Pacing Strategy Research Articles

Role of conduction system pacing in ablate and pace strategies for atrial fibrillation.

With the advent of conduction system pacing, the threshold for performing 'ablate and pace' procedures for atrial fibrillation has gone down markedly in many centres due to the ability to provide a simple and physiological means of pacing the ventricles. This article reviews the technical considerations for this strategy as well as the current evidence, recognized indications, and future perspectives.

Rewind, Forward, Skip: Tabs of Memory to play with the Narrative Tempo

Abstract Memory narratives, like all fictional narratives, are characterized by variation in narrative pace, resulting from a variety of staging strategies. In memory literature, the change in narrative pace is particularly evident because the representation of memory encourages a variety of narrative pacing strategies – from acceleration to deceleration. A great deal of attention is given to the representation of memory content when reviewing narratology from a memory studies perspective. There is, however, one aspect that is often overlooked, namely the way in which memories themselves determine the pace of the narrative. Memory content not only affects the narrative pace in significant ways but in most cases, the representation of memory also dictates the narrative pace by employing several memory-elicited pace strategies. As part of this paper, we propose a narratological approach that emphasizes narrative pace as the basis for analyzing the memory literature related to transgenerational memory communication. This paper examines the narrative techniques in the the construction of memory-elicited narrative pace. Furthermore, this paper discusses how memory itself takes on different roles based on varying narrative paces and how memory itself can influence narrative pace. The paper uses three memory novels as case studies: Herzklappen von Johnson & Johnson by Valerie Fritsch, Briefe nach Breslau: Meine Geschichte über drei Generation by Maya Lasker-Wallfisch, and Zurück nach Berlin: wie mein Vater mit mir in seine Vergangenheit reiste by Jonathan Lichtenstein. Each of these novels focuses on the transmission of a transgenerational memory of World War II. Using examples from these novels, this paper explains how the suturing of memory content generates the five primary rhythms of narrative movement: ellipsis, summary, stretch, pause, and scene.

Be Aware of the Benefits of Drafting in Sports and Take Your Advantage: A Meta-Analysis.

In competitive sports, optimizing performance is the key. An interesting venue to explore is to consider drafting as a pacing strategy. The purpose of this study is to identify the magnitude of drafting benefits for biomechanical, physiological, and psychobiological parameters in and between athletes in cycling, kayaking, running, skating, skiing, and swimming. A systematic review and meta-analysis. Systematic searches were performed in PubMed, Web of Science, and Embase databases. In total, 205 studies were found, from which 22 were relevant (including 232 participants and 548 observations). Methodological quality was high for all the included articles. The meta-analyses for all parameters indicated strong evidence for a benefit of drafting, with moderate effects between leading and drafting athletes found for the heart rate (3.9%), VO2 (8.9%), power output (11.3%), and rating of perceived exertion (10.4%). Large effect sizes were found for blood lactate (24.2%), VE (16.2%), and EMG (56.4%). A moderator analysis showed differences between sports on the effect of drafting with most benefits in cycling. Discussion. Based on the observed effects of drafting in the biomechanical, physiological, and psychobiological parameters, it can be considered as an element of pacing, a strategy to conserve energy and optimize performance. There is strong evidence that drafting benefits athletes, with varying levels of effect for athletes in different sports. Knowledge about the magnitude of benefits can be used to improve training sessions, race strategies, and performance in competition.

Outcomes of Upgrading to LBBP in CRT Nonresponders: A Prospective, Multicenter, Nonrandomized, Case-Control Study

BackgroundCardiac resynchronization therapy (CRT) nonresponders account for nearly 30% of CRT candidates. Left-bundle branch pacing (LBBP) is an alternative to CRT. ObjectivesThis study aimed to evaluate the feasibility, clinical efficacy, and outcomes of upgrading to LBBP in CRT nonresponders, using propensity-score matching (PSM) analysis. MethodsCRT nonresponders were defined as those with an implantable CRT-pacemaker or CRT-defibrillator for more than 12 months who remained nonresponsive (a decrease in left ventricular end-systolic volume of <15% or a left ventricular ejection fraction [LVEF] absolute increase of <5%) after optimal medical therapy and device optimization compared with baseline. In total, 145 CRT nonresponders were prospectively enrolled and randomly divided into 2 groups: upgraded to LBBP (n = 48), and continuing biventricular pacing (BVP) (control; n = 97). PSM was performed at a 1:1 ratio, and clinical evaluation and echocardiographic assessments were compared at baseline and follow-up in paired cohorts. The primary composite endpoint for clinical outcomes (heart failure-related rehospitalization events, all-cause death, or heart transplantation) was analyzed. ResultsSuccessful upgrading to LBBP was achieved in 48/49 patients (97.96%), with a significant decrease in QRS duration (P < 0.001). In the paired LBBP group, LVEF significantly increased (baseline: 29.75% ± 7.79%; 6 months: 37.78% ± 9.25% [P < 0.001]; 12 months: 38.84% ± 12.13% [P < 0.001]) with 21/44 patients (47.73%) classified as echocardiographically responsive, whereas in the BVP control group, no significant improvement was observed (29.55% ± 6.74% vs 29.22% ± 8.10%; P = 0.840). In a multivariate logistic regression model, LV end-diastolic volume and baseline LBBB QRS morphology were independent predictors of echocardiographic response after upgrading to LBBP. At a median 24 months, the primary composite endpoint was significantly lower in the LBBP group (HR: 0.31; 95% CI: 0.14-0.72; log-rank P = 0.007). ConclusionsUpgrading to LBBP is feasible and effective in achieving significant heart function improvement and better clinical outcomes in CRT nonresponders, making it a reasonable and promising pacing strategy. (LBBP in CRT Non-Response patients; ChiCTR1900028131)

Abstract 14945: Left Bundle Branch Area Pacing Improves Right Ventricular Function in Heart Failure With Preserved Ejection Fraction: Evidence From PROPHET Trial

Introduction: Left bundle branch area pacing (LBBAP) has emerged as a promising pacing strategy, especially for patients with heart failure. However, the impact of LBBAP on hemodynamics and cardiac function in heart failure with preserved ejection fraction (HFpEF) has not been investigated yet. Hypothesis: LBBAP could improve cardiac function of patients with HFpEF. Methods: This prospective cohort study enrolled patients with preserved left ventricular ejection fraction who were receiving LBBAP, and two cohorts (non-HFpEF cohort and HFpEF cohort) were built based on diagnosis of HFpEF. Hemodynamics before and after LBBAP were measured using right heart catheterization (RHC). And the changes of cardiac function were evaluated by transthoracic speckle tracking echocardiography (STE) Results: 30 consecutive patients were included in the study, with 17 patients in the non-HFpEF group and 13 patients in the HFpEF group. Preprocedural STE showed worsened right ventricular function in the HFpEF group indicated by global longitudinal strain rate, free-wall strain rate, fractional area change, Tricuspid annular plane systolic excursion and Tei index. And RHC showed elevated right ventricular stroke work index (RVSWI, 8.6±4.1 non-HFpEF vs 15.0±5.6 HFpEF, P=0.170). While post-LBBAP evaluation showed a more significant reduction in RVSWI in the HFpEF group (6.7±2.5 (reduction 22.1%) non-HFpEF vs 8.0±1.0 (reduction 46.7%) HFpEF, P=0.043). Besides, post-LBBAP STE showed improvement of right ventricular function, despite no significant difference in the extent of improvement was found between groups. Conclusions: LBBAP might be more beneficial to patients with HFpEF as it could improve right ventricular function by alleviating the workload of right ventricle. Long-term benefit of LBBAP in HFpEF requires further investigation.

Abstract 13371: Left Bundle Branch Area Pacing: Experiences From the First Two Years Implanting in an Academic Training Program

Background: Left bundle branch area pacing (LBBAP) has emerged as a more durable physiologic pacing strategy to His bundle pacing and a promising alternative to cardiac resynchronization therapy. Integration of this procedural technique within an academic training program has not yet been described. Objective: Highlight the procedural learning curve of implanting LBBAP leads within a fellowship program. Methods: Retrospective analysis of consecutive patients who underwent placement of a Medtronic 3830 lead for LBBAP at our institution from 1/2021-12/2022. Results: A total of 180 patients underwent LBBAP lead placement over the study time period. Overall, total procedure time was 133.7±58.2min, lead placement time 30.7±20.0min, fluoroscopy time 22.5±21.2 min, left bundle branch (LBB) capture rate 70% and paced QRS duration 128.6±19.3 ms. When dividing the study period by 6-month intervals, there was a rise in procedural volume (21, 28, 62 and 59 cases, respectively), a trend towards less fluoroscopy use (20.2±12.2, 16.7±9.1, 16.2±12.6 and 16.6±14.4 min), less total radiation (345.2±323.3, 317.2±630.9, 214.9±271.2 and 171.7±253.9 mGy), decreased LBBAP lead placement time (37.8±24.3, 30.7±16.3, 28.2±21.5, 30.6±18.7 min), decreased delivery system exchanges (19%, 11%, 8% and 2%*, *p≤0.01 from first six months) and improved LBB capture rates (50%, 69%, 83%*, 64%, *p≤0.01 from first six months). Both fellowship classes showed significant improvements in LBB capture rates (40% to 94% and 38% to 84%, p≤0.01 for both) and paced-QRS duration (140.0±27.2ms to 120.2±16.5ms and 136.2±21.8ms to 121.7±17.2ms, p≤0.05 for both) after 12 months of experience. Conclusion: Over the first two years of performing LBBAP in an academic training program, there was a rise in procedural volume with trends towards less fluoroscopy use, decreased LBBAP lead placement time with significantly decreased delivery system exchanges and improved LBB capture rates. Significant improvements in LBB capture rates and paced-QRS duration were seen by fellows after 12 months of experience. LBBAP is an increasingly popular pacing technique that can be effectively integrated within a training program, with early introduction important to accommodate the initial learning curve.

Prophylactic epicardial pacemaker implantation in tricuspid valve replacement.

Patients undergoing surgical tricuspid valve replacement (TVR) are at high risk of atrioventricular conduction disorders. Because implanting a lead through the tricuspid bioprosthesis is discouraged, the patients who undergo TVR in our centre are usually given a prophylactic epicardial pacemaker. Our aim was to assess the benefits and risks of this strategy. Among the patients who underwent TVR with prophylactic epicardial pacemaker implantation, clinical evaluations and pacemaker reports were analysed retrospectively after surgery. The need for cardiac pacing were assessed by characterizing the atrioventricular conduction, while the risks were evaluated by listing and adjudicating post-operative events. A total of 80 patients were analysed (mean age was 57 ± 16 years old, 30% males). TVR was isolated in 28 (35%) patients, but most often associated with another valve surgery. In the postoperative period, heart rhythm was analysed in 59/80 patients during a median follow-up of 35 months. Cardiac pacing was needed in 46% patients: 14% had complete pacing dependency, 17% had high degree AV block, while 15% had a high ventricular pacing rate (>80%). No pre- or per-operative variables could predict cardiac pacing requirement. Post-operatively, a spontaneous heart rate >70bpm (P = 0.02) and the presence of narrow QRS (P = 0.03) were significantly associated with a lower risk of cardiac pacing requirement. Complications related to epicardial pacemaker were documented in 2 (2.5%) patients. After TVR, cardiac pacing was needed in 46% of patients for post-operative atrioventricular conduction disorders. This high incidence associated with an acceptable safety profile supports a prophylactic epicardial pacing strategy for the patients undergoing TVR.

Pacing Strategies Differ by Sex and Rank in 2020 CrossFit® Open Tests.

This retrospective study collected video recordings of a random selection of eighty men and women (n = 160) completing all five tests of the 2020 CrossFit® Open. All competitors were ranked within the top 10,000 overall but were sub-divided based on whether they ranked within the top 10% of their respective divisions. To examine the effect of sex and rank on pacing strategy, video analysis quantified the overall repetition completion rate on each test, as well as per minute (or round) repetition completion rates for each test's individual exercises, quantity of failed repetitions, break times, and transition times. All per minute (or round) data were aggregated into first- and last-half or total test average, slopes, and coefficient of variation. Sex and rank analyses of variance were performed on averages, slopes, and coefficients of variation for each variable calculated over the first and last halves of each test, except test 5 (total only). The top 10% of men were 17.5% faster (p < 0.001) than everyone else in tests 1, 3, and 5. The top 10% of women and remaining men were ~9.5% faster than remaining women in tests 1 and 3. In test 5, the remaining men were faster than top 10% of women (~11.2%, p < 0.001), and both were faster than the remaining women. In tests 2 and 4, the top 10% of athletes were 9.7% faster (p < 0.001) than remaining athletes, and at the same time, men were 7.7% faster (p < 0.001) than women. Analysis of each test's components revealed the top 10% of competitors to be faster and more consistent in most areas, while men were generally faster than women in gymnastics components and more consistent with their pace for resistance training exercises. These data provide insight into the differential factors linked to success in the men's and women's CFO divisions.

Outcomes of left bundle branch area pacing compared to His bundle pacing as a primary pacing strategy: Systematic review and meta-analysis.

Novel pacing technologies, such as His bundle pacing (HBP) and left bundle branch area pacing (LBBaP), have emerged to maintain physiological ventricular activation. We investigated the outcomes of LBBP with HBP for patients requiring a de novo permanent pacing. Systematic review of randomized clinical trials and observational studies comparing LBBaP with HBP until March 01, 2023 was performed. Random and fixed effects meta-analyses of the effect of pacing technology on outcomes were performed. Study outcomes included pacing metrics, QRS duration, lead revision, procedure parameters, all-cause mortality and heart failure hospitalization (HFH). Overall, 10 studies with 1596 patients were included. Implant success rate was higher in LBBaP compared with HBP (RR 1.24, 95% CI: 1.08 to 1.42, p=.002). LBBaP was associated with lower capture threshold at implantation (mean difference (MD) -0.62V, 95% CI: -0.74 to -0.51V, p<.0001) and at follow-up (MD -0.74V, 95% CI: -0.96 to -0.53, p<.0001), shorter procedure duration (MD -14.66min, 95% CI: -23.54 to -5.78, p=.001) and shorter fluoroscopy time (MD -4.2min, 95% CI: -8.4 to -0.0, p=.05). Compared with HBP, LBBaP was associated with a decreased risk of all-cause mortality (RR: 0.50, 95% CI: 0.33 to 0.77, p=.002) and HFH (RR: 0.57, 95% CI: 0.33 to 1.00, p=.05). No statistical differences were found in lead revisions and QRS duration before and after pacing. This meta-analysis found that LBBaP was superior to HBP regarding pacing metrics and implant success rate as an initial pacing strategy, although absence of head-to-head randomized comparison warrants caution in interpretation of the results.

Pacing Strategy of 800 m and 1500 m Freestyle Swimming Finals in the World Championships According to the Performance in Males and Females of Different Age Groups

Pacing strategy refers to the distribution of effort and speed throughout the race to achieve optimal performance. This study aims to understand whether the choice of pacing strategy in swimming depends on the length of competitions and how sex, age, and performance level influence this strategy. Participants were the finalists of the 800 m and 1500 m freestyle events at the elite and junior world championships in 2022–2023. Race outcomes and pacing parameters were compared between the two distances and across different groups of swimmers. Swimmers in both distances did not break world records. Pacing strategy generally followed a U-shape with significant differences in the frequency and duration of speed changes between the two distances. The 800 m exhibited more frequent changes in acceleration, while the 1500 m events generally followed a more consistent time-series pattern. There were differences in pacing strategies between males and females and between junior and elite swimmers. Swimmers closer to world records showed more consistent pacing patterns compared to those farther from records. This study suggests that pacing strategies are influenced by race distance, sex, age, and performance level. The research highlights the complex interplay between physiological and psychological factors that shape a swimmer’s decision-making during a race.

Performance and pacing of professional IRONMAN triathletes: the fastest IRONMAN World Championship ever—IRONMAN Hawaii 2022

Pacing during cycling and running in an IRONMAN triathlon has been investigated in only one study with elite IRONMAN triathletes. We have, however, no knowledge of how professional triathletes pace during an IRONMAN World Championship. To investigate the split-by-split speed, pacing strategies and pacing variability in professional female and male IRONMAN World Championship participants in the fastest IRONMAN World Championship ever in IRONMAN Hawaii 2022. For both cycling and running, 25 specific split times were recorded in each discipline. The best 30 men and 30 women overall were chosen from the official IRONMAN website database for further analysis. They were divided into three performance groups: Top 10, 11–20th place, and 21st–30th place. Mean speed, individual linear regressions with the corresponding correlation coefficients, and coefficient of variation were calculated to assess split-by-split speed, pacing strategies, and pacing variability, respectively. In both men’s and women’s cycling and running segments, the top ten participants exhibited faster split times compared to the slower performance groups. Notably, no discernible differences existed between the 11–20th and 21st–30th place in men’s cycling and women’s running times. Conversely, in men’s running and women’s cycling segments, those in the 11–20th place displayed quicker times than those in the 21st–30th place. In the cycling segment across all groups, men demonstrated a more negative pacing pattern (indicating an increase in speed), whereas women exhibited more consistent pacing. In the running segment, the top 10 men and all women’s groups showcased relatively similar slightly positive pacing profiles. However, men ranking 11–20th and 21st–30th displayed more pronounced positive pacing strategies, implying a more significant decline in speed over time. In terms of cycling, the variability in pacing remained relatively consistent across the three performance groups. Conversely, during the running segment, the top ten male triathletes and those in the 11–20th place displayed lower pacing variability than their counterparts in the 21st–30th position place and all women’s groups. In summary, performance and pacing were examined in professional male and female IRONMAN World Championship participants during IRONMAN Hawaii 2022. Top performers showed faster cycling and running split times, with differences in pacing strategies between sexes. The pacing was more consistent in cycling, while running pacing varied more, particularly among male triathletes in different performance groups.

Noninvasive Electrical Mapping Compared with the Paced QRS Complex for Optimizing CRT Programmed Settings and Predicting Multidimensional Response

The aim was to test the hypothesis that left ventricular (LV) and right ventricular (RV) activation from body surface electrical mapping (CardioInsight 252-electrode vest, Medtronic) identifies optimal cardiac resynchronization therapy (CRT) pacing strategies and outcomes in 30 patients. The LV80, RV80, and BIV80 were defined as the times to 80% LV, RV, or biventricular electrical activation. Smaller differences in the LV80 and RV80 (|LV80-RV80|) with synchronized LV pacing predicted better LV function post-CRT (p = 0.0004) than the LV-paced QRS duration (p = 0.32). Likewise, a lower RV80 was associated with a better pre-CRT RV ejection fraction by CMR (r = − 0.40, p = 0.04) and predicted post-CRT improvements in myocardial oxygen uptake (p = 0.01) better than the biventricular-paced QRS (p = 0.38), while a lower LV80 with BIV pacing predicted lower post-CRT B-type natriuretic peptide (BNP) (p = 0.02). RV pacing improved LV function with smaller |LV80-RV80| (p = 0.009). In conclusion, 3-D electrical mapping predicted favorable post-CRT outcomes and informed effective pacing strategies.Graphical

Profiling Professional Rugby Union Activity After Peak Match Periods.

The aim of this investigation was to quantify professional rugby union player activity profiles after the most intense (peak) passages of matches. Movement data were collected from 30 elite and 30 subelite professional rugby union athletes across respective competitive seasons. Accelerometer-derived PlayerLoad and global navigation satellite system-derived measures of mean speed and metabolic power were analyzed using a rolling-average method to identify the most intense 5- to 600-second passages (ie,worst-case scenarios) within matches. Player activity profiles immediately post their peak 5- to 600-second match intensity were identified using 5 epoch duration-matched intervals. Mean speed, metabolic power, and PlayerLoad declined sharply (∼29%-86%) after the most intense 5 to 600seconds of matches. Following the most intense periods of rugby matches, exercise intensity declined below the average match-half intensity 81% of the time and seldom returned to or exceeded it, likely due to a host of individual physical and physiological characteristics, transient and/or accumulative fatigue, contextual factors, and pacing strategies. Typically, player exercise intensities after the most intense passages of matches were similar between match halves, positional groups, and levels of rugby competition. Accurate identification of the peak exercise intensities of matches and movement thereafter using novel methodologies has improved the limited understanding of professional rugby union player activity profiles following the worst-case scenarios of matches. Findings of the present study may inform match-representative training prescription, monitoring, and tactical match decisions (eg,substitutions and positional changes).

Tricuspid regurgitation following pacemaker implantation for bradycardia: a two-year study comparing different pacing strategies.

Tricuspid regurgitation following pacemaker implantation for bradycardia: a two-year study comparing different pacing strategies.

Conduction system pacing on track to replace CRT? Review of current evidence and prospects of conduction system pacing.

Conduction system pacing (CSP) has been emerging over the last decade as a pacing option instead of conventional right ventricular (RV) pacing and biventricular (BiV) pacing. Numerous case reports, some observational studies and a few randomized control trials have looked at optimum pacing strategies for heart failure (HF) with left bundle branch block (LBBB) or cases where left ventricular (LV) dysfunction is anticipated due to chronic RV pacing (RVP). Evolution of pacing strategies from standard RVP to septal RVP, BiV pacing and now CSP have shown improving hemodynamic responses and possible ease of implantation of CSP systems. In this review article, we review the literature on the evolution of CSP and common scenarios where it might be beneficial.

Women’s Experiences of Managing Fatigue During Breast Cancer Treatment: Strategies from Patients in a Low-Resource Setting

Cancer-related fatigue can lead to a reduced health-related quality of life among patients with cancer. We explored the experiences of fatigue among women undergoing breast cancer treatment at a public hospital in South Africa. We recruited 12 participants using purposive sampling. In-depth, semi-structured interviews were conducted by registered clinical psychologists. The interviews were audio recorded and transcribed. A thematic analysis of the data produced three themes, namely, fatigue is tiredness, the pervasive impact of fatigue and fatigue management strategies. These strategies included rest, pacing, physical activity, energy drinks, instrumental support and cognitive strategies such as distraction and self-talk. Our recommendation is that healthcare providers need to prioritise communication about fatigue and provide appropriate management strategies.

Risk of Atrial Fibrillation Following Left Bundle Branch Area Pacing versus Right Ventricular Pacing and Biventricular Pacing: A Systematic Review and Meta-Analysis.

Left bundle branch pacing (LBBP) is a relatively novel physiological pacing strategy with better electrocardiogram characteristics and pacing parameters than other pacing strategies. At present, no meta-analysis or systematic review has examined the risk of atrial fibrillation (AF) after LBBP compared to other pacing strategies. We searched the PubMed, Embase, and Cochrane Library databases from inception through September 18, 2022 to identify relevant studies reporting AF incidence rates after LBBP. The incidence of AF following LBBP and that associated with other pacing strategies were extracted and summarized for the meta-analysis. We used odds ratios (ORs) and 95% confidence intervals (CIs) as summary estimates. Five studies with 1144 participants were included. The pooled rate of AF was 3.7% (95% CI, 0.8%-8.0%) in the LBBP group and 15.5% (95% CI: 9.6%-22.4%) in the other pacing strategies (right ventricular pacing [RVP] and biventricular pacing [BVP]). Compared with other pacing strategies, LBBP was associated with a lower AF risk (OR, 0.33; 95% CI: 0.22-0.51, = 0.0%; p = 0.485). Similar results were observed for LBBP when compared with RVP (OR: 0.33, 95% CI: 0.22-0.51, = 0.0%, p = 0.641) and BVP (OR: 0.47, 95% CI: 0.01-15.22, = 60.4%, p = 0.112). Compared with BVP and RVP, LBBP was associated with a significantly lower risk of AF. However, further large-sample randomized controlled trials are needed to confirm that LBBP is superior to other pacing strategies in reducing AF risk.

Consecutive Experience with Left Bundle Branch Area Pacing in a High-Volume Australian Centre.

Left-bundle branch area pacing (LBBAP) is a relatively new technique for conduction system pacing. Australian safety and efficacy data is currently lacking. We aim to evaluate the learning curve, medium-term safety, and lead performance in a high-volume Australian setting. We performed a retrospective cohort study of 200 consecutive LBBAP procedures performed by a single operator at two centres between January 2019 and May 2020. Left bundle branch area pacing was performed predominantly via left subclavian access using a 69 cm Medtronic SelectSecure 3830 pacing lead and a preformed non-steerable C315-His sheath. Procedural success was defined as evidence of left septal or left bundle branch area capture as evidenced by a right bundle branch block-like paced morphology. Procedural characteristics, and follow-up (including lead performance) data were collected. Procedural efficiency over time, as well as safety data, were collected. Median age was 78.26 years (interquartile range [IQR] 71-85), 37% were female. Atrial fibrillation was present in 22%. The left ventricular ejection fraction <50% in 24%, atrioventricular (AV) block was present in 43.5%, left bundle branch block in 22.5% and right bundle branch block in 24.5%. Acute procedural success was 91.5%. Implant threshold was 0.6V @ 0.5 ms, and 0.75V @ 0.5 ms at 11.9 months of follow-up. The QRS was significant reduced (baseline 134 ms vs implant 114 ms, p<0.001) There was a reduction in procedural time and X-ray dose over the course of the study. There were no complications specific toLBBAP. LBBAP appears to be a safe and effective pacing strategy. The QRS duration was significantly reduced compared to baseline. There appears to be an early learning curve with LBBAP.

Safety and efficacy of left bundle branch area pacing compared with right ventricular pacing in patients with bradyarrhythmia and conduction system disorders: Systematic review and meta-analysis

BackgroundRight Ventricular Pacing (RVP) may have detrimental effects in ventricular function. Left Bundle Branch Area Pacing (LBBAP) is a new pacing strategy that appears to have better results. The aim of this systematic review and meta-analysis is to compare the safety and efficacy of LBBAP vs RVP in patients with bradyarrhythmia and conduction system disorders. MethodsMEDLINE, EMBASE and Pubmed databases were searched for studies comparing LBBAP with RVP. Outcomes were all-cause mortality, atrial fibrillation (AF) occurrence, heart failure hospitalizations (HFH) and complications. QRS duration, mechanical synchrony and LVEF changes were also assessed. Pairwise meta-analysis was conducted using random and fixed effects models. ResultsTwenty-five trials with 4250 patients (2127 LBBAP) were included in the analysis. LBBAP was associated with lower risk for HFH (RR:0.33, CI 95%:0.21 to 0.50; p < 0.001), all-cause mortality (RR:0.52 CI 95%:0.34 to 0.80; p = 0.003), and AF occurrence (RR:0.43 CI 95%:0.27 to 0.68; p < 0.001) than RVP. Lead related complications were not different between the two groups (p = 0.780). QRSd was shorter in the LBBAP group at follow-up (WMD: −32.20 msec, CI 95%: −40.70 to −23.71; p < 0.001) and LBBAP achieved better intraventricular mechanical synchrony than RVP (SMD: -1.77, CI 95%: −2.45 to −1.09; p < 0.001). LBBAP had similar pacing thresholds (p = 0.860) and higher R wave amplitudes (p = 0.009) than RVP. ConclusionsLBBAP has better clinical outcomes, preserves ventricular electrical and mechanical synchrony and has excellent pacing parameters, with no difference in complications compared to RVP.

Identifying Pacing Profiles in 2000 Metre World Championship Rowing

The pacing strategy adopted by athletes is a major determinants of success during timed competition. Various pacing profiles are reported in the literature and its importance depends on the mode of sport. However, in 2000 metre rowing, the definition of these pacing profiles has been limited by the minimal availability of data. Purpose: Our aim is to objectively identify pacing profiles used in World Championship 2000 metre rowing races using reproducible methods. Methods: We use the average speed for each 50 metre split for each available boat in every race of the Rowing World Championships from 2010-2017. This data was scraped from www.worldrowing.com. This data set is publicly available (https://github.com/danichusfu/rowing_pacing_profiles) to help the field of rowing research. Pacing profiles are determined by using k-shape clustering, a time series clustering method. A multinomial logistic regression is then fit to test whether variables such as boat size, gender, round, or rank are associated with pacing profiles. Results: Four pacing strategies (Even, Positive, Reverse J-Shaped, and U-Shaped) are identified from the clustering process. Boat size, round (Heat vs Finals), rank, gender, and weight class are all found to affect pacing profiles. Conclusion: We use an objective methodology with more granular data to identify four pacing strategies. We identify important associations between these pacing profiles and race factors. Finally, we make the full data set public to further rowing research and to replicate our results.