Daniel Keene

Haran Burri

Paul Foley

Frédéric Anselme

Óscar Cano Pérez

Karol Čurila

Michael Derndorfer

László Gellér

Michael Glikson

Wim Huybrechts

Marek Jastrzebski

Krzysztof Kaczmarek

Grigorios Katsouras

Jonathan Lyne

Pablo Peñafiel Verdú

Christian Restle

Sergio Richter

Stefan Timmer

Kevin Vernooy

Zachary Whinnett

Abstract: Aims The field of conduction system pacing (CSP) is evolving, and our aim was to obtain a contemporary picture of European CSP practice. Methods and results A survey was devised by a European CSP Expert Group and sent electronically to cardiologists utilizing CSP. A total of 284 physicians were invited to contribute of which 171 physicians (60.2%; 85% electrophysiologists) responded. Most (77%) had experience with both His-bundle pacing (HBP) and left bundle branch area pacing (LBBAP). Pacing indications ranked highest for CSP were atrioventricular block (irrespective of left ventricular ejection fraction) and when coronary sinus lead implantation failed. For patients with left bundle branch block (LBBB) and heart failure (HF), conventional biventricular pacing remained first-line treatment. For most indications, operators preferred LBBAP over HBP as a first-line approach. When HBP was attempted as an initial approach, reasons reported for transitioning to utilizing LBBAP were: (i) high threshold (reported as >2 V at 1 ms), (ii) failure to reverse bundle branch block, or (iii) > 30 min attempting to implant at His-bundle sites. Backup right ventricular lead use for HBP was low (median 20%) and predominated in pace-and-ablate scenarios. Twelve-lead electrocardiogram assessment was deemed highly important during follow-up. This, coupled with limitations from current capture management algorithms, limits remote monitoring for CSP patients. Conclusions This survey provides a snapshot of CSP implementation in Europe. Currently, CSP is predominantly used for bradycardia indications. For HF patients with LBBB, most operators reserve CSP for biventricular implant failures. Left bundle branch area pacing ostensibly has practical advantages over HBP and is therefore preferred by many operators. Practical limitations remain, and large randomized clinical trial data are currently lacking

Conduction System Pacing, a European Survey: Insights from Clinical Practice

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Une heure avant la mort de mon frère

Alison Croggon

Dez is a flesher. She scrapes a living with her brother Bo and her mother Bel in the banns outside Newport City, the only habitable place left on a hostile planet.All fleshers are different, but Dez is more different than most. A splice with a rogue nanobot means that she¿s a tech wizard, able to hack into any network. For years her family has kept Dez's abilities secret, but when she accidentally kills a cop during a routine raid everything begins to unravel. Now she's broken into Newport City OpSec and discovered there's going to be a cull. Millions of people - most of the fleshers - will be exterminated. The only people who can help are a shadowy group called the Alchems and a bent cop called Brian Mac. But Dez hates Morro, the glamorous Alchem who has designs on her girlfriend, and Brian Mac is a screw up. And what chance do any of them have against the full force of OpSec? But nothing is what it seems, as Dez and her friends are plunged into the most desperate struggle of their lives.

Fleshers

Daniel Keene

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