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11 pages, 1873 KiB

Open AccessArticle

Left Atrial Appendage Occlusion versus Novel Oral Anticoagulation for Stroke Prevention in Atrial Fibrillation—One-Year Survival

by Shmuel Tiosano, Ariel Banai, Wesam Mulla, Ido Goldenberg, Gabriella Bayshtok, Uri Amit, Nir Shlomo, Eyal Nof, Raphael Rosso, Michael Glikson, Victor Guetta, Israel Barbash and Roy Beinart

J. Clin. Med. 2023, 12(20), 6693; https://doi.org/10.3390/jcm12206693 - 23 Oct 2023

Cited by 1 | Viewed by 982

Abstract

Aim To compare the 1-year survival rate of patients with atrial fibrillation (AF) following left atrial appendage occluder (LAAO) implantation vs. treatment with novel oral anticoagulants (NOACs). Methods: We have conducted an indirect, retrospective comparison between LAAO and NOAC registries. The LAAO registry [...] Read more.

Aim To compare the 1-year survival rate of patients with atrial fibrillation (AF) following left atrial appendage occluder (LAAO) implantation vs. treatment with novel oral anticoagulants (NOACs). Methods: We have conducted an indirect, retrospective comparison between LAAO and NOAC registries. The LAAO registry is a national prospective cohort of 419 AF patients who underwent percutaneous LAAO between January 2008 and October 2015. The NOACs registry is a multicenter prospective cohort of 3138 AF patients treated with NOACs between November 2015 and August 2018. Baseline patient characteristics were retrospectively collected from coded diagnoses of hospitalization and outpatient clinic notes. Follow-up data was sorted from coded diagnoses and the national civil registry. Subjects were matched according to propensity score. Baseline characteristics were compared using Chi-Square and student’s t-test. Survival analysis was performed using Kaplan-Meier survival curves, log-rank test, and multivariable Cox regression, adjusting for possible confounding variables. Results: This study included 114 subjects who underwent LAAO implantation and 342 subjects treated with NOACs. The mean age of participants was 77.9 ± 7.44 and 77.1 ± 11.2 years in the LAAO and NOAC groups, respectively (p = 0.4). The LAAO group had 70 (61%) men compared to 202 (59%) men in the NOAC group (p = 0.74). No significant differences were found in baseline comorbidities, renal function, or CHA₂DS₂-VASc score. One-year mortality was observed in 5 (4%) patients and 32 (9%) patients of the LAAO and NOAC groups, respectively. After adjusting for confounders, LAAO was significantly associated with a lower risk for 1-year mortality (HR 0.38, 95%CI 0.14–0.99). In patients with impaired renal function, this difference was even more prominent (HR 0.21 for creatinine clearance (CrCl) < 60 mL/min). Conclusions: In a pooled analysis of two registries, we found a significantly lower risk for 1-year mortality in patients with AF who were implanted with LAAO than those treated with NOACs. This finding was more prominent in patients with impaired renal function. Future prospective direct studies should further investigate the efficacy and adverse effects of both treatment strategies. Full article

(This article belongs to the Special Issue Cardiac Electrophysiology: Clinical Advances and Practice Updates)

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11 pages, 482 KiB

Open AccessArticle

Long-Term Follow-Up of Empirical Slow Pathway Ablation in Pediatric and Adult Patients with Suspected AV Nodal Reentrant Tachycardia

by Marta Telishevska, Sarah Lengauer, Tilko Reents, Verena Kantenwein, Miruna Popa, Fabian Bahlke, Florian Englert, Nico Erhard, Isabel Deisenhofer and Gabriele Hessling

J. Clin. Med. 2023, 12(20), 6532; https://doi.org/10.3390/jcm12206532 - 15 Oct 2023

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Abstract

Background: The aim of this study was to assess long-term efficacy and safety of empirical slow pathway (ESP) ablation in pediatric and adult patients with a special interest in patients without dual AV nodal physiology (DAVNP). Methods: A retrospective single-center review of patients [...] Read more.

Background: The aim of this study was to assess long-term efficacy and safety of empirical slow pathway (ESP) ablation in pediatric and adult patients with a special interest in patients without dual AV nodal physiology (DAVNP). Methods: A retrospective single-center review of patients who underwent ESP ablation between December 2014 and September 2022 was performed. Follow-up included telephone communication, letter questionnaire and outpatient presentation. Recurrence was based on typical symptoms. Results: 115 patients aged 6–81 years (median age 36.3 years, 59.1% female; 26 pts < 18 years) were included. A typical history was present in all patients (100%), an ECG documentation of narrow complex tachycardia in 97 patients (84%). Patients were divided into three groups: Group 1 without DAVNP (n = 23), Group 2 with AH jump (n = 30) and Group 3 with AH jump and at least one AV nodal echo beat (n = 62). No permanent AV block was observed. During a median follow-up of 23.6 ± 22.7 months, symptom recurrence occurred in 7/115 patients (6.1%) with no significant difference between the groups (p = 0.73, log-rank test). Symptom recurrence occurred significantly more often in patients without (5/18 patients; 27%) as compared to patients with ECG documentation (2/97 patients; 2.1%; p = 0.025). No correlation between age and success rate was found (p > 0.1). Conclusions: ESP ablation is effective and safe in patients with non-inducible AVNRT. Overall, recurrence of symptoms during long-term follow-up is low, even if no DAVNP is present. Tachycardia documentation before the EP study leads to a significantly lower recurrence rate following ESP ablation. Full article

(This article belongs to the Special Issue Cardiac Electrophysiology: Clinical Advances and Practice Updates)

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9 pages, 590 KiB

Open AccessArticle

Intracardiac Echocardiography Guidance Improves Procedural Outcomes in Patients Undergoing Cavotricuspidal Isthmus Ablation for Typical Atrial Flutter

by Marton Turcsan, Kristof-Ferenc Janosi, Dorottya Debreceni, Daniel Toth, Botond Bocz, Tamas Simor and Peter Kupo

J. Clin. Med. 2023, 12(19), 6277; https://doi.org/10.3390/jcm12196277 - 29 Sep 2023

Cited by 2 | Viewed by 743

Abstract

Atrial flutter (AFL) represents a prevalent variant of supraventricular tachycardia, distinguished by a macro-reentrant pathway encompassing the cavotricuspid isthmus (CTI). Radiofrequency (RF) catheter ablation stands as the favored therapeutic modality for managing recurring CTI-dependent AFL. Intracardiac echocardiography (ICE) has been proposed as a [...] Read more.

Atrial flutter (AFL) represents a prevalent variant of supraventricular tachycardia, distinguished by a macro-reentrant pathway encompassing the cavotricuspid isthmus (CTI). Radiofrequency (RF) catheter ablation stands as the favored therapeutic modality for managing recurring CTI-dependent AFL. Intracardiac echocardiography (ICE) has been proposed as a method to reduce radiation exposure during CTI ablation. This study aims to comprehensively compare procedural parameters between ICE-guided CTI ablation and fluoroscopy-only procedures. A total of 370 consecutive patients were enrolled in our single-center retrospective study. In 151 patients, procedures were performed using fluoroscopy guidance only, while 219 patients underwent ICE-guided CTI ablation. ICE guidance significantly reduced fluoroscopy time (73 (36; 175) s vs. 900 (566; 1179) s; p < 0.001), fluoroscopy dose (2.45 (0.6; 5.1) mGy vs. 40.5 (25.7; 62.9) mGy; p < 0.001), and total procedure time (70 (52; 90) min vs. 87.5 (60; 102.5) min; p < 0.001). Total ablation time (657 (412; 981) s vs. 910 (616; 1367) s; p < 0.001) and the time from the first to last ablation (20 (11; 36) min vs. 40 (25; 55) min; p < 0.01) were also significantly shorter in the ICE-guided group. Acute success rate was 100% in both groups, and no major complications occurred in either group. ICE-guided CTI ablation in patients with AFL resulted in shorter procedure times, reduced fluoroscopy exposure, and decreased ablation times, compared to the standard fluoroscopy-only approach. Full article

(This article belongs to the Special Issue Cardiac Electrophysiology: Clinical Advances and Practice Updates)

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9 pages, 1857 KiB

Open AccessArticle

Electroanatomical Mapping System-Guided vs. Intracardiac Echocardiography-Guided Slow Pathway Ablation: A Randomized, Single-Center Trial

by Botond Bocz, Dorottya Debreceni, Kristof-Ferenc Janosi, Marton Turcsan, Tamas Simor and Peter Kupo

J. Clin. Med. 2023, 12(17), 5577; https://doi.org/10.3390/jcm12175577 - 26 Aug 2023

Cited by 1 | Viewed by 1064

Abstract

Radiofrequency (RF) catheter ablation is an effective treatment option for targeting the slow pathway (SP) in atrioventricular nodal reentry tachycardia (AVNRT). Previous data suggested that using intracardiac echocardiography (ICE) guidance could improve procedural outcomes when compared to using fluoroscopy alone. In this prospective [...] Read more.

Radiofrequency (RF) catheter ablation is an effective treatment option for targeting the slow pathway (SP) in atrioventricular nodal reentry tachycardia (AVNRT). Previous data suggested that using intracardiac echocardiography (ICE) guidance could improve procedural outcomes when compared to using fluoroscopy alone. In this prospective study, we aimed to compare the effectiveness of an electroanatomical mapping system (EAMS)-guided approach with an ICE-guided approach for SP ablation. Eighty patients undergoing SP ablation for AVNRT were randomly assigned to either the ICE-guided or EAMS-guided group. If the procedural endpoint was not achieved after 8 RF applications; patients were allowed to crossover to the ICE-guided group. The ICE-guided approach reduced the total procedure time (61.0 (56.0; 66.8) min vs. 71.5 (61.0; 80.8) min, p < 0.01). However, the total fluoroscopy time was shorter (0 (0–0) s vs. 83.5 (58.5–133.25) s, p < 0.001) and the radiation dose was lower (0 (0–0) mGy vs. 3.3 (2.0–4.7) mGy, p < 0.001) with EAMS-guidance. The ICE-guided group had a lower number of RF applications (4 (3–5) vs. 5 (3.0–7.8), p = 0.03) and total ablation time (98.5 (66.8–186) s vs. 136.5 (100.5–215.8) s, p = 0.02). Nine out of 40 patients (22.5%) in the EAMS-guided group crossed over to the ICE-guided group, and they were successfully treated with similar RF applications in terms of number, time, and energy compared to the ICE-guided group. There were no recurrences during the follow-up period. In conclusion, the utilization of ICE guidance during SP ablation has demonstrated notable reductions in procedural time and RF delivery when compared to procedures guided by EAMS. In challenging cases, an early switch to ICE-guided ablation may be the optimal choice for achieving successful treatment. Full article

(This article belongs to the Special Issue Cardiac Electrophysiology: Clinical Advances and Practice Updates)

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12 pages, 1888 KiB

Open AccessArticle

Identification of Pacemaker Lead Position Using Fluoroscopy to Avoid Significant Tricuspid Regurgitation

by Dicky A. Hanafy, Amiliana M. Soesanto, Budhi Setianto, Suzanna Immanuel, Sunu B. Raharjo, Herqutanto, Muzakkir Amir and Yoga Yuniadi

J. Clin. Med. 2023, 12(14), 4782; https://doi.org/10.3390/jcm12144782 - 19 Jul 2023

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Abstract

Permanent pacemaker implantation improves survival but can cause tricuspid valve dysfunction in the form of tricuspid regurgitation (TR). The dominant mechanism of pacemaker-mediated TR is lead impingement. This study evaluated the association between the location of the pacemaker leads crossing the tricuspid valve [...] Read more.

Permanent pacemaker implantation improves survival but can cause tricuspid valve dysfunction in the form of tricuspid regurgitation (TR). The dominant mechanism of pacemaker-mediated TR is lead impingement. This study evaluated the association between the location of the pacemaker leads crossing the tricuspid valve and the incidence of worsening TR and lead impingement using fluoroscopy. Lead positions were evaluated using perpendicular right anterior oblique (RAO) and parallel left anterior oblique (LAO) fluoroscopic angulation views of the tricuspid annulus. A two-dimensional transthoracic echocardiogram (TTE) was performed to evaluate the maximum TR jet area-to-right atrium ratio and define regurgitation severity. A three-dimensional TTE was performed to evaluate lead impingement. A worsening of TR was observed in 23 of 82 subjects. Most leads had an inferior position in the RAO view and a septal position in the LAO view. The mid position in the RAO view and septal position in the LAO view were risk factors for lead impingement. Mid and septal positions were associated with higher risks of significant TR and lead impingement. Lead impingement was associated with a high risk of significant TR. Pacemaker-mediated TR remains a significant problem after lead implantation. Full article

(This article belongs to the Special Issue Cardiac Electrophysiology: Clinical Advances and Practice Updates)

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13 pages, 1779 KiB

Open AccessArticle

Complicated Pocket Infection in Patients Undergoing Lead Extraction: Characteristics and Outcomes

by Anat Milman, Anat Wieder-Finesod, Guy Zahavi, Amit Meitus, Saar Kariv, Yuval Shafir, Roy Beinart, Galia Rahav and Eyal Nof

J. Clin. Med. 2023, 12(13), 4397; https://doi.org/10.3390/jcm12134397 - 29 Jun 2023

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Abstract

Cardiac implantable electronic device (CIED) infection can present with pocket or systemic manifestations, both necessitating complete device removal and pathogen-directed antimicrobial therapy. Here, we aim to characterize those presenting with both pocket and systemic infection. A retrospective analysis of CIED extraction procedures included [...] Read more.

Cardiac implantable electronic device (CIED) infection can present with pocket or systemic manifestations, both necessitating complete device removal and pathogen-directed antimicrobial therapy. Here, we aim to characterize those presenting with both pocket and systemic infection. A retrospective analysis of CIED extraction procedures included 300 patients divided into isolated pocket (n = 104, 34.7%), complicated pocket (n = 54, 18%), and systemic infection (n = 142, 47.3%) groups. The systemic and complicated pocket groups frequently presented with leukocytosis and fever > 37.8, as opposed to the isolated pocket group. Staphylococcus aureus was the most common pathogen in the systemic and complicated pocket groups (43.7% and 31.5%, respectively), while Coagulase-negative staphylococci (CONS) predominated (31.7%) in the isolated pocket group (10.6%, p < 0.001). No differences were observed in procedural success or complications rates. Kaplan–Meier survival analysis found that at three years of follow-up, the rate of all-cause mortality was significantly higher among patients with systemic infection compared to both pocket groups (p < 0.001), with the curves diverging at thirty days. In this study, we characterize a new entity of complicated pocket infection. Despite the systemic pattern of infection, their prognosis is similar to isolated pocket infection. We suggest that this special category be presented separately in future publications of CIED infections. Full article

(This article belongs to the Special Issue Cardiac Electrophysiology: Clinical Advances and Practice Updates)

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9 pages, 640 KiB

Open AccessArticle

Inducibility of Multiple Ventricular Tachycardia’s during a Successful Ablation Procedure Is a Marker of Ventricular Tachycardia Recurrence

by Johnatan Nissan, Avi Sabbag, Roy Beinart and Eyal Nof

J. Clin. Med. 2023, 12(11), 3660; https://doi.org/10.3390/jcm12113660 - 25 May 2023

Cited by 1 | Viewed by 716

Abstract

Even after a successful ventricular tachycardia ablation (VTA), some patients have recurrent ventricular tachycardia (VT) during their follow-up. We assessed the long-term predictors of recurrent VT after having a successful VTA. The patients who underwent a successful VTA (defined as the non-inducibility of [...] Read more.

Even after a successful ventricular tachycardia ablation (VTA), some patients have recurrent ventricular tachycardia (VT) during their follow-up. We assessed the long-term predictors of recurrent VT after having a successful VTA. The patients who underwent a successful VTA (defined as the non-inducibility of any VT at the procedure’s end) in 2014–2021 at our center in Israel were retrospectively analyzed. A total of 111 successful VTAs were evaluated. Out of them, 31 (27.9%) had a recurrent event of VT after the procedure during a median follow-up time of 264 days. The mean left ventricular ejection fraction (LVEF) was significantly lower among patients with recurrent VT events (28.9 ± 12.67 vs. 23.53 ± 12.224, p = 0.048). A high number of induced VTs (>two) during the procedure was found to be a significant predictor of VT recurrence (24.69% vs. 56.67%, 20 vs. 17, p = 0.002). In a multivariate analysis, a lower LVEF (HR, 0.964; p = 0.037) and a high number of induced VTs (HR, 2.15; p = 0.039) were independent predictors of arrhythmia recurrence. The inducibility of more than two VTs during a VTA procedure remains a predictor of VT recurrence even after a successful VT ablation. This group of patients remains at high risk for VT and should be followed up with and treated more vigorously. Full article

(This article belongs to the Special Issue Cardiac Electrophysiology: Clinical Advances and Practice Updates)

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10 pages, 906 KiB

Open AccessArticle

A Referral Center Experience with Cerebral Protection Devices: Challenging Cardiac Thrombus in the EP Lab

by Jan Berg, Alberto Preda, Nicolai Fierro, Alessandra Marzi, Andrea Radinovic, Paolo Della Bella and Patrizio Mazzone

J. Clin. Med. 2023, 12(4), 1549; https://doi.org/10.3390/jcm12041549 - 16 Feb 2023

Cited by 3 | Viewed by 1440

Abstract

BACKGROUND: Cerebral protection devices (CPD) are designed to prevent cardioembolic stroke and most evidence that exists relates to TAVR procedures. There are missing data on the benefits of CPD in patients that are considered high risk for stroke undergoing cardiac procedures like left [...] Read more.

BACKGROUND: Cerebral protection devices (CPD) are designed to prevent cardioembolic stroke and most evidence that exists relates to TAVR procedures. There are missing data on the benefits of CPD in patients that are considered high risk for stroke undergoing cardiac procedures like left atrial appendage (LAA) closure or catheter ablation of ventricular tachycardia (VT) when cardiac thrombus is present. PURPOSE: This work aimed to examine the feasibility and safety of the routine use of CPD in patients with cardiac thrombus undergoing interventions in the electrophysiology (EP) lab of a large referral center. METHODS: The CPD was placed under fluoroscopic guidance in all procedures in the beginning of the intervention. Two different CPDs were used according to the physician’s discretion: (1) a capture device consisting of two filters for the brachiocephalic and left common carotid arteries placed over a 6F sheath from a radial artery; or (2) a deflection device covering all three supra-aortic vessels placed over an 8F femoral sheath. Retrospective periprocedural and safety data were obtained from procedural reports and discharge letters. Long-term safety data were obtained by clinical follow-up in our institution and telephone consultations. RESULTS: We identified 30 consecutive patients in our EP lab who underwent interventions (21 LAA closure, 9 VT ablation) with placement of a CPD due to cardiac thrombus. Mean age was 70 ± 10 years and 73% were male, while mean LVEF was 40 ± 14%. The location of the cardiac thrombus was the LAA in all 21 patients (100%) undergoing LAA-closure, whereas, in the 9 patients undergoing VT ablation, thrombus was present in the LAA in 5 cases (56%), left ventricle (n = 3, 33%) and aortic arch (n = 1, 11%). The capture device was used in 19 out of 30 (63%) and the deflection device in 11 out of 30 cases (37%). There were no periprocedural strokes or transitory ischemic attacks (TIA). CPD-related complications comprised the vascular access and were as follows: two cases of pseudoaneurysm of the femoral artery not requiring surgery (7%), 1 hematoma at the arterial puncture site (3%) and 1 venous thrombosis (3%) resolved by warfarin. At long-term follow-up, 1 TIA and 2 non-cardiovascular deaths occurred, with a mean follow-up time of 660 days. CONCLUSIONS: Placement of a cerebral protection device prior to LAA closure or VT ablation in patients with cardiac thrombus proved feasible, but possible vascular complications needed to be taken into account. A benefit in periprocedural stroke prevention for these interventions seemed plausible but has yet to be proven in larger and randomized trials. Full article

(This article belongs to the Special Issue Cardiac Electrophysiology: Clinical Advances and Practice Updates)

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14 pages, 1417 KiB

Open AccessArticle

Long-Term Outcomes of Tachycardia-Induced Cardiomyopathy Compared with Idiopathic Dilated Cardiomyopathy

by Moshe Katz, Amit Meitus, Michael Arad, Anthony Aizer, Eyal Nof and Roy Beinart

J. Clin. Med. 2023, 12(4), 1412; https://doi.org/10.3390/jcm12041412 - 10 Feb 2023

Cited by 2 | Viewed by 1345

Abstract

Background: data on the natural course and prognosis of tachycardia-induced cardiomyopathy (TICMP) and comparison with idiopathic dilated cardiomyopathies (IDCM) are scarce. Objective: To compare the clinical presentation, comorbidities, and long-term outcomes of TICMP patients with IDCM patients. Methods: a retrospective cohort study of [...] Read more.

Background: data on the natural course and prognosis of tachycardia-induced cardiomyopathy (TICMP) and comparison with idiopathic dilated cardiomyopathies (IDCM) are scarce. Objective: To compare the clinical presentation, comorbidities, and long-term outcomes of TICMP patients with IDCM patients. Methods: a retrospective cohort study of patients hospitalized with new-onset TICMP or IDCM. The primary endpoint was a composite of death, myocardial infarction, thromboembolic events, assist device, heart transplantation, and ventricular tachycardia or fibrillation (VT/VF). The secondary endpoint was recurrent hospitalization due to heart failure (HF) exacerbation. Results: the cohort was comprised of 64 TICMP and 66 IDCM patients. The primary composite endpoint and all-cause mortality were similar between the groups during a median follow-up of ~6 years (36% versus 29%, p = 0.33 and 22% versus 15%, p = 0.15, respectively). Survival analysis showed no significant difference between TICMP and IDCM groups for the composite endpoint (p = 0.75), all-cause mortality (p = 0.65), and hospitalizations due to heart failure exacerbation. Nonetheless, the incidence of recurrent hospitalization was significantly higher in TICMP patients (incidence rate ratio 1.59; p = 0.009). Conclusions: patients with TICMP have similar long-term outcomes as those with IDCM. However, it portends a higher rate of HF readmissions, mostly due to arrhythmia recurrences. Full article

(This article belongs to the Special Issue Cardiac Electrophysiology: Clinical Advances and Practice Updates)

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11 pages, 1442 KiB

Open AccessArticle

Left Ventricular “Longitudinal Rotation” and Conduction Abnormalities—A New Outlook on Dyssynchrony

by Ibrahim Marai, Rabea Haddad, Nizar Andria, Wadi Kinany, Yevgeni Hazanov, Bruce M. Kleinberg, Edo Birati and Shemy Carasso

J. Clin. Med. 2023, 12(3), 745; https://doi.org/10.3390/jcm12030745 - 17 Jan 2023

Cited by 1 | Viewed by 1023

Abstract

Background: The complete left bundle branch block (CLBBB) results in ventricular dyssynchrony and a reduction in systolic and diastolic efficiency. We noticed a distinct clockwise rotation of the left ventricle (LV) in patients with CLBBB (“longitudinal rotation”). Aim: The aim of this study [...] Read more.

Background: The complete left bundle branch block (CLBBB) results in ventricular dyssynchrony and a reduction in systolic and diastolic efficiency. We noticed a distinct clockwise rotation of the left ventricle (LV) in patients with CLBBB (“longitudinal rotation”). Aim: The aim of this study was to quantify the “longitudinal rotation” of the LV in patients with CLBBB in comparison to patients with normal conduction or complete right bundle branch block (CRBBB). Methods: Sixty consecutive patients with normal QRS, CRBBB, or CLBBB were included. Stored raw data DICOM 2D apical-4 chambers view images cine clips were analyzed using EchoPac plugin version 203 (GE Vingmed Ultrasound AS, Horten, Norway). In EchoPac–Q-Analysis, 2D strain application was selected. Instead of apical view algorithms, the SAX-MV (short axis—mitral valve level) algorithm was selected for analysis. A closed loop endocardial contour was drawn to initiate the analysis. The “posterior” segment (representing the mitral valve) was excluded before finalizing the analysis. Longitudinal rotation direction, peak angle, and time-to-peak rotation were recorded. Results: All patients with CLBBB (n = 21) had clockwise longitudinal rotation with mean four chamber peak rotation angle of −3.9 ± 2.4°. This rotation is significantly larger than in patients with normal QRS (−1.4 ± 3°, p = 0.005) and CRBBB (0.1 ± 2.2°, p = 0.00001). Clockwise rotation was found to be correlated to QRS duration in patients with the non-RBBB pattern. The angle of rotation was not associated with a lower ejection fraction or the presence of regional wall abnormalities. Conclusions: Significant clockwise longitudinal rotation was found in CLBBB patients compared to normal QRS or CRBBB patients using speckle-tracking echocardiography. Full article

(This article belongs to the Special Issue Cardiac Electrophysiology: Clinical Advances and Practice Updates)

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11 pages, 1228 KiB

Open AccessArticle

Can the Norton Scale Score Be Used as an Adjunct Tool for Implantable Defibrillator Patient Selection? A Retrospective Single-Center Cohort Study

by Shir Ben Asher Kestin, Ariel Israel, Eran Leshem, Anat Milman, Avi Sabbag, Ilan Goldengerg, Eyal Nof and Roy Beinart

J. Clin. Med. 2023, 12(1), 214; https://doi.org/10.3390/jcm12010214 - 27 Dec 2022

Cited by 1 | Viewed by 981

Abstract

(1) Background: Implantable cardioverter defibrillators (ICDs) have become the standard of care in the prevention of sudden cardiac death, yet studies have shown that competing causes of death may limit ICD benefits. The Norton scale is a pressure ulcer risk score shown to [...] Read more.

(1) Background: Implantable cardioverter defibrillators (ICDs) have become the standard of care in the prevention of sudden cardiac death, yet studies have shown that competing causes of death may limit ICD benefits. The Norton scale is a pressure ulcer risk score shown to have prognostic value in other fields. The purpose of this study was to assess the use of the Norton scale as an aid for ICD patient selection; (2) Methods: The study was comprised of consecutive patients who underwent defibrillator implantation at Sheba Medical Center between 2008 and 2016. A competing risk analysis was performed to assess the likelihood of death prior to device therapy; (3) Results: 695 patients were included. A total of 59 (8.5%) patients had low admission Norton scale score (ANSS) (≤14), 81 (11.7%) had intermediate ANSS (15–17), and the remainder (79.8%) had high (18–20) ANSS. The cumulative probability of all-cause mortality within one year of ICD implantation in patients with low ANSS was 30%, compared with 20% and 7% among the intermediate- and high-ANSS groups, respectively. Moreover, the one-year mortality rate without ICD therapy in low-ANSS patients was over four-fold compared with that of high-ANSS patients (33% versus 7%, p < 0.0001); (4) Conclusions: The Norton scale could be a useful additional tool in predicting the life expectancy of ICD candidates, thereby improving patient selection. Full article

(This article belongs to the Special Issue Cardiac Electrophysiology: Clinical Advances and Practice Updates)

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11 pages, 786 KiB

Open AccessFeature PaperArticle

Is Less Always More? A Prospective Two-Centre Study Addressing Clinical Outcomes in Leadless versus Transvenous Single-Chamber Pacemaker Recipients

by Michele Bertelli, Sebastiano Toniolo, Matteo Ziacchi, Alessio Gasperetti, Marco Schiavone, Roberto Arosio, Claudio Capobianco, Gianfranco Mitacchione, Giovanni Statuto, Andrea Angeletti, Cristian Martignani, Igor Diemberger, Giovanni Battista Forleo and Mauro Biffi

J. Clin. Med. 2022, 11(20), 6071; https://doi.org/10.3390/jcm11206071 - 14 Oct 2022

Cited by 7 | Viewed by 1250 | Correction

Abstract

(1) Background: Leadless (LL) stimulation is perceived to lower surgical, vascular, and lead-related complications compared to transvenous (TV) pacemakers, yet controlled studies are lacking and real-life experience is non-conclusive. (2) Aim: To prospectively analyse survival and complication rates in leadless versus transvenous VVIR [...] Read more.

(1) Background: Leadless (LL) stimulation is perceived to lower surgical, vascular, and lead-related complications compared to transvenous (TV) pacemakers, yet controlled studies are lacking and real-life experience is non-conclusive. (2) Aim: To prospectively analyse survival and complication rates in leadless versus transvenous VVIR pacemakers. (3) Methods: Prospective analysis of mortality and complications in 344 consecutive VVIR TV and LL pacemaker recipients between June 2015 and May 2021. Indications for VVIR pacing were “slow” AF, atrio-ventricular block in AF or in sinus rhythm in bedridden cognitively impaired patients. LL indication was based on individualised clinical judgement. (4) Results: 72 patients received LL and 272 TV VVIR pacemakers. LL pacemaker indications included ongoing/expected chronic haemodialysis, superior venous access issues, active lifestyle with low pacing percentage expected, frailty causing high bleeding/infectious risk, previous valvular endocarditis, or device infection requiring extraction. No significant difference in the overall acute and long-term complication rate was observed between LL and TV cohorts, with greater mortality occurring in TV due to selection of older patients. (5) Conclusions: Given the low complication rate and life expectancy in this contemporary VVIR cohort, extending LL indications to all VVIR candidates is unlikely to provide clear-cut benefits. Considering the higher costs of LL technology, careful patient selection is mandatory for LL PMs to become advantageous, i.e., in the presence of vascular access issues, high bleeding/infectious risk, and long life expectancy, rendering lead-related issues and repeated surgery relevant in the long-term perspective. Full article

(This article belongs to the Special Issue Cardiac Electrophysiology: Clinical Advances and Practice Updates)

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3 pages, 205 KiB

Open AccessReply

Reply to Kataoka, N.; Imamura, T. How to Improve Clinical Outcomes in Patients with Tachycardia-Induced Cardiomyopathy. Comment on “Katz et al. Long-Term Outcomes of Tachycardia-Induced Cardiomyopathy Compared with Idiopathic Dilated Cardiomyopathy. J. Clin. Med. 2023, 12, 1412”

by Moshe Katz, Amit Meitus, Michael Arad, Anthony Aizer, Eyal Nof and Roy Beinart

J. Clin. Med. 2023, 12(18), 5849; https://doi.org/10.3390/jcm12185849 - 08 Sep 2023

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Abstract

In a letter to the editor titled “How to improve clinical outcomes in patients with tachycardia-induced cardiomyopathy”, Dr. Naoya Kataoka and Dr. Teruhiko Imamura [...] Full article

(This article belongs to the Special Issue Cardiac Electrophysiology: Clinical Advances and Practice Updates)

2 pages, 171 KiB

Open AccessComment

How to Improve Clinical Outcomes in Patients with Tachycardia-Induced Cardiomyopathy. Comment on Katz et al. Long-Term Outcomes of Tachycardia-Induced Cardiomyopathy Compared with Idiopathic Dilated Cardiomyopathy. J. Clin. Med. 2023, 12, 1412

by Naoya Kataoka and Teruhiko Imamura

J. Clin. Med. 2023, 12(15), 5065; https://doi.org/10.3390/jcm12155065 - 01 Aug 2023

Cited by 1 | Viewed by 383

Abstract

The clinical course of tachycardia-induced cardiomyopathy (TICM) has not yet been well studied thus far [...] Full article

(This article belongs to the Special Issue Cardiac Electrophysiology: Clinical Advances and Practice Updates)

3 pages, 4318 KiB

Open AccessCorrection

Correction: Bertelli et al. Is Less Always More? A Prospective Two-Centre Study Addressing Clinical Outcomes in Leadless versus Transvenous Single-Chamber Pacemaker Recipients. J. Clin. Med. 2022, 11, 6071

by Michele Bertelli, Sebastiano Toniolo, Matteo Ziacchi, Alessio Gasperetti, Marco Schiavone, Roberto Arosio, Claudio Capobianco, Gianfranco Mitacchione, Giovanni Statuto, Andrea Angeletti, Cristian Martignani, Igor Diemberger, Giovanni Battista Forleo and Mauro Biffi

J. Clin. Med. 2023, 12(6), 2311; https://doi.org/10.3390/jcm12062311 - 16 Mar 2023

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Abstract

The authors wish to make the following corrections to this paper [...] Full article

(This article belongs to the Special Issue Cardiac Electrophysiology: Clinical Advances and Practice Updates)

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