Circulation: Arrhythmia and Electrophysiology最新文献

{"title":"Prior Sternotomy in Transvenous Lead Extraction: Risk Analysis Tempered by Clinical Experience.","authors":"Michael Eskander, V. Pretorius, U. Birgersdotter-Green","doi":"10.1161/CIRCEP.119.007762","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.007762","url":null,"abstract":"Transvenous lead extraction (TLE) is a complex yet effective procedure to remove indwelling leads belonging to cardiac devices with a potential for serious complications. Consequently, the 2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction maintains that TLE be performed only at centers with an environment fully supportive of a lead extraction program, which includes a team-based approach, incorporating equipment and capable of managing all potential complications.1 An experienced center will evaluate the patient based on the current presentation and comorbid conditions, while incorporating the procedural and patient-related risks. Despite our best evaluation and preparation, however, a flawless risk stratification approach for those in consideration for TLE remains elusive. Patients with prior sternotomy (PS) is a group of interest due to theoretical mediastinal scarring which may protect against vascular tears and conversely increased adhesions and fibrosis which may delay precious life-saving surgical access after vascular complication from TLE. Historically, patients with PS have been shown to have increased operative morbidity and mortality. In a Swiss cohort undergoing coronary artery bypass grafting, postoperative mortality rate was 9.6% (57/594) in PS compared with 2.8% (87/3184) in those with no prior sternotomy (NPS). Low cardiac output syndrome, intraaortic balloon pump support, prolonged ventilatory support (>24 hours), hemorrhage and gastrointestinal complications were prominent features in those with PS as compared with those undergoing primary coronary artery bypass grafting. While some recently published data may suggest PS as a predictor of clinical success in the setting of TLE, there continues to be a significant risk of urgent cardiac surgery—which carries high mortality, and appropriate planning with cardiothoracic backup is crucial.3,4 In this issue, Tsang et al5 present a single-center experience with prior sternotomy on outcomes in transvenous lead extractions. Of 1480 patients undergoing TLE, 455 had PS and were more likely to be male and have more comorbid conditions (coronary artery disease, hypertension, diabetes mellitus, and chronic kidney disease) than those with NPS. Patients with PS were more likely to have defibrillator leads (70.1% versus 62.3%; P=0.004) and more leads extracted per case (2.1±1.0 versus 1.9±0.9; P=0.006) though mean lead dwell time was similar between patient groups. Despite some baseline differences, procedural success rates were similar in both groups, 97.6% in the PS versus 98.4% in the NPS group (P=0.257). Major complications occurred in 9 (2.0%) PS patients and 23 (2.2%) patients with NPS (P=0.746). Notably, patients with EDITORIAL","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86787617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effective Use of Percutaneous Stellate Ganglion Blockade in Patients With Electrical Storm.","authors":"Ying Tian, E. Wittwer, S. Kapa, Christopher J. McLeod, P. Xiao, P. Noseworthy, S. Mulpuru, A. Deshmukh, Hon-chi Lee, M. Ackerman, S. Asirvatham, T. Munger, Xingpeng Liu, P. Friedman, Y. Cha","doi":"10.1161/CIRCEP.118.007118","DOIUrl":"https://doi.org/10.1161/CIRCEP.118.007118","url":null,"abstract":"BACKGROUND\u0000Percutaneous stellate ganglion blockade (SGB) has been used for drug-refractory electrical storm due to ventricular arrhythmia (VA); however, the effects and long-term outcomes have not been well studied.\u0000\u0000\u0000METHODS\u0000This study included 30 consecutive patients who had drug-refractory electrical storm and underwent percutaneous SGB between October 1, 2013, and March 31, 2018. Bupivacaine, alone or combined with lidocaine, was injected into the neck with good local anesthetic spread in the vicinity of the left stellate ganglion (n=15) or both stellate ganglia (n=15). Data were collected for patient clinical characteristics, immediate and long-term outcomes, and procedure-related complications.\u0000\u0000\u0000RESULTS\u0000Clinical characteristics included age, 58±14 years; men, 73.3%; and left ventricular ejection fraction, 34±16%. At 24 hours, 60% of patients were free of VA. Patients whose VA was controlled had a lower hospital mortality rate than patients whose VA continued (5.6% versus 50.0%; P=0.009). Implantable cardioverter-defibrillator interrogation showed a significant 92% reduction in VA episodes from 26±41 to 2±4 in the 72 hours after SGB (P<0.001). Patients who died during the same hospitalization (n=7) were more likely to have ischemic cardiomyopathy (100% versus 43.5%; P=0.03) and recurrent VA within 24 hours (85.7% versus 26.1%; P=0.009). There were no procedure-related major complications.\u0000\u0000\u0000CONCLUSIONS\u0000SGB effectively attenuated electrical storm in more than half of patients without procedure-related complications. Percutaneous SGB may be considered for stabilizing ventricular rhythm in patients for whom other therapies have failed.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84682608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Prior Sternotomy on Outcomes in Transvenous Lead Extraction.","authors":"D. Tsang, Adryan A Perez, T. Boyle, R. Carrillo","doi":"10.1161/CIRCEP.119.007278","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.007278","url":null,"abstract":"BACKGROUND\u0000A history of open-heart surgery has been a heavily debated topic in transvenous lead extraction. This study evaluates the impact of prior sternotomy on transvenous lead extraction outcomes.\u0000\u0000\u0000METHODS\u0000Data for all patients undergoing transvenous lead extraction at a tertiary referral center were prospectively gathered from 2004 to 2017. Relevant clinical information was compared between patients with a history of sternotomy before transvenous lead extraction and those without. After considering baseline differences, multivariate regression, and propensity-matched analysis were performed. Outcome variables included major and minor complication rates, clinical success, and in-hospital mortality as defined by the 2017 Heart Rhythm Society consensus statement.\u0000\u0000\u0000RESULTS\u0000Of 1480 patients in the study period, 455 had a prior sternotomy. When compared with patients with no prior sternotomy, those with prior sternotomy were more likely to be older, male, and present with more comorbidities and leads targeted for extraction. No statistical differences were identified in major and minor complication rates (P=0.75, P=0.41), clinical success rate (P=0.26), and in-hospital mortality (P=0.08). In patients with prior sternotomy, there were no instances of pericardial effusion after extraction. Prior sternotomy was not an independent predictor of clinical or procedural outcomes. No associations were elucidated after propensity-matched analysis.\u0000\u0000\u0000CONCLUSIONS\u0000In a large, single-center series, no differences in clinical or procedural outcomes were elucidated between patients with a history of sternotomy and those without. Patients with sternotomies before lead extraction who experienced vascular or cardiac perforations clinically presented with hemothoraces rather than pericardial effusions.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80623046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stellate Block in Refractory Ventricular Tachycardia: The Calm After the Storm.","authors":"B. Narasimhan, H. Tandri","doi":"10.1161/CIRCEP.119.007707","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.007707","url":null,"abstract":"The increasing use of implantable defibrillators for sudden death prevention and the recent advances in heart failure therapies have significantly altered the natural history of heart disease. An unfortunate consequence of this is the increasing incidence of refractory tachyarrhythmias. The most serious of ventricular arrhythmias (VA) is the electrical storm, defined as ≥3 episodes of sustained ventricular tachyarrhythmia over a 24-hour period.1 The annual incidence varies from 2% to 10% and is associated with a 2to 8-fold increase in mortality. This is most likely a testament to the severely compromised underlying myocardial substrate than to the electrical storm itself. It is well established that the sympathetic nervous system plays an integral role in initiating and driving electrical storm.2 Pharmacological approaches to sympathetic blockade using β-blockers though effective have several shortcomings. The sympathetic nervous system involves multiple nonadrenergic pathways and neuromodulators which are unaffected by these medications. Additionally, the β2 receptor which is untouched by the conventionally cardio-selective β-blockers appears to play an integral proarrhythmic role as well. These shortcomings are overcome by surgical approaches where the cardiac sympathetic supply in its entirety is decentralized. The earliest attempt at surgical sympathectomy was over a century ago when Jonnesco3 performed a left cardiac sympathetic denervation in a successful attempt to relieve refractory angina in syphilitic aortitis.2 Since that time the field has burgeoned with a number of interventions targeting multiple sites along the sympathetic chain. These range from thoracic epidural/general anesthesia, stellate ganglion blockade, renal artery denervation to surgical stellate ganglion resection. Cardiac sympathetic denervation is undeniably beneficial in certain conditions—however, consensus about where it fits into regular practice remains to be established. Percutaneous stellate ganglion blockade (PC-SGB) is currently the least invasive method available, and its role in management of electrical storm is comprehensively explored in this issue of Heart Rhythm by Tian et al.4 In the largest prospective study of PC-SGB to date, 30 patients presenting with drug-refractory electric storm between 2013 and 2018 were included (58±14 years, 73.3% males, mean left ventricular election fraction, 34±15). Ultrasound guidance was used in the majority of patients with half the study population undergoing a left-sided stellate block, with bilateral blockade in the remainder. An incremental approach was used with an initial left-sided SGB, and progression to bilateral block if recurrence of arrhythmia was noted within 10 minutes. Rise in ipsilateral arm temperature was used as a surrogate for efficacy of block, though the authors themselves indicate that the temperatures were inadequately measured. EDITORIAL","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73611970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inflammasome Formation in Granulomas in Cardiac Sarcoidosis.","authors":"J. Kron, A. Mauro, A. Bonaventura, S. Toldo, Fadi N. Salloum, K. Ellenbogen, A. Abbate","doi":"10.1161/CIRCEP.119.007582","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.007582","url":null,"abstract":"September 2019 1 Cardiac sarcoidosis (CS) can occur in ≤25% of patients with sarcoidosis in other organ systems leading to life-threatening ventricular arrhythmias, heart block, heart failure, and death. An essential part of the innate immune system, the inflammasome is a macromolecular structure in the cell that responds to a danger signal by releasing IL (interleukin)-1β and amplifying the inflammatory response.1 IL-1β is indeed the prototypical proinflammatory cytokine processed within the inflammasome.1 A role for IL-1β in the pathogenesis of sarcoidosis has been proposed. IL-1β participates in the pathogenesis of granuloma formation in the mouse.2 The ratio of IL-1 receptor antagonist/IL-1β was a marker in predicting the persistence of pulmonary granulomatous lesions in patients.3 Importantly, the main mechanism of action of IL-1β is to activate the nuclear transcription factor NF-kB (nuclear factor-kappa B), also a target of glucocorticoids. We hypothesized that CS would lead to the formation of the inflammasome. We studied cardiac pathology specimens from 3 patients with a diagnosis of CS based on Heart Rhythm Society 2014 Consensus Statement Criteria4 obtained from the left ventricle during total artificial heart implantation in 1 patient and left ventricular assist device implantation and subsequent orthotopic heart transplant in 2 patients. The regions of the heart to be sampled were chosen based on abnormalities upon macroscopic inspection. The study was approved by the Institutional Review Board of the Virginia Commonwealth University, Richmond, VA. Patient No. 1 is a 59-year-old man with pulmonary sarcoidosis who presented with complete heart block, ventricular tachycardia, and left ventricular systolic dysfunction. The patient was treated with prednisone, mycophenolate mofetil, and hydroxychloroquine. Cardiac 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) 1 month before total artificial heart showed severe-intensity FDG uptake in the apical septum and inferior walls (Figure [A and B]). Because of progressive heart failure symptoms, he underwent total artificial heart followed 7 months later by orthotopic heart transplant. Patient No. 2 is a 60-year-old woman with biopsy-proven pulmonary sarcoidosis who presented with complete atrioventricular block and left ventricular systolic dysfunction. FDG-PET performed 2 months before left ventricular assist device showed moderate-intensity diffuse FDG uptake extending into the left ventricular apex (Figure [E and F]). She then underwent Heartmate II implantation followed 3 months later by orthotopic heart transplant. Patient No. 3 is a 64-year-old male with sinus node dysfunction and nonischemic cardiomyopathy. Cardiac PET showed FDG uptake concerning for CS and hilar and mediastinal lymphadenopathy. Carinal lymph node biopsy showed noncaseating granulomas. He was treated with prednisone and methotrexate. FDG-PET performed showed mild-intensity patchy hypermetabolic activity ","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83548750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Nonequilibrium Reactivation of Na\u0000 +\u0000 Current Drives Early Afterdepolarizations in Mouse Ventricle","authors":"","doi":"10.1161/hae.0000000000000043","DOIUrl":"https://doi.org/10.1161/hae.0000000000000043","url":null,"abstract":"","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74580820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variable Presentations and Ablation Sites for Manifest Nodoventricular/Nodofascicular Fibers.","authors":"B. Nazer, Tomos E. Walters, Thomas A. Dewland, Aditi Naniwadekar, J. Koruth, Mohammed Najeeb Osman, A. Intini, Minglong Chen, Jürgen Biermann, J. Steinfurt, J. Kalman, R. Tanel, Byron K. Lee, N. Badhwar, E. Gerstenfeld, M. Scheinman","doi":"10.1161/CIRCEP.119.007337","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.007337","url":null,"abstract":"BACKGROUND\u0000Nodofascicular and nodoventricular (NFV) accessory pathways connect the atrioventricular node and the Purkinje system or ventricular myocardium, respectively. Concealed NFV pathways participate as the retrograde limb of supraventricular tachycardia (SVT). Manifest NFV pathways can comprise the anterograde limb of wide-complex SVT but are quite rare. The purpose of this report is to highlight the electrophysiological properties and sites of ablation for manifest NFV pathways.\u0000\u0000\u0000METHODS\u0000Eight patients underwent electrophysiology studies for wide-complex tachycardia (3), for narrow-complex tachycardia (1), and preexcitation (4).\u0000\u0000\u0000RESULTS\u0000NFV was an integral part of the SVT circuit in 3 patients. Cases 1 to 2 were wide-complex tachycardia because of manifest NFV SVT. Case 3 was a bidirectional NFV that conducted retrograde during concealed NFV SVT and anterograde causing preexcitation during atrial pacing. NFV was a bystander during atrioventricular node re-entrant tachycardia, atrial fibrillation, atrial flutter, and orthodromic atrioventricular re-entrant tachycardia in 4 cases and caused only preexcitation in 1. Successful NFV ablation was achieved empirically in the slow pathway region in 1 case. In 5 cases, the ventricular insertion was mapped to the slow pathway region (2 cases) or septal right ventricle (3 cases). The NFV was not mapped in cases 5 and 7 because of its bystander role. QRS morphology of preexcitation predicted the right ventricle insertion sites in 4 of the 5 cases in which it was mapped. During follow-up, 1 patient noted recurrent palpitations but no documented SVT.\u0000\u0000\u0000CONCLUSIONS\u0000Manifest NFV may be critical for wide-complex tachycardia/manifest NFV SVT, act as the retrograde limb for narrow-complex tachycardia/concealed NFV SVT, or cause bystander preexcitation. Ablation should initially target the slow pathway region, with mapping of the right ventricle insertion site if slow pathway ablation is not successful. The QRS morphology of maximal preexcitation may be helpful in predicting successful right ventricle ablation site.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75576851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Grid Mapping Catheter for Ventricular Tachycardia Ablation.","authors":"K. Okubo, A. Frontera, C. Bisceglia, G. Paglino, A. Radinovic, L. Foppoli, F. Calore, P. Della Bella","doi":"10.1161/CIRCEP.119.007500","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.007500","url":null,"abstract":"BACKGROUND\u0000A new grid mapping catheter (GMC)-allowing for bipolar recordings of the electrograms in each orthogonal direction-became available. The aim of the current study is to evaluate the utility of the GMC in creating substrate and ventricular tachycardia (VT) activation maps during VT ablation procedures.\u0000\u0000\u0000METHODS\u0000From December 2017 to July 2018, 41 consecutive patients undergoing a VT ablation procedure using a GMC were studied. During the substrate mapping, 3 different maps were created using the 3 GMC bipolar configurations (along the spline, across the spline, HD wave solution); the low voltage area and late potential areas were compared. In case of inducible VTs, the GMC was used to create the VT activation maps focusing on the diastolic interval. The relation between diastolic activities during VT and substrate abnormality during sinus rhythm was also investigated.\u0000\u0000\u0000RESULTS\u0000The median low-voltage area drawn by the HD wave configuration was 28.9 cm2, 13% and 15% smaller than the low-voltage areas identified by the along and across configuration, respectively (33.1 and 33.9 cm2; P<0.0001). The late potential areas obtained with the 3 GMC configuration did not differ (P>0.05). VT activation mappings using the GMC were performed in 40 VTs, visualizing the full diastolic pathway in 22 (55%) of them. While the latest late potential areas were included in VT diastolic pathway in 17 VTs, the other 6 VTs showed mismatching of them. Identifying the full diastolic pathway led to a higher ongoing VT termination rate during the ablation than in case of partial recordings (88% versus 45%; P=0.03); furthermore, in the former situation, the noninducibility of the targeted VTs was achieved in all cases.\u0000\u0000\u0000CONCLUSIONS\u0000The GMC is a useful tool for performing substrate and VT activation mappings during the VT ablation procedure, precisely identifying the low-voltage areas and quickly visualizing the diastolic pathways.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75285504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Natural History of Left Bundle Branch Block Induced Cardiomyopathy.","authors":"W. Barake, Chance M. Witt, Vaibhav R. Vaidya, Y. Cha","doi":"10.1161/CIRCEP.119.007393","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.007393","url":null,"abstract":"September 2019 1 Left bundle branch block (LBBB) is associated with left ventricular dysfunction, heart failure, and increased mortality in patients with/without cardiac diseases.1–3 In our previous study of 1436 patients with mild to moderately reduced left ventricular ejection fraction (LVEF) and LBBB, the clinical outcomes were significantly worse than those of patients without conduction disease.3 Current data on incidence of LBBB-induced cardiomyopathy remain sparse. We further studied adult patients with LBBB and baseline normal LVEF of >50% from 1994 to 2014. Institutional Review Board approval was obtained for this study. Informed consents were waived given the retrospective aspect of the study and the minimal risks involved. Categorical variables were compared with the χ2 test and continuous variables with the ANOVA test. All statistical analysis was performed using JMP software (SAS Institute, Cary, NC). Only 549 patients who had baseline and follow-up echocardiograms were included out of a total 2235 patient with LBBB and baseline LVEF >50%. Patients who had a significant drop in LVEF (>10%) to less than 50% were reviewed to determine the cause of cardiomyopathy. The study cohort consisted of 549 patients (age 66.7±11.0 years; 55% females) with a LBBB, normal LVEF (>50%) at baseline, and a follow-up echocardiogram. Of these, 134 (24.4%) had a significant drop in LVEF. The baseline characteristics were comparable between patients with and without drop in the LVEF except for sex and hyperlipidemia (Table). Patients who had a drop in LVEF were more likely to be males (P=0.02) and more likely to be hyperlipidemic (P=0.04). The majority of patients who developed LV dysfunction had clearly identifiable causes of worsening LVEF (Figure). It is important to note that patients with other potential causes of cardiomyopathy may, in fact, have developed LV dysfunction due the LBBB. Nevertheless, to limit potential confounders, we did not consider the LBBB as the cause unless there were no other causes. Ischemic heart disease was the most common condition associated with LVEF drop (10%). The cause of cardiomyopathy in the remaining 29 patients (5.3%) was potentially related to the LBBB itself. All patients with suspected LBBB-induced cardiomyopathy had been evaluated with advanced imaging (cardiac MRI and cardiac positron emission tomography /computed tomography) to rule out other etiologies. Patients with possible LBBB-induced cardiomyopathy were more likely to be younger (average of 59.8 versus 66.6 years, P=0.02). Mean baseline LVEF was 56% and dropped to a low EF of 31% at an average of 4.6 years. Of this group, 83% developed new onset of heart failure; 30% died at an average of 7.2 years from the drop in EF. The EF was ≤35% in 24 (83%) patients, with cardiac resynchronization therapy instituted in only 7 (24%). In these patients, there was a significantly greater improvement in EF in those receiving cardiac resynchronization therapy compared w","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87967508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age and Sex Estimation Using Artificial Intelligence From Standard 12-Lead ECGs","authors":"Z. Attia, P. Friedman, P. Noseworthy, F. Lopez‐Jimenez, Dorothy J. Ladewig, Gaurav Satam, P. Pellikka, T. Munger, S. Asirvatham, C. Scott, R. Carter, S. Kapa","doi":"10.1161/CIRCEP.119.007284","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.007284","url":null,"abstract":"Supplemental Digital Content is available in the text.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"430 1","pages":"e007284 - e007284"},"PeriodicalIF":0.0,"publicationDate":"2019-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76639118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}