His bundle pacing, selective and non-selective: are they equally safe and effective?

Background

Permanent His Bundle Pacing (HBP) is the most physiological form of ventricular pacing. His bundle stimulation can be selective (s-HBP) or non-selective (ns-HBP). Few comparative data in terms of safety and efficacy among the two are available in literature.

Purpose

Evaluate the safety and efficacy of s-HBP and ns-HBP stimulation and identify predictors of one or the other stimulation.

Methods

Prospective analysis of patients with HBP implanted between December 2018 and July 2021. The clinical and instrumental parameters were collected at implant and at long-term follow-up. Follow-up data were collected both at outpatient visits and by remote monitoring systems.

Results

130 patients in need for antibradyarrhythmia therapy and 26 patients with an indication for cardiac resynchronization therapy were enrolled, 134 (86%) had successful HBP (34% s-HBP and 66% ns-HBP). There were no significant clinical differences between the two populations with the exception of the presence of right bundle branch block (RBBB: 17.4% s-HBP and 34.1% ns-HBP; p = <0.05) and baseline QRS duration (116.5±27.5 ms in s-HBP and 129.9±34.7 ms in ns-HBP; p = <0.05). There were no significant predictors of ns-HBP (Figure 1). At implantation and at an average 16-month follow-up there were no significant differences in the electrical parameters between the two HBP stimulation modalities.

Twenty-one patients (15.7% of the population, 24% of s-HBP and 12.5% of ns-HBP; p=0.38) had conduction system disease progression, manifested either by a significant increase in pacing threshold (13.3% of s-HBP and 10.2% of ns-HBP recipients; p=0.64; Figure 2A) or by loss of capture (6.5% of s-HBP and 2.2% of ns-HBP recipients; p=0.69). No statically significant predictors of conduction system disease progression were found (Figure 2B). While seventeen patients who had significant threshold elevation underwent device output reprogramming, four patients, who lost capture, and a single one experiencing lead dislodgment (nS-HBP patient) required lead repositioning (8.7% of s-HBP and 4.5% of ns-HBP recipients; p=0.33). s-HBP was significantly more vulnerable to atrial oversensing that required sensitivity reprogramming (17.4% of s-HBP and 4.5% of ns-HBP recipients; p<0.05).

No significant differences in clinical endpoints (cardiovascular death, heart failure, atrial fibrillation, syncope) were observed at follow-up.

Conclusions

In patients indicated to ventricular stimulation, the potential benefit represented by HBP is burdened by a non-negligible number of complications. Though no significant differences were detected at medium-long term between s-HBP and ns-HBP stimulation, s-HBP stimulation appears to be more affected by pacing threshold increase and progression of conduction tissue disease, which resulted in an almost 2-fold (although statistically not significant) incidence of repeated surgery.

Funding Acknowledgement

Type of funding sources: None.

Slow VT treatment in a contemporary population of primary prevention ICD recipients

Funding Acknowledgements

Type of funding sources: None.

Background

Implantable cardioverter defibrillator (ICD) is an effective therapy for sudden cardiac death (SCD). 2015 HRS/EHRA/APHRS/SOLAECE expert consensus document suggests long VT detection, above 185 bpm, as optimal ICD programming to reduce unnecessary therapies in primary prevention (PP).

Purpose

The aim of our study is to evaluate incidence, safety and efficacy of ICD treatment for VT arrhythmias below 185 bpm, in a contemporary population of PP ICD recipients with long detection intervals (LDI), morphological discrimination algorithm and antitachycardia pacing therapies (ATP) before shock.

Methods

We conducted a single centre retrospective study enrolling 236 patients implanted with a primary-prevention indication from January 2013 to June 2019. Patients were implanted with single or dual chamber single-lead transvenous ICD. All patients had standard device setting with long (at least 20 s in VT and 7 s in VF) VT/VF detection above 150 bpm and therapies starting from 171 with up to 5 ATP and multiple shocks. PainFREE-like bursts and Schaumann-like ramps ATP were always set in VT zone. Of each patient we collected a detailed report of up to five appropriate events and three inappropriate events. Arrhythmia diagnosis was confirmed from 3 independent expert physicians.  Date of the event, cycle length, type of morphology (polymorphic or monomorphic), therapies with their effect were collected.

Results

During a mean follow-up of 42 months, 47 (20 %) and 18 (8%) patients had at least one appropriate and inappropriate activation, respectively. The detailed-events analysis shows that 16 (7%) patients had 38 (30%) appropriate events with rate <188 bpm. At these rate ATP were 97% effective. 14 (38%) of inappropriate activations were caused by arrythmias with ventricular rate below 188 bpm and half of these received a shock; 30% of inappropriate shocks were due to arrhythmia with rate <188 bpm. 73% of treated events, with rate <188 bpm, were appropriate. Only 5.6% (n = 10) of ATP attempts cause arrhythmia acceleration.

Conclusions

One third of detected arrhythmias had a rate below 188 bpm and 73% were true VT. In this slow VT zone, ATP had a high success rate with low percentage of acceleration.

Mental Health and Empathy: Do Nursing Students Have Better Attitudes to Psychiatric Patients?

Background

Stigma towards mental illness has a major impact on the quality of life and the health care of psychiatric patients. Several studies have reported that health professionals have more negative attitudes than general population.

Aims

To explore empathy and attitudes towards mental illness in nursing students (NS) and non-health university students. Our purpose is to see how NS have more empathic and less stigmatizing attitudes towards psychiatric patients, compared to other university students.

Methods

We tested 96 university students (50 NS and 46 non-health university students), with the following questionnaires anonymously filled out:

– Community attitudes towards mental ill (CAMI), to evaluate the different students’ attitudes towards mental illness;

– Empathy quotient (EQ), to assess empathy.

Results

NS differs from the other group in 5 items of CAMI (P < 0.05 in 3 items and P < 0.01 in 2 items), and Authoritarianism subscale (P = 0.023). This shows that NS have a greater general awareness and less stigmatizing attitudes about the need to hospitalize the mentally ill, the difference between psychiatric patients and general population, the wrong need of segregation and the real causes of mental illness. There is also a significant difference in EQ (items 6, 21, 25, 44, 59): future nurses seem to have a slightly higher empathy, even though the EQ total score does not differ in the two groups.

Conclusions

These results suggest that there is a difference with respect to the attitudes towards psychiatric patients in NS and students who do not follow health-care courses: NS have more empathetic and less stigmatizing attitudes.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Different Attitudes Toward Psychiatry and Psychiatric Patients in Nursing Students: Can Personal Experiences Reduce Stigma?

Background

Psychiatric patients often do not receive the same health treatment reserved for patients with no mental disorders. Stigma in mental-health nurses can worsen the patients’ healing time and quality of care.

Objective

To explore the different attitudes towards mental illness and psychiatry in nursing students (NS) of the first and the final year of university, and the importance of having visited a psychiatric ward and having known a psychiatric patient.

Methods

Fifty NS completed the following tests:

– Community attitudes towards mental ill (CAMI);

– Attitudes towards psychiatry (ATP-30);

– Empathy quotient (EQ).

Results

NS of the final year differ significantly from those of the first year in 4 CAMI items, in Authoritarianism subscale (P = 0.041), Social Restrictiveness (P = 0.029) and Community Mental Health Ideology (P = 0.045), indicating a more mature and responsible approach to psychiatric patients, without considering them a threat to be secluded. EQ does not show a significant difference in empathy, not even considering the individual items. Final year NS also have more positive attitudes toward Psychiatry in 3 ATP-30 items and total score (P = 0.01). Those who visited a psychiatric ward have more positive attitudes towards mental illness and Psychiatry, in 6 CAMI items and 3 ATP-30 items. Having personally known a psychiatric patient leads to positive attitudes in only a few CAMI items.

Conclusions

Last-year NS, who have had more direct relationships with patients through practical training, have more empathetic and less stigmatizing attitudes. It is also very useful to attend a psychiatric ward during the nursing training.

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Disclosure of interest

The authors have not supplied their declaration of competing interest.