Impact on nurse workload and patient satisfaction of atrioventricular junction ablation performed simultaneously with conduction system pacing using a superior approach from the pocket compared to the conventional femoral approach.

AIMS: Conduction system pacing (CSP) and atrioventricular junction ablation (AVJA) improve outcomes in patients with symptomatic, refractory atrial fibrillation (AF). Superior approach (SA) from the pocket, via axillary or subclavian vein, has been recently proposed as an alternative to the conventional femoral venous approach (FA) to perform AVJA. In this study we compared the impact of these alternative approaches on the nurse workload (NWL) and on patient satisfaction. METHODS AND RESULTS: Prospective, observational study, enrolling consecutive patients undergoing simultaneous CSP and AVJA. ElectrophysiologyLaboratory (EP Lab) NWL was calculated with a self-developed model. Ward NWL was calculated using the MIDENF® validated scale. Patient satisfaction was collected using the Hospital Consumer Assessment of Healthcare Provider Systems (HCAHPS) questionnaire. A total of 119 patients were enrolled: in 50, AVJA was primarily attempted with SA, in 69 from FA. Compared to FA, SA was associated with a lower EP Lab NWL (169.8±26.7 vs. 202.7±38.9 minutes; p<0.001), and a lower Ward NWL (474.5±184.8 vs. 808.6±289.9 minutes; p<0.001). Multivariate analysis identified SA as an independent predictor of lower EP Lab NWL (hazard ratio 4.60; p=0.001), and of lower Ward NWL (hazard ratio 45.13; p<0.001). Compared to FA, SA was associated with a higher patient-reported rating regarding the experience during hospital stay (p=0.035), and the overall hospital evaluation (p=0.026). CONCLUSIONS: In patients undergoing simultaneous CSP and AVJA, the use of a SA for ablation is a valid alternative to conventional FA. Compared to FA, this approach significantly reduces NWL, and is associated with greater patient satisfaction.

Leadless pacemaker versus transvenous single-chamber pacemaker therapy: peri-procedural aspects, utilization of medical resources and patient acceptance.

BACKGROUND: Leadless pacemaker (L-PM) have been developed in order to overcome the lead- and pocket-related complications associated with transvenous pacemaker (T-PM). The impact of L-PM implantation on the utilization of medical resources, patient comfort and therapy acceptance could differ from that of T-PM. RESEARCH DESIGN AND METHODS: Prospective, single-center study enrolling 243 consecutive patients undergoing PM implantation. Propensity matching for baseline characteristics yielded 77 matched pairs. Procedural data, patient acceptance (assessed by Florida Patient Acceptance Survey, FPAS) and quality of life (QoL) (assessed at the baseline, 1 week, 3 and 6 months) were compared between the two groups (L-PM and T-PM). RESULTS: The implantation procedure was longer in L-PM than T-PM patients (42.2±16.3 vs. 28.9±11.9 minutes; p<0.001). L-PM was associated with lower intra- and post-operative pain intensity (all p<0.05), shorter hospitalization (3.2±0.5 vs. 3.5±1.1 days; p=0.034), greater patient acceptance (FPAS score: 58.7±7.1 vs. 40.5±4.1; p<0.001), and better QoL on both physical and mental health scales (all p<0.05). CONCLUSIONS: Although L-PM implantation takes longer than T-PM, it is better tolerated and accepted by patients and is associated with a better QoL.

Reduced long-term overall mortality in heart failure patients with prolonged QRS treated with CRT combined with ICD vs. heart failure patients with narrow QRS treated with ICD only.

AIMS: It is not known whether heart failure (HF) patients with prolonged QRS who undergo cardiac resynchronization therapy combined with a defibrillator (CRT-D) have a prognostic advantage over HF patients with narrow QRS (therefore without indication for CRT) treated with an implantable cardioverter defibrillator (ICD) only. The aim of this study was to compare the long-term mortality of a group of HF patients with prolonged QRS receiving CRT-D with that of a similar group of patients with narrow QRS receiving ICD only. METHODS AND RESULTS: A total of 312 patients (mean age 66 ± 13 years; 84% male, mean left ventricular ejection fraction 25 ± 4%, mean New York Heart Association class 2.6 ± 0.5) were included in the analysis. Of these, 138 with a QRS complex duration ≥120 ms received a CRT-D. During follow-up, the time and cause of death were assessed. During a median follow-up of 46 months, CRT-D patients showed significantly lower overall mortality (P = 0.038). Compared with patients receiving ICD only, CRT-D patients showed lower HF mortality (P = 0.003). Coronary mortality, non-cardiac mortality, and sudden mortality were similar in both groups (all P > 0.05). A positive response to CRT was an independent predictor of reduced mortality on multivariate analysis (hazard ratio: 0.27; P = 0.047). CONCLUSION: In HF patients treated with ICD, the subgroup of patients with prolonged QRS who receive CRT-D displays better long-term survival than narrow QRS ICD recipients, owing to their reduced HF mortality.