OBJECTIVE: To identify sex-based differences in meeting left bundle branch (LBB) capture criteria on postimplant ECGs. BACKGROUND: Despite differences in QRS duration (QRSd) between males and females, no sex-based criter...OBJECTIVE: To identify sex-based differences in meeting left bundle branch (LBB) capture criteria on postimplant ECGs. BACKGROUND: Despite differences in QRS duration (QRSd) between males and females, no sex-based criteria have been established for defining LBB capture during LBB area pacing (LBBAP). METHODS: Patients aged >18 y.o. with a pacing indication and dual-chamber LBBAP pacemaker implantation from 2020 to 2023 were studied. Baseline and postoperative day 1 (POD1) ECGs were assessed for electrical dyssynchrony (QRS-area, sum-absolute integral of QRS-T (SAI QRS-T)), with LBB capture defined based on R-wave peak times (RWPT) per the EHRA 2023 Consensus algorithm. RESULTS: The cohort included 222 patients (143 males/79 females, age 74.5±1.1 years, LVEF 53.7±0.4%). Baseline QRSd was significantly shorter among females than males (median 122 ms [90,134] vs 126 ms [102,146]; p = 0.018). LBB capture criteria were met in 83 (58.0%) male and 56 (70.9%) female patients (p = 0.058). Baseline and POD1 dyssynchrony were similar between sexes. However, RWPTs measured in leads V/I/aVL were ∼7 ms shorter in females than males (V-RWPT: 66.3 ± 1.6 ms vs. 73.7 ± 1.4 ms, p = 0.0008). Adjusting V-RWPT up by 7 ms in females resulted in 7/56 patients (12.5%) no longer meeting LBB capture criteria. Significant differences were eliminated when normalizing RWPTs to size parameters (LV size, height, body surface area (BSA)), with no significant correlation between V-RWPT and size. CONCLUSIONS: Females with LBB capture exhibit shorter V-RWPTs despite similar measures of electrical dyssynchrony. This difference disappears when normalizing for the smaller size of female hearts. Additional studies are warranted to establish sex-specific LBB capture criteria. GRAPHICAL ABSTRACT: Despite innate differences in QRS duration between males and females, no recommendations have been established to assess for left bundle branch (LBB) capture across different sexes in patients undergoing LBB area pacing (LBBAP). To this end, we performed a retrospective study analyzing postimplant ECGs from 222 patients (143 males/79 females). R-wave peak times (RWPTs), traditionally used to identify LBB capture, were noted to be ∼7 ms shorter in females vs. males, with the differences resolved when accounting for smaller size of female hearts despite no correlation between RWPT and body/heart size. These results argue towards establishing sex-based cutoffs for LBB capture.
BACKGROUND: Current guidelines recommend oral anticoagulation in atrial fibrillation (AF) patients with a CHADS-VASc score ≥2 for stroke prevention. However, Centers for Medicare & Medicaid Services (CMS) reimburses left...BACKGROUND: Current guidelines recommend oral anticoagulation in atrial fibrillation (AF) patients with a CHADS-VASc score ≥2 for stroke prevention. However, Centers for Medicare & Medicaid Services (CMS) reimburses left atrial appendage occlusion (LAAO) for patients with CHADS-VASc score ≥3. This study aimed to evaluate differences in outcomes and complications of LAAO therapy in AF patients with a CHADS-VASc score of ≥ 3 versus < 3. METHODS: National Inpatient Sample (NIS) and International Classification of Diseases, Tenth Revision codes were used to identify LAAO device implantation in the U.S. from years 2016 to 2020. The study population was stratified by stroke risk into two groups, CHADS-VASc ≥ 3 and < 3. Study endpoints assessed included procedural complications, inpatient outcomes and resource utilization. RESULTS: A total of 73,795 and 15,500 LAAO devices were implanted in patients with CHADS-VASc ≥ 3 and < 3, respectively. Compared to patients with CHADS-VASc score of ≥ 3, patients with CHADS-VASc < 3 had lower overall (6.9% vs 9.9%, P < 0.01) and major (4.5% vs 6.2%, P < 0.01) complications in the crude analysis. After multivariable adjustment for potential confounders, CHADS-VASc < 3 was associated with lower overall complications (aOR 0.84, 95% CI 0.78 - 0.91), major complications (aOR 0.90, 95% CI 0.81-0.99) and cost of hospitalization (aOR 0.95, 95% CI 0.91-0.99). CONCLUSIONS: Patients with CHADS-VASc < 3 had lower complications and hospitalization costs after LAAO device implantation. These data, if redemonstrated in a large randomized trial, can have important clinical implications for stroke prevention in AF patients.
BACKGROUND: Left bundle branch area pacing (LBBaP) is a recently emerged and widely adopted technique of cardiac physiological pacing. However, there is still limited data about LBBaP in children. METHODS: Eighteen patie...BACKGROUND: Left bundle branch area pacing (LBBaP) is a recently emerged and widely adopted technique of cardiac physiological pacing. However, there is still limited data about LBBaP in children. METHODS: Eighteen patients who consecutively underwent permanent pacemaker (PPM) implantation via LBBaP were enrolled in this study. Periprocedural and postprocedural follow-up data were retrospectively evaluated. RESULTS: The mean age was 12.3 ± 5.8 years (13 months-18 years). The mean body weight was 41.5 ± 21 kg (8-77 kg). PPM indications were congenital atrioventricular (AV) block in 13 (72%) and post-interventional AV block in 5 (27%) children. On 10/18, patients (55%) had previously received PPMs implanted in the right ventricular apex or epicardial region. The mean left ventricular activation time (LVAT), the V-V inter-peak delay, and the paced QRS duration were 61 ± 9 ms, 31 ± 13 ms, and 94 ± 13 ms, respectively. No complications were observed during the procedure and follow-up. During the mean 13.5 ± 7.5 months of follow-up, the mean ventricular lead impedance was 578 ± 90 ohms, and the pacing threshold was between 0.25 and 0.75 mV. CONCLUSION: The LBBaP is an effective and safe alternative for pacing in pediatric patients at short-term follow-up. The LBBaP acts as an alternative pacing site in children, offering improved electrical and mechanical synchronization for those who need a high rate of ventricular pacing and have a longer life expectancy.
BACKGROUND: Congenitally corrected transposition of the great arteries (ccTGA) involves atrio-ventricular/ventriculo-arterial discordance, leading to AV node-His bundle variations that complicate RVOT anterior AV node-or...BACKGROUND: Congenitally corrected transposition of the great arteries (ccTGA) involves atrio-ventricular/ventriculo-arterial discordance, leading to AV node-His bundle variations that complicate RVOT anterior AV node-origin atrial tachycardia (AT). CASE SUMMARY: A 16-year-old male with 3-year paroxysmal palpitations (worsened 6 months) had narrow QRS tachycardia. Echocardiography/CTA confirmed SLL-type ccTGA. Electrophysiologic study revealed dual AV conduction system (RVOT His potentials) and RVOT as the earliest activation site. Radiofrequency ablation succeeded, with no recurrence/AV block at 12-month follow-up. CONCLUSION: In ccTGA, pulmonary artery/RVOT is adjacent to the anteroseptum (aortic sinuses distant); redefining localization/ablation strategies ensures safety and success.
BACKGROUND: Brugada syndrome has been reported in myotonic dystrophy type 1, whereas its association with myotonic dystrophy type 2 (DM2) remains largely unexplored. CASE SUMMARY: We report a patient with genetically con...BACKGROUND: Brugada syndrome has been reported in myotonic dystrophy type 1, whereas its association with myotonic dystrophy type 2 (DM2) remains largely unexplored. CASE SUMMARY: We report a patient with genetically confirmed DM2 who presented with an electrocardiogram showing a Brugada type-2 ECG pattern. Sodium-channel blocker testing unmasked a diagnostic type 1 Brugada pattern. Genetic analysis excluded SCN5A variants and identified a rare heterozygous ANK2 missense variant, a gene involved in cardiac electrical stability. CONCLUSION: This case expands the spectrum of Brugada phenotypes to DM2 and highlights the importance of not underestimating suspicious Brugada-like ECG findings in patients with muscular dystrophies.
INTRODUCTION: Several studies have compared His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) regarding paced QRS duration and clinical outcomes. This study compared acute intraprocedural depolarization...INTRODUCTION: Several studies have compared His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) regarding paced QRS duration and clinical outcomes. This study compared acute intraprocedural depolarization and repolarization electrocardiographic changes between corrective HBP and LBBAP in the same patient with baseline left bundle branch block and reduced left ventricular ejection fraction. MATERIAL AND METHODS: Thirty-six patients with successful corrective LBBAP for cardiac resynchronization therapy (CRT), in whom corrective HBP was also demonstrated, were retrospectively reviewed. QRS duration (QRSd), QRS and T wave axes, left ventricular activation time (LVAT), corrected QT (QTc) and JT (JTc) intervals, QT dispersion (QTd), corrected T wave peak-to-end interval (Tpec) and Tpec/QTc were measured for both instances. RESULTS: Both pacing techniques produced significantly narrower QRS complexes than the baseline values without differences between them. The LVAT was shorter with HBP than baseline without reaching statistical significance. On the other hand, LBBAP was associated with significantly shorter LVATs than both baseline and HBP values. HBP and LBBAP had a similar impact on repolarization parameters, significantly reducing the QTc, JTc and Tpec. Final left bundle branch pacing was achieved in 24 and final left ventricular septal pacing in 12 patients. The former resulted in a shorter QRS duration and a significantly faster LVAT. Also, capturing the left conduction system reduced the QTc and JTc intervals, albeit without statistical significance. CONCLUSION: In patients with LBBB and an indication for resynchronization therapy, HBP and LBBAP resulted in similar significant improvements in electrocardiographic depolarization and repolarization parameters.
Noordman ABP, Rienstra M, Blaauw Y
… +3 more, Mulder BA, Groenveld H, Maass AH
Pacing Clin Electrophysiol
· 2026 Jul · PMID 41733054
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INTRODUCTION: Implantable cardioverter-defibrillators (ICDs) are important in the prevention of sudden cardiac death. However, some appropriate ICD therapies may be considered unnecessary, delivered when patients do not...INTRODUCTION: Implantable cardioverter-defibrillators (ICDs) are important in the prevention of sudden cardiac death. However, some appropriate ICD therapies may be considered unnecessary, delivered when patients do not experience symptoms of hemodynamic instability such as loss of consciousness. Therefore, we aimed to determine the incidence of appropriate ICD therapy with loss of consciousness and impaired consciousness, as well as the psychological impact following any ICD therapy, in patients with an ICD by investigating patient-reported symptoms. METHODS: In this prospective, single-center study conducted at the University Medical Center Groningen (UMCG), 100 consecutive patients with an ICD for primary or secondary prevention indications who received ICD shock and/or ATP within the previous 6 months completed a questionnaire. The primary outcome was appropriate ICD therapy with loss of consciousness. RESULTS: The patient population consisted of 100 patients, 92 (92.0%) of whom had appropriate therapy. The mean age was 62.7 ± 12.8 years and 21 (21.0%) were female. Loss of consciousness occurred in 40% of patients with appropriate ICD therapy and in 65% of patients with appropriate shocks. Determinants of appropriate ICD therapy with loss of consciousness included the shortest cycle length, ventricular fibrillation, the occurrence of shock, a secondary prevention indication for ICD, the presence of a CRT-D and the fragmentation and width of the QRS complex. The psychological impact of ICD shocks was considerable, with patients without loss of consciousness during ICD shocks suffering significantly more from anxiety than those with loss of consciousness (9 (60.0%) versus 12 (42.9%), p = 0.041). CONCLUSIONS: A considerable number of patients do not experience appropriate ICD therapy with loss of consciousness and thus experience potentially unnecessary therapy while still being at risk of sustaining the consequent psychological impact associated with ICD shocks.
BACKGROUND: Concomitant atrial fibrillation (AF) and gastrointestinal (GI) bleeding present a clinical challenge due to recurrent bleeding risk associated with anticoagulation for AF-associated stroke prevention. Left at...BACKGROUND: Concomitant atrial fibrillation (AF) and gastrointestinal (GI) bleeding present a clinical challenge due to recurrent bleeding risk associated with anticoagulation for AF-associated stroke prevention. Left atrial appendage occlusion (LAAO) offers an alternative stroke prevention strategy, but its impact on recurrent GI bleeding remains unknown. METHODS: This retrospective, multicenter cohort study used the TriNetX database to identify adults with AF on oral anticoagulation and a history of GI bleeding. Patients were stratified by treatment with or without LAAO. 1:1 propensity score matching (PSM) was employed. The primary outcome was recurrent GI bleeding. Cox regression analysis was used to generate hazard ratios (HRs) with 95% confidence intervals (CIs). Odds ratios (ORs) were used to evaluate effect sizes between groups. Kaplan-Meier curves were used for time-to-event analyses. RESULTS: After PSM, 9259 patients were compared in each group. Odds of recurrent GI bleeding were consistently lower in patients undergoing LAAO than without LAAO across all follow-up intervals: at 3 months (OR 0.84; 95% CI 0.78-0.91), 6 months, 1 year, 3 years, and 5 years (OR 0.87; 95% CI 0.82-0.92). Kaplan-Meier analysis demonstrated significantly lower risk of recurrent GI bleeding with LAAO (HR 0.80; 95% CI 0.76-0.84; p < 0.01). CONCLUSION: In patients with AF and prior GI bleeding, LAAO was associated with a significantly lower risk of recurrent GI bleeding at short-term and long-term time intervals.
BACKGROUND: Determining proper initial site on the right side of interventricular septum is the first step to implant LBBAP lead. Electrocardiographic features such as discordance of paced QRS polarity in leads II and II...BACKGROUND: Determining proper initial site on the right side of interventricular septum is the first step to implant LBBAP lead. Electrocardiographic features such as discordance of paced QRS polarity in leads II and III (alternatively in aVL and aVR) and the presence of notch in lead V1 are in use but have not yet been evaluated. This study aimed to establish the role of paced QRS morphology in determining the initial site for LBBAP lead deployment. METHODS: A group of 150 LBBAP device implantations containing 327 lead placement attempts were analyzed. Final electrocardiographic results of LBBAP and the success rate of lead deployment attempts were evaluated depending on paced QRS complex features at the initial site of lead placement. RESULTS: Final electrocardiographic outcomes of LBBAP (paced QRS duration, R-wave peak time in V6, prevalence of confirmed LBB capture) were independent of leads II and III dominant polarity combination (both negative vs. discordant vs. both positive). Lead deployment success rate was the highest in area with negative QRS in leads II and III (OR 2.99, p < 0.001). Notched QRS in V1 was also the predictor of successful lead placement (OR 1.95, p = 0.005). The 95.7% of screwings were attempted in area characterized by aVL and aVR discordance. No coronary complications were noted. LVEF was stable. CONCLUSIONS: Wide area of interventricular septum may be used for LBBAP with similar electrocardiographic outcome and aVL/aVR discordance may delineate a safe target zone. LBBAP lead implantation is probably the easiest in the inferior part of septum.
BACKGROUND: Venous access exhaustion poses a significant challenge for the implantation of intracardiac devices. Epicardial alternatives are often used in these cases, despite their long-term deleterious effects. This ca...BACKGROUND: Venous access exhaustion poses a significant challenge for the implantation of intracardiac devices. Epicardial alternatives are often used in these cases, despite their long-term deleterious effects. This case presents a transhepatic approach for left bundle branch pacing in a patient with Ebstein anomaly and a prior Glenn procedure. METHODS: Following pre-procedural evaluation with triphasic CT, ultrasound-guided hepatic vein puncture was performed. Guidewires were advanced into the right heart chambers, allowing passage of a delivery sheath for physiologic pacing. Atrial lead placement followed. RESULTS: Appropriate electrical parameters were achieved for both atrial and ventricular leads, with effective biventricular resynchronization via selective left bundle branch pacing. CONCLUSION: The transhepatic approach is a viable alternative when conventional venous access is not available. Although previously described for traditional pacing systems, this report documents the feasibility of left bundle branch pacing for cardiac resynchronization via the transhepatic route.
BACKGROUND: Pacing-induced cardiomyopathy (PIC) occurs in up to 30% of patients with conventional right ventricular (RV) pacing, often requiring upgrade to cardiac resynchronization therapy (CRT). Left bundle branch area...BACKGROUND: Pacing-induced cardiomyopathy (PIC) occurs in up to 30% of patients with conventional right ventricular (RV) pacing, often requiring upgrade to cardiac resynchronization therapy (CRT). Left bundle branch area pacing (LBBAP) offers a physiological alternative to biventricular pacing, but its role in PIC upgrades remains underexplored. METHODS: We retrospectively analyzed 31 patients who underwent LBBAP upgrades for PIC between June 2020 and September 2024. Procedural success, electrical remodeling, echocardiographic changes, and clinical outcomes were assessed. RESULTS: LBBAP was successful in 30 (97%) cases. Average procedure time was 80 (60-120) min. QRS duration significantly decreased (175 ± 17 ms to 130 ± 18 ms, p < 0.001). After a median 19 months of follow up, left ventricular ejection fraction (LVEF) improved from 33 ± 8% to 42 ± 8% (p < 0.001). Three patients (9%) were hospitalized for heart failure, and five (16%) died during follow-up. CONCLUSION: LBBAP is a safe and effective upgrade strategy for PIC, offering significant electrical and functional improvements. Further studies are needed to confirm its long-term benefits compared to biventricular pacing.
We report a rare case of broad complex atrioventricular reentrant tachycardia (AVRT) in an 18-year-old female, mediated by two distinct decrementally conducting accessory pathways (APs). The reentrant circuit consisted o...We report a rare case of broad complex atrioventricular reentrant tachycardia (AVRT) in an 18-year-old female, mediated by two distinct decrementally conducting accessory pathways (APs). The reentrant circuit consisted of antegrade conduction via an atrio-fascicular (AF) fiber and retrograde conduction through a concealed posteroseptal AP. Both APs exhibited decremental properties, and the circuit was independent of the atrioventricular (AV) node and His-Purkinje system, representing a classic example of pathway-to-pathway reentry. Sequential ablation of the retrograde and then the antegrade limbs successfully eliminated the arrhythmia. This case highlights the importance of meticulous electrophysiologic study (EPS) in identifying non-AV nodal dependent reentry mechanisms.
BACKGROUND: Left bundle branch pacing (LBBP) offers physiological ventricular activation and has been proposed as an effective pacing strategy in young patients, particularly to prevent pacing-induced cardiomyopathy. In...BACKGROUND: Left bundle branch pacing (LBBP) offers physiological ventricular activation and has been proposed as an effective pacing strategy in young patients, particularly to prevent pacing-induced cardiomyopathy. In vulnerable populations, such as pregnant women, eliminating fluoroscopy is paramount to avoid fetal radiation exposure. CASE SUMMARY: We describe a 23-year-old pregnant woman (20 weeks gestation) presenting with symptomatic complete atrioventricular (AV) block. A dual-chamber pacemaker with LBBP was implanted using a three-dimensional (3D) electroanatomic mapping (EAM) system, with complete fluoroscopy avoidance. The procedure was successful and safe, with stable pacing parameters and a favorable maternal-fetal outcome. CONCLUSION: This case highlights the feasibility and safety of zero-fluoroscopy LBBP guided by 3D EAM in pregnant patients, offering a radiation-free alternative in high-risk scenarios.
BACKGROUND: Catheter ablation for persistent atrial fibrillation (AF) exhibits suboptimal outcomes after pulmonary vein isolation (PVI) alone. The vein of Marshall (VOM) has emerged as an adjunctive ablation target, thro...BACKGROUND: Catheter ablation for persistent atrial fibrillation (AF) exhibits suboptimal outcomes after pulmonary vein isolation (PVI) alone. The vein of Marshall (VOM) has emerged as an adjunctive ablation target, through which ethanol infusion can achieve transmural lesions in regions resistant to radiofrequency ablation. OBJECTIVE: To evaluate the efficacy and safety of adjunctive VOM ethanol infusion in patients undergoing catheter ablation for persistent AF. METHODS: We conducted a meta-analysis of randomized controlled trials (RCTs) comparing PVI ± linear ablation with versus without VOM ethanol infusion for persistent AF. The primary outcome was freedom from AF recurrence, analyzed using odds ratios and hazard ratios for time-to-event data. Secondary outcomes included procedural metrics and complications. Data were pooled using random-effects models. RESULTS: Four RCTs (n = 1045 patients) were included. VOM ethanol infusion significantly improved sinus rhythm maintenance (65.8% vs. 48.6%; absolute difference 17.2%; OR: 1.68, 95% CI: 1.13-2.49, p = 0.025). Time-to-event analysis showed consistent benefit of maintaining sinus rhythm during the first post-procedure year (pooled HR: 0.73, 95% CI: 0.59-0.91, p = 0.005) with high mitral isthmus block rates (90%). Subgroup analysis showed consistent sinus rhythm maintenance whether ethanol was added to PVI alone (OR: 1.66) or PVI with linear ablation (OR: 1.69). Fluoroscopy time was longer (+10.3 min, p = 0.0009) with VOM ethanol infusion. Complication rates were similar (OR: 1.55, p = 0.46). CONCLUSION: Adjunctive VOM ethanol infusion significantly improves ablation outcomes in persistent AF without increasing major complications. It represents a promising strategy to enhance durable rhythm control. Further research is required to evaluate long-term outcomes.
BACKGROUND: Misinterpretation of atrial fibrillation (AF) poses significant clinical risks. While the impact of computerized ECG interpretations (CIE) on clinical decision-making is well-documented, there is limited real...BACKGROUND: Misinterpretation of atrial fibrillation (AF) poses significant clinical risks. While the impact of computerized ECG interpretations (CIE) on clinical decision-making is well-documented, there is limited real-world evidence on the diagnostic accuracy of emergency department (ED) clinicians in the absence of such tools. This study examines the frequency and clinical impact of AF misdiagnosis in an ED operating without CIE. METHODS: ECGs of consecutive patients discharged with a diagnosis of AF over a five-year period were reevaluated by two cardiologists, with an electrophysiologist serving as an arbitrator. Misdiagnosed cases underwent further clinical follow-up. RESULTS: Of 1828 ECGs initially identified as AF, 31 were excluded due to paced rhythms or indeterminate tracings, yielding a final cohort of 1797. Among these, 49 cases (2.7%) were misclassified, encompassing supraventricular tachycardia (n = 30), sinus rhythm with premature atrial contractions, Mobitz type I block, or artifact (n = 18), and multifocal atrial tachycardia (n = 1). Patients with erroneous AF diagnoses were older (mean age 76.7 vs. 72.5 years, p = 0.032) and frequently received inappropriate therapies, including rate-control agents (n = 12), antiarrhythmics (n = 8), and anticoagulants (n = 24). CONCLUSIONS: AF misdiagnosis remains prevalent in the ED and can lead to unnecessary pharmacotherapy. The misdiagnosis rate appears comparable between CIE-assisted and physician-only interpretations.
Benachi C, Nagel P, Lucas J
… +7 more, Landmesser U, Hindricks G, Tscholl V, Biewener S, Huemer M, Attanasio P, Schreiber T
Pacing Clin Electrophysiol
· 2026 Jul · PMID 41717709
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In patients with atrial fibrillation (AF), sinus node disease (SND) represents a potentially reversible concomitant condition. Initial treatment with catheter ablation (CA) aimed at restoration of sinus rhythm may provid...In patients with atrial fibrillation (AF), sinus node disease (SND) represents a potentially reversible concomitant condition. Initial treatment with catheter ablation (CA) aimed at restoration of sinus rhythm may provide an alternative to pacemaker implantation. In this case series, 15 elderly patients (>65 years) with AF and SND underwent CA, with follow-up monitoring provided by implantable loop recorders (ILR). Despite CA of AF, pacemaker implantation was necessary in 40% of patients during a mean follow-up period of 37 months.
Safdar NZ, Gadani RM, Cole CA
… +10 more, Lowry JE, Kamalathasan S, Datla S, Brown OI, Rahunathan N, Paton MF, Kearney MT, Straw S, Witte KK, Gierula J
Pacing Clin Electrophysiol
· 2026 Jun · PMID 41717680
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BACKGROUND: Quadripolar left ventricular (LV) epicardial leads capable of multipoint pacing (MPP) may have an advantage over conventional bipolar leads for delivering cardiac resynchronization therapy (CRT) by stimulatin...BACKGROUND: Quadripolar left ventricular (LV) epicardial leads capable of multipoint pacing (MPP) may have an advantage over conventional bipolar leads for delivering cardiac resynchronization therapy (CRT) by stimulating the lateral LV wall from two distinct locations simultaneously. AIM: We aimed to determine the acute and longer-term effects of MPP compared with single-point pacing (SPP) on LV contractility and exercise capacity in individuals with heart failure with reduced ejection fraction receiving CRT. METHODS: Participants were enrolled into a randomized crossover study with echocardiographic assessment of the comparative effects of acute MPP and SPP on LV contractility and cardiopulmonary exercise testing at 6-weeks and 6-months following device implantation. Participants were then randomized in a parallel-group study to either MPP or SPP for further 6-months. RESULTS: Twenty-three participants (mean age 73 years [95% confidence interval: 69, 78], 91% male, 91% New York Heart Association [NYHA] class II, LV ejection fraction 31.3% [27.4, 35.1]) were included. At resting heart rates, LV contractility was significantly higher with MPP compared to SPP (2.29 mmHg/mL/m [1.74, 2.84] vs. 2.03 [1.58, 2.47]; p = 0.019). However, it was not different between MPP and SPP at higher heart rates or at 6-months, and there were no differences in exercise performance between MPP and SPP at any point including following 6 months of chronic treatment. CONCLUSION: Although CRT with MPP resulted in improved LV contractility at resting heart rates acutely post implantation, it did not translate into consistent mechanistic or patient-orientated benefits in the short or longer-term.
BACKGROUND: The implantable cardioverter-defibrillator (ICD) is an intervention for patients with cardiac abnormalities, serving as both a primary and secondary prevention of sudden cardiac death. However, reduced qualit...BACKGROUND: The implantable cardioverter-defibrillator (ICD) is an intervention for patients with cardiac abnormalities, serving as both a primary and secondary prevention of sudden cardiac death. However, reduced quality of life and adverse psychological effects have been reported. This qualitative study aims to gain further insights into the perspectives and psychological impacts of living with an ICD. FINDINGS AND CONCLUSION: A comprehensive interview was conducted with 15 participants who were selected from a follow-up clinic. The interviews were subjected to qualitative descriptive analysis, and verbatim transcripts were coded and analyzed using a thematic analysis approach. Through this process, five main themes emerged from the data: (i) Shock experiences and concerns regarding receiving shock, (ii) lack of concern about receiving shock, (iii) changes in health and quality of life after implantation, (iv) expectations from implantation, and (v) follow-up program as a concern reliever. Overall, this qualitative study provided valuable insights into the experiences, perspectives, and psychological effects of living with an ICD. Remarkably, the majority of participants demonstrate a lack of concern about getting shocked from an ICD. The investigation revealed additional concerns associated with the device, highlighting that these concerns can vary among individuals. Additionally, the follow-up program for individuals with ICDs should prioritize enhancing quality of life and supporting mental well-being, rather than focusing solely on the function of the device. General questions to screen for anxiety and depression triggered by device implantation should be conducted in every setting.