Heart Rhythm O2最新文献

{"title":"Delineating postinfarct ventricular tachycardia substrate with dynamic voltage mapping in areas of omnipolar vector disarray","authors":"Joao Grade Santos MBBS ,&nbsp;Mark T. Mills MBChB, MSc ,&nbsp;Peter Calvert MBChB, MRCP ,&nbsp;Nicole Worthington BSc ,&nbsp;Calum Phenton BSc ,&nbsp;Simon Modi MD ,&nbsp;Reza Ashrafi MBBS, MRCP ,&nbsp;Derick Todd MD ,&nbsp;Johan Waktare MD ,&nbsp;Saagar Mahida PhD, MRCP ,&nbsp;Dhiraj Gupta MD ,&nbsp;Vishal Luther PhD, MRCP","doi":"10.1016/j.hroo.2024.02.006","DOIUrl":"10.1016/j.hroo.2024.02.006","url":null,"abstract":"<div><h3>Background</h3><p>Defining postinfarct ventricular arrhythmic substrate is challenging with voltage mapping alone, though it may be improved in combination with an activation map. Omnipolar technology on the EnSite X system displays activation as vectors that can be superimposed onto a voltage map.</p></div><div><h3>Objective</h3><p>The study sought to optimize voltage map settings during ventricular tachycardia (VT) ablation, adjusting them dynamically using omnipolar vectors.</p></div><div><h3>Methods</h3><p>Consecutive patients undergoing substrate mapping were retrospectively studied. We categorized omnipolar vectors as uniform when pointing in one direction, or in disarray when pointing in multiple directions. We superimposed vectors onto voltage maps colored purple in tissue &gt;1.5 mV, and the voltage settings were adjusted so that uniform vectors appeared within purple voltages, a process termed dynamic voltage mapping (DVM). Vectors in disarray appeared within red-blue lower voltages.</p></div><div><h3>Results</h3><p>A total of 17 substrate maps were studied in 14 patients (mean age 63 ± 13 years; mean left ventricular ejection fraction 35 ± 6%, median 4 [interquartile range 2-8.5] recent VT episodes). The DVM mean voltage threshold that differentiated tissue supporting uniform vectors from disarray was 0.27 mV, ranging between patients from 0.18 to 0.50 mV, with good interobserver agreement (median difference: 0.00 mV). We found that VT isthmus components, as well as sites of latest activation, isochronal crowding, and excellent pace maps colocated with tissue along the DVM border zone surrounding areas of disarray.</p></div><div><h3>Conclusion</h3><p>DVM, guided by areas of omnipolar vector disarray, allows for individualized postinfarct ventricular substrate characterization. Tissue bordering areas of disarray may harbor greater arrhythmogenic potential.</p></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666501824000321/pdfft?md5=3954dfda8c0211c3fb367bff5b054b46&pid=1-s2.0-S2666501824000321-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140464416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of an innovative cloud-based storage software for ablation redo procedures: Initial experience","authors":"Saverio Iacopino MD ,&nbsp;Gennaro Fabiano MSc ,&nbsp;Paolo Francesco Sorrenti MSc ,&nbsp;Pasquale Filannino MD ,&nbsp;Paolo Artale MD ,&nbsp;Jacopo Colella MD ,&nbsp;Giovanni Statuto MD ,&nbsp;Alessandro Di Vilio MD ,&nbsp;Giuseppe Campagna MSc ,&nbsp;Gianluca Peluso MSc ,&nbsp;Emmanuel Fabiano MD ,&nbsp;Federico Cecchini MD ,&nbsp;Giuseppe Speziale MD ,&nbsp;Andrea Petretta MD","doi":"10.1016/j.hroo.2024.03.003","DOIUrl":"10.1016/j.hroo.2024.03.003","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666501824000606/pdfft?md5=d954abec462c56a75d9049afd9455cc8&pid=1-s2.0-S2666501824000606-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140271555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simultaneous sinoatrial exit block and atrioventricular block","authors":"David T. Zhang MD,&nbsp;Anthony V. Delicce MD,&nbsp;Roger Fan MD, FACC, FHRS,&nbsp;Eric J. Rashba MD, FACC, FHRS","doi":"10.1016/j.hroo.2024.03.005","DOIUrl":"https://doi.org/10.1016/j.hroo.2024.03.005","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266650182400062X/pdfft?md5=023f07147690dc9d208f3af3cfc88ef7&pid=1-s2.0-S266650182400062X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140618984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cryoballoon cardioneuroablation: New electrophysiological insights","authors":"Bengt Herweg MD, FHRS ,&nbsp;Ritesh S. Patel MD ,&nbsp;Sami Noujaim PhD ,&nbsp;Joseph Spano MS ,&nbsp;Nicholas Mencer DO ,&nbsp;Pugazhendhi Vijayaraman MD, FHRS","doi":"10.1016/j.hroo.2024.03.004","DOIUrl":"https://doi.org/10.1016/j.hroo.2024.03.004","url":null,"abstract":"<div><h3>Background</h3><p>Cardioneuroablation (CNA) targeting ganglionated plexi has shown promise in treating vasovagal syncope. Only radiofrequency ablation has been used to achieve this goal thus far.</p></div><div><h3>Objective</h3><p>The purpose of this study was to investigate the utility of cryoballoon ablation (CBA) of the pulmonary veins (PVs) as a potential simplified approach to CNA.</p></div><div><h3>Methods</h3><p>We report our observations of autonomic modulation in a series of 17 patients undergoing CBA for atrial fibrillation and our early experience using CBA of the PVs in 3 patients with malignant vagal syncope. In 17 patients undergoing CBA of AF, sinus cycle length was recorded intraprocedurally after ablation of individual PVs.</p></div><div><h3>Results</h3><p>The most pronounced shortening of the sinus cycle length was observed after isolation of the right upper PV, which was ablated last. Reduced sinus node recovery time and atrioventricular (AV) nodal effective refractory period were observed after CBA. Resting heart rate was elevated by 6–7 bpm after CBA and persisted during 12-month follow-up. CBA of the PVs was performed in 3 patients with recurrent vagal syncope mediated by sinus arrest (n = 2) and AV block (n = 1). In all patients, isolation of the right upper PV resulted in marked shortening of sinus cycle length. During follow-up of 178 ± 43 days (134–219 days), CNA resulted in abolition of pauses, bradycardia-related symptoms, and syncope in all patients.</p></div><div><h3>Conclusion</h3><p>CBA of the PVs (particularly the right upper PV) may be a predictable anatomic CNA approach in patients with refractory vagal syncope due to sinus arrest and/or AV block and may warrant systematic investigation as a tool to perform CNA.</p></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666501824000618/pdfft?md5=44ff78a5a7899f18d63d7b47da0aced8&pid=1-s2.0-S2666501824000618-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140618983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes and care quality metrics for people living with rheumatic heart disease and atrial fibrillation in Uganda","authors":"Chinonso C. Opara MD ,&nbsp;Roy H. Lan MD ,&nbsp;Joselyn Rwebembera MD ,&nbsp;Emmy Okello MBChB, PhD ,&nbsp;David A. Watkins MD, MPH ,&nbsp;Andrew Y. Chang MD, MS ,&nbsp;Chris T. Longenecker MD","doi":"10.1016/j.hroo.2024.02.002","DOIUrl":"10.1016/j.hroo.2024.02.002","url":null,"abstract":"<div><h3>Background</h3><p>Atrial fibrillation (AF) is a common complication of rheumatic heart disease (RHD) and is challenging to treat in lower-resourced settings in which RHD remains endemic.</p></div><div><h3>Objective</h3><p>We characterized demographics, treatment outcomes, and factors leading to care retention for participants with RHD and AF in Uganda.</p></div><div><h3>Methods</h3><p>We conducted a retrospective analysis of the Uganda national RHD registry between June 2009 and May 2018. Participants with AF or atrial flutter were included. Demographics, survival, and care metrics were compared with participants without AF. Multivariable logistic regression was used to identify factors associated with retention in care among participants with AF.</p></div><div><h3>Results</h3><p>A total of 1530 participants with RHD were analyzed and 293 (19%) had AF. The median age was 24 (interquartile range 14–38) years. Mortality was similar in both groups (adjusted hazard ratio 1.183, <em>P =</em> .77) over a median follow-up of 203 (interquartile range 98–275) days. A total of 79% of AF participants were prescribed anticoagulation, and 43% were aware of their target international normalized ratio. Retention in care was higher in participants with AF (18% vs 12%, <em>P &lt;</em> .01). Factors associated with decreased retention in care include New York Heart Association functional class III/IV (adjusted odds ratio [OR] 0.48, 95% confidence interval [CI] 0.30–0.76) and distance to nearest health center (adjusted OR 0.94, 95% CI 0.90–0.99). Anticoagulation prescription was associated with enhanced care retention (adjusted OR 1.86, 95% CI 1.24–2.79).</p></div><div><h3>Conclusion</h3><p>Participants with RHD and AF in Uganda do not experience higher mortality than those without AF. Anticoagulation prescription rates are high. Although retention in care is poor among RHD participants, those with concurrent AF are more likely to be retained.</p></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266650182400028X/pdfft?md5=940d7fcba95e9a7afe388411d05037d4&pid=1-s2.0-S266650182400028X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139891258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful extravascular implantable cardioverter-defibrillator implantation in a patient with recurrent transvenous implantable cardioverter-defibrillator erosion","authors":"Andrea Robinson MSN,&nbsp;Sreedhar Billakanty MD,&nbsp;Eugene Fu MD,&nbsp;Anish Amin MD","doi":"10.1016/j.hroo.2024.02.007","DOIUrl":"10.1016/j.hroo.2024.02.007","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666501824000576/pdfft?md5=36beb598ae338b002813a566106caef7&pid=1-s2.0-S2666501824000576-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140279789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pericardial effusion requiring intervention in patients undergoing leadless pacemaker implantation: A real-world analysis from the National Inpatient Sample database","authors":"Muhammad Zia Khan MD, MS ,&nbsp;Yasar Sattar MD ,&nbsp;Waleed Alruwaili MD ,&nbsp;Sameh Nassar MD ,&nbsp;Mohamed Alhajji MD ,&nbsp;Bandar Alyami MD ,&nbsp;Amanda T. Nguyen MD ,&nbsp;Joseph Neely MD ,&nbsp;Zain Ul Abideen Asad MD, MS ,&nbsp;Siddharth Agarwal MD ,&nbsp;Sameer Raina MD ,&nbsp;Sudarshan Balla MD ,&nbsp;Bao Nguyen MD ,&nbsp;Dali Fan MD ,&nbsp;Douglas Darden MD ,&nbsp;Muhammad Bilal Munir MD","doi":"10.1016/j.hroo.2024.02.004","DOIUrl":"10.1016/j.hroo.2024.02.004","url":null,"abstract":"<div><h3>Background</h3><p>Pericardial effusion requiring percutaneous or surgical-based intervention remains an important complication of a leadless pacemaker implantation.</p></div><div><h3>Objective</h3><p>The study sought to determine real-world prevalence, risk factors, and associated outcomes of pericardial effusion requiring intervention in leadless pacemaker implantations.</p></div><div><h3>Methods</h3><p>The National Inpatient Sample and International Classification of Diseases–Tenth Revision codes were used to identify patients who underwent leadless pacemaker implantations during the years 2016 to 2020. The outcomes assessed in our study included prevalence of pericardial effusion requiring intervention, other procedural complications, and in-hospital outcomes. Predictors of pericardial effusion were also analyzed.</p></div><div><h3>Results</h3><p>Pericardial effusion requiring intervention occurred in a total of 325 (1.1%) leadless pacemaker implantations. Patient-level characteristics that predicted development of a serious pericardial effusion included &gt;75 years of age (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.08–1.75), female sex (OR 2.03, 95% CI 1.62–2.55), coagulopathy (OR 1.50, 95% CI 1.12–1.99), chronic pulmonary disease (OR 1.36, 95% CI 1.07–1.74), chronic kidney disease (OR 1.53, 95% CI 1.22–1.94), and connective tissue disorders (OR 2.98, 95% CI 2.02–4.39). Pericardial effusion requiring intervention was independently associated with mortality (OR 5.66, 95% CI 4.24–7.56), prolonged length of stay (OR 1.36, 95% CI 1.07–1.73), and increased cost of hospitalization (OR 2.49, 95% CI 1.92–3.21) after leadless pacemaker implantation.</p></div><div><h3>Conclusion</h3><p>In a large, contemporary, real-world cohort of leadless pacemaker implantations in the United States, the prevalence of pericardial effusion requiring intervention was 1.1%. Certain important patient-level characteristics predicted development of a significant pericardial effusion, and such effusions were associated with adverse outcomes after leadless pacemaker implantations.</p></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666501824000308/pdfft?md5=b2058078a30e7dee51db9d170cb45c0d&pid=1-s2.0-S2666501824000308-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140466554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rising burden of cardiac arrest– and heart failure–related mortality in the United States from 1999 to 2020","authors":"Vardhmaan Jain MD,&nbsp;Birju Rao MD,&nbsp;Leonardo Knijnik MD,&nbsp;Anand D. Shah MD,&nbsp;Michael S. Lloyd MD,&nbsp;Mikhael F. El-Chami MD,&nbsp;Neal Bhatia MD,&nbsp;Stacy Westerman MD, MPH,&nbsp;Faisal M. Merchant MD","doi":"10.1016/j.hroo.2024.03.001","DOIUrl":"10.1016/j.hroo.2024.03.001","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666501824000588/pdfft?md5=630865d4f4f54cf1acadf495129c335d&pid=1-s2.0-S2666501824000588-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140268795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Zero-fluoroscopy transseptal puncture guided by right atrial high-density precision mapping","authors":"Jun Lu MD,&nbsp;Fengqiang Xu MD,&nbsp;Bingxue Song MD,&nbsp;Xin Liu MD,&nbsp;Haichu Yu MD,&nbsp;Yingying Zhang MD","doi":"10.1016/j.hroo.2024.02.003","DOIUrl":"10.1016/j.hroo.2024.02.003","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666501824000291/pdfft?md5=0522066bf53694f2d3d493b94d4d33c2&pid=1-s2.0-S2666501824000291-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139965861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left bundle branch pacing vs ventricular septal pacing for cardiac resynchronization therapy","authors":"Jingjing Chen MD ,&nbsp;Fatima M. Ezzeddine MD ,&nbsp;Xiaoke Liu MD, PhD ,&nbsp;Vaibhav Vaidya MBBS ,&nbsp;Christopher J. McLeod MB ChB, PhD ,&nbsp;Arturo M. Valverde MD ,&nbsp;Freddy Del-Carpio Munoz MD ,&nbsp;Abhishek J. Deshmukh MBBS ,&nbsp;Malini Madhavan MBBS ,&nbsp;Ammar M. Killu MBBS ,&nbsp;Siva K. Mulpuru MD ,&nbsp;Paul A. Friedman MD ,&nbsp;Yong-Mei Cha MD","doi":"10.1016/j.hroo.2024.01.005","DOIUrl":"10.1016/j.hroo.2024.01.005","url":null,"abstract":"<div><h3>Background</h3><p>The outcomes of left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP) in patients with heart failure remain to be learned.</p></div><div><h3>Objective</h3><p>The objective of this study was to assess the echocardiographic and clinical outcomes of LBBP, LVSP, and deep septal pacing (DSP).</p></div><div><h3>Methods</h3><p>This retrospective study included patients who met the criteria for cardiac resynchronization therapy (CRT) and underwent attempted LBBP in 5 Mayo centers. Clinical, electrocardiographic, and echocardiographic data were collected at baseline and follow-up.</p></div><div><h3>Results</h3><p>A total of 91 consecutive patients were included in the study. A total of 52 patients had LBBP, 25 had LVSP, and 14 had DSP. The median follow-up duration was 307 (interquartile range 208, 508) days. There was significant left ventricular ejection fraction (LVEF) improvement in the LBBP and LVSP groups (from 35.9 ± 8.5% to 46.9 ± 10.0%, <em>P &lt;</em> .001 in the LBBP group; from 33.1 ± 7.5% to 41.8 ± 10.8%, <em>P &lt;</em> .001 in the LVSP group) but not in the DSP group. A unipolar paced right bundle branch block morphology during the procedure in lead V1 was associated with higher odds of CRT response. There was no significant difference in heart failure hospitalization and all-cause deaths between the LBBP and LVSP groups. The rate of heart failure hospitalization and all-cause deaths were increased in the DSP group compared with the LBBP group (hazard ratio 5.10, 95% confidence interval 1.14–22.78, <em>P =</em> .033; and hazard ratio 7.83, 95% confidence interval 1.38–44.32, <em>P =</em> .020, respectively).</p></div><div><h3>Conclusion</h3><p>In patients undergoing CRT, LVSP had comparable CRT outcomes compared with LBBP.</p></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666501824000060/pdfft?md5=19a9c95523a969e70e7e37669486bcdd&pid=1-s2.0-S2666501824000060-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139637618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}