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The aim of this document is to provide guidance for the management of women and birthing people with a permanent pacemaker (PPM) or implantable cardioverter defibrillator (ICD). Cardiac devices are becoming more common in obstetric practice and a reference document for contemporary evidence‐based practice is required. Where evidence is limited, expert consensus has established recommendations. The purpose is to improve safety and reduce the risk of adverse events relating to implanted cardiac devices during pregnancy, birth and the postnatal period. [ABSTRACT FROM AUTHOR]

Implantable cardioverter-defibrillators (ICD) are increasingly being used among the pediatric population for indications of both primary and secondary prevention. There is limited long-term data on the outcomes of pediatric patients following ICD implantation. The aim of this study was to investigate the characteristics of this population, burden of appropriate and inappropriate shock and complication rate in a large tertiary pediatric medical center. Included were children under the age of 18 years who underwent ICD implantation and had clinical follow up at our center. Data were retrospectively collected between study period 2005–2020. Primary outcome was the incidence of ICD shock appropriate and inappropriate. Secondary outcome was defining our patient population characteristics. Our cohort included 51 patients who underwent ICD implantation. Mean age at implantation was 10.9 ± 4.7 years and average follow-up time was 67 months. Diagnoses of implanted patients were: 28 (55%) patients with syndromes with risk for sudden death, cardiomyopathy in 14 patients (27%) and congenital heart disease (CHD) in 9 patients (18%). Forty-two (82%) patients had an ICD implanted for secondary prevention after experiencing a life-threatening arrhythmia and 9 (18%) for primary prevention. An endocardial system was implanted in 39 (76%) patients and an epicardial systems in 12 (24%) patients. A total of 20 (39%) patients received appropriate shocks for ventricular fibrillation(VF). 5 patients received inappropriate shocks, 4 due to sinus tachycardia and 1 due to rapidly conducted atrial fibrillation. Those who received an inappropriate shock had a significantly shorter ICD-programmed VF detection cycle length compared to those who did not receive an inappropriate shock (320 ms versus 270 ms, p = 0.062). This single center study demonstrates a high rate of appropriate ICD shocks (39%) and a low rate of inappropriate ICD shocks. Accurate programming of ICD devices in the pediatric population is paramount to avoid inappropriate ICD shocks. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction Methods and Results Conclusion Implantable cardioverter defibrillators (ICDs) lead fractures are rare but serious complications, often leading to inappropriate shocks. The early occurrence of such fractures post‐implantation is exceptionally uncommon.We present a case of a 53‐year‐old male with hypertrophic cardiomyopathy who experienced an inappropriate shock due to a lead fracture just 4 days after ICD implantation. The fractured lead was successfully extracted and replaced using a gooseneck snare passed through an oversized TightRail with no immediate complications.Early lead fractures can occur shortly after ICD implantation, leading to inappropriate shocks. Successful management, including extraction and reimplantation, is possible even in these early cases. Clinicians should remain vigilant, and remote monitoring can play a crucial role in the timely detection of such complications. [ABSTRACT FROM AUTHOR]

Leadless pacemakers (LPs) are self-contained pacemakers implanted inside the heart, providing a clinical strategy of pacing without pacemaker leads or a subcutaneous pocket. From an experimental therapy first used clinically in 2012, a decade later this technology is an established treatment option. Because of technologic advances and growing evidence, LPs are increasingly being used. Herein, the experience gained from a decade of leadless pacing is reviewed. We cover the safety and efficacy of single-chamber LPs, including comparisons with transvenous pacemakers and various models, and the initial clinical results of the first dual-chamber LP system. Furthermore, evidence and considerations regarding the optimal replacement strategy will be covered. Finally, we discuss future device developments that may broaden indications, such as LPs communicating with subcutaneous implantable cardiac defibrillators and energy-harvesting LPs. [Display omitted] • LPs have been designed to avoid lead- and pocket-related complications encountered with conventional transvenous pacemakers. • Single-chamber LPs seem to have less overall short- and long-term complications than transvenous pacemakers, but challenges exist. • The adoption of leadless pacing is dependent on clinical experience, evidence, and technologic advances. [ABSTRACT FROM AUTHOR]

Background: In the contemporary management of heart failure with reduced ejection fraction (HFrEF), the recommended quadruple guideline-directed medical therapy (GDMT) consists of angiotensin receptor-neprilysin inhibitor (ARNI), evidence-based beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), and sodium-glucose cotransporter-2 inhibitors (SGLT-2i). This study explored the impact of adding implantable cardioverter-defibrillator (ICD) therapy to this comprehensive regimen in HFrEF patients. Methods: Utilizing deidentified data from the National Electronic Database of the Turkish Ministry of Health, we conducted a nationwide retrospective cohort study on 5450 HFrEF patients receiving quadruple GDMT, including ARNI. Among them, 709 patients underwent additional ICD or cardiac resynchronization therapy defibrillator (CRT-D) implantation. Propensity score matching ensured balanced baseline characteristics between groups. Primary endpoint was determined as all-cause mortality. Results: In the matched cohort, all-cause mortality occurred in 108 out of 619 patients (17.4%) in the GDMT group and 101 out of 619 patients (16.3%) in the ICD group, with a hazard ratio (HR) of 0.74 and a 95% confidence interval (CI) ranging from 0.57 to 0.98. The median follow-up time was 1365 days in the matched cohort, 1283 days in the GDMT group. Subgroup analyses consistently demonstrated benefits, particularly among individuals aged 61 years and older (HR: 0.60, 95% CI: 0.42–0.87, p = 0.006), those with sinus rhythm (HR: 0.55, 95% CI: 0.34–0.89, p = 0.013), individuals not using amiodarone (HR: 0.61, 95% CI: 0.42–0.89, p = 0.011), and those with an estimated glomerular filtration rate lower than 61.9 (HR: 0.66, 95% CI: 0.48–0.91, p = 0.011). Conclusions: This study may offer a glimmer of hope that even after achieving the best current optimal medical therapy, the addition of device therapy could still yield positive outcomes in the management of patients with HFrEF. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction Methods Results Conclusion Brugada syndrome (BS) is a genetic channelopathy characterized by an increased risk of sudden cardiac death (SCD) in the absence of structural heart disease. Prognostic stratification is necessary to determine which patients are candidates for implantable cardioverter defibrillator (ICD). The present study aims to evaluate EKG changes during exercise stress tests in patients with BS and to identify any poor prognosis variables.This was an observational, case‐control study. Three comparison groups were created: patients with Type 1 BS with or without prior arrhythmic events (BE and BNoE subgroups) and age‐ and sex‐matched healthy individuals. Patients underwent EST and electrocardiographic variables were analyzed.The study recruited 36 patients with type 1 BS, 12 with prior Event (BE) and 24 without (BNoE). Patients in the BE group, in all postexercise recordings, had lower heart rates, notably in the first minute. A significant difference was also observed in the HR drop in the recovery phase, with a greater drop in relation to maximum HR in the first minute in the group of patients who had events.BS patients with prior events had a lower capacity to increase heart rate at peak effort and a greater proportional drop in the recovery phase. No relationship was observed between the occurrence of arrhythmic events and ST‐segment elevation during the exercise test. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims Methods and Results Conclusions This study aimed to determine the relationship between sleep problems, shock pain, and shock anxiety in patients with implantable cardioverter defibrillator (ICD) and the affecting factors.The population of this descriptive cross‐sectional study consisted of all patients who underwent ICD implantation in university hospital (N = 200), and the sample consisted of patients who met the inclusion criteria of the study (n = 132). Data were obtained using a “General Information Form”, the “Florida Shock Anxiety Scale (FSAS)”, the “Epworth Sleepiness Scale (ESS)”, the “Pittsburgh Sleep Quality Index (PSQI)”, and the “Visual Pain Scale (VPS)”. The mean age of the patients was 66.13 years. The VPS was 6.40 ± 3.36; the mean FSAS score was 29.98 ± 8.46; the mean PSQI score was 8.02 ± 3.81; the mean ESS score was 7.59 ± 4.10. PSQI had a statistically significant correlation with the total FSAS score (p < 0.001) and a statistically insignificant correlation with ESS (p > 0.001). Age, sex, marital status, smoking status, cohabitants, previous ICD shocks, the status of lying on ICD, and fear of dislocation of ICD affected the total FSAS score; sex, employment status, history of heart attack, defined sleep disorder, awakening from sleep due to nightmares, and cessation of breathing during sleep affected the total PSQI score; history of previously defined sleep disorder, history of heart attack, use of medication for a sleep disorder, the pain felt when lying on ICD, and pain experienced during ICD shocks affected the total ESS score. The mean shock VPS scores differed between patients who received an ICD shock during sleep and those who were awakened by nightmares.It was found that the shock anxiety and shock pain scores of ICD patients were above average, that they had poor sleep quality, and that their sleepiness was at the level of “normal but increased daytime sleepiness”. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusions The implantable cardioverter defibrillator reduces mortality among patients with heart failure (HF) due to ischemic heart disease. Clinical trial data have called into question the benefit of an ICD in patients with HF due to nonischemic cardiomyopathy (NICM). We developed a risk stratification score for ventricular tachyarrhythmia (VTA) among patients with NICM receiving a primary prevention ICD.The study population comprised 1515 patients with NICM who were enrolled in the landmark MADIT trials. Fine and Gray analysis was used to develop a model to predict the occurrence of VTAs and ICD therapies while accounting for the competing risk of non‐arrhythmic mortality. External validation was carried out in the RAID Trial population.Four risk factors associated with increased risk for VTA were identified: male sex, left ventricular ejection fraction ≤25%, no indication for cardiac resynchronization therapy with a defibrillator (CRT‐D), and Black race. A score was generated based on this model, and patients were stratified into low (N = 390), intermediate (N = 728), and high‐risk (N = 387) groups. The 5‐year cumulative incidences of VTA were 15%, 24%, and 42%, respectively. Application of score groups for the secondary endpoints of Fast VT or VF and Appropriate ICD Shock revealed similar findings. Recurrent event analysis yielded consistent results. The AUC in the validation cohort for the endpoint of Appropriate ICD Shock was 69.3.Our study shows that patients with NICM can be risk stratified using demographic and clinical variables and may be used when evaluating such patients for a primary prevention ICD. [ABSTRACT FROM AUTHOR]

Aims Methods Conclusion Timely referrals for transplantation and left ventricular assist device (LVAD) play a key role in favourable outcomes in patients with advanced heart failure (HF). Cardiovascular mortality, driven by sudden cardiac death, is the main reason for dying while waiting for heart transplantation (HTx). The purpose of the Preventive Catheter Ablation for ventricular arrhythmiaS in patients with end‐sTage heart faiLure rEferred for heart transplantation eValuaTion (CASTLE‐VT) trial is to test the hypothesis that prophylactic catheter ablation of arrhythmogenic ventricular scar tissue will reduce mortality, need for LVAD implantation, and urgent HTx in patients with end‐stage HF related to ischaemic cardiomyopathy (ICM).CASTLE‐VT is a randomized evaluation of prophylactic ablative treatment of arrhythmogenic ventricular scar in patients referred for HTx evaluation and diagnosed with ICM. Ablation will be performed with the use of a substrate‐based approach in which the myocardial scar is mapped and ablated while the heart remains predominantly in sinus rhythm. The primary endpoint is the composite of all‐cause mortality, worsening of HF requiring prioritized transplantation or LVAD implantation. The main secondary study endpoints are all‐cause mortality, cardiovascular mortality, incidence of implantable cardioverter‐defibrillator (ICD) therapy, hospitalizations, quality of life, time to first ICD therapy, number of device‐detected ventricular tachycardia/ventricular fibrillation episodes, left ventricular function, and exercise tolerance. CASTLE‐VT will randomize 160 patients with a follow‐up period of 2 years.CASTLE‐VT will determine whether prophylactic catheter ablation of arrhythmogenic ventricular scar tissue reduces mortality in patients with end‐stage HF who are referred for HTx evaluation. [ABSTRACT FROM AUTHOR]

Background and Aims Risk stratification of sudden cardiac death after myocardial infarction and prevention by defibrillator rely on left ventricular ejection fraction (LVEF). Improved risk stratification across the whole LVEF range is required for decision-making on defibrillator implantation. Methods The analysis pooled 20 data sets with 140 204 post-myocardial infarction patients containing information on demographics, medical history, clinical characteristics, biomarkers, electrocardiography, echocardiography, and cardiac magnetic resonance imaging. Separate analyses were performed in patients (i) carrying a primary prevention cardioverter-defibrillator with LVEF ≤ 35% [implantable cardioverter-defibrillator (ICD) patients], (ii) without cardioverter-defibrillator with LVEF ≤ 35% (non-ICD patients ≤ 35%), and (iii) without cardioverter-defibrillator with LVEF > 35% (non-ICD patients >35%). Primary outcome was sudden cardiac death or, in defibrillator carriers, appropriate defibrillator therapy. Using a competing risk framework and systematic internal–external cross-validation, a model using LVEF only, a multivariable flexible parametric survival model, and a multivariable random forest survival model were developed and externally validated. Predictive performance was assessed by random effect meta-analysis. Results There were 1326 primary outcomes in 7543 ICD patients, 1193 in 25 058 non-ICD patients ≤35%, and 1567 in 107 603 non-ICD patients >35% during mean follow-up of 30.0, 46.5, and 57.6 months, respectively. In these three subgroups, LVEF poorly predicted sudden cardiac death (c -statistics between 0.50 and 0.56). Considering additional parameters did not improve calibration and discrimination, and model generalizability was poor. Conclusions More accurate risk stratification for sudden cardiac death and identification of low-risk individuals with severely reduced LVEF or of high-risk individuals with preserved LVEF was not feasible, neither using LVEF nor using other predictors. [ABSTRACT FROM AUTHOR]

This case report presents a notable instance of subcutaneous implantable cardioverter defibrillator (S-ICD) implantation in a 9-year-old patient diagnosed with Timothy syndrome (TS), which is a rare condition characterized by mutations in the CACNA1c gene. Conventional therapies often have limited efficacy in managing TS. This case is significant, as it represents the youngest age for S-ICD implantation recorded in mainland China. While the absence of ventricular arrhythmias during hospitalization and follow-up is encouraging, it is not sufficient to conclusively establish the safety and feasibility of this intervention in young TS patients. Further research is needed to evaluate the long-term outcomes and to consider S-ICD as a potential standard treatment option for TS. Additionally, there is a need for a more detailed exploration of the molecular mechanisms underlying gene therapy and personalized interventions. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction Methods Results Conclusions The subcutaneous implantable cardioverter defibrillator (S‐ICD) is an alternative to a transvenous ICD in patients who meet the criteria for ICD implantation without concurrent need for cardiac pacing. The objective of this study is to examine the rates of and indications for S‐ICD removal and extraction.A retrospective analysis of all patients who underwent S‐ICD implantation between 2010 and 2022 at a single multihospital healthcare system was performed. The primary endpoint was S‐ICD removal or extraction. Patient and device characteristics were abstracted from the electronic medical record. Univariate and multivariate analyses were completed to determine factors associated with S‐ICD extraction.A total of 372 patients (69.5% male; 48.6 ± 14.4 years old) underwent S‐ICD implantation during the study period. There were 22 (5.9%) patients (81.8% male; 52.1 ± 13.2 years old) who underwent S‐ICD extraction over a median follow‐up period of 4.4 [2.0−6.5] years. The median length of time between implantation and extraction was 39.6 [8.3−64.6] months. The most common indications for S‐ICD extraction were the need for bradycardia pacing (frequency among extractions, 18.2%), infection (22.7%), and inappropriate shocks due to oversensing (22.7%). A smoking history and higher body mass index were independently associated with S‐ICD extraction.The overall rate of S‐ICD extraction over 4.4 [2.0−6.5] years was 5.9%, with the most common indications for extraction being the need for bradycardia pacing, infection, and inappropriate shocks due to oversensing. A smoking history and high body mass index are associated with increased rates of S‐ICD extraction. With appropriate patient selection for the S‐ICD, the need to remove the device after implantation is low. [ABSTRACT FROM AUTHOR]

The historical restriction of magnetic resonance imaging (MRI) for patients with cardiac implantable electronic devices (CIEDs) has been lifted by certified MRI-conditional systems in recent years. Mixed-brand CIED systems consisting of a generator from one manufacturer and at least one lead from another manufacturer are not certified for MRI. We evaluated the temporal trend in the prevalence of mixed-brand systems in the era of MRI-conditional systems. Data were analyzed on 5853 CIEDs implanted de novo between 2012 and 2022 in 81 Italian centers linked to the nationwide Home Monitoring Expert Alliance network. The percentage of mixed-brand implants was calculated by device type (pacemaker, implantable cardioverter-defibrillator [ICD], cardiac resynchronization therapy [CRT] device) and over time. A mixed-brand system was implanted in 4.1% (95% CI, 3.6-4.6%) of analyzed patients or, by device type, in 4.5% (3.5-5.7%) of pacemaker patients, 1.1% (0.7-1.7%) of ICD patients, and 6.8% (5.7-7.9%) of CRT pacemaker/defibrillator patients (p < 0.001). Prevalence of mixed-brand implants exhibited significant temporal fluctuations, first declining from 6.6% (2012–2014) to 1.3% (2019), and then increasing to 5.1% (2022). Temporal changes were statistically significant for pacemakers (p < 0.001) and CRT devices (p = 0.001), but not for ICDs (p = 0.438). In the decade between 2012 and 2022, mixed-brand CIED systems were more prevalent in patients treated with pacemakers and CRT devices than in ICD recipients. A decline in the prevalence of mixed-brand systems was observed after the introduction of MRI-conditional systems, reaching a minimum in 2019, followed by a progressive increase in the subsequent years. [ABSTRACT FROM AUTHOR]

Background: Implantable Cardioverter-Defibrillator (ICD) implantation is a life-saving intervention for individuals at risk of life-threatening arrhythmias. However, the psychosocial impact of ICD implantation extends beyond its cardiovascular benefits, potentially influencing emotional well-being and sexual health. This can lead to erectile dysfunction, which, is often associated with alexithymia. Both erectile dysfunction and alexithymia can significantly affect the psychological well-being of both patients and their partners. Aims: This study examines the association of erectile dysfunction with alexithymia in patients after ICD implantation. Additionally, we investigate potential moderators of this association. Method: Patients (N=165) completed self-rating questionnaires: Toronto Alexithymia scale (TAS-20), International Index of Erectile Function (IIEF-5), Adjustment disorder – new module (ADNM-20). Descriptive statistics, correlations, multivariate linear regressions, and moderation analysis were conducted. Results: The determinants of erectile dysfunction in ICD patients were explored in a regression model explaining 22% of the total variance. The ADNM-20 subscale preoccupation was found to significantly moderate the relationship between the alexithymia subscale externally oriented thinking and erectile dysfunction (R2 = 0.02, p=0.03). Conclusion: We did not find evidence for a relationship between externally oriented thinking and erectile dysfunction at low to average levels of preoccupation. However, evidence for such a relationship was found at high levels of preoccupation, where more externally oriented thinking was related to more erectile dysfunction. The intersection of alexithymia and erectile dysfunction represents a promising avenue for future research, offering opportunities to unravel the intricate connections between emotional processing and sexual health. Enhancing insights into this relationship could lead to innovative interventions that address the needs of individuals struggling with both conditions, fostering improved emotional expression, intimate relationships, and sexual satisfaction. [ABSTRACT FROM AUTHOR]

Introduction: Recently, a subcostal en‐face view of the tricuspid valve (TV) was described which can determine right ventricular (RV) lead position on the TV level. We sought to (1) prospectively evaluate the feasibility of this novel view in patients with cardiac implantable electronic devices (CIED) to visualize the position of the device lead relative to the TV leaflets and (2) study the association between lead position and degree of tricuspid regurgitation (TR). Methods: Consecutive patients with a history of CIED implantation with at least one RV lead who underwent echocardiography for any cause at our tertiary center were included in this prospective observational study. A subcostal 2D en‐face view of the TV was obtained and the position of the RV lead in the TV plane was determined whenever feasible. Results: A total of 176 patients were included, 70% were male, the median age was 74 years. The exact RV lead position in respect to the TV plane could be determined in 112/176 patients (64%) via the proposed view. In 37 patients (21%) moderate TR could be found, while 10 patients (6%) presented with severe TR. The lead position was not associated with the degree of TR. Conclusion: A novel 2D en‐face view of the TV can accurately identify the RV lead position in the TV plane. At least moderate TR was present in 27% of patients with CIED. There was no association of lead position with the occurrence of moderate or more TR. [ABSTRACT FROM AUTHOR]

Cardiovascular magnetic resonance imaging (MRI) in patients with cardiac implants, such as pacemakers and defibrillators, has gained importance in recent years with the development of modern cardiac implantable electronic devices. The increasing clinical need to perform MRI examinations in patients with cardiac implants has driven the development of new advanced MRI sequences to mitigate image artifacts associated with cardiac implants. More specifically, advances in imaging techniques, such as wideband late gadolinium enhancement imaging, wideband T1 mapping, and wideband perfusion, have been designed to improve image quality and examinations in patients with cardiac implants, enabling a comprehensive and more reliable diagnosis, which was previously unattainable in these patients. This review article explores recent developments and applications of wideband techniques in the field of cardiovascular MRI, offering insights into their transformative potential. Clinical applications of wideband cardiovascular MRI are highlighted, particularly in assessing myocardial viability, guiding ventricular tachycardia ablation, and characterizing myocardial tissue. [ABSTRACT FROM AUTHOR]

Background: Post-infarction heart failure with reduced ejection fraction (HFrEF) patients often face persistent risks of sudden cardiac arrest leading to sudden cardiac death. While implanting a cardioverter-defibrillator (ICD) can enhance prognosis, complications and costs limit its widespread use. Current patient qualification criteria, relying on imperfect parameters, require refinement. The impairment of the cardiac adrenergic system in heart failure is associated with ventricular arrhythmias. The goal of the study was to assess the utility of cardiac adrenergic system scintigraphy in qualifying patients for ICD placement. Methods: In this prospective study of 85 post-infarction HFrEF patients at a single center, clinical assessments, laboratory tests, echocardiography, [123I]MIBG scintigraphy, and ICD implantation were performed. Scintigraphy involved planar chest images and evaluating the heart-to-mediastinum ratio (H/M) and washout rate (WO). SPECT imaging assessed [123I]MIBG uptake in 17 left ventricular segments to calculate the summed difference score (SDS). Results: During a median of 4-year follow-up, 22% of patients experienced appropriate ICD interventions, and 25% of patients died or underwent heart transplantation. The mean values of analyzed parameters did not significantly differ between groups. In the univariate analysis, younger age and moderately impaired left ventricular ejection fraction (LVEF) were correlated with more frequent ICD interventions. In comparison, older age and elevated NT-proBNP levels were associated with death or heart transplantation. Additionally, the univariate analysis identified SDS-15′ as a prognostic factor for death/heart transplant. The multivariate analysis identified predictors for ICD interventions, including younger age, an EF of 30% or greater, and a larger left ventricular end-diastolic diameter. In contrast, older age and an LVEF of less than 25% were significant predictors of death or heart transplantation. Conclusions: Scintigraphic parameters did not effectively predict ICD interventions or death/heart transplantation, though the summed difference score demonstrated potential as a prognostic factor. Younger age with moderately impaired EF correlated with frequent ICD interventions, while in older age, EF < 25% predicted death or transplantation. Further investigation is needed for patients with borderline EF values. [ABSTRACT FROM AUTHOR]

Introduction: Due to its unique features, pulsed field ablation (PFA) could potentially overcome some limitations of current radiofrequency (RF) ventricular tachycardia (VT) ablation. However, data on the use of PFA in this setting are currently scarce. Methods: Two patients with ischemic cardiomyopathy and previously failed RF VT ablations were treated with PFA. Results: A total of 18 bipolar applications (case1) and seven bipolar applications (case2) were delivered to the infero‐lateral and infero‐septal areas (case1) and to the apical lateral left ventricular (LV) wall (case2), placing the catheter adjacent to the LV wall in the flower configuration. A rapid cessation of VT and restoration of sinus rhythm were observed during PFA delivery in both cases. Further applications were delivered to achieve complete elimination of late potentials. In case 1, during the in‐hospital stay, ECG monitoring did not show VT recurrences. Six‐month follow‐up was uneventful, with no VT recurrences at ICD interrogation. In case 2, due to postdischarge VT recurrences, a second RF procedure was scheduled 1 month later. The voltage map performed in sinus rhythm showed a low‐voltage zone located at the anterolateral wall, near the previous ablation site. Numerous late potentials were recorded. At the 6‐month follow‐up, no further VT recurrences were documented after RF redo ablation. Conclusion: While the speed of application and potential transmural effect can facilitate the ablation of large diseased endocardial areas, early loss of contact due to difficult pentaspline catheter manipulation in the LV could lead to insufficient contact force and, consequently, inadequate energy penetration. [ABSTRACT FROM AUTHOR]

Background: Complications associated with cardiovascular implantable electronic devices may necessitate device and lead removal. An open approach to removal may be electively chosen in cases with high risk of complications or those requiring additional concomitant cardiac surgery. This study aimed to investigate outcomes of patients who underwent elective open lead extractions (OLE) at two large tertiary care centers. Methods: The records of 29 patients undergoing elective OLE were analyzed through retrospective chart review. Results: 69 total leads were extracted from 29 patients (77% completely, 23% partially). The average age of the oldest leads was 13.3 ± 11.3 years. Infective endocarditis with severe valvular insufficiency requiring valvular intervention (41%)—an infectious etiology, and tricuspid valve intervention to correct RV lead‐related severe TR (38%)—a noninfectious etiology, were the most common reasons for OLE. 38% of the patients had additional co‐primary or secondary indications for open extraction, such as CABG and pericardiectomies. The rate of major complications and procedural failure was 3% each (1/29). 30‐day survival was 100%, and 1‐year survival was 92%. The average length of hospital stay was 15 days and higher among those undergoing OLE for infectious indications. Conclusion: Open lead extractions offered a similar clinical success rate (97%) to transvenous extractions in this cohort and may be a viable alternative for those necessitating valvular intervention or when the risk of complications from TLE is considered very high. [ABSTRACT FROM AUTHOR]

Introduction: Atrial high‐rate episodes (AHRE) have been linked to increased thromboembolic risk and all‐cause mortality in patients with cardiac implantable electronic devices (CIEDs). Various predictors of AHRE development have been identified, emphasizing the need for close monitoring and the potential transition to clinical atrial fibrillation (AF). However, the predictive value of P wave characteristics on AHRE development remains conflicting. This meta‐analysis aims to summarize existing data to investigate this association. Method: We examined studies from MEDLINE and EMBASE databases up to May 2024 to investigate the association of baseline P‐wave duration (PWD), P‐wave dispersion (PWDIS), and interatrial block (IAB) with the risk of developing AHRE. We extracted the mean and standard deviations of PWD and PWDIS to calculate the pooled mean difference (MD). Risk ratios (RR) and 95% confidence intervals (CIs) were used to assess the association between IAB and AHRE risk, using the generic inverse variance method for combination. Results: The meta‐analysis included nine studies. Patients with AHRE had longer PWD and PWDIS compared to those without AHRE, with a pooled MD for PWD of 9.17 ms (95% CI: 4.74–13.60; I2 = 47%, p < 0.001) and a pooled MD for PWDIS of 20.56 ms (95% CI: 11.57–29.56; I2 = 57%, p < 0.001). Additionally, patients with IAB had a higher risk of developing AHRE, with a pooled RR of 3.33 (95% CI: 2.53–4.38; I2 = 0%, p < 0.001), compared to those without IAB. Conclusions: Our meta‐analysis found that patients with AHRE had higher PWD and PWDIS than those without AHRE. Additionally, IAB was associated with a higher risk of developing AHRE. These findings emphasize the importance of close monitoring and risk stratification, particularly for patients with P wave abnormalities. [ABSTRACT FROM AUTHOR]

Background: Recent studies have demonstrated an obesity paradox, where obese patients with cardiovascular disease have a better outcome compared to those with normal weight. However, the effect of obesity and body mass index (BMI) on the outcome of patients with cardiac resynchronization therapy (CRT) devices remains unclear. The current study aims to investigate this relationship using all available published data. Methods: We systematically reviewed studies from Medline and EMBASE databases from inception to January 2024. Eligible studies must investigate the association between BMI status and all‐cause mortality in individuals with CRT devices. Relative risk (RR) or hazard ratio (HR) and 95% CIs were retrieved from each study and combined using the generic inverse variance method. Results: A total of 12 cohort studies were included in the meta‐analysis. Pooled analysis showed that overweight and obesity patients had lower all‐cause mortality compared to those with normal body weight with the pooled risk ratios (RR) for overweight of 0.77 (95% CI 0.69–0.87, I2 47%) and for obesity of 0.81 (95% CI 0.67–0.97, I2 59%). Conversely, the underweight exhibited higher all‐cause mortality than the group with normal weight, with a pooled RR of 1.37 (95% CI 1.14–1.64, I2 0%). Additionally, higher BMI as continuous data was associated with decreased all‐cause mortality, with a pooled HR of 0.94 (95% CI 0.89–0.98, I2 72%). Conclusions: The pooled analyses observed an obesity paradox in patients with CRT, where overweight and obesity were associated with reduced all‐cause mortality, while underweight individuals exhibited higher all‐cause mortality. Further research is necessary to investigate the underlying mechanisms and their implications for clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Modern cardiovascular implantable electronic devices (CIEDs) have mechanisms that prevent damage from external electric shocks, and malfunction following accidental electrocution is rare. However, the effects of lightning injuries in patients with CIEDs are uncertain. Case presentation: A 74‐year‐old man with a dual‐chamber pacemaker due to complete heart block was struck by a lightning while farming. He had no serious injury at the time and sought medical evaluation 1 month later, when he presented with asymptomatic bradycardia. Device interrogation suggested major battery and lead damage, requiring extraction and subsequent placement of a new pacing system. Discussion: While a previous report depicted pacing threshold elevation without extensive device impairment, our patient presented with major damage to the whole pacing system. The factors contributing to these divergent outcomes are unclear. Differences in injury mechanism, pacemaker model, and the pattern of electric current dispersion within the device may each play a part in this discrepancy. [ABSTRACT FROM AUTHOR]

The article offers information on the safety of particle radiotherapy in patients with cardiac implantable electronic devices (CIEDs). Topics discussed include the risk of CIED malfunctions due to secondary neutrons and electromagnetic interference; the variability of malfunction rates based on particle therapy type and device manufacturer; and the minimal adverse effects reported with appropriate monitoring.

We describe two cases of secondary prevention subcutaneous implantable cardioverter defibrillator (S‐ICD) implantation and subsequent S‐ICD electrode displacement which initially went undetected. One presentation was a result of a coincidental chest x‐ray for respiratory exacerbation and another with an untreated episode highlighted via remote monitoring, both patients were booked to clinic for further investigation. Our findings highlighted had there been a comparison of the existing subcutaneous electrogram (S‐ECG) to captured S‐ECGs at time of implant the electrode displacement would have been detected beforehand. This underpins the importance of introducing the simple management strategy into routine follow‐up. [ABSTRACT FROM AUTHOR]

Introduction: English yew is an evergreen conifer frequently planted in household gardens and, when ingested in large doses, results in severe cardiotoxicity characterized by difficult to control ventricular arrhythmias with high rates of mortality. Case report: A previously healthy teenage female presented as an out-of-hospital cardiac arrest with refractory ventricular arrhythmias and severe biventricular dysfunction. Due to rapid deterioration in her clinical status, she was cannulated onto venoarterial extracorporeal membrane oxygenation (ECMO) which resulted in rapid normalization of her rhythm and ventricular function. Discussion: Our case highlights the importance of keeping a broad differential diagnosis when considering etiologies of ventricular arrhythmias in the pediatric population. The final diagnosis was not made until after discharge and implantable cardiac defibrillator (ICD) placement. Conclusion: The delayed diagnosis of this intentional English yew ingestion ultimately resulted subsequent ICD removal. Early ECMO activation in cases of English yew toxicity can be essential for patient survival. [ABSTRACT FROM AUTHOR]

Purpose: Wideband phase‐sensitive inversion recovery (PSIR) late gadolinium enhancement (LGE) enables myocardial scar imaging in implantable cardioverter defibrillators (ICD) patients, mitigating hyperintensity artifacts. To address subendocardial scar visibility challenges, a 2D breath‐hold single‐shot electrocardiography‐triggered black‐blood (BB) LGE sequence was integrated with wideband imaging, enhancing scar‐blood contrast. Methods: Wideband BB, with increased bandwidth in the inversion pulse (0.8–3.8 kHz) and T2 preparation refocusing pulses (1.6–5.0 kHz), was compared with conventional and wideband PSIR, and conventional BB, in a phantom and sheep with and without ICD, and in six patients with cardiac devices and known myocardial injury. ICD artifact extent was quantified in the phantom and specific absorption rate (SAR) was reported for each sequence. Image contrast ratios were analyzed in both phantom and animal experiments. Expert radiologists assessed image quality, artifact severity, and scar segments in patients and sheep. Additionally, histology was performed on the sheep's heart. Results: In the phantom, wideband BB reduced ICD artifacts by 62% compared to conventional BB while substantially improving scar‐blood contrast, but with a SAR more than 24 times that of wideband PSIR. Similarly, the animal study demonstrated a considerable increase in scar‐blood contrast with wideband BB, with superior scar detection compared with wideband PSIR, the latter confirmed by histology. In alignment with the animal study, wideband BB successfully eliminated severe ICD hyperintensity artifacts in all patients, surpassing wideband PSIR in image quality and scar detection. Conclusion: Wideband BB may play a crucial role in imaging ICD patients, offering images with reduced ICD artifacts and enhanced scar detection. [ABSTRACT FROM AUTHOR]

The "5 gauss line" is a phrase that is likely to be familiar to everyone working with MRI, but what is its significance, how was it defined, and what changes are currently in progress? This review explores the history of 5 gauss (0.5 mT) as a threshold for protecting against inadvertently putting cardiac pacemakers, implantable cardioverter defibrillators, and other active implantable medical devices into a "magnet mode." Additionally, it describes the background to the recent change of this threshold to 9 gauss (0.9 mT) in the International Standard IEC 60601‐2‐33 edition 4.0 that defines basic safety requirements for MRI. Practical implications of this change and some ongoing and emerging issues are also discussed. [ABSTRACT FROM AUTHOR]

Background: The association between the triglyceride-glucose (TyG) index and ventricular arrhythmias (VAs) is unclear. This study aimed to investigate the relationship between the TyG index, VAs, and major cardiovascular events in patients at high risk of sudden cardiac death (SCD). Methods: We enrolled 1046 patients at high risk of SCD with an indication for implantable cardioverter-defibrillator (ICD) implantation at the Chinese National Center for Cardiovascular Diseases. The primary outcome was VAs, defined as sustained ventricular tachycardia and ventricular fibrillation documented by the ICD. The secondary outcomes were cardiac mortality, heart transplantation, and rehospitalization for heart failure. Results: The mean (± SD) age was 59.6 ± 14.0 years old, and 25.7% were female. During the mean follow-up of 36.1 months, 342 (32.7%) patients had VAs, and 185 (17.7%) patients had major cardiovascular events. The mean fasting glucose and triglyceride levels were 111.9 ± 42.7 mg/dL and 140.0 ± 95.4 mg/L, respectively, with a TyG index range of 6.96–11.8. In the Fine-Gray subdistribution hazard model analysis, an increase in the TyG index was associated with a significant increase in the VAs (per 1 TyG index, hazard ratio [HR] 2.95; 95% confidence interval [CI], 2.29–3.80) and secondary outcome (HR 2.84; 95% CI 1.86–4.34). When stratified into tertiles, the risk of VAs was significantly higher in the highest tertile (HR 4.08; 95% CI, 2.81–5.92) than in the lowest tertile. Analysis of the secondary outcome revealed similar findings (HR 3.18; 95% CI, 1.73–5.85). Conclusions: In our cohort, the pre-operational TyG index is significantly associated with VAs and major cardiovascular events for patients with high risk of SCD. [ABSTRACT FROM AUTHOR]

BACKGROUND: Septal reduction therapy (SRT) provides substantial symptomatic improvement in patients with obstructive hypertrophic cardiomyopathy (HCM). However, long-term disease course after SRT and predictors of adverse outcomes have not been systematically examined. METHODS: Data from 13 high clinical volume HCM centers from the international SHARE (Sarcomeric Human Cardiomyopathy Registry) were analyzed. Patients were followed from the time of SRT until last follow-up or occurrence of heart failure (HF) composite outcome (cardiac transplantation, implantation of a left ventricular assist device, left ventricular ejection fraction <35%, development of New York Heart Association class III or IV symptoms), ventricular arrhythmias composite outcome (sudden cardiac death, resuscitated cardiac arrest, or appropriate implantable cardioverter defibrillator therapy), or HCM-related death. Cox proportional hazards models were used to identify predictors of outcome. RESULTS: Of the 10 225 patients in SHARE, 1832 (18%; 968 [53%] male) underwent SRT, including 455 (25%) with alcohol septal ablation and 1377 (75%) with septal myectomy. The periprocedural 30-day mortality rate was 0.4% (8 of 1832) and 1499 of 1565 (92%) had a maximal left ventricular outflow tract gradient <50 mm Hg at 1 year. After 6.8 years (range, 3.4–9.8 years; 12 565 person-years) from SRT, 77 (4%) experienced HCM-related death (0.6% per year), 236 (13%) a composite HF outcome (1.9% per year), and 87 (5%) a composite ventricular arrhythmia outcome (0.7% per year). Among adults, older age at SRT was associated with a higher incidence of HCM death (hazard ratio, 1.22 [95 CI, 1.1–1.3]; P <0.01) and the HF composite (hazard ratio, 1.14 [95 CI, 1.1–1.2] per 5-year increase; P <0.01) in a multivariable model. Female patients also had a higher risk of the HF composite after SRT (hazard ratio, 1.4 [95 CI, 1.1–1.8]; P <0.01). De novo atrial fibrillation occurred after SRT in 387 patients (21%). Among pediatric patients followed for a median of 13 years after SRT, 26 of 343 (16%) developed the HF composite outcome, despite 96% being free of recurrent left ventricular outflow tract obstruction. CONCLUSIONS: Successful short- and long-term relief of outflow tract obstruction was observed in experienced multidisciplinary HCM centers. A subset of patients progressed to develop HF, but event-free survival at 10 years was 83% and ventricular arrhythmias were rare. Older age, female sex, and SRT during childhood were associated with a greater risk of developing HF. [ABSTRACT FROM AUTHOR]

Background: Patient education is a crucial strategy for promoting prevention and diabetes self-management since glycemic control achievement involves taking medications, medical nutrition therapy, physical exercise, and behavior changes. However, patient education programs are still barely implemented in low- and middle-income countries. This trial aims to investigate whether a lifestyle education intervention added to physical exercising is superior to sole physical exercising regarding functional capacity, disease-related knowledge, health behaviors, cardiometabolic health parameters, quality of life, depression, and diet quality in individuals with prediabetes or diabetes. Methods: Multicenter double-blinded randomized controlled trial with two parallel arms involving 12-week intervention and 6-month follow-up. The eligible individuals (≥ 18 years, living with prediabetes or diabetes, literate, no clinical decompensation and/or physical and/or mental limitations that contraindicate physical exercising, written physician permission for exercise, no cognitive impairment, no vision limitations for reading, no confirmed diagnosis of unstable coronary disease or heart failure, no pacemaker and/or implantable cardioverter-defibrillator, no complex ventricular arrhythmias, no intermittent claudication, no recent cardiovascular event or cardiac surgery, and no currently enrolled in a structured exercise program) were recruited from two Brazilian cities and randomized to either (1) an Exercise and Lifestyle Education Program (ExLE) or (2) an Exercise Program (Ex), which can be delivered on-site or remotely based on the participants' internet access and technology literacy. The primary outcomes will be changes in functional capacity and disease-related knowledge. The secondary outcomes will involve changes in health behaviors (health literacy, physical activity level, exercise self-efficacy, and medication adherence) and cardiometabolic health parameters (glycemic control, anthropometric measures, and cardiac autonomic control). Program adherence, satisfaction with the program, diabetes-related morbidity, and changes in quality of life, depression, and diet quality will be the tertiary outcomes. Assessments will occur at baseline, post-intervention, and after 6-month follow-up. Discussion: If superior effectiveness of ExLE compared to Ex program to improve the outcomes measures is found, this program could be delivered broadly in the Brazilian health system, especially in the primary care facilities where most individuals living with prediabetes and diabetes in our country are assisted. Trial registration: ClinicalTrials.gov, NCT03914924. Registered on April 16, 2019. [ABSTRACT FROM AUTHOR]

BACKGROUND The subcutaneous implantable cardioverter-defibrillator (ICD) is associated with fewer lead-related complications than a transvenous ICD; however, the subcutaneous ICI) cannot provide bradycardia and antitachycardia pacing. Whether a modular pacing-defibrillator system comprising a leadless pacemaker in wireless communication with a subcutaneous ICD to provide antitachycardia and bradycardia pacingis safe remains unknown. METHODS We conducted a multinational, single-group study that enrolled patients at risk for sudden death from ventricular arrhythmias and followed them for 6 months after implantation of a modular pacemaker-defibrillator system. The safety end point was freedom from leadless pacemaker-related major complications, evaluated against a performance goal of 8696. The two primary performance end points were successful communication between the pacemaker and the ICD (performance goal, 8890) and a pacing threshold of up to 2.0 V at a 0.4-msec pulse width (performance goal, 8096). RESULTS We enrolled 293 patients, 162 of whom were in the 6-month end-point cohort and 151 of whom completed the 6-month follow-up period. The mean age of the patients was 60 years, 16.7% were women, and the mean (*SD) left ventricular ejection fraction was 33.1112.6%. The percentage of patients who were free from leadless pacemakerrelated major complications was 9Z5°/o, which exceeded the prespecified performance goal. Wireless-device communication was successful in 98.8% of communication tests, which exceeded the prespecified goal. Of 151 patients, 147 (97.496) had pacing thresholds of 2.0 V or less, which exceeded the prespecified goal. The percentage of episodes of arrhythmia that were successfully terminated by antitachycardia pacing was 61.3°/0, and there were no episodes for which antitachycardia pacing was not delivered owing to communication failure. Of 162 patients, 8 died (4.996); none of the deaths were deemed to be related to arrhythmias or the implantation procedure. CONCLUSIONS The leadless pacemaker in wireless communication with a subcutaneous ICD exceeded performance goals for freedom from major complications related to the leadless pacemaker, for communication between the leadiess pacemaker and subcutaneous ICD, and for the percentage of patients with a pacing threshold up to 2.0 V at a 0.4-msec pulse width at 6 months. (Funded by Boston Scientific; MODULAR ATP ClinicalTrials.gov NCT04798768.). [ABSTRACT FROM AUTHOR]

Background: Antiarrhythmic therapy for recurrent ventricular arrhythmias (VAs) in patients having undergone catheter ablation and in whom amiodarone and/or beta-blockers were ineffective or contraindicated is a controversial issue. Purpose: The present study sought to compare the efficacy and tolerability of oral procainamide and mexiletine in patients with recurrent ventricular arrhythmias when the standard therapy strategy failed. Methods: All patients with an implantable cardioverter defibrillator (ICD) treated with oral procainamide or mexiletine for recurrent ventricular tachycardia (VT) or ventricular fibrillation (VF) in two cardiology divisions between January 2010 and January 2020 were enrolled. Patients were divided into group A (oral procainamide) and group B (mexiletine) and the two groups were compared to each other. The primary endpoint was the efficacy of therapy; the secondary endpoint was the discontinuation of therapy. All events that occurred during procainamide or mexiletine treatment were compared with a matched duration period before the initiation of the therapy. Antiarrhythmic therapy was considered effective when a ≥80% reduction of the sustained ventricular arrhythmias burden recorded by the ICD was achieved. Results: A total of 68 consecutive patients (61 males, 89.7%; mean age 74 ± 10 years) were included in this retrospective analysis. After a median follow-up of 19 months, 38 (56%) patients had a significant reduction in the VA burden. After multivariable adjustment, therapy with procainamide was independently associated with an almost 3-fold higher efficacy on VA suppression compared to mexiletine (HR 2.54, 95% CI 1.06–6.14, p = 0.03). Only three patients (9%) treated with procainamide presented severe side effects (dyspnea or hypotension) requiring discontinuation of therapy compared with six patients (18%) treated with mexiletine who interrupted therapy because of severe side effects (p = 0.47). Conclusions: Compared to mexiletine, oral procainamide had a higher efficacy for the treatment of recurrent and refractory VAs, and showed a good profile of tolerability. [ABSTRACT FROM AUTHOR]

Introduction: Infection is a significant complication of cardiac implantable electronic device (CIED) therapy. The European TauroPace™ Registry investigates the safety and efficacy of TauroPace™ (TP), an antimicrobial solution containing taurolidine, designed to prevent CIED infections. Methods: This multicenter study included patients undergoing CIED procedures at participating centers where TP was used as a disinfectant for external hardware surfaces and an antiseptic for irrigating surgical sites. All patients eligible for CIED placement with adjunctive TP as the standard of care were included. Other aspects of CIED procedures adhered to current guidelines. Data on CIED-related infective endocarditis, CIED pocket infection, device and procedure-related complications, adverse events, and all-cause mortality were prospectively collected for 12 months. In cases of revision, the previous procedure was censored, and a new procedure was created. Binomial and Kaplan–Meier statistics were employed to analyze event rates. Results: From January 2020 to November 2022, TP was used in 822 out of 1170 CIED procedures. Among patients who completed the 3-month follow-up, no CIED pocket infections were observed, and one case of CIED-related infective endocarditis was reported. In the 12-month follow-up cohort, two additional local pocket CIED infections were observed, resulting in a total of three major CIED infections within 1 year after the CIED placement procedure. The 3-month and 12-month major CIED infection rates were 0.125% and 0.51%, respectively. During the observation a complication rate of 4.4% was reported. No adverse events related to TP were observed. Conclusions: TP appears to be effective and safe in preventing CIED infections. ClinicalTrials.gov Identifier: NCT04735666. [ABSTRACT FROM AUTHOR]

Background Purpose Methods Results Conclusions Stereotactic arrhythmia radioablation (STAR) is a novel treatment approach for refractory ventricular tachycardia (VT). The risk of treatment‐induced toxicity and geographic miss can be reduced with online MRI‐guidance on an MR‐linac. However, most VT patients carry cardiac implantable electronic devices (CIED), which compromise MR images.Robust MR‐linac imaging sequences are required for cardiac visualization and accurate motion monitoring in presence of a CIED during MRI‐guided STAR. We optimized two clinically available cine sequences for cardiorespiratory motion estimation in presence of a CIED on a 1.5 T MR‐linac. The image quality, motion estimation accuracy, and geometric fidelity using these cine sequences were evaluated.Clinically available 2D balanced steady‐state free precession (bSSFP, voxel size = 3.0 ×$\times$ 3.0 ×$\times$ 10 mm3, Tscan = 96 ms, bandwidth (BW) = 1884 Hz/px) and T1${\rm T}_{1}$‐spoiled gradient echo (T1${\rm T}_{1}$‐GRE, voxel size = 4.0 ×$ \times$ 4.0 ×$ \times$ 10 mm3, Tscan = 97 ms, BW = 500 Hz/px) sequences were adjusted for real‐time cardiac visualization and cardiorespiratory motion estimation on a 1.5 T Unity MR‐linac (Elekta AB, Stockholm, Sweden), while complying with safety guidelines for MRI in presence of CIEDs (specific absorption rate <$ <$ 2 W/kg and dBdt<$\frac{dB}{dt}<$ 80 mT/s). Cine acquisitions were performed in five healthy volunteers, with and without an implantable cardioverter– defibrillator (ICD) placed on the clavicle, and a VT patient. Generalized divergence‐curl (GDC) deformable image registration (DIR) was used for automated landmark motion estimation in the left ventricle (LV). Gaussian processes (GP), a machine‐learning technique, was trained using GDC landmarks and deployed for real‐time cardiorespiratory motion prediction. B0$B_{0}$‐mapping was performed to assess geometric image fidelity in the presence of CIEDs.CIEDs introduced banding artifacts partially obscuring cardiac structures in bSSFP acquisitions. In contrast, the T1${\rm T}_{1}$‐GRE was more robust to CIED‐induced artifacts at the expense of a lower signal‐to‐noise ratio. In presence of an ICD, image‐based cardiorespiratory motion estimation was possible for 85% (100%) of the volunteers using the bSSFP (T1${\rm T}_{1}$‐GRE) sequence. The in‐plane 2D root‐mean‐squared deviation (RMSD) range between GDC‐derived landmarks and manual annotations using the bSSFP (T1‐GRE) sequence was 3.1–3.3 (3.3–4.1) mm without ICD and 4.6–4.6 (3.2–3.3) mm with ICD. Without ICD, the RMSD between the GP‐predictions and GDC‐derived landmarks ranged between 0.9 and 2.2 mm (1.3–3.0 mm) for the bSSFP (T1‐GRE) sequence. With ICD, the RMSD between the GP‐predictions and GDC‐derived landmarks ranged between 1.3 and 2.2 mm (1.2–3.2 mm) using the bSSFP (T1‐GRE) sequence resulting in an RMSD‐increase of 42%–143% (bSSFP) and −61%–142% (T1‐GRE). Lead‐induced spatial distortions ranged between −0.2 and 0.2 mm (−0.7–1.2 mm) using the bSSFP (T1${\rm T}_{1}$‐GRE) sequence. The 98th percentile range of the spatial distortions in the gross target volume of the patient was between 0.0 and 0.4 mm (0.0–1.8 mm) when using bSSFP (T1${\rm T}_{1}$‐GRE).Tailored bSSFP and T1${\rm T}_{1}$‐GRE sequences can facilitate real‐time cardiorespiratory estimation using GP trained with GDC‐derived landmarks in the majority of landmark locations in the LV despite the presence of CIEDs. The need for high temporal resolution noticeably reduced achievable spatial resolution of the cine MRIs. However, the effect of the CIED‐induced artifacts is device, patient and sequence dependent and requires specific assessment per case. [ABSTRACT FROM AUTHOR]

Aims Conduction system pacing (CSP) and atrioventricular junction ablation (AVJA) improve outcomes in patients with symptomatic, refractory atrial fibrillation (AF). Superior approach (SA) from the pocket, via the axillary or subclavian vein, has been recently proposed as an alternative to the conventional femoral access (FA) to perform AVJA. In this study, we compare the impact of these alternative approaches on nurse workload (NWL) and patient satisfaction. Methods and results This was a prospective, observational study enrolling consecutive patients undergoing simultaneous CSP and AVJA. Electrophysiology laboratory (EP Lab) NWL was calculated by using a self-developed model. Ward NWL was calculated using the MIDENF® validated scale. Patient satisfaction was collected using the Hospital Consumer Assessment of Healthcare Provider Systems questionnaire. A total of 119 patients were enrolled: in 50, AVJA was primarily attempted with SA, and in 69 with FA. Compared with FA, SA was associated with a lower EP Lab NWL (169.8 ± 26.7 vs. 202.7 ± 38.9 min; P < 0.001) and a lower Ward NWL (474.5 ± 184.8 vs. 808.6 ± 289.9 min; P < 0.001). Multivariate analysis identified SA as an independent predictor of lower EP Lab NWL [hazard ratio (HR) 4.60; P = 0.001] and of lower Ward NWL (HR 45.13; P < 0.001). Compared with FA, SA was associated with a higher patient-reported rating regarding their experience during hospital stay (P = 0.035) and the overall hospital evaluation (P = 0.026). Conclusion In patients undergoing simultaneous CSP and AVJA, the use of an SA for ablation is a valid alternative to conventional FA. Compared with FA, this approach significantly reduces NWL and is associated with greater patient satisfaction. Registration ClinicalTrials.gov : NCT03612635 [ABSTRACT FROM AUTHOR]

INTRODUCTION: Heart failure with reduced ejection fraction (HFrEF) patients need to be risk stratify as guidelines have shown that patients with left ventricular ejection fraction (LVEF) <35% could be prevented from sudden cardiac death (SCD) by insertion of prophylactic implantable cardioverter-defibrillator (ICD). Thus we conducted a retrospective single tertiary centre study to evaluate the used of electrocardiogram (ECG) risk score model in identifying the individuals who at higher risk of SCD. MATERIALS AND METHODS: A total of 356 heart failure with reduced ejection fraction (HFrEF) patients treated at University Malaya Medical Centre between January 2017 and December 2021 were enrolled into this study. The patients' demographics, types of heart failure, medications, and ECG parameters data were collected. The study outcomes were survivor or death in and the cause of death were subdivided into SCD or non-sudden cardiac death (non-SCD). RESULTS: A total of 156 study patients were survivor whereas another 120 had SCD and 70 had non-SCD. There were six ECG parameters that remained significant in the final model, namely the bundle branch block (BBB), abnormal P waves, QRS duration, QTc duration, TpTe interval and PR interval. The significant ECG parameters were combined into a risk score to enumerate prediction ability towards SCD. From our ECG risk score model, subject with =2 ECG abnormalities had more than 3-fold increased risk for SCD (HR 3.739, 95% CI 1.703-8.211, P 0.001) and the risk proportionately increased with increasing ECG abnormalities. CONCLUSION: Our findings suggested that the cumulative ECG risk score model was independently associated with SCD and particularly effective for LVEF <40% where risk stratification model remained scarce. So, we would like to propose for a prospective study to further evaluate our study outcome. [ABSTRACT FROM AUTHOR]

Background: Cardiac resynchronization therapy (CRT) is a standard treatment for patients with heart failure and electrical dyssynchrony. Cardiac magnetic resonance (CMR) is the gold standard for assessing left ventricular (LV) function. However, the feasibility of using CMR with active CRT is still uncertain. Purpose: To assess the feasibility of a CRT "off‐on" protocol during CMR and measure the acute effects of CRT interruption on LV function. Methods: Patients underwent CMR before (pre‐CRT) and 6 months after (post‐CRT) an MR‐conditional CRT defibrillator implantation. The post‐CRT scan included two complete sets of cine images, one with inactive (post‐CRTOFF) and one with active CRT (post‐CRTON), maintaining a continuous connection between device and programmer. Results: Out of 29 enrolled patients, 8 (28%) had complete and analyzable post‐CRT data. Unsuccessful procedures were attributed to connection problems between the CRT device and the programmer (n = 10), poor image quality (n = 7), and lack of patient cooperation (n = 4). LV ejection fraction significantly increased between pre‐CRT scan (28.1%) and both post‐CRTOFF (37.9%; p = 0.046) and post‐CRTON CMR (35.0%; p = 0.037), with a nonstatistically significant trend toward decreased LV volumes. No adverse events or significant changes in device electrical parameters (including battery level) were detected during the post‐CMR scan period. Conclusion: A CRT "off‐on" protocol during CMR studies can be safely executed in patients with an MR‐conditional CRT defibrillator. However, technical improvements are needed to facilitate high‐quality scans during active CRT. Favorable changes in LV function induced by CRT remodeling were not acutely reversed with the interruption of electrical therapy. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases, including sudden cardiac death (SCD), are the leading cause of mortality among kidney transplant recipients (KTRs). While implantable cardioverter defibrillators (ICDs) are established for SCD prevention in the general population, data on the benefits in patients with CKD is scarce and controversial, and there is no established general consensus on their use in this group of patients. Furthermore, data for KTRs are lacking. The aim of this study is to present our experience with ICDs in KTRs and evaluate the outcomes in this population. Methods: We retrospectively analyzed medical records of KTRs who received a kidney allograft between October 1973 and December 2023 and received ICDs for the prevention of SCD. Results: Of 2282 KTRs, 10 patients (0.44%) underwent an ICD implantation with an average age of 60.6 years at the time of implantation; 9 were male. Primary prevention of SCD was the most common indication, with only one patient receiving an ICD following sudden cardiac arrest. The female patient received an ICD while on dialysis, and the rest of the patients received ICDs in the posttransplant period with an average time of 9.1 years after KT. Kidney allograft function was reduced in all patients at the time of the ICD implantation with an average estimated glomerular filtration rate (eGFR) of 44 mL/min/1.73 m2. No ICD-related complications were recorded. Six patients are alive with an average follow-up of 5.2 years. Conclusions: ICD implantation in carefully selected KTRs may offer survival benefits and can be a valuable tool in preventing SCD. Larger studies are needed to confirm these findings and establish clear guidelines for ICD use in this specific population. [ABSTRACT FROM AUTHOR]

Background: Conventional transvenous implantable cardioverter‐defibrillator (TV‐ICD) is the standard device used for primary prevention of sudden cardiac death (SCD) in patients with reduced left ventricular ejection fraction (LVEF). Nonetheless its use is associated with lead‐related complications including infection and malfunction. A subcutaneous implantable cardioverter‐defibrillator (S‐ICD) offers an alternative option without the need for a transvenous lead but has limitations. The decision to implant a TV‐ICD or S‐ICD in patients with impaired LVEF for primary prevention of SCD is controversial. Several randomised controlled trials and large observational studies have confirmed similar safety and efficacy of S‐ICDs and TV‐ICDs in such population. Methods: A literature review was conducted to compare the outcomes of subcutaneous (S‐ICD) versus transvenous (TV‐ICD) implantable cardioverter‐defibrillators. Databases including PubMed, MEDLINE, and Cochrane were searched for relevant peer‐reviewed articles. Studies were selected based on relevance and quality. Key outcomes like complication rates, efficacy, and patient survival were summarized in a comparative table. Results: Different factors that influence the choice between an TV‐ICD and S‐ICD for primary prevention of SCD in patients with LVEF are highlighted to guide selection of the appropriate device in different patient populations. Moreover, future perspective on the combination of SICD with leadless pacemaker, and the latest development of the extravascular implantable cardioverter defibrillator are also discussed. Conclusions: S‐ICD offers a safe and efficacious option to primary prevention in reduced ejection fraction. Future development including incorporation of leadless pacemaker will add to the arsenal of choice to protect patients from sudden cardiac death. [ABSTRACT FROM AUTHOR]

Background: Transvenous lead extraction (TLE) for cardiovascular implantable electronic device (CIED)‐related infections has increased. The incidence of TLE in nonagenarians is low, with limited reports outlining the outcomes of this procedure. Therefore, in this study, we aimed to clarify the outcomes of TLE in nonagenarians. Methods: Patients with TLE treated at our hospital between 2014 and 2023 were retrospectively examined; patient characteristics, device type, indications, procedures, complications, and clinical data of nonagenarians were analyzed. Results: Of 12 patients with 24 leads (active fixation lead, n = 11; passive fixation lead, n = 13) who underwent TLE, the indication for TLE was infection (pocket infection, n = 8; sepsis, n = 4). Methicillin‐resistant Staphylococcus epidermidis was the most frequently identified causative agent (n = 4). The median patient age was 91 years; five patients were female. The median lead dwell time was 9 years. Excimer laser sheath (16 leads), mechanical sheath (five leads), Evolution RL (one lead), and manual traction (two leads) were employed in TLE. The procedure was successful in all patients, and only one had a minor complication. Six patients required CIED re‐implantation, and leadless pacemakers were selected for five patients. The 30‐day mortality after TLE was 0%. Conclusion: TLE can be safely performed in nonagenarians. The decision to perform TLE should not be based on old age alone; the suitability of removing infected CIEDs should be determined based on each patient's condition. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) patients are at constant risk of decompensation, and urgent hospital admissions can be life‐threatening events. Monitoring biological variables has been proved to be an important mechanism to anticipate decompensations. TriageHF is a validated diagnostic algorithm tool available on Medtronic® cardiac implantable electronic devices that combines physiological data to stratify a patient's risk of HF hospitalization in the following 30 days in low, medium or high risk. We aimed to evaluate the utility of TriageHF algorithm to predict the occurrence of acute clinical decompensation events (ACDE), including HF and non‐HF cardiovascular events, within a 30‐day period in a population of HF patients with reduced ejection fraction. Methods: We reviewed the transmissions received by the Medtronic® Carelink™ Network between August 2022 and July 2023. The heart failure risk status (HFRS) and the device parameters contributing to that risk, from the previous 30 days, were collected, along with the occurrence of ACDEs within 30 days. Results: We retrospectively assessed 207 transmissions from the 64 patients included in the study. Among the 93 medium HFRS transmissions, 16 (17.2%) resulted in ACDEs. For the 21 high HFRS transmissions, 10 (47.6%) resulted in ACDEs. Considering the ACDEs, 60.7% were preceded by an alarm‐initiated transmission. Except for heart rate variability, each diagnostic parameter demonstrated effectiveness in stratifying risk for ACDEs. Optivol® and the Combined Heart Rhythm showed independent association with ACDEs (p <.001). Patients with medium and high HFRS were, respectively, 8.6 and 29.1 times more likely to experience an ACDE in the next 30 days than low risk patients. A medium‐high HFRS conferred a sensitivity of 92.9% and a NPV of 97.8% for an ACDE. Conclusion: TriageHF is a useful method for predicting ACDEs and has the potential to trigger medical actions to prevent hospitalizations. [ABSTRACT FROM AUTHOR]

Background: Implantable Cardioverter Defibrillator (ICD) implantation has significantly modified the natural history of patients at high risk of sudden cardiac death (SCD) in various types of heart diseases. However there is a high rate of psychological distress and reduced quality of life in patients with an ICD, more evident in younger individuals. The ICD removal upon patient request is a very rare event and causes many clinical and ethical issues. Methods: The article discusses the case of a young patient affected by hypertrophic obstructive cardiomyopathy, who underwent implantable cardioverter defibrillator (ICD) implantation as a primary prevention of sudden cardiac death (SCD). Two years after the implantation, the patient repeatedly requested removal of the ICD due to of a significant and untreatable psychological device intolerance. Results: Intervention became possible only after extensive psychological evaluation, which excluded specific pathology, and the ratification of Italian law 219/2017 on informed consent and advance directives, which guarantees the patient's independent decisions on current and future medical treatment. The explantation was performed 7 years after the implant. The patient is alive and in good health. Conclusions: The paper debates the issues related to establishing a patient–physician relationship based on respect for the patient's autonomy and experience of illness, in reference to principles such as beneficence and non‐maleficence, and the conflicts that sometimes arise between them. If a paternalistic approach in the patient–physician relationship evolves into a patient‐centered model, it is more certain that the patient's choice is realistically known and shared, and that it is consistent with the patient's values and life goals. The shared decision making (SDM) process and the use of pathology‐specific decision aids are able to transform the informed consent tool, usually related to medical‐legal issues, into an aid for true partnership between the patient and the medical care team. [ABSTRACT FROM AUTHOR]

Introduction: In patients with cardiac sarcoidosis (CS), implantable cardioverter‐defibrillators (ICDs) are important for preventing sudden cardiac death. This study aimed to investigate sex disparities in CS patients undergoing ICD implantation. Methods: The 2016–2020 National Inpatient Sample (NIS) database compared the characteristics and outcomes of males and females with CS receiving ICDs. Results: Among 760 CS patients who underwent inpatient ICD implantation, 66.4% were male. Males were younger (55.0 vs. 56.9 years, p <.01), had higher rates of diabetes (31.7% vs. 21.6%, p <.01) and chronic kidney disease (CKD) (16.8% vs. 7.8%, p <.01) but lower prevalence of atrial fibrillation (AF) (11.9% vs. 23.5%, p <.01), sick sinus syndrome (4.0% vs. 7.8%, p =.024), ventricular fibrillation (VF) (9.9% vs. 15.7%, p =.02), and black ancestry (31.9% vs. 58.0%, p <.01). Unadjusted major adverse cardiovascular events (MACE), defined as a composite of in‐hospital death, myocardial infarction (MI), and ischemic stroke, was higher in females (11.8% vs. 6.9%, p =.024), but when adjusted for age and tCharlson Comorbidity Index (CCI), females demonstrated significantly lower odds of experiencing MACE (aOR: 0.048, 95% CI: 0.006–0.395, p =.005). Incidence of acute kidney injury (AKI) post‐ICD was significantly lower in females (15.7% vs. 23.8%, p =.01) as was the adjusted odds (aOR: 0.282, 95% CI: 0.146–0.546, p <.01). There was comparable mean length of stay and hospital charges. Conclusion: ICD utilization in CS patients is more common among males, who have a higher prevalence of diabetes and CKD but a lower prevalence of AF, sick sinus syndrome, and VF. Adjusted MACE and AKI were significantly lower in females. [ABSTRACT FROM AUTHOR]

Introduction: Transvenous lead extraction (TLE) is generally considered a safe procedure, albeit not without risks. While gender‐based disparities have been noted in short‐term outcomes following TLE, a notable gap exists in understanding the long‐term consequences of this procedure. The objective of this analysis was to investigate sex differences in both acute and long‐term outcomes among patients who underwent TLE at a tertiary referral center. Methods: In this retrospective cohort study, consecutive patients who underwent TLE between January 2014 and January 2016 were enrolled. The primary outcome comprised a composite of all‐cause mortality and need for repeated TLE procedures. Secondary outcomes included fluoroscopy time, lead extraction techniques, success rates, and major and minor complications. Results were compared between female and male cohorts. Results: The study population comprised 191 patients (median age, 70 years), 29 (15.2%) being women and 162 men (84.8%). Study groups had similar baseline characteristics. Complete procedural success was achieved in 189 out of 191 patients (99.0%), with no significant difference observed between the two groups (p =.17). No major complications were reported in the total cohort. However, there was a significantly higher incidence of minor complications in women compared to men (17.2% vs. 2.5%, p <.01). Following a median follow‐up of 6.5 years, the incidence of the primary composite outcome occurred similarly between the study groups (log‐rank p =.68). Conclusion: Women who underwent TLE exhibited a significantly higher incidence of minor acute intra‐ and peri‐procedural complications than men. However, no differences in long‐term outcomes between genders were observed. [ABSTRACT FROM AUTHOR]

Introduction: Early‐onset atrial fibrillation (AF) has already been observed in approximately 2% of patients with genetically proven long QT syndrome (LQTS). This frequency is higher than population‐based estimates of early‐onset AF. However, the concomitant expression of AF in LQTS is likely underestimated. The purpose of this study was to examine the clinical presentation, genetic background, and outcomes of a cohort of patients with LQTS and early‐onset AF referred to a single tertiary center. Methods: Twenty‐seven patients diagnosed with congenital LQTS were included in the study based on the documentation of early‐onset (age ≤50 years) clinical or subclinical AF episodes in all available medical records, including standard electrocardiograms, wearable monitor or cardiac implantable electronic devices. Results: Seventeen patients experienced clinical AF during the follow‐up period. Subclinical AF was detected in 10 patients through insertable or wearable cardiac monitors. In our series, the mean heart rate during AF episodes was found to be relatively low despite the patients' young age and the low or minimal effective doses of beta‐blockers used for QTc interval control. All patients exhibiting LQTS and early‐onset AF were genotype positive, carrying mutations in the KCNQ1 (66%), KCNH2, KCNE1, and SCN5A genes. Notably, most of these patients carried the same p.(R231C) mutation in the KCNQ1 gene (59%) and were from the same families, suggesting concurrent expression of familial AF and LQTS. Conclusion: LQTS patients are prone to developing clinical and subclinical AF, even at a younger age. The occurrence of early‐onset AF in the LQTS population could be more frequent than previously assumed. AF should be considered as a potential dysrhythmia related to LQTS. Our study emphasizes the importance of carefully researching clinical and/or subclinical episodes of AF through strict heart rhythm monitoring in the LQTS population. [ABSTRACT FROM AUTHOR]

Objective: Examine the temporal trends in medical device implant procedures in the Australian population. Methods: We used data from the Australian Institute of Health and Welfare from the financial years 2007–08 to 2021–22 and chose the most frequently performed medical device implant procedures. We estimated the annual change in volume of procedures and age-standardised rates by calculating the compound annual growth rate (CAGR), and used regression with the Newey–West robust variance estimator to examine whether there was a linear trend in the age-standardised rates for each procedure. Results: For procedures including cardiac pacemakers, heart valves, hip and knee arthroplasties, and intraocular lenses, the crude CAGR was over 3%. For the age-standardised rates, the CAGR was largest for cardiac pacemaker, followed by heart valve replacement and hip arthroplasty procedures. For some procedures, the growth was more than in the Australian population, including cardiac pacemakers (β = 1.00; 95% CI: 0.14–1.86), heart valve replacements (β = 0.41; 95% CI: 0.28–0.54), hip arthroplasty (β = 3.50; 95% CI: 1.61–5.38), and knee arthroplasty (β = 4.31; 95% CI: 0.54–8.09) procedures. The trend of standardised rates of procedures, including incisional hernia with mesh, breast implants, coronary stents, and cardiac defibrillators, grew at the same rate as the population, whereas the rate for gastric banding procedures decreased (β = −3.14; 95% CI: −4.92 to −1.34). Conclusion: The findings from the current study, showing a large increase in medical device implant procedures, will assist in future healthcare planning and efforts in post-market surveillance of safety of medical devices. What is known on this topic? Previous studies investigated trends in medical device implants on either a particular medical procedure or total procedures conducted on particular anatomical sites. What this study adds? Unlike previous studies, this study investigates a general population-level trend analysis of all major device implants using the most recent national-level database, covering all hospitals in Australia. What are the implications for practitioners? Findings from this study are useful for future healthcare planning and allocation of resources for the healthcare delivery of necessary healthcare to patients in Australia. In addition, the results can be used to inform efforts to improve post-marked surveillance of medical devices by providing estimates of the volume and standardised rates of procedures for type of devices. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study was to determine the effect of moderately strenuous aerobic exercise training on heart rate variability (HRV) and heart rate turbulence (HRT) in patients with an implantable cardioverter defibrillator (ICD). Methods: Patients were randomized to a 24-week home-based aerobic exercise (EX) training program (n = 84) or to usual care (UC) (n = 76). All subjects underwent 24-h Holter monitoring at baseline, 8 and 24 weeks. Generalized estimating equations were used to test the effects of exercise on HRV and HRT outcomes. Results: The study group was comprised of n = 160 patients (124 M, 36 F, age 54.9 ± 12.2 years) with an ICD for primary (43%) or secondary prevention (57%). Compared to UC, EX was associated with a significant improvement in parasympathetic HRV for root mean square of successive differences (rMSSD; p =.05) at 8 weeks and global HRV for standard deviation of all normal (N-N) intervals (SDNN; p =.05) and standard deviation of 5-min averages N-N intervals (SDANN; p =.03) at 24 weeks. When stratified by adherence, those who were ≥80% adherent (minutes/week) had significant improvements in parasympathetic HRV (rMSSD, pNN50) and global HRV (SDNN, SDANN) at 8 weeks, and a further significant improvement in global HRV (SDNN, SDANN, SDNN index) at 24 weeks. Neither HRT nor ventricular ectopy changed with exercise training. Conclusion: Moderately strenuous aerobic exercise improved parasympathetic and global HRV indices following an ICD, with greater adherence associated with greater improvements. Clinical trial registration: Clinicaltrials.gov: NCT 00522340. [ABSTRACT FROM AUTHOR]

Heart failure and chronic kidney disease are common and clinically important conditions that regularly coexist. Electrophysiologic changes of advanced heart failure often result in abnormal conduction, causing dyssynchronous contraction, and development of ventricular arrhythmias, which can lead to sudden cardiac arrest. In the last 2 decades, implantable cardioverter-defibrillator and cardiac resynchronization therapy devices have been developed to address these complications. However, when the coexisting chronic kidney disease is advanced, the associated pathophysiologic cardiovascular changes can alter the efficacy and safety of those interventions and complicate the management. This review explores the impact of comorbid advanced heart failure and advanced chronic kidney disease on the efficacy and safety of implantable cardioverter-defibrillator and cardiac resynchronization therapy, the currently available evidence, and potential future directions. [Display omitted] • The efficacy and safety of ICD and CRT devices have not been established for patients with advanced CKD, and available data suggest that they may be less favorable than in patients without advanced CKD. • Factors limiting the effectiveness of these devices in patients with advanced CKD include the frequency of nonshockable arrhythmias, increased defibrillation thresholds, noncapture, myocardial fibrosis, coexisting atrial fibrillation, limited use of guideline-directed therapies for heart failure, and relatively high rates of nonarrhythmic mortality. • Randomized trials are needed to improve selection of patients with advanced CKD for these device-based therapies. [ABSTRACT FROM AUTHOR]