Right ventricular pacing for hypertrophic obstructive cardiomyopathy: meta-analysis and meta-regression of clinical trials

Arnold, Ahran; Howard, James P.; Chiew, Kayla; Kerrigan, William J.; Vere, Felicity de; Johns, Hannah; Churlilov, Leonid; Ahmad, Yousif; Keene, Daniel; Shun-Shin, Matthew; Cole, Graham D.; Kanagaratnam, Prapa; Sohaib, S.M. Afzal; Varnava, Amanda; Francis, Dárrel P.; Whinnett, Zachary I.

doi:10.1093/ehjqcco/qcz006

Cited by 6 publications

(4 citation statements)

References 44 publications

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“…579 A recent meta-analysis-comprising 34 studies and 1135 patients-found that pacing reduced the LV outflow gradient by 35%, with a non-significant trend towards reduction in NYHA class. 584 Shared decision-making should be employed when considering the treatment of choice for patients with obstructive HCM.…”

Section: Pacing For the Management Of Left Ventricular Outflow Tract ...mentioning

confidence: 99%

2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: Developed by the Task Force on cardiac pacing and cardiac resynchronization therapy of the European Society of Cardiology (ESC) With the special contribution of the European Heart Rhythm Association (EHRA)

Glikson¹,

Nielsen²,

Kronborg³

et al. 2022

Revista Española de Cardiología (English Edition)

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Section: Pacing For the Management Of Left Ventricular Outflow Tract ...mentioning

confidence: 99%

2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: Developed by the Task Force on cardiac pacing and cardiac resynchronization therapy of the European Society of Cardiology (ESC) With the special contribution of the European Heart Rhythm Association (EHRA)

Glikson¹,

Nielsen²,

Kronborg³

et al. 2022

Revista Española de Cardiología (English Edition)

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“…RV apical pacing results in broad QRS complexes with left bundle branch block (LBBB) morphology. 7 Ventricular pacing has been standard practice for decades and has resulted in a high global prevalence of experienced staff competent at interpreting paced ECGs recorded from conventional pacing locations.…”

Section: Introductionmentioning

confidence: 99%

Discriminating electrocardiographic responses to His-bundle pacing using machine learning

Arnold¹,

Howard²,

Gopi

et al. 2020

Cardiovascular Digital Health Journal

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BACKGROUND His-bundle pacing (HBP) has emerged as an alternative to conventional ventricular pacing because of its ability to deliver physiological ventricular activation. Pacing at the His bundle produces different electrocardiographic (ECG) responses: selective His-bundle pacing (S-HBP), non-selective His bundle pacing (NS-HBP), and myocardium-only capture (MOC). These 3 capture types must be distinguished from each other, which can be challenging and time-consuming even for experts. OBJECTIVE The purpose of this study was to use artificial intelligence (AI) in the form of supervised machine learning using a convolutional neural network (CNN) to automate HBP ECG interpretation. METHODS We identified patients who had undergone HBP and extracted raw 12-lead ECG data during S-HBP, NS-HBP, and MOC. A CNN was trained, using 3-fold cross-validation, on 75% of the segmented QRS complexes labeled with their capture type. The remaining 25% was kept aside as a testing dataset. RESULTS The CNN was trained with 1297 QRS complexes from 59 patients. Cohen kappa for the neural network's performance on the 17-patient testing set was 0.59 (95% confidence interval 0.30 to 0.88; P ,.0001), with an overall accuracy of 75%. The CNN's accuracy in the 17-patient testing set was 67% for S-HBP, 71% for NS-HBP, and 84% for MOC. CONCLUSION We demonstrated proof of concept that a neural network can be trained to automate discrimination between HBP ECG responses. When a larger dataset is trained to higher accuracy, automated AI ECG analysis could facilitate HBP implantation and follow-up and prevent complications resulting from incorrect HBP ECG analysis.

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“…This relationship is bidirectional, as arrhythmia can be secondary to ventricular fibrosis or microvascular ischaemia, which may impair LV function, but also cause deterioration through persistent tachycardia. Some of these patients respond poorly to right ventricular pacing, which has previously been used to reduce LV outflow tract gradient, 21 most probably by inducing ventricular asynchrony 22 . Dyssynchronous contraction may be detrimental over time and cause adverse remodelling 23 .…”

Section: Discussionmentioning

confidence: 99%

Hypokinetic hypertrophic cardiomyopathy: clinical phenotype, genetics, and prognosis

et al. 2022

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AimsTo describe the phenotype, genetics, and events associated with the development of hypertrophic cardiomyopathy (HCM) with reduced ventricular function (HCMr). Heart failure in HCM is usually associated with preserved ejection fraction, yet some HCM patients develop impaired systolic function that is associated with worse outcomes. Methods and resultsOur registry included 1328 HCM patients from two centres in Spain and Israel. Patients with normal baseline ventricular function were matched, and a competing-risk analysis was performed to find factors associated with HCMr development. Patient records were reviewed to recognize clinically significant events that occurred closely before the development of HCMr. Genetic data were collected in patients with HCMr. A composite of all-cause mortality or ventricular assist device (VAD)/heart transplantation was assessed according to ventricular function. Median age was 56, and 34% were female patients. HCMr at evaluation was seen in 37 (2.8%) patients, and 46 (3.5%) developed HCMr during median follow up of 9 years. HCMr was associated with younger age of diagnosis, poor functional class, and ventricular arrhythmia. Atrial fibrillation, pacemaker implantation, and baseline left ventricular ejection fraction (LVEF) of ≤55% were significant predictors of future HCMr development, while LV obstruction predicted a lower risk. Genetic testing performed in 53 HCMr patients, identifying one or more pathogenic variant in 38 (72%): most commonly in myosin binding protein C (n = 20). Six of these patients had an additional pathogenic variant in one of the sarcomere genes. Patients with baseline HCMr had a higher risk (hazard ratio 6.4, 4.1-10.1) for the composite outcome and for the individual components. Patients who developed HCMr in the course of the study had similar mortality but a higher rate of VAD/heart transplantation compared with HCM with normal LVEF. Conclusions Hypertrophic cardiomyopathy with reduced ejection fraction is associated with heart failure and poor outcome. Arrhythmia, cardiac surgery, and device implantation were commonly documented prior to HCMr development, suggesting they may be either a trigger or the result of adverse remodelling. Future studies should focus on prediction and prevention of HCMr.

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Right ventricular pacing for hypertrophic obstructive cardiomyopathy: meta-analysis and meta-regression of clinical trials

Cited by 6 publications

References 44 publications

2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: Developed by the Task Force on cardiac pacing and cardiac resynchronization therapy of the European Society of Cardiology (ESC) With the special contribution of the European Heart Rhythm Association (EHRA)

2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: Developed by the Task Force on cardiac pacing and cardiac resynchronization therapy of the European Society of Cardiology (ESC) With the special contribution of the European Heart Rhythm Association (EHRA)

Discriminating electrocardiographic responses to His-bundle pacing using machine learning

Hypokinetic hypertrophic cardiomyopathy: clinical phenotype, genetics, and prognosis

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