Success and failure for implantation of left bundle branch pacing using stylet-driven pacing leads : a single center experience

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction :Left bundle area pacing is a new modality of physiological pacing. By screwing the pacing lead deep into the interventricular septum, the left bundle branch could be recruited for pacing purpose. Initially left bundle area pacing was performed with fixed helix lead supported by the delivery catheter. On the other hand, there are studies showing the feasibility of using a style-driven extendable helix with the new delivery sheath for left bundle area pacing. Purpose :To study the feasibility of left bundle area pacing and explore factors associated with success and failure Methods :This is a retrospective study from September 2020 to January 2021 in a local hospital. Baseline patient characters, procedural characters, acute complication and reason for failure were recorded. Logistic regression was done to explore factors associated with success and failure. Results :In 14 patients, the mean age is 81 +/- 6.8 years with 28% female. Pacing indications were sick sinus syndrome (n = 3) and atrio-ventricular block (n = 11). The success rate is 64% (n = 9/14). The average R wave sensing was 11.4 +/- 4.5mV, the average V pacing threshold was 0.88 +/- 0.23V @ 0.4ms and average impedance was 633 +/- 93.6 Ohm. There were no septal perforation nor pericardial effusion after implantation. The most common reason for failure is lead dislodgement during implantation (n = 4) and the other reason is failure to locate and capture the left bundle (n = 1). In logistic regression, there was no clinical risk factor identified to predict failure for implantation , i.e. diabetics ( OR 0.95, p =0.15), hyperlipidaemia (OR 0.87, p =0.94), chronic renal disease (OR 0.88, p = 0.94), coronary heart disease (OR 0.37, p = 0.66). Gender(OR 4.5, p = 0.37), age(OR 1.1, p = 0.32) and hypertension(OR 25, p = 0.25) may appear to predict failure for implantation but the results were not statistically significant. Conclusion :Left bundle area pacing could be feasible and safely implanted using style-driven lead with good pacing parameters. No clinical factor is identified to predict the failure of implantation, the main reason for failure is dislodgement of lead during implantation. Similar finding was noted in a study comparing lumen-less lead and stylet-driven lead.2 In this study found that reason for failure of left bundle area pacing using style-driven lead was due to repetitive lead dislodgement after slitting the delivery sheath, fail advancement of lead into septum and loose septal endocardium. Stability and ability to screw into septum remain a great obstacle for left bundle area pacing using stylet-driven lead. This study is limited by small sampling size and single center retrospective study. Further studies are needed to see the long term outcome of left bundle area pacing using style-driven lead and investigate other methods to predict success/ failure of implantation, such as the role of imaging.

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Prognostic Factors for Outcome and Survival after Laparotomy in Patients with Pancreatic Trauma: One Single-center Experience.

10.21203/rs.3.rs-21555/v1 ◽

2020 ◽

Author(s):

Chao Yang ◽

Baochen Liu ◽

Cuili Wu ◽

Yongle Wang ◽

Kai Wang ◽

...

Keyword(s):

Logistic Regression ◽

Prognostic Factors ◽

Retrospective Study ◽

Binary Logistic Regression ◽

Hemodynamic Instability ◽

Single Center ◽

Pancreatic Trauma ◽

Abdominal Infection ◽

Postoperative Serum ◽

Intra Abdominal Infection

Abstract Background: Pancreatic trauma results in significant morbidity and mortality. Few studies have investigated the postoperative prognostic factors in patients with pancreatic trauma after surgery. Methods: A retrospective study was conducted on 152 consecutive patients with pancreatic trauma who underwent surgery in Jinling Hospital, a national referral trauma center in China, from January 2012 to December 2019. Univariate and binary logistic regression analyses were performed to identify the perioperative clinical parameters that may affect the morbidity of the patients. Results: A total of 184 patients with pancreatic trauma were admitted during the study period, and 32 patients with nonoperative management were excluded. The remaining 152 patients underwent laparotomy due to pancreatic trauma. Sixty-four patients were referred from other centers due to postoperative complications. Abdominal bleeding caused by pancreatic leakage ( 10 of all deaths) and severe intra-abdominal infection (12 of all deaths) were the major causes of mortality. Twenty-eight (77.8%) of the 36 patients who had damage control laparotomy survived. Univariate analysis showed that age, hemodynamic status, and injury severe score (ISS) as well as postoperative serum levels of C-reactive protein (CRP), procalcitonin, albumin and creatinine and the volume of intraoperative blood transfusion had significant effects on the mortality ( P <0.05). Binary logistic regression analysis showed that the independent risk factors for prognosis after pancreatic trauma surgery were age ( P =0.012), preoperative hemodynamic instability ( P =0.018), postoperative CPR ≥154 mg/L ( P =0.016), and postoperative serum creatinine ≥177 μmol/L ( P =0.017). The 30-day mortality rate was 15.8%. Conclusions: In this single-center retrospective study, we first demonstrated that severe intra-abdominal infection and bleeding were the major factors affecting the prognosis of patients with pancreatic trauma after surgery. Preoperative hemodynamic instability, severe postoperative inflammation (CRP ≥154 mg/L) and acute renal failure (creatinine ≥177 μmol/L) were associated with a significant risk of mortality.

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P029 Background factors associated with the prognosis of patients with Crohn's disease: A single-center, retrospective study

The American Journal of Gastroenterology ◽

10.14309/01.ajg.0000578188.71330.93 ◽

2019 ◽

Vol 114 (1) ◽

pp. S8-S8

Author(s):

Ezaki Kaoru

Keyword(s):

Crohn’S Disease ◽

Retrospective Study ◽

Crohn's Disease ◽

Single Center ◽

Background Factors ◽

Factors Associated

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Individual Patient Factors Associated with Effective Tinnitus Treatment

Journal of the American Academy of Audiology ◽

10.3766/jaaa.25.7.2 ◽

2014 ◽

Vol 25 (07) ◽

pp. 631-643 ◽

Cited By ~ 5

Author(s):

Sarah M. Theodoroff ◽

Andrew Schuette ◽

Susan Griest ◽

James A. Henry

Keyword(s):

Logistic Regression ◽

Treatment Outcome ◽

Clinical Study ◽

Emotional Health ◽

The Other ◽

Self Report ◽

Patient Factors ◽

Tinnitus Handicap Inventory ◽

Factors Associated ◽

Controlled Clinical Study

Background: Little is known about patient factors that might influence outcomes of tinnitus interventions. Determining such factors would offer insights into why some individuals benefit from tinnitus intervention whereas others do not. Purpose: The purpose of this study was to evaluate selected patient factors that may be associated with outcomes of tinnitus intervention. Factors studied include demographics, tinnitus characteristics, psychoacoustic tinnitus measures, audiometric data, and overall physical/emotional health status. Research Design: A retrospective analysis was performed on data obtained from a controlled clinical study that compared factors associated with tinnitus relief after tinnitus masking and tinnitus retraining therapy. Study Sample: A total of 126 military veterans participated in this controlled clinical study. Of these, 89 completed outcome measures at both baseline and 12 mo and were included in the present analysis. Data Collection and Analysis: A “responder” to intervention was identified as having a decrease (improvement) of 20 or more points on the Tinnitus Handicap Inventory between baseline and 12 mo. A “nonresponder” did not achieve a 20-point improvement on the Tinnitus Handicap Inventory. Individual patient factors were examined using independent t-tests or χ2 analysis. A logistic regression model was used to determine how well each factor predicted treatment outcome (responder or nonresponder) while controlling for each of the other factors. Results: Five patient factors were significantly different (p ≤ 0.05) between responders and nonresponders. Responders tended to (1) be younger in age; (2) have better low-frequency hearing sensitivity; (3) have greater problems with overall hearing; (4) be more likely to have tinnitus for shorter durations; and (5) perceive their tinnitus to be located “in the head” versus “in the ears.” A logistic regression was then performed to determine how well each factor predicted the treatment outcome (responder versus nonresponder) while controlling for each of the other factors. Results from the logistic regression revealed two of the five factors, localization of tinnitus and self-report of hearing problems, to be statistically significant. Conclusions: Examining the association of individual patient factors to a specific tinnitus intervention yielded several significant findings. Although these findings are not definitive, they reveal the capability that exists to perform these kinds of analyses to investigate relationships between individual patient characteristics and outcomes of intervention for tinnitus. Prospective research using systematic approaches is needed to identify these relationships that would contribute toward the ability to differentially predict outcomes of various tinnitus interventions. Obtaining this information would lead to more targeted therapy and ultimately more effective intervention.

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Coagulopathy and damage control resuscitation during transfer due to massive hemorrhage –a single-center retrospective study–

10.21203/rs.3.rs-63082/v1 ◽

2020 ◽

Author(s):

Hiroyuki Takahashi ◽

Tomohisa Shoko ◽

Mitsuaki Kojima ◽

Satoshi Nara

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Damage Control ◽

Massive Hemorrhage ◽

Categorical Variables ◽

Stepwise Logistic Regression ◽

Damage Control Resuscitation ◽

Single Center ◽

Factors Associated

Abstract Background: To assess medical procedures, particularly damage control resuscitation, at the time of transfer between hospitals for the purpose of treating massive hemorrhage.Methods: This study used a single-center retrospective observational design, enrolling patients referred to Teine Keijinkai Hospital from another hospital between April 2012 and March 2019 for the treatment of massive hemorrhage. We excluded patients who entered cardiac arrest before arriving at our center. Qualitative or categorical variables were compared using the χ2 or Fisher’s exact test, as appropriate. Quantitative continuous variables were compared using Mann-Whitney nonparametric tests, as appropriate. Risk factors associated with coagulopathy from univariate analyses (fibrinogen level £150 mg/dl; prothrombin time-international normalized ratio ³1.5) were entered into stepwise logistic regression analysis. Significance was defined for values of p < 0.05.Results: Multiple logistic regression analysis revealed trauma (odds ratio (OR) 4.800; 95% confidence interval (CI) 2.016–11.433; p < 0.001) and volume of crystalloid solution (OR 1.001; 95%CI 1.000–1.001; p = 0.008) as independent factors associated with coagulopathy. Patients with coagulopathy showed higher 24-h mortality rates (10.9%) than patients without coagulopathy (1.2%; p = 0.021), and cause of death was hemorrhagic shock for all cases of death within 24 h.Conclusion: In our area, withholding intravenous fluid to achieve permissive hypotension, early administration of fresh frozen plasma, and use of fibrinogen concentrate may improve the prognosis of patients with massive hemorrhage undergoing transfer between hospitals.Trial registration: UMIN, UMIN000041201. Registered 24 July 2020 – Retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/icdr_e/ctr_view.cgi?recptno=R000047048

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