Pace-Pacing and Clinical Electrophysiology最新文献

{"title":"Multistep Algorithm to Predict RVOT PVC Site of Origin for Successful Ablation Using Available Criteria: A Two-Center Cross-Validation Study.","authors":"Muhammad Rafdi Amadis, Li-Wei Lo, Simon Salim, Muhammad Yamin, Yenn-Jiang Lin, Shih-Lin Chang, Yu-Feng Hu, Fa-Po Chung, Rubiana Sukardi, Chin-Yu Lin, Ting-Yung Chang, Ling Kuo, Angga Pramudita, Chih-Min Liu, Shin-Huei Liu, Cheng-I Wu, Yu-Shan Huang, Dinh Son Ngoc Nguyen, Dat Cao Tran, Shih-Ann Chen","doi":"10.1111/pace.15118","DOIUrl":"https://doi.org/10.1111/pace.15118","url":null,"abstract":"<p><strong>Background: </strong>Predicting premature ventricular contraction (PVC) origin pre-ablation is a fundamental step, as right ventricular outflow tract (RVOT) PVC often leads to higher success rates.</p><p><strong>Objective: </strong>To compare nine published ECG criteria to differentiate between RVOT and non-RVOT origins of PVCs and develop a stepwise algorithm using those criteria to better determine PVC origin to predict ablation success.</p><p><strong>Methods: </strong>Two centers were involved in this study, the derivation group and the validation group. The derivation group included 65 patients with PVC left bundle branch block (LBBB) pattern morphology (predominantly negative in lead V₁) and inferior axis (predominantly positive in leads II and III), who underwent ablation at Cipto Mangunkusumo Hospital (RSCM) (2017-2022). The validation group included 291 patients who underwent ablation at the Taipei Veteran General Hospital (2020-2023). We calculated and compared six diagnostic accuracy measures from nine previously published ECG morphology criteria to develop an algorithm to enhance the accuracy of predicting RVOT PVC origin for successful ablation.</p><p><strong>Results: </strong>Our multistep algorithm using Criteria 5, 8, and 1 enhanced diagnostic performance compared to using each criterion alone. The accuracy, sensitivity, and specificity in the derivation group were 86.2%, 93.6%, and 66.7%, respectively; those in the validation group were 85.9%, 90.8%, and 64.7%, respectively. The ROC curve AUCs were 0.802 and 0.775, respectively.</p><p><strong>Conclusion: </strong>In cases of inferior axis and LBBB pattern PVCs, a multistep algorithm using multiple criteria increases the accuracy of predicting RVOT PVC origin instead of using a single criterion.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803517","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":"Transseptal Sheath Perfused with High Concentration Heparinized Saline for Reducing Sheath-associated Thrombus.","authors":"Juan Xu, Shi Peng, Yuanjun Sun, Zhenning Nie, Ya Zhen, Xiaomeng Yin, Xiaofeng Lu, Yan Liu, Xiaoyu Zhang, Dayang Huang, Shuai Guo, Yong Wei, Genqing Zhou, Yunlong Xia, Jun Li, Shaowen Liu, Songwen Chen","doi":"10.1111/pace.15115","DOIUrl":"https://doi.org/10.1111/pace.15115","url":null,"abstract":"<p><strong>Background: </strong>Transseptal catheterization is critical for atrial fibrillation (AF) ablation but risks thromboembolism. Transseptal sheaths (TSS) were suggested for continuous heparinized saline solution flush. The safety and effectiveness of a simple TSS management to reduce sheath-associated thrombus development risk was investigated.</p><p><strong>Methods: </strong>AF patients who underwent radiofrequency ablation with the simple TSS management were studied under a retrospective multi-center observation study and a prospective single-center observation study. TSS and dilators were washed and perfused with high concentration heparinized saline (20 u/mL). Immediately after two successful transseptal punctures, activated clotting time ≥300 s was maintained by heparin infusion. TSS aspiration with negative suction and re-perfusion with high concentration heparinized saline (20 u/mL) was performed for the remaining procedure before and after catheter withdrawal.</p><p><strong>Results: </strong>A total of 4765 AF patients underwent 5367 ablation procedures were enrolled in the retrospective study, involving 156 (2.9% per procedure) complications. No acute stroke occurred during all the procedures. Perioperative thromboembolic complications occurred in 10 (0.21%) patients and in 10 (0.19%) procedures. Thromboembolic complications occurred within 24 h, between 24-48 h, and after 48 h post-procedure in six, two, and two patients, respectively. In the prospective observation study, neither sheath- nor catheter-associated thrombus were detected by the intracardiac echocardiography during all 127 procedures, without any perioperative thromboembolic complications. No hemorrhagic cerebrovascular complication was encountered in both observational studies.</p><p><strong>Conclusion: </strong>For AF radiofrequency ablation, it was safe and effective for TSS high concentration heparinized saline infusion only. This approach could avoid sheath-associated thrombus for interventional procedures.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803518","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":"Utility of the Novel Auto + A3 Threshold Function in Maintaining Atrioventricular Synchrony.","authors":"Ryo Ohinata, Naoya Inoue, Shuji Morikawa","doi":"10.1111/pace.15119","DOIUrl":"https://doi.org/10.1111/pace.15119","url":null,"abstract":"<p><strong>Introduction: </strong>The VDD-leadless pacemaker aims to maintain high atrioventricular (AV) synchrony, but proper sensing setup is crucial.</p><p><strong>Methods and results: </strong>This case was an elderly woman with an AV block who received a dual-chamber pacemaker. Due to ventricular pacing failure, a Micra AV2 was implanted. However, postimplantation, high sinus rate, and frequent premature ventricular contractions were noted. Therefore, the auto + A3 threshold function was used in the atrial-sensing setup. A few days later, the MAM test confirmed good AV synchrony.</p><p><strong>Conclusion: </strong>The auto + A3 threshold function equipped in the Micra AV2 may offer to maintain high AV synchrony.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803519","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":"Characterization of Myocardial Recovery in Patients With Tachycardiomyopathy.","authors":"Neeta Bachani, Harshad Shah, Raghav Bansal, Vijay Soorampally, Gopi Krishna Panicker, Yash Lokhandwala","doi":"10.1111/pace.15116","DOIUrl":"https://doi.org/10.1111/pace.15116","url":null,"abstract":"<p><strong>Background: </strong>The degree and time course of improvement in left ventricular (LV) function with treatment in patients with tachycardiomyopathy (TCMP) is highly variable. This study aims to clinically characterize the recovery of TCMP based on the extent and course of improvement in LV function and identify predictors of complete myocardial recovery.</p><p><strong>Methods: </strong>In this prospective, single-center, observational study, patients with suspected TCMP who underwent successful tachyarrhythmia termination/control were included. Clinical and echocardiographic assessment of LV function was done at baseline, within 1 h after tachyarrhythmia termination, 24 h later, and at 12 weeks follow-up.</p><p><strong>Results: </strong>Ninety-nine patients were enrolled in the study. Six patients had immediate normalization of LV ejection fraction (LVEF) with reversion to sinus rhythm and were labeled as \"pseudo-TCMP\"; the remaining 93 patients were included in the analysis. Based on complete versus partial normalization of LVEF at 12-week follow-up, 50 patients (53.8%) were labeled as completely recovered TCMP and 43 (46.2%) as partially recovered TCMP respectively. Causative arrhythmias included atrial fibrillation (38%), focal atrial tachycardia (28%), atrial flutter (22%), ventricular arrhythmias (11%), and orthodromic re-entrant tachycardia (2%). The LVEF at presentation was 0.25 ± 0.05 which improved to 0.36 ± 0.11 within 1 h after tachycardia termination (p < 0.0001), 0.41 ± 0.14 24 h later (p = 0.009) and to 0.52 ± 0.12 at 12 weeks follow-up (p < 0.0001). Male gender was the only differentiating statistically significant variable between completely recovered and partially recovered TCMP, 24 (48%) versus 30 (69.7%) respectively (p = 0.0339).</p><p><strong>Conclusion: </strong>Nearly half of the TCMP patients have complete recovery of LV function at 12 weeks follow-up, while the other half have a partial recovery only. There was no robust predictor of complete myocardial recovery.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803515","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":"Atrioventricular Block in the Setting of Immune Myocarditis: A Pragmatic Approach to Diagnosis and Treatment.","authors":"Muhammet Gürdoğan, Gökay Taylan, Uğur Özkan, Mustafa Ebik, Nilay Solak, Yekta Gürlertop, Kenan Yalta","doi":"10.1111/pace.15108","DOIUrl":"10.1111/pace.15108","url":null,"abstract":"<p><p>Immunotherapy has revolutionized cancer treatment in the last decade and has significantly improved patient survival. However, immunotherapy is associated with serious cardiac adverse events including myocarditis and conduction disturbances. In the literature, the mortality rate in patients with immunotherapy-associated myocarditis and complete AV block is reported to be approximately 60%. Current cardio-oncology guidelines provide a series of recommendations for the management of immune myocarditis (IM). However, there is no recommendation on whether or when pacemaker implantation should be performed in the setting of complete AV block associated with myocarditis. This gap in the literature has led to a trend in cardio-oncology practice to implant permanent pacemakers (PPMs) in a significant proportion of patients without waiting for a response to immunosuppressive therapy. However, in a significant proportion of patients undergoing PPM implantation, complete AV block resolves after immunosuppressive therapy. This suggests that in cases of complete AV block in the setting of IM, more robust clues are needed for PPM implantation. This review aims to present algorithms for the management of myocarditis and complete AV block, one of the most lethal complications of immunotherapy, to help fill this gap in the literature.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1617-1626"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645217","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":"Substrate Modification for Atrial Fibrillation Induced by Mechanical Irritation That May Be Associated With Non-Pulmonary Vein Foci.","authors":"Koichiro Sonoda, Shunpei Hyakutake, Kentaro Furukawa, Kaishi Otsuka, Asumi Takei, Koji Maemura","doi":"10.1111/pace.15073","DOIUrl":"10.1111/pace.15073","url":null,"abstract":"<p><p>The importance of treating non-pulmonary vein (PV) foci is increasing with improvements in the durability of PV isolation. We describe two cases wherein non-PV foci were induced by mechanical irritation and conventional induction in the same area, which was impossible to induce after ablation, suggesting a relationship between mechanical irritation and induction of non-PV foci. In a recurrent case of non-PV foci, atrial fibrillation (AF) was induced only by mechanical irritation. No recurrence has been observed since the ablation of the area. Thus, treatment of the AF induction site with mechanical irritation could be considered an effective therapy for non-PV foci.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1632-1636"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11630806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unique Tachycardia Recorded on a Cardiac Implantable Electronic Device: What is the Mechanism?","authors":"Yuta Sudo","doi":"10.1111/pace.15088","DOIUrl":"10.1111/pace.15088","url":null,"abstract":"<p><p>In a 55-year-old man with nonischemic cardiomyopathy, a unique tachycardia was recorded on a dual-chamber implantable cardioverter defibrillator (St. Jude Medical [Abbott]) as an automatic mode switch episode. This case report discusses the mechanism of tachycardia, how it can be differentiated from similar rhythms, and its clinical implications. The report explores device limitations in managing such tachycardias and presents reprograming strategies to prevent recurrence. This case emphasizes the importance of careful analysis of device-mediated arrhythmias and appropriate programming.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1614-1616"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481120","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":"His-Bundle Pacing for Pulmonary Hypertension With Bradycardia in Congenital Heart Disease: A Case Report.","authors":"Daiji Takeuchi, Takashi Fujii, Tomomi Nishimura, Kei Inai, Morio Shoda","doi":"10.1111/pace.15098","DOIUrl":"10.1111/pace.15098","url":null,"abstract":"<p><p>Bradycardia, atrial tachyarrhythmia, heart failure, residual shunts, and pulmonary hypertension (PH) are significant problems after congenital heart disease surgery. We performed His-bundle pacing (HBP) for drug-resistant PH with bradycardia in a woman post-total anomalous pulmonary venous return repair complicated by bradycardia, hypertension, PH, residual atrial shunts, and heart failure. Significant improvement in PH post-HBP was achieved without exacerbation of left ventricular function. We successfully closed the atrial shunts 12 months after HBP.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1637-1641"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513118","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":"Comparing Low-to-Zero Fluoroscopic Navigation Systems for AVNRT Catheter Ablation: A Network Meta-Analysis.","authors":"Akaravit Thamthanaruk, Vanit Nokkhuntong, Patavee Pajareya, Noppachai Siranart, Daniel Martin Simadibrata, Witina Techasatian, Ronpichai Chokesuwattanaskul, Krit Jongnarangsin, Eugene Ho-Joon Chung","doi":"10.1111/pace.15096","DOIUrl":"10.1111/pace.15096","url":null,"abstract":"<p><strong>Background: </strong>Low-to-zero fluoroscopic navigation systems lower radiation exposure which improves health outcomes. Conventional x-ray fluoroscopy (CF) has long been the standard to guide to catheter location for cardiac ablation. With advancements in technology, alternative safety navigation systems have been developed. Three primary modalities commonly utilized are three-dimensional electroanatomic mapping (3D-EAM), magnetic navigation system (MNS), and intracardiac echocardiography (ICE), all of which can reduce radiation exposure during the procedure.</p><p><strong>Objective: </strong>We aim to compare the efficacy and safety among ICE, EAM, MNS, and CF in ablation of atrioventricular nodal reentrant tachycardia (AVNRT).</p><p><strong>Methods: </strong>This is a meta-analysis consisting of observational studies and randomized controlled trials, which evaluated the performance of navigation systems of catheter ablation in AVNRT patients. Primary endpoint was to access the AVNRT recurrence after the procedure during follow-up periods. Secondary endpoints were technical success, fluoroscopic time, fluoroscopic dose area product, radiofrequency ablation time, and adverse events. Random-effect model was applied for pooled estimated effects of included studies.</p><p><strong>Results: </strong>A total of 21 studies (21 CF, 2 ICE, 9 EAM, 11 MNS) including 1716 patients who underwent catheter ablation for AVNRT treatment were analyzed. Of these, 16 were observational studies and 5 were randomized controlled trials.</p><p><strong>Primary outcome: </strong>Point estimation of AVNRT recurrence showed ICE exhibited a pooled odds ratio (ORs) of 1.06 (95% confidence interval [CI]: 0.064-17.322), MNS with ORs of 0.51 (95% CI: 0.214-1.219], and EAM with ORs of 0.394 (95% CI: 0.119-1.305) when compared to CF.</p><p><strong>Secondary outcomes: </strong>EAM had significant higher technical success with ORs of 2.781 (95% CI: 1.317-5.872) when compared to CF. Regarding fluoroscopy time, EAM showed the lowest time with mean differences (MD) of -10.348 min (95% CI: -13.385 to -7.3101) and P-score of 0.998. It was followed by MNS with MD of -3.712 min (95% CI: -7.128 to -0.295) and P-score of 0.586, ICE with MD of -1.150 min (95% CI: -6.963 to 4.662) with a P-score of 0.294 compared to CF, which has a P-score of 0.122. There were insignificant adverse events across the procedures.</p><p><strong>Conclusion: </strong>AVNRT ablation navigated by low-to-zero fluoroscopic navigation systems achieves higher efficacy and comparable safety to conventional fluoroscopywhile also reducing risk of radiation exposure time.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1574-1585"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513116","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":"Atrial Fibrillation in Young Patients: Insights From the National Inpatient Sample.","authors":"Prasanti A Kotta, Tusharbhai J Patel, Vijay Nambi, Arunima Misra, Hamid Afshar, Mihail G Chelu, Mohammad Saeed, Dmitry Abramov, Abdul Mannan Khan Minhas","doi":"10.1111/pace.15082","DOIUrl":"10.1111/pace.15082","url":null,"abstract":"<p><strong>Background: </strong>The burden of atrial fibrillation (AF) hospitalizations in young patients is not well characterized. We aimed to study the burden, comorbidities, outcomes, and resource utilization of AF hospitalizations in young patients.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of all primary AF hospitalizations in patients 18-45 years of age using the National Inpatient Sample data from January 1, 2008 to December 31, 2019. We collected data on various clinical and socioeconomic features including demographics and clinical outcomes.</p><p><strong>Results: </strong>AF hospitalizations decreased over time from 18.7 per 100,000 in 2008 to 13.0 per 100,000 in 2019 (p < 0.001). AF hospitalizations were higher amongst males compared to females (24.0 vs. 7.5 per 100,000), and higher in Black patients compared to other ethnicities (20.4 for Black vs. 15.6 for White vs. 8.5 Hispanic per 100,000). The utilization of electrical cardioversion increased from 17.6% in 2008 to 21.9% in 2019 (p < 0.001), and catheter ablation decreased from 7.1% in 2008 to 4.3% in 2019 (p < 0.001). Men were more likely to undergo electrical cardioversion than women (20.1% vs. 14.8%, p < 0.001). White patients were more likely to undergo electrical cardioversion (20.8% vs. 14.3% vs. 15.5%, p < 0.001) and catheter ablation (6.1% vs. 3.3% vs. 4.2%, p < 0.001) compared to Black and Hispanic patients, respectively. Patients in the highest income residence quartile were more likely to undergo electrical cardioversion (21.9% vs. 16.4%, p < 0.001) and catheter ablation (8.0% vs. 3.7%, p < 0.001) compared to patients in the lowest income residence quartile.</p><p><strong>Conclusions: </strong>We found significant differences in inpatient AF management based on sex, ethnicity, and SES.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1688-1697"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632133","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}