Risk Of Injury Research Articles

"Extreme sports" in patients with heart disease: an informative approach to patient counseling

The term "extreme sports" includes a range of sporting activities, predominantly individual, practised outdoors in a wild and non-competitive environment, which have in common the critical role of environmental variables, the importance of qualitative parameters in evaluating performance, the centrality of technological elements and the high perceived risk which, together with the spectacularity, attracts the attention of the media, favoring its popularity. Despite their diversity, these disciplines share specific risks and physiological and pathophysiological aspects. The average age of participants is generally higher than that of traditional and competitive sports, and the prevalence of male subjects implies a higher likelihood of cardiological evaluation whose path has yet to be codified like that of traditional sports. The risk of severe injuries in these sports is not higher than that of traditional sports and non-sporting activities. In contrast, the risk of cardiovascular events is documented only for some sports practised in the mountains, such as mountaineering, skiing and mountain biking, and it does not appear to be higher than that of equivalent physical activities performed at low altitudes. The diagnostic and prognostic criteria for cardiological counseling of enthusiasts are not defined. Environmental exposure to extremes of temperature, altitude, wind and humidity, and dehydration are typical characteristics of these activities, which should be addressed with adequate experience, preparation and equipment to minimize the potential impact on health. Finally, many of these activities are often conducted in "remote areas" compared to the possibility of emergency response, which should be considered in the risk assessment of an acute cardiovascular event. The definition of cardiovascular risk constitutes an open area of research to allow the practice of these sports to an increasing number of participants.

Urinary catheterization during laparoscopic inguinal hernia repair: Really necessary or a habit?

BackgroundDuring laparoscopic inguinal hernia repair (LIH) repair, it is common practice to insert a urinary catheter (UC) to mitigate the risk of bladder injury or acute postoperative urinary retention. However, this procedure often leads to potential complications or infections. This study aims to evaluate the implications of the UC placement during LIH repair. MethodsThis retrospective, monocentric study included patients who underwent LIH repair between 01/01/2018 to 31/12/2022. Patients were divided into two groups: UC and no-UC. Results212 patients were included: 119 (56 %) in the no-UC group and 93 (44 %) in the UC group. The UC group presented a higher prevalence of bilateral hernias (38.7 % vs. 52.7 %), (p=0.01) and a greater frequency of intraperitoneal approach (TAPP) (83.9 % vs. 100 %), (p=0.01). No intraoperative complications were attributable to the absence of the UC. Four patients in the UC group had postoperative acute urinary retention necessitating intermittent catheterization, allowing discharge (p = 0.13). Rates of readmission and reoperation rates were comparable between groups. One month post-surgery, 7.5 % of UC group patients (vs. 0.8 %) developed urinary tract infection (p=0.01). Subgroup analysis confirmed a higher incidence of urinary tract infections in unilateral hernia and in TAPP procedure. ConclusionRoutine UC insertion during LIH repair seems unnecessary; rather, it increases the risk of postoperative urinary tract infections and should thus be avoided.

A Biopsychosocial Model for Understanding Training Load, Fatigue, and Musculoskeletal Sport Injury in University Athletes: A Scoping Review.

McClean, ZJ, Pasanen, K, Lun, V, Charest, J, Herzog, W, Werthner, P, Black, A, Vleuten, RV, Lacoste, E, and Jordan, MJ. A biopsychosocial model for understanding training load, fatigue, and musculoskeletal sport injury in university athletes: A scoping review. J Strength Cond Res 38(6): 1177-1188, 2024-The impact of musculoskeletal (MSK) injury on athlete health and performance has been studied extensively in youth sport and elite sport. Current research examining the relationship between training load, injury, and fatigue in university athletes is sparse. Furthermore, a range of contextual factors that influence the training load-fatigue-injury relationship exist, necessitating an integrative biopsychosocial model to address primary and secondary injury prevention research. The objectives of this review were (a) to review the scientific literature examining the relationship between training load, fatigue, and MSK injury in university athletes and (b) to use this review in conjunction with a transdisciplinary research team to identify biopsychosocial factors that influence MSK injury and develop an updated, holistic biopsychosocial model to inform injury prevention research and practice in university sport. Ten articles were identified for inclusion in this review. Key findings were an absence of injury surveillance methodology and contextual factors that can influence the training load-fatigue-MSK injury relationship. We highlight the inclusion of academic load, social load, and mental health load as key variables contributing to a multifactorial, gendered environmental, scientific inquiry on sport injury and reinjury in university sport. An integrative biopsychosocial model for MSK injury in university sport is presented that can be used to study the biological, psychological, and social factors that modulate injury and reinjury risk in university athletes. Finally, we provide an example of how causal inference can be used to maximize the utility of longitudinally collected observational data that is characteristic of sport performance research in university sport.

Major Traffic Safety Reform and Road Traffic Injuries Among Low-Income New York Residents, 2009-2021.

Objectives. To evaluate the effects of a comprehensive traffic safety policy-New York City's (NYC's) 2014 Vision Zero-on the health of Medicaid enrollees. Methods. We conducted difference-in-differences analyses using individual-level New York Medicaid data to measure traffic injuries and expenditures from 2009 to 2021, comparing NYC to surrounding counties without traffic reforms (n = 65 585 568 person-years). Results. After Vision Zero, injury rates among NYC Medicaid enrollees diverged from those of surrounding counties, with a net impact of 77.5 fewer injuries per 100 000 person-years annually (95% confidence interval = -97.4, -57.6). We observed marked reductions in severe injuries (brain injury, hospitalizations) and savings of $90.8 million in Medicaid expenditures over the first 5 years. Effects were largest among Black residents. Impacts were reversed during the COVID-19 period. Conclusions. Vision Zero resulted in substantial protection for socioeconomically disadvantaged populations known to face heightened risk of injury, but the policy's effectiveness decreased during the pandemic period. Public Health Implications. Many cities have recently launched Vision Zero policies and others plan to do so. This research adds to the evidence on how and in what circumstances comprehensive traffic policies protect public health. (Am J Public Health. 2024;114(6):633-641. https://doi.org/10.2105/AJPH.2024.307617).

Injury Profiles of Elite, Semielite, and Recreational Golfers, and Their Associated Risk Factors: A Systematic Review

Abstract Garrett, JM, Beaumont, PL, van den Hoek, DJ, Veugelers, K, Schmitz, M, and Bennett, H. Injury profiles of elite, semielite, and recreational golfers, and their associated risk factors: a systematic review. J Strength Cond Res 38(6): 1157–1176, 2024—Golf is one of the most participated sports played worldwide. However, how injury distributions change between different golf populations is unknown, and associated injury risk factors are unclear. Therefore, this review aimed to describe the common musculoskeletal injuries in different golf populations and identify their associated risk factors. A systematic search was performed to identify eligible articles through PubMed, SPORTDiscus, EMBASE, and Scopus up until September 4, 2023. Of the 4643 studies identified, 58 satisfied the inclusion criteria. Data from 10,437 subjects were extracted, with the most common area of injury to all golf populations being the lower back. Different injury distributions were found between populations with elite male golfers (n = 1924 injuries, 62% of all injuries) and recreational male golfers (n = 442 injuries, 45% of all injuries) reporting the trunk as the most injured region, whereas upper-extremity injuries were the most prevalent injury in elite female golfers (n = 890 injuries, 42% of all injuries) and recreational female golfers (n = 178 injuries, 47% of all injuries). Range-of-motion deficits at the hip and spine were identified as risk factors for elite golfers, whereas measures of lower-limb and trunk strength endurance were identified as risk factors for recreational golfers, suggesting areas of focus for golf practitioners. However, there is a paucity of robust studies evaluating the epidemiology of musculoskeletal injuries in all golf populations, and because of the variety of methods and measures used, detailed comparisons and definitive recommendations were difficult to make. Nonetheless, this review provides an overview of the common golf injuries and possible risk factors, which can aid partitioners in developing strategies for injury prevention for all golfing demographics.

Urinary Catheter-Related Meatal Pressure Injury Risk Factors in Male Critical Care Patients: A Prospective Repeated-Measures Study.

Urinary catheter-related meatal pressure injury (UCR-MPI) is a preventable and serious complication of indwelling urinary catheter use. This prospective study aimed to determine the prevalence and risk factors of UCR-MPI in male critical care patients. A total of 138 male patients 18 years and older using an indwelling urinary catheter were included in the study. Participants' perineal areas were assessed daily for the development of MPI. The UCR-MPI prevalence was 26.1% (n = 36/138). Most patients (61.1%) had a grade I UCR-MPI with intact skin and mucosa and nonblanchable erythema. Urinary catheter irrigation (P = .001), lower Braden Scale scores (P = .040), lower Glasgow Coma Scale score (P = .002), higher Itaki Fall Risk Scale score (P = .040), higher dependency level (P = .027), hypoalbuminemia (P = .002), and perineal edema (P = .001) were risk factors for UCR-MPI. The prevalence of UCR-MPI was high in this sample. Providers should take preventive measures to prevent UCR-MPI in patients with a penis including early and frequent risk assessment.

Athlete Performance Prediction Using Random Forest

Abstract: Fitness and health applications are increasingly being integrated into athletes' training routines, providing new opportunities for personalized performance optimization. This research paper investigates the utilization of smartwatch metrics and machine learning algorithms for predicting athlete performance, focusing on metrics such as power. Through a comprehensive analysis of collected data and employing advanced machine learning techniques, the study aims to provide insights into the predictive capabilities of smartwatch data in the realm of sports science. The introduction of a user-friendly athlete interface further enhances the accessibility and usability of this innovative technology. Smartwatch metrics combined with machine learning algorithms offer a potent toolset for predicting athlete performance. Smartwatches collect vast amounts of data on an athlete's biometrics, such as heart rate, activity levels, and more. Machine learning algorithms analyse this data to uncover patterns, correlations, and trends that are often imperceptible to human observation. By training models on historical data from athletes and their performances, these algorithms can make predictions about future performance, injury risk, optimal training schedules, and even suggest personalized strategies for improvement. This fusion of technology enables coaches and athletes to make data-driven decisions, optimize training regimens, and enhance overall performance while minimizing the risk of injury.

Automating Helmet Usage Detection: A YOLOv8 Based Framework

Abstract: The biggest threat to Powered two-wheeler(PTW) riders is a head injury. With the humongous amount of daily commuters on such PTWs, the risk only increases substantially. In such cases, helmets reduce the risk of head injuries in accidents but not every citizen is keen on their use. In India, where the use of motorcycles is widespread, ensuring helmetuse remains a challenge. This study explores the effectiveness of YOLOv8(You Only Look Once) a state-of-the-art single-stage object detection algorithm for helmet detection on Indian roads [14]. The CNN(Convolutional Neural Networks) based technologyimplements many other efficient, reliable and quick algorithmsto train, validate and predict the object’s detection, segmentationand classification task. We leverage the use of a publicly available Indian helmet dataset from Kaggle, containing 942 images with annotations. This an image dataset of real-life powered two-wheeler riders. The dataset has images and video frames for training on 5 different objects/classes along with annotations that specify thoseobjects. This multi-class approach offers valuable insight intohelmet usage patterns paves shows us the way for real-world applications for automated traffic monitoring. Real-time helmet and number plate detection can become a game changer in trafficmonitoring and can strengthen basic safety laws

Virtual Fitness Trainer Using AI: A Research Paper

Abstract: Our research delves into the creation of a Virtual Fitness Trainer using Artificial Intelligence (AI) to offer personalized workout guidance and real-time feedback. This project harnesses advanced computer vision, machine learning, and natural language processing techniques to develop an intelligent system capable of accurately detecting human poses, tracking exercise repetitions, and providing corrective feedback. Utilizing Python's OpenCV library to capture live webcam feeds, processed by MediaPipe's BlazePose tool for precise pose estimation, our application employs a novel topology with 33 keypoints, enhancing the accuracy of body movement analysis. The frontend interface, designed with Flask, HTML, CSS, and Bootstrap, ensures an intuitive user experience, allowing selection from various exercises such as squats, curls, jumping jacks, push-ups, lateral raises, and pull-ups. Each exercise page offers detailed instructions and demonstration videos for correct technique execution. The system processes live video streams frame-by-frame, converting them into formats suitable for pose analysis and accuracy assessment. BlazePose tracks user movements in real-time, displaying a 33-keypoint exoskeleton via OpenCV, aiding in understanding body movements and tracking progress through repetition counts. The system also provides real-time feedback on exercise form, suggesting corrective actions to optimize the workout and minimize injury risks. Our Virtual Fitness Trainer addresses the limitations of existing fitness apps by enabling accurate, independent home workouts, bridging the gap left by the absence of gyms and personal trainers. It highlights AI's potential in fitness, with future advancements expected to enhance gesture recognition, adaptive workout plans, and integration with biometric data from wearables. As AI algorithms evolve, the Virtual Fitness Trainer aims to become indispensable for achieving health and wellness goals, offering a convenient, engaging, and supportive platform.

Association of triglyceride glucose index with the risk of acute kidney injury in patients with coronary revascularization: a cohort study

BackgroundThe triglyceride glucose (TyG) index is a novel and reliable alternative marker for insulin resistance. Previous studies have shown that TyG index is closely associated with cardiovascular outcomes in cardiovascular diseases and coronary revascularization. However, the relationship between TyG index and renal outcomes of coronary revascularization is unclear. The purpose of this study was to investigate the correlation between TyG index and the risk of acute kidney injury (AKI) in patients with coronary revascularization.MethodsA retrospective cohort study was conducted to select eligible patients with coronary revascularization admitted to ICU in the medical information mart for intensive care IV (MIMIC-IV). According to the TyG index quartile, these patients were divided into four groups (Q1-Q4). The primary endpoint was the incidence of AKI, and secondary endpoints included 28-day mortality and the rate of renal replacement therapy (RRT) use in the AKI population. Multivariate Cox regression analysis and restricted cubic splines (RCS) were used to analyze TyG index association with AKI risk. Kaplan-Meier survival analysis was performed to assess the incidence of endpoints in the four groups.ResultsIn this study, 790 patients who underwent coronary revascularization surgery were included, and the incidence of AKI was 30.13%. Kaplan-Meier analysis showed that patients with a high TyG index had a significantly increased incidence of AKI (Log-rank P = 0.0045). Multivariate Cox regression analysis showed that whether TyG index was a continuous variable (HR 1.42, 95% CI 1.06–1.92, P = 0.018) or a categorical variable (Q4: HR 1.89, 95% CI 1.12–3.17, P = 0.017), and there was an independent association between TyG index and AKI in patients with coronary revascularization. The RCS curve showed a linear relationship between higher TyG index and AKI in this particular population (P = 0.078). In addition, Kaplan-Meier analysis showed a significantly increased risk of RRT application in a subset of AKI patients based on quartiles of TyG index (P = 0.029).ConclusionTyG index was significantly associated with increased risk of AKI and adverse renal outcomes in patients with coronary revascularization. This finding suggests that the TyG index may be useful in identifying people at high risk for AKI and poor renal outcomes in patients with coronary revascularization.

The Injury Risk Prediction of Firefighters with Biomechanical Parameters during Single- and Double-Leg Jumps

The incidence of knee injuries during firefighter training is high, but there is a lack of research on predictive factors and risk assessment for such injuries. Biomechanical assessments can provide a better understanding of how the body’s load changes during exercise, which may alter the risk of injury. Ten firefighters were recruited for our study. Each participant completed the FMS test and the single- and double-leg jump tasks. Motion information was collected and musculoskeletal models of the participants were constructed using OpenSim 4.4 to obtain the joint angle and joint moment. The peak GRF and CoM-CoP angle were also calculated. The findings showed a significantly larger PKFM (p = 0.0195), VAFM (p = 0.0039), and peak AP GRF (p = 0.0039) during the single-leg jump. The opposite performance was observed for KFA (p = 0.0098) and MPA (p = 0.0273). A stepwise multiple linear regression analysis was used to explore the relationship between these parameters and both the FMS score and the times of injuries. The risk of injury is higher in the single-leg jump compared to the double-leg jump. The biomechanical parameters of these two jumps can be used to assess sports injuries and to provide methods and references for injury risk monitoring during firefighter occupational training.

Biological ultrathin amniotic membrane flap to close refractory macular holes associated with high myopia.

To propose an ultrathin biological amniotic membrane (btAM) thinner than 10μm as the graft to treat highly myopic macular holes (MH). This pilot study included 14 patients affected by refractory macular holes associated with high myopia. btAM was used as a bandage covering the holes. The best-corrected visual acuity (BCVA), fundus photography, and optical coherence tomography (OCT) before and after surgery were compared. The mean MH size was 865.93 ± 371.72μm and all the MHs achieved anatomical closure. The btAM located centrally and fully on MHs from fundus photography yet no obvious visual masking was complained. The average BCVA 1month, 3, and 6months after surgery were 0.95 ± 0.24, 0.92 ± 0.23, 0.92 ± 0.23 logMAR, respectively, improved significantly compared to pre-operative BCVA (1.24 ± 0.42 logMAR, all P < 0.05). Ten out of 14 (71.4%) exhibited 2C closure patterns (formally closed and no bare RPE) on OCT. The btAM thinner showed a favorable anatomical success with less risk of parafoveal atrophy or iatrogenic injuries and shortened the dissolving time.

Is vaginal birth after cesarean section a risk factor for obstetric anal sphincter injury?

To investigate whether women undergoing their first vaginal delivery after a previous cesarean section (secundiparous) are at increased risk for obstetric anal sphincter injury (OASI) compared with primiparous women. A retrospective cohort study of 85 428 women who delivered vaginally over a 10-year period in a single tertiary medical center. Incidence of OASI, risk factors, and clinical characteristics were compared between primiparous women who delivered vaginally and secundiparous women who underwent their first vaginal birth after cesarean section (VBAC). A multivariable logistic regression analysis was used to study the association between VBAC and OASI. Overall, 36 250 primiparous and 1602 secundiparous women were enrolled, 309 of whom had OASI. The rates of OASI were similar among secundiparous women who had VBAC and primiparous women who underwent vaginal delivery (15 [0.94%] vs 294 [0.81%], P = 0.58). The proportions of third- and fourth-degree tears were also similar among secundiparous and primiparous women who experienced OASI (87% vs 91.5%, and 13% vs 8.5%, respectively, P = 0.68). Furthermore, the rates of OASI were similar in both study groups, although secundiparous women who underwent VBAC had higher rates of birth weights exceeding 3500 g (414 [25.8%] vs 8284 [22.8%], P = 0.016), and higher rates of vacuum-assisted deliveries (338 [21%] vs 6224 [17.2%], P < 0.001). A multivariate logistic regression analysis failed to establish a statistically significant association between VBAC and OASI (odds ratio 0.672, 95% confidence interval 0.281-1.61, P = 0.37). No increased risk for OASI was found in secundiparous women who underwent VBAC compared with primiparous women at their first vaginal birth.

Burns Resulting from Electric Vehicle Manufacturing in Silicon Valley.

The development of electric vehicles (EVs) has introduced novel technologies and manufacturing processes that expose workers to new risks of burn injury. We identified six patients who were admitted to our burn center for injuries that occurred while working in EV manufacturing facilities. The burns fell into three categories: flash flame burns due to lithium-ion battery explosions, high-voltage electrical injuries, and burns caused by contact with molten metal. Recognizing these recurrent patterns of injury should inform future prevention efforts and prepare health systems to evaluate and treat patients burned in EV manufacturing.

A Model for Causality of Pitching-related Overuse Injuries in Women's Fastpitch Softball.

Fastpitch softball is a popular women's sport, and athletes, particularly pitchers, are at high risk for overuse injury. Softball-related injury rates are low; however, the prevalence of overuse injuries is high. Injuries at the high school and collegiate levels occur early in the season, and approximately 50% of shoulder and elbow injuries in softball are attributable to overuse. Survey research showed 77% of high school pitchers pitch with pain, and 73% of collegiate pitchers reported an overuse injury in the previous season. Modifiable and non-modifiable intrinsic and extrinsic risk factors contribute to injury risk in a model that can be used in history taking, clinical examination, and management of softball-related injuries. In this manuscript, we present a scoping review of fastpitch softball injury research by competitive levels from 1990 to present. We also introduce a model for overuse injury causality in this athlete population. With this information, clinicians will be able to identify risk factors related to injury in softball pitchers. More research is needed to make evidence-based recommendations for injury prevention in this athlete population.

Complex knee injuries in football : Management from injury to return to competition

Knee joint injuries are aregular and serious injury in football, often resulting in along period of absence for players and are, therefore, asignificant disadvantage for clubs. The various structures of the knee joint, such as ligaments, meniscus or cartilage, are exposed to the risk of injury due to different sport-specific situations in football and require different and specific therapeutic approaches for their adequate healing. Both surgical and conservative treatment measures have been well investigated scientifically, especially for knee joint injuries in football, so that asuccessful and sustainable return to play on field is highly possible. Only in professional football is there adeviation from the usual standard of treatment in special situations in order to meet the demands and goals of professional footballers. In order to do address different subpopulations in football in the various injury types, both in treatment and in the return to play decision and, thus, sustainable secondary prevention, in addition to knowledge of scientific evidence on knee joint injuries, basic experience in the sport in which the patients with knee joint injuries are active is also useful.

Design and Development of Multi-Featured Medical Stretcher

The multi-featured medical stretcher represents a significant leap forward in patient care and hospital operations. Its innovative design combines various features aimed at enhancing both patient comfort and healthcare worker efficiency. At the core of its design is a commitment to making patient movement easier and safer. Through its adjustable height mechanism, the stretcher can be tailored to individual patient needs and seamlessly integrated into various medical procedures. This adaptability not only enhances patient comfort but also facilitates smoother transitions between different stages of care. Furthermore, the inclusion of storage compartments ensures that essential medical supplies are readily accessible, minimizing disruptions during patient transport and treatment. This organizational feature not only saves time but also contributes to a more efficient workflow for healthcare workers. Importantly, the stretcher's ability to move patients from stretcher to bed with minimal human assistance is a game-changer. By reducing the reliance on manpower for transfers, it streamlines hospital operations and minimizes the risk of patient discomfort or injury during movement. Overall, the multi-featured medical stretcher represents a significant advancement in hospital equipment, offering a comprehensive solution to the challenges associated with patient transport. Its integration of comfort-enhancing features and efficiency-boosting functionalities marks a substantial improvement in patient care delivery and contributes to a smoother and safer hospital environment for both patients and healthcare workers alike.

C.4 Neurologic injury in pediatric patients cannulated for rescue extracorporeal life support

Background: Historical literature suggests the risk of neurologic injury in children supported by extracorporeal life support (ECLS) is between 10-20%, however recent studies suggest the incidence may be much higher. Methods: The Alberta Children’s Hospital (ACH) Rescue ECLS program cannulates patients who are then transferred to the partner program at Stollery Children’s Hospital. Data was systematically collected from all patients cannulated for Rescue ECLS at ACH October 2011 and May 2023. Neuroimaging (CT, MR) performed after cannulation was reviewed for evidence of ischemic and hemorrhagic strokes and hypoxic-ischemic brain injury. Results: Seventy-one patients were included in the Rescue ECLS cohort. Median age at cannulation was 1.74 years (range 0-17.6 years, 51% female). Survival to hospital discharge was 65%. Primary indication for ECLS included cardiac (42%), respiratory (33.3%), extracorporeal cardiopulmonary resuscitation (ECPR; 23.2%) and trauma (1.4%). Seventy four percent of the cohort underwent neuroimaging, of whom 67% had evidence of neurologic injury including stroke (ischemic 67%; hemorrhagic 50%) or hypoxic-ischemic injury (33%). Risk of neurologic injury did not differ by indication for ECLS. Conclusions: Neuroimaging abnormalities are present in most pediatric patients imaged post-cannulation for Rescue ECLS. Further research into modifiable risk factors for specific ECLS-related brain injuries may help to improve outcomes for survivors.

Long-term outcome after catheter ablation for fascicular ventricular tachycardia in a single high-volume center in Germany

Abstract Background Idiopathic Fascicular Ventricular Tachycardia (IFVT) accounts for less than 10% of all VTs and represents the most common idiopathic ventricular tachycardia of the left ventricle. This study reports on clinical and procedural characteristics and the long-term outcome of patients undergoing catheter ablation of premature ventricular complexes (PVC) and ventricular tachycardias (VTs) arising in proximity of the left ventricular conduction system. Methods and results This study includes 27 patients (17 male, 45 ± 17 years; 10 females, 50 ± 11 years) who underwent electrophysiological examinations at a tertiary ablation center over a period of 14 years (2009 to 2022). Follow-up was performed via regular Holter-ECGs and clinical evaluations, or via structured follow-up within the prospective TRUST registry. In 21/27 patients (77.8%), the left posterior fascicle (LPF) was involved in the IFVT. In 4 (14.8%) the left anterior fascicle (LAF) was involved and in 2 (7.4%) patients an origin in the upper septal (US) area was demonstrated. 22/27 (81.5%) patients had a preserved left ventricular ejection fraction (LVEF) and only 5 (18.5%) patients had a LVEF less than 50% at the time of presentation. 14/27 (51.9%) patients presented with PVC or non-sustained VTs with the following distribution: 10 (71.4%) originating from the LPF, 3 (21.4%) from the LAF and 1 (7.1%) from the US. 21/27 (77.8%) patients presented with sustained VTs: 16 (76.2%) arising from the LPF, 4 (19%) from the LAF and 1 (4.8%) from the US. However, only 2 (7.4%) patients presented in sustained VT at the beginning of the EP procedure. In 16 (59.3%) patients a sustained VT was induced during the EP study via isoprenaline and/or programmed ventricular stimulation. Mean QRS duration of the VT was 124.5 ± 14.6 msec. In 21 (77.7%) patients only a retrograde approach was used, in 3 (11.1%) patients a retrograde and an additional transeptal approach and in only 3 (11.1%) patients solely a transeptal approach. Mean number of radiofrequency applications was 11.8 ± 12.6 (30 to 40 Watts, 27545.6 ± 30524.4 Joules). FVT ablation was acutely successful in 24 patients (88.9%). In 2 patients (7.4%) no ablation was performed due to inability to induce VT under sedation. 3/27 patients (11.1%) underwent re-ablation due to FVT recurrence after previous ablation procedures. Moreover, 3 (11.1%) additional patients underwent repeated VT ablations during follow-up, but the arrhythmia originated from a different LV area. No procedure-related complication occurred. In 4 patients (14.8%) left fascicular posterior block was caused by ablation and in 3 (11.1%) patients a complete left bundle block. Mean procedure time was 130 ± 48.9 minutes. Conclusion Ablation of FVT in a tertiary ablation center is associated with a high single procedural success rate of 88.9% during long-term follow-up, with a mild risk of fascicular injury. 11.1% of patients underwent re-ablation due to FVT recurrence.

Electrocardiogram predictors of leadless pacemaker implantation in the right ventricular free wall

Abstract Background Leadless pacemakers (LLP) carry the potential risk of cardiac injury, especially when implanted in the free wall of the right ventricle. Purpose To investigate the ECG criteria for distinguishing free wall implantation of LLP, further clarification is needed. Methods We conducted a retrospective study involving 17 patients who underwent LLP implantation, followed by chest computed tomography to confirm the implantation site. Patients were categorized into three groups based on the location of implantation (septum [Sep], apex [Apex], and free wall [FW]), and we compared the morphology of the 12-lead ECG during LLP pacing. Results Among the implantation sites, nine were in the Sep (52.9%), five in the Apex (29.4%), and three in the FW (15.8%). In terms of pacing QRS morphology, the FW group exhibited significantly longer QRS duration (Sep: 145.6±15.2 vs. Apex: 161.6±3.6 vs. FW: 175.3±16.6, P&amp;lt;0.01), a notched QRS complex in lead III (Sep: 0.0% vs. Apex: 0.0% vs. FW: 100.0%, P&amp;lt;0.01), and a shorter peak deflection index (PDI) in lead V1 (Sep: 0.59±0.07 vs. Apex: 0.55±0.06 vs. FW: 0.40±0.02, P&amp;lt;0.01) than the other two groups. Receiver operating curve analysis to predict FW implantation revealed that a PDI of 0.42 in lead V1 (Area under the curve [AUC]=1.00, specificity=100.0%, sensitivity=100.0%, P&amp;lt;0.01) and a QRS duration of 173 msec (AUC=0.89, specificity=100%, sensitivity=66.7%, P&amp;lt;0.01) were the optimal cutoff values. Conclusion The LLP FW implantation group had a longer QRS duration, a notched QRS complex in lead III, and a shorter PDI in lead V1 compared to the other pacing sites.