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Gold MR, Auricchio A, Leclercq C, Wold N, Stein KM, Ellenbogen KA. Atrioventricular optimization improves cardiac resynchronization response in patients with long interventricular electrical delays: A pooled analysis of the SMART-AV and SMART-CRT trials. Heart Rhythm 2024:S1547-5271(24)02277-X. [PMID: 38604592 DOI: 10.1016/j.hrthm.2024.03.1783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/21/2024] [Accepted: 03/24/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND The utility of atrioventricular (AV) optimization (AVO) algorithms remains in question. A substudy of the SMART-AV trial found that patients with prolonged interventricular delays ≥70 ms were more likely to benefit from cardiac resynchronization therapy (CRT) with AVO. The SMART-CRT trial evaluated AVO on the basis of these results, but the study was underpowered. OBJECTIVE To increase statistical power, data from SMART-AV patients meeting the inclusion criterion of interventricular delay ≥70 ms were pooled with data from SMART-CRT to reassess AVO. METHODS SMART-CRT and SMART-AV were prospective, randomized, multicenter clinical trials. Patients in both studies were randomized to be programmed with an AVO algorithm (SmartDelay) or fixed AV delay (120 ms). Paired echocardiograms obtained at baseline and 6 months were compared, with CRT response defined as ≥15% reduction in left ventricular end-systolic volume. RESULTS A total of 451 complete patient data sets were pooled and analyzed. The baseline demographics between studies did not differ statistically in terms of age, sex, left ventricular ejection fraction, or left ventricular end-systolic volume. The AVO group had a greater proportion of CRT responders (SmartDelay, 73.9%; fixed, 63.1%; P = .014) and greater changes in measures of reverse remodeling. SmartDelay patients with a recommended sensed AV delay outside the nominal range (100-120 ms) had 2.3 greater odds of CRT response than fixed AV delay patients. CONCLUSION Greater CRT response and measures of reverse remodeling were observed in patients with SmartDelay enabled vs a fixed AV delay. This study supports the use of SmartDelay in patients with a CRT indication and interventricular delay ≥70 ms. CLINICALTRIALS GOV REGISTRATION NCT00677014 and NCT03089281.
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Affiliation(s)
- Michael R Gold
- Medical University of South Carolina, Charleston, South Carolina.
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Özkartal T, Demarchi A, Conte G, Pongan D, Klersy C, Caputo ML, Bergonti M, Bernasconi E, Gaia V, Granger CB, Auricchio A. Cardiac implantable electronic devices and bloodstream infections: management and outcomes. Eur Heart J 2024; 45:1269-1277. [PMID: 38546408 PMCID: PMC10998729 DOI: 10.1093/eurheartj/ehae127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 01/18/2024] [Accepted: 02/15/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND AND AIMS Bloodstream infection (BSI) of any cause may lead to device infection in cardiac implantable electronic device (CIED) patients. Aiming for a better understanding of the diagnostic approach, treatment, and outcome, patients with an implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy and defibrillator (CRT-D) hospitalized with BSI were investigated. METHODS This is a single-centre, retrospective, cohort analysis including consecutive ICD/CRT-D patients implanted between 2012 and 2021. These patients were screened against a list of all hospitalized patients having positive blood cultures consistent with diagnosed infection in any department of a local public hospital. RESULTS The total cohort consisted of 515 patients. Over a median follow-up of 59 months (interquartile range 31-87 months), there were 47 BSI episodes in 36 patients. The majority of patients with BSI (92%) was admitted to non-cardiology units, and in 25 episodes (53%), no cardiac imaging was performed. Nearly all patients (85%) were treated with short-term antibiotics, whereas chronic antibiotic suppression therapy (n = 4) and system extraction (n = 3) were less frequent. Patients with BSI had a nearly seven-fold higher rate (hazard ratio 6.7, 95% confidence interval 3.9-11.2; P < .001) of all-cause mortality. CONCLUSIONS Diagnostic workup of defibrillator patients with BSI admitted to a non-cardiology unit is often insufficient to characterize lead-related endocarditis. The high mortality rate in these patients with BSI may relate to underdiagnosis and consequently late/absence of system removal. Efforts to increase an interdisciplinary approach and greater use of cardiac imaging are necessary for timely diagnosis and adequate treatment.
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Affiliation(s)
- Tardu Özkartal
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, Lugano 6900, Switzerland
| | - Andrea Demarchi
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, Lugano 6900, Switzerland
| | - Giulio Conte
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, Lugano 6900, Switzerland
- Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland
| | - Damiano Pongan
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, Lugano 6900, Switzerland
| | - Catherine Klersy
- Biostatistics and Clinical Trial Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maria Luce Caputo
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, Lugano 6900, Switzerland
| | - Marco Bergonti
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, Lugano 6900, Switzerland
| | - Enos Bernasconi
- Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland
- Internal Medicine, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Faculty of Medicine, Department of Internal Medicine, University of Geneva, Geneva, Switzerland
| | - Valeria Gaia
- Department of Laboratory Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Christopher B Granger
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Angelo Auricchio
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, Lugano 6900, Switzerland
- Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland
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Bergonti M, Sacher F, Arbelo E, Crotti L, Sabbag A, Casella M, Saenen J, Rossi A, Monaco C, Pannone L, Compagnucci P, Russo V, Heller E, Santoro A, Berne P, Bisignani A, Baldi E, Van Leuven O, Migliore F, Marcon L, Dagradi F, Sfondrini I, Landra F, Comune A, Cespón-Fernández M, Nesti M, Santoro F, Magnocavallo M, Vicentini A, Conti S, Ribatti V, Brugada P, de Asmundis C, Brugada J, Tondo C, Schwartz PJ, Haissaguerre M, Auricchio A, Conte G. Implantable loop recorders in patients with Brugada syndrome: the BruLoop study. Eur Heart J 2024; 45:1255-1265. [PMID: 38445836 PMCID: PMC10998731 DOI: 10.1093/eurheartj/ehae133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/09/2024] [Accepted: 02/19/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND AND AIMS Available data on continuous rhythm monitoring by implantable loop recorders (ILRs) in patients with Brugada syndrome (BrS) are scarce. The aim of this multi-centre study was to evaluate the diagnostic yield and clinical implication of a continuous rhythm monitoring strategy by ILRs in a large cohort of BrS patients and to assess the precise arrhythmic cause of syncopal episodes. METHODS A total of 370 patients with BrS and ILRs (mean age 43.5 ± 15.9, 33.8% female, 74.1% symptomatic) from 18 international centers were included. Patients were followed with continuous rhythm monitoring for a median follow-up of 3 years. RESULTS During follow-up, an arrhythmic event was recorded in 30.7% of symptomatic patients [18.6% atrial arrhythmias (AAs), 10.2% bradyarrhythmias (BAs), and 7.3% ventricular arrhythmias (VAs)]. In patients with recurrent syncope, the aetiology was arrhythmic in 22.4% (59.3% BAs, 25.0% VAs, and 15.6% AAs). The ILR led to drug therapy initiation in 11.4%, ablation procedure in 10.9%, implantation of a pacemaker in 2.5%, and a cardioverter-defibrillator in 8%. At multivariate analysis, the presence of symptoms [hazard ratio (HR) 2.5, P = .001] and age >50 years (HR 1.7, P = .016) were independent predictors of arrhythmic events, while inducibility of ventricular fibrillation at the electrophysiological study (HR 9.0, P < .001) was a predictor of VAs. CONCLUSIONS ILR detects arrhythmic events in nearly 30% of symptomatic BrS patients, leading to appropriate therapy in 70% of them. The most commonly detected arrhythmias are AAs and BAs, while VAs are detected only in 7% of cases. Symptom status can be used to guide ILR implantation.
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Affiliation(s)
- Marco Bergonti
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, CH-6900 Lugano, Switzerland
| | - Frederic Sacher
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L’Institut de Rythmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Lia Crotti
- Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Departement of Medicine and Surgery, University Milano Bicocca, Milan, Italy
| | - Avi Sabbag
- The Davidai Center for Rhythm Disturbances and Pacing, Chaim Sheba Medical Center, Tel Hashomer and the faculty of medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital ‘Ospedali Riuniti’, Ancona, Italy
- Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Johan Saenen
- Department of Cardiology, University Hospital Antwerp, Edegem, Belgium
| | - Andrea Rossi
- Arrhythmology Division, Fondazione Gabriele Monasterio CNR-Regione Toscana, via Giuseppe Moruzzi, Pisa, Italy
| | - Cinzia Monaco
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L’Institut de Rythmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital ‘Ospedali Riuniti’, Ancona, Italy
| | - Vincenzo Russo
- Cardiology Unit, Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, Monaldi Hospital, Naples, Italy
| | - Eyal Heller
- The Davidai Center for Rhythm Disturbances and Pacing, Chaim Sheba Medical Center, Tel Hashomer and the faculty of medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amato Santoro
- Division of Cardiology, Cardio Thoracic and Vascular Department, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Paola Berne
- Department of Cardiology, Ospedale Santissima Annunziata, University of Sassari, Sassari, Italy
| | - Antonio Bisignani
- Institute of Cardiology, Catholic University of the Sacred Heart, Roma, Italy
| | - Enrico Baldi
- Arrhythmia and Electrophysiology, Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Federico Migliore
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Lorenzo Marcon
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical, Surgery and Dentist Sciences, University of Milan, Milan, Italy
| | - Federica Dagradi
- Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Irene Sfondrini
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, CH-6900 Lugano, Switzerland
| | - Federico Landra
- Arrhythmology Division, Fondazione Gabriele Monasterio CNR-Regione Toscana, via Giuseppe Moruzzi, Pisa, Italy
- Division of Cardiology, Cardio Thoracic and Vascular Department, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Angelo Comune
- Cardiology Unit, Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, Monaldi Hospital, Naples, Italy
| | - María Cespón-Fernández
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Martina Nesti
- Division of Cardiology, Cardio Thoracic and Vascular Department, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Francesco Santoro
- Cardiothoracic Department, Cardiology Unit, Policlinico Riuniti, Foggia, Italy
| | | | - Alessandro Vicentini
- Arrhythmia and Electrophysiology, Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sergio Conti
- Department of Cardiac Electrophysiology, ARNAS Ospedali Civico Di Cristina Benfratelli, Palermo, Italy
| | - Valentina Ribatti
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical, Surgery and Dentist Sciences, University of Milan, Milan, Italy
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Josep Brugada
- Arrhythmia Section, Cardiology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Claudio Tondo
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical, Surgery and Dentist Sciences, University of Milan, Milan, Italy
| | - Peter J Schwartz
- Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Michel Haissaguerre
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L’Institut de Rythmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Angelo Auricchio
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, CH-6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, via la Santa 1, 6962 Lugano, Switzerland
| | - Giulio Conte
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, CH-6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, via la Santa 1, 6962 Lugano, Switzerland
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Caputo ML, Baldi E, Burkart R, Wilmes A, Cresta R, Benvenuti C, Oezkartal T, Cianella R, Primi R, Currao A, Bendotti S, Compagnoni S, Gentile FR, Anselmi L, Savastano S, Klersy C, Auricchio A. Validation of Utstein-Based score to predict return of spontaneous circulation (UB-ROSC) in patients with out-of-hospital cardiac arrest. Resuscitation 2024; 197:110113. [PMID: 38218400 DOI: 10.1016/j.resuscitation.2024.110113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/20/2023] [Accepted: 12/30/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND AND AIMS The Utstein Based-ROSC (UB-ROSC) score has been developed to predict ROSC in OHCA victims. Aim of the study was to validate the UB-ROSC score using two Utstein-based OHCA registries: the SWiss REgistry of Cardiac Arrest (SWISSRECA) and the Lombardia Cardiac Arrest Registry (Lombardia CARe), northern Italy. METHODS Consecutive patients with OHCA of any etiology occurring between January 1st, 2019 and December 31st 2021 were included in this retrospective validation study. UB-ROSC score was computed for each patient and categorized in one of three subgroups: low, medium or high likelihood of ROSC according to the UB-ROSC cut-offs (≤-19; -18 to 12; ≥13). To assess the performance of the UB-ROSC score in this new cohort, we assessed both discrimination and calibration. The score was plotted against the survival to hospital admission. RESULTS A total of 12.577 patients were included in the study. A sustained ROSC was obtained in 2.719 patients (22%). The UB-ROSC model resulted well calibrated and showed a good discrimination (AUC 0.71, 95% CI 0.70-0.72). In the low likelihood subgroup of UB-ROSC, only 10% of patients achieved ROSC, whereas the proportion raised to 36% for a score between -18 and 12 (OR 5.0, 95% CI 2.9-8.6, p < 0.001) and to 85% for a score ≥13 (OR 49.4, 95% CI 14.3-170.6, p < 0.001). CONCLUSIONS UB-ROSC score represents a reliable tool to predict ROSC probability in OHCA patients. Its application may help the medical decision-making process, providing a realistic stratification of the probability for ROSC.
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Affiliation(s)
- Maria Luce Caputo
- Department of Cardiology, Cardiocentro Ticino Institute-EOC, Lugano, Switzerland; Fondazione Ticino Cuore, Lugano, Switzerland.
| | - Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardiac Arrest and Resuscitation Science Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roman Burkart
- Interassociation for Rescue Services (IVR-IAS), Aarau, Switzerland
| | - André Wilmes
- Interassociation for Rescue Services (IVR-IAS), Aarau, Switzerland
| | - Ruggero Cresta
- Fondazione Ticino Cuore, Lugano, Switzerland; Federazione Cantonale Ticinese Servizi Autoambulanze, Bellinzona, Switzerland
| | | | - Tardu Oezkartal
- Department of Cardiology, Cardiocentro Ticino Institute-EOC, Lugano, Switzerland
| | - Roberto Cianella
- Federazione Cantonale Ticinese Servizi Autoambulanze, Bellinzona, Switzerland
| | - Roberto Primi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardiac Arrest and Resuscitation Science Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessia Currao
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardiac Arrest and Resuscitation Science Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Bendotti
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardiac Arrest and Resuscitation Science Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Compagnoni
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardiac Arrest and Resuscitation Science Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Francesca Romana Gentile
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardiac Arrest and Resuscitation Science Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Luciano Anselmi
- Federazione Cantonale Ticinese Servizi Autoambulanze, Bellinzona, Switzerland
| | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardiac Arrest and Resuscitation Science Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Catherine Klersy
- Service of Biostatistics and Clinical Trial Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Angelo Auricchio
- Department of Cardiology, Cardiocentro Ticino Institute-EOC, Lugano, Switzerland; Fondazione Ticino Cuore, Lugano, Switzerland
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Jelisejevas J, Regoli F, Hofer D, Conte G, Oezkartal T, Saguner AM, Caputo ML, Grazioli L, Steffel J, Auricchio A, Breitenstein A. Leadless Pacemaker Implantation in Patients With a Prior Conventional Pacing System. CJC Open 2024; 6:649-655. [PMID: 38708054 PMCID: PMC11065736 DOI: 10.1016/j.cjco.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/11/2023] [Indexed: 05/07/2024] Open
Abstract
Background Leadless pacing has been established as an alternative approach to transvenous devices for selected patients. Often, leadless pacemaker (LP) implantation is a de novo procedure, but in an increasing number of patients, an LP is used after previous implantation of a conventional pacing system (CPS). Methods A retrospective analysis was conducted of the efficacy and safety of LP implantation in the context of a previously implanted CPS, from 2 large Swiss centres. Results A total of 257 consecutive patients undergoing LP implantation were included. They were divided into 2 groups: group 1 consisted of 233 patients who did not have a previous CPS, and group 2 consisted of 24 patients with an in situ CPS. In group 2, a total of 20 patients (83%) required transvenous lead extraction due to infection, malfunction, or other reasons. In 3 patients with device-related infection, lead extraction and LP implantation was performed as a single procedure, whereas in the remaining 11 cases, a time window occurred between the 2 procedures (median: 11.5 days; range: 2-186 days). Electrical device parameters at implantation and during follow-up did not differ between the 2 groups (mean: 12.5 ± 9.3 months). Eight major periprocedural complications (3.1%) were encountered (4 pericardial effusions, 3 instances of femoral bleeding, and 1 instance of intra-abdominal bleeding) in the entire cohort within a 30-day period. No complications occurred in the group with a previous device. No infections were registered, even when complete extraction of an infected CPS was performed prior to LP implantation. Conclusions Implantation of an LP in patients with a prior CPS (with or without extraction of the previous system) was effective and safe in our population of patients.
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Affiliation(s)
- Julius Jelisejevas
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - François Regoli
- Fondazione Cardiocentro Ticino, Lugano, Switzerland
- Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Daniel Hofer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Giulio Conte
- Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | | | - Ardan M. Saguner
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Jan Steffel
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
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Ahmed A, Auricchio A, Mittal S, Pickett RA, Wilkoff BL, Jacobsen LD, Marti AK, Holbrook RW, Soderlund DM, Curtis AB. Mortality Benefit Among Primary Prevention Implantable Cardioverter Defibrillator Recipients on Contemporary Heart Failure Treatment. JACC Clin Electrophysiol 2024:S2405-500X(24)00090-2. [PMID: 38520434 DOI: 10.1016/j.jacep.2024.102334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/19/2024] [Accepted: 01/20/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Past clinical trials have shown the benefit of implantable cardioverter-defibrillators (ICDs) for reducing sudden cardiac death in at-risk patients. However, heart failure management and ICD technology have changed since these trials were first published. An updated assessment of ICD mortality benefit is needed. OBJECTIVES The purpose of this study was to compare mortality rates between patients with a primary prevention (PP) indication for an ICD who did or did not receive an ICD using a contemporary, real-world data set. METHODS Data was obtained from a large electronic health record data set covering patients in the United States from 2012 through 2020 who had a PP indication for an ICD and survived at least 1-year postindication. RESULTS A total of 25,296 patients were identified as having a PP indication for ICD implantation, of which 2,118 (8.4%) were treated with an ICD within a year. Treated patients were younger than nontreated patients (63.4 years vs 66.1 years) with a smaller proportion of women (25.0% vs 36.7%). After 4-to-1 propensity matching, treated patients had similar clinical characteristics to nontreated patients. A Cox proportional hazard model estimated a 24.3% lower risk of all-cause mortality in patients when treated vs not treated with an ICD (HR: 0.757; CI: 0.678-0.835; P <0.001). There was no detectable difference in ICD benefit between patients with ischemic and nonischemic heart disease (P = 0.50). CONCLUSIONS ICD treatment of patients with a PP indication is associated with improved mortality even in the context of evolving adjunctive HF treatment, consistent with earlier landmark trials.
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Affiliation(s)
- Aamir Ahmed
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
| | - Angelo Auricchio
- Division of Cardiology, Istituto Cardiocentro Ticino - Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Suneet Mittal
- The Valley Health System and the Snyder Center for Comprehensive Atrial Fibrillation, Ridgewood, New Jersey, USA
| | | | - Bruce L Wilkoff
- Cleveland Clinic Heart, Thoracic, and Vascular Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Anne B Curtis
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
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Müller MP, Metelmann C, Thies KC, Greif R, Scquizzato T, Deakin CD, Auricchio A, Barry T, Berglund E, Böttiger BW, Burkart R, Busch HJ, Caputo ML, Cheskes S, Cresta R, Damjanovic D, Degraeuwe E, Ekkel MM, Elschenbroich D, Fredman D, Ganter J, Gregers MCT, Gronewald J, Hänsel M, Henriksen FL, Herzberg L, Jonsson M, Joos J, Kooy TA, Krammel M, Marks T, Monsieurs K, Ng WM, Osche S, Salcido DD, Scapigliati A, Schwietring J, Semeraro F, Snobelen P, Sowa J, Stieglis R, Tan HL, Trummer G, Unterrainer J, Vercammen S, Wetsch WA, Metelmann B. Reporting standard for describing first responder systems, smartphone alerting systems, and AED networks. Resuscitation 2024; 195:110087. [PMID: 38097108 DOI: 10.1016/j.resuscitation.2023.110087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/15/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023]
Abstract
Standardized reporting of data is crucial for out-of-hospital cardiac arrest (OHCA) research. While the implementation of first responder systems dispatching volunteers to OHCA is encouraged, there is currently no uniform reporting standard for describing these systems. A steering committee established a literature search to identify experts in smartphone alerting systems. These international experts were invited to a conference held in Hinterzarten, Germany, with 40 researchers from 13 countries in attendance. Prior to the conference, participants submitted proposals for parameters to be included in the reporting standard. The conference comprised five workshops covering different aspects of smartphone alerting systems. Proposed parameters were discussed, clarified, and consensus was achieved using the Nominal Group Technique. Participants voted in a modified Delphi approach on including each category as a core or supplementary element in the reporting standard. Results were presented, and a writing group developed definitions for all categories and items, which were sent to participants for revision and final voting using LimeSurvey web-based software. The resulting reporting standard consists of 68 core items and 21 supplementary items grouped into five topics (first responder system, first responder network, technology/algorithm/strategies, reporting data, and automated external defibrillators (AED)). This proposed reporting standard generated by an expert opinion group fills the gap in describing first responder systems. Its adoption in future research will facilitate comparison of systems and research outcomes, enhancing the transfer of scientific findings to clinical practice.
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Affiliation(s)
- M P Müller
- Department of Anaesthesiology, Intensive Care and Emergency Medicine, St. Josefs Hospital, Freiburg, Germany; Region of Lifesavers, Freiburg, Germany; German Resuscitation Council (GRC), Ulm, Germany.
| | - C Metelmann
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Medicine Greifswald, Greifswald, Germany; German Resuscitation Council (GRC), Ulm, Germany
| | - K C Thies
- Department of Anaesthesiology and Critical Care, EvKB, Bielefeld University Hospitals, Campus Bethel, Bielefeld, Germany
| | - R Greif
- University of Bern, Bern, Switzerland; School of Medicine, Sigmund Freud University Vienna, Vienna, Austria; European Resuscitation Council, Niel, Belgium
| | - T Scquizzato
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Italian Resuscitation Council (IRC), Bologna, Italy
| | - C D Deakin
- Department of Anaesthesia, University Hospital Southampton, Southampton, UK, South Central Ambulance Service NHS Foundation Trust, Otterbourne, UK
| | - A Auricchio
- Division of Cardiology, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland; Fondazione Ticino Cuore, Lugano, Switzerland
| | - T Barry
- Department of General Practice, School of Medicine, University College Dublin, Dublin, Ireland
| | - E Berglund
- Center for Resuscitation Science, Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - B W Böttiger
- University of Cologne, Faculty of Medicine, and University Hospital of Cologne, Department of Anaesthesiology and Intensive Care Medicine, Cologne, Germany; German Resuscitation Council (GRC), Ulm, Germany; European Resuscitation Council, Niel, Belgium
| | - R Burkart
- Interverband für Rettungswesen IVR-IAS, Aarau, Switzerland; Swiss Resuscitation Council, Bern, Switzerland
| | - H J Busch
- Department of Emergency Medicine, Faculty of Medicine, University Hospital of Freiburg, University of Freiburg, Freiburg, Germany; Region of Lifesavers, Freiburg, Germany; German Resuscitation Council (GRC), Ulm, Germany
| | - M L Caputo
- Division of Cardiology, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland; Fondazione Ticino Cuore, Lugano, Switzerland
| | - S Cheskes
- Department of Family and Community Medicine, Division of Emergency Medicine, University of Toronto, Canada
| | - R Cresta
- Fondazione Ticino Cuore, Lugano, Switzerland; Federazione Cantonale Ticinese Servizi Autoambulanze (FCTSA), Bellinzona, Switzerland
| | - D Damjanovic
- Department of Cardiovascular Surgery, Faculty of Medicine, University Hospital of Freiburg, University of Freiburg, Germany
| | - E Degraeuwe
- Department of Internal Medicine and Pediatrics (GE35), Gent University, Ghent, Belgium; Department of Internal Medicine and Pediatrics, Gent University Hospital, Ghent, Belgium; Belgian First Responder Network EVapp, Belgium
| | - M M Ekkel
- Amsterdam University Medical Center, Location AMC, Department of Cardiology, Amsterdam, the Netherlands
| | - D Elschenbroich
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - D Fredman
- Heartrunner Citizen Responder System, Heartrunner Sweden AB, Solna, Sweden
| | - J Ganter
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - M C T Gregers
- Emergency Medical Services, Capital Region of Denmark, Copenhagen, Denmark
| | - J Gronewald
- Department of Cardiovascular Surgery, Faculty of Medicine, University Hospital of Freiburg, University of Freiburg, Germany
| | - M Hänsel
- Carl Gustav Carus Faculty of Medicine, Carus Teaching Center, Technische Universität Dresden, Dresden, Germany
| | - F L Henriksen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - L Herzberg
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Medicine Greifswald, Greifswald, Germany
| | - M Jonsson
- Center for Resuscitation Science, Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - J Joos
- Region of Lifesavers, Freiburg, Germany
| | - T A Kooy
- Stan, Citizen Responder Network HartslagNu, Netherlands
| | - M Krammel
- Emergency Medical Service Vienna, Vienna, Austria; PULS Austrian Cardiac Arrest Awareness Association, Vienna, Austria
| | - T Marks
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Medicine Greifswald, Greifswald, Germany; Department of Surgery, Kreiskrankenhaus Demmin, Demmin, Germany
| | - K Monsieurs
- Antwerp University Hospital and University of Antwerp, Belgium; European Resuscitation Council, Niel, Belgium
| | - W M Ng
- Department of Emergency Medicine, Ng Teng Fong General Hospital, Singapore
| | - S Osche
- German Red Cross, Berlin, Germany; German Resuscitation Council (GRC), Ulm, Germany
| | - D D Salcido
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - A Scapigliati
- Insitute of Anesthesia and Intensive Care, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy; Italian Resuscitation Council (IRC), Bologna, Italy
| | - J Schwietring
- ADAC Air Ambulance, Dept. of Medicine, Munich, Germany
| | - F Semeraro
- Department of Anaesthesia, Intensive Care and EMS, Maggiore Hospital, Bologna, Italy; European Resuscitation Council, Niel, Belgium
| | - P Snobelen
- Peel Regional Paramedic Services, Ontario, Canada
| | - J Sowa
- Department of Cardiovascular Surgery, Faculty of Medicine, University Hospital of Freiburg, University of Freiburg, Germany
| | - R Stieglis
- Amsterdam University Medical Center, Location AMC, Department of Cardiology, Amsterdam, the Netherlands
| | - H L Tan
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands
| | - G Trummer
- Department of Cardiovascular Surgery, Faculty of Medicine, University Hospital of Freiburg, University of Freiburg, Germany; Region of Lifesavers, Freiburg, Germany; German Resuscitation Council (GRC), Ulm, Germany
| | - J Unterrainer
- Institute of Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - S Vercammen
- Department of Internal Medicine and Pediatrics, Gent University Hospital, Ghent, Belgium
| | - W A Wetsch
- University of Cologne, Faculty of Medicine, and University Hospital of Cologne, Department of Anaesthesiology and Intensive Care Medicine, Cologne, Germany; German Resuscitation Council (GRC), Ulm, Germany
| | - B Metelmann
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Medicine Greifswald, Greifswald, Germany; German Resuscitation Council (GRC), Ulm, Germany
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Jelisejevas J, Regoli F, Hofer D, Conte G, Oezkartal T, Saguner AM, Caputo ML, Grazioli L, Steffel J, Auricchio A, Breitenstein A. Leadless Pacemaker Implantation, Focusing on Patients With Conduction System Disorders Post-Transcatheter Aortic Valve Replacement: A Retrospective Analysis. CJC Open 2024; 6:96-103. [PMID: 38585679 PMCID: PMC10994977 DOI: 10.1016/j.cjco.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/09/2023] [Indexed: 04/09/2024] Open
Abstract
Background Impairment of the conduction system is a common complication of transcatheter aortic valve replacement (TAVR), which is typically performed in elderly patients. A leadless pacemaker (LP) may be a suitable option in this frail population, but the available scientific data concerning the efficacy and safety of leadless pacing after TAVR are sparse. The purpose of this analysis was to evaluate the efficacy and safety of LP implantation in patients with relevant bradycardias after TAVR, compared to other indications. Methods Consecutive patients were retrospectively enrolled. Demographics, background heart diseases, interventional parameters, and follow-up data were collected. Results A total of 257 consecutive patients who underwent LP implantation were included. In 26 patients, the device was implanted due to bradycardias after TAVR (TAVR group), whereas the remaining 231 patients were in the population without previous TAVR (non-TAVR group). The mean implantation duration (56 ± 22 minutes in the TAVR group vs 48 ± 20 minutes in the non-TAVR group; P = not significant [NS]) and the implantation success rate (100% in the TAVR group vs 98.7% in the non-TAVR group; P = NS) were similar in the 2 cohorts. No significant differences occurred in pacing parameters (sensing, impedance, and threshold, respectively) between the 2 groups, either at implantation or during follow-up. A total of 8 major periprocedural complications (3.1% of patients in total; 3.8% in the TAVR group vs 3.0% in the non-TAVR group; P = NS) occurred within 30 days, without significant difference between the 2 groups. Conclusions LP implantation appears to be safe and effective in patients after TAVR, and therefore, this procedure is a suitable option for this often old and frail population.
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Affiliation(s)
- Julius Jelisejevas
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - François Regoli
- Fondazione Cardiocentro Ticino, Lugano, Switzerland
- Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Daniel Hofer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Giulio Conte
- Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | | | - Ardan M. Saguner
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Jan Steffel
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
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9
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Baldi E, Klersy C, Chan P, Elmer J, Ball J, Counts CR, Rosell Ortiz F, Fothergill R, Auricchio A, Paoli A, Karam N, McNally B, Martin-Gill C, Nehme Z, Drucker CJ, Ruiz Azpiazu JI, Mellett-Smith A, Cresta R, Scquizzato T, Jouven X, Primi R, Al-Araji R, Guyette FX, Sayre MR, Daponte Codina A, Benvenuti C, Marijon E, Savastano S. The impact of COVID-19 pandemic on out-of-hospital cardiac arrest: An individual patient data meta-analysis. Resuscitation 2024; 194:110043. [PMID: 37952575 DOI: 10.1016/j.resuscitation.2023.110043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
AIM Prior studies have reported increased out-of-hospital cardiac arrests (OHCA) incidence and lower survival during the COVID-19 pandemic. We evaluated how the COVID-19 pandemic affected OHCA incidence, bystander CPR rate and patients' outcomes, accounting for regional COVID-19 incidence and OHCA characteristics. METHODS Individual patient data meta-analysis of studies which provided a comparison of OHCA incidence during the first pandemic wave (COVID-period) with a reference period of the previous year(s) (pre-COVID period). We computed COVID-19 incidence per 100,000 inhabitants in each of 97 regions per each week and divided it into its quartiles. RESULTS We considered a total of 49,882 patients in 10 studies. OHCA incidence increased significantly compared to previous years in regions where weekly COVID-19 incidence was in the fourth quartile (>136/100,000/week), and patients in these regions had a lower odds of bystander CPR (OR 0.49, 95%CI 0.29-0.81, p = 0.005). Overall, the COVID-period was associated with an increase in medical etiology (89.2% vs 87.5%, p < 0.001) and OHCAs at home (74.7% vs 67.4%, p < 0.001), and a decrease in shockable initial rhythm (16.5% vs 20.3%, p < 0.001). The COVID-period was independently associated with pre-hospital death (OR 1.73, 95%CI 1.55-1.93, p < 0.001) and negatively associated with survival to hospital admission (OR 0.68, 95%CI 0.64-0.72, p < 0.001) and survival to discharge (OR 0.50, 95%CI 0.46-0.54, p < 0.001). CONCLUSIONS During the first COVID-19 pandemic wave, there was higher OHCA incidence and lower bystander CPR rate in regions with a high-burden of COVID-19. COVID-19 was also associated with a change in patient characteristics and lower survival independently of COVID-19 incidence in the region where OHCA occurred.
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Affiliation(s)
- Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardiac Arrest and Resuscitation Science Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Catherine Klersy
- Biostatistics & Clinical Trial Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paul Chan
- Department of Medicine, Saint Luke's Mid America Heart Institute, Kansas City, USA
| | - Jonathan Elmer
- Departments of Emergency Medicine, Critical Care Medicine and Neurology, University of Pittsburgh, Pittsburgh, USA
| | - Jocasta Ball
- Centre of Cardiovascular Research & Education in Therapeutics (CCRET), School of Public Health and Preventive Medicine, Monash University, Clayton, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia; Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia
| | - Catherine R Counts
- University of Washington School of Medicine, Seattle, USA; Seattle Fire Department, Seattle, USA
| | - Fernando Rosell Ortiz
- Servicio de Emergencias 061 de La Rioja, Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
| | - Rachael Fothergill
- Clinical Audit & Research Unit, London Ambulance Service NHS Trust, London, UK
| | - Angelo Auricchio
- Fondazione Ticino Cuore, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland; Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Andrea Paoli
- Centrale Operativa Provinciale SUEM 118, Azienda ULSS 5 Polesana, Rovigo, Italy
| | - Nicole Karam
- Division of Cardiology, European Georges Pompidou Hospital, Paris, France
| | - Bryan McNally
- Emory University School of Medicine, Rollins School of Public Health, Atlanta, USA
| | - Christian Martin-Gill
- Departments of Emergency Medicine, Critical Care Medicine and Neurology, University of Pittsburgh, Pittsburgh, USA
| | - Ziad Nehme
- Centre of Cardiovascular Research & Education in Therapeutics (CCRET), School of Public Health and Preventive Medicine, Monash University, Clayton, Australia; Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia
| | | | - José Ignacio Ruiz Azpiazu
- Servicio de Emergencias 061 de La Rioja, Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
| | - Adam Mellett-Smith
- Clinical Audit & Research Unit, London Ambulance Service NHS Trust, London, UK
| | - Ruggero Cresta
- Fondazione Ticino Cuore, Lugano, Switzerland; Federazione Cantonale Ticinese Servizi Autoambulanze, Lugano, Switzerland
| | - Tommaso Scquizzato
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Xavier Jouven
- Division of Cardiology, European Georges Pompidou Hospital, Paris, France
| | - Roberto Primi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardiac Arrest and Resuscitation Science Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Rabab Al-Araji
- Emory University, Woodruff Health Sciences Center, Atlanta, USA
| | - Francis X Guyette
- Departments of Emergency Medicine, Critical Care Medicine and Neurology, University of Pittsburgh, Pittsburgh, USA
| | - Michael R Sayre
- University of Washington School of Medicine, Seattle, USA; Seattle Fire Department, Seattle, USA
| | - Antonio Daponte Codina
- Andalusian School of Public Health, CIBER Epidemiology and Public Health (CIBERESP), Granada, Spain
| | | | - Eloi Marijon
- Division of Cardiology, European Georges Pompidou Hospital, Paris, France
| | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardiac Arrest and Resuscitation Science Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Auricchio A. Editorial. Europace 2023; 26:euae008. [PMID: 38207128 PMCID: PMC10803038 DOI: 10.1093/europace/euae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Indexed: 01/13/2024] Open
Affiliation(s)
- Angelo Auricchio
- Istituto Cardiocentro Ticino - Ente Ospedaliero Cantonale, Via Tesserete 48, 6900 Lugano, Switzerland
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11
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Monachino G, Zanchi B, Fiorillo L, Conte G, Auricchio A, Tzovara A, Faraci FD. Deep Generative Models: The winning key for large and easily accessible ECG datasets? Comput Biol Med 2023; 167:107655. [PMID: 37976830 DOI: 10.1016/j.compbiomed.2023.107655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/04/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
Large high-quality datasets are essential for building powerful artificial intelligence (AI) algorithms capable of supporting advancement in cardiac clinical research. However, researchers working with electrocardiogram (ECG) signals struggle to get access and/or to build one. The aim of the present work is to shed light on a potential solution to address the lack of large and easily accessible ECG datasets. Firstly, the main causes of such a lack are identified and examined. Afterward, the potentials and limitations of cardiac data generation via deep generative models (DGMs) are deeply analyzed. These very promising algorithms have been found capable not only of generating large quantities of ECG signals but also of supporting data anonymization processes, to simplify data sharing while respecting patients' privacy. Their application could help research progress and cooperation in the name of open science. However several aspects, such as a standardized synthetic data quality evaluation and algorithm stability, need to be further explored.
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Affiliation(s)
- Giuliana Monachino
- Institute of Digital Technologies for Personalized Healthcare - MeDiTech, Department of Innovative Technologies, University of Applied Sciences and Arts of Southern Switzerland, Via la Santa 1, Lugano 6900, Switzerland; Institute of Informatics, University of Bern, Neubrückstrasse 10, Bern 3012, Switzerland.
| | - Beatrice Zanchi
- Institute of Digital Technologies for Personalized Healthcare - MeDiTech, Department of Innovative Technologies, University of Applied Sciences and Arts of Southern Switzerland, Via la Santa 1, Lugano 6900, Switzerland; Department of Quantitative Biomedicine, University of Zurich, Schmelzbergstrasse 26, Zurich 8091, Switzerland
| | - Luigi Fiorillo
- Institute of Digital Technologies for Personalized Healthcare - MeDiTech, Department of Innovative Technologies, University of Applied Sciences and Arts of Southern Switzerland, Via la Santa 1, Lugano 6900, Switzerland
| | - Giulio Conte
- Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, Lugano 6900, Switzerland; Centre for Computational Medicine in Cardiology, Faculty of Informatics, Università della Svizzera Italiana, Via la Santa 1, Lugano 6900, Switzerland
| | - Angelo Auricchio
- Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, Lugano 6900, Switzerland; Centre for Computational Medicine in Cardiology, Faculty of Informatics, Università della Svizzera Italiana, Via la Santa 1, Lugano 6900, Switzerland
| | - Athina Tzovara
- Institute of Informatics, University of Bern, Neubrückstrasse 10, Bern 3012, Switzerland; Sleep Wake Epilepsy Center | NeuroTec, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 16, Bern 3010, Switzerland
| | - Francesca Dalia Faraci
- Institute of Digital Technologies for Personalized Healthcare - MeDiTech, Department of Innovative Technologies, University of Applied Sciences and Arts of Southern Switzerland, Via la Santa 1, Lugano 6900, Switzerland
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12
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Moens E, Degraeuwe E, Caputo Maria L, Cresta R, Arys R, Van Moorter N, Tackaert T, Benvenuti C, Auricchio A, Vercammen S. A roadmap to building first responder networks: Lessons learned and best practices from Belgium and Switzerland. Resusc Plus 2023; 16:100469. [PMID: 37779882 PMCID: PMC10539931 DOI: 10.1016/j.resplu.2023.100469] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
Background/Aims Limited bystander assistance and delayed emergency medical service arrival reduce the chances of survival in cardiac arrest victims. Early basic life support through trained first responders (FR) and automatic external defibrillation both improve the outcome. Well-organized FR networks have shown promise, but guidance on effective implementation is lacking. This study evaluates two FR networks, in Belgium and in Switzerland, to identify main advancements in the development of such systems. Method Direct comparison is made of the barriers and facilitators in the development of both FR systems from 2006 up until December 2022, and summarized within a roadmap. Results The Roadmap comprises four integral steps: exploration, installation, initiation, and implementation. Exploration involves understanding the national legislation, engaging with advisory bodies, and establishing local steering committees. The installation phase focuses on FR recruitment, engaging specific professional groups such as firemen, registering public Automated External Defibrillators (AEDs), and requesting feedback. The initiation step includes implementing improvement cycles and fidelity measures. Finally, implementation expands the network, leading to increased survival rates and the integration of these practices into legislation. A significant focus is placed on FR's psychological wellbeing. Moreover, the roadmap highlights the use of efficient geo-mapping to simplify optimal AED placement and automatically assign FRs to tasks. Conclusion The importance of FR networks for early resuscitation is increasingly recognized and various systems are being developed. Key developmental strategies of the EVapp and Ticino Cuore app system may serve as a roadmap for other systems and implementations within Europe and beyond.
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Affiliation(s)
| | - Eva Degraeuwe
- Ghent University, Ghent, Belgium
- Ghent University Hospital, Ghent, Belgium
- Emergency Volunteer Application (EVapp) NGO, Belgium
| | - Luce Caputo Maria
- Cardiocentro Ticino Institute, Lugano, Switzerland
- Fondazione Ticino Cuore, Lugano, Switzerland
| | | | - Robin Arys
- Emergency Volunteer Application (EVapp) NGO, Belgium
| | - Nina Van Moorter
- Emergency Volunteer Application (EVapp) NGO, Belgium
- OLVG Hospital, Amsterdam, The Netherlands
| | - Thomas Tackaert
- Ghent University, Ghent, Belgium
- Ghent University Hospital, Ghent, Belgium
- Emergency Volunteer Application (EVapp) NGO, Belgium
| | | | - Angelo Auricchio
- Cardiocentro Ticino Institute, Lugano, Switzerland
- Fondazione Ticino Cuore, Lugano, Switzerland
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13
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Zanchi B, Faraci FD, Gharaviri A, Bergonti M, Monga T, Auricchio A, Conte G. Identification of Brugada syndrome based on P-wave features: an artificial intelligence-based approach. Europace 2023; 25:euad334. [PMID: 37944131 PMCID: PMC10683037 DOI: 10.1093/europace/euad334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/27/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023] Open
Abstract
AIMS Brugada syndrome (BrS) is an inherited disease associated with an increased risk of ventricular arrhythmias. Recent studies have reported the presence of an altered atrial phenotype characterized by abnormal P-wave parameters. The aim of this study was to identify BrS based exclusively on P-wave features through an artificial intelligence (AI)-based model. METHODS AND RESULTS Continuous 5 min 12-lead ECG recordings were obtained in sinus rhythm from (i) patients with spontaneous or ajmaline-induced BrS and no history of AF and (ii) subjects with suspected BrS and negative ajmaline challenge. The recorded ECG signals were processed and divided into epochs of 15 s each. Within these epochs, P-waves were first identified and then averaged. From the averaged P-waves, a total of 67 different features considered relevant to the classification task were extracted. These features were then used to train nine different AI-based supervised classifiers. A total of 2228 averaged P-wave observations, resulting from the analysis of 33 420 P-waves, were obtained from 123 patients (79 BrS+ and 44 BrS-). Averaged P-waves were divided using a patient-wise split, allocating 80% for training and 20% for testing, ensuring data integrity and reducing biases in AI-based model training. The BrS+ patients presented with longer P-wave duration (136 ms vs. 124 ms, P < 0.001) and higher terminal force in lead V1 (2.5 au vs. 1.7 au, P < 0.01) compared with BrS- subjects. Among classifiers, AdaBoost model had the highest values of performance for all the considered metrics, reaching an accuracy of over 81% (sensitivity 86%, specificity 73%). CONCLUSION An AI machine-learning model is able to identify patients with BrS based only on P-wave characteristics. These findings confirm the presence of an atrial hallmark and open new horizons for AI-guided BrS diagnosis.
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Affiliation(s)
- Beatrice Zanchi
- Department of Innovative Technologies, Institute of Digital Technologies for Personalized Healthcare of SUPSI, Lugano, Switzerland
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
| | - Francesca Dalia Faraci
- Department of Innovative Technologies, Institute of Digital Technologies for Personalized Healthcare of SUPSI, Lugano, Switzerland
| | - Ali Gharaviri
- Center for Computational Medicine in Cardiology, USI, via La Santa 1, 6900, Lugano, Switzerland
- Centre of Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland
| | - Marco Bergonti
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, via Tesserete 64, 6900, Lugano, Switzerland
| | - Tomas Monga
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Angelo Auricchio
- Center for Computational Medicine in Cardiology, USI, via La Santa 1, 6900, Lugano, Switzerland
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, via Tesserete 64, 6900, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Giulio Conte
- Center for Computational Medicine in Cardiology, USI, via La Santa 1, 6900, Lugano, Switzerland
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, via Tesserete 64, 6900, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
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14
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Savastano S, Baldi E, Schnaubelt S, Auricchio A. Post resuscitation ST-segment elevation: When a few minutes make the difference between a class I and a class III indication for immediate coronary angiography. Resuscitation 2023; 192:109971. [PMID: 37730098 DOI: 10.1016/j.resuscitation.2023.109971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 09/22/2023]
Affiliation(s)
- Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardiac Arrest and Resuscitation Science Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardiac Arrest and Resuscitation Science Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Angelo Auricchio
- Fondazione Ticino Cuore, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland; Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
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15
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Feijen M, Beles M, Tan YZ, Cordon A, Dupont M, Treskes RW, Caputo ML, VAN Bockstal K, Auricchio A, Egorova AD, Maes E, Beeres SLMA, Heggermont WA. Fewer Worsening Heart Failure Events With HeartLogic on top of Standard Care: a Propensity-Matched Cohort Analysis. J Card Fail 2023; 29:1522-1530. [PMID: 37220824 DOI: 10.1016/j.cardfail.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND The implantable cardiac defibrillator-based HeartLogic algorithm aims to detect impending fluid retention in patients with heart failure (HF). Studies show that HeartLogic is safe to integrate into clinical practice. The current study investigates whether HeartLogic provides clinical benefit on top of standard care and device telemonitoring in patients with HF. METHODS A multicenter, retrospective, propensity-matched cohort analysis was performed in patients with HF and implantable cardiac defibrillators, and it compared HeartLogic to conventional telemonitoring. The primary endpoint was the number of worsening HF events. Hospitalizations and ambulatory visits due to HF were also evaluated. RESULTS Propensity score matching yielded 127 pairs (median age 68 years, 80% male). Worsening HF events occurred more frequently in the control group (2; IQR 0-4) compared to the HeartLogic group (1; IQR 0-3; P = 0.004). The number of HF hospitalization days was higher in controls than in the HeartLogic group (8; IQR 5-12 vs 5; IQR 2-7; P = 0.023), and ambulatory visits for diuretic escalation were more frequent in the control group than in the HeartLogic group (2; IQR 0-3 vs 1; IQR 0-2; P = 0.0001). CONCLUSION Integrating the HeartLogic algorithm in a well-equipped HF care path on top of standard care is associated with fewer worsening HF events and shorter duration of fluid retention-related hospitalizations.
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Affiliation(s)
- Michelle Feijen
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Monika Beles
- Cardiovascular Research Centre Aalst,OLV Clinic, Department of Cardiology, Aalst, Belgium
| | - Yan Zhi Tan
- Deloitte HEOR (Health-Economics and Outcome Research), Zaventem, Belgium
| | - Audrey Cordon
- Deloitte HEOR (Health-Economics and Outcome Research), Zaventem, Belgium
| | - Matthias Dupont
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Roderick W Treskes
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Maria-Luce Caputo
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Koen VAN Bockstal
- Cardiovascular Research Centre Aalst,OLV Clinic, Department of Cardiology, Aalst, Belgium
| | - Angelo Auricchio
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Anastasia D Egorova
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Edith Maes
- Cardiovascular Research Centre Aalst,OLV Clinic, Department of Cardiology, Aalst, Belgium
| | - Saskia L M A Beeres
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
| | - Ward A Heggermont
- Cardiovascular Research Centre Aalst,OLV Clinic, Department of Cardiology, Aalst, Belgium
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16
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Patel RB, Reddy VY, Komtebedde J, Wegerich SW, Sekaric J, Swarup V, Walton A, Laurent G, Chetcuti S, Rademann M, Bergmann M, McKenzie S, Bugger H, Bruno RR, Herrmann HC, Nair A, Gupta DK, Lim S, Kapadia S, Gordon R, Vanderheyden M, Noel T, Bailey S, Gertz ZM, Trochu JN, Cutlip DE, Leon MB, Solomon SD, van Veldhuisen DJ, Auricchio A, Shah SJ. Atrial Fibrillation Burden and Atrial Shunt Therapy in Heart Failure With Preserved Ejection Fraction. JACC Heart Fail 2023; 11:1351-1362. [PMID: 37480877 DOI: 10.1016/j.jchf.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is a common comorbidity in patients with heart failure with preserved ejection fraction (HFpEF) and in heart failure with mildly reduced ejection fraction (HFmrEF). OBJECTIVES This study sought to describe AF burden and its clinical impact among individuals with HFpEF and HFmrEF who participated in a randomized clinical trial of atrial shunt therapy (REDUCE LAP-HF II [A Study to Evaluate the Corvia Medical, Inc IASD System II to Reduce Elevated Left Atrial Pressure in Patients with Heart Failure]) and to evaluate the effect of atrial shunt therapy on AF burden. METHODS Study investigators characterized AF burden among patients in the REDUCE LAP-HF II trial by using ambulatory cardiac patch monitoring at baseline (median patch wear time, 6 days) and over a 12-month follow-up (median patch wear time, 125 days). The investigators determined the association of baseline AF burden with long-term clinical events and examined the effect of atrial shunt therapy on AF burden over time. RESULTS Among 367 patients with cardiac monitoring data at baseline and follow-up, 194 (53%) had a history of AF or atrial flutter (AFL), and median baseline AF burden was 0.012% (IQR: 0%-1.3%). After multivariable adjustment, baseline AF burden ≥0.012% was significantly associated with heart failure (HF) events (HR: 2.00; 95% CI: 1.17-3.44; P = 0.01) both with and without a history of AF or AFL (P for interaction = 0.68). Adjustment for left atrial reservoir strain attenuated the baseline AF burden-HF event association (HR: 1.71; 95% CI: 0.93-3.14; P = 0.08). Of the 367 patients, 141 (38%) had patch-detected AF during follow-up without a history of AF or AFL. Atrial shunt therapy did not change AF incidence or burden during follow-up. CONCLUSIONS In HFpEF and HFmrEF, nearly 40% of patients have subclinical AF by 1 year. Baseline AF burden, even at low levels, is associated with HF events. Atrial shunt therapy does not affect AF incidence or burden. (A Study to Evaluate the Corvia Medical, Inc IASD System II to Reduce Elevated Left Atrial Pressure in Patients with Heart Failure [REDUCE LAP-HF II]; NCT03088033).
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Affiliation(s)
- Ravi B Patel
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Illinois, USA
| | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | - Gabriel Laurent
- Department of Cardiology, Dijon University Hospital, Dijon, France
| | - Stanley Chetcuti
- Division of Cardiology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Matthias Rademann
- Department of Cardiology, University of Giessen, Bad Nauheim, Germany
| | - Martin Bergmann
- Department of Interventional Cardiology, Cardiologicum, Hamburg, Germany
| | - Scott McKenzie
- School of Medicine, University of Queensland, The Prince Charles Hospital, Brisbane, Australia
| | - Heiko Bugger
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Raphael Romano Bruno
- Division of Cardiology, Pulmonology, and Vascular Medicine, Faculty of Medicine, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Howard C Herrmann
- Division of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ajith Nair
- Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA
| | - Deepak K Gupta
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott Lim
- Division of Cardiology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Samir Kapadia
- Division of Cardiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert Gordon
- Division of Cardiology, NorthShore University Health System, Evanston, Illinois, USA
| | | | - Thomas Noel
- Southern Medical Group, P.A., Tallahassee, Florida, USA
| | - Steven Bailey
- Division of Cardiology, Louisiana State University School of Medicine, Baton Rouge, Louisiana, USA
| | - Zachary M Gertz
- Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Jean-Noël Trochu
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Donald E Cutlip
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Martin B Leon
- Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, New York, USA
| | - Scott D Solomon
- Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Dirk J van Veldhuisen
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Angelo Auricchio
- Division of Cardiology, Ticino Cardiocentro Institute, Lugano, Switzerland
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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17
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Guerini Giusteri V, Caputo ML, Baldi E, Auricchio A, Savastano S. Effect of COVID-19 on out-of-hospital cardiac arrest survival: No light at the end of the tunnel yet. Resuscitation 2023; 191:109957. [PMID: 37661015 DOI: 10.1016/j.resuscitation.2023.109957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023]
Affiliation(s)
| | - Maria Luce Caputo
- Department of Cardiology, Cardiocentro Ticino Institute-EOC, Lugano, Switzerland; Fondazione Ticino Cuore, Lugano, Switzerland.
| | - Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Angelo Auricchio
- Department of Cardiology, Cardiocentro Ticino Institute-EOC, Lugano, Switzerland; Fondazione Ticino Cuore, Lugano, Switzerland
| | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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18
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Atar D, Auricchio A, Blomström-Lundqvist C. Cardiac device infection: removing barriers to timely and adequate treatment. Eur Heart J 2023; 44:3323-3326. [PMID: 37529893 PMCID: PMC10499543 DOI: 10.1093/eurheartj/ehad490] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/13/2023] [Accepted: 07/19/2023] [Indexed: 08/03/2023] Open
Affiliation(s)
- Dan Atar
- Dept. of Cardiology, Oslo University Hospital Ullevaal, Kirkeveien 166, 0450 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Kirkeveien 166, Soesterhjemmet, 0450 Oslo, Norway
| | - Angelo Auricchio
- Division of Cardiology, Clinical Electrophysiology Unit, Instituto Cardiocentro Ticino, Lugano, Switzerland
| | - Carina Blomström-Lundqvist
- Department of Medical Science, Uppsala University, Uppsala, Sweden
- Department of Cardiology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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19
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Auricchio A, Hindricks G, Camm JA, Sutton R. A European journal serving the world electrophysiological community: 25 years of EP Europace journal. Europace 2023; 25:euad207. [PMID: 37622572 PMCID: PMC10450794 DOI: 10.1093/europace/euad207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Affiliation(s)
- Angelo Auricchio
- Division of Cardiology, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Via Tesserete 48, CH-6900 Lugano, Switzerland
| | - Gerhard Hindricks
- Deutsches Herzzentrum der Charité (DHZC), Department of Cardiology, Angiology and Intensive Care Medicine, Charitéplatz 1, D-10117 Berlin, Germany
- Department of Cardiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, D-10117 Berlin, Germany
- Department of Cardiology, German Centre for Cardiovascular Research (DZHK), Partner Site, Berlin
| | - John A Camm
- Department of Cardiology, Cardiology Clinical Academic Group, Molecular & Clinical Sciences Institute, St. George’s University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Richard Sutton
- Department of Cardiology, Hammersmith Hospital, National Heart & Lung Institute, Imperial College, Du Cane Road, London W12 0HS, UK
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20
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Ellenbogen KA, Auricchio A, Burri H, Gold MR, Leclercq C, Leyva F, Linde C, Jastrzebski M, Prinzen F, Vernooy K. The evolving state of cardiac resynchronization therapy and conduction system pacing: 25 years of research at EP Europace journal. Europace 2023; 25:euad168. [PMID: 37622580 PMCID: PMC10450796 DOI: 10.1093/europace/euad168] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 08/26/2023] Open
Abstract
Cardiac resynchronization therapy (CRT) was proposed in the 1990s as a new therapy for patients with heart failure and wide QRS with depressed left ventricular ejection fraction despite optimal medical treatment. This review is aimed first to describe the rationale and the physiologic effects of CRT. The journey of the landmark randomized trials leading to the adoption of CRT in the guidelines since 2005 is also reported showing the high level of evidence for CRT. Different alternative pacing modalities of CRT to conventional left ventricular pacing through the coronary sinus have been proposed to increase the response rate to CRT such as multisite pacing and endocardial pacing. A new emerging alternative technique to conventional biventricular pacing, conduction system pacing (CSP), is a promising therapy. The different modalities of CSP are described (Hirs pacing and left bundle branch area pacing). This new technique has to be evaluated in clinical randomized trials before implementation in the guidelines with a high level of evidence.
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Affiliation(s)
- Kenneth A Ellenbogen
- Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Angelo Auricchio
- Division of Cardiology, Università della Svizzera Italiana and Istituto Cardiocentro Ticino, Lugano, Switzerland
| | - Haran Burri
- Cardiac Pacing Unit, Cardiology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Michael R Gold
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | | | - Francisco Leyva
- Aston University, Birmingham NHS Trust at Queen Elizabeth Hospital, Birmingham, UK
| | - Cecilia Linde
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Marek Jastrzebski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
| | - Frits Prinzen
- Physiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC), Maastricht, the Netherlands
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21
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Haeberlin A, Noti F, Breitenstein A, Auricchio A, Reichlin T, Conte G, Klersy C, Curti M, Pruvot E, Domenichini G, Schaer B, Kühne M, Gruszczynski M, Burri H, Kobza R, Grebmer C, Regoli FD. Transvenous Lead Extraction during Cardiac Implantable Device Upgrade: Results from the Multicenter Swiss Lead Extraction Registry. J Clin Med 2023; 12:5175. [PMID: 37629216 PMCID: PMC10455660 DOI: 10.3390/jcm12165175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Device patients may require upgrade interventions from simpler to more complex cardiac implantable electronic devices. Prior to upgrading interventions, clinicians need to balance the risks and benefits of transvenous lead extraction (TLE), additional lead implantation or lead abandonment. However, evidence on procedural outcomes of TLE at the time of device upgrade is scarce. METHODS This is a post hoc analysis of the investigator-initiated multicenter Swiss TLE registry. The objectives were to assess patient and procedural factors influencing TLE outcomes at the time of device upgrades. RESULTS 941 patients were included, whereof 83 (8.8%) had TLE due to a device upgrade. Rotational mechanical sheaths were more often used in upgraded patients (59% vs. 42.7%, p = 0.015) and total median procedure time was longer in these patients (160 min vs. 105 min, p < 0.001). Clinical success rates of upgraded patients compared to those who received TLE due to other reasons were not different (97.6% vs. 93.0%, p = 0.569). Moreover, multivariable analysis showed that upgrade procedures were not associated with a greater risk for complications (HR 0.48, 95% confidence interval 0.14-1.57, p = 0.224; intraprocedural complication rate of upgraded patients 7.2% vs. 5.5%). Intraprocedural complications of upgraded patients were mostly associated with the implantation and not the extraction procedure (67% vs. 33% of complications). CONCLUSIONS TLE during device upgrade is effective and does not attribute a disproportionate risk to the upgrade procedure.
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Affiliation(s)
- Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3015 Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3015 Bern, Switzerland
| | | | - Angelo Auricchio
- Cardiology Department, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3015 Bern, Switzerland
| | - Giulio Conte
- Cardiology Department, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
| | - Catherine Klersy
- Biostatistics and Clinical Trial Center, Fondazione IRCCS San Matteo di Pavia, 27100 Pavia, Italy
| | - Moreno Curti
- Biostatistics and Clinical Trial Center, Fondazione IRCCS San Matteo di Pavia, 27100 Pavia, Italy
| | - Etienne Pruvot
- Department of Cardiology, CHUV, 1011 Lausanne, Switzerland
| | | | - Beat Schaer
- Department of Cardiology, University Hospital of Basel, 4002 Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital of Basel, 4002 Basel, Switzerland
| | | | - Haran Burri
- Department of Cardiology, HUG, 1205 Geneva, Switzerland
| | - Richard Kobza
- Department of Cardiology, Luzerner Kantonsspital, 6004 Luzern, Switzerland
| | - Christian Grebmer
- Department of Cardiology, Luzerner Kantonsspital, 6004 Luzern, Switzerland
| | - François D. Regoli
- Cardiology Department, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
- Department of Cardiology Service, San Giovanni Hospital, Cardiocentro Ticino Institute, 6500 Bellinzona, Switzerland
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22
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Boriani G, Auricchio A, Botto GL, Joseph JM, Roberts GJ, Grammatico A, Nabutovsky Y, Piccini JP. Insertable cardiac monitoring results in higher rates of atrial fibrillation diagnosis and oral anticoagulation prescription after ischaemic stroke. Europace 2023; 25:euad212. [PMID: 37490349 PMCID: PMC10403249 DOI: 10.1093/europace/euad212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/20/2023] [Indexed: 07/27/2023] Open
Abstract
AIMS After an ischaemic stroke, atrial fibrillation (AF) detection allows for improved secondary prevention strategies. This study aimed to compare AF detection and oral anticoagulant (OAC) initiation in patients with an insertable cardiac monitor (ICM) vs. external cardiac monitor (ECM) after ischaemic stroke. METHODS AND RESULTS Medicare Fee-for-Service (FFS) insurance claims and Abbott Labs device registration data were used to identify patients hospitalized with an ischaemic stroke in 2017-2019 who received an ICM or ECM within 3 months. Patients with continuous Medicare FFS insurance and prescription drug enrolment in the prior year were included. Patients with prior AF, atrial flutter, cardiac devices, or OAC were excluded. Insertable cardiac monitor and ECM patients were propensity score matched 1:4 on demographics, comorbidities, and stroke hospitalization characteristics. The outcomes of interest were AF detection and OAC initiation evaluated with Kaplan-Meier and Cox proportional hazard regression analyses. A total of 5702 Medicare beneficiaries (ICM, n = 444; ECM, n = 5258) met inclusion criteria. The matched cohort consisted of 2210 Medicare beneficiaries (ICM, n = 442; ECM, n = 1768) with 53% female, mean age 75 years, and mean CHA₂DS₂-VASc score 4.6 (1.6). Insertable cardiac monitor use was associated with a higher probability of AF detection [(hazard ratio (HR) 2.88, 95% confidence interval (CI) (2.31, 3.59)] and OAC initiation [HR 2.91, CI (2.28, 3.72)] compared to patients monitored only with ECM. CONCLUSION Patients with an ischaemic stroke monitored with an ICM were almost three times more likely to be diagnosed with AF and to be prescribed OAC compared to patients who received ECM only.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo, 71, Modena 41124, Italy
| | - Angelo Auricchio
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Giovanni Luca Botto
- Department of Cardiology—Electrophysiology, ASST Rhodense, Civile Hospital Rho and Salvini Hospital Garbagnate Milanese Hospital, Milan, Italy
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23
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Pannone L, Gauthey A, Conte G, Osei R, Campanale D, Baldi E, Berne P, Vicentini A, Vergara P, Sorgente A, Rootwelt-Norberg C, Della Rocca DG, Monaco C, Bisignani A, Miraglia V, Spolverini M, Paparella G, Overeinder I, Bala G, Almorad A, Ströker E, de Ravel T, Medeiros-Domingo A, Sieira J, Haugaa KH, Brugada P, La Meir M, Auricchio A, Chierchia GB, Van Dooren S, de Asmundis C. Genetics in Probands With Idiopathic Ventricular Fibrillation: A Multicenter Study. JACC Clin Electrophysiol 2023; 9:1296-1306. [PMID: 37227348 DOI: 10.1016/j.jacep.2023.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/07/2023] [Accepted: 03/15/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Different genes have been associated with idiopathic ventricular fibrillation (IVF); however, there are no studies correlating genotype with phenotype. OBJECTIVES The aim of this study was to define the genetic background of probands with IVF using large gene panel analysis and to correlate genetics with long-term clinical outcomes. METHODS All consecutive probands with a diagnosis of IVF were included in a multicenter retrospective study. All patients had: 1) IVF diagnosis throughout the follow-up; and 2) genetic analysis with a broad gene panel. All genetic variants were classified as pathogenic/likely pathogenic (P+), variants of unknown significance (VUS) or no variants (NO-V), following current guidelines of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology. The primary endpoint was occurrence of ventricular arrhythmias (VA). RESULTS Forty-five consecutive patients were included. A variant was found in 12 patients, 3 P+ and 9 VUS carriers. After a mean follow-up time of 105.0 months, there were no deaths and 16 patients (35.6%) experienced a VA. NO-V patients had higher VA free survival during the follow-up, compared with both VUS (72.7% vs 55.6%, log-rank P < 0.001) and P+ (72.7% vs 0%, log-rank P = 0.013). At Cox analysis, P+ or VUS carrier status was a predictor of VA occurrence. CONCLUSIONS In probands with IVF, undergoing genetic analysis with a broad panel, the diagnostic yield for P+ is 6.7%. P+ or VUS carrier status is a predictor of VA occurrence.
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Affiliation(s)
- Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Anaïs Gauthey
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Giulio Conte
- Division of Cardiology, Istituto Cardiocentro Ticino, Ente Cantonale Ospedaliero, Lugano, Switzerland
| | - Randy Osei
- Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Clinical Sciences, Research Group Reproduction and Genetics, Centre for Medical Genetics, Brussels, Belgium
| | - Daniela Campanale
- Division of Cardiology, Istituto Cardiocentro Ticino, Ente Cantonale Ospedaliero, Lugano, Switzerland
| | - Enrico Baldi
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy; Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paola Berne
- Department of Cardiology, Ospedale Santissima Annunziata, University of Sassari, Sassari, Italy
| | - Alessandro Vicentini
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy; Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Pasquale Vergara
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Antonio Sorgente
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Christine Rootwelt-Norberg
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; University of Oslo, Oslo, Norway
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Cinzia Monaco
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Antonio Bisignani
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Vincenzo Miraglia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Marcello Spolverini
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy; Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gaetano Paparella
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Ingrid Overeinder
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Gezim Bala
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Alexandre Almorad
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Thomy de Ravel
- Centre for Medical Genetics Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium, and European Reference Networks Guard-Heart, Brussels, Belgium
| | | | - Juan Sieira
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Kristina H Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; University of Oslo, Oslo, Norway
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Mark La Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Angelo Auricchio
- Division of Cardiology, Istituto Cardiocentro Ticino, Ente Cantonale Ospedaliero, Lugano, Switzerland
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Sonia Van Dooren
- Centre for Medical Genetics Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium, and European Reference Networks Guard-Heart, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium.
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Hofer D, Regoli F, Saguner AM, Conte G, Jelisejevas J, Luce Caputo M, Graup V, Grazioli Gauthier L, Gasperetti A, Steffel J, Auricchio A, Breitenstein A. Efficacy and Safety of Leadless Pacemaker Implantation in Octogenarians. Cardiology 2023; 148:441-447. [PMID: 37487479 DOI: 10.1159/000532075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 07/04/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION Long-term complication rates in standard transvenous pacemakers are reported around 4-12% with a higher incidence in the elderly population. We report our experience in octogenarians undergoing leadless pacemaker implantation in two large-volume centers in Switzerland. METHODS Consecutive patients undergoing leadless pacemaker implantation at two Swiss large volume centers (University Hospital Zurich, Zurich and Cardiocentro Ticino Institute, Lugano) between October 2015 and March 2020 were included in this retrospective analysis. Demographic information, clinical data, and procedural characteristics were recorded at the day of implantation and during follow-up. RESULTS Two hundred and twenty patients (mean age 80.6 ± 7.7 years, male 66%) were included. The main indication for pacemaker implantation was slow ventricular rate atrial fibrillation (111 of 220 patients, 50.4%). Out of the 220 patients, 124 (56.3%) were ≥80 years. Overall successful implantation rate was 98.6%. In the octogenarian population, the median procedure time (45 ± 20.2 min vs. 40 ± 19.6 min, p = 0.03) and radiation duration (6.1 ± 8.2 min vs. 5.0 ± 7.2 min, p = 0.03) were longer compared to patients <80 years. Major complications (2.7%, n = 6) and device measurements during follow-up were similar between patients ≥80 and <80 years. CONCLUSION Implantation of a leadless pacemaker device in octogenarians is safe and effective with a similarly low complication rate compared to non-octogenarians.
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Affiliation(s)
- Daniel Hofer
- Electrophysiology, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - François Regoli
- Cardiocentro Ticino Institute, Lugano, Switzerland
- Cardiology, San Giovanni Hospital, Bellinzona, Switzerland
| | - Ardan M Saguner
- Electrophysiology, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Giulio Conte
- Cardiocentro Ticino Institute, Lugano, Switzerland
| | - Julius Jelisejevas
- Electrophysiology, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Vera Graup
- Department of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Alessio Gasperetti
- Electrophysiology, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Jan Steffel
- Electrophysiology, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Alexander Breitenstein
- Electrophysiology, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
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Regoli FD, Saguner AM, Auricchio A, Demarchi A, Pasotti E, Conte G, Caputo ML, Özkartal T, Breitenstein A. Peri-Procedural Management of Direct-Acting Oral Anticoagulants (DOACs) in Transcatheter Miniaturized Leadless Pacemaker Implantation. J Clin Med 2023; 12:4814. [PMID: 37510929 PMCID: PMC10381618 DOI: 10.3390/jcm12144814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/07/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION Data on peri-operative management of direct-acting oral anticoagulants (DOACs) during transcatheter pacing leadless system (TPS) implantations remain limited. This study aimed to evaluate a standardized DOAC management regime consisting of interruption of a single dose prior to implantation and reinitiation within 6-24 h; also, patient clinical characteristics associated with this approach were identified. METHOD Consecutive patients undergoing standard TPS implantation procedures from two Swiss tertiary centers were included. DOAC peri-operative management included the standardized approach (Group 1A) or other approaches (Group 1B). RESULTS Three hundred and ninety-two pts (mean age 81.4 ± 7.3 years, 66.3% male, left ventricular ejection fraction 55.5 ± 9.6%) underwent TPS implantation. Two hundred and eighty-two pts (71.9%) were under anticoagulation therapy; 192 pts were treated with DOAC; 90 pts were under vitamin-K antagonist. Patients treated with DOAC less often had structural heart disease, diabetes mellitus, and advanced renal failure. The rate of major peri-procedural complications did not differ between groups 1A (n = 115) and 1B (n = 77) (2.6% and 3.8%, p = 0.685). Compared to 1B, 1A patients were implanted with TPS for slow ventricular rate atrial fibrillation (AF) (p = 0.002), in a better overall clinical status, and implanted electively (<0.001). CONCLUSIONS Standardized peri-procedural DOAC management was more often implemented for elective TPS procedures and did not seem to increase bleeding or thromboembolic adverse events.
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Affiliation(s)
- François Diederik Regoli
- Service of Cardiology, Hospital of San Giovanni, Cardiocentro Ticino Institute, 6500 Bellinzona, Switzerland
- Cardiology Department, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
| | - Ardan M Saguner
- University Heart Center Zurich, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Angelo Auricchio
- Cardiology Department, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
| | - Andrea Demarchi
- Cardiology Department, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
| | - Elena Pasotti
- Cardiology Department, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
| | - Giulio Conte
- Cardiology Department, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
| | - Maria Luce Caputo
- Cardiology Department, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
| | - Tardu Özkartal
- Cardiology Department, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
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Jonsson M, Berglund E, Baldi E, Caputo ML, Auricchio A, Blom MT, Tan HL, Stieglis R, Andelius L, Folke F, Hollenberg J, Svensson L, Ringh M. Dispatch of Volunteer Responders to Out-of-Hospital Cardiac Arrests. J Am Coll Cardiol 2023; 82:200-210. [PMID: 37438006 DOI: 10.1016/j.jacc.2023.05.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/26/2023] [Accepted: 05/05/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Systems for dispatch of volunteer responders to collect automated external defibrillators and/or to provide cardiopulmonary resuscitation (CPR) in cases of nearby out-of-hospital cardiac arrest (OHCA) are widely implemented. OBJECTIVES This study aimed to investigate whether the activation of a volunteer responder system to OHCAs was associated with higher rates of bystander CPR, bystander defibrillation, and 30-day survival vs no system activation. METHODS This was a retrospective observational analysis within the ESCAPE-NET (European Sudden Cardiac Arrest network: Towards Prevention, Education, New Effective Treatment) collaborative research network. Included were cases of OHCA between 2015 and 2019 from 5 European sites with volunteer responder systems. At all sites, systems were activated by dispatchers at the emergency medical communication center in response to suspected OHCA. Exposed cases (system activation) were compared with nonexposed cases (no system activation). Risk ratios (RRs) were calculated for the outcomes of bystander CPR, bystander defibrillation, and 30-day survival after inverse probability treatment weighting. Missing data were handled using multiple imputation. RESULTS In total, 9,553 cases were included. In 4,696 cases, the volunteer responder system was activated, and in 4,857 it was not. The pooled RRs were 1.30 (95% CI: 1.15-1.47) for bystander CPR, 1.89 (95% CI: 1.36-2.63) for bystander defibrillation, and 1.22 (95% CI: 1.07-1.39) for 30-day survival. CONCLUSIONS Activation of a volunteer response system in cases of OHCA was associated with a higher chance of bystander CPR, bystander defibrillation, and 30-day survival vs no system activation. A randomized controlled trial is necessary to determine fully the causal effect of volunteer responder systems.
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Affiliation(s)
- Martin Jonsson
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden.
| | - Ellinor Berglund
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Enrico Baldi
- Section of Cardiology, Department of Molecular Medicine, University of Pavia, Pavia, Italy; Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, San Matteo Foundation Institute for Research, Hospitalization and Health Care, Pavia, Italy
| | - Maria Luce Caputo
- Division of Cardiology, Ticino Cardiocentro Institute, Cantonal Hospital Group, Lugano, Switzerland
| | - Angelo Auricchio
- Division of Cardiology, Ticino Cardiocentro Institute, Cantonal Hospital Group, Lugano, Switzerland
| | - Marieke T Blom
- Department of Cardiology, Heart Center, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Free University of Amsterdam, Amsterdam, the Netherlands
| | - Hanno L Tan
- Department of Cardiology, Heart Center, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Remy Stieglis
- Department of Cardiology, Heart Center, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Linn Andelius
- Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark
| | - Fredrik Folke
- Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Hollenberg
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Leif Svensson
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Mattias Ringh
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
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Metelmann B, Elschenbroich D, Auricchio A, Baldi E, Beckers SK, Burkart R, Fredman D, Ganter J, Krammel M, Marks T, Metelmann C, Müller MP, Scquizzato T, Stieglis R, Strickmann B, Christian Thies K. Proposal to increase safety of first responders dispatched to cardiac arrest. Resusc Plus 2023; 14:100395. [PMID: 37215185 PMCID: PMC10199241 DOI: 10.1016/j.resplu.2023.100395] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Affiliation(s)
- Bibiana Metelmann
- Department of Anaesthesiology, University Medicine Greifswald, Germany
| | - Daniel Elschenbroich
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany
| | | | - Angelo Auricchio
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Fondazione Ticino Cuore, Breganzona, Switzerland
| | - Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefan K. Beckers
- Fire Department & Emergency Medical Service, City of Aachen, Aachen, Germany
- Aachen Institute for Rescue Management & Public Safety, University Hospital RWTH Aachen University & City of Aachen, Aachen, Germany
| | - Roman Burkart
- Swiss Resuscitation Council, Bern, Switzerland
- Interverband für Rettungswesen, Aarau, Switzerland
| | - David Fredman
- Karolinska Institutet, Stockholm, Sweden
- Heartrunner Citizen Responder System, Heartrunner Sweden AB, Solna, Sweden
| | - Julian Ganter
- Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine, University Hospital of Freiburg, University of Freiburg, Freiburg, Germany
| | - Mario Krammel
- Emergency Medical Service Vienna, Vienna, Austria
- PULS Austrian Cardiac Arrest Awareness Association, Vienna, Austria
| | - Tore Marks
- Department of Anaesthesiology, University Medicine Greifswald, Germany
| | - Camilla Metelmann
- Department of Anaesthesiology, Intensive Care and Emergency Medicine, St. Josef’s Hospital, Freiburg im Breisgau, Germany
| | - Michael P Müller
- Department of Anaesthesiology, Intensive Care and Emergency Medicine, St. Josef’s Hospital, Freiburg im Breisgau, Germany
| | - Tommaso Scquizzato
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Remy Stieglis
- Amsterdam University Medical Center, Location AMC, Department of Cardiology, Amsterdam, the Netherlands
| | - Bernd Strickmann
- Emergency Medical Service, City and District of Gütersloh, Gütersloh, Germany
| | - Karl Christian Thies
- Klinik für Anaesthesiologie, EvKB, Universitätsklinikum OWL der Universitaet Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany
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Baldi E, D'Alto A, Benvenuti C, Caputo ML, Cresta R, Cianella R, Auricchio A. Perceived threats and challenges experienced by first responders during their mission for an out-of-hospital cardiac arrest. Resusc Plus 2023; 14:100403. [PMID: 37287957 PMCID: PMC10242624 DOI: 10.1016/j.resplu.2023.100403] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/04/2023] [Accepted: 05/16/2023] [Indexed: 06/09/2023] Open
Abstract
Aim No study has systematically captured the perceived threat, discomfort or issues experienced by First Responders (FRs). We aimed to report the FRs' experience during a mission for an out-of-hospital cardiac arrest (OHCA) in a ten-year span. Methods We collected all the 40-items questionnaires filled out by the FRs dispatched in Ticino Region (Switzerland) from 01/10/2010 to 31/12/2020. We compared results between FRs alerted by SMS or APP and between professional and citizen FRs. Results 3391 FRs filled the questionnaire. The OHCA information was considered complete more frequently by FRs alerted by APP (85.6% vs 76.8%, p < 0.001), but a challenge in reaching the location was more frequent (15.5% vs 11.4%, p < 0.001), mainly due to wrong GPS coordinate. The FRs initiated/participated in resuscitation in 64.6% and used an AED in 31.9% of OHCAs, without issue in 97.9%. FRs reported a very high-level of satisfaction (97%) in EMS collaboration, but one-third didn't have the possibility to debrief. Citizen FRs used AED more frequently than professional FRs (34.6% vs 30.7%, p < 0.01), but experienced more often difficulties in performing CPR (2.6% vs 1.2%, p = 0.02) and wore more in need to debrief (19.7% vs 13%, p < 0.01). Conclusions We provide a unique picture from the FRs' point of view during a real-life OHCA reporting high-level of satisfaction, great motivation but also the need of systematic debrief. We identified areas of improvements including geolocation accuracy, further training on AED use and support program dedicated to citizen FRs.
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Affiliation(s)
- Enrico Baldi
- Fondazione Ticino Cuore, Breganzona, Switzerland
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessia D'Alto
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | | | - Maria Luce Caputo
- Fondazione Ticino Cuore, Breganzona, Switzerland
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Ruggero Cresta
- Fondazione Ticino Cuore, Breganzona, Switzerland
- Federazione Cantonale Ticinese Servizi Autoambulanze, Lugano, Switzerland
| | - Roberto Cianella
- Federazione Cantonale Ticinese Servizi Autoambulanze, Lugano, Switzerland
| | - Angelo Auricchio
- Fondazione Ticino Cuore, Breganzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
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Arnold M, Richards M, D’Onofrio A, Faulknier B, Gulizia M, Thakur R, Sakata Y, Lin W, Pollastrelli A, Grammatico A, Auricchio A, Boriani G. Avoiding unnecessary ventricular pacing is associated with reduced incidence of heart failure hospitalizations and persistent atrial fibrillation in pacemaker patients. Europace 2023; 25:euad065. [PMID: 36942949 PMCID: PMC10227662 DOI: 10.1093/europace/euad065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/11/2023] [Indexed: 03/23/2023] Open
Abstract
AIMS In bradycardia patients treated with dual-chamber pacing, we aimed to evaluate whether pacing with atrioventricular (AV) delay management [AV hysteresis (AVH)], compared with standard pacing with fixed AV delays, reduces unnecessary ventricular pacing percentage (VPP) and is associated with better clinical outcomes. Main study endpoints were the incidence of heart failure hospitalizations (HFH), persistent atrial fibrillation (AF), and cardiac death. METHODS AND RESULTS Data from two identical prospective observational studies, BRADYCARE I in the USA and BRADYCARE II in Europe, Africa, and Asia, were pooled. Overall, 2592 patients (75 ± 10 years, 45.1% female, 50% with AVH) had complete clinical and device data at 1-year follow-up and were analysed. Primary pacing indication was sinus node disease (SND) in 1177 (45.4%), AV block (AVB) in 974 (37.6%), and other indications in 441 (17.0%) patients. Pacing with AVH, compared with standard pacing, was associated with a lower 1-year incidence of HFH [1.3% vs. 3.1%, relative risk reduction (RRR) 57.5%, P = 0.002] and of persistent AF (5.3% vs. 7.7%, RRR = 31.1%, P = 0.028). Cardiac mortality was not different between groups (1.0% vs. 1.4%, RRR = 27.8%, P = 0.366). Pacing with AVH, compared with standard pacing, was associated with a lower (P < 0.001) median VPP in all patients (7% vs. 75%), in SND (3% vs. 44%), in AVB (25% vs. 98%), and in patients with other pacing indications (3% vs. 47%). CONCLUSION Cardiac pacing with AV delay management via AVH is associated with reduced 1-year incidence of HFH and persistent AF, most likely due to a reduction in VPP compared to standard pacing.
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Affiliation(s)
- Martin Arnold
- Cardiology Department, Friedrich-Alexander-Universität, Erlangen, Germany
| | - Mark Richards
- Cardiology Department, Yakima Heart and Vascular, Yakima, WA, USA
| | - Antonio D’Onofrio
- Cardiology Department, UOSD di Elettrofisiologia, Studio e Terapia delle Aritmie A.O.R.N. ‘Ospedali dei Colli’ Osp Monaldi, Napoli, Italy
| | | | - Michele Gulizia
- Cardiology Department, Azienda Ospedaliera Garibaldi Nesima, Catania, Italy
| | - Ranjan Thakur
- Cardiology Department, Thoracic Cardio Healthcare Foundation, Lansing, MI, USA
| | - Yasushi Sakata
- Cardiology Department, Osaka University Hospital, Osaka, Japan
| | | | | | | | - Angelo Auricchio
- Clinical Electrophysiology Unit, Cardiocentro Ticino Institute, Lugano, Switzerland
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena University Hospital, Via del Pozzo, 71, Modena 41124, Italy
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30
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Gold MR, Ellenbogen K, Leclercq C, Lowy J, Rials S, Shoda M, Tomassoni G, Issa Z, Sarrazin JF, Jennings J, Nair D, Wold N, Yong P, Harbin MM, Stein KM, Auricchio A. Effects of Atrioventricular Optimization on Left Ventricular Reverse Remodeling With Cardiac Resynchronization Therapy: Results of the SMART-CRT Trial. Circ Arrhythm Electrophysiol 2023:e011714. [PMID: 37183700 DOI: 10.1161/circep.122.011714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND The role of atrioventricular optimization (AVO) to improve cardiac resynchronization therapy outcomes remains controversial. Previous post hoc analyses of a multicenter trial showed that measures of electrical dyssynchrony (right ventricular-left ventricular [LV] or QLV durations) are associated with patients who benefit from AVO. METHODS This was a global, multicenter, prospective, randomized trial of de novo cardiac resynchronization therapy implant patients with an right ventricular-LV duration ≥70 ms to determine whether AVO results in greater reverse remodeling. Patients were randomized 1:1 for either an AVO algorithm (SmartDelay) that determines atrioventricular delay and pacing chamber, biventricular or LV only, or a fixed atrioventricular delay of 120 ms with biventricular pacing. Paired echocardiograms performed at baseline and 6 months were evaluated. The primary end point was echocardiographic cardiac resynchronization therapy response, defined dichotomously as a >15% reduction in LV end-systolic volume. RESULTS A total of 310 patients (n=120 women) were randomized and had completed 6 months of follow-up. The echocardiographic cardiac resynchronization therapy response rate did not statistically differ between the groups (SmartDelay, 74.8%; fixed, 67.7%; P=0.17). Analyses of prespecified secondary end points demonstrated significant improvements in the absolute (median: SmartDelay, -41.0 mL; fixed, -33.0 mL; P=0.01) and relative change in LV end-systolic volume (SmartDelay, -38.3%; fixed, -27.8%; P=0.03) for patients with SmartDelay optimization. Similar results were observed for the relative improvement in LV ejection fraction (SmartDelay, 46.7%; fixed, 32.1%; P=0.050); absolute improvement in LV ejection fraction trended to be higher with SmartDelay (P=0.06). CONCLUSIONS Analysis of reverse remodeling parameters demonstrated that AVO via SmartDelay, relative to the nonoptimized fixed atrioventricular delay comparator group, improved absolute and relative changes in LV function in patients with longer right ventricular-LV duration. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03089281.
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Affiliation(s)
- Michael R Gold
- Medical University of South Carolina, Charleston (M.R.G.)
| | | | | | | | - Seth Rials
- Ohio Health Research and Innovation Institute, Riverside Methodist Hospital, Gahanna (S.R., M.S.)
- Tokyo Women's Medical University, Japan (S.R., M.S.)
| | - Morio Shoda
- Ohio Health Research and Innovation Institute, Riverside Methodist Hospital, Gahanna (S.R., M.S.)
- Tokyo Women's Medical University, Japan (S.R., M.S.)
| | | | - Ziad Issa
- St. John's Hospital Prairie Heart Institute, Springfield, IL (Z.I.)
| | | | | | - Devi Nair
- St. Bernards Medical Center, Jonesboro, AR (D.N.)
| | - Nicholas Wold
- Boston Scientific Corporation, Saint Paul, MN (N.W., P.Y., M.M.H., K.M.S.)
| | - Patrick Yong
- Boston Scientific Corporation, Saint Paul, MN (N.W., P.Y., M.M.H., K.M.S.)
| | - Michelle M Harbin
- Boston Scientific Corporation, Saint Paul, MN (N.W., P.Y., M.M.H., K.M.S.)
| | - Kenneth M Stein
- Boston Scientific Corporation, Saint Paul, MN (N.W., P.Y., M.M.H., K.M.S.)
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Gentile FR, Baldi E, Klersy C, Schnaubelt S, Caputo ML, Clodi C, Bruno J, Compagnoni S, Fasolino A, Benvenuti C, Domanovits H, Burkart R, Primi R, Ruzicka G, Holzer M, Auricchio A, Savastano S. Association Between Postresuscitation 12-Lead ECG Features and Early Mortality After Out-of-Hospital Cardiac Arrest: A Post Hoc Subanalysis of the PEACE Study. J Am Heart Assoc 2023; 12:e027923. [PMID: 37183852 DOI: 10.1161/jaha.122.027923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Background Once the return of spontaneous circulation after out-of-hospital cardiac arrest is achieved, a 12-lead ECG is strongly recommended to identify candidates for urgent coronary angiography. ECG has no apparent role in mortality risk stratification. We aimed to assess whether ECG features could be associated with 30-day survival in patients with out-of-hospital cardiac arrest. Methods and Results All the post-return of spontaneous circulation ECGs from January 2015 to December 2018 in 3 European centers (Pavia, Lugano, and Vienna) were collected. Prehospital data were collected according to the Utstein style. A total of 370 ECGs were collected: 287 men (77.6%) with a median age of 62 years (interquartile range, 53-70 years). After correction for the return of spontaneous circulation-to-ECG time, age >62 years (hazard ratio [HR], 1.78 [95% CI, 1.21-2.61]; P=0.003), female sex (HR, 1.5 [95% CI, 1.05-2.13]; P=0.025), QRS wider than 120 ms (HR, 1.64 [95% CI, 1.43-1.87]; P<0.001), the presence of a Brugada pattern (HR, 1.49 [95% CI, 1.39-1.59]; P<0.001), and the presence of ST-segment elevation in >1 segment (HR, 1.75 [95% CI, 1.59-1.93]; P<0.001) were independently associated with 30-day mortality. A score ranging from 0 to 26 was created, and by dividing the population into 3 tertiles, 3 classes of risk were found with significantly different survival rate at 30 days (score 0-4, 73%; score 5-7, 66%; score 8-26, 45%). Conclusions The post-return of spontaneous circulation ECG can identify patients who are at high risk of mortality after out-of-hospital cardiac arrest earlier than other forms of prognostication. This provides important risk stratification possibilities in postcardiac arrest care that could help to direct treatments and improve outcomes in patients with out-of-hospital cardiac arrest.
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Affiliation(s)
- Francesca Romana Gentile
- Department of Molecular Medicine, Section of Cardiology University of Pavia Pavia Italy
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Enrico Baldi
- Department of Molecular Medicine, Section of Cardiology University of Pavia Pavia Italy
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Catherine Klersy
- Clinical Epidemiology and Biometry Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | | | | | - Christian Clodi
- Department of Emergency Medicine Medical University of Vienna Wien Austria
| | | | - Sara Compagnoni
- Department of Molecular Medicine, Section of Cardiology University of Pavia Pavia Italy
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Alessandro Fasolino
- Department of Molecular Medicine, Section of Cardiology University of Pavia Pavia Italy
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | | | - Hans Domanovits
- Clinical Epidemiology and Biometry Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | | | - Roberto Primi
- Division of Cardiology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Gerhard Ruzicka
- Department of Emergency Medicine Medical University of Vienna Wien Austria
| | - Michael Holzer
- Department of Emergency Medicine Medical University of Vienna Wien Austria
| | | | - Simone Savastano
- Division of Cardiology Fondazione IRCCS Policlinico San Matteo Pavia Italy
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32
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Varma N, Parreira L, Tsyganov A, Artyukhina E, Vernooy K, Tondo C, Ascione C, Carvalho S, Egger M, Holm M, Shapieva A, van Stipdonk A, Taymasova I, Zubarev S, Auricchio A. Activation time at left ventricular pacing site (QLV) relative to actual site of latest activation - implications for response to cardiac resynchronization therapy. Heart Rhythm 2023:S1547-5271(23)02176-8. [PMID: 37116633 DOI: 10.1016/j.hrthm.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 04/30/2023]
Affiliation(s)
- Niraj Varma
- Department of Cardiovascular Medicine, Cleveland Clinic, USA.
| | | | - Alexey Tsyganov
- I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation; Petrovsky National Research Centre of Surgery, Moscow, Russian Federation
| | - Elena Artyukhina
- A.V. Vishnevsky National Medical Research Center of Surgery, Moscow, Russian Federation
| | - Kevin Vernooy
- Department of Cardiology, Medical University Center, Maastricht, The Netherlands
| | - Claudio Tondo
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Ciro Ascione
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | | | - Magnus Holm
- EP Solutions SA, Yverdon-les-Bains, Switzerland
| | - Albina Shapieva
- Petrovsky National Research Centre of Surgery, Moscow, Russian Federation
| | | | - Irina Taymasova
- A.V. Vishnevsky National Medical Research Center of Surgery, Moscow, Russian Federation
| | - Stepan Zubarev
- Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation
| | - Angelo Auricchio
- Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
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33
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Pavon AG, Ceriani L, Raditchkova M, Leo LA, Pedrazzini G, Auricchio A, Caporali E. What is this image? 2023 image 5 result: Role of 18-Fluorodeoxyglucose positron emission tomography and computed tomography in cardiac implanted electronic device infection. J Nucl Cardiol 2023; 30:480-483. [PMID: 36972001 DOI: 10.1007/s12350-023-03228-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Affiliation(s)
- Anna Giulia Pavon
- Cardiovascular Department, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, 6900, Lugano, Switzerland
| | - Luca Ceriani
- Clinic of Nuclear Medicine and PET-CT Centre, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6900, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, 6900, Lugano, Switzerland
| | - Mariana Raditchkova
- Clinic of Nuclear Medicine and PET-CT Centre, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6900, Lugano, Switzerland
| | - Laura Anna Leo
- Cardiovascular Department, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, 6900, Lugano, Switzerland
| | - Giovanni Pedrazzini
- Cardiovascular Department, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, 6900, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, 6900, Lugano, Switzerland
| | - Angelo Auricchio
- Cardiovascular Department, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, 6900, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, 6900, Lugano, Switzerland
| | - Elena Caporali
- Cardiovascular Department, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, 6900, Lugano, Switzerland.
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34
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Sterns LD, Auricchio A, Schloss EJ, Lexcen D, Jacobsen L, DeGroot P, Molan A, Kurita T. Reply to the Editor-Programming more ATP sequences is not a case of no harm, no foul. Heart Rhythm 2023; 20:479-480. [PMID: 36509318 DOI: 10.1016/j.hrthm.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Laurence D Sterns
- Vancouver Island Arrhythmia Clinic, Victoria, British Columbia, Canada.
| | - Angelo Auricchio
- Division of Cardiology, Istituto Cardiocentro Ticino, Lugano, Switzerland
| | | | | | | | | | - Amy Molan
- Medtronic Inc., Mounds View, Minnesota
| | - Takashi Kurita
- Division of Cardiology, Department of Medicine, Kindai University, School of Medicine, Osaka, Japan
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35
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Parreira L, Tsyganov A, Artyukhina E, Vernooy K, Tondo C, Adragao P, Ascione C, Carmo P, Carvalho S, Egger M, Ferreira A, Ghossein M, Holm M, Kalinin V, Malakhova M, Meine M, Nunes S, Podolyak D, Revishvili A, Shapieva A, Stepanova V, van Stipdonk A, Taymasova I, Wouters P, Zubarev S, Leyva F, Auricchio A, Varma N. Non-invasive three-dimensional electrical activation mapping to predict cardiac resynchronization therapy response: site of latest left ventricular activation relative to pacing site. Europace 2023; 25:1458-1466. [PMID: 36857597 PMCID: PMC10105854 DOI: 10.1093/europace/euad041] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/04/2023] [Indexed: 03/03/2023] Open
Abstract
AIMS Pacing remote from the latest electrically activated site (LEAS) in the left ventricle (LV) may diminish response to cardiac resynchronization therapy (CRT). We tested whether proximity of LV pacing site (LVPS) to LEAS, determined by non-invasive three-dimensional electrical activation mapping [electrocardiographic Imaging (ECGI)], increased likelihood of CRT response. METHODS AND RESULTS Consecutive CRT patients underwent ECGI and chest/heart computed tomography 6-24 months of post-implant. Latest electrically activated site and the distance to LVPS (dp) were assessed. Left ventricular end-systolic volume (LVESV) reduction of ≥15% at clinical follow-up defined response. Logistic regression probabilistically modelled non-response; variables included demographics, heart failure classification, left bundle branch block (LBBB), ischaemic heart disease (IHD), atrial fibrillation, QRS duration, baseline ejection fraction (EF) and LVESV, comorbidities, use of CRT optimization algorithm, angiotensin-converting enzyme inhibitor(ACE)/angiotensin-receptor blocker (ARB), beta-blocker, diuretics, and dp. Of 111 studied patients [64 ± 11 years, EF 28 ± 6%, implant duration 12 ± 5 months (mean ± SD), 98% had LBBB, 38% IHD], 67% responded at 10 ± 3 months post CRT-implant. Latest electrically activated sites were outside the mid-to-basal lateral segments in 35% of the patients. dp was 42 ± 23 mm [31 ± 14 mm for responders vs. 63 ± 24 mm non-responders (P < 0.001)]. Longer dp and the lack of use of CRT optimization algorithm were the only independent predictors of non-response [area under the curve (AUC) 0.906]. dp of 47 mm delineated responders and non-responders (AUC 0.931). CONCLUSION The distance between LV pacing site and latest electrical activation is a strong independent predictor for CRT response. Non-invasive electrical evaluation to characterize intrinsic activation and guide LV lead deployment may improve CRT efficacy.
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Affiliation(s)
- Leonor Parreira
- Department of Electrophysiology, Hospital da Luz, S.A., Lisbon, Portugal
| | - Alexey Tsyganov
- I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.,Petrovsky National Research Centre of Surgery, Moscow, Russian Federation
| | - Elena Artyukhina
- A.V. Vishnevsky National Medical Research Center of Surgery, Moscow, Russian Federation
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Claudio Tondo
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Pedro Adragao
- Department of Electrophysiology, Hospital da Luz, S.A., Lisbon, Portugal
| | - Ciro Ascione
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Pedro Carmo
- Department of Electrophysiology, Hospital da Luz, S.A., Lisbon, Portugal
| | - Salomé Carvalho
- Department of Electrophysiology, Hospital da Luz, S.A., Lisbon, Portugal
| | | | - Antonio Ferreira
- Department of Electrophysiology, Hospital da Luz, S.A., Lisbon, Portugal
| | - Mohammed Ghossein
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Magnus Holm
- EP Solutions SA, Yverdon-les-Bains, Switzerland
| | | | - Maria Malakhova
- Petrovsky National Research Centre of Surgery, Moscow, Russian Federation
| | - Mathias Meine
- Heart and Lung Division, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Silvia Nunes
- Department of Electrophysiology, Hospital da Luz, S.A., Lisbon, Portugal
| | - Dmitry Podolyak
- Petrovsky National Research Centre of Surgery, Moscow, Russian Federation
| | - Amiran Revishvili
- A.V. Vishnevsky National Medical Research Center of Surgery, Moscow, Russian Federation
| | - Albina Shapieva
- Petrovsky National Research Centre of Surgery, Moscow, Russian Federation
| | - Vera Stepanova
- North-Western State Medical University, Saint-Petersburg, Russian Federation
| | - Antonius van Stipdonk
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Irina Taymasova
- A.V. Vishnevsky National Medical Research Center of Surgery, Moscow, Russian Federation
| | - Philippe Wouters
- Heart and Lung Division, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Stepan Zubarev
- Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation
| | - Francisco Leyva
- Department of Cardiology, Queen Elizabeth Hospital, Aston University,, Birmingham, UK
| | - Angelo Auricchio
- Division of Cardiology, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Niraj Varma
- Department of Cardiovascular Medicine, Cleveland Clinic, 2977 Essex Road, Cleveland Heights, OH, USA
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Sterns LD, Auricchio A, Schloss EJ, Lexcen D, Jacobsen L, DeGroot P, Molan A, Kurita T. Antitachycardia pacing success in implantable cardioverter-defibrillators by patient, device, and programming characteristics. Heart Rhythm 2023; 20:190-197. [PMID: 36272710 DOI: 10.1016/j.hrthm.2022.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 09/25/2022] [Accepted: 10/07/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Antitachycardia pacing (ATP) is an established implantable cardioverter-defibrillator (ICD) therapy that terminates ventricular tachycardias (VTs) without painful ICD shocks. However, factors influencing ATP success are not well understood. OBJECTIVE The purpose of this study was to examine ATP success rates by patient, device, and programming characteristics. METHODS This retrospective analysis of the PainFree SmartShock Technology study included spontaneous ATP-treated monomorphic VT episodes. ATP success rates were calculated for various factors. Also, the relationship of ATP programming on shock burden and syncope were investigated. RESULTS Of the 2770 enrolled patients (2200 [79%] male; mean age 65 years), 1699 (61%) received an ICD and 1071 (39%) a cardiac resynchronization therapy - defibrillator. ATP had >80% rate of success for terminating VTs overall, with similar rates observed between ICD and cardiac resynchronization therapy - defibrillator devices (82.2% vs 80.3%, respectively; P = .81) as well as between primary and secondary prevention patients with ICDs (77.2% vs 83.9% respectively; P = .25). Arrhythmias with a median cycle length of ≥320 ms had a significantly higher ATP success rate (88.0%; 95% confidence interval 84.8%-90.6%). The cumulative percentage of ATP success increased from 71% at 1 ATP sequence delivered to 87% at ≥8 sequences delivered. Programming more ATP sequences was associated with lower shock burden (P = .0005). There was no evidence that more sequences were associated with higher rates of syncope (P = .16). CONCLUSION Delivering more ATP sequences resulted in a higher overall success of terminating VTs, while programming more ATP was associated with decreased shock burden and no evidence of increased syncope or acceleration. This suggests that more ATP sequences should be programmed when possible, but confirmation in prospective studies will be necessary.
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Affiliation(s)
- Laurence D Sterns
- Vancouver Island Arrhythmia Clinic, Victoria, British Columbia, Canada.
| | - Angelo Auricchio
- Division of Cardiology, Istituto Cardiocentro Ticino, Lugano, Switzerland
| | | | | | | | | | - Amy Molan
- Medtronic Inc., Mounds View, Minnesota
| | - Takashi Kurita
- Division of Cardiology, Department of Medicine, Kindai University School of Medicine, Osaka, Japan
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Piciacchia F, Auricchio A, Behr ER, Wilde AA, Conte G. Family History of Sudden Cardiac Death in the Young and Inherited Arrhythmia Syndromes: Awareness and Attitudes of General Practitioners and Private Practice Cardiologists. Circ Genom Precis Med 2023; 16:e003913. [PMID: 36716170 PMCID: PMC9946158 DOI: 10.1161/circgen.122.003913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Flavia Piciacchia
- Division of Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland (F.P., A.A., G.C.)
| | - Angelo Auricchio
- Division of Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland (F.P., A.A., G.C.).,Faculty of Biomedical Sciences, USI, Lugano, Switzerland (A.A., G.C.)
| | - Elijah R. Behr
- ERN GUARDHEART (E.R.B., A.A.M.W.),Cardiology Clinical Academic Group (E.R.B.),St. George’s, University of London and St. George’s University Hospitals NHS Foundation Trust, London, UK (E.R.B.)
| | - Arthur A.M. Wilde
- ERN GUARDHEART (E.R.B., A.A.M.W.),Department of Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, The Netherlands (A.A.M.W.)
| | - Giulio Conte
- Division of Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland (F.P., A.A., G.C.).,Faculty of Biomedical Sciences, USI, Lugano, Switzerland (A.A., G.C.)
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van Nieuwenhoven FA, Schroen B, Barile L, van Middendorp L, Prinzen FW, Auricchio A. Plasma Extracellular Vesicles as Liquid Biopsy to Unravel the Molecular Mechanisms of Cardiac Reverse Remodeling Following Resynchronization Therapy? J Clin Med 2023; 12:jcm12020665. [PMID: 36675594 PMCID: PMC9862724 DOI: 10.3390/jcm12020665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
Cardiac resynchronization therapy (CRT) has become a valuable addition to the treatment options for heart failure, in particular for patients with disturbances in electrical conduction that lead to regionally different contraction patterns (dyssynchrony). Dyssynchronous hearts show extensive molecular and cellular remodeling, which has primarily been investigated in experimental animals. Evidence showing that at least several miRNAs play a role in this remodeling is increasing. A comparison of results from measurements in plasma and myocardial tissue suggests that plasma levels of miRNAs may reflect the expression of these miRNAs in the heart. Because many miRNAs released in the plasma are included in extracellular vesicles (EVs), which protect them from degradation, measurement of myocardium-derived miRNAs in peripheral blood EVs may open new avenues to investigate and monitor (reverse) remodeling in dyssynchronous and resynchronized hearts of patients.
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Affiliation(s)
- Frans A. van Nieuwenhoven
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Blanche Schroen
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Lucio Barile
- Laboratory for Cardiovascular Theranostics, Istituto Cardiocentro Ticino, 6900 Lugano, Switzerland
| | - Lars van Middendorp
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, 6200 MD Maastricht, The Netherlands
| | - Frits W. Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, The Netherlands
- Correspondence:
| | - Angelo Auricchio
- Department of Cardiology, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
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39
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Caputo ML, Baldi E, Krüll JD, Pongan D, Cresta R, Benvenuti C, Cianella R, Primi R, Currao A, Bendotti S, Compagnoni S, Gentile FR, Anselmi L, Savastano S, Klersy C, Auricchio A. Impact of sex and role of coronary artery disease in out-of-hospital cardiac arrest presenting with refractory ventricular arrhythmias. Front Cardiovasc Med 2023; 10:1074432. [PMID: 37113702 PMCID: PMC10126276 DOI: 10.3389/fcvm.2023.1074432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/24/2023] [Indexed: 04/29/2023] Open
Abstract
Introduction There are limited data on sex-related differences in out-of hospital cardiac arrests (OHCAs) with refractory ventricular arrhythmias (VA) and, in particular, about their relationship with cardiovascular risk profile and severity of coronary artery disease (CAD). Purpose Aim of this study was to characterize sex-related differences in clinical presentation, cardiovascular risk profile, CAD prevalence, and outcome in OHCA victims presenting with refractory VA. Methods All OHCAs with shockable rhythm that occurred between 2015 and 2019 in the province of Pavia (Italy) and in the Canton Ticino (Switzerland) were included. Results Out of 680 OHCAs with first shockable rhythm, 216 (33%) had a refractory VA. OHCA patients with refractory VA were younger and more often male. Males with refractory VA had more often a history of CAD (37% vs. 21%, p 0.03). In females, refractory VA were less frequent (M : F ratio 5 : 1) and no significant differences in cardiovascular risk factor prevalence or clinical presentation were observed. Male patients with refractory VA had a significantly lower survival at hospital admission and at 30 days as compared to males without refractory VA (45% vs. 64%, p < 0.001 and 24% vs. 49%, p < 0.001, respectively). Whereas in females, no significant survival difference was observed. Conclusions In OHCA patients presenting with refractory VA the prognosis was significantly poorer for male patients. The refractoriness of arrhythmic events in the male population was probably due to a more complex cardiovascular profile and in particular due to a pre-existing CAD. In females, OHCA with refractory VA were less frequent and no correlation with a specific cardiovascular risk profile was observed.
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Affiliation(s)
- Maria Luce Caputo
- Cardiology Department, Cardiocentro Ticino Institute, Lugano, Switzerland
- Correspondence: Maria Luce Caputo
| | - Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Joel Daniel Krüll
- Cardiology Department, Cardiocentro Ticino Institute, Lugano, Switzerland
| | - Damiano Pongan
- Cardiology Department, Cardiocentro Ticino Institute, Lugano, Switzerland
| | | | | | - Roberto Cianella
- Federazione Cantonale Ticinese Servizi Autoambulanze, Bellinzona, Switzerland
| | - Roberto Primi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessia Currao
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Bendotti
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Compagnoni
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Francesca Romana Gentile
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Luciano Anselmi
- Federazione Cantonale Ticinese Servizi Autoambulanze, Bellinzona, Switzerland
| | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Catherine Klersy
- Service of Clinical Epidemiology and Biostatistics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Angelo Auricchio
- Cardiology Department, Cardiocentro Ticino Institute, Lugano, Switzerland
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Varma N, Kondo Y, Park SJ, Auricchio A, Gold MR, Boehmer J, Pandurangi U, Watanabe E, Lee K, Singh JP. Utilization of remote monitoring among patients receiving cardiac resynchronization therapy and comparison between Asia and the Americas. Heart Rhythm O2 2022; 3:868-870. [PMID: 36589006 PMCID: PMC9795253 DOI: 10.1016/j.hroo.2022.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Niraj Varma
- Cleveland Clinic London, London, United Kingdom,Address reprint requests and correspondence: Dr Niraj Varma, Cleveland Clinic London, 40 Grosvenor Place, London SW1X 7AW, United Kingdom.
| | - Yusuke Kondo
- Chiba University Graduate School of Medicine, Chiba, Japan
| | | | | | - Michael R. Gold
- Medical University of South Carolina, Charleston, South Carolina
| | - John Boehmer
- Pennsylvania State University, Hershey, Pennsylvania
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Meyre PB, Blum S, Hennings E, Aeschbacher S, Reichlin T, Rodondi N, Beer JH, Stauber A, Müller A, Sinnecker T, Moutzouri E, Paladini RE, Moschovitis G, Conte G, Auricchio A, Ramadani A, Schwenkglenks M, Bonati LH, Kühne M, Osswald S, Conen D. Bleeding and ischaemic events after first bleed in anticoagulated atrial fibrillation patients: risk and timing. Eur Heart J 2022; 43:4899-4908. [PMID: 36285887 DOI: 10.1093/eurheartj/ehac587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 08/29/2022] [Accepted: 10/04/2022] [Indexed: 01/12/2023] Open
Abstract
AIMS To determine the risk of subsequent adverse clinical outcomes in anticoagulated patients with atrial fibrillation (AF) who experienced a new bleeding event. METHODS AND RESULTS Anticoagulated AF patients were followed in two prospective cohort studies. Information on incident bleeding was systematically collected during yearly follow-up visits and events were adjudicated as major bleeding or clinically relevant non-major bleeding (CRNMB) according to the International Society on Thrombosis and Haemostasis guidelines. The primary outcome was a composite of stroke, myocardial infarction (MI), or all-cause death. Time-updated multivariable Cox proportional-hazards models were used to compare outcomes in patients with and without incident bleeding. Median follow-up was 4.08 years [interquartile range (IQR): 2.93-5.98]. Of the 3277 patients included (mean age 72 years, 28.5% women), 646 (19.7%) developed a new bleeding, 297 (9.1%) a major bleeding and 418 (12.8%) a CRNMB. The incidence of the primary outcome was 7.08 and 4.04 per 100 patient-years in patients with and without any bleeding [adjusted hazard ratio (aHR): 1.36, 95% confidence interval (CI): 1.16-1.61; P < 0.001; median time between a new bleeding and a primary outcome 306 days (IQR: 23-832)]. Recurrent bleeding occurred in 126 patients [incidence, 8.65 per 100 patient-years (95% CI: 7.26-10.30)]. In patients with and without a major bleeding, the incidence of the primary outcome was 11.00 and 4.06 per 100 patient-years [aHR: 2.04, 95% CI: 1.69-2.46; P < 0.001; median time to a primary outcome 142 days (IQR: 9-518)], and 59 had recurrent bleeding [11.61 per 100 patient-years (95% CI: 8.99-14.98)]. The incidence of the primary outcome was 5.29 and 4.55 in patients with and without CRNMB [aHR: 0.94, 95% CI: 0.76-1.15; P = 0.53; median time to a composite outcome 505 days (IQR: 153-1079)], and 87 had recurrent bleeding [8.43 per 100 patient-years (95% CI: 6.83-10.40)]. Patients who had their oral anticoagulation (OAC) discontinued after their first bleeding episode had a higher incidence of the primary composite than those who continued OAC (63/89 vs. 159/557 patients; aHR: 4.46, 95% CI: 3.16-6.31; P < 0.001). CONCLUSION In anticoagulated AF patients, major bleeding but not CRNMB was associated with a high risk of adverse outcomes, part of which may be explained by OAC discontinuation. Most events occurred late after the bleeding episode, emphasizing the importance of long-term follow-up in these patients.
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Affiliation(s)
- Pascal B Meyre
- Division of Cardiology, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Basel-Stadt, Switzerland.,Division of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Basel-Stadt, Switzerland
| | - Steffen Blum
- Division of Cardiology, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Basel-Stadt, Switzerland.,Division of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Basel-Stadt, Switzerland
| | - Elisa Hennings
- Division of Cardiology, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Basel-Stadt, Switzerland.,Division of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Basel-Stadt, Switzerland
| | - Stefanie Aeschbacher
- Division of Cardiology, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Basel-Stadt, Switzerland.,Division of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Basel-Stadt, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 16p, 3010 Bern, Switzerland
| | - Jürg H Beer
- Department of Medicine, Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zurich, Im Ergel 1, 5404 Baden, Aargau, Switzerland
| | - Annina Stauber
- Department of Cardiology, Triemli Hospital Zurich, Birmensdorferstrasse 497, 8063 Zurich, Switzerland
| | - Andreas Müller
- Department of Cardiology, Triemli Hospital Zurich, Birmensdorferstrasse 497, 8063 Zurich, Switzerland
| | - Tim Sinnecker
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Basel-Stadt, Switzerland.,Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering, University of Basel, Marktgasse 8, 4051 Basel, Basel-Stadt, Switzerland
| | - Elisavet Moutzouri
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 16p, 3010 Bern, Switzerland
| | - Rebecca E Paladini
- Division of Cardiology, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Basel-Stadt, Switzerland.,Division of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Basel-Stadt, Switzerland
| | - Giorgio Moschovitis
- Division of Cardiology, Ospedale Regionale di Lugano, Via Tesserete 46, 6900 Lugano, Switzerland
| | - Giulio Conte
- Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Via Tesserete 48, 6900 Lugano, Switzerland
| | - Angelo Auricchio
- Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Via Tesserete 48, 6900 Lugano, Switzerland
| | - Alexandra Ramadani
- Division of Cardiology, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Basel-Stadt, Switzerland.,Division of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Basel-Stadt, Switzerland
| | - Matthias Schwenkglenks
- Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland.,Institute of Pharmaceutical Medicine (ECPM), University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland
| | - Leo H Bonati
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Basel-Stadt, Switzerland
| | - Michael Kühne
- Division of Cardiology, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Basel-Stadt, Switzerland.,Division of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Basel-Stadt, Switzerland
| | - Stefan Osswald
- Division of Cardiology, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Basel-Stadt, Switzerland.,Division of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Basel-Stadt, Switzerland
| | - David Conen
- Population Health Research Institute, McMaster University, 237 Barton St E, Hamilton, ON L8L 2X2, Canada
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Auricchio A, Demarchi A, Özkartal T, Campanale D, Caputo ML, di Valentino M, Menafoglio A, Regoli F, Facchini M, Del Bufalo A, Foglia P, Ferrari N, Bomio F, Medeiros-Domingo A, Moccetti T, Pedrazzini GB, Klersy C, Conte G. Role of genetic testing in young patients with idiopathic atrioventricular conduction disease. Europace 2022; 25:643-650. [PMID: 36352534 PMCID: PMC9934995 DOI: 10.1093/europace/euac196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 09/08/2022] [Indexed: 11/11/2022] Open
Abstract
AIMS To investigate the role of genetic testing in patients with idiopathic atrioventricular conduction disease requiring pacemaker (PM) implantation before the age of 50 years. METHODS AND RESULTS All consecutive PM implantations in Southern Switzerland between 2010 and 2019 were evaluated. Inclusion criteria were: (i) age at the time of PM implantation: < 50 years; (ii) atrioventricular block (AVB) of unknown aetiology. Study population was investigated by ajmaline challenge and echocardiographic assessment over time. Genetic testing was performed using next-generation sequencing panel, containing 174 genes associated to inherited cardiac diseases, and Sanger sequencing confirmation of suspected variants with clinical implication. Of 2510 patients who underwent PM implantation, 15 (0.6%) were young adults (median age: 44 years, male predominance) presenting with advanced AVB of unknown origin. The average incidence of idiopathic AVB computed over the 2010-2019 time window was 0.7 per 100 000 persons per year (95% CI 0.4-1.2). Most of patients (67%) presented with specific genetic findings (pathogenic variant) or variants of uncertain significance (VUS). A pathogenic variant of PKP2 gene was found in one patient (6.7%) with no overt structural cardiac abnormalities. A VUS of TRPM4, MYBPC3, SCN5A, KCNE1, LMNA, GJA5 genes was found in other nine cases (60%). Of these, three unrelated patients (20%) presented the same heterozygous missense variant c.2531G > A p.(Gly844Asp) in TRPM4 gene. Diagnostic re-assessment over time led to a diagnosis of Brugada syndrome and long-QT syndrome in two patients (13%). No cardiac events occurred during a median follow-up of 72 months. CONCLUSION Idiopathic AVB in adults younger than 50 years is a very rare condition with an incidence of 0.7 per 100 000 persons/year. Systematic investigations, including genetic testing and ajmaline challenge, can lead to the achievement of a specific diagnosis in up to 20% of patients. Heterozygous missense variant c.2531G > A p.(Gly844Asp) in TRPM4 gene was found in an additional 20% of unrelated patients, suggesting possible association of the variant with the disease.
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Affiliation(s)
- Angelo Auricchio
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano 6900, Switzerland
| | - Andrea Demarchi
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano 6900, Switzerland
| | - Tardu Özkartal
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano 6900, Switzerland,Division of Cardiology, Ospedale di Bellinzona, Bellinzona 6500, Switzerland
| | - Daniela Campanale
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano 6900, Switzerland
| | - Maria Luce Caputo
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano 6900, Switzerland
| | | | - Andrea Menafoglio
- Division of Cardiology, Ospedale di Bellinzona, Bellinzona 6500, Switzerland
| | - Francois Regoli
- Division of Cardiology, Ospedale di Bellinzona, Bellinzona 6500, Switzerland
| | - Marco Facchini
- Division of Cardiology, Ospedale di Locarno, Locarno 6600, Switzerland
| | - Alessandro Del Bufalo
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano 6900, Switzerland
| | - Pietro Foglia
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano 6900, Switzerland
| | - Nicola Ferrari
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano 6900, Switzerland
| | - Fulvio Bomio
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano 6900, Switzerland
| | | | - Tiziano Moccetti
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano 6900, Switzerland
| | - Giovanni B Pedrazzini
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano 6900, Switzerland
| | - Catherine Klersy
- Service Clinical Epidemiology and Biometry, Fondazione IRCCS Policlinico San Matteo, Pavia 27100, Italy
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Aebersold H, Serra-Burriel M, Foster-Wittassek F, Moschovitis G, Aeschbacher S, Auricchio A, Beer JH, Blozik E, Bonati LH, Conen D, Felder S, Huber CA, Kuehne M, Mueller A, Oberle J, Paladini RE, Reichlin T, Rodondi N, Springer A, Stauber A, Sticherling C, Szucs TD, Osswald S, Schwenkglenks M. Patient clusters and cost trajectories in the Swiss Atrial Fibrillation cohort. Heart 2022; 109:763-770. [PMID: 36332981 DOI: 10.1136/heartjnl-2022-321520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Abstract
ObjectiveEvidence on long-term costs of atrial fibrillation (AF) and associated factors is scarce. As part of the Swiss-AF prospective cohort study, we aimed to characterise AF costs and their development over time, and to assess specific patient clusters and their cost trajectories.MethodsSwiss-AF enrolled 2415 patients with variable duration of AF between 2014 and 2017. Patient clusters were identified using hierarchical cluster analysis of baseline characteristics. Ongoing yearly follow-ups include health insurance clinical and claims data. An algorithm was developed to adjudicate costs to AF and related complications.ResultsA subpopulation of 1024 Swiss-AF patients with available claims data was followed up for a median (IQR) of 3.24 (1.09) years. Average yearly AF-adjudicated costs amounted to SFr5679 (€5163), remaining stable across the observation period. AF-adjudicated costs consisted mainly of inpatient and outpatient AF treatment costs (SFr4078; €3707), followed by costs of bleeding (SFr696; €633) and heart failure (SFr494; €449). Hierarchical analysis identified three patient clusters: cardiovascular (CV; N=253 with claims), isolated-symptomatic (IS; N=586) and severely morbid without cardiovascular disease (SM; N=185). The CV cluster and SM cluster depicted similarly high costs across all cost outcomes; IS patients accrued the lowest costs.ConclusionOur results highlight three well-defined patient clusters with specific costs that could be used for stratification in both clinical and economic studies. Patient characteristics associated with adjudicated costs as well as cost trajectories may enable an early understanding of the magnitude of upcoming AF-related healthcare costs.
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Affiliation(s)
- Helena Aebersold
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Miquel Serra-Burriel
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | | | - Giorgio Moschovitis
- Division of Cardiology, Ente Ospedaliero Cantonale (EOC), Opsedale Regionale di Lugano, Lugano, Switzerland
| | - Stefanie Aeschbacher
- Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Angelo Auricchio
- Department of Cardiology, Instituto Cardiocentro Ticino, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Jürg Hans Beer
- Department of Medicine, Cantonal Hospital of Baden, Baden, Switzerland
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Eva Blozik
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Leo H Bonati
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - David Conen
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Stefan Felder
- Faculty of Business and Economics, University of Basel, Basel, Switzerland
| | - Carola A Huber
- Department of Health Sciences, Helsana Group, Zurich, Switzerland
| | - Michael Kuehne
- Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Andreas Mueller
- Department of Cardiology, Triemli Hospital Zurich, Zurich, Switzerland
| | - Jolanda Oberle
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Rebecca E Paladini
- Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Anne Springer
- Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Annina Stauber
- Department of Cardiology, Triemli Hospital Zurich, Zurich, Switzerland
| | - Christian Sticherling
- Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Thomas D Szucs
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
| | - Stefan Osswald
- Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Matthias Schwenkglenks
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
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Jadczyk T, Maffessanti F, Wilczek J, Conte G, Caputo ML, Golba KS, Biernat J, Cybulska M, Caluori G, Regoli F, Krause R, Wojakowski W, Prinzen FW, Auricchio A. Electromechanical factors associated with response to cardiac resynchronization therapy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Cardiac resynchronization therapy (CRT) is clinically proven in patients with heart failure (HF) and left bundle branch block (LBBB). However, approximately 30% of CRT individuals are non responsive to the therapy while factors affecting electromechanical coupling remain not fully understood.
Objective
To determine the optimal combination of electromechanical parameters associated with responsiveness to CRT.
Methods
Sixty-two patients with HF/LBBB underwent invasive anatomo-electromechanical mapping (AEMM) of the left ventricle using NOGA XP system (Biosense Webster), cardiac magnetic resonance (cMR), transthoracic echocardiography and 12-lead ECG. Remodeling was quantified based on the end-systolic volume (ΔESV) decrease at 6-month follow-up. Response to CRT was defined as ΔESV ≤−15%. QRS duration (QRSd) was measured from a surface ECG. Area strain was obtained from AEMM and used to calculate systolic stretch index (SSI) and total left ventricular mechanical time (TLVMT). Total left ventricular activation time (TLVAT) and transeptal time (TST) were derived from AEMM and ECG. Scar burden was evaluated from cMR late gadolinium enhancement imaging.
Results
Significant correlations were observed between ΔESV and TST (rho=0.42; responder: 50 [20–58] vs non-responder: 33 [8–44] ms), TLVAT (−0.68; 81 [73–97] vs 112 [96–127] ms), scar burden (−0.27; 0.0 [0.0–1.2] vs 8.7 [0.0 19.1]%) and SSI (0.41; 10.7 [7.1–16.8] vs 4.2 [2.9–5.5]), but not QRSd (0.11; 155 [140–176] vs 167 [155–177] ms). TLVAT and SSI had a high predictive value for CRT response (AUC>0.80). TLVAT (OR=1.50), scar burden (0.91) and SSI (0.04) were independent factors associated with a positive response to CRT. Individuals with SSI >7.9% and TLVAT <91 ms all responded to CRT, while low SSI and prolonged TLVAT were more common in non-responders.
Conclusion
Electromechanical parameters show better correlation with CRT response than traditional surface ECG measurements. The absence of scar combined with high SSI and low TLVAT ensures effectiveness of CRT.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Swiss National Science Foundation, Statutory funds of the Medical University of Silesia
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Affiliation(s)
- T Jadczyk
- Medical University of Silesia, Department of Cardiology and Structural Heart Diseases , Katowice , Poland
| | - F Maffessanti
- Università della Svizzera Italiana, Center for Computational Medicine in Cardiology , Lugano , Switzerland
| | - J Wilczek
- Medical University of Silesia, Department of Electrocardiology and Heart Failure , Katowice , Poland
| | - G Conte
- Cardiocentro Ticino Institute, Division of Cardiology , Lugano , Switzerland
| | - M L Caputo
- Cardiocentro Ticino Institute, Division of Cardiology , Lugano , Switzerland
| | - K S Golba
- Medical University of Silesia, Department of Electrocardiology and Heart Failure , Katowice , Poland
| | - J Biernat
- Medical University of Silesia, Department of Electrocardiology and Heart Failure , Katowice , Poland
| | - M Cybulska
- Medical University of Silesia, Department of Electrocardiology and Heart Failure , Katowice , Poland
| | - G Caluori
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université , Pessac , France
| | - F Regoli
- Cardiocentro Ticino Institute, Division of Cardiology , Lugano , Switzerland
| | - R Krause
- Università della Svizzera Italiana, Center for Computational Medicine in Cardiology , Lugano , Switzerland
| | - W Wojakowski
- Medical University of Silesia, Department of Cardiology and Structural Heart Diseases , Katowice , Poland
| | - F W Prinzen
- Maastricht University, Department of Physiology, CARIM , Maastricht , The Netherlands
| | - A Auricchio
- Università della Svizzera Italiana, Center for Computational Medicine in Cardiology , Lugano , Switzerland
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Feijen M, Beles M, Than YZ, Cordon A, Dupont M, Treskes RW, Caputo M, Mullens W, Van Bokstal K, Auricchio A, Egorova AD, Maes E, Beeres SLMA, Heggermont WA. Activation of the HeartLogic algorithm on top of heart failure care: a multicenter propensity-matched cohort analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Hospitalization for decompensated heart failure may be prevented by early detection of fluid retention. The multisensory HeartLogic™ algorithm, incorporated in a cardiac implantable electronic device (CIED) aims to detect impending fluid retention and thereby enables timely adjustment of medical therapy. However, it is to be investigated whether HeartLogic™ provides clinical benefit compared to heart failure care with conventional telemonitoring. This analysis investigates the effects of activating HeartLogic™ on top of heart failure care with telemonitoring on the number of episodes with fluid retention and heart failure related hospitalizations.
Methods
Heart failure patients with a CIED were recruited from the outpatient clinics of four European cardiology departments. All patients were included from January 2017 until December 2020, and followed-up for 365 days. Patients with a CIED and an activated HeartLogic™ algorithm were compared to a 1:1 propensity score-based matched control group consisting of patients with CIED on routine telemonitoring. Data of all episodes of (impending) fluid retention with ≥2 signs and symptoms of congestion were included for analyses.
Results
Data of 127 patients with an activated HeartLogic™ algorithm were adequately matched with 127 heart failure patients with a CIED on routine telemonitoring. Median age was 68 [59–75], majority of patients were male (80%), 46% had an ischemic etiology of heart failure. Total follow-up consisted of 254 patient years. During follow up, 77 (61%) individual patients with HeartLogic™ experienced an episode of fluid retention, compared to 85 (67%) induvial patients on routine telemonitoring. Patients with an activated HeartLogic™ algorithm had 1.62±1.78 events of fluid retention per patient year (PPY) compared to 2.61±3.71 events PPY in patients on routine telemonitoring, p<0.01 (Figure 1). Hospitalization for fluid retention occurred in 7 (6%) HeartLogic™ patients (0.06±0.27 hospitalizations PPY) compared to 13 (10%) patients on routine telemonitoring (0.15±0.45 PPY), p=0.07 (Figure 2A). Mean length of hospitalization in days PPY was 0.29±1.46 in patients with HeartLogic™ and 1.59±6.30 in patients on routine telemonitoring, p=0.02 (Figure 2B).
Conclusion
In a real-world multicenter heart failure population, activation of the HeartLogic™ algorithm was associated with a lower number of episodes of fluid retention per patient and a shorter duration of hospitalization for congestive heart failure.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Feijen
- Leiden University Medical Center , Leiden , The Netherlands
| | - M Beles
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - Y Z Than
- Deloitte HEOR (Health-Economics and Outcome Research) , Zaventem , Belgium
| | - A Cordon
- Deloitte HEOR (Health-Economics and Outcome Research) , Zaventem , Belgium
| | - M Dupont
- Hospital Oost-Limburg (ZOL) , Genk , Belgium
| | - R W Treskes
- Leiden University Medical Center , Leiden , The Netherlands
| | - M Caputo
- Cardiocentro Ticino Foundation , Lugano , Switzerland
| | - W Mullens
- Hospital Oost-Limburg (ZOL) , Genk , Belgium
| | - K Van Bokstal
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - A Auricchio
- Cardiocentro Ticino Foundation , Lugano , Switzerland
| | - A D Egorova
- Leiden University Medical Center , Leiden , The Netherlands
| | - E Maes
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - S L M A Beeres
- Leiden University Medical Center , Leiden , The Netherlands
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47
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Maffessanti F, Jadczyk T, Wilczek J, Conte G, Caputo ML, Gołba KS, Biernat J, Cybulska M, Caluori G, Regoli F, Krause R, Wojakowski W, Prinzen FW, Auricchio A. Electromechanical factors associated with favourable outcome in cardiac resynchronization therapy. Europace 2022; 25:546-553. [PMID: 36106562 PMCID: PMC9935025 DOI: 10.1093/europace/euac157] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/08/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS Electromechanical coupling in patients receiving cardiac resynchronization therapy (CRT) is not fully understood. Our aim was to determine the best combination of electrical and mechanical substrates associated with effective CRT. METHODS AND RESULTS Sixty-two patients were prospectively enrolled from two centres. Patients underwent 12-lead electrocardiogram (ECG), cardiovascular magnetic resonance (CMR), echocardiography, and anatomo-electromechanical mapping (AEMM). Remodelling was measured as the end-systolic volume (ΔESV) decrease at 6 months. CRT was defined effective with ΔESV ≤ -15%. QRS duration (QRSd) was measured from ECG. Area strain was obtained from AEMM and used to derive systolic stretch index (SSI) and total left-ventricular mechanical time. Total left-ventricular activation time (TLVAT) and transeptal time (TST) were derived from AEMM and ECG. Scar was measured from CMR. Significant correlations were observed between ΔESV and TST [rho = 0.42; responder: 50 (20-58) vs. non-responder: 33 (8-44) ms], TLVAT [-0.68; 81 (73-97) vs. 112 (96-127) ms], scar [-0.27; 0.0 (0.0-1.2) vs. 8.7 (0.0-19.1)%], and SSI [0.41; 10.7 (7.1-16.8) vs. 4.2 (2.9-5.5)], but not QRSd [-0.13; 155 (140-176) vs. 167 (155-177) ms]. TLVAT and SSI were highly accurate in identifying CRT response [area under the curve (AUC) > 0.80], followed by scar (AUC > 0.70). Total left-ventricular activation time (odds ratio = 0.91), scar (0.94), and SSI (1.29) were independent factors associated with effective CRT. Subjects with SSI >7.9% and TLVAT <91 ms all responded to CRT with a median ΔESV ≈ -50%, while low SSI and prolonged TLVAT were more common in non-responders (ΔESV ≈ -5%). CONCLUSION Electromechanical measurements are better associated with CRT response than conventional ECG variables. The absence of scar combined with high SSI and low TLVAT ensures effectiveness of CRT.
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Affiliation(s)
| | - Tomasz Jadczyk
- Corresponding author. Tel: +48 32 252 39 30; fax: +48 32 252 39 30. E-mail address:
| | - Jacek Wilczek
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Giulio Conte
- Division of Cardiology, Istituto Cardiocentro Ticino, Lugano, Switzerland
| | - Maria Luce Caputo
- Division of Cardiology, Istituto Cardiocentro Ticino, Lugano, Switzerland
| | - Krzysztof S Gołba
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Jolanta Biernat
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Magdalena Cybulska
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Guido Caluori
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, University of Bordeaux & INSERM, U 1045,Cardiothoracic Research Center of Bordeaux, Pessac, France
| | - François Regoli
- Division of Cardiology, Istituto Cardiocentro Ticino, Lugano, Switzerland,Cardiology Service, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Rolf Krause
- Center for Computational Medicine in Cardiology, Università della Svizzera Italiana, Lugano, Switzerland,Euler institute, Università della Svizzera Italiana, Lugano, Switzerland
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Frits W Prinzen
- Department of Physiology, CARIM, Maastricht University, Maastricht, The Netherlands
| | - Angelo Auricchio
- Center for Computational Medicine in Cardiology, Università della Svizzera Italiana, Lugano, Switzerland,Division of Cardiology, Istituto Cardiocentro Ticino, Lugano, Switzerland
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48
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Bisignani A, Conte G, Pannone L, Sieira J, Del Monte A, Lipartiti F, Bala G, Miraglia V, Monaco C, Ströker E, Overeinder I, Almorad A, Gauthey A, Franchetti Pardo L, Raes M, Detriche O, Brugada P, Auricchio A, Chierchia GB, de Asmundis C. Long-Term Outcomes of Pulmonary Vein Isolation in Patients With Brugada Syndrome and Paroxysmal Atrial Fibrillation. J Am Heart Assoc 2022; 11:e026290. [PMID: 35862178 PMCID: PMC9375506 DOI: 10.1161/jaha.122.026290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Pharmacological treatment of atrial fibrillation (AF) in the setting of Brugada syndrome (BrS) is challenging. In addition, patients with BrS with an implantable cardioverter-defibrillator (ICD) might experience inappropriate shocks for fast AF. Long-term outcome of pulmonary vein isolation in BrS has not been well established yet, and it is still unclear whether pulmonary vein triggers are the only pathophysiological mechanism of AF in BrS. The aim of the study is to assess the long-term outcomes in patients with BrS undergoing pulmonary vein isolation for paroxysmal AF compared with a matched cohort of patients without BrS. Methods and Results Sixty patients with BrS undergoing pulmonary vein isolation with cryoballoon catheter ablation for paroxysmal AF were matched with 60 patients without BrS, who underwent the same procedure. After a mean follow-up of 58.2±31.7 months, freedom from atrial tachyarrhythmias was achieved in 61.7% in the BrS group and in 78.3% in the non-BrS group (log-rank P=0.047). In particular, freedom from AF was 76.7% in the first group and in 83.3% in the second (P=0.27), while freedom from atrial tachycardia/atrial flutter was 85% and 95% (P=0.057). In the BrS group, 29 patients (48.3%) had an ICD and 8 (27.6%) had a previous ICD-inappropriate shock for fast AF. In the BrS cohort, ICD-inappropriate interventions for AF were significantly reduced after ablation (3.4% versus 27.6%; P=0.01). Conclusions Pulmonary vein isolation in patients with BrS was associated with higher rate of arrhythmic recurrence. Despite this, catheter ablation significantly reduced inappropriate ICD interventions in BrS patients and can be considered a therapeutic strategy to prevent inappropriate device therapies.
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Affiliation(s)
- Antonio Bisignani
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium.,Institute of Cardiology Università Cattolica del Sacro Cuore Rome Italy
| | - Giulio Conte
- Division of Cardiology Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale Lugano Switzerland
| | - Luigi Pannone
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Juan Sieira
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Alvise Del Monte
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Felicia Lipartiti
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Gezim Bala
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Vincenzo Miraglia
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Cinzia Monaco
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Erwin Ströker
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Ingrid Overeinder
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Alexandre Almorad
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Anaïs Gauthey
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Livia Franchetti Pardo
- Division of Cardiology Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale Lugano Switzerland
| | - Matthias Raes
- Anaesthesiology Department Vrije Universiteit Brussel Brussels Belgium
| | - Olivier Detriche
- Anaesthesiology Department Vrije Universiteit Brussel Brussels Belgium
| | - Pedro Brugada
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Angelo Auricchio
- Division of Cardiology Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale Lugano Switzerland
| | - Gian-Battista Chierchia
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Carlo de Asmundis
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
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49
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. [2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy Developed by the Task Force on cardiac pacing and cardiac resynchronization therapy of the European Society of Cardiology (ESC) With the special contribution of the European Heart Rhythm Association (EHRA)]. G Ital Cardiol (Rome) 2022; 23:e1-e94. [PMID: 35771031 DOI: 10.1714/3824.38087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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50
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Verzaal NJ, van Deursen CJM, Pezzuto S, Wecke L, van Everdingen WM, Vernooy K, Delhaas T, Auricchio A, Prinzen FW. Synchronization of repolarization after cardiac resynchronization therapy: a combined clinical and modeling study. J Cardiovasc Electrophysiol 2022; 33:1837-1846. [PMID: 35662306 PMCID: PMC9539692 DOI: 10.1111/jce.15581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022]
Abstract
Introduction The changes in ventricular repolarization after cardiac resynchronization therapy (CRT) are poorly understood. This knowledge gap is addressed using a multimodality approach including electrocardiographic and echocardiographic measurements in patients and using patient‐specific computational modeling. Methods In 33 patients electrocardiographic and echocardiographic measurements were performed before and at various intervals after CRT, both during CRT‐ON and temporary CRT‐OFF. T‐wave area was calculated from vectorcardiograms, and reconstructed from the 12‐lead electrocardiography (ECG). Computer simulations were performed using a patient‐specific eikonal model of cardiac activation with spatially varying action potential duration (APD) and repolarization rate, fit to a patient's ECG. Results During CRT‐ON T‐wave area diminished within a day and remained stable thereafter, whereas QT‐interval did not change significantly. During CRT‐OFF T‐wave area doubled within 5 days of CRT, while QT‐interval and peak‐to‐end T‐wave interval hardly changed. Left ventricular (LV) ejection fraction only increased significantly increased after 1 month of CRT. Computer simulations indicated that the increase in T‐wave area during CRT‐OFF can be explained by changes in APD following chronic CRT that are opposite to the change in CRT‐induced activation time. These APD changes were associated with a reduction in LV dispersion in repolarization during chronic CRT. Conclusion T‐wave area during CRT‐OFF is a sensitive marker for adaptations in ventricular repolarization during chronic CRT that may include a reduction in LV dispersion of repolarization.
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Affiliation(s)
- Nienke J Verzaal
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - Caroline J M van Deursen
- Department of Cardiology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Simone Pezzuto
- Center for Computational Medicine in Cardiology, Euler Institute, Università della Svizzera Italiana, via via Buffi 13, 6900, Lugano, Switzerland
| | - Liliane Wecke
- Heart Clinic, Capio St. Göran's Hospital, Sankt Göransplan 1, 11281, Stockholm, Sweden
| | | | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Tammo Delhaas
- Department of Biomedical Engineering, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - Angelo Auricchio
- Center for Computational Medicine in Cardiology, Euler Institute, Università della Svizzera Italiana, via via Buffi 13, 6900, Lugano, Switzerland.,Department of Cardiology, Istituto Cardiocentro Ticino, Lugano, Switzerland
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
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