Pacemaker Insertion Research Articles

Abstract 4143217: Gender Disparities in Clinical Outcomes Following Transcatheter Aortic Valve Replacement: Insights from the National Inpatient Sample

Background: Transcatheter aortic valve replacement (TAVR) has revolutionized the management of aortic stenosis, offering a less invasive alternative to surgical valve replacement, particularly for high-risk patients. While TAVR has demonstrated efficacy and safety in various patient populations, there is growing recognition of gender-specific differences in clinical outcomes post-procedure.Understanding gender-related variations in TAVR outcomes is crucial for optimizing patient care and ensuring equitable access to this life-saving therapy. Methods: Using the National Inpatient Sample (2017-2020), we analyzed the characteristics and comorbidities of male and female patients undergoing TAVR. We then assessed the incidence of clinical outcomes between genders, including in-hospital mortality, mechanical ventilation, length of stay, hospital charges, vasopressor requirement, heart block, pacemaker insertion, stroke, acute kidney injury (AKI), vascular complications, and discharge disposition. Multivariate analysis was performed to evaluate mortality risk among congestive heart failure (CHF) patients. Results: Among 234,860 total admissions, females comprised 44.5% (104,365) of the population. Females were slightly older (mean age 79.4 vs. 78.5 years, p < 0.001) and had a lower mean Charlson Comorbidity Index (2.8 vs. 3.1, p < 0.001) compared to males. After adjusting for confounding factors, females had a higher odds ratio for in-hospital mortality (OR 1.48, 95% CI 1.37-1.60, p < 0.001), mechanical ventilation (OR 1.14, 95% CI 1.07-1.20, p < 0.001), stroke (OR 1.55, 95% CI 1.46-1.65, p < 0.001), and vascular complications (OR 1.24, 95% CI 1.19-1.31, p < 0.001). Length of stay (mean difference 0.37 days, 95% CI 0.32-0.42, p < 0.001) and hospital charges (mean difference $3,795, 95% CI 2,488-5,102, p < 0.001) were also significantly higher in females (p < 0.001 for both). Conclusion: The divergent clinical profile and poorer outcomes observed among females undergoing TAVR, characterized by elevated in-hospital mortality, stroke, and vascular complications compared to males, may emphasize the need for gender-specific approaches in TAVR management.

Can variants of genes associated with familial heart block predict conduction disease in the general population? A UK Biobank study.

Abstract Background Progressive familial heart block is a genetic disease that can present with worsening cardiac conduction disease (CCD) and risk of life-threatening bradycardia. The prevalence, penetrance, and expressivity of known rare pathogenic/likely pathogenic variants (P/LP) in the general population is unclear. In addition, the role of common genetic variation in this phenotypic expression is unknown. Understanding this is essential for patient management in clinic. Purpose 1). To investigate the prevalence of variants linked with early-onset CCD and phenotypic expression in a large biobank. 2). To investigate whether a PR interval polygenic risk score (PRS) improves risk prediction. Methods Early-onset conduction disease P/LP or variants of uncertain significance (VUS) were identified from ClinVar, genetic testing reports at a teaching hospital (6 variants), and the literature, mapping to 22 genes. From the full UK Biobank prospective cohort, 469,511 participants passed genetic quality control and were assigned to P/LP, VUS, or genotype negative (G-) groups, using whole exome sequencing analysed with bcftools. A PR-PRS was constructed using weights from a published meta-analysis excluding UKB data. The primary outcome was CCD (atrioventricular (AV) block, bundle branch block, pacemaker or ICD implantation) and secondary outcomes were high-grade AV block or pacemaker insertion, compared with lifetime risk Cox proportional hazards controlled for sex and age as a timescale. Results 55% of participants were female, 95% had European ancestry, and average age at censor was 71 years. There were 25 P/LP carriers, and 8,862 with a VUS, in 6 genes (MYH7, SCN5A, TNNI3K, TRPM4, TTN, and LMNA). Major demographic factors were the same between groups. CCD was significantly more prevalent in P/LP individuals (28% vs 5.8% in VUS vs 5.5% in G-; p<0.001) with a hazard ratio of HR 6.47 [95% CI=3.09-13.6] vs G-. This was driven by AV block and pacemaker implantation (HR 23.2 [95% CI=8.69-61.8] and 13.4 [95% CI=6.01-29.8], respectively). Results were similar in an unrelated subset and controlling for ischaemic heart disease and heart failure. The 7 P/LP individuals with conduction disease were mostly linked to a single LMNA variant (4 out of 6 carriers with penetrant disease). In the full cohort, the PR-PRS was predictive of CCD (HR=1.07 [95% CI=1.06-1.08]), AV block (HR=1.09 [95% CI=1.06-1.13]), and pacemaker implantation (HR=1.04 [95% CI=1.02-1.06]). When combined with P/LP status, both PR-PRS (HR=1.07 [95% CI=1.06-1.08]) and P/LP (HR=6.42 [95% CI=3.06-13.5]) were independent predictors of CCD. Conclusion(s) Rare variant carrier status predicts a 6.5-fold increased lifetime risk of CCD, a 23-fold increased risk of AV block and 13-fold risk for pacemaker requirement. However, phenotypic expression for some variants is highly variable. A PR-PRS captures risk independent of P/LP variants and warrants further investigation with updated PRS construction methods.

Transcatheter aortic valve implantation in failed bioprosthetic or native valves: a systematic review and meta analysis

Abstract Background and purpose Currently, there is no comparative assessment of pooled clinical outcomes between valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) for either failed transcatheter or surgical bioprosthetic aortic valves (TAV or SAV) and native aortic valve TAVI (NV-TAVI) for aortic stenosis. Thus, this systematic review investigated the clinical outcomes of ViV-TAVI compared with NV-TAVI. Methods A meta-analysis was conducted according to Cochrane Handbook and the PRISMA statement. A systematic literature search was performed, using EMBASE and MEDLINE from inspection to December 25, 2023, to explore the comparative outcomes between ViV-TAVI and NV-TAVI. RStudio software was used to calculate pooled odds ratio (OR) with 95% confidence intervals (CI). Random-effects model was used to allow a more conservative assessment. Results Eighteen cohort studies (n=65,350) met eligibility criteria. Studies were categorized into 2 groups according to initially implanted bioprosthetic valve: TAV-in-TAV (5 studies, n=14490) and TAV-in-SAV implantation (13 studies, n=50860). Each ViV-TAVI group was compared with NV-TAVI. TAV-in-TAV implantation: There were no significant differences in all-cause mortality or stroke rates at ≥ 12 months between groups. The follow-up period was 12 months in all studies except in one (i.e., 24 months). Sensitivity analyses, by removing that study, did not show difference for both outcomes [(OR=1.25, 95%CI: 0.72-2.18) and (OR=1.14, 95%CI: 0.59-2.20), respectively]. TAV-in-TAV implantation was associated with higher rates of permanent pacemaker (PPM) insertion (OR=1.78, 95%CI: 1.10-2.88) within 30-day of follow-up. PPM insertion rate remained higher by 34% (OR=1.34, 95%CI: 1.02-1.76) even after removing the study that reported PPM insertion during index admission. Early conversion to open heart surgery and coronary occlusion (OR=3.75, 95%CI: 0.99-1417) did not differ between groups. TAV-in-SAV implantation: TAV-in-SAV implantation did not significantly reduce the risk of all-cause mortality, but stroke risk was reduced by 19% at ≥ 12 months follow-up. Sensitivity analyses by removing the studies with 24 months follow-up yielded comparable results [(OR=0.88, 95%CI: 0.64-1.21) and (OR=0.81, 95%CI: 0.70-0.94), respectively]. TAV-in-SAV implantation was associated with lower rates of PPM insertion compared with NV-TAVI (OR=0.33, 95%CI: 0.17-0.62) within 30-day of follow-up. The risk remained significantly lower by 69% (OR=0.31, 95%CI: 0.10-0.92) upon removing the studies that reported PPM insertion during the index admission. Early conversion to open heart surgery and coronary occlusion (OR=1.88, 95%CI: 0.82-4.32) did not differ between groups. Conclusion In comparison with NV-TAVI, TAV-in-TAV implantation was associated with higher PPM insertion rates, whereas, TAV-in-SAV implantation was associated with lower stroke and PPM insertion rates without an impact on mortality.

Machine learning-based prediction of new onset of atrial fibrillation after mitral valve surgery

Abstract Background New-onset postoperative atrial fibrillation (nPOAF) is a common complication after cardiac surgery (30–50%), being associated with unfavorable long-term outcomes. Using the Society of Thoracic Surgeons National Adult Cardiac Database, we used machine learning (ML) to predict nPOAF and related 30-day outcomes following mitral valve (MV) surgery. A total of 27,856 MV operations were performed at 910 centers between 7/1/2017 and 6/30/2020 on patients without AF or a prior permanent pacemaker. The primary endpoint was nPOAF postoperatively. ML techniques utilized included penalized logistic regression, gradient boosting, decision trees, and random forests. Results The overall incidence of nPOAF was 35.4% and that of new pacemaker insertion was 5.6%. Patients who developed nPOAF were older (67 ± 10 vs 60 ± 13 years), had more mitral valve stenosis (14.1% vs 11.7%), and hypertension (72.1% vs 63.3%). They underwent more mitral valve replacement (39.1% vs 32.7%) and coronary artery bypass grafting (23.9% vs 16%). For predicting nPOAF, ML methods offer sensitivity, specificity and precision superior to logistic regression. The accuracy rate was identical with penalized and non-penalized logistic regression (0.672). Conclusions Predicting nPOAF and its short-term sequelae following MV surgery remains highly challenging. Machine learning methods offer a moderate degree of improvement in predicting nPOAF even in large national-level studies, in the absence of multi-modal data, such as real-time wearables data, electrocardiograms, heart rhythm monitoring, or cardiac imaging.

Non-arteritic anterior ischemic optic neuropathy in Black patients

Prior studies have shown that non-arteritic anterior ischemic optic neuropathy (NAION) is uncommon in persons of Black race compared to those of White race, but the reasons behind this discrepancy remain unknown. Our goal was to analyze the systemic and ocular features of Black NAION patients compared to White patients. Retrospective cross-sectional study METHODS: Self-reported race was collected from all NAION patients seen between 2014-2022 from a single US neuro-ophthalmology service. All Black NAION patients and a randomly selected sample of White NAION patients were included. We collected information on hypertension, hyperlipidemia, diabetes mellitus, hypothyroidism, obesity, ischemic heart disease, atrial fibrillation, pacemaker insertion, chronic kidney disease, dialysis, anemia, obstructive sleep apnea, deep vein thrombosis, stroke, use of phosphodiesterase inhibitors, and smoking status. We reviewed color fundus photographs and optic nerve OCT images to assess cup-to-disc ratio and document the presence of optic disc drusen. Counterfactual random forest was used to estimate associations for each characteristic of interest by race controlling for the other exposures. We included 32 Black NAION patients (mean age 57 ± 11 years, 38% men) and 69 of 432 White patients (mean age 57 ± 15 years, 59% men). Time between NAION onset and neuro-ophthalmic examination was significantly longer in Black patients (1.5 to <3 months: OR 4.07, P = 0.03; 6 to <12 months: OR 6.05, P = 0.007). Chronic kidney disease (OR 7.53, P = 0.003) and hemodialysis (OR 13.69, P = 0.02) were significantly more frequent in Black patients. No significant differences in cup-to-disc ratio were present (0.15 to <0.25: OR 2.83, P = 0.09; 0.25 to <0.35: OR 0.56, P = 0.46; ≥0.35: OR 0.66, P = 0.44). Referral delay occurs in Black patients with NAION, likely due to its relative rarity and concern for alternate diagnoses. Black NAION patients were substantially more likely to have chronic kidney disease and be on dialysis than White patients. Despite known racial differences in cup-to-disc ratio, we found no difference between Black and White NAION patients, suggesting that the underlying proposed compartment mechanism is the same between races.

Right ventriculography to guide left bundle branch pacing in pacing-induced cardiomyopathy: a novel case report

Abstract Background There is emerging evidence for the potential utility of left bundle branch area pacing (LBBAP), as an alternative to conventional cardiac resynchronization therapy (CRT). The utility of right ventriculography by way of power injector to facilitate lead placement has not yet been reported in the literature. Case summary A 79-year-old female, with a background of poorly rate-controlled atrial fibrillation, presented with worsening dyspnoea. She had recently undergone single-chamber pacemaker insertion prior to an atrioventricular nodal (AVN) ablation, owing to failure in achieving successful CRT coronary sinus lead placement. She had clinical evidence of volume overload, and her electrocardiogram demonstrated right ventricular pacing. Echocardiography demonstrated left ventricular (LV) impairment, with an ejection fraction (EF) of 35%, and severe functional mitral regurgitation (MR). Her diagnosis was overall consistent with pacing-induced cardiomyopathy (PIC). In this patient, the use of right ventriculography, using power-injector-delivered contrast, successfully facilitated placement of an LBBAP lead, with confirmation of good threshold and sensing parameters. Following an upgrade to conduction system pacing, the patient recovered well. On recent follow-up, repeat echocardiography (24 months post initial presentation) demonstrated improved LV function (EF 45% from 35%) and only mild-to-moderate MR. Discussion In conclusion, we demonstrate the utility of right ventriculography to facilitate placement of an LBBAP lead, successfully treating a patient who developed PIC from chronic right ventricular pacing following AVN ablation.

Study on Unguided Temporary Pacing Via the Jugular Vein at the Mohamed VI University Hospital of Marrakech: Safety, Effectiveness and Practicability

This study evaluates the safety, effectiveness, and feasibility of unguided temporary pacemaker insertion in 348 patients at the Mohamed VI University Hospital of Marrakech. The procedure was performed by cardiology residents and showed a high success rate of 99.71%, with successful access to the right internal jugular vein in 89.66% of cases. The majority of patients (66.38%) achieved venous access on the first attempt, with an average procedure time of 11.5 ± 2.1 minutes. Minor complications were observed in 10.63% of patients, including local hematomas (3.45%), accidental arterial punctures (2.30%), pneumothorax (1.15%), and other issues such as local infections and non-sustained ventricular tachycardia. No deaths attributable to the procedure were reported. The clinical significance of this study lies in its demonstration that unguided temporary pacemaker insertion is a safe and effective alternative in resource-limited settings, reducing treatment delays and potentially lowering mortality among patients requiring temporary cardiac pacing. Based on these results, it is recommended to encourage clinicians in primary and secondary healthcare settings to adopt this approach to improve access to urgent cardiac care in under-resourced regions.

Microbial growth on temporary pacemaker leads post-TAVR: pathogen spectrum and clinical implications.

Transcatheter aortic valve replacement (TAVR) is an established treatment option for patients with symptomatic severe aortic stenosis across all stages of surgical risk. Rapid pacing during the procedure and the risk for the occurrence of conduction disturbances after TAVR requires the pre-interventional insertion of a temporary pacemaker (TP). However, this approach poses risks, including the risk of infection. For this reason, the following study aimed to investigate microbial growth on temporary pacemaker leads and its association with outcome post-TAVR and to identify associated pathogens and related risk factors. A prospective study was conducted including 344 patients undergoing TAVR at the Heart Centre Bonn. Of these, 97 patients did not require TP leads as they already had permanent pacemakers; this group was considered as comparison group. The TP leads of the remaining 247 patients were removed, sonicated, and cultured to investigate bacterial growth over a period of 14days. Finally, we compared patients without microbial growth (n = 184) and patients with microbial growth (n = 63). The primary endpoint of the study was 30-day all-cause mortality, secondary endpoints were periprocedural infections, the length of the postprocedural hospital stay, 30-day major vascular complications and the 30-day stroke rate. The majority of cases (74.5%) showed no bacterial growth. In the remaining cases (25.5%), diverse microorganisms were identified, mostly non-pathogenic bacteria. The statistical analysis revealed no significant differences between groups according to microbial growth in terms of 30-day mortality (p = 0.446), postprocedural hospital stay (p = 0.401), periprocedural infections (p = 0.434), 30-day major vascular complications (p = 1.0), and 30-day stroke rate (p = 1.0). Notably, the timing of sheath insertion was significantly associated with microbial growth; sheath placement more than 2days prior to the procedure was associated with a significantly higher risk of microbial growth (OR: 2.1; 95% CI 1.1-4.3) (p = 0.030). The presence of temporary leads does not significantly impact clinical outcomes, irrespective of bacterial growth on the lead. However, the timing and duration of sheath placement plays a crucial role in contamination incidence. Thus, temporary leads/sheaths should be placed shortly before the procedure and removed promptly to reduce the risk of contamination/infection.

Mitral valve surgery in octogenarians: long-term and hemodynamic results.

Octogenarians are often denied mitral valve (MV) surgery secondary to concerns over increased perioperative morbidity and mortality. The objective of this study was to examine the outcomes of octogenarians undergoing mitral valve repair (MVr) and replacement (MVR). The outcomes of 139 patients between the ages of 80-90 who underwent MVR/MVr between 2004-2018 at the Mazankowski Alberta Heart Institute (Edmonton, AB, Canada) were retrospectively analyzed. Follow-up was extended to a maximum of 15.8 years. Following MVR, all-cause mortality at 30 days, 1 year, 5 years, 10 years, and the longest follow-up was 7%, 14%, 36.3%, 61.8%, and 67.7%, respectively. Post-MVr, all-cause mortality at the same time points was 1.9%, 7.6%, 22.5%, 55.5%, and 100%, respectively. During the Hospitalization Index, rates of new-onset atrial fibrillation, sepsis, acute kidney injury, superficial sternal wound infection, deep sternal wound infection, mediastinal bleeding, and permanent pacemaker insertion ranged from 22.1-34.0%, 3.8-11.0%, 7.6-22.0%, 1.9-2.4%, 0-1.2%, 0%, and 0-6.1%, respectively. Rates of overall rehospitalization, as well as readmission for heart failure, stroke, myocardial infarction, and MV reoperation ranged from 71.0-85.5%, 52.2-63.3%, 10.9-22.8%, 1.9-6.0%, and 0% during the follow-up period. There were significant reductions in peak MV gradient (P=0.042) and left ventricular internal diameter in diastole (LVIDd; P=0.008) post-MVR, as well as LVIDd (P<0.001) and Left Atrial (LA) Volume Index (P=0.019) post-MVr. Octogenarians exhibit positive left atrial and left ventricular remodeling following MVR. Perioperative morbidity is low, late survival is reasonable, and long-term morbidity is considerable. Overall, these results add to the growing literature that MV surgery is relatively safe and effective in octogenarians.

Long-term outcomes of minimally invasive concomitant mitral and tricuspid valve surgery with surgical ablation.

We compared the outcomes of a right mini-thoracotomy (RMT) versus those of a sternotomy for concomitant mitral and tricuspid valve surgery and surgical ablation. We analysed patients who underwent concomitant mitral and tricuspid valve surgery and surgical ablation at a single institution (mean follow-up: 7 years) after propensity score matching. The primary and secondary outcomes were all-cause death, composite major adverse events (including stroke, reoperation, readmission, permanent pacemaker insertion) and recurrence of atrial fibrillation (A-fib). A subgroup analysis was performed. A total of 797 procedures (mean age: 61.6 years; RMT: 45.2%; female: 66.5%; mitral valve repair: 33.6%) were done; 267 pairs were matched. The 5- and 10-year overall survival in the matched cohort was 92.7% and 86.9% for the RMT group and 92.1% and 83.1% for the sternotomy group (P = 0.879). Significant differences were not observed in major adverse events (P = 0.273; hazard ratio: 0.76) and A-fib recurrence (P = 0.080; hazard ratio: 0.72). The RMT group had lower rates of postoperative low cardiac output syndrome (P = 0.019) and acute renal failure (P = 0.003). Atrial fibrillation high-risk factors (including long-standing A-fib, enlarged left atrium, old age) exhibited significant interactions (P for interaction = 0.002) with the approach regarding A-fib recurrence. In this study, an RMT exhibited no significant differences in long-term outcomes compared to a sternotomy, but it could remain a clinically reasonable option. Patients with a high risk of A-fib may have favourable ablation outcomes with a sternotomy.

Palliative care consultation in patients hospitalized with out-of-hospital cardiac arrest: Impact on invasive procedures, do-not-resuscitate orders, and healthcare costs

BackgroundThe impact of palliative care consultation on the management and outcomes of patients hospitalized with out-of-hospital cardiac arrest (OHCA) remains poorly understood. This study examined associations between palliative care consultation and in-hospital outcomes of patients hospitalized with OHCA, stratified by survival status. MethodThis cross-sectional study used data from the National Inpatient Sample (2016–2021). Adult patients hospitalized with OHCA who received cardiopulmonary resuscitation were included. Multivariable analyses assessed associations between palliative care consultation and outcomes in non-terminal and terminal OHCA hospitalizations, adjusting for demographics, hospital characteristics, and comorbidities. ResultsAmong 488,700 OHCA hospitalizations, palliative care consultation was associated with lower odds of invasive procedures in non-terminal hospitalizations, including percutaneous coronary intervention (PCI) (aOR 0.30, 95 % CI 0.25–0.36), mechanical circulatory support (aOR 0.54, 95 % CI 0.44–0.68), permanent pacemaker (aOR 0.27, 95 % CI 0.20–0.37) and implantable cardioverter defibrillator insertion (aOR 0.22, 95 % CI 0.16–0.31), and cardioversion (aOR 0.62, 95 % CI 0.55–0.70). In terminal hospitalizations, palliative care was associated with lower odds of PCI (aOR 0.78, 95 % CI 0.70–0.87) and cardioversion (aOR 0.91, 95 % CI 0.85–0.97), but higher odds of therapeutic hypothermia (aOR 3.12, 95 % CI 2.72–3.59), gastrostomy (aOR 1.22, 95 % CI 1.05–1.41), and renal replacement therapy (aOR 1.19, 95 % CI 1.12–1.26). Palliative care was associated with higher DNR utilization in both subgroups and lower hospital costs in non-terminal hospitalizations but higher costs in terminal hospitalizations. ConclusionPalliative care consultation in OHCA is associated with differences in invasive procedures, DNR utilization, and hospital costs, varying by survival status.

Bariatric Surgery in Patients with Previous Cardiac Revascularization: Review of Literature.

Background: The diet and physical activity of the world's population determine the increase in the number of bariatric surgeries. The most common types of bariatric surgery are laparoscopic sleeve gastrectomy (LSG) and Roux-Y gastric bypass (RYGB). Surgical interventions are carried out in patients with numerous comorbidities, among which the most common are cardiovascular diseases. The aim of the present study was to review the literature regarding the safety and results of surgical treatment in patients with cardiac revascularization prior to surgery. Methods: We performed an online search in Pubmed in September 2023 to identify articles that reported cardiac revascularization prior to bariatric surgery. The extracted information included details of the working method, number of patients, types of cardiovascular disease-heart failure (HF) and cardiac artery disease (CAD), types of revascularization-coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI) or both CABG + PCI, demographic data (age, gender, race), clinical characteristics (body mass index-BMI, smoking status), comorbidities (diabetes mellitus, hypertension, prior myocardial infarction), postoperative complications, and postoperative results. Results: A total of 171 records were identified by the initial search, and 165 papers were excluded after applying the exclusion criteria (types of cardiovascular disease, types of revascularization, and demographic data). We evaluated a group of 9479 patients of which 730 had HF, 2621 CAD, and 1426 underwent prior cardiac revascularization. The analysis of the demographic data showed an average age of 55.5 years and a fluctuation of the male gender between 39% and 71.1%, and the female gender between 28.9% and 61%. The main types of bariatric interventions were RYGB (3659 cases) and LSG (659 cases), to which adjustable gastric band (AGB) and bilio-pancreatic diversion-duodenal switch (BPD-DS) were added. Among the most postprocedural complications were ST-segment elevation myocardial infarction (2 patients), gastro-intestinal bleeding (51 cases), pulmonary embolism (1 patient), arrhythmia (3 patients) and pacemaker insertion (1 patient). The recorded postoperative mortality rate was 0.42% (6 cases). Conclusions: Bariatric surgery remains safe in patients with cardiac revascularization. These finding need to be confirmed in more large-scale randomized trials.

Prevalence of cardiomyopathy following pacemaker insertion in an iranian population; a cross-sectional study

Objectives: This study aimed to determine the prevalence of pacemaker-induced cardiomyopathy in patients with pacemaker implantation and to identify the associated risk factors. Methods: This cross-sectional study examined all patients who were implanted with a pacemaker at Afshar Hospital Yazd in 2019 and wore it for two to three years. A new EF test was performed for all patients and compared with the old EF. If a reduction in EF of more than 10% was observed, or the EF was less than 50% due to another reason, it was considered HF. All data were analyzed using SPSS, version 22. Results: One hundred eleven patients participated in this study, 52 (46.8%) men and 59 (53.2%) women. The results showed that ejection fraction (EF) was more than 50% in 93 patients (83.8%). The mean EF decreased from 62.1 to 36.2% over three years. Statistical analysis showed that there is a significant association between diabetes and the incidence of cardiomyopathies in these patients (p = 0.016), but there was no association with hypertension. The mean length of the QRS wave in the electrocardiogram was significantly longer in the group with cardiac pacemakers than in the other patients (P = 0.49). Conclusions: We concluded that 22.5% of referring patients with implantation of a right ventricular pacemaker will develop cardiomyopathy within 2-3 years.

Perforation of the Left Anterior Descending Artery Following Insertion of a Dual Chamber Permanent Pacemaker

Perforation of the Left Anterior Descending Artery Following Insertion of a Dual Chamber Permanent Pacemaker

Outcomes of maze procedure and mitral valve surgery in atrial functional mitral regurgitation: a retrospective study

BackgroundAtrial functional mitral regurgitation (AFMR) is a newly discovered condition associated with longstanding atrial fibrillation. This retrospective study aimed to analyze the outcomes of the maze procedure and mitral regurgitation (MR) surgery in AFMR and atrial fibrillation in comparison with those in degenerative MR (DMR).MethodsPatients who underwent mitral valve repair/replacement with a maze procedure at a hospital (July 2012–August 2021) were included. We excluded patients aged below 18 years undergoing concomitant coronary artery bypass grafting or atrial septal defect repair and those with MR etiology other than ARMR or DMR.ResultsWe included 35 patients with AFMR and 50 patients with DMR. Patient characteristics and postoperative outcomes were not significantly different between the two groups. Long-term outcomes revealed no significant differences in the ratio of cardiac mortality, stroke, or hospital readmission. However, after the maze procedure, the sinus rhythm restoration rate was significantly lower (62% vs. 28.5%, p < 0.001), a junctional rhythm state (p < 0.001) and permanent pacemaker insertion for sick sinus syndrome (SSS) (p = 0.03) were significantly more common in AFMR than DMR. On postoperative transthoracic echocardiography (TTE), the pulmonary artery systolic pressure was significantly less decreased in the AFMR group than in the DMR group compared with that on preoperative TTE (p = 0.04).ConclusionsAFMR showed excellent mitral valve surgery outcomes, similar to DMR, but had a significantly higher risk of pacemaker insertion for SSS after the maze procedure.

Epicardial pacing outcomes in infants with heart block: Lead and device complications from a multicenter experience

BackgroundInfants with complete heart block (CHB) require epicardial pacemaker (PM) insertion. Prior studies described epicardial pacing outcomes in infants and children, although they were limited by small or heterogeneous populations. ObjectiveThis study aimed to explore patient- and procedure-level associations with device complications in infants with CHB who received a permanent PM. MethodsThis was a multicenter, retrospective cohort study including infants receiving an epicardial PM between 2000 and 2021 for CHB. The primary outcome was time to device-related adverse event: lead failure requiring revision; pocket infection; exit block requiring increased pacing output; or lead-related coronary artery compression. Time-to-event analysis was performed by the Kaplan-Meier method with a multivariable Cox proportional hazards model. ResultsThere were 174 infants who received an epicardial PM (282 bipolar, 39 unipolar leads) for CHB. Median age and weight at PM were 93.5 days and 4.5 kg, respectively. Pacing indication was postoperative CHB in 63% and congenital CHB in 37%. The median follow-up was 2.1 years. The primary outcome occurred in 26 infants at a median time to event of 0.6 year. Age ≤90 days at PM implantation was the most significant risk factor for a device-related adverse event (hazard ratio, 7.02; P < .001), primarily driven by pocket infections. Lead failure occurred in 3% of leads with a 5- and 10-year freedom from failure of 93% and 83%, respectively. ConclusionDevice complications affect 15% of infants receiving a permanent PM for heart block. Age ≤90 days at PM implantation is especially associated with infectious complications. Epicardial lead durability appears similar to previously reported pediatric experiences.

An Unusual ECG Finding during Adenosine Stress Myocardial Perfusion Imaging

Adenosine is extensively utilized in myocardial stress perfusion imaging for the detection and risk stratification of coronary artery disease. It has a well-established safety profile. The majority of the undesirable effects experienced during adenosine infusion are transient (owing to its brief half-life of ~10 s) and arise from the stimulation of receptors in the atrio-ventricular (AV) node (AV block) and bronchial smooth muscles (bronchospasm). We hereby report an unusual electrocardiographic finding during adenosine stress perfusion imaging, in a patient who had previously undergone single chamber pacemaker insertion and was referred for the assessment of atypical chest pain.

Impact of Sex on Long-Term Outcomes Following Surgical Aortic Valve Replacement

The impact of sex on outcomes following surgical aortic valve replacement (SAVR) remains unclear. It has been proposed that females experience inferior outcomes, but this has yet to be conclusively established, particularly in the long term. The objective of this study is to identify discrepancies in postoperative outcomes between males and females following SAVR to better inform consideration for surgical intervention. We retrospectively reviewed the outcomes of 4,927 patients who underwent SAVR from 2004 to 2018 at our centre. In total, 531 propensity-matched males and females were included in the final analysis. The primary outcome was mortality at any point during the follow-up period. Secondary outcomes included various measures of postoperative morbidity. Follow-up duration was 15 years. In SAVR all-comers, females experienced inferior short-term mortality, but equivalent mid-term and long-term mortality. Rates of mediastinal bleeding, sternal wound infections, sepsis, heart failure, and pacemaker insertion were all equivalent between the sexes; however, males experienced a higher rate of acute kidney injury and readmission for stroke at the longest follow-up while females experienced a longer intensive care unit and hospital length of stay. In a sub-analysis of isolated SAVR, males and females experienced equivalent early, mid, and late mortality. Of note, a trend towards increased aortic valve reoperation was noted in females at the longest follow-up. Males and females experience equivalent long-term mortality following isolated SAVR. Sex is not an independent risk factor of poor outcomes post-SAVR; however, the increased preoperative risk profile of females requires diligent consideration.

Long-term outcomes of isolated mechanical versus bioprosthetic mitral valve replacement in different age groups of propensity-matched patients.

Prothesis choice in isolated mitral valve replacement for patients aged 75 years or younger remains debated as most studies comparing prothesis type have included large proportions of combined operations and benefits are influenced by concomitant procedures. This study compared long-term outcomes of isolated mechanical versus bioprosthetic mitral valves in different age groups of propensity-matched populations. This is a retrospective, multicentre, propensity-matched observational study. Baseline characteristics, operative details and long-term outcomes (mortality and freedom from surgical/transcatheter reintervention) were collected. Totally, 1536 isolated mitral valve replacements (806 mechanical, 730 bioprosthetic) were performed between 2000 and 2017. Over 90% of eligible patients successfully underwent propensity matching, yielding 226 each of mechanical and bioprosthetic valves in patients aged <65 years and 171 each of bioprosthetic and mechanical valves in patients aged 65-75 years with median follow-up of 13 years (maximum 20 years). In matched patients <65 years, 10-year survival was superior with mechanical valves versus bioprosthetic valves (78.2% vs 69.8%, P = 0.029), as was 10-year freedom from reintervention (96.2% vs 81.3%, P < 0.001). For matched patients between 65 and 75 years, there were no differences between mechanical and bioprosthetic valves in 10-year survival (64.6% vs 60.8%, P = 0.86) or 10-year freedom from reintervention (94.0% vs 97.2%, P = 0.23). Rates of post-operative stroke, gastrointestinal bleeding, renal failure and permanent pacemaker insertion were similar. In patients requiring isolated mitral valve replacement, mechanical valves confer significantly better long-term survival and freedom from reintervention for patients <65 years, while no benefit is observed at age 65-75 years compared to bioprosthetic valves.

Double left brachiocephalic vein in a paediatric patient with CHD: a case report

AbstractAnomalous brachiocephalic vein (ABCV) is a rare entity of head and neck venous channel variations and malformations. Amongst the five subtypes of ABVC, double left brachiocephalic vein (DLBCV) is the rarest. We present the case of a 1-year-11-month-old syndromic child, who had global developmental delay (GDD) with Sprengel deformity and failure to thrive (suspected Klippel Feil phenotype), who presented to us for the cardiac evaluation. Her 2D echocardiography revealed unobstructed total anomalous supra-cardiac pulmonary venous connection. However, for the delineation of individual pulmonary venous course, CT-pulmonary angiography was advised. CTPA revealed supra-cardiac total anomalous pulmonary venous connection (TAPVC) with incidentally noted DLBCV. Importance of recognition of DLBCV enables us to prevent accidental venous injury during cardiac surgery and to avoid intraoperative technical issues during transvenous pacemaker insertion.