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Aims Left bundle branch pacing (LBBP) has been shown to better maintain electrical synchrony compared with right ventricular pacing (RVP), but little is known about its impact on mechanical synchrony. This study investigates whether LBBP better preserves left ventricular (LV) mechanical synchronicity and function compared with RVP. Methods and results Sixty patients with pacing indication for bradycardia were included: LBBP (n = 31) and RVP (n = 29). Echocardiography was performed before and shortly after pacemaker implantation and at 1-year follow-up. The lateral wall–septal wall (LW–SW) work difference was used as a measure of mechanical dyssynchrony. Septal flash, apical rocking, and septal strain patterns were also assessed. At baseline, LW–SW work difference was small and similar in two groups. SW was markedly decreased, while LW work remained mostly unchanged in RVP, resulting in a larger LW–SW work difference compared with LBBP (1253 ± 687 mmHg·% vs. 439 ± 408 mmHg·%, P < 0.01) at last follow-up. In addition, RVP more often induced septal flash or apical rocking and resulted in more advanced strain patterns compared with LBBP. At 1 year follow-up, LV ejection fraction (EF) and global longitudinal strain (GLS) were more decreased in RVP compared with LBBP (ΔLVEF: −7.4 ± 7.0% vs. 0.3 ± 4.1%; ΔLVGLS: −4.8 ± 4.0% vs. −1.4 ± 2.5%, both P < 0.01). In addition, ΔLW–SW work difference was independently correlated with LV adverse remodelling (r = 0.42, P < 0.01) and LV dysfunction (ΔLVEF: r = −0.61, P < 0.01 and ΔLVGLS: r = −0.38, P = 0.02). Conclusion LBBP causes less LV mechanical dyssynchrony than RVP as it preserves a more physiologic electrical conduction. As a consequence, LBBP appears to preserve LV function better than RVP. [ABSTRACT FROM AUTHOR]

Background: Intracardiac echocardiography (ICE) technology has been increasingly accepted as an integral part of atrial fibrillation (AF) ablation procedures. It is still unknown whether ICE can routinely replace transesophageal echocardiography (TEE) for routine thrombus screening in non‐selective AF patients. Objective: To assess whether ICE can routinely replace TEE in screening for left atrial (LA)/left atrial appendage (LAA) thrombus in general patients undergoing catheter ablation for AF. Methods: A total of 2003 consecutive patients undergoing AF ablation were included. 1155 patients (ICE group) received intra‐procedural ICE examination for LA/LAA thrombus screening, while 848 patients (TEE group) received pre‐procedure TEE examination. The incidence of thrombus, peri‐procedure complications, and hospital efficiency were assessed. Results: The LA and LAA were adequately visualized in all patients. Five patients in the ICE group and 15 patients in the TEE group were found to have LAA thrombus. The incidence of major periprocedural thrombo‐embolic events was comparable between two groups (0.2% vs. 0.1%, p =.76), none were due to undetected LA/LAA thrombus. Other major periprocedural complications occurred at similar rates in both groups, while post‐procedure fever was less common in the ICE group (12.7% vs. 17.4%, p <.001). Procedure times and hospital length of stay were both shorter in the ICE group (142 min [87–197 min] vs. 150 min [95–205 min], and 3[2–4] day vs. 4[3–5] day, respectively, both p <.001). Conclusions: ICE can replace TEE for atrial thrombus screening in AF patients undergoing ablation without increased complications. An "ICE replacing TEE" workflow can also reduce the incidence of postoperative fever and improve hospital efficiency. [ABSTRACT FROM AUTHOR]

Objectives: To explore the feasibility of applying smart-planes fetal heart (S-Planes FH) to 3D volumes to generate and display the outflow tract views (OFTVs) and evaluate its agreement and reliability in determining fetal vessel dimensions.Methods: A total of 147 normal fetuses in the second or third trimester were enrolled. Once conventional 2D sonographic examination was finished, one or more 3D static volumes were then acquired in the 4-chamber view (4CV). The OFTVs automatically generated and displayed via a simple offline operation using S-Planes FH software. Per fetus, a single qualified S-Planes FH image was selected by an expert. The inner diameters of the aorta (AO) and pulmonary artery (PA) were measured in 2D and S-Planes FH images, respectively. The agreement and reliability of the two methods were verified by the Bland-Altman method and the intraclass correlation coefficient (ICC), respectively.Results: A total of 515 3D static volumes were successfully acquired in 147 fetuses. The OFTVs were generated and displayed using S-Planes FH in 138 (93.9%) cases. S-Planes FH had good agreement in measuring the diameters of great arteries (95% CI of limits, -0.9419 to 1.1464 for AO diameter, -0.8871 to 1.7007 for PA diameter). The intraobserver and interobserver ICCs in this study were greater than 0.81, indicating almost perfect reliability of the two methods with regard to observers.Conclusions: S-Planes FH software is a feasible method for generating OFTVs as well as determining vessel dimensions in the second and third trimesters and had good agreement with 2D examination. Therefore, it possesses clinical value in screening for CHD and can be operated by different sonographers. [ABSTRACT FROM AUTHOR]

Aims: Left bundle branch pacing (LBBP) has been shown to better maintain electrical synchrony compared with right ventricular pacing (RVP), but little is known about its impact on mechanical synchrony. This study investigates whether LBBP better preserves left ventricular (LV) mechanical synchronicity and function compared with RVP., Methods and Results: Sixty patients with pacing indication for bradycardia were included: LBBP (n = 31) and RVP (n = 29). Echocardiography was performed before and shortly after pacemaker implantation and at 1-year follow-up. The lateral wall-septal wall (LW-SW) work difference was used as a measure of mechanical dyssynchrony. Septal flash, apical rocking, and septal strain patterns were also assessed. At baseline, LW-SW work difference was small and similar in two groups. SW was markedly decreased, while LW work remained mostly unchanged in RVP, resulting in a larger LW-SW work difference compared with LBBP (1253 ± 687 mmHg·% vs. 439 ± 408 mmHg·%, P < 0.01) at last follow-up. In addition, RVP more often induced septal flash or apical rocking and resulted in more advanced strain patterns compared with LBBP. At 1 year follow-up, LV ejection fraction (EF) and global longitudinal strain (GLS) were more decreased in RVP compared with LBBP (ΔLVEF: -7.4 ± 7.0% vs. 0.3 ± 4.1%; ΔLVGLS: -4.8 ± 4.0% vs. -1.4 ± 2.5%, both P < 0.01). In addition, ΔLW-SW work difference was independently correlated with LV adverse remodelling (r = 0.42, P < 0.01) and LV dysfunction (ΔLVEF: r = -0.61, P < 0.01 and ΔLVGLS: r = -0.38, P = 0.02)., Conclusion: LBBP causes less LV mechanical dyssynchrony than RVP as it preserves a more physiologic electrical conduction. As a consequence, LBBP appears to preserve LV function better than RVP., Competing Interests: Conflict of interests: None declared., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: The aim of this study was to assess the characteristics of mitral annular plane systolic excursion (MAPSE) in different longitudinal directions in normal fetuses using a new method, automatic cardiac motion quantification (aCMQ)., Methods: A cross-sectional study was conducted in 164 fetuses with structurally normal hearts. The time-displacement curves of the septal mitral annulus (SMA) in three directions, including point A, B and C (MAPSE-SMA-A, MAPSE-SMA-B, MAPSE-SMA-C), were recorded by aCMQ. The time to peak (TTP) in three directions, including point A, B and C (TTP-SMA-A, TTP-SMA-B, TTP-SMA-C) were recorded. In the same way, various parameters of the lateral mitral annulus (LMA) were obtained including MAPSE-LMA-A, MAPSE-LMA-B, MAPSE-LMA-C, TTP-LMA-A, TTP-LMA-B and TTP-LMA-C. Free angle M-mode echocardiography (FAM) was used to obtain MAPSE of LMA (FAM-MAPSE). Finally, all the data were analyzed statistically., Results: MAPSE was positively correlated with gestational age, and the difference between the second- and third-trimester groups was statistically significant. MAPSE-LMA in point B and C were greater than those of SMA. MAPSE-LMA-C and MAPSE-SMA-A were the largest in three directions.The difference between point B and C were statistically significant ( p <  .05), with no significant difference at point A ( p  > .05). There was no significant difference found in all TTP (all p  > .05). The MAPSE-LMA-C was less than the FAM-MAPSE, and the differences were found significantly ( p  < .05), but there was better correlation ( p  < .05)., Conclusions: The longitudinal movement of the fetal mitral annulus is comprehensive, with multiple directions and different displacements. Perpendicular to the mitral annulus is the maximum displacement. It is positively related to the gestational age. From the second trimester, the longitudinal contraction of the left ventricle wall has good synchronization. It possesses clinical value in selecting different methods and parameters during evaluating left ventricular function.

Background: Left atrial appendage (LAA) dysfunction is associated with increased risk of thromboembolic events. However, little is known about LAA mechanical dispersion (MD) would provide additional information toward thromboembolism over the CHA2DS2-VASc score. The aim of this study was to determine the association of LAA mechanics as assessed by speckle-tracking imaging with thromboembolic events in patients with nonvalvular atrial fbrillation (AF)., Methods: A total of 116 consecutive patients with AF referred for transesophageal echocardiography (TEE) were prospectively enrolled. Of these, 17(14.7%) patients had prior embolic events. Using speckle-tracking echocardiography (STE), we measured the LAA strain in each of 24 segments in mid-esophageal TEE views obtained at 0°, 45°, 90° and 135°. LAA MD was defined as the standard deviation (SD) of time to peak positive strain corrected by the R-R interval., Results: Patients with embolism had lower LAA global longitudinal strain (GLS) (8.56 ± 2.62% vs 11.37 ± 5.54%, p = 0.002) and higher LAA MD (16.90 ± 6.67% vs 12.10 ± 3.94%; P = 0.010) than those without embolism. LAA MD >13.1% differentiated patients with embolism from controls, with an area under the curve (AUC) of 0.709(p = 0.004). LAA MD was independently associated with the presence of thromboembolism in multivariate analysis (odds ratio, 1.24; 95% confidence interval, 1.08-1.42; P = 0.002). The model based on CHA 2 DS 2 -VASc score for discrimination of patients with embolism was significantly improved by adding LAA MD (P < 0.01)., Conclusion: LAA MD obtained from strain echocardiography was significantly associated with a prior history of embolic events and had incremental diagnostic value over CHA2DS2VASc score, suggesting that LAA MD may be useful in refining thromboembolic risk stratification in patients with AF., Competing Interests: Declaration of competing interest None declared., (Copyright © 2020 Elsevier B.V. All rights reserved.)