Effect of leadless left ventricular endocardial and left bundle branch area pacing on biventricular repolarization metrics.

Background: Cardiac resynchronization therapy (CRT) delivered with left ventricular (LV) epicardial pacing may increase arrhythmic risk through detrimental effects on ventricular repolarization. Leadless LV endocardial CRT including leadless left bundle branch area pacing (LBBAP) may mitigate this by preserving a more physiological transmural activation pattern.

Objective: This study aimed to evaluate the effect of leadless LV endocardial and leadless LBBAP on repolarization metrics derived from electrocardiographic imaging (ECGi).

Optimizing outcomes from cardiac resynchronization therapy: what do recent data and insights say?

Introduction: Cardiac Resynchronization Therapy (CRT) is an effective treatment for heart failure (HF) in approximately two-thirds of recipients, with a third remaining CRT 'non-responders.' There is an increasing body of evidence exploring the reasons behind non-response, as well as ways to preempt or counteract it.

Areas Covered: This review will examine the most recent evidence regarding optimizing outcomes from CRT, as well as explore whether traditional CRT indeed remains the best first-line therapy for electrical resynchronization in HF.

CAA-ri Masquerading as a High-Grade Glioma: A Case Report.

This case describes a 76-year-old male with initial clinical concern for a high-grade glioma, who was ultimately diagnosed with cerebral amyloid angiopathy-related inflammation The patient's presentation included a tonic-clonic seizure followed by aphasia and right-sided hemiparesis. Magnetic resonance brain imaging demonstrated a large left frontal lesion with parenchymal contrast enhancement. Magnetic resonance spectroscopy indicated elevated choline to creatine and choline to N-acetyl aspartate ratios, further suggestive of high-grade glioma.

Optimizing electrical efficacy of leadless cardiac resynchronization therapy and leadless left ventricular septal pacing: Insights on left and right ventricular activation from electrocardiographic imaging.

Background: Leadless cardiac resynchronization therapy (CRT) is an emerging heart failure treatment. An implanted electrode delivers lateral or septal endocardial left ventricular (LV) pacing (LVP) upon detection of a right ventricular (RV) pacing stimulus from a coimplanted device, thus generating biventricular pacing (BiVP). Electrical efficacy data regarding this therapy, particularly leadless LV septal pacing (LVSP) for potential conduction system capture, are limited.

Convergent ablation for persistent atrial fibrillation: A UK multicentre perspective.

Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide and remains a major cause of morbidity and mortality. Unfortunately, a significant proportion of patients have persistent AF, for which conventional catheter ablation is less effective. However, convergent ablation has emerged in recent years as a hybrid treatment targeting both the epicardium and endocardium in a multidisciplinary joint cardiothoracic and electrophysiology procedure, with promising efficacy outcomes in recent studies.

Heart Size Difference Drives Sex-Specific Response to Cardiac Resynchronization Therapy: A Post Hoc Analysis of the MORE-MPP CRT Trial.

Background: Studies have reported that female sex predicts superior cardiac resynchronization therapy (CRT) response. One theory is that this association is related to smaller female heart size, thus increased relative dyssynchrony at a given QRS duration (QRSd). Our objective was to investigate the mechanisms of sex-specific CRT response relating to heart size, relative dyssynchrony, cardiomyopathy type, QRS morphology, and other patient characteristics.

Consensus recommendations for the assessment and management of idiopathic intracranial hypertension in children and young people.

Background: Idiopathic intracranial hypertension (IIH) is a potentially disabling condition. There is a lack of evidence and national guidance on how to diagnose and treat paediatric IIH, leading to variation in clinical practice. We conducted a national Delphi consensus via the Children's Headache Network to propose a best-practice diagnostic and therapeutic pathway.

Enhancing transvenous lead extraction risk prediction: Integrating imaging biomarkers into machine learning models.

Background: Machine learning (ML) models have been proposed to predict risk related to transvenous lead extraction (TLE).

Objective: The purpose of this study was to test whether integrating imaging data into an existing ML model increases its ability to predict major adverse events (MAEs; procedure-related major complications and procedure-related deaths) and lengthy procedures (≥100 minutes).

Methods: We hypothesized certain features-(1) lead angulation, (2) coil percentage inside the superior vena cava (SVC), and (3) number of overlapping leads in the SVC-detected from a pre-TLE plain anteroposterior chest radiograph (CXR) would improve prediction of MAE and long procedural times.

The BLISTER Score: A Novel, Externally Validated Tool for Predicting Cardiac Implantable Electronic Device Infections, and Its Cost-Utility Implications for Antimicrobial Envelope Use.

Background: Antimicrobial envelopes reduce the incidence of cardiac implantable electronic device infections, but their cost restricts routine use in the United Kingdom. Risk scoring could help to identify which patients would most benefit from this technology.

Methods: A novel risk score (BLISTER [Blood results, Long procedure time, Immunosuppressed, Sixty years old (or younger), Type of procedure, Early re-intervention, Repeat procedure]) was derived from multivariate analysis of factors associated with cardiac implantable electronic device infection.

Heart size disparity drives sex-specific response to cardiac resynchronization therapy: a post-hoc analysis of the MORE-MPP CRT trial.

Background: Studies have reported that female sex predicts superior cardiac resynchronization therapy (CRT) response. One theory is that this association is related to smaller female heart size, thus increased "relative dyssynchrony" at given QRS durations (QRSd).

Objective: To investigate the mechanisms of sex-specific CRT response relating to heart size, relative dyssynchrony, cardiomyopathy type, QRS morphology, and other patient characteristics.

Computational Modelling Enabling In Silico Trials for Cardiac Physiologic Pacing.

Conduction system pacing (CSP) has the potential to achieve physiological-paced activation by pacing the ventricular conduction system. Before CSP is adopted in standard clinical practice, large, randomised, and multi-centre trials are required to investigate CSP safety and efficacy compared to standard biventricular pacing (BVP). Furthermore, there are unanswered questions about pacing thresholds required to achieve optimal pacing delivery while preventing device battery draining, and about which patient groups are more likely to benefit from CSP rather than BVP.

Cost-effectiveness analysis of leadless cardiac resynchronization therapy.

Background: The Wireless Stimulation Endocardially for CRT (WiSE-CRT) system is a novel technology used to treat patients with dyssynchronous heart failure (HF) by providing leadless cardiac resynchronization therapy (CRT). Observational studies have demonstrated its safety and efficacy profile, however, the treatment cost-effectiveness has not previously been examined.

Methods: A cost-effectiveness evaluation of the WiSE-CRT System was performed using a cohort-based economic model adopting a "proportion in state" structure.

Managing arrhythmia in cardiac resynchronisation therapy.

Arrhythmia is an extremely common finding in patients receiving cardiac resynchronisation therapy (CRT). Despite this, in the majority of randomised trials testing CRT efficacy, patients with a recent history of arrhythmia were excluded. Most of our knowledge into the management of arrhythmia in CRT is therefore based on arrhythmia trials in the heart failure (HF) population, rather than from trials dedicated to the CRT population.

Left bundle branch area pacing reduces epicardial dispersion of repolarization compared with biventricular cardiac resynchronization therapy.

Background: Biventricular endocardial pacing (BiV-endo) and left bundle branch area pacing (LBBAP) are novel methods of delivering cardiac resynchronization therapy. These techniques are associated with improved activation times and acute hemodynamic response compared with conventional biventricular epicardial pacing (BiV-epi); however, the effects on repolarization and arrhythmic risk are unknown.

Objective: The purpose of this study was to compare the effects of temporary BiV-epi, BiV-endo, and LBBAP on epicardial left ventricular (LV) repolarization using electrocardiographic imaging (ECGi).

Long-term survival following transvenous lead extraction: unpicking differences according to sex.

Aims: Female sex is a recognized risk factor for procedure-related major complications including in-hospital mortality following transvenous lead extraction (TLE). Long-term outcomes following TLE stratified by sex are unclear. The purpose of this study was to evaluate factors influencing long-term survival in patients undergoing TLE according to sex.

Leadless Pacing: Therapy, Challenges and Novelties.

Leadless pacing is a rapidly growing field. Initially designed to provide right ventricular pacing for those who were contraindicated for conventional devices, the technology is growing to explore the potential benefit of avoiding long-term transvenous leads in any patient who requires pacing. In this review, we first examine the safety and performance of leadless pacing devices.

Uncertainty aware training to improve deep learning model calibration for classification of cardiac MR images.

Quantifying uncertainty of predictions has been identified as one way to develop more trustworthy artificial intelligence (AI) models beyond conventional reporting of performance metrics. When considering their role in a clinical decision support setting, AI classification models should ideally avoid confident wrong predictions and maximise the confidence of correct predictions. Models that do this are said to be well calibrated with regard to confidence.

Impact of exercise training duration on obesity and cardiometabolic biomarkers: a systematic review.

Introduction: Physical exercise deters the risk and reduce the adjusted Odds Ratio related to obesity and cardiometabolic diseases but the amount of physical exercise required for initiating those potential advantageous developments in the human body for normal obese individuals is still debatable and thus made many face the health burden during pandemic, despite of their claiming to be physically active.

Objective: The primary aim of this review was to find an ideal duration and form of exercise that could help reduce the risk of cardiometabolic diseases and its complications for subjects with obesity and deranged cardiometabolic risk markers.

Method: Electronic database PubMed/MedLine, Scopus and PEDro for available literature on Experimental studies and RCT on exercise prescription and its effect on anthropometric measurements as well as key biomarkers in obese individuals, 451 records were procured, 47 full text articles were identified to assess eligibility criteria out of which 19 were finally included in the review.

Evaluation of the safety, immunogenicity and efficacy of a new live-attenuated lumpy skin disease vaccine in India.

Lumpy skin disease (LSD) was reported for the first time in India in 2019 and since then, it has become endemic. Since a homologous (LSD-virus based) vaccine was not available in the country, goatpox virus (GPV)-based heterologous vaccine was authorized for mass immunization to induce protection against LSD in cattle. This study describes the evaluation of safety, immunogenicity and efficacy of a new live-attenuated LSD vaccine developed by using an Indian field strain, isolated in 2019 from cattle.