Indian Pacing and Electrophysiology Journal最新文献

{"title":"Multi-catheter cryotherapy for the treatment of resistant accessory pathways","authors":"Lisa WM. Leung,&nbsp;Banu Evranos,&nbsp;Hanney Gonna,&nbsp;Idris Harding,&nbsp;Giulia Domenichini,&nbsp;Mark M. Gallagher","doi":"10.1016/j.ipej.2023.11.002","DOIUrl":"10.1016/j.ipej.2023.11.002","url":null,"abstract":"<div><h3>Objective</h3><p>To investigate the utility of simultaneous multi-catheter cryotherapy for the treatment of APs that were previously resistant to standard radiofrequency (RF) catheter ablation.</p></div><div><h3>Background</h3><p>Catheter ablation is established in the treatment of accessory pathways (AP), with high rates of permanent procedural success with a single attempt. However, there are still instances of acute procedural failure and AP recurrences with standard RF and cryotherapy methods.</p></div><div><h3>Methods</h3><p>Seven consecutive cases of pre-excitation syndromes with prior failed RF catheter ablation had the novel treatment. Cryotherapy was delivered using two 8 mm tip focal cryoablation catheters (Freezor® Max, Medtronic, Minneapolis, Minnesota, USA).</p></div><div><h3>Results</h3><p>Accessory pathway localisation was septal in 5 cases, left posterolateral in 1, right lateral in 1. In all cases, ablation of the AP was acutely successful with no procedural complications. Median procedure and fluoroscopy durations were 199 and 35 min, sequentially. Median Procedure duration fell significantly in the second half of series (174 min) compared to the first half (233 min, P = 0.05). One patient had evidence of a recurring AP conduction with pre-excitation at 5-week follow up. After a median follow up of 66.8+-6.5 months, 6 out of 7 patients remained asymptomatic and free of pre-excitation.</p></div><div><h3>Conclusion</h3><p>Simultaneous multi-catheter cryotherapy is feasible, safe and can provide definitive cure of accessory pathways that were previously resistant to standard radiofrequency ablation. Further study is required in the assessment of this novel form of advanced cryotherapy to treat complex and resistant arrhythmias.</p></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"24 1","pages":"Pages 1-5"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0972629223001079/pdfft?md5=f2ea89d9561932f7e9026fe2eae26081&pid=1-s2.0-S0972629223001079-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136399582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An unusual case of duplicated left brachiocephalic vein with right sided aortic arch and aberrant origin of LSCA in a patient undergoing implantable cardioverter defibrillator (ICD) implantation","authors":"Kshitij Prasad ,&nbsp;Satyavir Yadav ,&nbsp;Niraj Nirmal Pandey ,&nbsp;Neeraj Kumar","doi":"10.1016/j.ipej.2023.12.003","DOIUrl":"10.1016/j.ipej.2023.12.003","url":null,"abstract":"<div><h3>Background</h3><p>Anomalous left brachiocephalic vein (ALBCV) is a rare venous anomaly. Double Left brachiocephalic vein is the rarest type of ALBCV anomaly.</p></div><div><h3>Case report</h3><p>Here we report a case of gentleman with post myocardial infarction ventricular tachycardia who underwent ICD implantation, where we could not place the lead initially through left side. CT angiography revealed presence of a duplicated circumaortic left BCV. It's cranial limb coursing normally anterior to arch and compressed at its confluence with RBCV and the caudal limb with a subaortic course draining into the RSVC. We report this first case of double LBCV along with right sided aortic arch and aberrant origin of LSCA arising from Kommerel's diverticulum.</p></div><div><h3>Conclusion</h3><p>This case highlights that interventional cardiologists should be aware of these venous anomalies for proper planning and implantation of CIED successfully via transvenous approach.</p></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"24 1","pages":"Pages 49-52"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0972629223001298/pdfft?md5=c7c3a3540c6348ff0e7632aa18909e7a&pid=1-s2.0-S0972629223001298-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138804961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prenatal diagnosis of fetal bradyarrhythmia and postnatal outcome","authors":"Keerthana Kothandaraman,&nbsp;Ponmozhi Ganesan,&nbsp;Vikram Nadig NS,&nbsp;K. Manikandan","doi":"10.1016/j.ipej.2023.10.003","DOIUrl":"10.1016/j.ipej.2023.10.003","url":null,"abstract":"<div><h3>Introduction</h3><p>Prenatal diagnosis of Fetal bradyarrhythmia leads to parental and care provider anxiety as data on outcome is scarce. We aimed to correlate the prenatal presentation of fetal bradyarrhythmia with postnatal outcome.</p></div><div><h3>Methods</h3><p>Retrospective analysis of case records from 2017 to 2021. All fetuses with sustained bradyarrhythmia beyond 11 weeks were included in the study.</p></div><div><h3>Results</h3><p>Twenty fetuses were identified: mean gestational age at diagnosis was 23 weeks 2 days. The type of bradyarrhythmia was as follows: Complete atrioventricular block 10 (50 %), Sinus Bradycardia 7 (35 %), second degree atrioventricular block 2 (10 %), and Unclassified 1 (5 %). In 10 fetuses, cardiac and extracardiac anatomy were normal; 8 fetuses (40 %) had cardiac anomalies,1 fetus had intraventricular hemorrhage and 1 had nuchal cystic hygroma. Among the fetuses with associated anomalies, there were 5 terminations of pregnancy (TOP), 1 intrauterine fetal demise (IUD), 3 neonatal demise (NND) and 1 livebirth. Among fetuses with normal anatomy, there were 2 TOP and 8 livebirths; five of the 10 mothers (50 %) tested positive for Anti Ro/La antibodies. All the 6 liveborn fetuses with complete atrioventricular block are on conservative management: 2 on metaproterenol and 4 on clinical follow up. Nine out of the 10 cases that had a postnatal paediatric cardiology assessment had a correct prenatal diagnosis.</p></div><div><h3>Conclusion</h3><p>Correct prenatal identification of fetal bradyarrhythmia is feasible in about 90 % of cases. The risk of postnatal pacemaker requirement appears to be low irrespective of maternal Anti Ro/La status.</p></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"24 1","pages":"Pages 20-24"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0972629223001031/pdfft?md5=4028fa727aca2c13e0ce34d8b1f2a703&pid=1-s2.0-S0972629223001031-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41214854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diastolic mitral regurgitation after dual chamber pacemaker","authors":"Harshal Pamecha,&nbsp;Sridevi Chennapragada ,&nbsp;David Sampath Kumar Gollapally,&nbsp;Calambur Narasimhan","doi":"10.1016/j.ipej.2023.12.005","DOIUrl":"10.1016/j.ipej.2023.12.005","url":null,"abstract":"<div><p>First-degree Atrioventricular (AV) block can lead to symptoms of heart failure, due to AV dyssynchrony. We report a case of 40-year-old male with symptomatic 2:1 AV block with intermittent first-degree AV block who was implanted with dual chamber pacemaker with conduction system pacing (CSP). With conventional programming of managed ventricular pacing (MVP) and long AV delays, patient developed dyspnea due to diastolic mitral regurgitation because of AV dyssynchrony. Hence, AV delay optimization was done, and the patient became asymptomatic with atrial sensing and 100 % ventricular pacing. This report emphasizes the importance of AV delay optimization in CSP for symptomatic benefit.</p></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"24 1","pages":"Pages 53-56"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0972629223001316/pdfft?md5=8b58f8918fc75ca3cda41b3ab4e72868&pid=1-s2.0-S0972629223001316-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139106765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiofrequency catheter ablation of ventricular arrhythmias in patients with hypertrophic cardiomyopathy","authors":"Muthiah Subramanian,&nbsp;Daljeet Kaur Saggu,&nbsp;Auras R. Atreya,&nbsp;Vijay Shekar,&nbsp;Sachin D. Yalagudri,&nbsp;C. Narasimhan","doi":"10.1016/j.ipej.2023.11.006","DOIUrl":"10.1016/j.ipej.2023.11.006","url":null,"abstract":"<div><h3>Background</h3><p>Compared to other non-ischemic substrates, there is limited data on the role and outcome of catheter ablation in HCM. The objective of this study is to assess the safety and efficacy of catheter ablation for the treatment of VT in patients with HCM.</p></div><div><h3>Methods</h3><p>Fourteen patients with HCM and drug refractory VT who underwent catheter ablation at a single center were included in this study. The data was evaluated retrospectively. Acute success, procedure-related complications, and long-term outcomes were documented during follow up.</p></div><div><h3>Results</h3><p>Among the 14 patients (mean age 48.2 ± 8.2 years, 85.7% males, mean LVEF 42.6 ± 6.5%), 4 had an apical aneurysm. Eleven patients had evidence of scar-related VT and three patients had a bundle-branch re-entry VT. The most common sites for scar-related VT were the border-zones of the apical aneurysms, basal septum, and LV lateral wall. Patient either underwent an endocardial ablation or a combined endocardial and epicardial ablation. Acute success was achieved in all patients. In 6 patients VT was terminated during ablation. In two patients, non-clinical VTs were inducible at the end of the procedure. No major or minor complications were observed during and after the procedure in all patients. During long-term follow up, elimination of VTs reached 78%.</p></div><div><h3>Conclusion</h3><p>Catheter ablation of VT in patients with HCM is safe and successful in eliminating VT. Combining endocardial and epicardial ablation techniques can potentially lead to better outcomes in these patients. Bundle branch re-entry should be considered as a potential mechanism of VT in patients with HCM.</p></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"24 1","pages":"Pages 9-13"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0972629223001262/pdfft?md5=52df18e92d33167528fc0cfcefdbf8f2&pid=1-s2.0-S0972629223001262-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138471034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improved left atrial catheterization efficiency and consistency using a novel steerable transseptal puncture sheath","authors":"Kimberly Berggren ,&nbsp;Travis Lampert ,&nbsp;Ajit H. Janardhan","doi":"10.1016/j.ipej.2023.10.001","DOIUrl":"10.1016/j.ipej.2023.10.001","url":null,"abstract":"<div><h3>Background</h3><p>While steerable sheaths are widely used to improve catheter stability and contact force during radiofrequency (RF) catheter ablation in patients with atrial fibrillation (AF), steerable sheaths are less commonly used during transseptal puncture. This study evaluated whether left atrial catheterization efficiency can be improved using the VersaCross combined steerable sheath and transseptal system compared to previous standard workflow.</p></div><div><h3>Methods</h3><p>This study retrospectively analyzed AF ablation performed using the VersaCross Workflow consisting of VersaCross steerable sheath and RF wire for transseptal puncture and catheter ablation (VCW) to the standard workflow using a fixed curve sheath with RF needle followed by exchange for an Agilis steerable sheath for catheter ablation (STW).</p></div><div><h3>Results</h3><p>Thirty patients underwent RF ablation for paroxysmal or persistent AF, 15 using the VCW and 15 using the STW. Transseptal puncture time was 10.8 mins faster with the VCW compared to the standard workflow (20.9 ± 5.9 min vs. 31.7 ± 15.1 min; p = 0.024). Time to left atrial catheterization was 40% faster with the VCW compared to the STW (21.3 ± 5.8 min vs. 35.2 ± 14.4 min; p = 0.003). Overall procedure time was 14.2 min faster in the VCW compared to the STW (86.3 ± 16.1 min vs. 100.5 ± 19.3 min; p = 0.044).</p></div><div><h3>Conclusions</h3><p>Use of the VersaCross steerable system significantly reduced time to transseptal puncture, time to left atrial catheterization, and overall RF ablation time.</p></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"24 1","pages":"Pages 35-39"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0972629223001018/pdfft?md5=22a094ca08620dc03ad554d277054586&pid=1-s2.0-S0972629223001018-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41151936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Absent ventriculo-atrial conduction during right ventricular apical pacing but nodal response during para-Hisian pacing – What is the mechanism?","authors":"Debabrata Bera ,&nbsp;Sanjeev S. Mukherjee ,&nbsp;Ashesh Halder ,&nbsp;Saroj Kumar Choudhury","doi":"10.1016/j.ipej.2023.12.002","DOIUrl":"10.1016/j.ipej.2023.12.002","url":null,"abstract":"<div><p>A 13-year-old-girl presented with one episode of pre-syncope while standing in a train. Her ECG was suggestive of preexcitation. Echocardiography revealed structurally normal heart without any ventricular hypertrophy. During electrophysiology study, her ventriculo-atrial (VA) conduction was absent even on isoprenaline. However, a para-Hisian pacing maneuver (PHP) revealed consistent VA conduction with a nodal response. This finding indicated that the VA dissociation at baseline was at infra-Hisian (VH) level and conduction at HA level was intact. In addition, this finding is coherent with a speculation of a fasciculo-ventricular pathway (FVP) resulting in such an ECG pattern in her. Pacing from various atrial sites (right atrium, coronary sinus) exhibited nearly fixed preexcitation and short non-varying HV interval confirmatory of FVP. Testing for a PRKAG mutation was advised for her.</p></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"24 1","pages":"Pages 45-48"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0972629223001286/pdfft?md5=ce21576dd153c2cb8e3fa6888365be11&pid=1-s2.0-S0972629223001286-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138831978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence, clinical characteristics, electrophysiological characteristics and outcomes of patients with baseline PR prolongation undergoing radiofrequency ablation for Atrioventricular nodal reentrant tachycardia","authors":"Sameer Rane ,&nbsp;Shomu Bohora ,&nbsp;Debashish Acharya ,&nbsp;Rujuta Parikh ,&nbsp;Raghav Bansal","doi":"10.1016/j.ipej.2023.11.005","DOIUrl":"10.1016/j.ipej.2023.11.005","url":null,"abstract":"<div><h3>Aims and objectives</h3><p>Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common supraventricular tachycardia (SVT). Prolonged PR interval(&gt;200 ms) on baseline electrocardiogram (ECG) is uncommon in such patients. The aim of the current study was to evaluate the incidence, clinical, electrophysiological characteristics, and outcomes of patients with baseline prolongation of PR interval undergoing radio-frequency ablation (RFA) for AVNRT.</p></div><div><h3>Methods</h3><p>Over 10 years, out of the total number of 1435 patients with diagnosed AVNRT, 16 patients had prolonged PR intervals at baseline. All underwent elective RFA. A retrospective analysis of clinical, and electrophysiological characteristics and outcomes was done. The PR interval and atria-ventricular block cycle length values were compared with those patients with a normal interval at baseline and had undergone a successful slow pathway modification for AVNRT.</p></div><div><h3>Results</h3><p>Out of 1435 patients with AVNRT, 16 (0.9 %) patients had baseline PR prolongation on ECG. The mean(+SD) age of the study population was 62.9 + 15.9 years. 10 (62.5 %) were males. The average PR interval was 264.2 + 24.1 ms. Slow fast AVNRT was seen in all. The anatomical site of success for ablation was the lower part of Koch's triangle in all patients. During ablation, a good sustained junctional rhythm was noted in all, with no AV (Atrioventricular) block or PR prolongation noted during ablation in any of the patients. PR interval decreased by more than 20 ms in 10 (62.5 %) patients. AVBCL (AV node block cycle length) increased on an average of 58.7 ms post-ablation. Only one patient developed AV block on follow-up.</p></div><div><h3>Conclusion</h3><p>A prolonged PR interval on baseline ECG is uncommon in patients with AVNRT. In these patients, slow pathway modification can be done safely and effectively. AVBCL (AV node block cycle length) increases immediately post-ablation. The risk of AV block though low persists on follow-up.</p></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"24 1","pages":"Pages 16-19"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0972629223001250/pdfft?md5=fdcb7416559d3f883f3b8720a28d7573&pid=1-s2.0-S0972629223001250-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139020263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The interventricular conduction delays guide best cardiac resynchronization therapy: A tailored-patient approach to perform a CRT through Conduction System Pacing","authors":"Amato Santoro ,&nbsp;Maria Barilli ,&nbsp;Carmine Marallo ,&nbsp;Claudia Baiocchi","doi":"10.1016/j.ipej.2023.11.004","DOIUrl":"10.1016/j.ipej.2023.11.004","url":null,"abstract":"<div><p>Evaluation of conduction intervals to predict success of resynchronization in biventricular pacing(BiVP) or Conduction System Pacing(CSP) is not spread in clinical practice. A right ventricle-to-left ventricle intrinsic conduction interval (RVs–LVs) &gt; 70 ms or prolonged RVpaced – LVs(RVp-LVs)interval can predict Cardiac Resynchronization Therapy (CRT)response.This paper describes a case of cardiac resynchronization guided by spontaneous and paced interventricular conduction delays (IVCD) obtained in BiVP that led to changing intraoperative approach. A strategy for cardiac resynchronization based on the CSP/BiVP approach according to the IVCD could represent a viable and reliable solution to obtain a narrow paced QRS and to improve the CRT response.</p></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"24 1","pages":"Pages 42-44"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0972629223001249/pdfft?md5=0c0de0431bde4d7f8508aec3b32f0438&pid=1-s2.0-S0972629223001249-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138048052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thanks to Reviewers","authors":"","doi":"10.1016/S0972-6292(24)00022-6","DOIUrl":"https://doi.org/10.1016/S0972-6292(24)00022-6","url":null,"abstract":"","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"24 1","pages":"Page I"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140000270","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}