212 results found
Butcher CJ, Cantor E, Sohaib A, et al., 2023, NVariation in Optimal Haemodynamic Atrio-ventricular Delay of Biventricular Pacing with Different Endocardial Left Ventricular Lead Locations using Precision Haemodynamics., J Cardiovasc Electrophysiol
BACKGROUND: It is not known whether the optimal Atrioventricular delay (AVopt ) varies between left ventricular (LV) pacing site during endocardial biventricular pacing (BiVP) and may therefore needs consideration. METHODS: We assessed the haemodynamic AVopt in patients with chronic heart failure undergoing endocardial LV lead implantation. AVopt was assessed during atrio-biventricular pacing (BVP) with a "roving LV lead". Up to four locations were studied: mid lateral wall, mid septum (or a close alternative), site of greatest haemodynamic improvement and LV lead implant site. The AVopt was compared to a fixed AV delay of 180ms. RESULTS: Seventeen patients were included (12 male, aged 66.5 +/- 12.8 years, ejection fraction 26 +/- 7%, 16 left bundle branch block or high percentage of right ventricular pacing (RVP), QRS duration 167 +/-27 ms). In most locations (62/63), AVopt increased systolic blood pressure during BiVP compared with RVP (relative improvement 6 mmHg, IQR 4-9mmHg). Compared to a fixed AV delay the haemodynamic improvement at AVopt was higher (1mmHg, IQR 0.2-2.6mmHg, p<0.001). Within most patients (16/17), we observed a difference in AVopt between pacing sites (median paced AVopt 209 ms, IQR 117-250). Within this range, the haemodynamic impact of these differences was small (median loss 0.6 mmHg, IQR 0.1-2.6mmHg). CONCLUSION: Within a patient, different endocardial LV lead locations have slightly different haemodynamic AVopt which are superior to a fixed AV delay. The haemodynamic consequence of applying an optimum from a different lead location is small. This article is protected by copyright. All rights reserved.
Ali N, Arnold AD, Miyazawa AA, et al., 2023, Comparison of methods for delivering cardiac resynchronization therapy: an acute electrical and haemodynamic within-patient comparison of left bundle branch area, His bundle, and biventricular pacing, EP Europace, Pages: 1-8, ISSN: 1099-5129
AimsLeft bundle branch area pacing (LBBAP) is a promising method for delivering cardiac resynchronization therapy (CRT), but its relative physiological effectiveness compared with His bundle pacing (HBP) is unknown. We conducted a within-patient comparison of HBP, LBBAP, and biventricular pacing (BVP).Methods and resultsPatients referred for CRT were recruited. We assessed electrical response using non-invasive mapping, and acute haemodynamic response using a high-precision haemodynamic protocol. Nineteen patients were recruited: 14 male, mean LVEF of 30%. Twelve had time for BVP measurements. All three modalities reduced total ventricular activation time (TVAT), (ΔTVATHBP -43 ± 14 ms and ΔTVATLBBAP −35 ± 20 ms vs. ΔTVATBVP −19 ± 30 ms, P = 0.03 and P = 0.1, respectively). HBP produced a significantly greater reduction in TVAT compared with LBBAP in all 19 patients (−46 ± 15 ms, −36 ± 17 ms, P = 0.03). His bundle pacing and LBBAP reduced left ventricular activation time (LVAT) more than BVP (ΔLVATHBP −43 ± 16 ms, P < 0.01 vs. BVP, ΔLVATLBBAP −45 ± 17 ms, P < 0.01 vs. BVP, ΔLVATBVP −13 ± 36 ms), with no difference between HBP and LBBAP (P = 0.65). Acute systolic blood pressure was increased by all three modalities. In the 12 with BVP, greater improvement was seen with HBP and LBBAP (6.4 ± 3.8 mmHg BVP, 8.1 ± 3.8 mmHg HBP, P = 0.02 vs. BVP and 8.4 ± 8.2 mmHg for LBBAP, P = 0.3 vs. BVP), with no difference between HBP and LBBAP (P = 0.8).ConclusionHBP delivered better ventricular resynchronization than LBBAP because right ventricular activation was slower during LBBAP. But LBBAP was not inferior to HBP with respect to LV electrical resynchronization and acute haemodynamic response.
Whinnett ZI, Shun-Shin MJ, Tanner M, et al., 2023, Effects of haemodynamically atrio-ventricular optimized His bundle pacing on heart failure symptoms and exercise capacity: the His Optimized Pacing Evaluated for Heart Failure (HOPE-HF) randomized, double-blind, cross-over trial., Eur J Heart Fail, Vol: 25, Pages: 274-283
AIMS: Excessive prolongation of PR interval impairs coupling of atrio-ventricular (AV) contraction, which reduces left ventricular pre-load and stroke volume, and worsens symptoms. His bundle pacing allows AV delay shortening while maintaining normal ventricular activation. HOPE-HF evaluated whether AV optimized His pacing is preferable to no-pacing, in a double-blind cross-over fashion, in patients with heart failure, left ventricular ejection fraction (LVEF) ≤40%, PR interval ≥200 ms and either QRS ≤140 ms or right bundle branch block. METHODS AND RESULTS: Patients had atrial and His bundle leads implanted (and an implantable cardioverter-defibrillator lead if clinically indicated) and were randomized to 6 months of pacing and 6 months of no-pacing utilizing a cross-over design. The primary outcome was peak oxygen uptake during symptom-limited exercise. Quality of life, LVEF and patients' holistic symptomatic preference between arms were secondary outcomes. Overall, 167 patients were randomized: 90% men, 69 ± 10 years, QRS duration 124 ± 26 ms, PR interval 249 ± 59 ms, LVEF 33 ± 9%. Neither peak oxygen uptake (+0.25 ml/kg/min, 95% confidence interval [CI] -0.23 to +0.73, p = 0.3) nor LVEF (+0.5%, 95% CI -0.7 to 1.6, p = 0.4) changed with pacing but Minnesota Living with Heart Failure quality of life improved significantly (-3.7, 95% CI -7.1 to -0.3, p = 0.03). Seventy-six percent of patients preferred His bundle pacing-on and 24% pacing-off (p < 0.0001). CONCLUSION: His bundle pacing did not increase peak oxygen uptake but, under double-blind conditions, significantly improved quality of life and was symptomatically preferred by the clear majority of patients. Ventricular pacing delivered via the His bundle did not adversely impact ventricular function during the
Sau A, 2023, Artificial intelligence-enabled electrocardiogram to distinguish atrioventricular re-entrant tachycardia from atrioventricular nodal re-entrant tachycardia, Cardiovascular Digital Health Journal, Pages: 1-8, ISSN: 2666-6936
BackgroundAccurately determining arrhythmia mechanism from a 12-lead electrocardiogram (ECG) of supraventricular tachycardia can be challenging. We hypothesized a convolutional neural network (CNN) can be trained to classify atrioventricular re-entrant tachycardia (AVRT) vs atrioventricular nodal re-entrant tachycardia (AVNRT) from the 12-lead ECG, when using findings from the invasive electrophysiology (EP) study as the gold standard.MethodsWe trained a CNN on data from 124 patients undergoing EP studies with a final diagnosis of AVRT or AVNRT. A total of 4962 5-second 12-lead ECG segments were used for training. Each case was labeled AVRT or AVNRT based on the findings of the EP study. The model performance was evaluated against a hold-out test set of 31 patients and compared to an existing manual algorithm.ResultsThe model had an accuracy of 77.4% in distinguishing between AVRT and AVNRT. The area under the receiver operating characteristic curve was 0.80. In comparison, the existing manual algorithm achieved an accuracy of 67.7% on the same test set. Saliency mapping demonstrated the network used the expected sections of the ECGs for diagnoses; these were the QRS complexes that may contain retrograde P waves.ConclusionWe describe the first neural network trained to differentiate AVRT from AVNRT. Accurate diagnosis of arrhythmia mechanism from a 12-lead ECG could aid preprocedural counseling, consent, and procedure planning. The current accuracy from our neural network is modest but may be improved with a larger training dataset.
Arnold AD, Shun-Shin MJ, Ali N, et al., 2023, Contributions of Atrioventricular Delay Shortening and Ventricular Resynchronization to Hemodynamic Benefits of Biventricular Pacing., JACC Clin Electrophysiol, Vol: 9, Pages: 117-119
Kanagaratnam P, McCready J, Tayebjee M, et al., 2022, Ablation versus anti-arrhythmic therapy for reducing all hospital episodes from recurrent atrial fibrillation: a prospective, randomized, multi-centre, open label trial, EP Europace, ISSN: 1099-5129
Aims:There is rising healthcare utilization related to the increasing incidence and prevalence of atrial fibrillation (AF) worldwide. Simplifying therapy and reducing hospital episodes would be a valuable development. The efficacy of a streamlined AF ablation approach was compared to drug therapy and a conventional catheter ablation technique for symptom control in paroxysmal AF.Methods and results:We recruited 321 patients with symptomatic paroxysmal AF to a prospective randomized, multi-centre, open label trial at 13 UK hospitals. Patients were randomized 1:1:1 to cryo-balloon ablation without electrical mapping with patients discharged same day [Ablation Versus Anti-arrhythmic Therapy for Reducing All Hospital Episodes from Recurrent (AVATAR) protocol]; optimization of drug therapy; or cryo-balloon ablation with confirmation of pulmonary vein isolation and overnight hospitalization. The primary endpoint was time to any hospital episode related to treatment for atrial arrhythmia. Secondary endpoints included complications of treatment and quality-of-life measures. The hazard ratio (HR) for a primary endpoint event occurring when comparing AVATAR protocol arm to drug therapy was 0.156 (95% CI, 0.097–0.250; P < 0.0001 by Cox regression). Twenty-three patients (21%) recorded an endpoint event in the AVATAR arm compared to 76 patients (74%) within the drug therapy arm. Comparing AVATAR and conventional ablation arms resulted in a non-significant HR of 1.173 (95% CI, 0.639–2.154; P = 0.61 by Cox regression) with 23 patients (21%) and 19 patients (18%), respectively, recording primary endpoint events (P = 0.61 by log-rank test).Conclusion:The AVATAR protocol was superior to drug therapy for avoiding hospital episodes related to AF treatment, but conventional cryoablation was not superior to the AVATAR protocol. This could have wide-ranging implications on how demand for AF symptom control is met.Trial registrationClinical Trials Registration: NCT02459574.
Huang W, Wang S, Su L, et al., 2022, His-bundle pacing vs biventricular pacing following atrioventricular nodal ablation in patients with atrial fibrillation and reduced ejection fraction: A multicenter, randomized, crossover study-The ALTERNATIVE-AF trial, HEART RHYTHM, Vol: 19, Pages: 1948-1955, ISSN: 1547-5271
- Author Web Link
- Citations: 7
Kaza N, Htun V, Miyazawa A, et al., 2022, Upgrading right ventricular pacemakers to biventricular pacing or conduction system pacing: a systematic review and meta-analysis, EUROPACE, ISSN: 1099-5129
Simader FA, Howard JP, Ahmad Y, et al., 2022, Catheter ablation improves cardiovascular outcomes in patients with atrial fibrillation and heart failure: a meta-analysis of randomized controlled trials, EUROPACE, ISSN: 1099-5129
- Author Web Link
- Citations: 1
Cai M, Wu S, Wang S, et al., 2022, Left Bundle Branch Pacing Postatrioventricular Junction Ablation for Atrial Fibrillation: Propensity Score Matching With His Bundle Pacing, CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY, Vol: 15, ISSN: 1941-3149
- Author Web Link
- Citations: 3
Sau A, Ibrahim S, Ahmed A, et al., 2022, Artificial intelligence-enabled electrocardiogram to distinguish cavotricuspid isthmus dependence from other atrial tachycardia mechanisms, European Heart Journal – Digital Health, Vol: 3, Pages: 405-414, ISSN: 2634-3916
Aims:Accurately determining atrial arrhythmia mechanisms from a 12-lead electrocardiogram (ECG) can be challenging. Given the high success rate of cavotricuspid isthmus (CTI) ablation, identification of CTI-dependent typical atrial flutter (AFL) is important for treatment decisions and procedure planning. We sought to train a convolutional neural network (CNN) to classify CTI-dependent AFL vs. non-CTI dependent atrial tachycardia (AT), using data from the invasive electrophysiology (EP) study as the gold standard.Methods and results:We trained a CNN on data from 231 patients undergoing EP studies for atrial tachyarrhythmia. A total of 13 500 five-second 12-lead ECG segments were used for training. Each case was labelled CTI-dependent AFL or non-CTI-dependent AT based on the findings of the EP study. The model performance was evaluated against a test set of 57 patients. A survey of electrophysiologists in Europe was undertaken on the same 57 ECGs. The model had an accuracy of 86% (95% CI 0.77–0.95) compared to median expert electrophysiologist accuracy of 79% (range 70–84%). In the two thirds of test set cases (38/57) where both the model and electrophysiologist consensus were in agreement, the prediction accuracy was 100%. Saliency mapping demonstrated atrial activation was the most important segment of the ECG for determining model output.Conclusion:We describe the first CNN trained to differentiate CTI-dependent AFL from other AT using the ECG. Our model matched and complemented expert electrophysiologist performance. Automated artificial intelligence-enhanced ECG analysis could help guide treatment decisions and plan ablation procedures for patients with organized atrial arrhythmias.
Knops RE, Pepplinkhuizen S, Delnoy PPHM, et al., 2022, Device-related complications in subcutaneous versus transvenous ICD: a secondary analysis of the PRAETORIAN trial, EUROPEAN HEART JOURNAL, Vol: 43, Pages: 4872-4883, ISSN: 0195-668X
- Author Web Link
- Citations: 2
Jastrzebski M, Kielbasa G, Cano O, et al., 2022, Left bundle branch area pacing outcomes: the multicentre European MELOS study, EUROPEAN HEART JOURNAL, Vol: 43, Pages: 4161-+, ISSN: 0195-668X
- Author Web Link
- Citations: 9
Vijayaraman P, Cano O, Ponnusamy SS, et al., 2022, Left bundle branch area pacing in patients with heart failure and right bundle branch block: Results from International LBBAP Collaborative-Study Group, HEART RHYTHM O2, Vol: 3, Pages: 358-367, ISSN: 2666-5018
- Author Web Link
- Citations: 6
Perl L, Meerkin D, D'amario D, et al., 2022, The V-LAP System for Remote Left Atrial Pressure Monitoring of Patients With Heart Failure Remote Left Atrial Pressure Monitoring, JOURNAL OF CARDIAC FAILURE, Vol: 28, Pages: 963-972, ISSN: 1071-9164
- Author Web Link
- Citations: 6
Miyazawa AA, Francis DP, Whinnett ZI, 2022, Basic Principles of Hemodynamics in Pacing., Card Electrophysiol Clin, Vol: 14, Pages: 133-140
Pacing therapy aims to improve overall cardiac function by normalizing cardiac electrical activation. Although hemodynamic measurements allow the impact of cardiac pacing on cardiac function to be quantified, the protocol is crucial to minimize the effect of noise and achieve greater precision. Multiple steps can be undertaken to optimize accuracy of hemodynamic measurements. These include comparing with a reference state, using an average of a set number of beats, making repeated measurements, ensuring all beats are included, and pacing at faster heart rates. These measurements can aid comparison between different pacing modalities and guide optimal programming.
Kaza N, Keene D, Whinnett ZI, 2022, Generating Evidence to Support the Physiologic Promise of Conduction System Pacing: Status and Update on Conduction System Pacing Trials., Card Electrophysiol Clin, Vol: 14, Pages: 345-355
Conduction system pacing avoids the potential deleterious effects of right ventricular pacing in patients with bradycardia and provides an alternative approach to cardiac resynchronization therapy. We focus on the available observational and randomized evidence and review studies supporting the safety, feasibility, and physiologic promise of conduction system approaches. We evaluate the randomized data generated from the available clinical trials of conduction system pacing, which have led to the recent inclusion of CSP in international guidelines. The scope for future randomized trials will building on the physiologic promise of conduction system approaches and offering information on clinical end points is explored.
Nagy SZ, Kasi P, Afonso VX, et al., 2022, Cycle length evaluation in persistent atrial fibrillation using kernel density estimation to identify transient and stable rapid atrial activity, Cardiovascular Engineering and Technology, Vol: 13, Pages: 219-233, ISSN: 1869-408X
PurposeLeft atrial (LA) rapid AF activity has been shown to co-localise with areas of successful atrial fibrillation termination by catheter ablation. We describe a technique that identifies rapid and regular activity.MethodsEight-second AF electrograms were recorded from LA regions during ablation for psAF. Local activation was annotated manually on bipolar signals and where these were of poor quality, we inspected unipolar signals. Dominant cycle length (DCL) was calculated from annotation pairs representing a single activation interval, using a probability density function (PDF) with kernel density estimation. Cumulative annotation duration compared to total segment length defined electrogram quality. DCL results were compared to dominant frequency (DF) and averaging.ResultsIn total 507 8 s AF segments were analysed from 7 patients. Spearman’s correlation coefficient was 0.758 between independent annotators (P < 0.001), 0.837–0.94 between 8 s and ≥ 4 s segments (P < 0.001), 0.541 between DCL and DF (P < 0.001), and 0.79 between DCL and averaging (P < 0.001). Poorer segment organization gave greater errors between DCL and DF.ConclusionDCL identifies rapid atrial activity that may represent psAF drivers. This study uses DCL as a tool to evaluate the dynamic, patient specific properties of psAF by identifying rapid and regular activity. If automated, this technique could rapidly identify areas for ablation in psAF.
Kim M-Y, Coyle C, Tomlinson DR, et al., 2022, Ectopy-triggering ganglionated plexus ablation to prevent atrial fibrillation: GANGLIA-AF study., Heart Rhythm, Vol: 19, Pages: 516-524, ISSN: 1547-5271
BACKGROUND: The ganglionated plexuses (GP) of the intrinsic cardiac autonomic system may play a role in atrial fibrillation (AF). OBJECTIVES: We hypothesized that ablating the ectopy-triggering GPs (ET-GP) prevents AF. METHODS: GANGLIA-AF (NCT02487654) was a prospective, randomized, controlled, 3-centre trial. ET-GP were mapped using high frequency stimulation (HFS), delivered within the atrial refractory period and ablated until non-functional. If triggered AF became incessant, atrioventricular dissociating GPs (AVD-GP) were ablated. We compared GP ablation (GPA) without pulmonary vein isolation (PVI) against PVI, in patients with paroxysmal AF. Follow-up was for 12 months including 3-monthly 48hr Holter monitors. The primary endpoint was documented ≥30s atrial arrhythmia after a 3-month blanking period. RESULTS: 102 randomized patients were analysed on a per-protocol basis after GPA (n=52) or PVI (n=50). GPA patients had 89±26 HFS sites tested, identifying median 18.5 (IQR 16; 21%) GPs. RF ablation time in GPA was 22.9±9.8mins and 38±14.4mins in PVI (p<0.0001). The freedom from ≥30s atrial arrhythmia at 12-month follow-up with GPA was 50% (26/52) vs 64% (32/50) with PVI (log rank p=0.09). ET-GP ablation without AVD-GP ablation achieved 58% (22/38) freedom from the primary endpoint. There was a significantly higher reduction in AAD usage post-ablation after GPA vs PVI (55.5% vs 36%; p=0.05). Patients were referred for redo ablations in 31% (16/52) after GPA and 24% (12/50) after PVI (p=0.53). CONCLUSIONS: GPA did not prevent atrial arrhythmias more than PVI. However, less RF ablation was delivered to achieve a higher reduction in AAD usage with GPA than PVI.
Knops RE, van der Stuijt W, Delnoy PPHM, et al., 2022, Efficacy and Safety of Appropriate Shocks and Antitachycardia Pacing in Transvenous and Subcutaneous Implantable Defibrillators: Analysis of All Appropriate Therapy in the PRAETORIAN Trial, CIRCULATION, Vol: 145, Pages: 321-329, ISSN: 0009-7322
- Author Web Link
- Citations: 7
Keene D, Miyazawa AA, Johal M, et al., 2022, Optimizing atrio-ventricular delay in pacemakers using potentially implantable physiological biomarkers, PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, Vol: 45, Pages: 461-470, ISSN: 0147-8389
Ribeiro HDM, Arnold A, Howard JP, et al., 2022, ECG-based real-time arrhythmia monitoring using quantized deep neural networks: A feasibility study, COMPUTERS IN BIOLOGY AND MEDICINE, Vol: 143, ISSN: 0010-4825
- Author Web Link
- Citations: 8
Glikson M, Nielsen JC, Kronborg MB, et al., 2022, 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy., Europace, Vol: 24, Pages: 71-164, ISSN: 1099-5129
Ng GA, Mistry A, Newton M, et al., 2022, Rationale and study design of the MINERVA study: Multicentre Investigation of Novel Electrocardiogram Risk markers in Ventricular Arrhythmia prediction-UK multicentre collaboration, BMJ OPEN, Vol: 12, ISSN: 2044-6055
Whinnett Z, Tanner M, Chandrasekaran B, et al., 2021, His-Optimized Pacing in Patients With a Long PR Interval, Narrow QRS and Heart Failure: Results of the Hope-hf Clinical Trial, Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: E587-E587, ISSN: 0009-7322
Huang W, Wang S, Su L, et al., 2021, Comparison of Benefits Between His Bundle Pacing and Bi-Ventricular Pacing For Heart Failure in Atrial Fibrillation Post Atrial-Ventricular Node Ablation: The Alternative Study, Scientific Sessions of the American-Heart-Association / Resuscitation Science Symposium, Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: E580-E580, ISSN: 0009-7322
Whinnett Z, Tanner M, Chandrasekaran B, et al., 2021, His-Optimized Pacing in Patients With a Long PR Interval, Narrow QRS and Heart Failure: Results of the Hope-hf Clinical Trial, Scientific Sessions of the American-Heart-Association / Resuscitation Science Symposium, Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: E587-E587, ISSN: 0009-7322
Huang W, Wang S, Su L, et al., 2021, Comparison of Benefits Between His Bundle Pacing and Bi-Ventricular Pacing For Heart Failure in Atrial Fibrillation Post Atrial-Ventricular Node Ablation: The Alternative Study, Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: E580-E580, ISSN: 0009-7322
Gould J, Claridge S, Jackson T, et al., 2021, Standard care vs. TRIVEntricular pacing in Heart Failure (STRIVE HF): a prospective multicentre randomized controlled trial of triventricular pacing vs. conventional biventricular pacing in patients with heart failure and intermediate QRS left bundle branch block, EUROPACE, Vol: 24, Pages: 796-806, ISSN: 1099-5129
Perl L, Meerkin D, D'Amario D, et al., 2021, Initial Results From the VECTOR-HF Trial-A System for Remote Left Atrial Pressure Monitoring for Patients With Heart Failure, Publisher: ELSEVIER SCIENCE INC, Pages: B55-B55, ISSN: 0735-1097
- Author Web Link
- Citations: 1
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.