Nima Hatam

Objectives: Cardiopulmonary bypass (CPB) priming may influence haemodilution, bleeding, and end-organ injury during HeartMate 3 (HM3) implantation, but evidence in contemporary left ventricular assist device (LVAD) surgery is limited. Methods: We retrospectively analysed 92 HM3 implantations (2015-2025) by priming strategy (blood-based [FFP + RBC], n = 36; crystalloid, n = 56). The primary end-point was postoperative right heart failure (RHF; Interagency Registry for Mechanically Assisted Circulatory Support [INTERMACS]). Multivariable regression and propensity score-based inverse probability of treatment weighting (IPTW) sensitivity analyses were performed. Results: Baseline characteristics were balanced between groups, with comparable age (blood-based: 58 [49.5-66.0]; crystalloid: 62 [55.8-68.2]; P = .069) and female sex (blood-based: n = 3/36 [8.3%]; crystalloid: n = 8/56 [14.3%]; P = .518). Right heart failure was lower with blood-based priming (blood-based: n = 3/36 [8.3%]; crystalloid: n = 17/56 [30.4%]; P = .012; adjusted OR 0.23 [95% confidence interval (CI) 0.06-0.86]; P = .030). Dialysis was lower unadjusted (blood-based: n = 4/36 [11.1%]; crystalloid: n = 18/56 [32.1%]; P = .021), with a directionally lower adjusted estimate (OR 0.30 [95% CI, 0.09-1.01]; P = .053). Delirium was lower with blood-based priming (blood-based: n = 3/36 [8.3%]; crystalloid: n = 16/56 [28.6%]; P = .019; adjusted OR 0.22 [95% CI, 0.06-0.84]; P = .027). Survival did not differ significantly (log-rank P = .055; adjusted HR 0.59 [95% CI, 0.27-1.32]; P = .201). IPTW analyses showed lower delirium (OR 0.23 [95% CI, 0.06-0.84]) and an attenuated RHF association (OR 0.35 [95% CI, 0.10-1.23]). Conclusions: Blood-based CPB priming was associated with lower RHF and delirium, and directionally lower dialysis rates, after HM3 implantation. Survival estimates were not statistically significant. Findings require prospective validation. Clinical registration number: Ethics Committee of the Medical Faculty of RWTH Aachen (EK 25-154).

Objectives: Acute intermediate–high-risk pulmonary embolism (PE) is associated with right-ventricular (RV) dysfunction, biomarker elevation, and risk of early clinical deterioration. Ultrasound-assisted catheter-directed thrombolysis (USAT) using the Eko Sonic Endovascular System (EKOS) system is increasingly used in selected patients; however, real-world data on physiological response and clinically relevant in-hospital outcomes remain limited. Methods: We conducted a retrospective single-centre analysis of 128 consecutive patients with acute intermediate–high-risk PE treated with EKOS-guided USAT within a structured Pulmonary Embolism Response Team (PERT) pathway between August 2017 and December 2023. Changes in RV/LV ratio, B-type natriuretic peptide (BNP), and cardiac troponin before and after intervention were assessed. A composite end-point of death, extracorporeal membrane oxygenation (ECMO), renal replacement therapy, or invasive mechanical ventilation captured clinically meaningful deterioration. Multivariable logistic regression identified determinants of the composite end-point. Results: RV/LV ratio and biomarkers improved significantly after intervention. Median RV/LV ratio decreased from 1.6 to 1.0, and BNP declined from 2365 to 877 pg/mL (both P < .001). Clinically meaningful in-hospital deterioration requiring escalation of organ support occurred in a subset of patients and was predominantly associated with baseline disease severity. Short-term survival remained favourable (60-day probability 96.9%). Conclusions: In this real-world, PERT-guided cohort, EKOS was associated with rapid physiological improvement and favourable short-term survival in patients with intermediate–high-risk PE. These findings should be interpreted as descriptive single-centre experience.

Background: Systemic thrombolysis for intermediate-high and high-risk pulmonary embolism (PE) is limited by major bleeding risk. Ultrasound-facilitated catheter-directed thrombolysis (USAT) enables targeted fibrinolysis with lower thrombolytic doses, but comparative effectiveness data are often confounded by selection bias. We aimed to evaluate the safety and efficacy of USAT versus conventional therapy (anticoagulation or systemic thrombolysis) in a propensity score-matched cohort of patients managed within a multidisciplinary Pulmonary Embolism Response Team (PERT) pathway. Methods: We performed a retrospective study of 230 consecutive patients within a multidisciplinary PERT pathway. Patients received USAT using the EkoSonic Endovascular System or conventional therapy consisting of anticoagulation or systemic lysis. One-to-one propensity score matching (PSM) was performed, adjusting for age, sex, Pulmonary Embolism Severity Index (PESI), chronic kidney disease, history of deep vein thrombosis, obesity, and baseline troponin. A doubly robust logistic regression (PSM plus regression adjustment) was used to account for residual imbalance in left heart failure. Results: PSM yielded 81 matched pairs. USAT was associated with significantly lower in-hospital mortality (2.5% vs. 17.3%, P=0.003) and shorter hospital stay (13.0 vs. 17.5 days, P=0.008). Doubly robust post-match logistic regression confirmed USAT as an independent predictor of survival (adjusted odds ratio 0.17, P=0.007). Regarding safety, USAT had significantly fewer International Society on Thrombosis and Hemostasis (ISTH) major bleeding events (1.2% vs. 11.1%, P=0.02), whereas clinically relevant non-major bleeding was more common (17.3% vs. 1.2%, P30 kg/m²), USAT showed a similar mortality signal (3.1% vs. 33.3%, P=0.02). Conclusions: USAT was associated with lower in-hospital mortality and shorter hospital stay compared with conventional therapy. USAT was also associated with fewer major bleeding events, whereas clinically relevant non-major bleeding was more frequent. Exploratory subgroup analysis in obese patients suggested a similar mortality signal.

A reliable method of measuring diaphragmatic function at the bedside is still lacking. Widely used two-dimensional (2D) ultrasonographic measurements, such as diaphragm excursion, diaphragm thickness, and fractional thickening (FT) have failed to show clear correlations with diaphragmatic function. A reason for this is that 2D ultrasonographic measurements, like FT, are merely able to measure the deformation of muscular diaphragmatic tissue in the transverse direction, while longitudinal measurements in the direction of contracting muscle fibres are not possible. Speckle tracking ultrasonography, which is widely used in cardiac imaging, overcomes this disadvantage and allows observations of movement in the direction of the contracting muscle fibres, approximating muscle deformation and the deformation velocity. Several studies have evaluated speckle tracking as a promising method to assess diaphragm contractility in healthy subjects. This technical note demonstrates the feasibility of speckle tracking ultrasonography of the diaphragm in a group of 20 patients after an aortocoronary bypass graft procedure. The results presented herein suggest that speckle tracking ultrasonography is able to depict alterations in diaphragmatic function after surgery better than 2D ultrasonographic measurements.

Long‐Term Cardiac Neurostimulation. Introduction: The right inferior ganglionated plexus (RIGP) selectively innervates the atrioventricular node. Temporary electrical stimulation of this plexus reduces the ventricular rate during atrial fibrillation (AF). We sought to assess the feasibility of chronic parasympathetic stimulation for ventricular rate control during AF with a nonthoracotomy intracardiac neurostimulation approach. Methods and Results: In 9 mongrel dogs, the small endocardial area inside the right atrium, which overlies the RIGP, was identified by 20 Hz stimulation over a guiding catheter with integrated electrodes. Once identified, an active‐fixation lead was implanted. The lead was connected to a subcutaneous neurostimulator. An additional dual‐chamber pacemaker was implanted for AF induction by rapid atrial pacing and ventricular rate monitoring. Continuous neurostimulation was delivered for 1–2 years to decrease the ventricular rate during AF to a range of 100–140 bpm. Implantation of a neurostimulation lead was achieved within 37 ± 12 min. The latency of the negative dromotropic response after on/offset or modulation of neurostimulation was Conclusion: Chronic parasympathetic stimulation can be achieved via a cardiac neurostimulator. The approach is safe, effective, and well tolerated in the long term. The atrioventricular nodal selectivity and the opportunity to adjust the negative dromotropic effect within seconds may represent an advantage over pharmacological rate control. (J Cardiovasc Electrophysiol, Vol. 21, pp. 193‐199, February 2010)

A novel magnetic navigation system allows remote steering of guidewires and catheters. This system may be used for left ventricular lead placement for cardiac resynchronization therapy (CRT). We sought to evaluate the feasibility and safety of magnetic guidewire navigation for CRT procedures. 123 consecutive patients underwent CRT implantation/revision procedures (including pacemaker upgrades in n=22 and left ventricular lead placement after dislocation in n=4 patients). Left ventricular lead placement in a coronary sinus side branch was performed either conventionally or using magnetic navigation. The magnetic navigation system (Niobe) consists of two permanent magnets creating a steerable magnetic field. Guidewires with integrated magnets align to the magnetic field and were used for over-the-wire implantation of pacemaker leads in the coronary sinus. Patients were assigned to conventional (n=93) or magnetic (n=30) navigation according to room availability. Venography of the coronary venous system was performed to select a target vessel for lead implantation. Guidewire access to the target vessel was achieved in 100% using magnetic navigation compared to 87% with the conventional approach (P < 0.05). Implantation success rates, total procedure and fluoroscopy times did not differ significantly between groups. No periprocedural death and no intraoperative device dysfunction occurred in either group.The magnetic guidewire ruptured in one patient. Left ventricular lead placement using magnetic guidewire navigation to engage the desired coronary sinus side branch can be successfully performed for CRT.