Cardiac Devices Research Articles

Efficacy of a gentamycin-collagen sponge to prevent infection in implantable cardioverter defibrillator patients undergoing revision surgery - results of a monocentric ICD registry observational study

Abstract Introduction Despite the obvious benefits, the use of implantable cardioverter defibrillators (ICDs) is associated with serious complications, including infections. In particular, device replacement or revision procedures are associated with an increased risk of infection. Aim of the study was to compare the cardiac device infection rate with and without the use of the gentamycin-collagen sponge (GCS) in patients undergoing device replacement or revision procedures of implanted ICDs. Methods A total of 491 consecutive ICD patients from a prospective single-centre ICD-registry who underwent elective device replacement, system upgrade or lead revision between 2017 and 6/2023 were analyzed. From September 2020 onwards, a GCS was inserted into the device pocket (GCS group, n = 256). These patients were compared to the patients implanted/ revised between 2017 and 8/2020 (control group, n = 235). Results The baseline characteristics and the PADIT score were similar in both groups (Table 1). The GCS was well tolerated and there were no complications associated with the GCS. The mean follow-time was 15 + 10 months in the GCS group and 30 + 11 months in the control group. The Kaplan-Meier estimated infection rate after one year was 1.0% in the GCS group and 3.5% in the control group (p = 0.03, Figure 1). Time from revision to infection was 144 + 134 days in the GCS group vs. 362 + 297 days in the control group. Conclusion Adjunctive use of a GCS was associated with a lower incidence of device infections than standard-of-care infection-prevention strategies alone.

Efficacy of Different Exercise Modalities in Patients with Implantable Cardiac Devices: A Systematic Review

Efficacy of Different Exercise Modalities in Patients with Implantable Cardiac Devices: A Systematic Review

Ablation of persistent atrial fibrillation based on atrial electrogram duration map: methodology and clinical outcomes from the AEDUM pilot study

Abstract Background Catheter ablation of persistent atrial fibrillation (PsAF) represents a challenge for the electrophysiologist and there are still divergences regarding the best ablative approach to adopt. Objectives Create a new map of the duration of atrial bipolar electrograms (Atrial Electrogram DUration Map, AEDUM) to recognize a functional substrate during sinus rhythm and guide a patient-tailored ablative strategy for PsAF. Methods 40 PsAF subjects were assigned in a 1:1 ratio to either for PVI alone (Group B1) or PVI+AEDUM areas ablation (Group B2). A cohort of 15 patients without AF history undergoing left-sided accessory pathway ablation was used as a control group (Group A). In all patients, voltage and AEDUM maps were created during sinus rhythm. The minimum follow-up was 12-months, with rhythm monitoring via 48-h ECG Holter or by implantable cardiac device. Results Electrogram (EGM) duration was higher in Group B than in Group A (49±16.2ms vs 34.2±3.8ms; p-value<0.001). In Group B the mean cumulative AEDUM area was 21.8±8.2cm2; no difference between the two subgroups was observed (22.3±9.1cm2 vs 21.2±7.2cm2; p-value=0.45). The overall bipolar voltage recorded inside the AEDUM areas was lower than in the remaining atrial areas [median:1.30mV (IQR:0.71–2.38mV) vs 1.54mV (IQR:0.79–2.97mV); p-value:<0.001)]. Low voltage areas (<0.5mV) were recorded in three (7.5%) patients in Group B. During the follow-up [median 511 days(376-845days)] patients who underwent PVI-only experienced more AF recurrence than those receiving a tailored approach (65% vs 35%; p-value=0.04). Conclusions All PsAF patients exhibited AEDUM areas. An ablation approach targeting these areas resulted in a more effective strategy compared with PVI only.AEDUM mapAEDUM map and lesion set

Patient informed consent, ethical and legal considerations in the context of digital vulnerability with smart, cardiac implantable electronic devices.

Advancements in digitalisation with cardiac implantable electronic devices (CIEDs) allow patients opportunities for improved autonomy, quality of life, and a potential increase in life expectancy. However, with the digital and functional practicalities of CIEDs, there exists also cyber safety issues with transferring wireless information. If a digital network were to be hacked, a CIED patient could experience both the loss of sensitive data and the loss of functional control of the CIED due to an unwelcome party. Moreover, if a CIED patient were to become victim of a cyber attack, which resulted in a serious or lethal event, and if this information were to become public, the trust in healthcare would be impacted and legal consequences could result. A cyber attack therefore poses not only a direct threat to the patient's health but also the confidentiality, integrity, and availability of the CIED, and these cyber threats could be considered "patient-targeted threats." Informed consent is a key component of ethical care, legally concordant practice, and promoting patient-as-partner therapeutic relationships [1]. To date, there are no standardised guidelines for listing cybersecurity risks within the informed consent or for discussing them during the consent process. Providers are responsible for adhering to the ethical principles of autonomy, beneficence, non-maleficence, and justice, both in medical practice generally and the informed consent process specifically. At present, the decision to include cybersecurity risks is mainly left to the provider's discretion, who may also have limited cyber risk information. Without effective and in-depth communication about all possible cybersecurity risks during the consent process, CIED patients can be left unaware of the privacy and physical risks they possess by carrying such a device. Therefore, cyber risk factors should be covered within the patients' informed consent and reviewed on an ongoing basis as new risk information becomes available. By including cyber risk information in the informed consent process, patients are given the autonomy to make the best-informed decision.

Multimodal preoperative imaging for transcatheter mitral valve replacement in the domestic sheep model

Preclinical in vivo evaluation is an essential step in the progression of new cardiac devices into patient use, with studies predominantly performed in the domestic sheep model. A growing area of interest in cardiac device development is transcatheter mitral valve replacement (TMVR). Clinically, multimodal imaging, or computed tomography (CT) and echocardiography (echo) are used extensively to preoperatively determine mitral valve morphology prior to an intervention, but there is no description on how these modalities can be implemented to support preclinical studies. The purpose of this study is to apply clinically relevant CT and echo acquisition and assessment techniques to a large group of naive research sheep in order to analyze and report modality-related effects on mitral valve dimensional reference intervals in the sheep model. To this end, fifty-five adult domestic sheep underwent preoperative CT and echo exams and resultant images were analyzed using a landmark-based multiplanar measurement protocol and compiled into a master dataset for statistical analysis. We found moderate agreement between CT and echo-derived measurements of the mitral valve in sheep and propose the first clinically-relevant dimensional indices for the sheep’s naive mitral valve which can be used to guide future studies evaluating novel TMVR devices. This study is the first of its kind in proposing a reproducible method for detailed examination of the mitral valve in the sheep model using clinically-relevant multimodal imaging. As in patients, CT and echo can reveal accurate native mitral valve dimensions in the sheep prior to preclinical TMVR studies.

Pulsed field ablation in patients with cardiac implantable electronic devices: an ex vivo assessment of safety.

Pulse field ablation (PFA) is a novel catheter ablation technology with potential safety benefits due to its tissue selectivity. It has the potential to directly damage or interact with the functionality of cardiac implantable electronic devices (CIEDs) in the form of electromagnetic interference (EMI). The aim of our study was to assess the impact of PFA on CIEDs. PFA lesions (45 per CIED) were applied from the Farapulse system to CIEDs (< 5 cm from the lead tip and < 15 cm from the generator). All devices were checked before and after PFA application for proper sensing and pacing functionality as well as for integrity of shock circuits in ICDs using a heart simulator. Moreover, devices were then interrogated for any spontaneous reprogramming, mode switching or other EMI effects. In total, 44 CIEDs were tested (16 pacemaker, 21 ICDs, 7 CRT-P/D) with 1980 PFA applications. There was no change in device settings, functionality and electrical parameters, and there was no macroscopic damage to the devices. The risk of damage to the electric components or leads on a patient-based analysis is 0/44 (95% CI 0-8%) and on a PFA pulse-based analysis is 0/1980 (95% CI 0-0.2%). Clinically relevant EMI appeared with oversensing and pacing inhibition but not tachycardia detection. Bipolar PFA appears safe and does not result in damage to CIEDs or leads. Clinically relevant EMI does occur, but appropriate peri-procedural programming may mitigate this. In vivo studies are needed to confirm our findings.

Patient Information Needs and Decision-Making Before a Cardiac Implantable Electronic Device: A Qualitative Study Utilizing Social Media Data.

The decision to receive a cardiac implantable electronic device (CIED) represents a challenging experience for patients. However, the majority of previous research has only considered retrospective accounts of patient experiences. This study aimed to use social media data to characterize the information sought by people anticipating or considering CIED implantation and factors that influence their decision-making experiences. A Python-based script was used to collect posts made to a community intended for discussions concerning CIEDs on the social media platform Reddit. Reflexivecontent analysis was used to analyze the collected data. From 799 posts collected, 101 made by 86 participants were analyzed. The reported median (range) age of participants was 34 (16-67), and most were anticipating or considering a pacemaker. Three overarching categories classified the data: "Use of social media to meet informational and other needs"; "Factors influencing acceptance of the need for implantation"; and "Specific concerns considered during decision-making." Participants anticipating or considering a CIED predominantly sought experiential information. Among asymptomatic participants, doubts were prevalent, with acceptance being an influential factor in decision-making. Healthcare professionals should recognize the informational and emotional needs of prospective CIED patients and tailor support mechanisms to better facilitate their decision-making.

Phage Therapy for Cardiac Implantable Electronic Devices and Vascular Grafts: A Targeted Literature Review.

Infections of cardiac implantable electronic devices (CIEDs) and vascular grafts are some of the most dreaded complications of these otherwise life-saving devices. Many of these infections are not responsive to conventional treatment, such as systemic antibiotics and surgical irrigation and debridement. Therefore, innovative strategies to prevent and manage these conditions are warranted. Among these, there is an increasing interest in phages as a therapeutical option. In this review, we aim to collect the available evidence for the clinical application of phage therapy for CIED and vascular graft infections through literature research. We found 17 studies for a total of 34 patients. Most of the indications were left ventricular assist device (LVAD) (n = 20) and vascular graft infections (n = 7). The bacteria most often encountered were Staphylococcus aureus (n = 18) and Pseudomonas aeruginosa (n = 16). Clinical improvements were observed in 21/34 (61.8%) patients, with microbiological eradication in 18/21 (85.7%) of them. In eight cases, an adverse event related to phage therapy was reported. Phage therapy is a promising option for difficult-to-treat CIED and vascular graft infections by means of an individualized approach. Clinical trials and expanded access programs for compassionate use are needed to further unveil the role of phage therapy in clinical application.

MAGNETIC RESONANCE AND CARDIAC IMPLANTABLE DEVICES: A SAFE COMBINATION

Abstract Despite guidelines the presence of a cardiac implantable device (CIED) in a magnetic resonance (MR) ambient raises fears and perplexities and generates the often inappropriate request for support from the electrophysiologist. From January 2019 to November 2023 all patients with a cardiac implantable device (CIED) undergoing magnetic resonance (MR) were evaluated. All CIEDS were classified into three subgroups: MR–conditional, MR–unsafe and "non MR–conditional" (catheters and generators MR–conditional but of different manufacturers). No implantable loop recorders were enrolled. We performed a device control immediately before and after the RM procedure. We analyzed the percentage variations of each parameter (sensing, impedance and pacing threshold) pre– and post–MR and the variation versus the latest or the subsequent ambulatory control. 151 patients were proposed to undergo MR. 16 patients underwent multiple exams. The districts explored from RM were head (47%), column (21%), breast (1%), heart (3%), abdomen (20%), prostate (2%) and arms (16%). The median age was 70 years old, and 102 patients were males. CIEDS were pacemaker in 67% (3 leadless and 1 CRT–P), 33% defibrillators (5 S–ICD and 10 CRT–D). 85% of the systems were classified as MR–conditional, 3% as MR–unsafe and 12% as "non MR–conditional". The percentage median variation of atrial and ventricular sensing, impedance and threshold during the exam was 0%. MR did not significantly modify the parameters considered. No adverse events arise at the end of MR or in the days after. In our experience, there is no need for the presence of the electrophysiologist during the procedure due to safety even in "non MRI–conditional" or MR–unsafe patients.

MANAGEMENT OF REMOTE MONITORING FOR IMPLANTABLE DEVICES CONTROLS: SINGLE CENTER EXPERIENCE

Abstract Background Nowadays the benefits of remote monitoring (RM)of cardiac implantable electronic devices (CIEDs) are Known: an improved both device surveillance and patient clinical management and a decrease in office follow up. So RM is used as supplement in clinic follow up for patients with CIED.However despite decades to RM utilization there are challenges in managing patients with RM including large number of trasmissions and lack of trained staff. There are many different model of care to RM management. Methods We describe our model of care to management CIED recipients with RM considering data collected from January 2021 to November 2023. Results Our model of care consists of 4 electrophysiologists Physicians and 4 Tecnicians. RM enrollment is performed at scheduled in office visit after ten days from hospital discharge after device implantation. implantable cardiac device(ICD)recipients with RM are annualy followed in office and biennal for pacemaker (PM) recipients and they send every three months transmissions. Trained tecnicians gives home monitor, take care of patients education and collected and screen transmissions. Tecnicians inform immediately physicians in case of urgent alert (shock or antitachicardia pacing therapy (ATP), sustained ventricular tachycardia(TV), ventricular fibrillation (Fv) indicator of elective replacement (ERI), lead releted alert or noise). Physician contact patients the same day (exept Saturday and Sunday). In addiction Physicians twice a week review less urgent and scheduled transmissions and call the patients by phone for visit in office for patients with low rate of biventricular pacing, detection of atrial fibrillation. We have 1000 patients with RM: 746 ICD recipients (103 Biotronik, 150 Abbott, 200 Boston scientific, 293 medtronic), 50 implantable cardiac monitor (ICM) recipients and 204 PM recipients. We analyze 12721 transmissions.Considering ICD recipient we detect 96 episode of ATP and 31 of shock. Shock of ICD was registered in 52 patients (6,9%)We received 1982 atrial fibrillation (AF) detection, with 35 for new detectable AF.The most of transmisisone were for low bIV pacing. We contacted these patients by phone about clinical status and in some case we called them in office. Conclusions Our model of care allows to control a large number of trasmissions with fast management of urgent alert trasmissions.

ATRIAL FIBRILLATION IN A CIED POPULATION: RESULTS FROM A TELEMONITORING FOLLOW–UP

Abstract Background Telemedicine has emerged as a crucial tool in managing patients with Cardiac Implantable Electronic Devices (CIED), addressing the common challenge of the Atrial Fibrillation (AF) in cardiology. The incidence of AF in CIED recipients varies widely (30–70%), influenced by implant indication, device type, and population characteristics. This study aims to evaluate AF in an unselected, real–world CIED population, considering patients’ characteristics and the remote follow–up. Methods and Results 808 consecutive CIED recipients were evaluated between 2021 and 2023 in two Italian Division of Cardiology by collecting patients’ baseline characteristics and the scheduled remote follow–up data. Mean age was 75.6±12.6 years, 42% were females. 16.7% of the population was working actively and 73% of individuals were assisted by at least one caregiver, reflecting a diminished quality of life (EQ–5D score 8.9±4.3). Over a median follow–up of 20.6 months, 8.9% of patients died. 68.8% of the patients received a pacemaker, 19.3% an ICD and 11.9% a loop recorder. History of AF was present in 40.1% of the population, with a prevalence of permanent AF (46.6%). Ongoing anticoagulant therapy was documented in 303 patients (37.5%), 71% of whom were taking direct oral anticoagulants. Baseline CHA2DS2–VASC score was ≥3 in 79.7%, and the median HAS–BLED score was 1. During the observation period, scheduled remote transmissions revealed 719 AF episodes (15.7 episodes/patient/year), causing 21% of the overall remote alarms. Among patients without AF history, 69 (14.3%) experienced AF episodes (4.8 episodes/patient/year). Notably, 21.8% of the AF episodes lasted less than 10 minutes. Conclusions The wide spreading of heart rhythm monitoring technologies reveals the challenge of the subclinical AF in healthcare systems. This study, encompassing an unselected CIED population of elderly and frail patients with high AF prevalence, highlights AF as a primary cause of remote alerts and a substantial burden in telemonitoring controls. Telemedicine facilitated new AF diagnoses in 14.3% of individuals without a prior AF history and resulted a valuable tool considering the significant cardioembolic risk in these patients. However, the initiation of anticoagulation therapy remains debatable, especially for episodes of brief duration which in our experience exceeded 20% of the cases.

WEARABLE CARDIOVERTER–DEFIBRILLATORS IN CLINICAL PRACTICE IMPLEMENTATION OF THE ANMCO POSITION PAPER FOR APPROPRIATE USE OF THE WEARABLE CARDIOVERTER DEFIBRILLATOR

Abstract Introduction Wearable cardioverter–defibrillators (WCD) have emerged as a valuable tool in the management of patients at risk for life–threatening arrhythmias. These devices offer a non–invasive and temporary solution, providing continuous monitoring and the potential for prompt defibrillation when needed. In this study, we explore the indications for WCD and evaluate arrhythmic events through comprehensive monitoring. Methods From November 2022 to December 2023, we conducted an outpatient follow–up of 18 patients receiving WCD. Regular check–ups and comprehensive echocardiography were performed to optimize therapy based on specific indications for each patient. Results The average age of the patients was 59.3±17.4 years, with 79% being male. Among the cohort, 58% had hypertension, and a similar percentage comprised smokers and individuals with dyslipidemia, while 32% were diabetic. The indications for receiving WCD were: de novo diagnosis of dilated cardiomyopathy with reduced ejection fraction in 9 (50%) patients, recent acute coronary syndrome and ejection fraction &amp;lt; 35% in 5 (28%), cardiac electronic device infections in 3 (17%) patients and myocarditis with electrical instability in 1 (5%) patient. Patients were in optimal medical therapy (OMT) tailored to their specific comorbidities, with 84% on renin–angiotensin–aldosterone system inhibitors, 95% on beta–blockers, 53% on mineralocorticoid receptor antagonists, 53% on sodium–glucose cotransporter–2 inhibitors, and 37% on antiarrhythmics. The average follow–up was 64±45 days according to specific etiology, with a daily wearing time of 22.9±1.1 hours. No device interventions were recorded. At the end of the follow–up period, 6 (33%) patients still required implantable cardioverter–defibrillator (ICD). Among these, 4 patients (22%) underwent to ICD implantation, 3 for secondary prevention, and 1 for primary prevention, while notably, 2 (11%) patients, declined the procedure. Conclusions The use of wearable cardioverter–defibrillators in the outpatient setting for patients at risk of life–threatening arrhythmias allowed to optimize therapy and restrict the indications for ICD, in our cohort up to 67%, with a good safety profile due to the low incidence of device interventions.

Spectral computed tomography (SCT) after cardiovascular electronic devices implantation: No more blinding lights

Accurate localization of intraventricular electrode tips in patients with Cardiac Implantable Electronic Devices (CIEDs) remains a challenge, necessitating advanced imaging techniques. Traditional methodologies, such as Chest X-ray (CXR) and echocardiography, may prove insufficient in precisely determining electrode positions. ECG-gated contrast enhanced coronary

Contemporary Advances in Cardiac Remote Monitoring: A Comprehensive, Updated Mini-Review

Over the past decade, remote monitoring (RM) has become an increasingly popular way to improve healthcare and health outcomes. Modern cardiac implantable electronic devices (CIEDs) are capable of recording an increasing amount of data related to CIED function, arrhythmias, physiological status and hemodynamic parameters, providing in-depth and updated information on patient cardiovascular function. The extensive use of RM for patients with CIED allows for early diagnosis and rapid assessment of relevant issues, both clinical and technical, as well as replacing outpatient follow-up improving overall management without compromise safety. This approach is recommended by current guidelines for all eligible patients affected by different chronic cardiac conditions including either brady- and tachy-arrhythmias and heart failure. Beyond to clinical advantages, RM has demonstrated cost-effectiveness and is associated with elevated levels of patient satisfaction. Future perspectives include improving security, interoperability and diagnostic power as well as to engage patients with digital health technology. This review aims to update existing data concerning clinical outcomes in patients managed with RM in the wide spectrum of cardiac arrhythmias and Hear Failure (HF), disclosing also about safety, effectiveness, patient satisfaction and cost-saving.

REMOTE CARDIAC DEVICE MANAGEMENT: REAL–WORLD INSIGHTS AND CHALLENGES

Abstract Background telemedicine plays a crucial role in managing patients with Cardiac Implantable Electronic Devices (CIEDs), offering unique technical and clinical benefits. This study explores the characteristics of a real–world population of CIED recipients undergoing entirely remote follow–up. Methods and Results in a prospective evaluation of 808 consecutive CIED patients from two Italian Cardiology Centers (2021–2023), initial on–site assessments were followed by remote evaluations, either scheduled or alert–triggered. The majority received pacemakers (68.8%), with others having Implantable Defibrillators (19.3%) or Implantable Loop Recorders (11.9%). The average age was 75.6±12.6 years, and 42% were female. Most of the patients were retired (83.3%), and 73% required at least one caregiver. The EQ–5D score indicated a lower quality of life (8.9±4.3) compared to the Italian general population. During the observation period (20.6 months), 34.9% of patients were admitted to the hospital, with 50% of cases being cardiovascular–related. Heart failure was the most common cause (13.2%). Device–related issues prompted outpatients’ cardiology clinic Department evaluations in 13.4% of cases. The telemedicine program produced 2780 remote transmissions, with 23% being automatic alerts. In–clinic evaluations were 1313, with a mean duration of 19.2 minutes. Atrial fibrillation (AF) history was prevalent (40.2%), and 719 AF episodes occurred during the observation period. Conclusions Managing CIED patients via telemedicine is feasible but requires structured organization considering patient characteristics and possible outcomes. AF management is crucial, given its high prevalence. Older age and compromised quality of life are significant factors, partly mitigated by the widespread presence of caregivers. Despite remote follow–up, many patients access healthcare structures for cardiovascular reasons, emphasizing the need for distinct pathways for device–related and general care necessities.

USE OF LIFE–VEST AND COMPLEX RE–IMPLANTATION OF CRT–D IN PATIENT WITH POCKET INFECTION BY MULTIRESISTENT S. AUREUS AND PERSISTENCE OF LEFT SUPERIOR VENA CAVA

Abstract Patient with primary hypokinetic dilated cardiomyopathy, previously underwent coronary angioplasty with stent implantation on MO branch and subsequent implantation of CRT–D in right subclavian region for persistence of left superior vena cava and complicated left sided implantation; hypertensive, dyslipidaemic, diabetic. Repeated subsequent surgery for shock channel malfunction with re–implantation of right ventricular lead. He came to our observation for infection of the CRT–D pocket by multiresistant Staphylococcus Aureus treated by intravenous antibiotic therapy and explantation of the infected device. We therefore proceeded to discharge the patient with Life–Vest as a bridging strategy until re–implantation and continued with long–acting antibiotic therapy administered every fortnight. After about 8 weeks, once the presence of infectious/inflammatory processes has been ruled out, CRT–D reimplantation is performed, after prophylaxis with Vancomycin, in the right subclavian region under sterile conditions and in the absence of complications. The management of cardiac device infections represents a challenge for the cardiologist especially in the complex patient with a history of re–interventions in which multi–resistant pathogens are often found. This clinical case demonstrates how collegial patient assessment and long–term protection strategies, such as the use of a Life–Vest, can achieve the diagnostic–therapeutic goal.

Lead placement in cardiac implantable electronic devices

The implantation of electrodes for cardiac implantable electronic devices (CIED) requires profound technical understanding and precise execution. The positioning of electrodes in the right ventricle and atrium has significant implications for patient safety and the effectiveness of CIED therapy. Particular focus is given to the distinction between apical and septal stimulation in ventricular positioning. Based on current data, this article provides apractice-oriented guide that leads implanters through the individual steps of electrode positioning. The implantation of electrodes for physiological stimulation (cardiac resynchronization therapy, CRT, and conduction system pacing, CSP) is not addressed in this article.

INFECTIOUS ENDOCARDITIS, ITS CHALLENGES AND UPDATING THE DUKE CRITERIA: A LITERATURE REVIEW

Infective endocarditis (IE) is an inflammatory process that occurs in the endocardium and also in implantable cardiac devices, the septum between the heart chambers, and in particular the heart valves, whether biological or prosthetic, this process comes from infection by some microorganism, especially bacteria. In 2023, the International Society of Cardiovascular Infectious Diseases (ISCVID) reformulated the diagnostic criteria, in particular those related to microbiological aspects. The aim of this study is to discuss the modified Duke criteria, therapeutic measures, and future challenges. The present study is a narrative bibliographical review that analyzed scientific production in online databases. Because it is a rare pathology, its annual incidence is between 3 and 10 cases per 100,000 people, and it is twice as common in males. Its treatment is complex, but its mainstay is antibiotic therapy and, when necessary, cardiac surgery. Empirical antibiotic treatment should be carried out as soon as possible after blood culture tests have been taken. In conclusion, IE is one of the most laborious and difficult medical conditions for physicians to practice, so it is important to employ a systemic approach based on scientific evidence for diagnostic investigation and therapeutic care for good results and patient well-being.

Three-dimensional assessment of image distortion induced by active cardiac implants in 3.0T CMR

CMR at 3.0T in the presence of active cardiac implants remains a challenge due to susceptibility artifacts. Beyond a signal void that cancels image information, magnetic field inhomogeneities may cause distorted appearances of anatomical structures. Understanding influencing factors and the extent of distortion are a first step towards optimizing the image quality of CMR with active implants at 3.0T. All measurements were obtained at a clinical 3.0T scanner. An in-house designed phantom with a 3D cartesian grid of water filled spheres was used to analyze the distortion caused by four representative active cardiac devices (cardiac loop recorder, pacemaker, 2 ICDs). For imaging a gradient echo (3D-TFE) sequence and a turbo spin echo (2D-TSE) sequence were used. The work defines metrics to quantify the different features of distortion such as changes in size, location and signal intensity. It introduces a specialized segmentation technique based on a reaction–diffusion-equation. The distortion features are dependent on the amount of magnetic material in the active implants and showed a significant increase when measured with the 3D TFE compared to the 2D TSE. This work presents a quantitative approach for the evaluation of image distortion at 3.0T caused by active cardiac implants and serves as foundation for both further optimization of sequences and devices but also for planning of imaging procedures.

Advances in Clinical Cardiology 2023: A Summary of Key Clinical Trials.

Over the course of 2023, numerous key clinical trials with valuable contributions to clinical cardiology were published or presented at major international conferences. This review seeks to summarise these trials and reflect on their clinical context. The authors collated and reviewed clinical trials presented at major cardiology conferences during 2023 including the American College of Cardiology (ACC), European Association for Percutaneous Cardiovascular Interventions (EuroPCR), European Society of Cardiology (ESC), Transcatheter Cardiovascular Therapeutics (TCT), American Heart Association (AHA), European Heart Rhythm Association (EHRA), Society for Cardiovascular Angiography and Interventions (SCAI), TVT-The Heart Summit (TVT) and Cardiovascular Research Technologies (CRT). Trials with a broad relevance to the cardiology community and those with potential to change current practice were included. A total of 80 key cardiology clinical trials were identified for inclusion. Key trials in acute coronary syndrome (ACS) and antiplatelet management such as HOST-IDEA, T-PASS and STOP-DAPT3 were included in addition to several pivotal interventional trials such as ORBITA 2, MULTISTARS-AMI, ILUMIEN-IV, OCTIVUS and OCTOBER. Additionally, several trials evaluated new stent design and technology such as BIOSTEMI, PARTHENOPE and TRANSFORM. Structural intervention trials included long-term data from PARTNER 3, new data on the durability of transcatheter aortic valve intervention (TAVI), in addition to major new trials regarding transcatheter tricuspid valve intervention from TRISCEND II. Heart failure (HF) and prevention covered several key studies including DAPA-MI, STEP-HF, ADVOR, DICTATE HF and CAMEO-DAPA. In cardiac devices and electrophysiology, several trial exploring novel ablation strategies in atrial fibrillation (AF) such as PULSED AF and ADVENT were presented with further data evaluating the efficacy of anticoagulation in subclinical AF in NOAH-AFNET 6, FRAIL AF and AZALEA-TIMI 71. This article presents a summary of key clinical cardiology trials published and presented during the past year and should be of interest to both practising clinicians and researchers.