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The termination of tachycardia may provide important clues toward the mechanism of the tachycardia and that close vigilance may clinch the diagnosis before proceeding to other pacing maneuvers., (© 2021 Wiley Periodicals LLC.)

Pacemaker lead dislodgement is one of the most undesired complications of pacemaker implantation. Repeated procedures are associated with an increased risk of complications, such as pocket infection, pneumothorax, and hematoma. We present a case who experienced dislodgement of the atrial pacemaker lead of a cardiac resynchronization therapy with defibrillator implantation device, which was corrected using a steerable ablation catheter by the transfemoral route., (© 2019 Wiley Periodicals, Inc.)

Introduction: Powered extraction tools are usually needed in chronically implanted leads. Comparative data are essential among different rotating dilator sheaths. The aim of the study was to compare procedural/clinical outcomes and adverse events in patients underwent lead extraction utilizing two different rotating dilator sheaths., Methods and Results: The current study was a retrospective review of consecutive patients at a single center. From December 2009 to August 2017, 163 lead extractions from 98 consecutive patients (median, 65 years; 71% male) utilizing a rotating mechanical sheath were analyzed for both efficacy (procedural and clinical success rates) and safety (adverse events). According to the type of the sheath used, the Evolution group (58 patients with 94 leads) and the TightRail group (40 patients with 69 leads) were determined. Extracted device was an implantable cardioverter-defibrillator (ICD) in two-thirds of patients. The majority of leads (87.7%) had passive-fixation mechanism. All ICD leads had dual-coil design. The median lead implant duration was 4 years, and no difference was found between the two groups. Infectious etiology was the main indication for extraction in 56.1% of patients. There were no statistically significant differences regarding the procedural success rate (96.6% vs 95.0%), clinical success rate (98.3% vs 97.5%), and total adverse event rate (5.2% vs 10.0%) between the Evolution and TightRail groups, respectively. Procedural success decreased with older leads and higher lead number., Conclusions: Procedural and clinical success rates utilizing both the Evolution and TightRail rotational extraction sheaths were high with low complication rate in chronically implanted leads., (© 2019 Wiley Periodicals, Inc.)

Background: The autonomic nervous system (ANS) is a potentially potent modulator of the initiation and perpetuation of atrial fibrillation (AF), whereas the presence of AF can activate and alter the ANS. The catheter ablation of AF (AFCA) may cause the cardiac ANS dysfunction, whereas restoration of sinus rhythm or sympathovagal imbalance by AFCA can reverse this process. Our principal goal was to investigate the short-term effect of AFCA on ANS functions evaluated by noninvasive chronotropic (CI), resting heart rate (RHR), and heart rate recovery (HRR) indices., Method: A total of 45 patients were enrolled with symptomatic, drug refractory paroxysmal AF undergoing first cryoballoon (CB) pulmonary vein antrum isolation (PVAI) with one 28-mm CB using single 3-minute freeze techniques without bonus applications. All patients underwent symptom-limited exercise treadmill testing to evaluate noninvasive parameters of ANS before PVAI. For those patients who remained in sinus rhythm, an additional exercise test was repeated after 1 and 3 months after discharge., Results: The autonomic CI and RHR/HRR indices were impaired after PVAI and persisted post-PVAI 3 months. However, these parameters were not different in patients with and without recurrence., Conclusion: This study demonstrated that the successful AFCA might concurrently impair the ANS parameters. The autonomic imbalance between the sympathetic and parasympathetic activity after AFCA could either become antiarrhythmic and/or proarrhythmic based on which of the two components was going to prevail after successful AFCA. The impaired ANS balance after PVAI might also be another hypothetical mechanism for AF recurrence particularly in the absence of PV reconnection., (© 2017 Wiley Periodicals, Inc.)

Background: Risk stratification for Wolff-Parkinson-White (WPW) pattern either by noninvasive or invasive tests is important to determine whether an ablation is necessary or not. The aim was to compare noninvasive tests and invasive studies in a pediatric WPW population., Methods: A total of 71 WPW patients (median age 14 years [interquartile range, 11-16 years]; 43 male) underwent Holter monitoring, exercise stress test (EST), and transesophageal electrophysiological study (TEEPS). In the case of a ≤270-ms effective refractory period of accessory pathway or induction of supraventricular tachycardia using TEEPS, patients were classified as high risk and underwent invasive electrophysiological study (EPS)., Results: Nine of 23 patients with low risk by Holter and eight of 26 patients with low risk by EST had high risk in TEEPS. Risky TEEPS results were detected in 42 of 71 patients and those patients underwent EPS. High-risk characteristic in EPS was detected in seven of nine patients with low risk by Holter and in seven of eight with low risk by EST. Both tests yielded moderate specificity (52-69%) and negative predictive value (61-69%) according to TEEPS., Conclusion: Holter and EST have low predictive value in WPW risk stratification. However, TEEPS and EPS are extremely valuable in WPW risk stratification. TEEPS may reveal important and useful results for WPW risk determination, especially in small children not having undergone EPS in order to avoid its complications., (© 2017 Wiley Periodicals, Inc.)

Background: Cardiac resynchronization therapy has been increasingly used for patients with heart failure. However, unstable and dislocated coronary sinus leads reduce the effectiveness of this important intervention., Aim: To examine the long-term effects of coronary sinus side branch stenting on sensing and pacing parameters of the left ventricular leads., Methods: A total of eight patients (six males; two females; mean age, 56.6 ± 14.4 years) whose coronary sinus lead dislocated during the procedure were included in the study. Targeted coronary sinus side branch stenting was performed to stabilize the leads. Sensing and pacing parameters including lead impedance, capture threshold, and R-wave amplitude were measured at implantation, first month, sixth month, and every 6-month period., Results: Mean follow-up period was 30.4 ± 7.4 months. At the time of implantation, lead impedance, capture threshold, and R-wave amplitude were 656 ± 162 Ω, 1.1 ± 0.5 V, and 13.0 ± 6.8 mV, respectively. No statistically significant mean lead impedance, capture threshold, and R-wave amplitude differences were observed between at the time of implantation and at the time of last follow-up (697 ± 164 Ω, 1.1 ± 0.5 V, 12.8 ± 6.9 mV, respectively)., Conclusion: In this long-term study, coronary sinus side branch stenting for the stabilization of dislocated leads seems to be effective., (©2010, The Authors. Journal compilation ©2010 Wiley Periodicals, Inc.)

Spontaneous twisting of a pacemaker electrode is a rare complication following implantation. If present, the electrode usually is twisted close to the pacemaker. This report presents the case of a 71-year-old female patient without any complaint associated with the twisting of the electrode. Telemetric study showed no abnormality thus, any intervention was not performed.