Pace-Pacing and Clinical Electrophysiology最新文献

{"title":"Low Voltage Area Modification in Older Patients With Atrial Fibrillation.","authors":"Ning Chen, Zhou Xu, Hongwu Chen, Gang Yang, Lei Wang, Youmei Shen, Nan Wu, Sion Ju, Weizhu Ju, Mingfang Li, Kai Gu, Hailei Liu, Minglong Chen","doi":"10.1111/pace.15203","DOIUrl":"https://doi.org/10.1111/pace.15203","url":null,"abstract":"<p><strong>Background: </strong>Age has been found as an important factor affecting the low voltage area (LVA) in patients with atrial fibrillation (AF). This study aims to investigate the potential benefit of LVA modification in older AF patients.</p><p><strong>Methods: </strong>This study constitutes a sub-analysis of the STABLE-SR-II and STABLE-SR-III trials, wherein patients with persistent AF (PeAF) or paroxysmal AF (PAF) were randomized to undergo either circumferential pulmonary vein isolation (CPVI) alone or additional LVA modification. Patients aged ≥65 years were analyzed. The primary outcome was freedom from atrial tachyarrhythmias (ATAs).</p><p><strong>Results: </strong>A total of 510 patients (mean age 70.2 ± 3.8 years, 264 male) were analyzed, comprising 96 PeAF and 414 PAF patients. Among patients without LVA, the risk of ATAs recurrence was similar between PeAF and PAF patients in the propensity score-matched model (adjusted HR, 1.49 [0.54-4.33]; p = 0.431). Both PeAF (adjusted HR, 0.35 [95% CI, 0.12-0.98]; p = 0.048) and PAF patients (adjusted HR, 0.41 [0.19-0.81]; p = 0.013) could benefit from additional LVA modification in the Cox proportional hazards model.</p><p><strong>Conclusions: </strong>In older patients with AF, the recurrence rate following CPVI alone is comparable between those with PAF and PeAF in the absence of LVA. However, the presence of LVA is associated with higher recurrence rates in both PAF and PeAF patients, while additional LVA modification effectively reduces recurrence irrespective of AF type.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stylet-Driven Lead Vs. Lumenless Lead for Left Bundle Branch Area Pacing: Systematic Literature Review and Meta-Analysis.","authors":"Ga-In Yu, Tae-Hoon Kim, Yun-Ho Cho, Jae-Seok Bae, Jong-Hwa Ahn, Jeong Yoon Jang, Choong Hwan Kwak","doi":"10.1111/pace.15209","DOIUrl":"https://doi.org/10.1111/pace.15209","url":null,"abstract":"<p><strong>Background: </strong>Left bundle branch area pacing (LBBAP) offers cardiac synchrony benefits over conventional ventricular pacing. Although many studies on LBBAP have used lumenless pacing leads (LLLs), stylet-driven pacing leads (SDLs) can also be used. In this study, we compared LLLs and SDLs for LBBAP through a systematic review and meta-analysis of the literature.</p><p><strong>Methods: </strong>The PubMed, Embase, and Cochrane Library databases were searched for full-text articles on LBBAP from their respective inception dates to April 9, 2024. The studies comparing LLLs and SDLs were extracted, and electrophysiological characteristics and procedural outcomes were analyzed. Of 2201 articles on LBBAP, 7 met the inclusion criteria of comparing LLLs and SDLs as implanted pacing leads.</p><p><strong>Results: </strong>The overall pooled analysis showed noninferiority in implant success rates for SDLs compared with LLLs for LBBAP (89% vs. 94%, odds ratio: 0.80, 95% confidence interval [CI]: 0.37-1.72, p = 0.566). The paced QRS duration of LBBAP using SDLs was not significantly different from that using LLLs (standardized mean difference: -0.19 ms, 95% CI: -0.50 to 0.12, p = 0.239). There were no differences in the stimulus to the left ventricular activation time and paced QRS duration between the two groups. Follow-up pacing parameters were stable in both groups.</p><p><strong>Conclusion: </strong>LBBAP using SDLs is noninferior to that using LLLs in terms of implantation success. There were no differences in procedural and electrophysiological characteristics between the two groups.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Texture Analysis of SPECT-MPI Provides Prognostic Value in Improving Cardiac Resynchronization Therapy Response.","authors":"Zhongwei Jiang, Ju Bu, Zhongqiang Zhao, Chunxiang Li, Dianfu Li, Qiushi Chen, Huiyuan Qin, Cheng Wang","doi":"10.1111/pace.15200","DOIUrl":"https://doi.org/10.1111/pace.15200","url":null,"abstract":"<p><strong>Background: </strong>Texture analysis (TA) is a powerful tool for extracting quantitative information, assessing myocardial heterogeneity, evaluating therapeutic efficacy, and predicting outcomes in heart disease. This study investigated whether TA based on gated single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI) can enhance the prediction of response to cardiac resynchronization therapy (CRT).</p><p><strong>Methods: </strong>A total of 165 patients who underwent gated SPECT MPI and received CRT were enrolled in the study. Quantitative analysis of SPECT imaging generated 1225 TA features. Phase analysis of resting gated short-axis SPECT myocardial perfusion images was utilized to assess left ventricular (LV) systolic and diastolic mechanical dyssynchrony (LVMD), including phase standard deviation (PSD), phase bandwidth (PBW), and entropy. Patients were categorized into CRT response and non-response groups based on a ≥5% improvement in LV ejection fraction (LVEF) measured by echocardiography at the 6-month follow-up. Variables with a p-value <0.05 in the univariate logistic regression analysis were incorporated into a backward stepwise multivariate logistic regression model for further analysis.</p><p><strong>Results: </strong>During follow-up, 60.0% (99 of 165 patients) demonstrated a response to CRT. Univariate logistic regression analysis revealed that CRT response was significantly associated with N-terminal pro-brain natriuretic peptide (NT-proBNP), non-sustained ventricular tachycardia (NS-VT), LV end-diastolic diameter (LVEDD), LV end-systolic diameter (LVESD), scar burden, systolic and diastolic PSD, PBW, entropy, and 51 TA parameters. In the backward stepwise multivariate regression analysis, inverse difference moment normalized (IDMN), NS-VT, NT-proBNP, diastolic PSD, and LVEDD emerged as independent predictors of CRT response.</p><p><strong>Conclusion: </strong>TA based on gated SPECT MPI provides independent prognostic predictor for CRT response in medically treated Heart failure patients.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional Substrate Mapping Using Atrial Decrement Evoked Potentials to Predict Critical Isthmus of Atrial Tachycardia.","authors":"Hikmet Yorgun, Cem Çöteli, Ahmet Haydar Keresteci, Mahmoud Obeidat, Kudret Aytemir","doi":"10.1111/pace.15205","DOIUrl":"https://doi.org/10.1111/pace.15205","url":null,"abstract":"<p><p>Recent reports highlighted the role of functional substrate mapping during sinus rhythm to predict the critical isthmus of left atrial tachycardias (AT). In this article, we reported a case of a 63-year-old female patient who was admitted with recurrent AT after pulmonary vein isolation. Although sinus rhythm revealed normal left atrium voltages, programmed stimulation with extrastimulus revealed decrement evoked potentials with prolongation in local electrograms on the anterior wall. Critical isthmus of AT was colocalized with deceleration zones during functional substrate mapping. Radiofrequency ablation successfully terminated AT.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastric Hypomotility After Pulmonary Vein Isolation With or Without Left Atrial Roof Ablation Using a Novel Cryoballoon.","authors":"Atsuhito Oda, Takatoshi Shigeta, Yuichiro Sagawa, Kazuya Murata, Hirofumi Arai, Yumi Yasui, Yuichi Fukami, Kaoru Okishige, Manabu Kurabayashi, Tetsuo Sasano, Yasuteru Yamauchi","doi":"10.1111/pace.15204","DOIUrl":"https://doi.org/10.1111/pace.15204","url":null,"abstract":"<p><strong>Background: </strong>The novel POLARx cryoballoon ablation (CBA) system offers enhanced cooling properties for the treatment of atrial fibrillation (AF); however, these capabilities may damage adjacent tissues. This study aimed to assess the prevalence and predictors of gastric hypomotility (GH) in patients undergoing pulmonary vein isolation (PVI) and left atrial (LA) roofline ablation using the POLARx.</p><p><strong>Methods: </strong>Patients who underwent CBA for PVI using the POLARx system were included in this study. Additional LA roofline ablation was performed in patients with non-paroxysmal AF and paroxysmal AF with LA enlargement. GH occurrence was assessed postoperatively by esophagogastroscopy, and the distance between the esophagus and surrounding tissues were measured.</p><p><strong>Results: </strong>Among the 61 patients who underwent PVI, 22 underwent additional LA roofline ablation. GH was confirmed in 12 patients (30.8%) who underwent PVI only and 12 patients (54.5%) who underwent additional LA roofline ablation. Symptomatic GH with acute gastric dilation occurred in three patients, all of whom had undergone roofline ablation. Multivariate analysis, a shorter distance between the esophagus and the midpoint of the vertebral body (odds ratio, 0.74; 95% confidence interval, 0.55-0.98; p = 0.04) was identified as the sole predictor of GH, with a cutoff of 20.0 mm (sensitivity, 80.0%; specificity, 81.8%).</p><p><strong>Conclusion: </strong>Adding LA roofline ablation to PVI using the POLARx may increase the risk of GH, particularly when the esophagus is in close proximity to the midpoint of the vertebral body.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Position-Dependent and Hidden Atrioventricular Dyssynchrony in Micra AV Leadless Pacemaker.","authors":"Yuta Sudo","doi":"10.1111/pace.15206","DOIUrl":"https://doi.org/10.1111/pace.15206","url":null,"abstract":"<p><p>Micra AV leadless pacemakers aim to maintain atrioventricular (AV) synchrony across various body positions. This report describes a case of position-dependent AV dyssynchrony in an 81-year-old man with nocturnal palpitations despite having normal routine evaluations. Rate histogram analysis revealed an unusual distribution pattern, and manual atrial mechanical (MAM) testing demonstrated an increased A3 signal amplitude in the left lateral position, which resulted in oversensing. Adjusting the A3 threshold and window end settings resolved the symptoms and normalized the rate histogram. This case highlights the importance of position-dependent signal variations and rate histogram analyses in patients with a Micra AV.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thoracoacromial Artery Injury Causing Pacemaker Pocket Pseudoaneurysm: A Case Report.","authors":"Di Ding, Xusen Sun, Wei Wang, Zheng Zhang","doi":"10.1111/pace.15198","DOIUrl":"https://doi.org/10.1111/pace.15198","url":null,"abstract":"<p><strong>Background: </strong>Pacemaker pocket pseudoaneurysm is a rare complications after pacemaker implantation and often do not respond to conservative treatments.</p><p><strong>Case presentation: </strong>We present a case of a 93-year-old man who developed pocket swelling and a significant hemoglobin decrease one week after pacemaker implantation. Conservative management, including compression and blood transfusion, proved ineffective. Angiography identified bleeding from the thoracoacromial artery, which was successfully addressed with coil embolization. The patient exhibited a favorable recovery during follow-up.</p><p><strong>Conclusion: </strong>Arterial injury should be considered in cases of persistent hematoma after pacemaker implantation. Early imaging and embolization are crucial for effective management.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paced QRS Duration and Morphology by Right Ventricular Inflow Tract Mid-Septal Lead Placement Using a 3D Stylet.","authors":"Tomomasa Takamiya, Akihiro Sato, Kensuke Fujiwara, Takashi Miyamoto, Makoto Mutoh, Shinsuke Miyazaki, Tetsuo Sasano","doi":"10.1111/pace.15201","DOIUrl":"https://doi.org/10.1111/pace.15201","url":null,"abstract":"<p><p>Paced QRS duration ≥150 ms is associated with pacing-induced cardiomyopathy (PICM). However, there is no established method for conventional stylet-driven pacing lead placement to achieve a narrow QRS duration. We placed a pacing lead on the right ventricular inflow tract (RVIT) mid-septum using a manually shaped three-dimensional (3D) stylet and three-directional fluoroscopic guidance in 9 consecutive patients with complete or advanced atrioventricular block and normal left ventricular systolic function. The median paced QRS duration was 140 (range, 122-153) ms, with a paced QRS duration <150 ms in 8 patients. The left superior axis and transitional zone of lead-V5 or lead-V6 were the most paced QRS morphologies. RVIT mid-septal lead placement using a 3D stylet with three-directional fluoroscopic guidance may reduce the incidence of PICM.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noninvasive Impedance Analysis During S-ICD Insertion Provides Justification for Defibrillation Based Testing Deferment.","authors":"Andreas G Kontopidis, Mark É Czeisler, David H Yoo, Olivia Whittaker, Daniel C Pipilas, Theofanie Mela","doi":"10.1111/pace.15199","DOIUrl":"https://doi.org/10.1111/pace.15199","url":null,"abstract":"<p><strong>Background: </strong>Following subcutaneous implantable cardioverter-defibrillator (S-ICD) insertion, induction of ventricular fibrillation (VF) and defibrillation threshold testing (DFT) is the standard of practice to assess system performance. In contrast, DFT testing is not routinely performed after transvenous ICD (T-ICD) insertion, supported by literature that emphasizes negative clinical repercussions and reliability of noninvasive predictors of successful defibrillation. There is a paucity of data for both the trajectory of noninvasive low voltage (LV) impedance measurements at S-ICD insertion through the time of potential DFT testing and for the proximity of LV impedance measurements and high voltage (HV) shock impedance from 65J DFT or 10J testing.</p><p><strong>Objective: </strong>We aim to characterize the trend in LV impedance from initial S-ICD connection (LV T0) to final intraprocedural impedance (LV T4) and to compare LV impedance with HV impedance.</p><p><strong>Methods: </strong>Data from patients who underwent S-ICD implantation between July 2022 and March 2024 were analyzed. LV impedance measurements were collected during implant and HV impedance measurements were collected if 65J DFT/10J testing was performed. Differences in mean impedances at each time point were evaluated using paired t-tests. For those who underwent 10J or 65J DFT testing, LV impedance was compared with HV impedance.</p><p><strong>Results: </strong>The primary analytic sample included 53 patients, with a mean age of 51 ± 15.7 years; 16 (30.2%) were female. LV impedance decreased by a mean of 14.5 ± 9.8 ohms (18.3%; p <0.001) from S-ICD connection (T0) to the final intraprocedural measurement, approximately 60 min postimplant (T4). Among 35 patients who underwent HV testing (65J DFT or 10J), LV impedance at T4 and HV impedance did not differ significantly (1.7 ± 6.3 ohms; p = 0.116).</p><p><strong>Conclusion: </strong>Our findings demonstrate a predictable reduction in LV impedance from S-ICD connection to subsequent intraprocedural measurements. We also found that LV impedance at LV T4, the final intraprocedural measurement, did not significantly differ from contemporaneous HV impedance. Together, these findings indicate that LV impedance at implant can be expected to decline, and that 60-min postimplant LV impedance may reliably approximate HV impedance. Evaluation of circumstances in which LV impedance could influence the decision to perform DFT testing is warranted.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indication of Implantable Cardioverter Defibrillators for Ventricular Arrhythmias in Coronary Spastic Angina.","authors":"Kenichi Tani, Mitsuru Takami, Kimitake Imamura, Hideya Suehiro, Atsusuke Yatomi, Hidehiro Iwai, Yusuke Nakanishi, Mitsuhiko Shoda, Atsushi Murakami, Shogo Yonehara, Hiroyuki Asada, Takahiro Kunigita, Mari Yamamoto, Tomofumi Doi, Ken-Ichi Hirata, Hiromasa Otake, Koji Fukuzawa","doi":"10.1111/pace.15194","DOIUrl":"https://doi.org/10.1111/pace.15194","url":null,"abstract":"<p><strong>Background: </strong>Coronary spastic angina (CSA) sometimes complicates ventricular arrhythmias (VAs) leading to sudden death. The appropriate secondary prevention strategy remains to be discussed. Recently, the relationship between J waves and VAs in CSA has been reported.</p><p><strong>Objectives: </strong>We aimed to investigate the incidence of VAs, J waves, the spatial relationship between J waves and culprit coronary spasm lesions, and VA recurrences in CSA.</p><p><strong>Methods: </strong>The patient characteristics, including the presence of J waves, were assessed in 130 CSA patients, and the spatial relationship between J waves and ischemic lesions was analyzed; a concordant pattern was defined when the localization of electrical and coronary blood supply abnormalities matched.</p><p><strong>Results: </strong>Thirty one patients (24%) had VAs (VA group) and 99 (76%) did not (non-VA group). More J waves were observed in the VA group than the non-VA group (19 of 31 patients [61%] vs. 16 of 99 patients [16%], p = 0.00003). A concordant pattern between the J waves and culprit coronary spasm lesions was significantly observed greater in the VA group than the non-VA group (14 of 19 patients [74%] vs. 5 of 16 patients [31%], p = 0.019). VAs reoccurred in 6 of 31 patients (19%) despite adequate medication during a mean of 4.6 years of follow-up and were not predictable.</p><p><strong>Conclusions: </strong>VAs occurred in one-quarter of the CSA patients and were closely related to J waves. The spatial concordance between coronary ischemia and electrical abnormalities might be a risk of a VA occurrence. VA recurrences are highly observed and unpredictable, justifying the indication of an implantable cardioverter defibrillator as secondary prevention.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}