Prevention Of Sudden Cardiac Death Research Articles

Prevention of Early Sudden Cardiac Death after Myocardial Infarction Using the Wearable Cardioverter Defibrillator-Results from a Real-World Cohort.

After acute myocardial infarction (AMI), patients are at risk of sudden cardiac death. The VEST trial failed to show a reduction in arrhythmic mortality in AMI patients with an LVEF ≤ 35% prescribed with a WCD, having a lower-than-expected WCD wearing compliance. The aim was to investigate on outcomes of patients in a real-world Austrian cohort with good compliance. A retrospective analysis of all eligible Austrian WCD patients according to the VEST trial inclusion and exclusion criteria between 2010 and 2020 was performed. In total, 105 Austrian patients (64 ± 11 years, 12% female; LVEF 28 ± 6%) received a WCD for a median of 69 (1; 277) days after AMI (wearing duration 23.5 (0; 24) hours/day). Within the first 90 days, 4/105 (3.8%) patients received 9 appropriate shocks (2 (1; 5) shocks). No inappropriate shocks were delivered, and 3/105 (2.9%) patients died during follow-up. Arrhythmic mortality (1.9% Austria vs. 1.6% VEST, p = 0.52), as well as all-cause mortality (2.9% vs. 3.1%, p = 0.42) was comparable in both cohorts. The WCD is a safe treatment option in a highly selected cohort of patients with LVEF ≤ 35% after AMI. However, despite excellent WCD wearing duration in our cohort, the arrhythmic mortality rate was not significantly different.

Characterization of the substernal space with computed tomography imaging in patients with and without median sternotomy: Assessing a novel implant location for extravascular defibrillation lead placement.

Implantable cardioverter-defibrillators (ICDs) provide clinically significant therapy for the prevention of sudden cardiac death. This study aimed to characterize the substernal space using computed tomography (CT) in patients with and without prior midline sternotomy to investigate the feasibility of substernal ICD lead implantation in post-sternotomy patients. High-quality electrocardiogram-gated CT images from 100 patients (71% male, average body mass index 23.5±2.9) were retrospectively collected, including 50 patients with prior midline sternotomy (S-group) and 50 patients with no prior sternotomy (NS-group). Distances were measured from the retrosternal surface to the epicardial surface of the heart and segmented into four regions from the xiphoid tip and superiorly along the sternum. Results generally showed a measurable but narrower average sternum-to-heart distance in the prior sternotomy group compared to the non-sternotomy group in all four regions (p<.05). In the S-group, the sternum-to-heart distances across all regions ranged from 0 to 32.0mm, while in the NS-group, the distances ranged from 0 to 39.9mm. Small but measurable separations between the heart and sternum were observed in patients with prior sternotomy, particularly near the xiphoid region, indicating the potential viability of extravascular substernal ICD lead implantation in post-sternotomy patients.

The detection of sudden cardiac death sports preparticipation in sports population adult: a narrative review

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The practice of sports by the general population is increasing, and, despite being beneficial to health, it can also increase the risk of sudden death. In recent studies, screening tests have been suggested to identify at-risk people and prevent sudden cardiac death. There is, however, considerable debate about who to screen, how to screen, and whether these programs are effective. Thus, it is important to review the scientific evidence in the literature on the most appropriate tests for preventing sudden cardiac death in adults and the role of nursing in your implementation. Methods A narrative Literature review. The content analysis method has been used (Mayring, 2000). Data from the papers was fragmented into descriptive codes assigned based on their content. The search was carried out in May 2022. The databases used were SCOPUS, WEB of Science, and PUBMED.A combination of the following keywords was used for adapted descriptors in each database: ‘sudden cardiac death’, ‘sport’, ‘screening ‘, ‘adults’ and ‘athletes ‘. Taking into account the complexity of the study subject, the inclusion criteria were: all the articles published in the past ten years in peer-reviewed journals in English and Spanish. 2 Investigators excluded duplicated studies and read and evaluated the title and abstract of the studies found. Articles which did not address the questions of the investigation were ruled out. Thereafter, all the articles published in the previous ten years and considered relevant to the review were included. The content analysis method has been used (Mayring, 2000). Data from the papers was fragmented into descriptive codes assigned based on their content. Results The results are organized: a) Clinical history and physical examination b) Electrocardiogram c) Other tests d) Clinical guidelines. Finally, 14 articles were analyzed, mostly literature reviews focused on the sports population. Conclusions The present study highlights a need to design specific and efficient screening strategies for sports preparticipation. Bearing this in mind, correct detection and prevention of sudden cardiac death is essential to ensure safe sports practice. For this, it is recommended to have a pre-sports participation cardiovascular examination. In addition, such a preparticipation cardiovascular evaluation offers the potential for detecting other potentially lethal cardiovascular conditions. Similarly, the nursing staff's role in these procedures ranges from the educational aspect to the supervision of the equipment and adequate organization to carry out the assessment.

Are anxiety and depression risk factors for poor medication adherence in patients with an implantable cardioverter defibrillator?

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): TrygFonden The Lundbeck Foundation Patient@Home Background The implantable cardioverter defibrillator (ICD) is the preferred treatment for prevention of sudden cardiac death. Most patients with an ICD receive adjunctive medication to manage their heart disease. Poor medication adherence is a prognostic risk factor for cardiac patients and is linked to psychological factors, such as anxiety and depression. To our knowledge, no studies have examined if anxiety and/or depression at the time of ICD implantation is associated with medication adherence during the first year post-implantation. This information is important as it could help health care professionals identify and prevent poor medication adherence in ICD patients. Purpose To examine if anxiety and/or depression at ICD implantation are associated with medication adherence one-year post-implantation in ICD patients. Methods Secondary outcome analysis of the ACQUIRE-ICD, multisite, randomised controlled trial. Out of 478 patients with a first-time ICD or cardiac resynchronization therapy defibrillator (CRT-D) included in the trial, 433 patients (90.6%) took heart medication. Of these 433 patients, 322 patients (74.4%) were included in the analyses as they completed assessments at both baseline (implantation) and at 12 months post-implantation. Medication adherence was measured with the 8-item Morisky Medication Adherence Scale (MMAS), anxiety with Generalized Anxiety Disorder scale (GAD-7), and depression with Patient Health Questionnaire-9 (PHQ-9). Results The mean age of the participants was 60.2 ± 11.2, mainly male (83.9%). Medication adherence was generally medium to high at baseline [6.8% low adherence, 40.1% medium adherence, 53.1% high adherence, mean MMAS score: 7.31 ± 0.94), and at 12-months follow-up (8.1% low adherence, 37.3% medium adherence, 54.6% high adherence, mean MMAS score: 7.33 ± 0.93). In univariate analyses, depression scores at baseline were significantly negatively associated with medication adherence at 12-months post-implantation while adjusting for baseline MMAS scores (B = -0.02, 95% CI [- 0.04, -0.00], p = .04). This association remained statistically significant in the multivariate analysis also adjusting for gender, intervention group, heart failure severity (NYHA class I-II versus III-IV), and implantation center (B = -0.03, 95% CI [- 0.05, -0.00], p = .02). Anxiety scores at baseline were not significantly associated with medication adherence at 12-months post-implantation in neither the univariate (B = -0.02, 95% CI [- 0.04, 0.01], p = .14) nor adjusted analyses (B = -0.02, 95% CI [- 0.04, 0.00], p = .09). Conclusion Depression symptoms at the time of ICD implantation were associated with medication adherence at 12 months post-implantation with higher depression symptoms being associated with lower medication adherence. Anxiety symptoms were not predictive of medication adherence. Patients presenting with depressive symptoms at ICD implantation might be at risk for poor medication adherence.

The Value of Strain Echocardiography in Predicting Electrical Progression in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy.

Arrhythmogenic right ventricular (RV) cardiomyopathy is a progressive disease characterized by the replacement of the normal myocardium with fibrofatty tissue. This study aimed to determine the value of echocardiographic RV deformation parameters in predicting electrical progression as assessed by serial changes in RV lead sensing and threshold in patients with arrhythmogenic RV cardiomyopathy. The present study recruited 40 patients with a definitive diagnosis of arrhythmogenic RV cardiomyopathy at a mean (SD) age of 38.6 (14.2) years between 2018 and 2020. All patients had received an implantable cardioverter-defibrillator for the primary or secondary prevention of sudden cardiac death. The patients underwent 2-dimensional (2D) and 3-dimensional (3D) transthoracic echocardiographic examinations and RV 2D and 3D strain analyses, comprising free-wall longitudinal strain, global longitudinal strain, and strain rate. They were then followed up for electrical progression. During a mean (SD) follow-up period of 20 (6) months, the RV lead amplitude decreased from 7.95 (IQR, 4.53-10.25) mV to 5.25 (IQR, 2.88-8.55) mV (P < .001), and the lead threshold increased from 0.75 (IQR, 0.50-0.79) V to 0.75 (IQR, 0.75-1.00) V (P < .001). Right ventricular 2D free-wall (ρ = 0.56, P = .01), RV 2D global (ρ = 0.58, P = .007), and RV 3D free-wall (ρ = 0.65; P = .003) longitudinal strain correlated with electrical progression. Right ventricular 2D and 3D deformation parameters were found to be significant predictors of electrical progression during follow-up of patients with arrhythmogenic RV cardiomyopathy. These findings suggest that echocardiography has a pivotal role in predicting patients at high risk for electrical progression.

Advancing Equity in Sudden Cardiac Death Prevention: Beware of Making Assumptions About the Effectiveness of Primary Prevention Implantable Cardioverter-Defibrillators in Black Patients

Advancing Equity in Sudden Cardiac Death Prevention: Beware of Making Assumptions About the Effectiveness of Primary Prevention Implantable Cardioverter-Defibrillators in Black Patients

Cardiovascular system damage in the late-onset Pompe disease

The article presents a clinical case of metabolic hypertrophic cardiomyopathy against the background of a late-onset form of Pompe disease, illustrating the difficulties of differential diagnostic search for the cause of the disease. The clinical, laboratory and genetic aspects of the diagnosis of Pompe disease are highlighted. The features of laboratory diagnostics, the difficult path to the correct diagnosis and the appointment of enzyme replacement therapy are discussed. Much attention is paid to the clinical symptoms of the disease — the most significant damage to the cardiovascular system, there is no damage to the musculoskeletal sphere. Clinical picture of late Pompe disease is presented: cardiac rhythm and conduction disorders (ventricular preexcitation syndrome — multiple additional atrioventricular fenestrations), unstable ventricular tachycardia, supraventricular tachycardia, sinus node weakness syndrome. Considered approaches to the prevention of sudden cardiac death the patient underwent surgical treatment: radiofrequency ablation, endocardial implantation of a cardioverter defibrillator. Pathogenetic therapy for Pompe disease has been started.

Appropriate Implantable Cardioverter-Defibrillator Therapy in Patients with Ventricular Arrhythmia of Unclear Cause in Secondary Prevention of Sudden Cardiac Death.

In this study, we sought to investigate the occurrence of appropriate implantable cardioverter-defibrillator (ICD) therapies and inappropriate shocks in secondary prevention ICD recipients with ventricular arrhythmia of unclear cause and ventricular arrhythmia in the context of underlying heart disease. In this retrospective study, consecutive patients with an ICD implanted for secondary prevention in the University Medical Center Groningen (UMCG), the Netherlands between 1 January 2012 and 31 December 2018 were included. Patients were classified as having ventricular arrhythmia of unclear cause if no clear cause was found which could explain the index ventricular arrhythmia. The primary outcome was appropriate ICD therapy. The study population consisted of 257 patients. In 220 patients, an underlying heart disease could be identified as the cause of ventricular arrhythmia, while 37 patients had an unclear cause of ventricular arrhythmia. The median age was 64 years (interquartile range (IQR) 53-72 years). Forty-five (18%) patients were women. During a median duration of follow-up of 6.2 years (IQR 4.8-7.8 years), appropriate ICD therapy occurred in 95 (37%) patients. This number was 90 (41%) in the group with a clear etiology and 5 (14%) in the group with an unclear etiology. In multivariable analysis, index ventricular arrhythmia of unclear cause was associated with fewer appropriate ICD therapies (HR 0.37 [95% CI 0.14-0.99]; p = 0.048), as well as an increased risk of inappropriate ICD shocks (HR 3.71 [95% CI 1.17-11.80]; p = 0.026). Index ventricular arrhythmia of unclear cause was significantly associated with fewer appropriate ICD therapies.

Clinical characteristics and factors associated with death from acute decompensated heart failure

Aim. To assess the diagnostic significance of clinical indicators and left ventricle ejection fraction (LV EF) for predicting the probability of death from acute decompensated heart failure (ADHF) in patients with chronic heart failure with a reduced LV EF (HFrEF) within one year after implantation of cardioverter defibrillator (ICD).Methods. The study included 384 patients with heart failure NYHA 3-4 functional class with LV EF ≤ 35%, undergoing ICD implantation for the purpose of primary prevention of sudden cardiac death. After ICD implantation the patients included in the study were prospectively observed during one year (visits to the clinic after 3, 6, 12 months). The primary end point - a case of ADHF was registered.Results. In a one-year observation, the primary endpoint was recorded in 38 patients (10 per cent). Single factor logistic regression analysis showed 5 factors with the greatest predictive potential (p&lt;0.1), related to the occurrence of the investigated endpoint. These included: history of arterial hypertension (AH) and obesity, LV EF based on the biplane Simpson’s method, LV EF ≤ 28% and systolic blood pressure. Based on the results of the multi-factor regression analysis, a predictive model was developed, which included three factors with the highest levels of statistical significance: the presence of AH, obesity and LV EF ≤ 28%. The diagnostic efficiency of the model was 69.5% (sensitivity 78.9%; specificity 68.5%).Conclusion. The results of the research indicate that the main predictor of one-year mortality due to ADHF in the studied cohort of HFrEF patients with NYHA class 3-4 is LV EF ≤ 28%. The presence in the history of AH and obesity was associated with the best prognosis for life.

Predictors for early cardiac death after discharge from successfully treated acute myocardial infarction.

The use of a cardioverter defibrillator for the primary prevention of sudden cardiac death is not recommended within 40 days after acute myocardial infarction (AMI). We investigated the predictors for early cardiac death among patients who were admitted for AMI and successfully discharged. Consecutive patients with AMI were enrolled in a multicenter prospective registry. Among 10,719 patients with AMI, 554 patients with in-hospital death and 62 patients with early non-cardiac death were excluded. Early cardiac death was defined as a cardiac death within 90 days after index AMI. Early cardiac death after discharge occurred in 168/10,103 (1.7%) patients. A defibrillator was not implanted in all patients with early cardiac death. Killip class ≥3, chronic kidney disease stage ≥4, severe anemia, cardiopulmonary support usage, no dual antiplatelet therapy at discharge, and left ventricular ejection fraction (LVEF) ≤35% were independent predictors for early cardiac death. The incidence of early cardiac death according to the number of factors added to LVEF criteria in each patient was 3.03% for 0 factor, 8.11% for 1 factor, and 9.16% for ≥2 factors. Each model that sequentially added the factors in the presence of LVEF criteria showed a significant gradual increase in predictive accuracy and an improvement in reclassification capability. A model with all factors showed C-index 0.742 [95% CI 0.702-0.781], p < 0.001; IDI 0.024 [95% CI 0.015-0.033], p < 0.001; and NRI 0.644 [95% CI 0.492-0.795], p < 0.001. We identified six predictors for early cardiac death after discharge from AMI. These predictors would help to discriminate high-risk patients over current LVEF criteria and to provide an individualized therapeutic approach in the subacute stage of AMI.

Prevention of Cardiac Implantable Electronic Device Infections: A Review

The importance of cardiac implantable electronic devices (CIEDs) in the treatment of cardiac rhythm disturbances, heart failure, and the prevention of sudden cardiac death is indisputable. However, CIED therapy is associated with complications, among which infections are particularly unfavourable in terms of prognosis. The diagnosis and management of CIED infections remain complex, with a significant impact on mortality and healthcare costs. For these reasons, the risk factors for CIED infections and methods of their prevention have been assessed in recent years. This review summarises the current state of knowledge on the subject. We also outlined the role of alternative methods, such as subcutaneous defibrillators, leadless pacemakers, and wearable cardioverter defibrillators.

Sudden Cardiac Death in Athletes: Consensuses and Controversies.

Exercise is widely considered beneficial for cardiovascular health. However, on rare occasions, athletes experience sudden cardiac death without any preceding symptoms. The devastating nature of these events necessitates us to understand the underlying causes. In younger athletes (age <35), the underlying causes are usually hereditary/genetic, whereasin older athletes (age >35), coronary artery disease is prevalent. Sudden cardiac death in athletes can occur regardless of the presence of any structural abnormality in the heart. Despite divergence between guidelines, the majority of cardiology societies recommend at least taking a comprehensive history and performing physical examinations for initial screening for all athletes.This article reviews the consensuses and controversies regarding the incidence, causes, and prevention of sudden cardiac death in athletes.

The Role of the Electrocardiogram (ECG) In the Screening and Prevention of Sudden Cardiac Death in Sports

The Role of the Electrocardiogram (ECG) In the Screening and Prevention of Sudden Cardiac Death in Sports Abstract: Athletes carry a higher risk for sports-related sudden cardiac death compared to the general population. The majority of these athletes suffer from an undiagnosed heart disease. Since physical activity is an essential trigger for sudden cardiac death in individuals with undiagnosed, usually hereditary, heart disease, sports can lead to sudden cardiac death in these athletes. Different heart diseases lead to sudden cardiac death at different ages during sports. The electrocardiogram (ECG) is an important screening tool to identify individuals of all ages with heart disease that are associated with sports-related sudden cardiac death. These individuals can then be treated and lives can be saved.

When Is Cardiac Resynchronization Therapy with a Defibrillator Indicated in Patients with Heart Failure, Especially Elderly Patients?

One benefit of an implantable cardioverter-defibrillator is the prevention of sudden cardiac death (SCD). It is recommended for patients with a low left ventricular ejection fraction (LVEF). However, the choice of cardiac resynchronization therapy (CRT) with or without a defibrillator (CRT-D and CRT-P) in elderly patients is controversial. To understand the current situation for proper device selection, we investigated the impact of defibrillators on mortality in elderly patients with heart failure.Consecutive patients who underwent CRT implantation were retrospectively recruited. Baseline characteristics, all-cause mortality, cardiac death, and defibrillator implantation rates were investigated in patients aged > 75 or ≤ 75 years.A total of 285 patients (79 patients aged > 75 years) were analyzed. Elderly patients had more comorbidities, but a lower proportion had ventricular arrhythmia. During the mean follow-up of 47 months, 109 patients died (67 due to cardiac death). Kaplan-Meier analysis showed higher mortality in elderly patients (P = 0.0428) but no significant difference in cardiac death by age group (P = 0.7472). There were no significant differences in mortality between patients with CRT-D versus CRT-P (P = 0.3386).SCD was rare. A defibrillator had no significant impact on mortality. In elderly patients, comorbidities are common and related to mortality. The selection of CRT-D versus CRT-P should take those factors into account.

Determinants of ventricular arrhythmias in sickle cell anemia: toward better prevention of sudden cardiac death

AbstractSudden death is 1 of the leading causes of death in adults with sickle cell anemia (SCA) but its etiology remains mostly unknown. Ventricular arrhythmia (VA) carries an increased risk of sudden death; however, its prevalence and determinants in SCA are poorly studied. This study aimed to identify the prevalence and predictors of VA in patients with SCA. From 2019 to 2022, 100 patients with SCA were referred to the physiology department to specifically analyze cardiac function and prospectively included in the DREPACOEUR registry. They underwent a 24-hour electrocardiogram monitoring (24h-Holter), transthoracic echocardiography, and laboratory tests on the same day. The primary end point was the occurrence of VA, defined as sustained or nonsustained ventricular tachycardia (VT), >500 premature ventricular contractions (PVCs) on 24h-Holter, or a recent history of VT ablation. The mean patient age was 46 ± 13 years, and 48% of the patients were male. Overall, VA was observed in 22 (22%) patients. Male sex (81% vs 34%; P = .02), impaired global longitudinal strain (GLS): –16% ± 1.9% vs –18.3% ± 2.7%; P = .02), and decreased platelet count (226 ± 96 giga per liter [G/L] vs 316 ± 130 G/L) were independently associated with VA. GLS correlated with PVC load every 24 hours (r = 0.39; P < .001) and a cutoff of –17.5% could predict VA with a sensitivity of 82% and a specificity of 63%. VAs are common in patients with SCA, especially in men. This pilot study uncovered GLS as a valuable parameter for improving rhythmic risk stratification.

Management of Ventricular Arrhythmias in Heart Failure.

Despite substantial progress in medical and device-based heart failure (HF) therapy, ventricular arrhythmias (VA) and sudden cardiac death (SCD) remain a major challenge. Here we review contemporary management of VA in the context of HF with one particular focus on recent advances in imaging and catheter ablation. Besides limited efficacy of antiarrhythmic drugs (AADs), their potentially life-threatening side effects are increasingly acknowledged. On the other hand, with tremendous advances in catheter technology, electroanatomical mapping, imaging, and understanding of arrhythmia mechanisms, catheter ablation has evolved into a safe, efficacious therapy. In fact, recent randomized trials support early catheter ablation, demonstrating superiority over AAD. Importantly, CMR imaging with gadolinium contrast has emerged as a central tool for the management of VA complicating HF: CMR is not only essential for an accurate diagnosis of the underlying entity and subsequent treatment decisions, but also improves risk stratification for SCD prevention and patient selection for ICD therapy. Finally, 3-dimensional characterization of arrhythmogenic substrate by CMR and imaging-guided ablation approaches substantially enhance procedural safety and efficacy. VA management in HF patients is highly complex and should be addressed in a multidisciplinary approach, preferably at specialized centers. While recent evidence supports early catheter ablation of VA, an impact on mortality remains to be demonstrated. Moreover, risk stratification for ICD therapy may have to be reconsidered, taking into account imaging, genetic testing, and other parameters beyond left ventricular function.

Appropriate and inappropriate therapies in remotely monitored patients with cardiac implantable devices long-term experiences of a tertiary centre

Abstract Funding Acknowledgements Type of funding sources: None. Background The evidence supporting the implantation of implantable cardioverter-defibrillator (ICD) in the primary prevention of sudden cardiac death (SCD) comes mostly from the times when optimal management of heart failure was not as effective as at present. Moreover, the detailed data on the long-term risk of arrhythmias in patients with ICD are scarce. Purpose To present the long-term results of the remote monitoring (RM) of patients with ICD from a large, tertiary cardiovascular centre registry. Methods The clinical data from the time of device implantation were derived from the COMMIT-HF registry, while the follow-up data were obtained from the investigator-initiated RM registry. In brief, the registry encompasses data regarding the types of the transmissions and their contents, with particular emphasis on the occurrence of arrhythmic episodes, device interventions, as well as the data on the causes of other alert transmissions. Results In total, 1,299 patients were included in the analysis. The median follow-up duration of RM was 4.4 years, and the primary indication for implantation was ischemic cardiomyopathy (60.3%). Appropriate antitachycardia pacing (ATP) and high-voltage therapy for ventricular arrhythmias occurred in respectively 25.3% and 26.1% of patients, while inappropriate ATP and HV in respectively 11.5% and 8.7%. The prevalence of AF was 40.8%. Conclusions In a large real-life cohort of continuously remotely monitored patients with ICDs, the percentage of patients with appropriate therapies for ventricular arrhythmias exceeded 25%. Further analyses are necessary to stratify the risk of ventricular arrhythmias in the contemporary practice.

Automatic subcutaneous defibrillator screening in patients with intracardiac devices: comparative study depending on the point of pacing

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Subcutaneous defibrillator (S-ICD) has been shown to be effective in the prevention of sudden cardiac death with the advantage of avoiding intravascular access. Although it should not be indicated when pacing indications exists, the need for pacing may arise in the course of underlying heart disease. Before implantation, it is necessary to screen the surface electrocardiogram (ECG) to avoid inappropriate shocks due to overdetection. Published studies so far show a drastic reduction in the percentage of patients eligible for screening with conventional pacing techniques (right ventricular apex, right ventricular outflow tract or resynchronisation with coronary sinus pacing). Purpose The change in screening signal produced by cardiac pacing during is unknown. So far, no studies have been published comparing the outcome of S-ICD screening between different pacing sites, including conduction system pacing (CSP, his and left bundle branch pacing). Our aim is to analyse the success rate of screening and its predictors in patients with cardiac pacing according to the pacing point. Methods A total of 102 patients were screened for S-ICD and divided into 5 groups according to pacing type: His bundle pacing (HBP), left bundle pacing (LBP), right ventricular apex (RVA), right ventricular outflow tract (RVOT) and biventricular cardiac resynchronisation (CRT). There were no significant differences in any variable between the HBP and LBP group, so they were unified as the CSP group. We used a control group of 10 healthy patients with no implantable devices or ECG abnormalities. All patients underwent automatic screening with paced rhythm using the automatic algorithm (Boston Scientific). We considered a suitable screening when at least one vector (primary, secondary or alternative) was positive in both decubitus and standing position, in left or right parasternal position. Results Baseline characteristics by group are summarised in table1. Paced QRS width was lower in the CSP group (135 [120-160] vs 120 [106-120] p=0,001). All healthy controls passed the screening (100%). 39 (97.5%) CSP patients passed the screening, compared to 15 (71.4%) CRT, 14 (70%) RVOT and 4 (19%) RVA. The differences were statistically significant, p &amp;lt; 0.001 (image 1 A &amp; B). In multivariate analysis, only pacing type was shown to be a predictor of positive screening (p 0.001), independent of paced QRS width. Conclusions In our experience, the probability of obtaining a positive screening of the S-ICD is higher with conduction system stimulation than with the other pacing points (AVD, RVOT or CRT).

Familial predisposition to cardiovascular disease and death in patients with an out-of-hospital cardiac arrest

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Rigshospitalet Introduction Familial predisposition to cardiovascular disease (CVD) and death among patients with out-of-hospital cardiac arrest (OHCA), is sparsely described in current literature. A higher rate of events in first-degree relatives might imply an increased risk of future cardiac arrest and could provide vital improvements in prevention of sudden cardiac death. Therefore, investigation of CVD and death in family of OHCA-victims is needed. Purpose Determine familial predisposition to CVD and death in patients with OHCA. Methods This study used the nationwide Danish Cardiac Arrest Registry to identify all patients with OHCA (probands) of presumed cardiac origin from 2001-2014 and &amp;lt;70 years of age at time of OHCA. First-degree relatives were identified using the Danish Family Relations Database. We included probands with at least one identifiable first-degree relative. Date of OHCA was defined as index for first-degree relatives. The probands were stratified in age groups (0-18, 19-29, 30-49, and 50-69 years at OHCA) and CVD and death among first-degree relatives was assessed in each group. CVD was defined as diagnosis with any ICD-10 I00-I51 code (hypertension (I10-I14) excluded) and CVD-death defined as death with CVD being the main cause. Probands were matched with a background population (1:4) on age and sex. First-degree relatives of the background population were identified and stratified similarly to those of probands. Rates of familial predisposition to CVD and death in probands was compared to the background population. Results We identified 5,443 probands (75% male, median age 51 years) with 16,260 first-degree relatives; 10,207 parents (48.2% fathers, median age 71 years) and 6,053 full siblings (52.7% brothers, median age 47.2 years). Parents to probands had a higher rate of CVD (27.5% vs. 21.9%), a higher mortality rate (51.4% vs. 38.4%) and death more often caused by CVD (39.9% vs. 34.1%) compared to parents of the background population (p&amp;lt;0.001 for all). Stratified by age groups, probands in groups 19-29, 30-49 and 50-69 all had a higher rate of mortality among their parents compared to corresponding groups in the background population (bar diagram in fig.1). Siblings to probands also had a higher rate of CVD (4.9% vs. 2.9%, p&amp;lt;0.001), a higher rate of mortality (3.5% vs. 2.0%, p&amp;lt;0.001), and death more often caused by CVD (16.9% vs. 12.4%, p=0.19) compared to siblings of the background population. Stratified by age group, probands in groups 30-49 and 50-69 both had a higher mortality rate among their siblings compared to corresponding groups in the background population (bar diagram in fig.2). Conclusion Familial predisposition to both cardiovascular disease and death is more prevalent in patients with an out-of-hospital cardiac arrest compared to the background population. These results indicate that, cardiovascular disease and death of first-degree relatives is important risk factors for sudden cardiac arrest in the family.

Single center experience with subcutaneous ICD in combination with previously implanted endocardial or epicardial antibradycardia or cardiac resynchronization devices

Abstract Funding Acknowledgements Type of funding sources: None. Background Subcutaneous ICD (S-ICD) is an established therapy for prevention of sudden cardiac death due to ventricular arrhythmias (VA). One major drawback of the S-ICD is the lack of antibradycardia pacing. Theroretically the S-ICD can be used in combination with endocardial or epicardial pacemaker (PM), or even cardiac resinchronization (CRT) devices, but recently there are only few case reports available on this topic. Purpose To evaluate the feasibility and safety of concomitant use of endocardial or epicardial PM or CRT devices and S-ICD in a single center patient cohort. Methods Fifty-seven patients underwent S-ICD implantation in our center between 2017 and 2022. Based on individualized decision making-process, six out of these patients underwent the S-ICD implantation without explantation of previuosly implanted transvenous devices, or after epicardial PM or CRT implantation (group 1). The procedural and follow-up data of these patients were compared with data of the other 51 patients (group 2). All patients underwent successful S-ICD screening before implantation. Patients with previously implanted devices were screened either in bipolar pacing mode and either during intrinsic rhythm, if present. S-ICD implantations were performed under general anaesthesia (33 %) or under deep sedation with ultrasound guided regional nerve blocks (66 %) using intermuscular generator placement and two incision technique. Defibrillation threshold test was performed successfully in all the 57 patients. Results All S-ICD implantations were performed successfully without any procedural complications. There were no significant difference between group 1 and group 2 in terms of age (52,3±20 yrs vs. 37,7±18,5 yrs, p=0,75), ejection fraction (49,2±25,6 % vs. 46,5±21 %, p=0,77), procedure duration (57±9,7 min. vs. 52,2±15,5 min., p=0,46), and the mean follow-up duration (20,5±23,6 months vs. 25±18,8 months, p=0,59). During follow-up, one patient in group 1 (17%), and 10 patients in group 2 (19,6 %) experienced adequate ICD therapies due to VA. There were no inadequate ICD therapy in group 1, but eight patients (15,6 %) in group 2 suffered from inadequate ICD shocks caused by T wave oversensing (3/8), atrial fibrillation (2/8) myopotential oversensing (2/8,) and S-ICD lead fracture (1/8). In group 1, no interferences occured between the implanted devices, and no missed S-ICD therapy were observed during induced or spontaeous VA due to pacing artefact oversensing by the S-ICD caused by undersensing of the VA by the pacemakers. Non of the patients in group 2 experienced symptomatic bradycardia required antibradycardia pacing during follow up. Conclusion Based on our observations, S-ICD implantation after previously implanted endocardial or epicardial pacemaker or CRT systems seems feasible and safe. After individualized decision-making, with careful screening and device programming the potential interference between the implanted devices can be prevented.