204 Permanent his bundle pacing using stylet-driven lead in patients with right atriomegaly: a single-centre experience

Aims His bundle pacing (HBP) is becoming an increasing widespread approach for physiological pacing. However, successful HBP procedure could be hampered by limited implantation tools especially in challenging anatomies. We aimed to report our experience with HBP technique using a novel stylet-driven lead system in patients with right atriomegaly. Methods and results Consecutive patients with right atrium (RA) volume >25 ml/m2 in men and >21 ml/m2 in women who underwent permanent HBP for standard indications were enrolled from March 2020 to March 2021. The tool of first choice for HBP attempt was a stylet-driven lead (Solia S 60, Biotronik) delivered via a dedicated introducer sheath (Selectra 3D, Biotronik). The acute, 1-month and 6-month procedural success rates were assessed. We enrolled 24 patients [median age: 75 (70–79) years, 85% men] with an average RA volume of 50.7 ± 7.8 ml/m2. At implant, conduction system pacing using stylet-driven lead was achieved in 21 patients (87%): 12 (50%) selective HBP, 6 (25%) non-selective HBP, and 3 (12.5%) left bundle branch area pacing. In the three failures, HBP was further attempted with a lumen-less lead with fixed helix (SelectSecure 3830, Medtronic) with final procedural success in two cases. In the successful cases, there was a significant reduction of QRS duration between paced and spontaneous beats [152.5 (130–167.5) ms vs. 130 (122.5–137.5) ms, P = 0.003]. No lead dislodgment nor significant pacing threshold increase was observed at 1-month (1.30 ± 0.76 [email protected] vs. 1.32 ± 0.80 [email protected] ms, P > 0.9) and 6-month follow-up (1.30 ± 0.76 [email protected] vs. 1.38 ± 0.97 [email protected] ms, P = 0.66). Conclusions In patients with right atriomegaly, the novel stylet-driven lead system showed high implant success rates with stable pacing thresholds.

Correlation Of Left Ventricular Ejection Fraction And Spatial Qrs-T Angle In Old Myocardial Infarct Patient

Objective: Spatial QRS-T angle (the angle between the QRS and T vectors) is a strong independent predictor of cardiovascular death. Spatial QRS-T angle calculations can be obtained from the ECG 12 lead with Kors visual transform applications closest to Frank lead system. Half of patients with coronary artery disease (CAD) died from sudden cardiac death (SCD) with Left Ventricular Ejection Fraction (LVEF) as a predictor. The aim of this study was to correlate spatial QRS-T with LVEF in patients with old myocardial infarction (OMI). Methods: This is a cross-sectional study in patients with OMI that have not undergone revascularization and have achieved medical therapy. 12-lead electrocardiography (ECG) and echocardiography were done simultaneously. Spatial QRS-T angle was measured by Kors visual transform applications. Statistical analysis was performed using Pearson correlation and multivariate analysis with linear regression. Results: 46 patients meet the inclusion criteria. Baseline characteristics: mean age 58 ± 8 years, 89% male, mean spatial QRS-T was 108.72 ± 43° with mean LVEF 39.39 ± 10%. The spatial QRS-T angle and LVEF was strong negative correlation (r=-0.66, p<0.01) after adjusted with left ventricular mass index (LVMI) correlation between spatial QRS-T angle and LVEF decreasing (r=-0.57, p<0.01). The Spatial QRS-T angle and LVEF of patients with OMI is negative correlation. Conclusion: The spatial QRS-T angle and LVEF of patients with OMI had negative correlation. Spatial QRS-T angle may be an easier index for assessing cardiac dysfunction in patients with OMI.

Lead Reconstruction Using Artificial Neural Networks for Ambulatory ECG Acquisition

One of the most powerful techniques to diagnose cardiovascular diseases is to analyze the electrocardiogram (ECG). To increase diagnostic sensitivity, the ECG might need to be acquired using an ambulatory system, as symptoms may occur during a patient’s daily life. In this paper, we propose using an ambulatory ECG (aECG) recording device with a low number of leads and then estimating the views that would have been obtained with a standard ECG location, reconstructing the complete Standard 12-Lead System, the most widely used system for diagnosis by cardiologists. Four approaches have been explored, including Linear Regression with ECG segmentation and Artificial Neural Networks (ANN). The best reconstruction algorithm is based on ANN, which reconstructs the actual ECG signal with high precision, as the results bring a high accuracy (RMS Error < 13 μV and CC > 99.7%) for the set of patients analyzed in this paper. This study supports the hypothesis that it is possible to reconstruct the Standard 12-Lead System using an aECG recording device with less leads.

Change starts with me: an impact evaluation of a multiprofessional leadership programme to support primary care networks in the South East of England

PurposeThis paper aims to present the impact evaluation findings from a multiprofessional leadership programme commissioned in the South East of England to support primary care networks (PCNs) to lead system improvement together. It identifies programme impact at micro and meso system levels; a leadership impact continuum that can be used by individuals and teams to evidence impact of improvements in PCN practices; the learning and development strategies that were effective and proposes implications for other networks. Design/methodology/approachMixed methods underpinned by practice development methodology were used to explore the impact of the programme on two practitioner cohorts across 16 PCNs. Data were collected at the start, mid-point and end of the eight-month programme. FindingsResults illustrate an innovative approach to collective leadership development. A continuum of impact created with participants offers insight into the journey of transformation, recognising that “change starts with me”. The impact framework identifies enablers, attributes and consequences for measuring and leading change at micro, meso and macro levels of the health-care system. Participants learned how to facilitate change and collaboratively solve problems through peer consulting which created a safe space for individuals to discuss workplace issues and receive multiprofessional views through action learning. These activities enabled teams to present innovative projects to commissioners for service redesign, enabling their PCN to be more effective in meeting population health needs. The authors believe that this programme may provide a model for other PCNs England and other place-based care systems internationally. Originality/valueThis study offers insight into how to enable a journey of transformation for individuals and PCN teams to enhance team effectiveness and collective leadership for system-wide transformation required by the National Health Service Long Term Plan (2019). Contribution to Impact