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Sciaraffia, Elena
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Publications (10 of 31) Show all publications
Kommata, V., Sciaraffia, E. & Blomström-Lundqvist, C. (2023). Epicardial conduction abnormalities in patients with Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) and mutation positive healthy family members – a study using electrocardiographic imaging. PLOS ONE, 18(1), Article ID e0280111.
Open this publication in new window or tab >>Epicardial conduction abnormalities in patients with Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) and mutation positive healthy family members – a study using electrocardiographic imaging
2023 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 18, no 1, article id e0280111Article in journal (Refereed) Published
Abstract [en]

Background: The diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC) in early stages is challenging. The aim was therefore to study whether electrocardiographic imaging (ECGI) can detect epicardial depolarization changes in ARVC patients and healthy mutation-carriers (M-carriers).

Method: Twelve ARVC patients, 20 M-carriers and 8 controls underwent 12-lead ECG, signal-averaged ECG, 2-dimensional echocardiography, 24-hours Holter monitoring and ECGI (body surface mapping and computer tomography with offline analysis of reconstructed epicardial signals). Total and Right Ventricular Activation Time (tVAT and RVAT respectively), area of Ventricular Activation during the terminal 20 milliseconds (aVAte20) and the activation patterns were compared between groups.

Results: In ARVC patients the locations of aVAte20 were scattered or limited to smaller RV parts versus in controls, in whom aVAte20 was confined to RVOT and LV base (+/- RV base). ARVC patients had smaller aVAte20 (35cm2 vs 87cm2, p<0.05), longer tVAT (99msec vs 58msec, p<0.05) and longer RVAT (66msec vs 43msec, p<0.05) versus controls. In 50% of M-carriers, the locations of aVAte20 were also eccentric. This sub-group presented smaller aVAte20 (53cm2 vs 87cm2, p= 0.009), longer RVAT (55msec vs 48msec, p=0.043), but similar tVAT (65msec vs 60msec, p=0.529) compared with the M-carriers with normal activation pattern.

Conclusions: The observation of localized delayed epicardial conduction in the RV in M-carriers suggests an early stage of ARVC and may be a useful diagnostic marker enhancing an early detection of the disease.

Place, publisher, year, edition, pages
Public Library of Science (PLoS), 2023
Keywords
Arrhythmogenic Right Ventricular Cardiomyopathy, diagnosis, gene carriers, electrocardiographic imaging
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:uu:diva-473210 (URN)10.1371/journal.pone.0280111 (DOI)000945431500001 ()36603020 (PubMedID)
Available from: 2022-04-22 Created: 2022-04-22 Last updated: 2023-04-03Bibliographically approved
Ostrowska, B., Lind, L., Sciaraffia, E. & Blomström-Lundqvist, C. (2023). Response to Letter by Kataoka and Imamura Regarding Article, "Short P-Wave Duration Is Associated with Incident Atrial Fibrillation" [Letter to the editor]. International Heart Journal, 64(2), 327-328
Open this publication in new window or tab >>Response to Letter by Kataoka and Imamura Regarding Article, "Short P-Wave Duration Is Associated with Incident Atrial Fibrillation"
2023 (English)In: International Heart Journal, ISSN 1349-2365, E-ISSN 1349-3299, Vol. 64, no 2, p. 327-328Article in journal, Letter (Other academic) Published
Place, publisher, year, edition, pages
International Heart Journal (Japanese Heart Journal), 2023
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-502403 (URN)10.1536/ihj.22-454 (DOI)000974582800028 ()36927933 (PubMedID)
Available from: 2023-05-25 Created: 2023-05-25 Last updated: 2023-05-25Bibliographically approved
Ostrowska, B., Lind, L., Sciaraffia, E. & Blomström-Lundqvist, C. (2022). A short P-wave duration is associated with incident heart failure in the elderly: a 15 years follow-up cohort study. Journal of Geriatric Cardiology, 19(9), 643-650
Open this publication in new window or tab >>A short P-wave duration is associated with incident heart failure in the elderly: a 15 years follow-up cohort study
2022 (English)In: Journal of Geriatric Cardiology, ISSN 1671-5411, Vol. 19, no 9, p. 643-650Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Early identification of patients at risk of congestive heart failure (HF) may alter their poor prognosis. The aim was therefore to test whether simple electrocardiographic variables, the P-wave and PR-interval, could predict incident HF.

METHODS: The PIVUS (Prospective Investigation of the Vasculature in Uppsala Seniors) study (1016 individuals all aged 70 years, 50% women) was used to identify predictors of HF. Subjects with prevalent HF, QRS duration z >= 130 ms, atrial tachyarrhythmias, implanted pacemaker/defibrillator, second- and third-degree atrioventricular block or delta waves at baseline were excluded. Cox proportional hazard analysis was used to relate the PR interval, P-wave duration (Pdur) and amplitude (Pamp), measured in lead V1, to incident HF. Adjustment was performed for gender, RR-interval, beta-blocking agents, systolic blood pressure, body mass index and smoking.

RESULTS: Out of 836 subjects at risk, 107 subjects were diagnosed with HF during a follow-up of 15 years. In the multivariate analysis, there was a strong U-shaped correlation between Pdur in lead V1 and incident HF (P= 0.0001) which was significant for a Pdur < 60 ms [HR = 2.75; 95% CI: 1.87-4.06, at Pdur 40 ms] but not for prolonged Pdur. There was no significant relationship between incident HF and the PR-interval or the Pamp. A Pdur < 60 ms improved discrimination by 3.7% when added to the traditional risk factors including sex, RR-interval, beta-blocking agents, systolic blood pressure, BMI and smoking (P= 0.048).

CONCLUSIONS: A short Pdur, an easily measured parameter on the ECG, may potentially be a useful marker of future HF, enabling its early detection and prevention, thus improving outcomes.

Place, publisher, year, edition, pages
Science Press, 2022
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-490898 (URN)10.11909/j.issn.1671-5411.2022.09.008 (DOI)000890664500002 ()36284675 (PubMedID)
Available from: 2022-12-19 Created: 2022-12-19 Last updated: 2024-01-09Bibliographically approved
Kommata, V., Sciaraffia, E. & Blomström-Lundqvist, C. (2022). Repolarisation abnormalities unmasked with a 252-lead BSM system in patients with ARVC and healthy Gene Carriers. Pacing and Clinical Electrophysiology, 45(4), 509-518
Open this publication in new window or tab >>Repolarisation abnormalities unmasked with a 252-lead BSM system in patients with ARVC and healthy Gene Carriers
2022 (English)In: Pacing and Clinical Electrophysiology, ISSN 0147-8389, E-ISSN 1540-8159, Vol. 45, no 4, p. 509-518Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Diagnosing Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) at an early stage can be challenging even after ECG recording and a combination of several imaging techniques. The purpose of this study was to explore if a Body Surface Mapping (BSM) system with 252-leads could identify repolarization abnormalities and thereby diagnose early stages of ARVC.

METHODS: ARVC patients, gene carriers without signs of ARVC and controls underwent a 12 lead resting ECG, signal-averaged ECG, echocardiography, 24-hours Holter monitoring and BSM with electrocardiographic imaging (ECGI). All 252-leads, divided into four quadrants of the vest, were analyzed regarding concordances between T wave polarity and QRS main vector.

RESULTS: Of 40 patients included there were 12 ARVC patients, 20 gene carriers and 8 controls. The ARVC patients had two different repolarization patterns, one with more pronounced negative T waves at the lower left panel and another with mixed changes that clearly differed from the controls, all of whom had a normal 12 lead ECGs and consistent repolarization patterns on their BSM recordings. The patterns observed in ARVC patients were also present in 5/20 (25%) gene carriers, three of whom had normal resting ECG. A novel repolarization index successfully detected all ARVC patients and 88% of gene carriers with pathologic repolarization pattern.

CONCLUSIONS: The finding that abnormal repolarization patterns could be unmasked by BSM in 25% of healthy gene carriers, suggests that it may potentially be a useful tool for identifying early manifestations of ARVC. Further and larger studies are warranted to assess its diagnostic accuracy.

Place, publisher, year, edition, pages
John Wiley & Sons, 2022
Keywords
Arrhythmogenic, Body Surface Mapping, Cardiomyopathy, Right Ventricular, repolarization
National Category
Medical and Health Sciences
Research subject
Cardiology
Identifiers
urn:nbn:se:uu:diva-467328 (URN)10.1111/pace.14456 (DOI)000768411000001 ()35077593 (PubMedID)
Funder
Erik, Karin och Gösta Selanders FoundationMedtronic, SwedenSwedish Heart Lung Foundation, 20150751
Available from: 2022-02-10 Created: 2022-02-10 Last updated: 2022-09-05Bibliographically approved
Ostrowska, B., Lind, L., Sciaraffia, E. & Blomström-Lundqvist, C. (2022). Short P-Wave Duration Is Associated with Incident Atrial Fibrillation: A Registry-Based Cohort Study. International Heart Journal, 63(4), 700-707
Open this publication in new window or tab >>Short P-Wave Duration Is Associated with Incident Atrial Fibrillation: A Registry-Based Cohort Study
2022 (English)In: International Heart Journal, ISSN 1349-2365, E-ISSN 1349-3299, Vol. 63, no 4, p. 700-707Article in journal (Refereed) Published
Abstract [en]

Atrial fibrillation (AF) is common and increases the risk for stroke and heart failure (HF). The early identification of patients at risk may prevent the development of AF and improve prognosis. This study, therefore, aimed to test the effect of the association between P-wave and PR-interval on the ECG and incident AF. The PIVUS (Prospective Investigation of the Vasculature in Uppsala Seniors) study (1016 individuals all aged 70 years; 50% women) was used to identify whether the ECG variables P-wave duration (Pdur) and PR-duration in lead V1 were related to new-onset AF. Exclusion criteria were prevalent AF, QRS-duration >= 130 milliseconds (msec), atrial tachyarrhythmias and implanted pacemaker/defibrillator. Cox proportional-hazards models were used for analyses. Adjustments were made for gender, RR-interval, beta-blocking agents, systolic blood pressure, body mass index, and smoking. Of 877 subjects at risk, 189 individuals developed AF during a 15-year follow-up. There was a U-shaped relationship between the Pdur and incident AF (P = 0.017) following multiple adjustment. Values below 60 msec were significantly associated with incident AF, with a hazard ratio of 1.55 (95% confidence interval 1.15-2.09) for a Pdur <= 42 msec. There was no significant relationship between incident AF and the PR-interval. A short Pdur derived from the ECG in V1 may be a useful marker for new-onset AF, enabling the early identification of at-risk patients.

Place, publisher, year, edition, pages
INT HEART JOURNAL ASSOC, 2022
Keywords
Short P-wave as predictor, P-wave in atrial fibrillation, P-wave indices, New-onset atrial fibrillation
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-483749 (URN)10.1536/ihj.21-797 (DOI)000838185800008 ()35831146 (PubMedID)
Available from: 2022-09-05 Created: 2022-09-05 Last updated: 2024-01-09Bibliographically approved
Jansson, V., Bergfeldt, L., Schwieler, J., Kennebäck, G., Rubulis, A., Jensen, S. M., . . . Blomström-Lundqvist, C. (2021). Atrial fibrillation burden, episode duration and frequency in relation to quality of life in patients with implantable cardiac monitor. IJC Heart & Vasculature, 34, Article ID 100791.
Open this publication in new window or tab >>Atrial fibrillation burden, episode duration and frequency in relation to quality of life in patients with implantable cardiac monitor
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2021 (English)In: IJC Heart & Vasculature, E-ISSN 2352-9067, Vol. 34, article id 100791Article in journal (Refereed) Published
Abstract [en]

Aims: To assess the relation between atrial fibrillation (AF) characteristics and health-related quality of life (QoL), and which AF characteristic had the greatest impact.

Method: The AF characteristics burden (percentage of time in AF), duration and number of AF episodes/month were obtained from implantable cardiac monitors during the 2-month run-in period in 150 patients included in the randomized CAPTAF trial comparing early ablation and antiarrhythmic drug therapy. The QoL was measured by the General Health and Vitality dimensions of the 36-Item Short-Form Health Survey. AF characteristics were analysed continuously and in quartiles (Q1-Q4).

Results: Greater AF burden (p = 0.003) and longer AF episodes (p = 0.013) were associated with impaired QoL (Vitality score only) in simple linear regression analyses. Greater AF burden was, however, the only AF characteristic associated with lower QoL, when adjusted for sex, type of AF, hypertension, heart rate above 110 beats per minute during AF, and beta-blocker use in multiple linear regression analyses. For every 10% increase in AF burden there was a 1.34-point decrease of Vitality score (95% confidence interval (CI) -2.67 to -0.02, p = 0.047). The Vitality score was 12 points lower (95% CI -22.73 to -1.27, p = 0.03) in patients with an AF burden > 33% (Q4) versus those with < 0.45% (Q1), but only in unadjusted analysis.

Conclusion: AF burden had a greater impact on QoL (Vitality), than the duration and number of AF episodes, corroborating that AF burden may be the preferred outcome measure of rhythm control in trials including relatively healthy AF populations.

Keywords
Atrial fibrillation, Atrial fibrillation burden, Health-related quality of life, Implantable cardiac monitor, Loop recorder, Randomized
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:uu:diva-444462 (URN)10.1016/j.ijcha.2021.100791 (DOI)000667480400024 ()34036145 (PubMedID)
Funder
Swedish Heart Lung Foundation, 20150751Swedish Research Council, 2014-36708-117759-70Erik, Karin och Gösta Selanders FoundationMedtronic, Sweden
Available from: 2021-06-07 Created: 2021-06-07 Last updated: 2023-07-28Bibliographically approved
Kommata, V., Elshafie, M., Sciaraffia, E., Perez, M. D., Augustine, R. & Blomström-Lundqvist, C. (2021). QRS dispersion detected in ARVC patients and healthy gene carriers using 252-leads body surface mapping: an explorative study of a potential diagnostic tool for arrhythmogenic right ventricular cardiomyopathy. Pacing and Clinical Electrophysiology, 44(8), 1355-1364
Open this publication in new window or tab >>QRS dispersion detected in ARVC patients and healthy gene carriers using 252-leads body surface mapping: an explorative study of a potential diagnostic tool for arrhythmogenic right ventricular cardiomyopathy
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2021 (English)In: Pacing and Clinical Electrophysiology, ISSN 0147-8389, E-ISSN 1540-8159, Vol. 44, no 8, p. 1355-1364Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The diagnosis of ARVC remains complex requiring both imaging and electrocardiographic (ECG) techniques. The purpose was therefore to investigate whether QRS dispersion assessed by body surface mapping (BSM) could be used to detect early signs of ARVC, particularly in gene carriers.

METHODS: ARVC patients, gene carriers without a history of arrhythmias or structural cardiac changes and healthy controls underwent 12-lead resting ECG, signal-averaged ECG, echocardiographic examination, 24-hours Holter monitoring, and BSM with electrocardiographic imaging. All 252-leads BSM recordings and 12-leads ECG recordings were manually analyzed for QRS durations and QRS dispersion.

RESULTS: Eight controls, 12 ARVC patients with definite ARVC and 20 healthy gene carriers were included. The ECG-QRS dispersion was significantly greater in ARVC patients (42 vs. 25 ms, p < .05), but failed to fully differentiate them from controls. The BSM-derived QRS dispersion was also significantly greater in ARVC patients versus controls (65 vs. 29 ms, p < .05) and distinguished 11/12 cases from controls using the cut-off 40msec. The BSM derived QRS dispersion was abnormal (> 40 ms) in 4/20 healthy gene carriers without signs of ARVC, which may indicate early depolarization changes.

CONCLUSIONS: QRS dispersion, when assessed by BSM versus 12-lead ECG, seem to better distinguish ARVC patients from controls, and could potentially be used to detect early ARVC in gene carriers. Further studies are required to confirm the value of BSM-QRS dispersion in this respect.

Keywords
QRS dispersion, arrhythmogenic, cardiomyopathy, right ventricular
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:uu:diva-451797 (URN)10.1111/pace.14295 (DOI)000671574700001 ()34109638 (PubMedID)
Funder
Swedish Heart Lung FoundationMedtronic, SwedenErik, Karin och Gösta Selanders Foundation
Available from: 2021-08-30 Created: 2021-08-30 Last updated: 2022-04-24Bibliographically approved
Jansson, V., Schwieler, J., Bergfeldt, L., Kennebäck, G., Jensen, S. M., Sciaraffia, E. & Blomström-Lundqvist, C. (2021). The results of health-related quality of life assessment depend on the prevailing rhythm at the assessment: Experience from the CAPTAF trial (Catheter Ablation Compared with Pharmacological Therapy for Atrial Fibrillation). Cardiovascular Electrophysiology, 32(8), 2159-2164
Open this publication in new window or tab >>The results of health-related quality of life assessment depend on the prevailing rhythm at the assessment: Experience from the CAPTAF trial (Catheter Ablation Compared with Pharmacological Therapy for Atrial Fibrillation)
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2021 (English)In: Cardiovascular Electrophysiology, ISSN 1045-3873, E-ISSN 1540-8167, Vol. 32, no 8, p. 2159-2164Article in journal (Refereed) Published
Abstract [en]

AIMS: To assess whether the prevailing rhythm at the time of replying to symptom and health-related quality of life (HR-QoL) questionnaires impacts the findings.

METHOD: A total of 150 patients from the randomized Catheter Ablation Compared with Pharmacological Therapy for Atrial Fibrillation-trial, comparing atrial fibrillation (AF) ablation versus drugs, were included. The effect of the prevailing rhythm on the outcome results of the HR-QoL 36-Item Short-Form Health Survey, the symptom severity questionnaire (SSQ), and the European Heart Rhythm Association (EHRA) score for classification of AF-related symptoms was assessed.

RESULTS: AF as the prevailing rhythm was independently associated with a significantly lower Vitality score; 18.4 points lower (95% confidence interval -32.7 to -4.1, p = .01) compared with sinus rhythm when adjusted for AF burden, median duration of episode, number of episodes, beta-blocker use, type of AF, and sex. The presence of AF did not affect the General Health score compared with sinus rhythm, nor did it influence symptoms assessed by the SSQ or EHRA score.

CONCLUSION: The observation that the presence of AF versus sinus rhythm when conducting HR-QoL tests had a negative impact on its outcome, leaving symptom-related questionnaires unaffected, implies that the prevailing rhythm should be taken into account when results of HR-QoL questionnaires are interpreted.

Place, publisher, year, edition, pages
John Wiley & Sons, 2021
Keywords
atrial fibrillation, health-related quality of life, implantable loop recorders, rhythm
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:uu:diva-451796 (URN)10.1111/jce.15147 (DOI)000671864200001 ()34223671 (PubMedID)
Funder
Swedish Research Council, 2014-36708-117759-70Swedish Heart Lung Foundation, 20150751Medtronic, Sweden, 1787
Available from: 2021-08-30 Created: 2021-08-30 Last updated: 2024-01-15Bibliographically approved
Normand, C., Linde, C., Bogale, N., Blomström-Lundqvist, C., Auricchio, A., Stellbrink, C., . . . Dickstein, K. (2019). Cardiac resynchronization therapy pacemaker or cardiac resynchronization therapy defibrillator: what determines the choice?-findings from the ESC CRT Survey II. Europace, 21(6), 918-927
Open this publication in new window or tab >>Cardiac resynchronization therapy pacemaker or cardiac resynchronization therapy defibrillator: what determines the choice?-findings from the ESC CRT Survey II
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2019 (English)In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 21, no 6, p. 918-927Article in journal (Refereed) Published
Abstract [en]

AIMS: The decision to implant a cardiac resynchronization therapy pacemaker (CRT-P) or a cardiac resynchronization therapy defibrillator (CRT-D) may be challenging. There are no clear guideline recommendations as no randomized study of cardiac resynchronization therapy (CRT) has been designed to compare the effects of CRT-P with those of CRT-D on patients' outcomes. In the CRT Survey II, we studied patient and implantation centre characteristics associated with the choice of CRT-P vs. CRT-D.

METHODS AND RESULTS: Clinical practice data from 10 692 patients undergoing CRT implantation of whom 7467 (70%) patients received a CRT-D and 3225 (30%) received a CRT-P across 42 ESC countries were collected and analysed between October 2015 and January 2017. Factors favouring the selection of CRT-P implantation included age >75 years, female gender, non-ischaemic heart failure (HF) aetiology, New York Heart Association functional Class III/IV symptoms, left ventricular ejection fraction >25%, atrial fibrillation, atrioventricular (AV) block II/III, and implantation in a university hospital.

CONCLUSION: In a large cohort from the CRT Survey II, we found that patients allocated to receive CRT-P exhibited particular phenotypes with more symptomatic HF, more frequent comorbidities, advanced age, female gender, non-ischaemic HF aetiology, atrial fibrillation, and evidence of AV block. There were substantial differences in the proportion of patients allocated to receive CRT-P vs. CRT-D between countries.

Keywords
Cardiac resynchronization therapy, Cardiac resynchronization therapy defibrillator, Cardiac resynchronization therapy pacemaker, Heart failure, Implantable cardioverter-defibrillator
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:uu:diva-385414 (URN)10.1093/europace/euz002 (DOI)000471244000019 ()31157387 (PubMedID)
Available from: 2019-06-13 Created: 2019-06-13 Last updated: 2019-07-05Bibliographically approved
Steen, T., Sciaraffia, E., Normand, C., Bogale, N., Dickstein, K., Linde, C. & Philbert, B. T. (2019). Contemporary practice of CRT implantation in Scandinavia compared to Europe. Scandinavian Cardiovascular Journal, 53(1), 9-13
Open this publication in new window or tab >>Contemporary practice of CRT implantation in Scandinavia compared to Europe
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2019 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 53, no 1, p. 9-13Article in journal (Refereed) Published
Abstract [en]

Objectives: To compare the contemporary practice of CRT implantation in Scandinavia and Europe.

Design: We used data from The European CRT Survey II to highlight similarities and differences in the practice of CRT implantation between Europe (EUR) and Scandinavia (SCAND) and between the Scandinavian countries Denmark, Norway and Sweden. Implant data from the national pacemaker registries were used to calculate coverage.

Results: The coverage was 24% in SCAND and 11% in EUR. SCAND patients were more often referred from another centre and follow-up was less often to be performed at the operating centre. Telemonitoring was more commonly used. More patients had AV-block or pacemaker dependency/expected high RV pacing percentage as indication for CRT. A CRT-P was more commonly used, and ischaemic aetiology was slightly less common. Echocardiography was more often used to determine LVEF, as well as occlusive venography and placing the RV lead first. In DK implanters tended to choose a septal RV position. Quadripolar leads were more often and a test shock less often used. The paced QRS duration was slightly longer and the narrowing of QRS with CRT more limited. Procedure times and preoperative LVEF were similar.

Conclusions: In Scandinavia AV-conduction disturbance and/or a ventricular pacing indication was a more common indication for CRT, suggesting adaptation of the most recent guidelines ahead of their publication. A test shock was almost never performed, in agreement with recent scientific evidence. CRT-P was more often used, the procedures seem more centralized and quadripolar leads were preferred.

Keywords
Cardiac resynchronisation therapy, cardiac pacing, heart failure, demographics, quality of care, Scandinavia
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-382364 (URN)10.1080/14017431.2019.1583364 (DOI)000463610600001 ()30761919 (PubMedID)
Available from: 2019-04-29 Created: 2019-04-29 Last updated: 2019-04-29Bibliographically approved
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