataldo D’Aleo
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo, S.S. 113, C.da Casazza, 98124 Messina, Italy
| | - Alessia Bramanti
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Marina Garofano
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Placido Bramanti
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo, S.S. 113, C.da Casazza, 98124 Messina, Italy
- Faculty of Psychology, Università degli Studi eCampus, Via Isimbardi 10, 22060 Novedrate, Italy
| | - Irene Cappadona
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo, S.S. 113, C.da Casazza, 98124 Messina, Italy
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13
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Kohno R, Hayashi K, Oginosawa Y, Abe H. How Are High-Voltage Devices Used for Primary Prevention in Very Elderly Patients? Circ J 2024; 88:1125-1126. [PMID: 38763734 DOI: 10.1253/circj.cj-24-0310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Affiliation(s)
- Ritsuko Kohno
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Katsuhide Hayashi
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Yasushi Oginosawa
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
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14
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Devarajan A, Wang K, Lokhandwala ZA, Emamimeybodi M, Shannon K, Tompkins JD, Hevener AL, Lusis AJ, Abel ED, Vaseghi M. Myocardial infarction causes sex-dependent dysfunction in vagal sensory glutamatergic neurotransmission that is mitigated by 17β-estradiol. JCI Insight 2024; 9:e181042. [PMID: 38885308 PMCID: PMC11383359 DOI: 10.1172/jci.insight.181042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/05/2024] [Indexed: 06/20/2024] Open
Abstract
Parasympathetic dysfunction after chronic myocardial infarction (MI) is known to predispose ventricular tachyarrhythmias (ventricular tachycardia/ventricular fibrillation [VT/VF]). VT/VF after MI is more common in males than females. The mechanisms underlying the decreased vagal tone and the associated sex difference in the occurrence of VT/VF after MI remain elusive. In this study, using optogenetic approaches, we found that responses of glutamatergic vagal afferent neurons were impaired following chronic MI in male mice, leading to reduced reflex efferent parasympathetic function. Molecular analyses of vagal ganglia demonstrated reduced glutamate levels, accompanied by decreased mitochondrial function and impaired redox status in infarcted males versus sham animals. Interestingly, infarcted females demonstrated reduced vagal sensory impairment, associated with greater vagal ganglia glutamate levels and decreased vagal mitochondrial dysfunction and oxidative stress compared with infarcted males. Treatment with 17β-estradiol mitigated this pathological remodeling and improved vagal neurotransmission in infarcted male mice. These data suggest that a decrease in efferent vagal tone following MI results from reduced glutamatergic afferent vagal signaling that may be due to impaired redox homeostasis in the vagal ganglia, which subsequently leads to pathological remodeling in a sex-dependent manner. Importantly, estrogen prevents pathological remodeling and improves parasympathetic function following MI.
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Affiliation(s)
| | - Kerry Wang
- Division of Cardiology
- Department of Medicine
| | | | | | | | | | - Andrea L Hevener
- Department of Medicine
- Division of Endocrinology, Diabetes, and Hypertension
| | - Aldons J Lusis
- Division of Cardiology
- Department of Medicine
- Department of Microbiology, Immunology, and Molecular Genetics, and
| | | | - Marmar Vaseghi
- Division of Cardiology
- Department of Medicine
- Molecular, Cellular, and Integrative Physiology Interdepartmental Program, UCLA, Los Angeles, California, USA
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15
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Aslan U, Beeres SLMA, Feijen M, Mulder GM, Jukema JW, Egorova AD. Efficacy of the Cardiac Implantable Electronic Device Multisensory Triage-HF Algorithm in Heart Failure Care: A Real-World Clinical Experience. SENSORS (BASEL, SWITZERLAND) 2024; 24:3664. [PMID: 38894453 PMCID: PMC11175325 DOI: 10.3390/s24113664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/23/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024]
Abstract
Heart failure (HF) admissions are burdensome, and the mainstay of prevention is the timely detection of impending fluid retention, creating a window for medical treatment intensification. This study evaluated the accuracy and performance of a Triage-HF-guided carepath in real-world ambulatory HF patients in daily clinical practice. In this prospective, observational study, 92 adult HF patients (71 males (78%), with a median age of 69 [IQR 59-75] years) with the Triage-HF algorithm activated in their cardiac implantable electronic devices (CIEDs), were monitored. Following high-risk alerts, an HF nurse contacted patients to identify signs and symptoms of fluid retention. The sensitivity and specificity were 83% and 97%, respectively. The positive predictive value was 89%, and negative predictive value was 94%. The unexplained alert rate was 0.05 alerts/patient year, and the false negative rate was 0.11 alerts/patient year. Ambulatory diuretics were initiated or escalated in 77% of high-risk alert episodes. In 23% (n = 6), admission was ultimately required. The median alert handling time was 2 days. Fifty-eight percent (n = 18) of high-risk alerts were classified as true positives in the first week, followed by 29% in the second-third weeks (n = 9), and 13% (n = 4) in the fourth-sixth weeks. Common sensory triggers included an elevated night ventricular rate (84%), OptiVol (71%), and reduced patient activity (71%). The CIED-based Triage-HF algorithm-driven carepath enables the timely detection of impending fluid retention in a contemporary ambulatory setting, providing an opportunity for clinical action.
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Affiliation(s)
- Ugur Aslan
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (U.A.); (S.L.M.A.B.); (G.M.M.); (J.W.J.)
| | - Saskia L. M. A. Beeres
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (U.A.); (S.L.M.A.B.); (G.M.M.); (J.W.J.)
| | - Michelle Feijen
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (U.A.); (S.L.M.A.B.); (G.M.M.); (J.W.J.)
| | - Gerlinde M. Mulder
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (U.A.); (S.L.M.A.B.); (G.M.M.); (J.W.J.)
| | - J. Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (U.A.); (S.L.M.A.B.); (G.M.M.); (J.W.J.)
- Netherlands Heart Institute, Morseelsepark 1, 3511 EP Utrecht, The Netherlands
| | - Anastasia D. Egorova
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (U.A.); (S.L.M.A.B.); (G.M.M.); (J.W.J.)
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16
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Mankad P, Ellenbogen KA. Conduction system pacing as cardiac resynchronization therapy in patients with heart failure with reduced ejection fraction: More optimism than caution! Heart Rhythm 2024; 21:890-892. [PMID: 38492872 DOI: 10.1016/j.hrthm.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 03/11/2024] [Indexed: 03/18/2024]
Affiliation(s)
- Pranav Mankad
- Division of Cardiology, Virgina Commonwealth University School of Medicine, Richmond, Virginia
| | - Kenneth A Ellenbogen
- Division of Cardiology, Virgina Commonwealth University School of Medicine, Richmond, Virginia.
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17
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Ferreira Felix I, Collini M, Fonseca R, Guida C, Armaganijan L, Healey JS, Carvalho G. Conduction system pacing versus biventricular pacing in heart failure with reduced ejection fraction: A systematic review and meta-analysis of randomized controlled trials. Heart Rhythm 2024; 21:881-889. [PMID: 38382686 DOI: 10.1016/j.hrthm.2024.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 02/16/2024] [Accepted: 02/16/2024] [Indexed: 02/23/2024]
Abstract
Conduction system pacing (CSP) has emerged as a promising alternative to biventricular pacing (BVP) in patients with heart failure with reduced ejection fraction (HFrEF) and ventricular dyssynchrony, but its benefits are uncertain. In this study, we aimed to evaluate clinical outcomes of CSP vs BVP for cardiac resynchronization in patients with HFrEF. PubMed, Scopus, and Cochrane databases were searched for randomized controlled trials comparing CSP to BVP for resynchronization therapy in patients with HFrEF. Heterogeneity was examined with I2 statistics. A random-effects model was used for all outcomes. We included 7 randomized controlled trials with 408 patients, of whom 200 (49%) underwent CSP. Compared to BVP, CSP resulted in a significantly greater reduction in QRS duration (MD -13.34 ms; 95% confidence interval [CI] -24.32 to -2.36, P = .02; I2 = 91%) and New York Heart Association functional class (standardized mean difference [SMD] -0.37; 95% CI -0.69 to -0.05; P = .02; I2 = 41%), and a significant increase in left ventricular ejection fraction (mean difference [MD] 2.06%; 95% CI 0.16 to 3.97; P = .03; I2 = 0%). No statistical difference was noted for left ventricular end-systolic volume (SMD -0.51 mL; 95% CI -1.26 to 0.24; P = .18; I2 = 83%), lead capture threshold (MD -0.08 V; 95% CI -0.42 to 0.27; P = .66; I2 = 66%), and procedure time (MD 5.99 minutes; 95% CI -15.91 to 27.89; P = .59; I2 = 79%). These findings suggest that CSP may have electrocardiographic, echocardiographic, and symptomatic benefits over BVP for patients with HFrEF requiring cardiac resynchronization.
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Affiliation(s)
- Iuri Ferreira Felix
- Department of Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, Minnesota.
| | - Michelle Collini
- Department of Medicine, Federal University of Paraná, Paraná, Brazil
| | - Rafaela Fonseca
- Department of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Camila Guida
- Division of Cardiology, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - Luciana Armaganijan
- Division of Cardiology, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - Jeffrey Sean Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Guilherme Carvalho
- Division of Cardiology, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
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18
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Jaffery OA, Melki L, Slabaugh G, Good WW, Roney CH. A Review of Personalised Cardiac Computational Modelling Using Electroanatomical Mapping Data. Arrhythm Electrophysiol Rev 2024; 13:e08. [PMID: 38807744 PMCID: PMC11131150 DOI: 10.15420/aer.2023.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/27/2023] [Indexed: 05/30/2024] Open
Abstract
Computational models of cardiac electrophysiology have gradually matured during the past few decades and are now being personalised to provide patient-specific therapy guidance for improving suboptimal treatment outcomes. The predictive features of these personalised electrophysiology models hold the promise of providing optimal treatment planning, which is currently limited in the clinic owing to reliance on a population-based or average patient approach. The generation of a personalised electrophysiology model entails a sequence of steps for which a range of activation mapping, calibration methods and therapy simulation pipelines have been suggested. However, the optimal methods that can potentially constitute a clinically relevant in silico treatment are still being investigated and face limitations, such as uncertainty of electroanatomical data recordings, generation and calibration of models within clinical timelines and requirements to validate or benchmark the recovered tissue parameters. This paper is aimed at reporting techniques on the personalisation of cardiac computational models, with a focus on calibrating cardiac tissue conductivity based on electroanatomical mapping data.
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Affiliation(s)
- Ovais A Jaffery
- School of Engineering and Materials Science, Queen Mary University of London London, UK
| | - Lea Melki
- R&D Algorithms, Acutus Medical Carlsbad, CA, US
| | - Gregory Slabaugh
- Digital Environment Research Institute, Queen Mary University of London London, UK
| | | | - Caroline H Roney
- School of Engineering and Materials Science, Queen Mary University of London London, UK
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19
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Preda A, Falco R, Tognola C, Carbonaro M, Vargiu S, Gallazzi M, Baroni M, Gigli L, Varrenti M, Colombo G, Zanotto G, Giannattasio C, Mazzone P, Guarracini F. Contemporary Advances in Cardiac Remote Monitoring: A Comprehensive, Updated Mini-Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:819. [PMID: 38793002 PMCID: PMC11122881 DOI: 10.3390/medicina60050819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/09/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024]
Abstract
Over the past decade, remote monitoring (RM) has become an increasingly popular way to improve healthcare and health outcomes. Modern cardiac implantable electronic devices (CIEDs) are capable of recording an increasing amount of data related to CIED function, arrhythmias, physiological status and hemodynamic parameters, providing in-depth and updated information on patient cardiovascular function. The extensive use of RM for patients with CIED allows for early diagnosis and rapid assessment of relevant issues, both clinical and technical, as well as replacing outpatient follow-up improving overall management without compromise safety. This approach is recommended by current guidelines for all eligible patients affected by different chronic cardiac conditions including either brady- and tachy-arrhythmias and heart failure. Beyond to clinical advantages, RM has demonstrated cost-effectiveness and is associated with elevated levels of patient satisfaction. Future perspectives include improving security, interoperability and diagnostic power as well as to engage patients with digital health technology. This review aims to update existing data concerning clinical outcomes in patients managed with RM in the wide spectrum of cardiac arrhythmias and Hear Failure (HF), disclosing also about safety, effectiveness, patient satisfaction and cost-saving.
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Affiliation(s)
- Alberto Preda
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.V.)
| | - Raffaele Falco
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.V.)
| | - Chiara Tognola
- Clinical Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy
| | - Marco Carbonaro
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.V.)
| | - Sara Vargiu
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.V.)
| | - Michela Gallazzi
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.V.)
| | - Matteo Baroni
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.V.)
| | - Lorenzo Gigli
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.V.)
| | - Marisa Varrenti
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.V.)
| | - Giulia Colombo
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.V.)
| | - Gabriele Zanotto
- Department of Cardiology, Ospedale Magalini di Villafranca, 37069 Villafranca di Verona, Italy
| | - Cristina Giannattasio
- Clinical Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Patrizio Mazzone
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.V.)
| | - Fabrizio Guarracini
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.V.)
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20
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Castagno D, Zanon F, Pastore G, De Ferrari GM, Marcantoni L. Is Conduction System Pacing a Valuable Alternative to Biventricular Pacing for Cardiac Resynchronization Therapy? J Cardiovasc Dev Dis 2024; 11:144. [PMID: 38786966 PMCID: PMC11122347 DOI: 10.3390/jcdd11050144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/28/2024] [Accepted: 04/30/2024] [Indexed: 05/25/2024] Open
Abstract
Cardiac resynchronization therapy (CRT) significantly improves clinical outcomes in patients with ventricular systolic dysfunction and dyssynchrony. Biventricular pacing (BVP) has a class IA recommendation for patients with symptomatic heart failure with reduced ejection fraction (HFrEF) and left bundle branch block (LBBB). However, approximately 30% of patients have a poor therapeutic response and do not achieve real clinical benefit. Pre-implant imaging, together with tailored programming and dedicated device algorithms, have been proposed as possible tools to improve success rate but have shown inconsistent results. Over the last few years, conduction system pacing (CSP) is becoming a real and attractive alternative to standard BVP as it can restore narrow QRS in patients with bundle branch block (BBB) by stimulating and recruiting the cardiac conduction system, thus ensuring true resynchronization. It includes His bundle pacing (HBP) and left bundle branch area pacing (LBBAP). Preliminary data coming from small single-center experiences are very promising and have laid the basis for currently ongoing randomized controlled trials comparing CSP with BVP. The purpose of this review is to delve into the emerging role of CSP as an alternative method of achieving CRT. After framing CSP in a historical perspective, the pathophysiological rationale and available clinical evidence will be examined, and crucial technical aspects will be discussed. Finally, evidence gaps and future perspectives on CSP as a technique of choice to deliver CRT will be summarized.
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Affiliation(s)
- Davide Castagno
- Division of Cardiology, Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (D.C.)
- Division of Cardiology, Cardiovascular and Thoracic Department, “Citta della Salute e della Scienza” Hospital, 10126 Turin, Italy
| | - Francesco Zanon
- Santa Maria della Misericordia Hospital, Arrhythmia and Electrophysiology Unit, 45100 Rovigo, Italy
| | - Gianni Pastore
- Santa Maria della Misericordia Hospital, Arrhythmia and Electrophysiology Unit, 45100 Rovigo, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (D.C.)
- Division of Cardiology, Cardiovascular and Thoracic Department, “Citta della Salute e della Scienza” Hospital, 10126 Turin, Italy
| | - Lina Marcantoni
- Santa Maria della Misericordia Hospital, Arrhythmia and Electrophysiology Unit, 45100 Rovigo, Italy
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21
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Nørregaard Jakobsen F, Sandgaard NCF, Olsen T, Brandes A, Djurhuus MS, Schæffer M, Mejldal A, Jørgensen OD, Johansen JB. Is interventional technique better than the traditional over-the-wire method for left ventricular lead implantation in cardiac resynchronization therapy? Heart Rhythm O2 2024; 5:281-288. [PMID: 38840765 PMCID: PMC11148483 DOI: 10.1016/j.hroo.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
Background Interventional cardiac resynchronization therapy (I-CRT) for left ventricular lead (LVL) placement works as a supplement to traditional (over-the-wire) cardiac resynchronization therapy (T-CRT). It has been argued that I-CRT is a time-consuming and complicated procedure. Objective The purpose of this study was to investigate differences in procedure-related, perioperative, postoperative, and clinical endpoints between I-CRT and T-CRT. Methods This single-center, retrospective, cohort study included all consecutive patients receiving a CRT-pacemaker/defibrillator between January 1, 2012, and August 31, 2018. Patients underwent T-CRT from January 1, 2012, to June 1, 2015, and I-CRT from January 1, 2016, to August 31, 2018. We obtained data from patient record files, fluoroscopic images, and the Danish Pacemaker and ICD Register. Data were analyzed using Wilcoxon rank-sum/linear regression for continuous variables and the Pearson χ2/Fisher exact for categorical variables. Results Optimal LVL placement was achieved in 82.7% of the I-CRT group and 76.8% of the T-CRT group (P = .015). In the I-CRT group, 99.0% of LVLs were quadripolar vs 55.3% in the T-CRT group (P <.001). Two or more leads were used during the procedure in 0.7% and 10.5% of all cases in the I-CRT and T-CRT groups, respectively (P <.001). Total implantation time was 81.0 minutes in the I-CRT group and 83.0 minutes in the T-CRT group (P = .41). Time with catheters in the coronary sinus was 45.0 minutes for the I-CRT group vs 37.0 minutes in the T-CRT group, respectively (P <.001). Conclusion I-CRT did not prolong total implantation time despite longer time with catheters in the coronary sinus. I-CRT allowed more optimal LVL placement, wider use of quadripolar leads, and use of fewer leads during the procedure.
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Affiliation(s)
| | | | - Thomas Olsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Axel Brandes
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Mie Schæffer
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Anna Mejldal
- Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Ole Dan Jørgensen
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
- The Danish Pacemaker and ICD Register, Odense, Denmark
| | - Jens Brock Johansen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- The Danish Pacemaker and ICD Register, Odense, Denmark
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22
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Andayeshgar B, Abdali-Mohammadi F, Sepahvand M, Almasi A, Salari N. Arrhythmia detection by the graph convolution network and a proposed structure for communication between cardiac leads. BMC Med Res Methodol 2024; 24:96. [PMID: 38678178 PMCID: PMC11055258 DOI: 10.1186/s12874-024-02223-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 04/17/2024] [Indexed: 04/29/2024] Open
Abstract
One of the most common causes of death worldwide is heart disease, including arrhythmia. Today, sciences such as artificial intelligence and medical statistics are looking for methods and models for correct and automatic diagnosis of cardiac arrhythmia. In pursuit of increasing the accuracy of automated methods, many studies have been conducted. However, in none of the previous articles, the relationship and structure between the heart leads have not been included in the model. It seems that the structure of ECG data can help develop the accuracy of arrhythmia detection. Therefore, in this study, a new structure of Electrocardiogram (ECG) data was introduced, and the Graph Convolution Network (GCN), which has the possibility of learning the structure, was used to develop the accuracy of cardiac arrhythmia diagnosis. Considering the relationship between the heart leads and clusters based on different ECG poles, a new structure was introduced. In this structure, the Mutual Information(MI) index was used to evaluate the relationship between the leads, and weight was given based on the poles of the leads. Weighted Mutual Information (WMI) matrices (new structure) were formed by R software. Finally, the 15-layer GCN network was adjusted by this structure and the arrhythmia of people was detected and classified by it. To evaluate the performance of the proposed new network, sensitivity, precision, specificity, accuracy, and confusion matrix indices were used. Also, the accuracy of GCN networks was compared by three different structures, including WMI, MI, and Identity. Chapman's 12-lead ECG Dataset was used in this study. The results showed that the values of sensitivity, precision, specificity, and accuracy of the GCN-WMI network with 15 intermediate layers were equal to 98.74%, 99.08%, 99.97% & 99.82%, respectively. This new proposed network was more accurate than the Graph Convolution Network-Mutual Information (GCN-MI) with an accuracy equal to 99.71% and GCN-Id with an accuracy equal to 92.68%. Therefore, utilizing this network, the types of arrhythmia were recognized and classified. Also, the new network proposed by the Graph Convolution Network-Weighted Mutual Information (GCN-WMI) was more accurate than those conducted in other studies on the same data set (Chapman). Based on the obtained results, the structure proposed in this study increased the accuracy of cardiac arrhythmia diagnosis and classification on the Chapman data set. Achieving such accuracy for arrhythmia diagnosis is a great achievement in clinical sciences.
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Affiliation(s)
- Bahare Andayeshgar
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, 6715847141, Iran
| | - Fardin Abdali-Mohammadi
- Department of Computer Engineering and Information Technology, Razi University, Kermanshah, 6714967346, Iran
| | - Majid Sepahvand
- Department of Computer Engineering and Information Technology, Razi University, Kermanshah, 6714967346, Iran
| | - Afshin Almasi
- Clinical Research Development Center, Mohammad Kermanshahi, and Farabi Hospitals, Imam Khomeini, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, 6715847141, Iran.
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, 6715847141, Iran.
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23
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Raes S, Prezzi A, Willems R, Heidbuchel H, Annemans L. Investigating the Cost-Effectiveness of Telemonitoring Patients With Cardiac Implantable Electronic Devices: Systematic Review. J Med Internet Res 2024; 26:e47616. [PMID: 38640471 PMCID: PMC11069092 DOI: 10.2196/47616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 09/13/2023] [Accepted: 02/13/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Telemonitoring patients with cardiac implantable electronic devices (CIEDs) can improve their care management. However, the results of cost-effectiveness studies are heterogeneous. Therefore, it is still a matter of debate whether telemonitoring is worth the investment. OBJECTIVE This systematic review aims to investigate the cost-effectiveness of telemonitoring patients with CIEDs, focusing on its key drivers, and the impact of the varying perspectives. METHODS A systematic review was performed in PubMed, Web of Science, Embase, and EconLit. The search was completed on July 7, 2022. Studies were included if they fulfilled the following criteria: patients had a CIED, comparison with standard care, and inclusion of health economic evaluations (eg, cost-effectiveness analyses and cost-utility analyses). Only complete and peer-reviewed studies were included, and no year limits were applied. The exclusion criteria included studies with partial economic evaluations, systematic reviews or reports, and studies without standard care as a control group. Besides general study characteristics, the following outcome measures were extracted: impact on total cost or income, cost or income drivers, cost or income drivers per patient, cost or income drivers as a percentage of the total cost impact, incremental cost-effectiveness ratios, or cost-utility ratios. Quality was assessed using the Consensus Health Economic Criteria checklist. RESULTS Overall, 15 cost-effectiveness analyses were included. All studies were performed in Western countries, mainly Europe, and had primarily a male participant population. Of the 15 studies, 3 (20%) calculated the incremental cost-effectiveness ratio, 1 (7%) the cost-utility ratio, and 11 (73%) the health and cost impact of telemonitoring. In total, 73% (11/15) of the studies indicated that telemonitoring of patients with implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy ICDs was cost-effective and cost-saving, both from a health care and patient perspective. Cost-effectiveness results for telemonitoring of patients with pacemakers were inconclusive. The key drivers for cost reduction from a health care perspective were hospitalizations and scheduled in-office visits. Hospitalization costs were reduced by up to US $912 per patient per year. Scheduled in-office visits included up to 61% of the total cost reduction. Key drivers for cost reduction from a patient perspective were loss of income, cost for scheduled in-office visits and transport. Finally, of the 15 studies, 8 (52%) reported improved quality of life, with statistically significance in only 1 (13%) study (P=.03). CONCLUSIONS From a health care and patient perspective, telemonitoring of patients with an ICD or a cardiac resynchronization therapy ICD is a cost-effective and cost-saving alternative to standard care. Inconclusive results were found for patients with pacemakers. However, telemonitoring can lead to a decrease in providers' income, mainly due to a lack of reimbursement. Introducing appropriate reimbursement could make telemonitoring sustainable for providers while still being cost-effective from a health care payer perspective. TRIAL REGISTRATION PROSPERO CRD42022322334; https://tinyurl.com/puunapdr.
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Affiliation(s)
- Sarah Raes
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Andrea Prezzi
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Rik Willems
- Department of Cardiovascular Sciences, Universiteit Leuven, Leuven, Belgium
| | - Hein Heidbuchel
- Department of Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton (GENCOR), Antwerp University, Antwerp, Belgium
| | - Lieven Annemans
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
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24
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Angeli F, Ricci F, Moscucci F, Sciomer S, Bucciarelli V, Bianco F, Mattioli AV, Pizzi C, Gallina S. Sex- and gender-related disparities in chest pain syndromes: the feminine mystique of chest pain. Curr Probl Cardiol 2024; 49:102457. [PMID: 38342350 DOI: 10.1016/j.cpcardiol.2024.102457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/13/2024]
Abstract
Chest pain syndromes encompass a wide range of different clinical conditions, being coronary artery disease one of the most important and feared aetiology. Sex and gender disparities have been reported in pathophysiology, clinical presentations, diagnostic work-up and outcomes of patients admitted for chest pain. Biological differences in sexual hormones and neurological pain procession pathways have been proposed as contributors to disparities between men and women; however, gender-related disparities in socio-economic and psychological status have emerged as additional factors involved in these conditions. A better understanding of gender- and sex-related disparities will lead to improved clinical care and management of chest pain syndromes in both men and women. In this comprehensive review, we describe the existing knowledge regarding sex and gender-based differences in management and outcomes of chest pain syndromes in order to stimulate and promote the development of a more sex- and gender-oriented approach to these conditions.
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Affiliation(s)
- Francesco Angeli
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy
| | - Federica Moscucci
- Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, Viale del Policlinico n. 155, 00161 Rome, Italy
| | - Susanna Sciomer
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, 'Sapienza', Rome University, Viale dell'Università, 37, 00185, Rome, Italy
| | - Valentina Bucciarelli
- Cardiovascular Sciences Department-Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Francesco Bianco
- Cardiovascular Sciences Department-Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Anna Vittoria Mattioli
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Carmine Pizzi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via Giuseppe Massarenti 9, 40138, Bologna, Italy.
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy
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25
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Bencardino G, Telesca A, Comerci G, Burzotta F. Acute myocardial infarction revealed by recurrent ventricular tachyarrhythmias detected by remote monitoring. BMJ Case Rep 2024; 17:e259951. [PMID: 38508603 PMCID: PMC10952909 DOI: 10.1136/bcr-2024-259951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
Remote monitoring (RM) of cardiac implantable electronic devices (CIED) represented a major improvement in clinical practice and has been used with multiple indications. Many parameters monitored on a daily basis by current CIED can indeed assist in clinical practice (eg, decompensated heart failure) by providing the patient with optimal timing for anticipated outpatient visit or urgent medical care. Recognition of acute myocardial infarction (AMI) is not usually considered among the capabilities of RM. We present the case of an AMI occurring without any ischaemic symptoms but associated with recurrent ventricular tachyarrhythmias effectively treated by multiple interventions of the implantable cardioverter defibrillator and promptly detected by RM personnel, who recommended the patient to quickly access to the emergency department where diagnosis and revascularization of an otherwise untreated myocardial infarction was performed.
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Affiliation(s)
- Gianluigi Bencardino
- Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart - Faculty of Medicine and Surgery, Rome, Italy
| | - Alessandro Telesca
- Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart - Faculty of Medicine and Surgery, Rome, Italy
| | - Gianluca Comerci
- Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart - Faculty of Medicine and Surgery, Rome, Italy
| | - Francesco Burzotta
- Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart - Faculty of Medicine and Surgery, Rome, Italy
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26
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Huang X, Zhang F, Fan H, Chang H, Zhou B, Li Z. Pseudo anomalies enhanced deep support vector data description for electrocardiogram quality assessment. Comput Biol Med 2024; 170:107928. [PMID: 38228029 DOI: 10.1016/j.compbiomed.2024.107928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/08/2023] [Accepted: 01/01/2024] [Indexed: 01/18/2024]
Abstract
Electrocardiogram (ECG) recordings obtained from wearable devices are susceptible to noise interference that degrades the signal quality. Traditional methods for assessing the quality of electrocardiogram signals (SQA) are mostly supervised and typically rely on limited types of noise in the training data, which imposes limitations in detecting unknown anomalies. The high variability of both ECG signals and noise presents a greater challenge to the generalization of traditional methods. In this paper, we propose a simple and effective unsupervised SQA method by modeling the SQA of ECG as a problem of anomaly detection, in which, a model of pseudo anomalies enhanced deep support vector data description is introduced to learn a more discriminative and generalized hypersphere of the high-quality ECG in a self-supervised manner. Specifically, we propose a series of ECG noise-generation methods to simulate the noise of real scenarios and use the generated noise samples as the pseudo anomalies to correct the hypersphere learned solely by the high-quality ECG samples. Finally, the quality of ECG can be measured based on the distance to the center of the hypersphere. Extensive experimental results on multiple public datasets and our constructed real-world 12-lead dataset demonstrate the effectiveness of the proposed method.
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Affiliation(s)
- Xunhua Huang
- School of Computer Science and Technology, Harbin University of Science and Technology, Harbin, 150080, China.
| | - Fengbin Zhang
- School of Computer Science and Technology, Harbin University of Science and Technology, Harbin, 150080, China.
| | - Haoyi Fan
- School of Computer and Artificial Intelligence, Zhengzhou University, Zhengzhou, 450001, China.
| | - Huihui Chang
- School of Computer and Artificial Intelligence, Zhengzhou University, Zhengzhou, 450001, China.
| | - Bing Zhou
- School of Computer and Artificial Intelligence, Zhengzhou University, Zhengzhou, 450001, China.
| | - Zuoyong Li
- Fujian Provincial Key Laboratory of Information Processing and Intelligent Control, Minjiang University, Fuzhou, 350121, China.
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27
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García-Fernández FJ, Calvo Simal S, Cano Pérez Ó, Calvo Cuervo D, Pombo Jiménez M, Fernández Lozano I, Villagraz Tercedor L, Fernández Palacios G, Martín González J. Impact of the COVID-19 pandemic on implantation of cardiac implantable electronic devices and remote monitoring activations. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:243-253. [PMID: 37516312 DOI: 10.1016/j.rec.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/07/2023] [Indexed: 07/31/2023]
Abstract
INTRODUCTION AND OBJECTIVES Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) is considered more reliable, efficient, and safer than conventional in-person follow-up. However, the implementation of RM is still suboptimal. This study aimed to analyze the impact of the COVID-19 pandemic on the rates of CIED implants and RM activations in Spain. METHODS The COVID-19 RM Spain Registry was used to analyze the monthly number of all CIED implantations and RM activations from January 2018 to December 2021. A descriptive analysis was performed using aggregated data from the five major CIED manufacturers. RESULTS A total of 205 345 CIEDs were recorded. The number of implants decreased sharply (48.2%) during the pandemic lockdown (March-June 2020) but gradually increased thereafter, compensating for the previous reduction. However, pacemakers and implantable cardiac defibrillators (ICD) showed an aggregate loss of 7% and 3%, respectively, from the annual average during 2020-2021. In contrast, cardiac resynchronization therapy defibrillators (CRT-D) increased by 17%, and pacemakers (CRT-P) by 4.5% over the 2-year period. The percentage of RM activations increased from 24.5% in 2018 to 49.0% in 2021, with a sharp increase during the lockdown. The RM activation rates consistently increased during the lockdown for all devices: pacemakers (14.4% vs 37.2%; P <.001); ICD (75.6% vs 94.2%; P <.001); CRT-D/CRT-P (68.6-44.2% vs 81.6-61%; P <.001), and implantable loop recorders (50.2% vs 68.7%; P <.001). CONCLUSIONS The significant decline in implants during the lockdown gradually recovered, except for pacemakers and ICD. However, the COVID-19 pandemic boosted RM for all CIEDs in Spain.
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Affiliation(s)
- F J García-Fernández
- Unidad de Arritmias, Servicio de Cardiología., Hospital Universitario de Burgos, Burgos, Spain.
| | - Sara Calvo Simal
- Unidad de Investigación, Fundación Burgos por las Ciencias de la Salud, Universidad de Burgos, Burgos, Spain
| | - Óscar Cano Pérez
- Unidad de Arritmias, área de Enfermedades Cardiovasculares, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - David Calvo Cuervo
- Unidad de Arritmias, Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | - Marta Pombo Jiménez
- Unidad de Arritmias, Servicio de Cardiología, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - Ignacio Fernández Lozano
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Lola Villagraz Tercedor
- Unidad de Arritmias, Servicio de Cardiología., Hospital Universitario de Burgos, Burgos, Spain
| | | | - Javier Martín González
- Unidad de Arritmias, Servicio de Cardiología., Hospital Universitario de Burgos, Burgos, Spain
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28
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Stellbrink C. [History of cardiac resynchronization therapy : 30 years of electrotherapeutic management for heart failure]. Herzschrittmacherther Elektrophysiol 2024; 35:68-76. [PMID: 38424340 PMCID: PMC10923969 DOI: 10.1007/s00399-024-01004-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Abstract
The first permanent biventricular pacing system was implanted more than 30 years ago. In this article, the historical development of cardiac resynchronization therapy (CRT), starting with the pathophysiological concept, followed by the initial "proof of concept" studies and finally the large prospective-randomized studies that led to the implementation of CRT in heart failure guidelines, is outlined. Since the establishment of CRT, both an expansion of indications, e.g., for patients with mild heart failure and atrial fibrillation, but also the return to patients with broad QRS complex and left bundle branch block who benefit most of CRT has evolved. New techniques such as conduction system pacing will have major influence on pacemaker therapy in heart failure, both as an alternative or adjunct to CRT.
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Affiliation(s)
- Christoph Stellbrink
- Universitätsklinikum OWL Campus Klinikum Bielefeld., Universitätsklinik für Kardiologie und Internistische Intensivmedizin, Teutoburger Straße 50, 33604, Bielefeld, Deutschland.
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29
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Dutta A, Alqabbani RRM, Hagendorff A, Tayal B. Understanding the Application of Mechanical Dyssynchrony in Patients with Heart Failure Considered for CRT. J Cardiovasc Dev Dis 2024; 11:64. [PMID: 38392278 PMCID: PMC10888548 DOI: 10.3390/jcdd11020064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/16/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Over the past two decades of CRT use, the failure rate has remained around 30-35%, despite several updates in the guidelines based on the understanding from multiple trials. This review article summarizes the role of mechanical dyssynchrony in the selection of heart failure patients for cardiac resynchronization therapy. Understanding the application of mechanical dyssynchrony has also evolved during these past two decades. There is no role of lone mechanical dyssynchrony in the patient selection for CRT. However, mechanical dyssynchrony can complement the electrocardiogram and clinical criteria and improve patient selection by reducing the failure rate. An oversimplified approach to mechanical dyssynchrony assessment, such as just estimating time-to-peak delays between segments, should not be used. Instead, methods that can identify the underlying pathophysiology of HF and are representative of a substrate to CRT should be applied.
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Affiliation(s)
- Abhishek Dutta
- Department of Cardiology, Nazareth Hospital, Philadelphia, PA 19020, USA
| | - Rakan Radwan M Alqabbani
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Andreas Hagendorff
- Department of Cardiology, Leipzig University Hospital, 04103 Leipzig, Germany
| | - Bhupendar Tayal
- Harrington and Heart and Vascular Center, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
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30
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Seo J, Alhuarrat MAD, Krishnan S, Saralidze T, Lim H, Chen B, Flomenbaum D, Naser A, Kharawala A, Apple SJ, Ferrick N, Chudow J, Di Biase L, Fisher JD, Krumerman A, Ferrick KJ. Utilization of the remote monitoring of cardiac implantable electronic devices in a diverse demographic cohort: Insights from a single-center observation. Pacing Clin Electrophysiol 2024; 47:185-194. [PMID: 38010836 DOI: 10.1111/pace.14883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/29/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Despite its clinical benefits, patient compliance to remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) varies and remains under-studied in diverse populations. OBJECTIVE We sought to evaluate RM compliance, clinical outcomes, and identify demographic and socioeconomic factors affecting RM in a diverse urban population in New York. METHODS This retrospective cohort study included patients enrolled in CIED RM at Montefiore Medical Center between December 2017 and May 2022. RM compliance was defined as the percentage of days compliant to RM transmission divided by the total prescribed days of RM. Patients were censored when they were lost to follow-up or at the time of death. The cohorts were categorized into low (≤30%), intermediate (31-69%), and high (≥70%) RM compliance groups. Statistical analyses were conducted accordingly. RESULTS Among 853 patients, median RM compliance was 55%. Age inversely affected compliance (p < .001), and high compliance was associated with guideline-directed medical therapy (GDMT) usage and implantable cardioverter defibrillator (ICD)/cardiac resynchronization defibrillator (CRTD) devices. The low-compliance group had a higher mortality rate and fewer regular clinic visits (p < .001) than high-compliance group. Socioeconomic factors did not significantly impact compliance, while Asians showed higher compliance compared with Whites (OR 3.67; 95% CI 1.08-12.43; p = .04). Technical issues were the main reason for non-compliance. CONCLUSION We observed suboptimal compliance to RM, which occurred most frequently in older patients. Clinic visit compliance, optimal medical therapy, and lower mortality were associated with higher compliance, whereas insufficient understanding of RM usage was the chief barrier to compliance.
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Affiliation(s)
- Jiyoung Seo
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Suraj Krishnan
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Tinatin Saralidze
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Hyomin Lim
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Brett Chen
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - David Flomenbaum
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ahmad Naser
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Amrin Kharawala
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Samuel J Apple
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Neal Ferrick
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jay Chudow
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - John D Fisher
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Andrew Krumerman
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kevin J Ferrick
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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Diaz JC, Tedrow UB, Duque M, Aristizabal J, Braunstein ED, Marin J, Niño C, Bastidas O, Lopez Cabanillas N, Koplan BA, Hoyos C, Matos CD, Hincapie D, Velasco A, Steiger NA, Kapur S, Tadros TM, Zei PC, Sauer WH, Romero JE. Left Bundle Branch Pacing vs Left Ventricular Septal Pacing vs Biventricular Pacing for Cardiac Resynchronization Therapy. JACC Clin Electrophysiol 2024; 10:295-305. [PMID: 38127008 DOI: 10.1016/j.jacep.2023.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/04/2023] [Accepted: 10/20/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP) are considered to be acceptable as LBBAP strategies. Differences in clinical outcomes between LBBP and LVSP are yet to be determined. OBJECTIVES The purpose of this study was to compare the outcomes of LBBP vs LVSP vs BIVP for CRT. METHODS In this prospective multicenter observational study, LBBP was compared with LVSP and BIVP in patients undergoing CRT. The primary composite outcome was freedom from heart failure (HF)-related hospitalization and all-cause mortality. Secondary outcomes included individual components of the primary outcome, postprocedural NYHA functional class, and electrocardiographic and echocardiographic parameters. RESULTS A total of 415 patients were included (LBBP: n = 141; LVSP: n = 31; BIVP: n = 243), with a median follow-up of 399 days (Q1-Q3: 249.5-554.8 days). Freedom from the primary composite outcomes was 76.6% in the LBBP group and 48.4% in the LVSP group (HR: 1.37; 95% CI: 1.143-1.649; P = 0.001), driven by a 31.4% absolute increase in freedom from HF-related hospitalizations (83% vs 51.6%; HR: 3.55; 95% CI: 1.856-6.791; P < 0.001) without differences in all-cause mortality. LBBP was also associated with a higher freedom from the primary composite outcome compared with BIVP (HR: 1.43; 95% CI: 1.175-1.730; P < 0.001), with no difference between LVSP and BIVP. CONCLUSIONS In patients undergoing CRT, LBBP was associated with improved outcomes compared with LVSP and BIVP, while outcomes between BIVP and LVSP are similar.
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Affiliation(s)
- Juan C Diaz
- Cardiac Arrhythmia Service, Division of Cardiology, Clinica Las Vegas, Universidad CES Medical School, Medellin, Colombia
| | - Usha B Tedrow
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Mauricio Duque
- Cardiac Arrhythmia Service, Division of Cardiology, Clinica Las Vegas, Universidad CES Medical School, Medellin, Colombia
| | - Julian Aristizabal
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Department of Medicine, Clinica Las Americas, Medellin, Colombia
| | - Eric D Braunstein
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai, Los Angeles, California, USA
| | - Jorge Marin
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Department of Medicine, Clinica Las Americas, Medellin, Colombia
| | - Cesar Niño
- Cardiac Arrhythmia and Electrophysiology Service, Clinica SOMER, Rionegro, Colombia
| | - Oriana Bastidas
- Cardiac Arrhythmia and Electrophysiology Service, Hospital Pablo Tobón Uribe, Medellin, Colombia
| | | | - Bruce A Koplan
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos D Matos
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Daniela Hincapie
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Alejandro Velasco
- Electrophysiology Section, University of Texas Health Sciences Center, San Antonio, Texas, USA
| | - Nathaniel A Steiger
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sunil Kapur
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas M Tadros
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Paul C Zei
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - William H Sauer
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jorge E Romero
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
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Sapp JL, Sivakumaran S, Redpath CJ, Khan H, Parkash R, Exner DV, Healey JS, Thibault B, Sterns LD, Lam NHN, Manlucu J, Mokhtar A, Sumner G, McKinlay S, Kimber S, Mondesert B, Talajic M, Rouleau J, McCarron CE, Wells G, Tang ASL. Long-Term Outcomes of Resynchronization-Defibrillation for Heart Failure. N Engl J Med 2024; 390:212-220. [PMID: 38231622 DOI: 10.1056/nejmoa2304542] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND The Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT) showed a greater benefit with respect to mortality at 5 years among patients who received cardiac-resynchronization therapy (CRT) than among those who received implantable cardioverter-defibrillators (ICDs). However, the effect of CRT on long-term survival is not known. METHODS We randomly assigned patients with New York Heart Association (NYHA) class II or III heart failure, a left ventricular ejection fraction of 30% or less, and an intrinsic QRS duration of 120 msec or more (or a paced QRS duration of 200 msec or more) to receive either an ICD alone or a CRT defibrillator (CRT-D). We assessed long-term outcomes among patients at the eight highest-enrolling participating sites. The primary outcome was death from any cause; the secondary outcome was a composite of death from any cause, heart transplantation, or implantation of a ventricular assist device. RESULTS The trial enrolled 1798 patients, of whom 1050 were included in the long-term survival trial; the median duration of follow-up for the 1050 patients was 7.7 years (interquartile range, 3.9 to 12.8), and the median duration of follow-up for those who survived was 13.9 years (interquartile range, 12.8 to 15.7). Death occurred in 405 of 530 patients (76.4%) assigned to the ICD group and in 370 of 520 patients (71.2%) assigned to the CRT-D group. The time until death appeared to be longer for those assigned to receive a CRT-D than for those assigned to receive an ICD (acceleration factor, 0.80; 95% confidence interval, 0.69 to 0.92; P = 0.002). A secondary-outcome event occurred in 412 patients (77.7%) in the ICD group and in 392 (75.4%) in the CRT-D group. CONCLUSIONS Among patients with a reduced ejection fraction, a widened QRS complex, and NYHA class II or III heart failure, the survival benefit associated with receipt of a CRT-D as compared with ICD appeared to be sustained during a median of nearly 14 years of follow-up. (RAFT ClinicalTrials.gov number, NCT00251251.).
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Affiliation(s)
- John L Sapp
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Soori Sivakumaran
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Calum J Redpath
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Habib Khan
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Ratika Parkash
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Derek V Exner
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Jeff S Healey
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Bernard Thibault
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Laurence D Sterns
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Nhat Hung N Lam
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Jaimie Manlucu
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Ahmed Mokhtar
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Glen Sumner
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Stuart McKinlay
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Shane Kimber
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Blandine Mondesert
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Mario Talajic
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Jean Rouleau
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - C Elizabeth McCarron
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - George Wells
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
| | - Anthony S L Tang
- From QEII Health Sciences Centre, Dalhousie University, Halifax, NS (J.L.S., R.P.), the Mazankowski Alberta Heart Institute, University of Alberta, Edmonton (S.S., S.K.), the University of Ottawa Heart Institute, Ottawa (C.J.R., N.H.N.L., G.W.), Schulich School of Medicine and Dentistry, Western University, London, ON (H.K., J.M., C.E.M., A.S.L.T.), Libin Cardiovascular Institute, Calgary, AB (D.V.E., G.S.), McMaster University, Hamilton, ON (J.S.H.), Montreal Heart Institute, Montreal (B.T., B.M., M.T., J.R.), Royal Jubilee Hospital, Victoria, BC (L.D.S.), and the University of Toronto, Toronto (S.M.) - all in Canada; and King Abdulaziz University, Jeddah, Saudi Arabia (A.M.)
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Stevenson LW, Montgomery JA. Seeking More Time with Synchrony. N Engl J Med 2024; 390:269-270. [PMID: 38231629 DOI: 10.1056/nejme2312419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Affiliation(s)
| | - Jay A Montgomery
- From the Division of Cardiology, Vanderbilt University Medical Center, Nashville
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Qin D, Singh JP. Cardiac Resynchronization Therapy for Non-Left Bundle Branch Block: Time for Change? JACC Clin Electrophysiol 2024; 10:27-30. [PMID: 38267169 DOI: 10.1016/j.jacep.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 01/26/2024]
Affiliation(s)
- Dingxin Qin
- Telemachus and Irene Demoulas Family Foundation Center for Cardiac Arrhythmias, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jagmeet P Singh
- Telemachus and Irene Demoulas Family Foundation Center for Cardiac Arrhythmias, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Xie C, Wang Z, Yang C, Liu J, Liang H. Machine Learning for Detecting Atrial Fibrillation from ECGs: Systematic Review and Meta-Analysis. Rev Cardiovasc Med 2024; 25:8. [PMID: 39077651 PMCID: PMC11262392 DOI: 10.31083/j.rcm2501008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 08/11/2023] [Accepted: 08/29/2023] [Indexed: 07/31/2024] Open
Abstract
Background Atrial fibrillation (AF) is a common arrhythmia that can result in adverse cardiovascular outcomes but is often difficult to detect. The use of machine learning (ML) algorithms for detecting AF has become increasingly prevalent in recent years. This study aims to systematically evaluate and summarize the overall diagnostic accuracy of the ML algorithms in detecting AF in electrocardiogram (ECG) signals. Methods The searched databases included PubMed, Web of Science, Embase, and Google Scholar. The selected studies were subjected to a meta-analysis of diagnostic accuracy to synthesize the sensitivity and specificity. Results A total of 14 studies were included, and the forest plot of the meta-analysis showed that the pooled sensitivity and specificity were 97% (95% confidence interval [CI]: 0.94-0.99) and 97% (95% CI: 0.95-0.99), respectively. Compared to traditional machine learning (TML) algorithms (sensitivity: 91.5%), deep learning (DL) algorithms (sensitivity: 98.1%) showed superior performance. Using multiple datasets and public datasets alone or in combination demonstrated slightly better performance than using a single dataset and proprietary datasets. Conclusions ML algorithms are effective for detecting AF from ECGs. DL algorithms, particularly those based on convolutional neural networks (CNN), demonstrate superior performance in AF detection compared to TML algorithms. The integration of ML algorithms can help wearable devices diagnose AF earlier.
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Affiliation(s)
- Chenggong Xie
- Hunan Provincial Key Laboratory of TCM Diagnostics, Hunan University of
Chinese Medicine, 410208 Changsha, Hunan, China
- School of Acupuncture and Tui-na and Rehabilitation, Hunan University of
Chinese Medicine, 410208 Changsha, Hunan, China
| | - Zhao Wang
- School of Chinese Medicine, Hunan University of Chinese Medicine, 410208
Changsha, Hunan, China
| | - Chenglong Yang
- Cardiovascular Department, the First Hospital of Hunan University of
Chinese Medicine, 410021 Changsha, Hunan, China
| | - Jianhe Liu
- Cardiovascular Department, the First Hospital of Hunan University of
Chinese Medicine, 410021 Changsha, Hunan, China
| | - Hao Liang
- Hunan Provincial Key Laboratory of TCM Diagnostics, Hunan University of
Chinese Medicine, 410208 Changsha, Hunan, China
- School of Chinese Medicine, Hunan University of Chinese Medicine, 410208
Changsha, Hunan, China
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Goldenberg I, Aktas MK, Zareba W, Tsu-Chau Huang D, Rosero SZ, Younis A, McNitt S, Stockburger M, Steinberg JS, Buttar RS, Merkely B, Kutyifa V. QRS Morphology and the Risk of Ventricular Tachyarrhythmia in Cardiac Resynchronization Therapy Recipients. JACC Clin Electrophysiol 2024; 10:16-26. [PMID: 38032575 DOI: 10.1016/j.jacep.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND There are conflicting data on the effect of cardiac resynchronization therapy with a defibrillator (CRT-D) on the risk of life-threatening ventricular tachyarrhythmia in heart failure patients. OBJECTIVES The authors aimed to assess whether QRS morphology is associated with risk of ventricular arrhythmias in CRT recipients. METHODS The study population comprised 2,862 patients implanted with implantable cardioverter defibrillator (ICD)/CRT-D for primary prevention who were enrolled in 5 landmark primary prevention ICD trials (MADIT-II [Multicenter Automated Defibrillator Implantation Trial], MADIT-CRT [Multicenter Automated Defibrillator Implantation Trial-Cardiac Resynchronization Therapy], MADIT-RIT [Multicenter Automated Defibrillator Implantation Trial-Reduction in Inappropriate Therapy], MADIT-RISK [Multicenter Automated Defibrillator Implantation Trial-RISK], and RAID [Ranolazine in High-Risk Patients With Implanted Cardioverter Defibrillators]). Patients with QRS duration ≥130 ms were divided into 2 groups: those implanted with an ICD only vs CRT-D. The primary endpoint was fast ventricular tachycardia (VT)/ventricular fibrillation (VF) (defined as VT ≥200 beats/min or VF), accounting for the competing risk of death. Secondary endpoints included appropriate shocks, any sustained VT or VF, and the burden of fast VT/VF, assessed in a recurrent event analysis. RESULTS Among patients with left bundle branch block (n = 1,792), those with CRT-D (n = 1,112) experienced a significant 44% (P < 0.001) reduction in the risk of fast VT/VF compared with ICD-only patients (n = 680), a significantly lower burden of fast VT/VF (HR: 0.55; P = 0.001), with a reduced burden of appropriate shocks (HR: 0.44; P < 0.001). In contrast, among patients with non-left bundle branch block (NLBBB) (N = 1,070), CRT-D was not associated with reduction in fast VT/VF (HR: 1.33; P = 0.195). Furthermore, NLBBB patients with CRT-D experienced a statistically significant increase in the burden of fast VT/VF events compared with ICD-only patients (HR: 1.90; P = 0.013). CONCLUSIONS Our data suggest a potential proarrhythmic effect of CRT among patients with NLBBB. These data should be considered in patient selection for treatment with CRT.
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Affiliation(s)
- Ido Goldenberg
- University of Rochester Medical Center, Rochester, New York, USA; Rochester General Hospital, Rochester, New York, USA.
| | - Mehmet K Aktas
- University of Rochester Medical Center, Rochester, New York, USA
| | - Wojciech Zareba
- University of Rochester Medical Center, Rochester, New York, USA
| | | | - Spencer Z Rosero
- University of Rochester Medical Center, Rochester, New York, USA
| | - Arwa Younis
- University of Rochester Medical Center, Rochester, New York, USA
| | - Scott McNitt
- University of Rochester Medical Center, Rochester, New York, USA
| | | | | | | | - Bela Merkely
- Semmelweis University, Heart Center, Budapest, Hungary
| | - Valentina Kutyifa
- University of Rochester Medical Center, Rochester, New York, USA; Semmelweis University, Heart Center, Budapest, Hungary
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Sakaguchi Y, Izumi D, Wada R, Akagawa R, Suzuki N, Hakamata T, Ikami Y, Hasegaw Y, Otsuki S, Yagihara N, Iijima K, Inomata T. Predictors of long-term survival in Japanese patients with heart failure with reduced ejection fraction (HFrEF) treated with cardiac resynchronization therapy-defibrillators (CRT-D). Pacing Clin Electrophysiol 2023; 46:1484-1490. [PMID: 37864809 DOI: 10.1111/pace.14848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/24/2023] [Accepted: 10/07/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Reports on the factors predicting long-term survival of CRT-D cases from Western countries are increasing, however, those from Asia including Japan are still sparse. We aimed to clarify the factors predicting long-term survival of Japanese CRT-D cases. METHODS We retrospectively analyzed consecutive 133 patients who underwent CRT-D implantation between 2006 and 2021. We compared clinical factors between patients who died within 5 years after implantation (short-survival group: n = 31) and who had survived for more than 5 years (long-survival group: n = 36) after implantation. RESULTS Major underlying heart diseases were dilated cardiomyopathy (45%) and ischemic heart disease (12%). There was no difference between the short-survival group and the long-survival group in incidence of CLBBB (32% vs. 30%), whereas CRBBB was more common in the short-survival group (26% vs. 0%, p = .004). Mechanical dyssynchrony at implantation was more frequent in the long-survival group (48% vs. 78%, p = .02). The incidence of response to CRT at 1 year after implantation was higher in long-survival group (19% vs. 50%, p = .02). Multiple logistic regression analysis identified NYHA class, mechanical dyssynchrony at implantation, and response at one year as predictors of long-term survival. CONCLUSIONS In Japanese CRT-D cases, lower NHYA class, preexisting mechanical dyssynchrony, and 1-year response to CRT predict long-term survival.
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Affiliation(s)
- Yuta Sakaguchi
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Daisuke Izumi
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Rhythm Wada
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Rie Akagawa
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Naomasa Suzuki
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takahiro Hakamata
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yasuhiro Ikami
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yuki Hasegaw
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Sou Otsuki
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Nobue Yagihara
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kenichi Iijima
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takayuki Inomata
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Rodero C, Baptiste TMG, Barrows RK, Lewalle A, Niederer SA, Strocchi M. Advancing clinical translation of cardiac biomechanics models: a comprehensive review, applications and future pathways. FRONTIERS IN PHYSICS 2023; 11:1306210. [PMID: 38500690 PMCID: PMC7615748 DOI: 10.3389/fphy.2023.1306210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Cardiac mechanics models are developed to represent a high level of detail, including refined anatomies, accurate cell mechanics models, and platforms to link microscale physiology to whole-organ function. However, cardiac biomechanics models still have limited clinical translation. In this review, we provide a picture of cardiac mechanics models, focusing on their clinical translation. We review the main experimental and clinical data used in cardiac models, as well as the steps followed in the literature to generate anatomical meshes ready for simulations. We describe the main models in active and passive mechanics and the different lumped parameter models to represent the circulatory system. Lastly, we provide a summary of the state-of-the-art in terms of ventricular, atrial, and four-chamber cardiac biomechanics models. We discuss the steps that may facilitate clinical translation of the biomechanics models we describe. A well-established software to simulate cardiac biomechanics is lacking, with all available platforms involving different levels of documentation, learning curves, accessibility, and cost. Furthermore, there is no regulatory framework that clearly outlines the verification and validation requirements a model has to satisfy in order to be reliably used in applications. Finally, better integration with increasingly rich clinical and/or experimental datasets as well as machine learning techniques to reduce computational costs might increase model reliability at feasible resources. Cardiac biomechanics models provide excellent opportunities to be integrated into clinical workflows, but more refinement and careful validation against clinical data are needed to improve their credibility. In addition, in each context of use, model complexity must be balanced with the associated high computational cost of running these models.
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Affiliation(s)
- Cristobal Rodero
- Cardiac Electro-Mechanics Research Group (CEMRG), National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Tiffany M. G. Baptiste
- Cardiac Electro-Mechanics Research Group (CEMRG), National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Rosie K. Barrows
- Cardiac Electro-Mechanics Research Group (CEMRG), National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Alexandre Lewalle
- Cardiac Electro-Mechanics Research Group (CEMRG), National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Steven A. Niederer
- Cardiac Electro-Mechanics Research Group (CEMRG), National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
- Turing Research and Innovation Cluster in Digital Twins (TRIC: DT), The Alan Turing Institute, London, United Kingdom
| | - Marina Strocchi
- Cardiac Electro-Mechanics Research Group (CEMRG), National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
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Cano Ó, Bazán V, Arana E. Spanish catheter ablation registry. 22nd official report of the Heart Rhythm Association of the Spanish Society of Cardiology (2022). REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:910-921. [PMID: 37730116 DOI: 10.1016/j.rec.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 07/18/2023] [Indexed: 09/22/2023]
Abstract
INTRODUCTION AND OBJECTIVES This article presents results of the Spanish catheter ablation registry for the year 2022. METHODS Data were retrospectively entered into a REDCap platform using a specific form. RESULTS A total of 103 centers participated (75 public, 28 private), which reported 23 360 ablation procedures, with a mean of 227±173 and a median of 202 [interquartile range, 77-312] procedures per center. Activity significantly increased (+5419 procedures,+30.2%) with more centers participating in the registry (10 more than in 2021). The most common procedure continued to be atrial fibrillation ablation (35%, 8185 procedures) followed by cavotricuspid isthmus ablation (20%, 4640 procedures), and intranodal re-entrant tachycardia (17%, 3898 procedures). There was an increase in all reported substrates, especially atrial fibrillation ablation (+40%), with slightly higher global acute success (96%) and lower complication rates (1.8%) and mortality (0.04%, n=10). In total, 525 procedures were performed in pediatric patients (2.2%) CONCLUSIONS: The Spanish catheter ablation registry systematically and continuously collects the national trajectory, which experienced a significant activity increase in 2022 in all of the reported substrates but especially in atrial fibrillation ablation. Acute success increased, while both complications and mortality decreased.
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Affiliation(s)
- Óscar Cano
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Víctor Bazán
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Eduardo Arana
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Seville, Spain
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Filippini FB, Ribeiro HB, Bocchi E, Bacal F, Marcondes-Braga FG, Avila MS, Sturmer JD, Marchi MFDS, Kanhouche G, Freire AF, Cassar R, Abizaid AA, de Brito FS. Percutaneous Strategies in Structural Heart Diseases: Focus on Chronic Heart Failure. Arq Bras Cardiol 2023; 120:e20220496. [PMID: 38126512 PMCID: PMC10773459 DOI: 10.36660/abc.20220496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 04/05/2023] [Accepted: 05/17/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Central Illustration : Percutaneous Strategies in Structural Heart Diseases: Focus on Chronic Heart Failure Transcatheter devices for monitoring and treating advanced chronic heart failure patients. PA: pulmonary artery; LA: left atrium; AFR: atrial flow regulator; TASS: Transcatheter Atrial Shunt System; VNS: vagus nerve stimulation; BAT: baroreceptor activation therapy; RDN: renal sympathetic denervation; F: approval by the American regulatory agency (FDA); E: approval by the European regulatory agency (CE Mark). BACKGROUND Innovations in devices during the last decade contributed to enhanced diagnosis and treatment of patients with cardiac insufficiency. These tools progressively adapted to minimally invasive strategies with rapid, widespread use. The present article focuses on actual and future directions of device-related diagnosis and treatment of chronic heart failure.
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Affiliation(s)
- Filippe Barcellos Filippini
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Hospital Alemão Oswaldo CruzSão PauloSPBrasil Hospital Alemão Oswaldo Cruz , São Paulo , SP – Brasil
| | - Henrique Barbosa Ribeiro
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasil Hospital Sírio-Libanês , São Paulo , SP – Brasil
| | - Edimar Bocchi
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Fernando Bacal
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Fabiana G. Marcondes-Braga
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Monica S. Avila
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Janine Daiana Sturmer
- Hospital Alemão Oswaldo CruzSão PauloSPBrasil Hospital Alemão Oswaldo Cruz , São Paulo , SP – Brasil
| | - Mauricio Felippi de Sá Marchi
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Gabriel Kanhouche
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Antônio Fernando Freire
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasil Hospital Sírio-Libanês , São Paulo , SP – Brasil
| | - Renata Cassar
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasil Hospital Sírio-Libanês , São Paulo , SP – Brasil
| | - Alexandre A. Abizaid
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasil Hospital Sírio-Libanês , São Paulo , SP – Brasil
| | - Fábio Sândoli de Brito
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasil Hospital Sírio-Libanês , São Paulo , SP – Brasil
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Menezes Junior AS, Rivera A, Ayumi Miyawaki I, Gewehr DM, Nascimento B. Long-Term Remote vs. Conventional Monitoring of Pacemakers: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Curr Cardiol Rep 2023; 25:1415-1424. [PMID: 37751037 DOI: 10.1007/s11886-023-01963-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE OF REVIEW Remote monitoring (RM) is the standard of care for patients with cardiac implantable electronic devices (CIEDs), particularly pacemakers. However, the long-term outcomes of RM versus conventional monitoring (CM) of pacemakers and its effectiveness in reducing in-office (IO) visits for device reprogramming require elucidation. This systematic review and meta-analysis aimed to compare the RM and CM of pacemakers over a long-term follow-up. RECENT FINDINGS We systematically searched the PubMed/MEDLINE, Embase, Cochrane, and ClinicalTrials.gov databases for randomized controlled trials (RCTs) comparing RM and CM of pacemakers with at least 12 months of follow-up. Binary endpoints were pooled with risk ratios (RRs), whereas continuous outcomes were computed using mean differences (MDs) or standardized MDs (SMDs). Heterogeneity was assessed using I2 statistics. Among the eight included RCTs, 2159 (48.9%) of 4063 patients underwent RM. Follow-up periods ranged from 12 to 24 months. There were no significant between-group differences in all-cause mortality (RR = 1.19; 95% confidence interval [CI], 0.90-1.57; p = 0.22; I2 = 0%), stroke (RR = 0.90; 95% CI, 0.43-1.91; p = 0.79; I2 = 23%), hospitalizations for cardiovascular and/or device-related adverse events (RR = 0.95; 95% CI, 0.75-1.21; p = 0.70; I2 = 0%), and quality of life (SMD = - 0.06; 95% CI, - 0.22 to 0.10; p = 0.473; I2 = 0%). RM was associated with fewer IO visits/patient/year (MD = 0.98; 95% CI, - 1.64 to - 0.33; p = 0.08; I2 = 98%) and higher rates of atrial tachyarrhythmia (ATA) detection (RR = 1.22; 95% CI, 1.01-1.48; p = 0.04; I2 = 0%) than was CM. This meta-analysis suggests that RM of pacemakers leads to higher rates of ATA detection and fewer IO visits/patient/year, without compromising patient safety.
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Affiliation(s)
| | - André Rivera
- Department of Medicine, Nove de Julho University, São Bernardo do Campo, Brazil
| | | | - Douglas Mesadri Gewehr
- Curitiba Heart Institute, Curitiba, Brazil
- Science, and Technology, Denton Cooley Institute of Research, Curitiba, Brazil
| | - Bárbara Nascimento
- Department of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Xin Y, Hang F, Wu Y. Predictors of Low Voltage Zone and Sex Differences in Low Voltage Zone Distribution in Patients with Atrial Fibrillation. Rev Cardiovasc Med 2023; 24:324. [PMID: 39076443 PMCID: PMC11272876 DOI: 10.31083/j.rcm2411324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/22/2023] [Accepted: 06/05/2023] [Indexed: 07/31/2024] Open
Abstract
Background Previous studies have revealed the left atrial (LA) low voltage zone (LVZ) are tightly linked to the recurrence of atrial fibrillation (AF). Furthermore ablation that targets the LA LVZ can improve patient prognosis. The aim of this study was to identify potential clinical predictors of the LA LVZ, to investigate possible sex differences in the distribution of LA LVZ, and to examine the relationship between LA LVZ and AF recurrence. Methods A total of 108 patients who underwent AF catheter ablation and LA high-density electro-anatomic mapping were enrolled in the study. Of these, 56 patients with LA LVZ ≥ 5% were assigned to the LVZ group, while the remaining 52 patients with LA LVZ < 5% were assigned to the non-LVZ group. Clinical characteristics and laboratory results for all patients were collected and compared between the two groups. Results Multivariate logistic regression analysis revealed that persistent AF (odds ratio [OR] = 4.563, 95% confidence interval [CI]: 1.194-17.431, p = 0.026), left atrial volume (LAV, OR = 1.030, 95% CI: 1.001-1.061, p = 0.044) and brain natriuretic peptide (BNP, OR = 1.010, 95% CI: 1.002-1.019, p = 0.015) were independent predictors for the presence of LA LVZ. In addition, female sex (OR = 7.161, 95% CI: 1.518-33.792, p = 0.013), LAV (OR = 1.028, 95% CI: 1.002-1.055, p = 0.035) and BNP (OR = 1.009, 95% CI: 1.001-1.016, p = 0.018) were independent predictors of severe LA LVZ (LA LVZ > 20%). The extent of LVZ was significantly greater in females than in males (32.8% ± 15.5% vs. 23.5% ± 12.7%, p = 0.021), especially in the anterior (34.5% ± 16.7% vs. 20.0% ± 16.4%, p = 0.003) and septal (44.9% ± 17.1% vs. 29.0% ± 18.9%, p = 0.004) walls. During follow-up, AF recurrence was significantly higher in patients with LA LVZ than in those without LA LVZ (31.3% vs. 12.8%, respectively, p = 0.023). Conclusions In this study cohort, persistent AF, LAV and BNP were independent predictors of LA LVZ. Furthermore, female sex, LAV and BNP were independent predictors of severe LA LVZ. Females had a significantly greater extent of LVZ than males, especially in the anterior and septal walls. Patients with LA LVZ had a higher risk of recurrent AF.
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Affiliation(s)
- Yu Xin
- Department of Cardiovascular Medicine, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China
| | - Fei Hang
- Department of Cardiovascular Medicine, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China
| | - Yongquan Wu
- Department of Cardiovascular Medicine, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China
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Abyzova E, Dogadina E, Rodriguez RD, Petrov I, Kolesnikova Y, Zhou M, Liu C, Sheremet E. Beyond Tissue replacement: The Emerging role of smart implants in healthcare. Mater Today Bio 2023; 22:100784. [PMID: 37731959 PMCID: PMC10507164 DOI: 10.1016/j.mtbio.2023.100784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 09/22/2023] Open
Abstract
Smart implants are increasingly used to treat various diseases, track patient status, and restore tissue and organ function. These devices support internal organs, actively stimulate nerves, and monitor essential functions. With continuous monitoring or stimulation, patient observation quality and subsequent treatment can be improved. Additionally, using biodegradable and entirely excreted implant materials eliminates the need for surgical removal, providing a patient-friendly solution. In this review, we classify smart implants and discuss the latest prototypes, materials, and technologies employed in their creation. Our focus lies in exploring medical devices beyond replacing an organ or tissue and incorporating new functionality through sensors and electronic circuits. We also examine the advantages, opportunities, and challenges of creating implantable devices that preserve all critical functions. By presenting an in-depth overview of the current state-of-the-art smart implants, we shed light on persistent issues and limitations while discussing potential avenues for future advancements in materials used for these devices.
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Affiliation(s)
- Elena Abyzova
- Tomsk Polytechnic University, Lenin ave. 30, Tomsk, Russia, 634050
| | - Elizaveta Dogadina
- Tomsk Polytechnic University, Lenin ave. 30, Tomsk, Russia, 634050
- Institute of Orthopaedic & Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
| | | | - Ilia Petrov
- Tomsk Polytechnic University, Lenin ave. 30, Tomsk, Russia, 634050
| | | | - Mo Zhou
- Institute of Orthopaedic & Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
| | - Chaozong Liu
- Institute of Orthopaedic & Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
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44
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Strik M, Sacristan B, Bordachar P, Duchateau J, Eschalier R, Mondoly P, Laborderie J, Gassa N, Zemzemi N, Laborde M, Garrido J, Matencio Perabla C, Jimenez-Perez G, Camara O, Haïssaguerre M, Dubois R, Ploux S. Artificial intelligence for detection of ventricular oversensing: Machine learning approaches for noise detection within nonsustained ventricular tachycardia episodes remotely transmitted by pacemakers and implantable cardioverter-defibrillators. Heart Rhythm 2023; 20:1378-1384. [PMID: 37406873 DOI: 10.1016/j.hrthm.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/13/2023] [Accepted: 06/28/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs) increasingly automatically record and remotely transmit nonsustained ventricular tachycardia (NSVT) episodes, which may reveal ventricular oversensing. OBJECTIVES We aimed to develop and validate a machine learning algorithm that accurately classifies NSVT episodes transmitted by PMs and ICDs in order to lighten health care workload burden and improve patient safety. METHODS PMs or ICDs (Boston Scientific, St Paul, MN) from 4 French hospitals with ≥1 transmitted NSVT episode were split into 3 subgroups: training set, validation set, and test set. Each NSVT episode was labeled as either physiological or nonphysiological. Four machine learning algorithms-2DTF-CNN, 2D-DenseNet, 2DTF-VGG, and 1D-AgResNet-were developed using training and validation data sets. Accuracies of the classifiers were compared with an analysis of the remote monitoring team of the Bordeaux University Hospital using F2 scores (favoring sensitivity over predictive positive value) using an independent test set. RESULTS A total of 807 devices transmitted 10,471 NSVT recordings (82% ICD; 18% PM), of which 87 devices (10.8%) transmitted 544 NSVT recordings with nonphysiological signals. The classification by the remote monitoring team resulted in an F2 score of 0.932 (sensitivity 95%; specificity 99%) The 4 machine learning algorithms showed high and comparable F2 scores (2DTF-CNN: 0.914; 2D-DenseNet: 0.906; 2DTF-VGG: 0.863; 1D-AgResNet: 0.791), and only 1D-AgResNet had significantly different labeling from that of the remote monitoring team. CONCLUSION Machine learning algorithms were accurate in detecting nonphysiological signals within electrograms transmitted by PMs and ICDs. An artificial intelligence approach may render remote monitoring less resourceful and improve patient safety.
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Affiliation(s)
- Marc Strik
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Université de Bordeaux, Pessac- Bordeaux, France.
| | - Benjamin Sacristan
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Université de Bordeaux, Pessac- Bordeaux, France
| | - Pierre Bordachar
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Université de Bordeaux, Pessac- Bordeaux, France
| | - Josselin Duchateau
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Université de Bordeaux, Pessac- Bordeaux, France
| | - Romain Eschalier
- Department of Cardiology, University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - Pierre Mondoly
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | | | - Narimane Gassa
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Université de Bordeaux, Pessac- Bordeaux, France
| | - Nejib Zemzemi
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Université de Bordeaux, Pessac- Bordeaux, France
| | - Maxime Laborde
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Université de Bordeaux, Pessac- Bordeaux, France
| | | | | | | | | | - Michel Haïssaguerre
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Université de Bordeaux, Pessac- Bordeaux, France
| | - Rémi Dubois
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Université de Bordeaux, Pessac- Bordeaux, France
| | - Sylvain Ploux
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Université de Bordeaux, Pessac- Bordeaux, France
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45
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Chung MK, Patton KK, Lau CP, Dal Forno ARJ, Al-Khatib SM, Arora V, Birgersdotter-Green UM, Cha YM, Chung EH, Cronin EM, Curtis AB, Cygankiewicz I, Dandamudi G, Dubin AM, Ensch DP, Glotzer TV, Gold MR, Goldberger ZD, Gopinathannair R, Gorodeski EZ, Gutierrez A, Guzman JC, Huang W, Imrey PB, Indik JH, Karim S, Karpawich PP, Khaykin Y, Kiehl EL, Kron J, Kutyifa V, Link MS, Marine JE, Mullens W, Park SJ, Parkash R, Patete MF, Pathak RK, Perona CA, Rickard J, Schoenfeld MH, Seow SC, Shen WK, Shoda M, Singh JP, Slotwiner DJ, Sridhar ARM, Srivatsa UN, Stecker EC, Tanawuttiwat T, Tang WHW, Tapias CA, Tracy CM, Upadhyay GA, Varma N, Vernooy K, Vijayaraman P, Worsnick SA, Zareba W, Zeitler EP, Lopez-Cabanillas N, Ellenbogen KA, Hua W, Ikeda T, Mackall JA, Mason PK, McLeod CJ, Mela T, Moore JP, Racenet LK. 2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure. J Arrhythm 2023; 39:681-756. [PMID: 37799799 PMCID: PMC10549836 DOI: 10.1002/joa3.12872] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
Cardiac physiologic pacing (CPP), encompassing cardiac resynchronization therapy (CRT) and conduction system pacing (CSP), has emerged as a pacing therapy strategy that may mitigate or prevent the development of heart failure (HF) in patients with ventricular dyssynchrony or pacing-induced cardiomyopathy. This clinical practice guideline is intended to provide guidance on indications for CRT for HF therapy and CPP in patients with pacemaker indications or HF, patient selection, pre-procedure evaluation and preparation, implant procedure management, follow-up evaluation and optimization of CPP response, and use in pediatric populations. Gaps in knowledge, pointing to new directions for future research, are also identified.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Eugene H Chung
- University of Michigan Medical School Ann Arbor Michigan USA
| | | | | | | | | | - Anne M Dubin
- Stanford University, Pediatric Cardiology Palo Alto California USA
| | - Douglas P Ensch
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Taya V Glotzer
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
| | - Michael R Gold
- Medical University of South Carolina Charleston South Carolina USA
| | - Zachary D Goldberger
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | | | - Eiran Z Gorodeski
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
| | | | | | - Weijian Huang
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
| | - Peter B Imrey
- Cleveland Clinic Cleveland Ohio USA
- Case Western Reserve University Cleveland Ohio USA
| | - Julia H Indik
- University of Arizona, Sarver Heart Center Tucson Arizona USA
| | - Saima Karim
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
| | - Peter P Karpawich
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
| | - Yaariv Khaykin
- Southlake Regional Health Center Newmarket Ontario Canada
| | | | - Jordana Kron
- Virginia Commonwealth University Richmond Virginia USA
| | | | - Mark S Link
- University of Texas Southwestern Medical Center Dallas Texas USA
| | - Joseph E Marine
- Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Wilfried Mullens
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
| | - Seung-Jung Park
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
| | | | | | - Rajeev Kumar Pathak
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
| | | | | | | | | | | | - Morio Shoda
- Tokyo Women's Medical University Tokyo Japan
| | - Jagmeet P Singh
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
| | - David J Slotwiner
- Weill Cornell Medicine Population Health Sciences New York New York USA
| | | | - Uma N Srivatsa
- University of California Davis Sacramento California USA
| | | | | | | | | | - Cynthia M Tracy
- George Washington University Washington District of Columbia USA
| | | | | | - Kevin Vernooy
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
| | | | | | - Wojciech Zareba
- University of Rochester Medical Center Rochester New York USA
| | | | - Nestor Lopez-Cabanillas
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Kenneth A Ellenbogen
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Wei Hua
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Takanori Ikeda
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Judith A Mackall
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Pamela K Mason
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Christopher J McLeod
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Theofanie Mela
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Jeremy P Moore
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Laurel Kay Racenet
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
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46
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Rorsman C, Farouq M, Marinko S, Mörtsell D, Chaudhry U, Wang L, Borgquist R. Sex-based differences in cardiac resynchronization therapy upgrade and outcome for patients with pacemaker and new-onset heart failure. Pacing Clin Electrophysiol 2023; 46:1153-1161. [PMID: 37638818 DOI: 10.1111/pace.14796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/29/2023] [Accepted: 07/17/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Patients with chronic right ventricular (RV) pacing are at an increased risk of heart failure. Previous studies have indicated that cardiac resynchronization therapy (CRT) is underused in this setting, and that there may be sex-based differences in both CRT use and clinical outcome. OBJECTIVE To evaluate sex-based differences in CRT use and clinical outcome for patients with new-onset heart failure post RV pacing. METHODS Data from the Swedish pacemaker registry was matched with data from the national death and disease registries. Patients with de novo pacemaker implant due to AV block during the period 2005-2020 were included. New-onset heart-failure within two years post-implant was evaluated, primary outcome was all-cause mortality. RESULTS In all, 30183 patients (37% female) were included. Women were on average 3 years older, but had less comorbidities than men. Median follow-up time was 4.5 [2.0-8.0] years. Women had better age- and comorbidity-adjusted survival (HR 0.78 [0.73-0.84], p < .001). For the 3560 patients (12.4% men and 10.7% women, p < .001) who were diagnosed with new-onset heart failure, 5-year mortality was similar for men and women (50% vs. 48%, p = .29). However, women were less likely to receive CRT-upgrade (3.8% vs. 9.1%, p < .001), and those who did were almost ten years younger than the men. CONCLUSION Women with pacemaker due to AV block are older but have less comorbidities than men. They are less likely to develop new-onset heart failure, but also less likely to receive a CRT upgrade if they do develop heart failure. Increased awareness of the positive effects of CRT upgrade and potential sex- and age-based discrimination is warranted.
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Affiliation(s)
- Cecilia Rorsman
- Cardiology, Department of Clinical, Sciences, Lund University, Lund, Sweden
- Internal Medicine Department, Varberg Hospital, Varberg, Sweden
| | - Maiwand Farouq
- Cardiology, Department of Clinical, Sciences, Lund University, Lund, Sweden
- Arrhythmia Section, Skane University Hospital, Lund, Sweden
| | - Sofia Marinko
- Cardiology, Department of Clinical, Sciences, Lund University, Lund, Sweden
- Arrhythmia Section, Skane University Hospital, Lund, Sweden
| | - David Mörtsell
- Cardiology, Department of Clinical, Sciences, Lund University, Lund, Sweden
- Arrhythmia Section, Skane University Hospital, Lund, Sweden
| | - Uzma Chaudhry
- Cardiology, Department of Clinical, Sciences, Lund University, Lund, Sweden
- Arrhythmia Section, Skane University Hospital, Lund, Sweden
| | - Lingwei Wang
- Cardiology, Department of Clinical, Sciences, Lund University, Lund, Sweden
- Arrhythmia Section, Skane University Hospital, Lund, Sweden
| | - Rasmus Borgquist
- Cardiology, Department of Clinical, Sciences, Lund University, Lund, Sweden
- Arrhythmia Section, Skane University Hospital, Lund, Sweden
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47
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Mohamed AA, Marques O. Diagnostic Efficacy and Clinical Relevance of Artificial Intelligence in Detecting Cognitive Decline. Cureus 2023; 15:e47004. [PMID: 37965412 PMCID: PMC10641267 DOI: 10.7759/cureus.47004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 11/16/2023] Open
Abstract
Cognitive impairment is an age-associated disorder of increasing prevalence as the aging population continues to grow. Classified based on the level of cognitive decline, memory, function, and capacity to conduct activities of daily living, cognitive impairment ranges from mild cognitive impairment to dementia. When considering the insidious nature of the etiologies responsible for varying degrees of cognitive impairment, early diagnosis may provide a clinical benefit through the facilitation of early treatment. Typical diagnosis relies heavily on evaluation in a primary care setting. However, there is evidence that other diagnostic tools may aid in an earlier diagnosis of the different underlying pathologies responsible for cognitive impairment. Artificial intelligence represents a new intersecting field with healthcare that may aid in the early detection of neurodegenerative disorders. When assessing the role of AI in detecting cognitive decline, it is important to consider both the diagnostic efficacy of AI algorithms and the clinical relevance and impact of early interventions as a result of early detection. Thus, this review highlights promising investigations and developments in the space of artificial intelligence and healthcare and their potential to impact patient outcomes.
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Affiliation(s)
- Ali A Mohamed
- Neurological Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
- Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, USA
| | - Oge Marques
- Biomedical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
- Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, USA
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48
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Yogasundaram H, Zheng Y, Ly E, Ezekowitz J, Ponikowski P, Lam CSP, O'Connor C, Blaustein RO, Roessig L, Temple T, Westerhout CM, Armstrong PW, Sandhu RK. Relationship between baseline electrocardiographic measurements and outcomes in patients with high-risk heart failure: Insights from the VerICiguaT Global Study in Subjects with Heart Failure with Reduced Ejection Fraction (VICTORIA) trial. Eur J Heart Fail 2023; 25:1822-1830. [PMID: 37655679 DOI: 10.1002/ejhf.3021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/03/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023] Open
Abstract
AIMS Whether electrocardiographic (ECG) measurements predict mortality in chronic heart failure with reduced ejection fraction (HFrEF) is unknown. METHODS AND RESULTS We studied 4880 patients from the Vericiguat Global Study in Subjects with Heart Failure with Reduced Ejection Fraction (VICTORIA) trial with a baseline 12-lead ECG. Associations between ECG measurements and mortality were estimated as hazard ratios (HR) and adjusted for the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score, N-terminal pro-B-type natriuretic peptide, and index event. Select interactions between ECG measurements, patient characteristics and mortality were examined. Over a median of 10.8 months, there were 824 cardiovascular (CV) deaths (214 sudden) and 1005 all-cause deaths. Median age was 68 years (interquartile range [IQR] 60-76), 24% were women, median ejection fraction was 30% (IQR 23-35), 41% had New York Heart Association class III/IV, and median MAGGIC score was 24 (IQR 19-28). After multivariable adjustment, significant associations existed between heart rate (per 5 bpm: HR 1.02), QRS duration (per 10 ms: HR 1.02), absence of left ventricular hypertrophy (HR 0.64) and CV death, and similarly so with all-cause death (HR 1.02; HR 1.02; HR 0.61, respectively). Contiguous pathologic Q waves were significantly associated with sudden death (HR 1.46), and right ventricular hypertrophy with all-cause death (HR 1.44). The only sex-based interaction observed was for pathologic Q waves on CV (men: HR 1.05; women: HR 1.64, pinteraction = 0.024) and all-cause death (men: HR 0.99; women: HR 1.57; pinteraction = 0.010). Whereas sudden death doubled in females, it did not differ among males (male: HR 1.25, 95% confidence interval [CI] 0.87-1.79; female: HR 2.50, 95% CI 1.23-5.06; pinteraction = 0.141). CONCLUSION Routine ECG measurements provide additional prognostication of mortality in high-risk HFrEF patients, particularly in women with contiguous pathologic Q waves.
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Affiliation(s)
| | - Yinggan Zheng
- Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada
| | - Eric Ly
- Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada
| | - Justin Ezekowitz
- Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada
| | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore & Duke-National University of Singapore, Singapore, Singapore
| | | | | | | | - Tracy Temple
- Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada
| | | | - Paul W Armstrong
- Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada
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49
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Ferrick AM, Raj SR, Deneke T, Kojodjojo P, Lopez-Cabanillas N, Abe H, Boveda S, Chew DS, Choi JI, Dagres N, Dalal AS, Dechert BE, Frazier-Mills CG, Gilbert O, Han JK, Hewit S, Kneeland C, DeEllen Mirza S, Mittal S, Ricci RP, Runte M, Sinclair S, Alkmim-Teixeira R, Vandenberk B, Varma N. 2023 HRS/EHRA/APHRS/LAHRS expert consensus statement on practical management of the remote device clinic. Heart Rhythm 2023; 20:e92-e144. [PMID: 37211145 DOI: 10.1016/j.hrthm.2023.03.1525] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 05/23/2023]
Abstract
Remote monitoring is beneficial for the management of patients with cardiovascular implantable electronic devices by impacting morbidity and mortality. With increasing numbers of patients using remote monitoring, keeping up with higher volume of remote monitoring transmissions creates challenges for device clinic staff. This international multidisciplinary document is intended to guide cardiac electrophysiologists, allied professionals, and hospital administrators in managing remote monitoring clinics. This includes guidance for remote monitoring clinic staffing, appropriate clinic workflows, patient education, and alert management. This expert consensus statement also addresses other topics such as communication of transmission results, use of third-party resources, manufacturer responsibilities, and programming concerns. The goal is to provide evidence-based recommendations impacting all aspects of remote monitoring services. Gaps in current knowledge and guidance for future research directions are also identified.
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Affiliation(s)
| | | | | | | | | | - Haruhiko Abe
- University of Occupational and Environmental Health Hospital, Kitakyushu, Japan
| | | | | | | | - Nikolaos Dagres
- Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
| | - Aarti S Dalal
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Olivia Gilbert
- Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Janet K Han
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | | | | | | | | | | | - Mary Runte
- University of Lethbridge, Lethbridge, Alberta, Canada
| | | | | | - Bert Vandenberk
- University of Calgary, Calgary, Alberta, Canada; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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50
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Ogano M, Iwasaki YK, Okada T, Tanabe J, Shimizu W, Asai K. Preferred left ventricular lead position for upgrade from right ventricular pacing to cardiac resynchronization therapy. J Cardiovasc Electrophysiol 2023; 34:1925-1932. [PMID: 37449446 DOI: 10.1111/jce.16005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Cardiac resynchronization therapy (CRT) is well-established for treating symptomatic heart failure with electrical dyssynchrony. The left ventricular (LV) lead position is recommended at LV posterolateral to lateral sites in patients with left bundle branch block; however, its preferred region remains unclear in patients being upgraded from right ventricular (RV) apical pacing to CRT. This study aimed to identify the preferred LV lead position for upgrading conventional RV apical pacing to CRT. METHODS We used electrode catheters positioned at the RV apex and LV anterolateral and posterolateral sites via the coronary sinus (CS) branches to measure the ratio of activation time to QRS duration from the RV apex to the LV anterolateral and posterolateral sites during RV apical pacing. Simultaneous biventricular pacing was performed at the RV apex and each LV site, and the differences in QRS duration and LV dP/dtmax from those of RV apical pacing were measured. RESULTS Thirty-seven patients with anterolateral and posterolateral LV CS branches were included. During RV apical pacing, the average ratio of activation time to QRS duration was higher at the LV anterolateral site than at the LV posterolateral site (0.90 ± 0.06 vs. 0.71 ± 0.11, p < .001). The decreasing ratio of QRS duration and the increasing ratio of LV dP/dtmax were higher at the LV anterolateral site than at the posterolateral site (45.7 ± 18.0% vs. 32.0 ± 17.6%, p < .001; 12.7 ± 2.9% vs. 3.7 ± 8.2%, p < .001, respectively) during biventricular pacing compared with RV apical pacing. CONCLUSION The LV anterolateral site is the preferred LV lead position in patients being upgraded from conventional RV apical pacing to CRT.
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Affiliation(s)
- Michio Ogano
- Department of Cardiovascular Medicine, Shizuoka Medical Center, Shimizu, Sunto Shizuoka, Japan
| | - Yu-Ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School, Bunkyo, Tokyo, Japan
| | - Taiji Okada
- Department of Cardiovascular Medicine, Shizuoka Medical Center, Shimizu, Sunto Shizuoka, Japan
| | - Jun Tanabe
- Department of Cardiovascular Medicine, Shizuoka Medical Center, Shimizu, Sunto Shizuoka, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Bunkyo, Tokyo, Japan
| | - Kuniya Asai
- Department of Cardiovascular Medicine, Nippon Medical School, Bunkyo, Tokyo, Japan
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