Search Results for: Il pacemaker si ricarica con il battito del cuore

Circulation, Volume 150, Issue Suppl_1, Page A4132498-A4132498, November 12, 2024. Background:Transcatheter aortic valve implantation (TAVI) is thought to be more effective than surgery for patients with small aortic annulus (SAA), however, the comparative efficacy of different transcatheter heart valves (THVs) remains uncertain. The objective of this meta-analysis was to compare the effects of balloon-expandable valves (BEVs) and self-expanding valves (SEVs) on hemodynamic parameters and clinical outcomes in patients with SAA who underwent TAVI.Methods:A thorough literature search was performed across PubMed/MEDLINE, Embase, and the Cochrane Library from their inception until May 2024 to identify eligible randomized controlled trials (RCTs) and propensity-score matched (PSM) studies. Clinical outcomes were evaluated using a random-effects model to pool risk ratios (RRs) with 95% confidence intervals (CIs).Results:The analysis included 8 studies; 2 RCTs and 6 PSM studies, with a total of 2,180 patients with SAA. BEVs were associated with a smaller indexed effective orifice area (MD: -0.18, 95% CI: -0.31 to -0.05) and a higher transvalvular mean pressure gradient (MD: 5.23, 95% CI 3.44 to 7.02) than SEVs. The risk for prosthesis-patient mismatch (PPM) (RR= 1.82, 95% CI: 1.27 to 2.60) and severe PPM (RR= 2.77, 95% CI: 1.93 to 3.98) was significantly higher for patients receiving BEVs than those receiving SEVs. However, no significant difference was observed between BEVs and SEVs regarding the risk of paravalvular leak (RR= 0.98, 95% CI: 0.57 to 1.69) and the permanent pacemaker implantation (RR= 0.78, 95% CI: 0.50 to 1.23). Although patients receiving BEVs showed a slightly lower risk of major bleeding events (RR= 0.69, 95% CI: 0.49 to 0.99), BEVs were associated with a significantly increased risk of 1-year cardiovascular mortality (RR= 1.61, 95% CI: 1.05 to 2.47) compared to those receiving SEVs. However, no significant differences were observed between BEVs and SEVs regarding 30-day all-cause mortality (RR= 1.19, 95% CI: 0.57 to 2.49), 1-year all-cause mortality (RR= 1.17, 95% CI: 0.89 to 1.53), stroke rates (RR= 0.83, 95% CI: 0.52 to 1.31) and any vascular complication (RR= 1.13, 95% CI: 0.72 to 1.75).Conclusion:In patients with SAA, SEVs showed reduced risks of PPM and severe PPM compared to BEVs, along with a larger indexed effective orifice area. Moreover, SEVs were associated with a lower risk of 1-year cardiovascular mortality.

Circulation, Volume 150, Issue Suppl_1, Page A4134594-A4134594, November 12, 2024. Description of Cases:Case 1: A 72 year old male with atrial fibrillation (AF) and tachy-brady syndrome underwent Micra implantation. On post-procedure day 2, pacing thresholds were unacceptably elevated. A new Micra device was deployed; subsequently, a microsnare was placed through the Micra delivery catheter and the docking button of the old Micra was successfully snared (Figure A). The old Micra was then captured over the delivery catheter and removed from the body.Case 2:A 76 year old male underwent Micra implantation and AV node ablation for AF with persistent tachycardia. One month later, he presented with heart failure and interval decrease in ejection fraction from 66% to 33%. After biventricular leads were implanted, an Agilis catheter was advanced towards the Micra. The docking button was successfully snared with a gooseneck snare (Figure B), and the Micra was extracted with gentle traction.Case 3:A 76 year old male with complete heart block and longstanding persistent AF received a Micra. Nine months later, he presented with heart failure and interval decrease in ejection fraction from 55% to 25%. A defibrillator lead was implanted but no suitable CS branch was identified. The Aveir retrieval catheter was advanced and the Micra docking button was captured with the triloop snare (Figure C). The protective sleeve was advanced over the Micra and it was successfully removed. Subsequently, a left bundle area lead was placed.Discussion:Although uncommon, extraction of the tined leadless pacemaker (Micra) may be indicated at times. As rates of implantation continue to increase, establishing uniform procedures for extraction becomes increasingly important. These three cases highlight unique options for Micra extraction, and the feasibility of each approach. However, a dedicated tool and protocol would be ideal for patient safety and consistency. No complications occurred with the above cases.

Circulation, Volume 150, Issue Suppl_1, Page A4141344-A4141344, November 12, 2024. Background:Leadless pacemakers offer a safe and effective alternative pacing strategy, crucial for patients with end-stage renal disease (ESRD) overcoming vascular access isues. However, there is limited data available on their use in this population.Methods:We utilized the Nationwide Readmission Database to extract data on all adult patients with ESRD who received either traditional transvenous or leadless pacemaker implantation from 2016 to 2021. We then compared in-hospital mortality, in-hospital complications, healthcare resource utilization, and 30-day readmission rates between these two groups.Results:A total of 6,384 patients (81.2%) were included in the transvenous pacemaker cohort, while 1,481 patients (18.8%) were in the leadless pacemaker cohort. In ESRD patients, leadless pacemaker implantation was associated with higher in-hospital complications compared to transvenous pacemakers, including cardiac complications (aOR 4.12, CI 1.70-9.98, p

Circulation, Volume 150, Issue Suppl_1, Page A4138912-A4138912, November 12, 2024. Background:Cardiac resynchronization therapy (CRT) is a well-established therapy for patients with heart failure with reduced ejection fraction (HFrEF) and wide QRS. Whether CRT-defibrillators (CRT-D) reduce mortality more than CRT-pacemakers (CRT-P) remains controversial.Aims:To compare the clinical outcomes of CRT-D vs CRT-P using data from 5 landmark CRT trials, both overall and stratified by etiology of cardiomyopathy (ischemic vs non-ischemic), sex (male vs female), age (≥ 70 y/o vs < 70 y/o), and QRS morphology (IVCD, LBBB, RBBB).Methods:We performed a meta-analysis of patient level data from 5 prospective CRT trials (MIRACLE, REVERSE, RAFT, COMPANION and MADIT-CRT). Inclusion criteria were CRT-P vs CRT-D status (randomized comparison only in COMPANION), age ≥ 18 y/o and LVEF ≤ 35%. Exclusion criteria included secondary prevention ICD, QRS < 120ms, pacemaker upgrade, ventricular pacing indication, or missing data. Primary outcome was composite of time to heart failure hospitalization (HFH) or all-cause death. Secondary outcomes were time to HFH and death. Outcomes were analyzed using a frequentist Cox Proportional Hazards mixed effects model adjusted for 17 variables.Results:A total of 3407 patients met inclusion criteria. Relative to patients with CRT-P (n=843), those with CRT-D (n=2564) were of similar age (66 y/o, p=0.5), less often female (24% vs 34%, p

Circulation, Volume 150, Issue Suppl_1, Page A4144428-A4144428, November 12, 2024. Background:Leadless pacemaker implantation (LPI) is common among patients with sick sinus syndrome (SSS) or atrioventricular block (AVB). Our study explores 30-day readmission rates (30-dr) following LPI for SSS and AVB, comparing outcomes between male and female patients.Methods:Using the Nationwide Readmissions Database, we conducted a retrospective analysis of patients who underwent LPI for SSS, and second or third-degree AVB between 2017 and 2021. Our study cohort was stratified by gender. The primary outcome was 30-dr, while secondary outcomes included inpatient mortality, length of stay (LOS), complications, and total hospital charge (THC).Results:Among the 17,759 patients meeting the inclusion criteria, 54.1% (n = 9,613) were males and 45.9% (n = 8,146) were females, with a mean age of 76.4 ± 12.6 years. The mean age was 75.5 ± 12.4 years for males and 77.4 ± 12.6 years for females (adjusted Wald test, p < 0.01).Logistic regression analysis revealed that females had higher odds of readmission (OR 1.21, 95% CI 1.06 - 1.39, p < 0.01) compared to males. However, inpatient mortality and LOS did not differ significantly between the two groups (p > 0.05, all). In addition, males had a higher rate of complications leading to hemodialysis and the use of mechanical ventilators (p < 0.05, all), while women had higher complications in pericardial effusions and tamponade (p < 0.05, all). The mean THC was higher in males ($50,589 vs 47,681), compared to females (adjusted Wald test, p = 0.02).Conclusion:Our study revealed that female patients have a higher risk for 30-dr after LPI for SSS and AVB,. While the difference between two groups was not significant for inpatient mortality and LOS, the males had higher THC. Moreover, the nature of complications differed between males and females as well. This highlights the need for tailored interventions to minimize readmissions in this patient population.

Circulation, Volume 150, Issue Suppl_1, Page A4141033-A4141033, November 12, 2024. Introduction:Pain discomfort increases procedural time in electrophysiology laboratory and prolongs surgical length. Virtual reality-based analgesia (VR-A) improves patient’s acceptance of the procedural steps, mostly in the emergency context. To date, routine adoption of VR-A is limited in cardiology since it is recommended for other surgeries.Hypothesis:we postulated that administration of VR-A would facilitate patient’s compliance, allowing to increasing number of electrophysiology procedures, to reducing burden of complications, and to accelerating discharge.Methods:from April 2024 to May 2024 patients admitted to our academic hospital for cardiac rhythm disorders requiring pacemaker (PM) or implantable cardioverter/defibrillator (ICD) were enrolled. They were randomized in two groups (allocation ratio 1:1) by including either standard sedation protocol, or VR-A for cardiac device implants. Numeric rating scale score was used to assess pain. Variation of vital parameters was measured at baseline, 15, 30 and 60 min after procedural start, as well as at 30 min after procedural ending for an objective evaluation of pain. Statistical analysis was performed with SPSS.Results:Baseline clinical characteristics did not differ between groups. Patients underwent PM (N=12) and ICD (N=8) implantations, showing similar allocation and mean procedural durations (69.5±23.4 min vs 69.5±10.9 min,p=0.3), but significant difference in numeric rating scale score (4.5±0.8 vs.5.9±1.7,p=0.02) in VR-A vs standard group. Standard protocol registered significant differences in blood pressure [F(4, 45)=6.95;p

Circulation, Volume 150, Issue Suppl_1, Page A4116639-A4116639, November 12, 2024. Background:Surgical aortic valve replacement (SAVR) is the preferred treatment option for patients with severe aortic regurgitation (AR). Recently, several patients with mixed aortic valve disease, comprising severe aortic stenosis (AS) and at least moderate AR, have been successfully treated with TAVR. However, the treatment of severe native aortic valve regurgitation (NAVR) without AS remains a matter of contention, and the efficacy of TAVR remains uncertain.Aims:The primary outcomes were 30-day mortality and the incidence of device success. The secondary outcomes included incidence of myocardial infarction (MI), stroke, major bleeding, acute kidney injury (AKI) ≥ stage 2, moderate-to-severe paravalvular leak (PVL), permanent pacemaker implantation (PPM), and post-procedural moderate-to-severe AR.Methods:We systematically searched PubMed, Cochrane Library, Scopus and ClinicalTrials.gov for published articles from inception until 2nd April 2024 to evaluate clinical outcomes of TAVR in patients with NAVR. The statistical analysis was conducted using R-Studio 5.3.3. The rates of events with 95% confidence intervals (CI) and the heterogeneity was assessed using p-value and I2statistics.Results:A total of 23 published articles with 4,397 patients were included. All-cause mortality at 30 days was 12% (95% CI: 6% to 23%), while device success was 86% (95% CI: 81% to 92%). The incidence of complications such as MI (3%, 95% CI: 2% to 4%), stroke (3%, 95% CI: 2% to 3%), major bleeding (8%, 95% CI: 5% to 11%), AKI ≥ stage 2 (8%, 95% CI: 5% to 12%), and major vascular complications were relatively low (6%, 95% CI: 4% to 7%). PPM was required for 15% of patients (95% CI: 11% to 18%). PVL was observed in 10% of patients (95% CI: 2% to 41%) and post-procedural moderate-to-severe AR occurred in 9% of patients (95% CI: 4% to 20%).Conclusion:TAVR is a viable and reasonable option for a specific population with NAVR. Nevertheless, it is imperative to conduct larger studies with a longer duration of follow-up to obtain more robust evidence of the feasibility of TAVR in patients with NAVR.

Circulation, Volume 150, Issue Suppl_1, Page A4138981-A4138981, November 12, 2024. Background:Conduction system disease, atrial and ventricular arrhythmias may require pacemaker or ICD implantation in transthyretin amyloid cardiomyopathy (ATTR-CM). The optimal pacing mode in ATTR-CM patients remains unknown.Objective:To assess how availability of cardiac resynchronization and conduction system pacing influenced pacemaker indications and to compare early electrical performance of conventional, resynchronisation and conduction system pacing in ATTR-CM.Methods and Results:67 of 250 (26.8%) patients presenting with ATTR-CM between June 2019 and February 2023 received a pacemaker [HA1] and were included in this retrospective analysis. Pacemaker implantation occurred in 25 patients (37.3%) prior to, and in 42 (62.7%) after ATTR-CM diagnosis. Implantation of conventional single- (VVI) or dual-chamber (DDD) pacemakers was more common (n=17/25, 68%) in undiagnosed ATTR-CM, while physiological pacing systems (CRT/ CSP) were preferably implanted in patients (n=24/42; 57.1%) after diagnosis. Sick sinus syndrome (11/35; 31.4% vs. 6/32; 18.8%) and higher degree AV-block (20/35; 57.1% vs. 9/32; 28.1%) were more common indications for VVI/DDD compared to CRT/CSP pacemakers, with pursuit of a pace/ablate strategy (12/32; 37.5%) and heart failure (5/32; 15.6%) contributing significantly to implantation of CRT/CSP. QRS width was significantly lower with CSP [122ms (IQR: 120-139)], compared to CRT [155ms (IQR: 141-160); p=0.005] or VVI/DDD [160ms (IQR: 144-180)], with the latter resulting in a significant increase in QRS width compared to intrinsic QRS [from 138 (IQR: 123-150) (p0.05).Conclusions:Pacing indications are changing with earlier diagnosis of ATTR-CM. CSP may offer improved electrical performance and resynchronization, the effect of conduction system pacing on clinical outcomes should be further explored.

Circulation, Volume 150, Issue Suppl_1, Page A4141415-A4141415, November 12, 2024. Lead related venous obstruction (LRVO) is an often underrecognized complication of pacemaker implantation. Symptoms of LRVO may include mild asymmetric upper extremity swelling to highly morbid superior vena cava (SVC) syndrome. We present an unusual case of a 54-year-old man with a history of retained pacemaker leads placed 26 years ago who presents with abdominal distention, lower extremity edema, and shortness of breath. He was found to have new onset ascites and significant pleural effusions. A liver biopsy showed hepatic fibrosis and pleural studies were consistent with chylothorax. After significant workup and diagnostic testing, it was believed that he had late complications often seen in Fontan physiology, notably hepatic fibrosis, lymphatic leakage, and protein losing enteropathy. A venogram and pressure measurements were performed which confirmed obstruction at the junction of the SVC and right atrium with elevated central filling pressures and significant flow through a markedly dilated azygous vein. A lymphangiogram suggested lymphatic leakage through the thoracic duct. An SVC stent was placed in an attempt to relieve the obstruction but the patient had progressive hemodynamic compromise leading to placement of mechanical circulatory support. Ultimately, the patient underwent surgical extraction of the retained pacemaker leads and reconstruction of the superior vena cava and right atrial junction, leading to near-resolution of his symptoms. This unusual presentation of SVC syndrome as a late complication of retained pacemaker leads highlights the potential severity of cardiac implanted electronic device lead-related complications.

Circulation, Volume 150, Issue Suppl_1, Page A4142141-A4142141, November 12, 2024. Background:Bileaflet mitral valve prolapse (BMVP) is a rare disease in the pediatric population. It may be a proarrhythmic substrate, particularly when present with mitral annular disjunction (MAD). There is less known about the genetic etiology and phenotypic spectrum of patients diagnosed with BMVP in childhood.Objective:To determine the genetic and phenotypic factors that influence arrhythmiadevelopment and cardiac arrest in pediatric patients with BMVP.Methods:We established a cohort of pediatric probands with at least one clinical encounter at Duke University Hospitals. Patients were categorized by underlying cardiac condition leading to groups of idiopathic BMVP, aortopathies, cardiac channelopathies/cardiomyopathies, and congenital heart disease (CHD). We grouped patients by presence of MAD. Primary outcome was ventricular arrhythmias. Secondary outcomes were cardiac arrest, pacemaker or implantable cardioverter defibrillator (ICD) placement, and secondary cardiac surgery. Rates of arrhythmia and secondary outcomes were compared using Fisher’s exact test. Freedom from event curves were generated to track first arrhythmia episodes and age at diagnosis and compared using a log-rank test.Results:54 pediatric patients were included with 30 (55.6%) female and an average age at diagnosis of 8.2 years. Patients with concurrent CHD had earlier BMVP diagnosis compared to those with idiopathic BMVP and cardiac channelopathies/cardiomyopathies (p < 0.05). Yield of gene panel testing was 71.88% LP/P overall, 56.25% in isolated BMVP, and 12.5% in MAD. Among the pathogenic variants found in MAD, 60% were aortopathy genes, 20% cardiomyopathy/channelopathy genes, and 20% in sudden unexpected death in epilepsy genes. The most common arrhythmia was ventricular tachycardia found in 52% of arrhythmia episodes, followed by supraventricular tachycardia (19%), and ventricular fibrillation (15%) which only was seen in MAD. The rate of arrhythmia in MAD was higher (55%) compared to 14% in patients with isolated BMVP (p < 0.001), and rates of breakthrough arrhythmia were similar between groups. Patients with MAD had a rate of 27.27% for pacemaker or ICD placement compared to 2.33% in patients with isolated BMVP (p < 0.05).Conclusions:BMVP is likely a common phenotype with a variety of genetic and phenotypic subtypes. Presence of MAD increases risk of arrhythmia and need for a pacemaker or ICD in patients with BMVP independent of the underlying cardiac condition.

Circulation, Volume 150, Issue Suppl_1, Page A4147674-A4147674, November 12, 2024. Background:Leadless pacemaker (LP) is a novel pacemaker offering an innovative approach to bradyarrhythmia treatment. Aveir LP and Micra LP are the two leadless pacing systems available in the United States. Aveir LP was approved by the Food and Drug Administration (FDA) in April 2022. Data regarding the adverse events (AE) following implantation of Aveir LP is scarce, largely limited to single centers, and no real-world comparative analyses were done previously.Methods:We queried the FDA Manufacturer and User Facility Device Experience (MAUDE) database between April 2022 and December 2023 to assess the safety and AE following implantation of Aveir LP. “AVIER” and “MICRA” were the key terms used to search the MAUDE database. The event types “death” and “injury” were included in our search to capture major clinical events related to the patient. Disproportionality analysis was performed using the reporting odds ratio (ROR) to compare the adverse events of Aveir LP with Micra LP. A signal to noise ratio was considered to be significant if the confidence interval (CI) did not cross the number “one”.Results:Our search resulted in 207 event reports for Aveir LP and 1969 event reports for Micra LP. Major device related adverse events with Aveir LP were capturing problem (33.8%) followed by dislodgement (16.9%), and sensing problem (7.2%). Most encountered device related AE with Micra LP were capturing problem (37.8%), pacing problem (11.5%), and sensing problem (9.3%). Frequencies of all the analyzed AE are shown in Figure 1. The reporting of pericardial effusion (ROR 2.84, 95% CI 2.18-3.71), and dislodgment (ROR 1.85, 95% CI 1.26-2.73) were significantly higher with Aveir, whereas cardiac arrest (ROR 0.18, 95% CI 0.04-0.74) was disproportionately lower. Overall, patient related AE were significantly higher (ROR 1.53, 95% CI 1.20-1.95) and device related events were significantly lower (ROR 0.65, 95% CI 0.51-0.83) with Aveir LP compared to Micra LP (Figure 2).Conclusion:This is the first real-world comparative analysis of two leadless pacing systems available in the United States. Our analysis showed that, when compared to Micra LP, the newer Aveir LP had lower device related events but higher patient related events, largely driven by pericardial effusion. These events could be attributed to the operator learning curve and long-term data are needed to further verify these findings.

Circulation, Volume 150, Issue Suppl_1, Page A4126987-A4126987, November 12, 2024. Background:COVID-19 infection has been associated with a broad range of clinical manifestations. There are very few reported cases of COVID-19 patients presenting with syncope as an initial symptom. We present an extraordinary case of recurrent neurocardiogenic syncope in a COVID-19 patient.Case:A 66-year-old male presented after experiencing two episodes of syncope. He denied any prodromal or anginal symptoms. His medications included propranolol 10 mg twice daily for essential tremors. He had no family history of unexplained syncope or sudden cardiac death. He was hemodynamically stable and had one episode of fever at 102°F. Telemetry recording showed vagal-mediated sinus arrest and pauses without escape. Blood work showed normal cell counts, electrolytes, thyroid-stimulating hormone, and erythrocyte sedimentation rate, with a slightly elevated C-reactive protein of 22.2 mg/L. He tested positive for COVID-19 and had negative Lyme and Ehrlichia serologies.Decision Making:Due to symptomatic long sinus pauses, propranolol was discontinued, and he received a temporary pacemaker set at 50 beats per minute (bpm). He had another syncopal episode while being paced at 50 bpm, suggesting a neurocardiogenic mechanism, so the pacing rate was increased to 70 bpm. An echocardiogram showed a normal ejection fraction without any significant valvular disease. The syncope was determined to be vasovagal due to autonomic dysfunction in the setting of COVID-19. After 72 hours without further syncope, the temporary pacemaker was removed, and he was discharged home with an implantable loop recorder (ILR). A one-month follow-up showed no syncope, and ILR interrogation showed no bradycardia or pauses.Conclusion:Neurocardiogenic syncope with prolonged asystole and sinus pauses is an uncommon presentation of COVID-19 infection. The clinical course of autonomic dysfunction following COVID-19 is not very clear, and monitoring with an ILR is reasonable before considering permanent pacemaker implantation.

Circulation, Volume 150, Issue Suppl_1, Page A4139575-A4139575, November 12, 2024. Background:Left bundle branch area pacing (LBBAP) has been persuasively adopted in clinical practice to achieve electrical and mechanical synchrony of the left ventricle. However, LBBAP in amyloid light chain cardiac amyloidosis (AL-CA) patients has not been studied in detail.Hypothesis:LBBAP could be a feasible and safe approach to rectify the conduction system diseases of AL-CA patients.Aim:To study the feasibility and safety of LBBAP in AL-CA patients.Methods:Consecutive patients with AL-CA and newly implanted pacemaker in our centre between 1st January 2022 and 31st December 2023 were retrospectively included. The diagnosis of AL-CA was confirmed according to the current ESC position statement. Indications for pacemaker fulfilled the current ESC guideline. All patients underwent attempts of LBBAP or right ventricular pacing (RVP) based on operators’ preference.Results:A total of 10 patients were included. RVP was chosen initially in 1 patient and LBBAP was attempted in 9 patients. LBBAP were successfully performed in 6 patients (66.7%, 6/9). Three patients crossed over to RVP group because LBBAP was failed to achieve(Fig.1).Baseline clinical characteristics and pacing parameters was compared between LBBAP group and RVP group (Table.1). Duration of intrinsic QRS was similar and paced QRS was wider in RVP group (P=0.029).During follow-up, one patient in LBBAP group died from sudden death 15 days after implantation, while 2 patients in RVP group died from sudden death and pneumonia 55 days and 17 days after implantation, respectively. Seven patients visited our centre at three-month follow-up without adverse events and interrogation reports were summarized inFig.1.Conclusion:LBBAP appears to be a reasonable method for physiological pacing for patients with AL-CA and bradycardia, but its impact on long-term prognosis needs further investigation.

Circulation, Volume 150, Issue Suppl_1, Page A4144048-A4144048, November 12, 2024. Background:Heart failure (HF) and paroxysmal atrial fibrillation (AF) are major causes of morbidity and mortality, each exacerbating the other and leading to poorer outcomes. Glucagon-like peptide-1 agonists (GLP-1a), primarily used for glycemic control in type 2 diabetes, may offer cardiovascular benefits in patients with concurrent HF and paroxysmal AF.Objective:This study aims to evaluate the impact of GLP-1a on clinical outcomes in patients with concurrent HF and paroxysmal AF.Methods:This retrospective study utilized data from 51,446 HFrEF patients across 91 global healthcare organizations between January 2014 and August 2023. Propensity score matching (PSM) analysis was used to compare cardiovascular outcomes such as all-cause mortality, the need for new antiarrhythmic medication, cardioversion, AF ablation, incidence of acute myocardial infarction (AMI), and cardiac arrest, between those treated with GLP-1a and those who were not.Results:Our analysis revealed that the GLP-1a group had significantly lower odds of requiring cardioversion (3.1% vs 5.0%, OR = 0.67, 95% CI: 0.45–0.99, p=0.041), AF ablation (1.7% vs 3.7%, OR = 0.51, 95% CI: 0.27–0.98, p=0.038), new antiarrhythmic drugs (12.0% vs 13.9%, OR = 0.81, 95% CI: 0.66–0.99, p=0.036), experiencing AMI (OR: 0.70, 95% CI: 0.50–0.98, p=0.035), experiencing cardiac arrest (OR: 0.54, 95% CI: 0.37–0.80, p=0.002), and all-cause mortality (OR: 0.59, 95% CI: 0.51–0.68, p

Circulation, Volume 150, Issue Suppl_1, Page A4143899-A4143899, November 12, 2024. Background & Objectives:Transcatheter aortic valve replacement (TAVR) is currently the treatment of choice for most patients with symptomatic severe aortic stenosis. We conducted this systematic review, and meta-analysis to compare the efficacy and procedural outcomes of using the cusp overlap technique (COT) versus the standard three-cusp technique during self-expandable valves implantation for the management of aortic stenosis.Methodology:We systematically searched PubMed, Scopus, Embase, Cochrane, and Web of Science (WOS) from inception to March 5, 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. To estimate the effect size, dichotomous outcomes were pooled as risk ratio (RR), and continuous outcomes were pooled as mean difference (MD) with their respective 95% confidence interval (CI).Results:We included seventeen studies in our systematic review and meta-analysis with a total of 3129 patients in cusp-overlap technique (COT) arm and 2818 patients in standard technique (ST) arm. The rate of 30-day mortality was significantly decreased in COT compared with ST (RR = 0.61; 95% CI: [0.37–1.00], P = 0.05). Regarding conduction abnormalities, COT was related to lower risk of complete atrioventricular (AV) block (RR = 0.51; 95% CI: [0.37–0.69],P< 0.01), reduced likelihood of left bundle branch block (RR = 0.77; 95% CI: [0.61–0.97], P = 0.03) and permanent pacemaker implantation (PPI) (RR = 0.56; 95% CI: [0.46–0.70], P < 0.01). There was also lower likelihood of major and life-threatening bleeding with the COT compared to ST (RR = 0.60; 95% CI: [0.46–0.79],P< 0.01). Our analysis also showed that COT was associated with significantly lower implantation depth compared with ST (MD = -1.00; 95% Cl: [-1.83 to -0.17],P= 0.02). Procedural success was similar between COT and ST (RR = 1.01; 95% CI: [0.98–1.04],P= 0.42). Major vascular complications (RR = 0.90; 95% CI: [0.61–1.33], P = 0.61), and mild to severe paravalvular leak (RR = 1.00; 95% CI: [0.66–1.51], P = 1.00) were also comparable between COT and ST.Conclusion:Our study findings suggest that COT offers several advantages over ST, including reduced 30-day mortality and decreased bleeding complications, without compromising long-term outcomes or increasing procedural complications. The COT most importantly lower risk of conduction abnormalities, and hence permanent pacemaker implantation.

Circulation, Volume 150, Issue Suppl_1, Page A4141158-A4141158, November 12, 2024. Background:The “weekend effect” on hospital admissions has been extensively studied, showing increased risks for patients admitted on weekends than those admitted on weekdays. We aimed to assess the “weekend effect” on in-hospital outcomes in patients undergoing transcatheter aortic valve replacement (TAVR).Methods:A nationwide cohort study was conducted using the National Inpatient Sample Database. We identified 82,094 eligible patients aged ≥ 18 years admitted for TAVR between 2013 and 2021. Patients were grouped into weekend or weekday cohorts based on day of admission. Propensity score matching (PSM) and multivariate regression models were employed to evaluate outcomes. After PSM, 2,688 weekend admissions and 13,440 weekday admissions were included in the analyses.Results:Multivariable regression, adjusted for propensity score, revealed that weekend admission was associated with 45% higher odds of in-hospital mortality (adjusted odds ratio: 1.45; 95% confidence interval: 1.13–1.85). Significant heterogeneity in mortality was observed based on admission urgency, with a 3.27 times higher increased risk of death observed for elective admissions on weekends than on weekdays (P for interaction = 0.001). Moreover, weekend admissions had significantly higher adjusted odds for cardiogenic shock, permanent pacemaker implantation, endocarditis, acute kidney injury, acute ischemic stroke, and blood transfusion. There was a trend of higher in-hospital mortality for weekend over weekday admissions throughout the study period.Conclusions:Weekend admissions for TAVR had higher mortality, complications, and resource utilization, particularly in elective cases. Our findings suggest that patients admitted for TAVR during weekends are at high risk and warrant special attention.