Search Results (104)

The accelerating pace of urbanization has significantly complicated traffic management systems, leading to mounting challenges, such as persistent congestion, increased travel delays, and heightened environmental impacts. In response to these challenges, this study presents a novel deep learning framework designed to enhance short-term traffic flow prediction and support intelligent transportation systems within the context of smart cities. The proposed model integrates Gated Recurrent Units (GRUs) and Long Short-Term Memory (LSTM) networks, augmented by an attention mechanism that dynamically emphasizes relevant temporal patterns. The model was rigorously evaluated using the publicly available datasets and demonstrated substantial improvements over current state-of-the-art methods. Specifically, the proposed framework achieves a 3.75% reduction in the Mean Absolute Error (MAE), a 2.00% reduction in the Root Mean Squared Error (RMSE), and a 4.17% reduction in the Mean Absolute Percentage Error (MAPE) compared to the baseline models. The enhanced predictive accuracy and computational efficiency offer significant benefits for intelligent traffic control, dynamic route planning, and proactive congestion management, thereby contributing to the development of more sustainable and efficient urban mobility systems. Full article

Background: Left bundle branch area pacing (LBBAP) has emerged as a physiological alternative to conventional pacing, offering improved ventricular synchrony and clinical outcomes. However, extraction of deeply implanted LBBAP leads remains challenging, particularly in the context of device-related infections. Case Summary: We report two cases of successful extraction of chronically implanted LBBAP leads using a novel technique based on femoral countertraction with pigtail catheters. In the first case, a deep septal implanted 3830 lead was extracted in a patient with persistent bacteremia and suspected device-related endocarditis. Continuous traction was applied to the mid-portion of the lead using a pigtail catheter introduced via femoral access, facilitating safe removal without the use of powered sheaths proximal to the distal tip of the lead. In the second case, three leads (RA, RV, LBBAP) from a cardiac resynchronization therapy with deffibrilation support (CRT-D) system were completely removed in a patient with device extrusion and pocket erosion, using a dual pigtail approach anchored to the atrial and septal leads. Results: In both cases, the technique enabled successful extraction without complications. Procedural times were approximately 70 and 65 min, respectively. In vitro testing suggested that the pigtail catheter applied a sustained moderate traction force (~0.06 kgf), translating to an estimated pressure of 0.85–1.91 kgf/cm² at the septal lead interface. Conclusions: This case series demonstrates that LBBAP lead extraction is feasible using a novel femoral countertraction technique with pigtail catheters. Steady, moderate traction over time may provide a safer alternative to forceful subclavicular extraction, especially in chronically implanted deep septal leads. Further studies are warranted to evaluate the reproducibility, safety, and clinical applicability of this approach. Full article

Gestational diabetes mellitus (GDM) is a frequently encountered medical complication during pregnancy that is increasing at a rapid pace globally, posing significant public health concerns. Similarly, there is a rising trend in the number of women who have utilized assisted reproductive technology (ART). Numerous studies have been carried out to investigate the relationship between GDM and ART. This comprehensive systematic review seeks to identify potential biomarkers for the early diagnosis of GDM in pregnancies conceived through ART. We conducted a PubMed search covering the past five years to identify studies that explore biomarkers associated with the development of GDM in pregnancies conceived through ART. The outcome measures included human chorionic gonadotropin (HCG), the body mass index (BMI), the Follicle Stimulating Hormone to Luteinizing Hormone (FSH/LH) ratio, increased hemoglobin A1c levels, fasting insulin concentrations, homeostatic model assessment of insulin resistance (HOMA-IR), triglyceride levels, total cholesterol levels, low-density lipoprotein cholesterol concentrations, low-density lipoprotein/high-density lipoprotein (LDL/HDL), total cholesterol to high-density lipoprotein (TC/HDL), the estradiol/follicle ratio, soluble fms-like tyrosine kinase-1 (sFlt-1), Placental Growth Factor (PLGF), endometrial thickness, and psychological stress. Seventeen studies were included. The identification and development of serum or ultrasound biomarkers for the early detection of GDM in pregnancies conceived through ART pose considerable challenges. These challenges arise from the multifactorial nature of GDM, the methodological variations in ART, and the limited availability of relevant studies. The most promising biomarker identified was the estradiol/follicle ratio. Women with a higher estradiol/follicle ratio exhibited significantly lower rates of GDM. There is a pressing necessity for biomarkers to enable the early detection of GDM in pregnancies conceived through ART. E2 levels, β-hCG, and the E2/F ratio, along with the TC/HDL and LDL/HDL ratios, show potential as reliable biomarkers for identifying GDM. Full article

Objectives: This review aims to systematically evaluate the clinical outcomes of left ventricle-only fusion pacing (LV-only fCRTp) and identify evidence-based selection criteria that may optimize patient response and long-term therapeutic benefit. Background: Cardiac resynchronization therapy (CRT) is traditionally associated with biventricular pacing (BiVp). However, approximately 20–40% of patients seem to remain non-responders to this therapy. LV-only fCRTp offers a more physiological alternative by combining left ventricular epicardial pacing with the intrinsic ventricular activation wavefront. Beyond optimization strategies, the observed variability in response highlights the need for better patient selection in order to fully unlock its therapeutic potential. Methods: A systematic literature search was conducted in PubMed and Cochrane Library for original articles published up to April 2025, following PRISMA 2020 guidelines. The search focused on LV-only fCRTp performed either through standard RA/LV/RV biventricular devices or RA/LV dual-chamber systems. Results: Twenty-seven studies met the inclusion criteria. Among these, 17 studies obtained LV-only fCRTp using biventricular devices, and 10 were considered true LV-only fCRTp using RA/LV dual-chamber devices. Standard and specific selection criteria were used to qualify patients for LV-only fCRTp. Preserved atrioventricular conduction, ischemic cardiomyopathy, arrhythmic risk stratification, and the management of supraventricular arrhythmias were common overlapping parameters among studies with high variability, highlighting their potential role in response. RA/LV devices yielded consistent clinical benefits and low complication rates, particularly in nonischemic patients with stable AV conduction and low arrhythmic risk, while having a lower financial burden. Conclusions: Beyond guideline recommendations for CRT, this review identifies supplementary selection criteria that could further influence the effectiveness and stability of fusion pacing. Full article

Background: The advent of subcutaneous implantable cardioverter defibrillators (S-ICDs) marked a significant milestone in the course of cardiac rhythm devices, particularly for patients who are deemed at high risk for ventricular arrhythmias and sudden cardiac death. This extracardiac approach makes the S-ICD an especially valuable option for young patients, those with difficult venous access, or those at high risk of infection. Although the S-ICD does not provide pacing for bradycardia or heart failure, it has shown efficacy in treating ventricular arrhythmias while minimizing complications associated with transvenous systems. Methods: The purpose of this multicenter retrospective analysis was to assess the real-world efficacy and safety of the S-ICD in a heterogeneous population. Results: The GASP registry consisted of 114 patients, 68% male, aged 41 ± 15 years, with a mean LVEF of 50%. In the follow-up of 35 months, inappropriate shocks occurred in 7% while appropriate shocks occurred in 6.2%. The most common reasons for inappropriate shocks were myopotentials and atrial tachyarrhythmias. Thirty-day complication-free rates were 97.3%, with the majority of patients requiring device extraction due to infection. Over the longer term, four patients required re-intervention due to local discomfort, while one device was extracted for infection. In a multivariate analysis, complications were not significantly higher in the sicker population, such as those with diabetes, kidney disease requiring dialysis, or heart failure. Conclusions: These findings support the growing role of the S-ICD as an alternative to the TV-ICD, especially in patients without pacing indications. Full article

Background and Objectives: Leadless pacemakers provide an innovative alternative to traditional transvenous pacemakers for managing cardiac arrhythmias. The objective of this systematic review is to conduct a meta-analysis comparing acute complication and mortality rates associated with leadless pacemakers versus transvenous pacemaker placements using national-level data. Specifically, we aim to summarize the current evidence and calculate pooled odds ratios for acute overall complications, acute device-related complications, and acute mortality to assess the early safety outcomes of leadless pacemaker placement relative to traditional transvenous pacemakers. Materials and Methods: A systematic search of PubMed, Scopus, ScienceDirect, and Google Scholar was conducted by two independent researchers using a predefined search protocol. The search included articles published up to 10 October 2024, without limits on review depth. Studies were included if they provided national-level data comparing leadless pacemaker and traditional pacemaker recipients in terms of acute mortality, acute overall complications, and acute device-related complications. Outcomes were pooled to calculate odds ratios using a random-effects model in RStudio (version 2024.12.1+563). Results: A total of five studies met the eligibility criteria. The pooled odds ratio for acute mortality was 2.03 (95% CI: 0.65–6.34, I² = 99%; p < 0.01), for acute overall complications was 1.08 (95% CI: 0.45–2.61, I² = 99%; p < 0.01), and for acute device-related complications was 1.02 (95% CI: 0.23–4.44, I² = 99%; p < 0.01). Conclusions: The reviewed studies suggest that leadless pacemakers offer a promising alternative to transvenous pacemakers, offering a comparable short-term safety profile. Ongoing technological advancements may further enhance their applicability in clinical practice. Full article

Conduction system pacing started with His bundle pacing (HBP) and then rapidly switched gears into left bundle branch pacing (LBBP). We describe our center’s experience with LBBP using either lumenless leads (LLLs) or stylet-driven leads (SDLs). Patients who were admitted to two tertiary centers between 1 April 2021 and 30 June 2024 and met the guidelines for pacing were recruited and prospectively followed up. A total of 124 patients underwent permanent pacemaker (PPM) implantation using the LBBP technique with a mean follow-up of 19.7 ± 13.3 months. In total, 90 patients were implanted with LLLs and 34 with SDLs. There was no significant difference in the procedural time and final paced QRS duration, but fluoroscopy time was significantly longer in the SDLs (26.2 ± 17.7 min vs. 17.5 ± 13.0 min, respectively, p = 0.026). The on-table impedance values were also significantly higher in the LLLs, and this persisted throughout the follow-up. There were no differences in the rates of complications. The success of conduction system pacing implantation with SDLs and LLLs is comparable with reasonable safety and reliable outcomes. Good pre-implant patient selection will contribute to improved outcomes. Full article

Adult congenital heart disease (ACHD) represents a significant portion of congenital anomalies, and with improved treatments leading to an increased life expectancy, its prevalence has been increasing over the past few decades. Nonetheless, a considerable number of patients with ACHD require cardiac rhythm management devices during their lifetime. Traditionally, transvenous pacemaker placement has been the standard mode of treatment for these patients. However, some patients with ACHD have anatomical barriers that obscure this mode of treatment. Leadless pacing systems (LPSs) have changed the field of pacing. Currently, two different LPSs are available. In a real-world setting, implanting an LPS in patients after tricuspid valve (TV) surgery seems to be a straightforward procedure with a low risk of complications, with patients showing no valvular dysfunction after the intervention. LPS implantation is an option to avoid device-related complications in patients with previous TV surgery. Moreover, it has been demonstrated that even the jugular approach seems as safe as the femoral approach and could be considered an alternative implantation method for LPSs. The Aveir VR leadless pacemaker is a helix LPS with unique features, such as its capacity as a dual-chamber leadless pacemaker, the ability to map electrical parameters before releasing the device, and its possibility of being retrievable. Hereby, we present the case of Ebstein’s anomaly, atrial septal defect closure, and previous TV surgery with symptomatic intermittent advanced atrioventricular block. This case illustrates that a transjugular approach for LPSs is also feasible in patients with ACHD. Full article

Introduction: Arrhythmias are a frequent complication of pulmonary hypertension (PH). Supraventricular tachycardias (SVT) are predominantly reported and are associated with clinical deterioration and an increased mortality. In contrast, the prevalence and clinical relevance of bradycardias is largely unclear. Therefore, the aim of the present study was to determine a prevalence of bradycardias in PH patients and to outline their clinical relevance. Material and methods: Between January 2000 and June 2013, consecutive PH patients were pro- and retrospectively enrolled in two cohorts. Patients received either a 24 h or 72 h Holter ECG. Results: A total of 314 patients (58% female, mean age: 63 years) from PH groups 1–5 (39%, 11%, 19%, 28%, 3%) were included. Basic heart rhythm was sinus rhythm in 87% of patients (9% atrial fibrillation, 2% atrial flutter and 2% paced rhythm). Further arrhythmias were detected in 34% of patients (SVT: 12%, non-sustained ventricular tachycardia: 16%) with a 6% prevalence of relevant bradycardias. Atrioventricular block was revealed in 5% of patients (seven first-degree, one and three second-degree Wenckebach and Mobitz type, respectively, four third-degree), and 1% revealed sinoatrial block (one second-degree, third-degree and unspecified each). Conclusions: The prevalence of bradycardias appears to be about 5–10% in PH patients. Most of them are short and self-limiting. However, some patients experience syncope or clinical deterioration and, therefore, need specific treatment. To find these patients, long-term ECG monitoring combined with ECG-symptom correlation may be useful. Bradycardic medication should be excluded as a cause. Full article

Remote monitoring of pacemakers decreases patient complications and reduces public health expenses. The transmission of passive real-time electrograms (EGM) has been shown to increase the diagnostic yield, but this may add to the work burden. Passive EGMs provide snapshots without adjustments, while active EGMs modify pacemaker settings temporarily to encourage sensing and pacing, potentially revealing issues such as undersensing, oversensing, or loss of capture. The added value of active EGMs compared to the passive EGM remains to be shown. The objective of this multicenter observational study is to evaluate, in a large population of patients implanted with a pacemaker capable of transmitting both passive and active periodic EGMs, the added benefit of active periodic EGMs on diagnostic yield of pacemaker-related anomalies. In a retrospective analysis of 7068 EGMs from 2733 patients, active modes detected significantly more anomalies (6.7%) than passive alone (3.3%, p < 0.001), particularly for atrial leads. However, the extended duration of active EGMs (36 s versus 12 s) was the primary contributor to improved detection rates rather than the active pacing modes themselves. Our findings suggest that focusing on longer passive EGMs may enhance diagnostic yield, reducing the need for active pacing adjustments. Full article

Cardiovascular diseases (CVDs) are the leading global cause of death, impacting nations worldwide. Despite medical advancements, managing patients who require temporary pacing (TP) after cardiac surgery remains challenging. TP devices are essential for stabilizing patients with unstable arrhythmias or post-surgical complications but demand manual adjustments and precise clinician management, unlike permanent pacemakers. There is an urgent need for improved TP training and standardisation, hindered by a lack of formal guidelines and adequate protocols. Existing simulators often omit crucial haemodynamic parameters and complex clinical scenarios, limiting their effectiveness. This paper introduces an advanced Temporary Cardiac Pacing Simulator (TCPS) that provides comprehensive physiological signals and complex scenarios for realistic training. It simulates various pacing modes—atrial, ventricular, and dual-chamber—while modeling pacing failures and haemodynamic changes. Sophisticated algorithms replicate clinical responses, offering real-time feedback and dynamic visualizations to enhance learning. Additionally, an innovative feature optimises atrioventricular (AV) delay settings, crucial for improving patient outcomes in both acute and postoperative care. Full article

Background: Leadless pacemakers offer a safe and effective alternative pacing strategy. However, limited data are available for patients with end stage renal disease (ESRD), a population of significant relevance. Methods: Using the Nationwide Readmission Database, we extracted data from all adult patients with ESRD who underwent traditional transvenous or leadless pacemaker implantation between 2016 and 2021. We compared in-hospital mortality, 30-day readmission rates, complication rates, and healthcare resource utilization between the two cohorts. Results: A total of 6384 (81.2%) patients were included in the transvenous pacemaker cohort, and 1481(18.8%) patients were included in the leadless pacemaker cohort. In patients with ESRD, leadless pacemaker implantation was linked to higher in-hospital complications when compared to transvenous pacemakers. These included the need for blood transfusion (aOR 1.85, 95% CI 1.32–2.60, p < 0.01), vascular complications (aOR 3.6, CI 1.40–9.26, p = 0.01), and cardiac complications (aOR 4.12, CI 1.70–9.98, p < 0.01). However, there were no differences between the two groups in terms of in-hospital mortality and 30-day readmission rates. The median length of stay was longer for leadless pacemaker implantation than transvenous pacemaker implantation (5 days vs. 4 days, p < 0.01). The total hospitalization charges were also higher ($139,826 vs. $93,919, p < 0.01). Conclusions: Although previous studies have demonstrated lower long-term complication rates with leadless pacemakers than transvenous pacemakers, our analysis shows a higher risk of short-term in-hospital complications in ESRD patients, though no differences in in-hospital mortality and 30-day readmissions. Full article

Background and Objectives: Computer-aided diagnostic systems have achieved remarkable success in the medical field, particularly in diagnosing malignant tumors, and have done so at a rapid pace. However, the generalizability of the results remains a challenge for researchers and decreases the credibility of these models, which represents a point of criticism by physicians and specialists, especially given the sensitivity of the field. This study proposes a novel model based on deep learning to enhance lung cancer diagnosis quality, understandability, and generalizability. Methods: The proposed approach uses five computed tomography (CT) datasets to assess diversity and heterogeneity. Moreover, the mixup augmentation technique was adopted to facilitate the reliance on salient characteristics by combining features and CT scan labels from datasets to reduce their biases and subjectivity, thus improving the model’s generalization ability and enhancing its robustness. Curriculum learning was used to train the model, starting with simple sets to learn complicated ones quickly. Results: The proposed approach achieved promising results, with an accuracy of 99.38%; precision, specificity, and area under the curve (AUC) of 100%; sensitivity of 98.76%; and F1-score of 99.37%. Additionally, it scored a 00% false positive rate and only a 1.23% false negative rate. An external dataset was used to further validate the proposed method’s effectiveness. The proposed approach achieved optimal results of 100% in all metrics, with 00% false positive and false negative rates. Finally, explainable artificial intelligence (XAI) using Gradient-weighted Class Activation Mapping (Grad-CAM) was employed to better understand the model. Conclusions: This research proposes a robust and interpretable model for lung cancer diagnostics with improved generalizability and validity. Incorporating mixup and curriculum training supported by several datasets underlines its promise for employment as a diagnostic device in the medical industry. Full article

Background: A leadless pacemaker (LP) is a modern alternative to a transvenous pacemaker, allowing certain complications to be avoided; however, some cannot be eliminated. Aim: To highlight the essential role of advanced speckle-tracking echocardiography (STE) in diagnosing pacing-induced cardiomyopathy (PICM) caused by an LP. Clinical case: A 79-year-old male, after LP implantation a year earlier, was admitted due to heart failure (HF). Left ventricular ejection fraction (LVEF) was 40%, global longitudinal strain (GLS) was −10%, and interventricular mechanical delay (IVMD) was 42 ms. All these parameters were significantly better before the operation. Myocardial work indices confirmed dyssynchrony due to the right ventricular (RV) stimulation pattern, and PICM was considered. To verify the impact of RV pacing on the LV, measurements were taken after restoring the native rhythm, showing an improvement in LVEF (45%), GLS (−13%), IVMD (7 ms), and myocardial work indices. After the next HF exacerbation with further deterioration of the LV function, a decision to convert the LP to a standard CRT-P system was made, with immediate relief in clinical symptoms and improved echocardiographic parameters. Conclusions: This case highlights the essential role of STE echocardiography in identifying the detrimental impact of RV pacing, diagnosing PICM, and selecting the appropriate treatment for patients with LPs. Full article

Permanent pacemaker implantation is a low-risk procedure. However, complications may occur at a rate of around 4–8%. We present a case where initial implantation resulted in complications that could have been avoided by meticulous assessment of lead position in different projections and early post-procedure X-ray that would have delineated other serious complications. We present a case where the right ventricular lead was placed in the coronary sinus, which resulted in the loss of pacing capture with further syncope after the pacemaker implant. This was apparent in the post-procedure electrocardiogram (ECG) with right bundle branch pacing and the lead was repositioned in the right ventricular apex the following day. Furthermore, the patient was discharged home without a chest X-ray (CXR), and she represented a week later with a haemo-pneumothorax and pericardial effusion. A chest drain was placed and was discharged after a slow recovery following several complications that could have been avoidable. Full article