32,914 results on '"Cardiac Pacing, Artificial"'
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2. Factors associated with cardiac implantable electronic device‐related infections, New South Wales, 2016–21: a retrospective cohort study.
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Shawon, Md Shajedur Rahman, Sotade, Oluwadamisola T, Li, Joan, Hill, Michelle D, Strachan, Liesl, Challis, Gabrielle, King, Kate, Ooi, Sze‐Yuan, and Jorm, Louisa
- Abstract
Objectives: To quantify the rate of cardiac implantable electronic device (CIED)‐related infections and to identify risk factors for such infections. Design: Retrospective cohort study; analysis of linked hospital admissions and mortality data. Setting, participants: All adults who underwent CIED procedures in New South Wales between 1 January 2016 and 30 June 2021 (public hospitals) or 30 June 2020 (private hospitals). Main outcome measures: Proportions of patients hospitalised with CIED‐related infections (identified by hospital record diagnosis codes); risk of CIED‐related infection by patient, device, and procedural factors. Results: Of 37 675 CIED procedures (23 194 men, 63.5%), 500 were followed by CIED‐related infections (median follow‐up, 24.9 months; interquartile range, 11.2–40.8 months), including 397 people (1.1%) within twelve months of their procedures, and 186 of 10 540 people (2.5%) at high risk of such infections (replacement or upgrade procedures; new cardiac resynchronisation therapy with defibrillator, CRT‐D). The overall infection rate was 0.50 (95% confidence interval [CI], 0.45–0.54) per 1000 person‐months; it was highest during the first month after the procedure (5.60 [95% CI, 4.89–6.42] per 1000 person‐months). The risk of CIED‐related infection was greater for people under 65 years of age than for those aged 65–74 years (adjusted hazard ratio [aHR], 1.71; 95% CI, 1.32–2.23), for people with CRT‐D devices than for those with permanent pacemakers (aHR, 1.46; 95% CI, 1.02–2.08), for people who had previously undergone CIED procedures (two or more v none: aHR, 1.51; 95% CI, 1.02–2.25) or had CIED‐related infections (aHR, 11.4; 95% CI, 8.34–15.7), or had undergone concomitant cardiac surgery (aHR, 1.62; 95% CI, 1.10–2.39), and for people with atrial fibrillation (aHR, 1.33; 95% CI, 1.11–1.60), chronic kidney disease (aHR, 1.54; 95% CI, 1.27–1.87), chronic obstructive pulmonary disease (aHR, 1.37; 95% CI, 1.10–1.69), or cardiomyopathy (aHR 1.60; 95% CI, 1.25–2.05). Conclusions: Knowledge of risk factors for CIED‐related infections can help clinicians discuss them with their patients, identify people at particular risk, and inform decisions about device type, upgrades and replacements, and prophylactic interventions. [ABSTRACT FROM AUTHOR]
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- 2024
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3. Arrhythmic Risk in Biventricular Pacing Compared With Left Bundle Branch Area Pacing: Results From the I-CLAS Study.
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Herweg, Bengt, Sharma, Parikshit S., Cano, Óscar, Ponnusamy, Shunmuga Sundaram, Zanon, Francesco, Jastrzebski, Marek, Zou, Jiangang, Chelu, Mihail G., Vernooy, Kevin, Whinnett, Zachary I., Nair, Girish M., Molina-Lerma, Manuel, Curila, Karol, Zalavadia, Dipen, Dye, Cicely, Vipparthy, Sharath C., Brunetti, Ryan, Mumtaz, Mishal, Moskal, Pawel, and Leong, Andrew M.
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VENTRICULAR ejection fraction , *CARDIAC pacing , *PROPORTIONAL hazards models , *VENTRICULAR tachycardia , *VENTRICULAR fibrillation , *CARDIAC pacemakers , *ATRIAL fibrillation - Abstract
BACKGROUND: Left bundle branch area pacing (LBBAP) may be associated with greater improvement in left ventricular ejection fraction and reduction in death or heart failure hospitalization compared with biventricular pacing (BVP) in patients requiring cardiac resynchronization therapy. We sought to compare the occurrence of sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) and new-onset atrial fibrillation (AF) in patients undergoing BVP and LBBAP. METHODS: The I-CLAS study (International Collaborative LBBAP Study) included patients with left ventricular ejection fraction ≤35% who underwent BVP or LBBAP for cardiac resynchronization therapy between January 2018 and June 2022 at 15 centers. We performed propensity score–matched analysis of LBBAP and BVP in a 1:1 ratio. We assessed the incidence of VT/VF and new-onset AF among patients with no history of AF. Time to sustained VT/VF and time to new-onset AF was analyzed using the Cox proportional hazards survival model. RESULTS: Among 1778 patients undergoing cardiac resynchronization therapy (BVP, 981; LBBAP, 797), there were 1414 propensity score–matched patients (propensity score–matched BVP, 707; propensity score–matched LBBAP, 707). The occurrence of VT/VF was significantly lower with LBBAP compared with BVP (4.2% versus 9.3%; hazard ratio, 0.46 [95% CI, 0.29–0.74]; P<0.001). The incidence of VT storm (>3 episodes in 24 hours) was also significantly lower with LBBAP compared with BVP (0.8% versus 2.5%; P=0.013). Among 299 patients with cardiac resynchronization therapy pacemakers (BVP, 111; LBBAP, 188), VT/VF occurred in 8 patients in the BVP group versus none in the LBBAP group (7.2% versus 0%; P<0.001). In 1194 patients with no history of VT/VF or antiarrhythmic therapy (BVP, 591; LBBAP, 603), the occurrence of VT/VF was significantly lower with LBBAP than with BVP (3.2% versus 7.3%; hazard ratio, 0.46 [95% CI, 0.26–0.81]; P=0.007). Among patients with no history of AF (n=890), the occurrence of new-onset AF >30 s was significantly lower with LBBAP than with BVP (2.8% versus 6.6%; hazard ratio, 0.34 [95% CI, 0.16–0.73]; P=0.008). The incidence of AF lasting >24 hours was also significantly lower with LBBAP than with BVP (0.7% versus 2.9%; P=0.015). CONCLUSIONS: LBBAP was associated with a lower incidence of sustained VT/VF and new-onset AF compared with BVP. This difference remained significant after adjustment for differences in baseline characteristics between patients with BVP and LBBAP. Physiological resynchronization by LBBAP may be associated with lower risk of arrhythmias compared with BVP. [ABSTRACT FROM AUTHOR]
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- 2024
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4. Reverse complete heart block using transcutaneous pacing and repeated plasmapheresis in a neonate with lupus: a case report
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Yanfei Liu, Wanwei Li, Kun Zhou, and Zhangxue Hu
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Neonatal systemic Lupus Erythematosus ,Congenital heart block ,Cardiac pacing, Artificial ,Plasmapheresis ,Case report ,Pediatrics ,RJ1-570 ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
Abstract Background It has been reported that the complete heart block (CHB) in neonatal lupus (NL) cannot be reversed. This study reported a case of NL-CHB that was reversed by transcutaneous pacing and repeated plasmapheresis. Case presentation A 35+ 6-week male preterm baby was transferred to the neonatal intensive care unit of the Army Medical Center in May 2020 for slight cyanosis around the lips and nose. Two days after birth, a sudden decrease in heart rate was observed during electrocardiogram (EGG) monitoring. Physical examination revealed a bluish-purple discoloration around the lips and an irregular heartbeat. EGG showed the presence of isolated P (142 bpm) and QRS (78 bpm) waves, ventricular escape beats, and a diagnosis of NL-CHB. To reverse the condition, transcutaneous pacing and five sessions of plasmapheresis were performed. At a 1.5-year follow-up, the baby exhibited well-developed cardiac structure and normal neurodevelopment. Conclusions Transcutaneous pacing and repeated plasmapheresis might be possible to reverse CHB in NL.
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- 2023
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5. Reverse complete heart block using transcutaneous pacing and repeated plasmapheresis in a neonate with lupus: a case report.
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Liu, Yanfei, Li, Wanwei, Zhou, Kun, and Hu, Zhangxue
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HEART block , *PLASMAPHERESIS , *NEONATAL intensive care units , *CYANOSIS , *PREMATURE infants , *NEWBORN infants , *HEART beat - Abstract
Background: It has been reported that the complete heart block (CHB) in neonatal lupus (NL) cannot be reversed. This study reported a case of NL-CHB that was reversed by transcutaneous pacing and repeated plasmapheresis. Case presentation: A 35+ 6-week male preterm baby was transferred to the neonatal intensive care unit of the Army Medical Center in May 2020 for slight cyanosis around the lips and nose. Two days after birth, a sudden decrease in heart rate was observed during electrocardiogram (EGG) monitoring. Physical examination revealed a bluish-purple discoloration around the lips and an irregular heartbeat. EGG showed the presence of isolated P (142 bpm) and QRS (78 bpm) waves, ventricular escape beats, and a diagnosis of NL-CHB. To reverse the condition, transcutaneous pacing and five sessions of plasmapheresis were performed. At a 1.5-year follow-up, the baby exhibited well-developed cardiac structure and normal neurodevelopment. Conclusions: Transcutaneous pacing and repeated plasmapheresis might be possible to reverse CHB in NL. [ABSTRACT FROM AUTHOR]
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- 2023
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6. Catheter‐related superior vena cava syndrome: an increasing problem.
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Harvey, John J, Vrazas, John I, Bekhit, Elhamy, Barnes, Chris, and Robinson, Philip J
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This article discusses a case of catheter-related superior vena cava syndrome (SVCS) in a 16-year-old female patient with cystic fibrosis. The patient had a central venous access device (TIVAD) for frequent antibiotic treatments. The TIVAD became occluded, leading to SVCS symptoms such as pleural effusions and prominent chest wall veins. The patient underwent a procedure to remove the catheter, stent graft the occluded veins, and insert a new central venous access device. The symptoms resolved, and the patient remains well over a year later. The article emphasizes the importance of careful catheter positioning and using the smallest catheter possible to reduce the risk of central venous stenosis. Endovascular stenting is recommended as the first-line treatment for SVCS, with covered stents offering longer patency and potentially avoiding the need for long-term anticoagulation. [Extracted from the article]
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- 2024
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7. Acute Effects of LBBP Versus BVP for CRT
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- 2022
8. Electrical Resynchronization and Acute Hemodynamic Effects of Direct His Bundle Pacing Compared to Biventricular Pacing
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Swiss National Fund for Scientific Research and Haran Burri, MD, Professor
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- 2020
9. Averting infections when implanting cardiac pacemakers and defibrillators.
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Heddle AM, William F
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A recent study conducted in New South Wales, Australia, examined the rate of infections following cardiac pacemaker and defibrillator implantation procedures. The study found that 1.1% of patients required re-hospitalization due to infections within twelve months of the procedure. Factors that increased the risk of infection included age, device type, previous procedures or infections, concomitant cardiac surgery, and certain medical conditions. The overall infection rate was consistent with international standards, and the identified risk factors were similar to those found in other studies. The study highlights the importance of adhering to aseptic techniques, using antibiotic prophylaxis, and having detailed discussions with patients about the risks associated with these procedures. [Extracted from the article]
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- 2024
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10. Transcoronary Pacing and Myocardial Viability
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- 2020
11. Differentiating Left Atrial Pressure Responses in Paroxysmal and Persistent Atrial Fibrillation: Implications for Diagnosing Heart Failure With Preserved Ejection Fraction and Managing Atrial Fibrillation.
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Park JS, Cho I, Kim D, Kim MH, Park JW, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, and Pak HN
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- Humans, Female, Male, Middle Aged, Aged, Prospective Studies, Heart Rate physiology, Catheter Ablation, Echocardiography, Cardiac Pacing, Artificial, Atrial Function, Left physiology, Ventricular Function, Left physiology, Isoproterenol administration & dosage, Atrial Fibrillation physiopathology, Atrial Fibrillation diagnosis, Atrial Fibrillation therapy, Atrial Fibrillation surgery, Heart Failure physiopathology, Heart Failure diagnosis, Heart Failure therapy, Stroke Volume physiology, Atrial Pressure physiology
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Background: Increased left atrial pressure (LAP) contributes to dyspnea and heart failure with preserved ejection fraction in patients with atrial fibrillation (AF). The purpose of this study was to investigate the differences in baseline LAP and LAP response to rapid pacing between paroxysmal and persistent AF., Methods and Results: This observational study prospectively enrolled 1369 participants who underwent AF catheter ablation, excluding those with reduced left ventricular ejection fraction. H
2 FPEF score was calculated by echocardiography and baseline characteristics. Patients underwent LAP measurements during AF, sinus rhythm, and heart rates of 90, 100, 110, and 120 beats per minute (bpm), induced by right atrial pacing and isoproterenol. The baseline LAP-peak in the persistent AF group consistently exceeded that in the paroxysmal AF (PAF) group across each H2 FPEF score subgroup (all P <0.05). LAP-peak increased with pacing (19.5 to 22.5 mm Hg) but decreased with isoproterenol (20.4 to 18.4 mm Hg). Under pacing, patients with PAF exhibited a significantly lower LAP-peak (90 bpm) than those with persistent AF (17.7±8.2 versus 21.1±9.3 mm Hg, P <0.001). However, there was no difference in LAP-peak (120 bpm) between the 2 groups (22.1±8.1 versus 22.9±8.4 mm Hg, P =0.056) because the LAP-peak significantly increased with heart rate in the group with PAF., Conclusions: Patients with PAF exhibited lower baseline LAP with greater increases during rapid pacing compared with individuals with persistent AF, indicating a need to revise the H2 FPEF score for distinguishing PAF from persistent AF and emphasizing the importance of rate and rhythm control in PAF for symptom control., Registration: URL: https://www.clinicaltrials.gov; Unique Identifier: NCT02138695.- Published
- 2024
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12. Observational study of left bundle branch area pacing: implantation of the solia S lead using the selectra 3D sheath at an inclined angle.
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Ju C, Zhou Y, Cheng K, and Xie X
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- Humans, Retrospective Studies, Male, Aged, Female, Treatment Outcome, Middle Aged, Time Factors, Pacemaker, Artificial, Aged, 80 and over, Bundle of His physiopathology, Bundle-Branch Block physiopathology, Bundle-Branch Block therapy, Bundle-Branch Block diagnosis, Heart Rate, Equipment Design, Action Potentials, Cardiac Pacing, Artificial
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Background: Left Bundle Branch Area Pacing (LBBaP) is a cardiac pacing technique designed to mimic the natural conduction system of the heart. Traditional right ventricular apical pacing has been associated with increased risks of heart failure and atrial fibrillation. This study investigates the stability and safety of LBBaP using the Selectra 3D sheath (Biotronik) with an inclined angle for implanting the Solia S lead (Biotronik, SE & Co, KG)., Methods: A single-center retrospective study was conducted on 25 patients who underwent LBBaP implantation using the Selectra 3D sheath at our hospital. The procedure involved inserting the Solia S lead into the interventricular septum at an inclined angle. Surgical and postoperative data were collected, including the success rate, depth and angle of electrode insertion, complications, and follow-up data., Results: The success rate of LBBaP implantation was 92%. The length of electrode insertion into the interventricular septum ranged from 12 to 23.0 mm, with an average of 18.1 ± 3.08 mm. The angle formed between the electrode and the septum ranged from 0° to 57.3°, with an average of 35.14°±14.31°. During the 3-month follow-up period, pacing parameters remained stable, and no complications were reported., Conclusions: LBBaP implantation using the Selectra 3D sheath with an inclined angle for the Solia S implantation demonstrates stability and safety. The procedure boasts a high success rate and offers an effective option for LBBaP implantation., (© 2024. The Author(s).)
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- 2024
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13. Carotid Sinus Syndrome Associated with Carcinoma Ex-Pleomorphic Adenoma: What Is the Role of Artificial Cardiac Stimulation?
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Lani VS, Elias Neto J, Silva MA, Andrade HA, Cotias EPZ, and Gomes FLT
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- Humans, Syndrome, Male, Cardiac Pacing, Artificial, Middle Aged, Female, Adenoma, Pleomorphic pathology
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- 2024
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14. Cutting the Cord: Time for Leadless Pacemakers to Untether Post-TAVR Patients?
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Vora AN, Freeman JV, and Enriquez AD
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- Humans, Treatment Outcome, Cardiac Catheterization instrumentation, Cardiac Catheterization adverse effects, Heart Valve Prosthesis, Equipment Design, Pacemaker, Artificial, Cardiac Pacing, Artificial
- Abstract
Competing Interests: Funding Support and Author Disclosures Dr Vora has served as a consultant for Medtronic. Dr Freeman has received research support from the National Institutes of Health/National Heart, Lung, and Blood Institute and the American College of Cardiology National Cardiovascular Data Registry; and has received Advisory Board/consulting fees from Boston Scientific, Medtronic, Abbott, Biosense Webster, and PaceMate. Dr Enriquez has reported that he has no relationships relevant to the contents of this paper to disclose.
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- 2024
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15. Entrainment response during ventricular tachycardia originating from the para-Hisian region: What is the mechanism?
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Moriwaki K, Doi A, Nishigaki K, Tsukamoto T, Tanaka S, Yamasaki R, Fukuda K, Yoshiyama T, Kawarabayashi T, and Fukuda D
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- Humans, Male, Cardiac Pacing, Artificial, Treatment Outcome, Electrocardiography, Middle Aged, Predictive Value of Tests, Female, Time Factors, Tachycardia, Ventricular physiopathology, Tachycardia, Ventricular diagnosis, Tachycardia, Ventricular surgery, Bundle of His physiopathology, Electrophysiologic Techniques, Cardiac, Action Potentials, Catheter Ablation, Heart Rate
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- 2024
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16. The association between paced left ventricular activation time and cardiac reverse remodeling in heart failure patients with left bundle branch block.
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Chen X, Xu J, Wu Y, Qin C, Xue S, Hu G, Zou J, Shan Q, Zhou X, and Hou X
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- Humans, Male, Female, Aged, Middle Aged, Time Factors, Treatment Outcome, Natriuretic Peptide, Brain blood, Recovery of Function, Stroke Volume, Retrospective Studies, Cardiac Pacing, Artificial, Cardiac Resynchronization Therapy, Bundle-Branch Block physiopathology, Bundle-Branch Block therapy, Bundle-Branch Block diagnosis, Ventricular Remodeling, Heart Failure physiopathology, Heart Failure therapy, Heart Failure diagnosis, Heart Failure complications, Ventricular Function, Left, Action Potentials, Heart Rate, Peptide Fragments blood
- Abstract
Introduction: The association between paced LVAT and cardiac structure and function at baseline, as well as whether longer LVAT is associated with worse cardiac reverse remodeling in patients with heart failure (HF) and left bundle branch block (LBBB) has not been well investigated. The purpose of this study is to investigate the association between paced LVAT and baseline echocardiographic parameters and cardiac reverse remodeling at follow-up., Methods: Patients with HF and LBBB receiving successful left bundle branch pacing (LBBP) from June 2018 to April 2023 were enrolled and grouped based on paced LVAT. NT-proBNP and echocardiographic parameters were recorded during routine follow-up. The relationships between paced LVAT and echocardiographic parameters at baseline and follow-up were analyzed., Results: Eighty-three patients were enrolled (48 males, aged 65 ± 9.8, mean LVEF 32.1 ± 7.5%, mean LVEDD 63.0 ± 8.5 mm, median NT-proBNP 1057[513-3158] pg/mL). The paced QRSd was significantly decreased (177 ± 17.9 vs. 134 ± 18.5, p < .001) and median paced LVAT was 80[72-88] ms. After a median follow-up of 12[9-29] months, LVEF increased to 52.1 ± 11.2%, LVEDD decreased to 52.6 ± 8.8 mm, and NT-proBNP decreased to 215[73-532]pg/mL. Patients were grouped based on paced LVAT: LVAT < 80 ms (n = 39); 80 ≤ LVAT < 90 ms (n = 24); LVAT ≥ 90 ms (n = 20). Patients with longer LVAT had larger LVEDD and lower LVEF (LVEDD
baseline : p < .001; LVEFbaseline : p = .001). The difference in LVEF6M was statistically significant among groups (p < .001) and patients with longer LVAT had lower LVEF6M , while the difference in LVEF1Y was not seen (p = .090). There was no significant correlation between ΔLVEF6M-baseline, ΔLVEF1Y-6M and LVAT respectively (ΔLVEF6M-baseline : p = .261, r = -.126; ΔLVEF1Y-6M : p = .085, r = .218)., Conclusion: Long paced LVAT was associated with worse echocardiographic parameters at baseline, but did not affect the cardiac reverse remodeling in patients with HF and LBBB. Those with longer LVAT required longer time to recover., (© 2024 Wiley Periodicals LLC.)- Published
- 2024
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17. Extraction of a 6-year-old leadless pacemaker (MICRA transcatheter pacing system) using commercially available removal tools: A case report.
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Chmielewska-Michalak L, Gwizdała A, Ciepłucha A, Katarzyńska-Szymańska A, Ochotny R, Lesiak M, and Mitkowski P
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- Humans, Cardiac Pacing, Artificial, Treatment Outcome, Male, Female, Time Factors, Aged, 80 and over, Aged, Pacemaker, Artificial, Device Removal, Equipment Design
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Introduction: Leadless pacemakers are associated with a low risk of infection, so indications for their removal are rare. One can expect that the dwell time of the device correlates with a more difficult removal, but it has not been proved so far., Methods and Results: We present a case of a patient in whom MICRA transcatheter pacing system was successfully removed with nondedicated commercially available tools, 70 months after implantation., Conclusion: A successful removal of the MICRA leadless pacemaker is possible, and may be safe even many years after the device implantation, despite a lack of dedicated tools. Due to the potential risk of complications, the benefits and risks of the procedure should be weighted before making a final decision., (© 2024 Wiley Periodicals LLC.)
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- 2024
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18. Comparison of His-Purkinje Conduction System Pacing with Atrial-Ventricular Node Ablation and Pharmacotherapy in HFpEF Patients with Recurrent Persistent Atrial Fibrillation (HPP-AF study).
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Zhang JF, Pan YW, Li J, Kong XG, Wang M, Xue ZM, Gao J, and Fu GS
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- Humans, Prospective Studies, Male, Female, Aged, Middle Aged, Treatment Outcome, Cardiac Pacing, Artificial, Randomized Controlled Trials as Topic, Ventricular Function, Left drug effects, Multicenter Studies as Topic, Heart Rate drug effects, Purkinje Fibers physiopathology, Time Factors, Bundle of His physiopathology, Exercise Tolerance drug effects, Atrial Fibrillation physiopathology, Atrial Fibrillation therapy, Atrial Fibrillation surgery, Atrial Fibrillation diagnosis, Atrial Fibrillation drug therapy, Catheter Ablation adverse effects, Recurrence, Heart Failure physiopathology, Heart Failure therapy, Heart Failure diagnosis, Heart Failure mortality, Atrioventricular Node physiopathology, Atrioventricular Node surgery, Stroke Volume drug effects, Anti-Arrhythmia Agents therapeutic use
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Background: There is currently no particularly effective strategy for patients with persistent atrial fibrillation accompanying heart failure with preserved ejection fraction (HFpEF), especially with recurrent atrial fibrillation after ablation. In this study, we will evaluate a new treatment strategy for patients with persistent atrial fibrillation who had at least two attempts (≧2 times) of radio-frequency catheter ablation but experienced recurrence, and physiologic conduction was reconstructed after atrioventricular node ablation or drug therapy, to control the patient's ventricular rate to maintain a regular heart rhythm, which is called His-Purkinje conduction system pacing (HPCSP) with atrioventricular node ablation., Methods and Results: This investigator-initiated, multicenter prospective randomized controlled trial aimed to recruit 296 randomized HFpEF patients with recurrent atrial fibrillation. All the enrolled patients were randomly assigned to the pacing group or the drug treatment group. The primary endpoint is differences in cardiovascular events and clinical composite endpoints (all-cause mortality) between patients in the HPCSP and drug-treated groups. Secondary endpoints included heart failure hospitalization, exercise capacity assessed by cardiopulmonary exercise tests, quality of life, echocardiogram parameters, 6-minute walk distance, NT-ProBNP, daily patient activity levels, and heart failure management report recorded by the CIED. It is planned to compete recruitment by the end of 2023 and report in 2025., Conclusions: The study aims to determine whether His-Purkinje conduction system pacing with atrioventricular node ablation can better improve patients' symptoms and quality of life, postpone the progression of heart failure, and reduce the rate of rehospitalization and mortality of patients with heart failure., Clinical Trial Registration Number: ChiCTR1900027723, URL: http://www.chictr.org.cn/edit.aspx?pid=46128&htm=4., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2024
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19. The Role of Electrocardiographic Exercise Testing for the Possibility of Permanent Pacemaker Implantation in Patients with Sinus Bradycardia.
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Pham LT, Chu SD, and Nguyen DX
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- Humans, Male, Female, Middle Aged, Cross-Sectional Studies, Prospective Studies, Aged, Adult, Clinical Decision-Making, Time Factors, Exercise Test, Bradycardia physiopathology, Bradycardia therapy, Bradycardia diagnosis, Pacemaker, Artificial, Heart Rate, Predictive Value of Tests, Electrocardiography, Exercise Tolerance, Cardiac Pacing, Artificial
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Objective: Study on the role of electrocardiographic (ECG) exercise testing for the possibility of permanent pacemaker implantation (PPI) in patients with sinus bradycardia (SB)., Methods: Cross-sectional descriptive, prospective study. The study on 60 patients with SB below 50 beats/minute on 12-lead electrocardiogram at rest, with or without symptoms of SB, conducted at the Vietnam National Heart Institute and Hanoi Heart Hospital from January 2020 to September 2021., Results: Sixty patients with SB were studied, 36 male (60%) and 24 female patients (40%), p > 0.05. The average age was 55.12 ± 13.89 years old. Maximum exercise capacity (MEC) is low and only reaches 7.78 ± 3.59 metabolic equivalents (METs); Not reaching 85% of predicted MEC accounts for 53.5%; Maximum exercise time is 10.53 ± 0.46 minutes; Impaired heart rate (HR) variability in patients with SB is high: Chronotropic Index <0.8 accounts for 53.5%, not reaching 85% of predicted HR max accounts for 45%. The average HR max was 129.90 ± 29.22 beats per minute (BPM). The average maximum workload systolic blood pressure was 155.23 ± 20.59 mmHg. The average value of maximum exercise diastolic blood pressure was 88.10 ± 9.11 mmHg. The HR decreased by 27.87 ± 16.82 BPM in the first minute. Not achieving 85% of predicted MEC (p = 0.062), so it is not an independent factor predicting the ability for PPI. Only the HR variability index <0.8 is an independent predictor for PPI in bradycardic patients, which has OR = 21.521 (95% CI: 2.27-04.34, p < 0.05)., Conclusion: Results can be seen that Chronotropic Index <0.8 is an important marker for physicians to decide on PPI in ECG during exercise testing in SB patients and is a potential prognostic factor for the need for PPI., Competing Interests: The authors report no conflicts of interest in this work., (© 2024 Pham et al.)
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- 2024
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20. An unusual cause of cardiac arrest in a young infant.
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Wu Y, Che S, and Li Y
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- Humans, Infant, Treatment Outcome, Atrioventricular Block diagnosis, Atrioventricular Block etiology, Atrioventricular Block therapy, Atrioventricular Block physiopathology, Sinus of Valsalva diagnostic imaging, Sinus of Valsalva abnormalities, Sinus of Valsalva surgery, Sinus of Valsalva physiopathology, Heart Arrest etiology, Heart Arrest therapy, Heart Arrest diagnosis, Coronary Angiography, Male, Electrocardiography, Computed Tomography Angiography, Coronary Vessel Anomalies complications, Coronary Vessel Anomalies diagnostic imaging, Coronary Vessel Anomalies therapy, Coronary Vessel Anomalies surgery, Cardiac Pacing, Artificial, Pacemaker, Artificial
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Background: Anomalous aortic origin of a coronary artery from the inappropriate sinus of Valsalva (AAOCA) is a rare congenital heart lesion. It is uncommon for patients with AAOCA to present with severe symptoms at a very young age., Case Presentation: We describe a very rare but critical presentation in a young infant with AAOCA that requires surgical repair and pacemaker placement. A three-month-old infant was referred because of syncope. Cardiac arrest occurred shortly after admission. The electrocardiogram indicated a complete atrioventricular block and a transvenous temporary pacemaker was implanted. A further coronary computed tomographic angiography (CTA) showed the anomalous origin of the right coronary artery from the left sinus of Valsalva. Coronary artery unroofing was performed due to an interarterial course with the intramural component, and a permanent epicardial pacemaker was implanted. The postoperative recovery was uneventful, and this patient was thriving and asymptomatic at the nine-month follow-up. However, the electrocardiogram still indicated a complete pacing rhythm., Conclusions: By timely diagnosis and treatment, this patient is successfully rescued. Although rare, AAOCA may be fatal even in infants., (© 2024. The Author(s).)
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- 2024
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21. Mechanisms of ischaemia-induced arrhythmias in hypertrophic cardiomyopathy: a large-scale computational study.
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Coleman JA, Doste R, Ashkir Z, Coppini R, Sachetto R, Watkins H, Raman B, and Bueno-Orovio A
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- Humans, Heart Rate, Risk Factors, Middle Aged, Male, Cardiac Pacing, Artificial, Female, Computer Simulation, Refractory Period, Electrophysiological, Risk Assessment, Cardiomyopathy, Hypertrophic physiopathology, Cardiomyopathy, Hypertrophic pathology, Myocardial Ischemia physiopathology, Myocardial Ischemia pathology, Myocytes, Cardiac pathology, Myocytes, Cardiac metabolism, Action Potentials, Models, Cardiovascular, Fibrosis, Arrhythmias, Cardiac physiopathology, Arrhythmias, Cardiac etiology
- Abstract
Aims: Lethal arrhythmias in hypertrophic cardiomyopathy (HCM) are widely attributed to myocardial ischaemia and fibrosis. How these factors modulate arrhythmic risk remains largely unknown, especially as invasive mapping protocols are not routinely used in these patients. By leveraging multiscale digital twin technologies, we aim to investigate ischaemic mechanisms of increased arrhythmic risk in HCM., Methods and Results: Computational models of human HCM cardiomyocytes, tissue, and ventricles were used to simulate outcomes of Phase 1A acute myocardial ischaemia. Cellular response predictions were validated with patch-clamp studies of human HCM cardiomyocytes (n = 12 cells, N = 5 patients). Ventricular simulations were informed by typical distributions of subendocardial/transmural ischaemia as analysed in perfusion scans (N = 28 patients). S1-S2 pacing protocols were used to quantify arrhythmic risk for scenarios in which regions of septal obstructive hypertrophy were affected by (i) ischaemia, (ii) ischaemia and impaired repolarization, and (iii) ischaemia, impaired repolarization, and diffuse fibrosis. HCM cardiomyocytes exhibited enhanced action potential and abnormal effective refractory period shortening to ischaemic insults. Analysis of ∼75 000 re-entry induction cases revealed that the abnormal HCM cellular response enabled establishment of arrhythmia at milder ischaemia than otherwise possible in healthy myocardium, due to larger refractoriness gradients that promoted conduction block. Arrhythmias were more easily sustained in transmural than subendocardial ischaemia. Mechanisms of ischaemia-fibrosis interaction were strongly electrophysiology dependent. Fibrosis enabled asymmetric re-entry patterns and break-up into sustained ventricular tachycardia., Conclusion: HCM ventricles exhibited an increased risk to non-sustained and sustained re-entry, largely dominated by an impaired cellular response and deleterious interactions with the diffuse fibrotic substrate., Competing Interests: Conflict of interest: none declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2024
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22. Outcomes of combined left bundle branch area pacing with atrioventricular nodal ablation in patients with atrial fibrillation and pulmonary disease.
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Sefton C, Tanaka-Esposito C, Dresing T, Lee J, and Chung R
- Subjects
- Humans, Male, Female, Retrospective Studies, Aged, Middle Aged, Cardiac Pacing, Artificial, Catheter Ablation methods, Lung Diseases surgery, Bundle of His physiopathology, Atrial Fibrillation surgery, Atrioventricular Node surgery, Atrioventricular Node physiopathology
- Abstract
Introduction: Concomitant left bundle branch area pacing (LBBAP) with atrioventricular (AV) nodal ablation is emerging as a viable management option in atrial fibrillation refractory to medical management. Its viability in patients with pulmonary disease and atrial fibrillation is unknown., Methods and Results: This is a retrospective, observational cohort study in consecutive patients who underwent concomitant LBBAP with AV nodal ablation with advanced pulmonary disease at the Cleveland Clinic Fairview Hospital between January 2019 and January 2023. Patient characteristics, comorbidities, and medication use were extracted via chart review. Rates of hospitalizations, medication use, and structural disease seen on echocardiography were compared before and after the procedure. There were 27 patients with group 3 pulmonary hypertension who underwent the procedure. In the 24 months preprocedure, there were 114 admissions for heart failure or atrial fibrillation compared to 9 admissions postprocedure (p < .001). Mean follow up was 17.3 ± 12.1 months. There were no significant complications or lead dislodgements. Echocardiographic characteristics were similar prior to and after pacemaker implantation. Use of medications for rate and rhythm control was common preprocedure, and was reduced dramatically postprocedure., Conclusion: This small, retrospective cohort study suggests concomitant LBBAP with AV nodal ablation may be safe and efficacious for management of atrial fibrillation in patients with advanced pulmonary disease., (© 2024 The Authors. Pacing and Clinical Electrophysiology published by Wiley Periodicals LLC.)
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- 2024
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23. A supraventricular tachycardia and the response to double ventricular extrastimulus pacing: What is the mechanism?
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Park JW, Ha YW, Park S, Choi Y, Kim SH, and Oh YS
- Subjects
- Humans, Male, Electrocardiography, Treatment Outcome, Female, Middle Aged, Tachycardia, Supraventricular physiopathology, Tachycardia, Supraventricular diagnosis, Tachycardia, Supraventricular surgery, Tachycardia, Supraventricular therapy, Cardiac Pacing, Artificial, Action Potentials, Electrophysiologic Techniques, Cardiac, Heart Rate
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- 2024
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24. AV-optimized conduction system pacing for treatment of AV dromotropathy: A randomized, cross-over study.
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Zupan Mežnar A, Mrak M, Mullens W, Štublar J, Ivanovski M, and Žižek D
- Subjects
- Humans, Male, Female, Treatment Outcome, Aged, Single-Blind Method, Middle Aged, Time Factors, Action Potentials, Recovery of Function, Stroke Volume, Atrioventricular Node physiopathology, Severity of Illness Index, Cross-Over Studies, Atrioventricular Block therapy, Atrioventricular Block physiopathology, Atrioventricular Block diagnosis, Cardiac Pacing, Artificial, Ventricular Function, Left, Exercise Tolerance, Heart Rate
- Abstract
Background: Severe first-degree atrioventricular (AV) block may produce symptoms similar to heart failure due to AV dyssynchrony, a syndrome termed AV dromotropathy. According to guidelines, it should be considered for permanent pacemaker implantation, yet evidence supporting this treatment is scarce., Objectives: This study aimed to determine the impact of AV-optimized conduction system pacing (CSP) in patients with symptomatic severe first-degree AV block and echocardiographic signs of AV dyssynchrony., Methods: Patients with symptomatic first-degree AV block (PR > 250 ms), preserved left ventricular ejection fraction, narrow QRS, and AV dyssynchrony were included in the study. In a single-blind cross-over design, patients were randomized to AV sequential CSP or backup VVI pacing with a base rate of 40 bpm. We compared exercise capacity, echocardiographic parameters, and symptom occurrence at the end of 3 months of each period., Results: Fourteen patients completed the study. During the AV-optimized CSP compared to the backup pacing period, patients achieved a higher workload on exercise test (147.2 ± 50.9 vs. 140.7 ± 55.8 W; p = .032), with a trend towards higher peak VO2 (23.3 ± 7.1 vs. 22.8 ± 7.1 mL/min/kg; p = .224), and higher left ventricular stroke volume (LVSV 74.5 ± 13.8 vs. 66.4 ± 12.5 mL; p < .001). Symptomatic improvement was recorded, with fewer patients reporting general tiredness and 71% of patients preferring the AV-optimized CSP (p = .008)., Conclusions: AV-optimized CSP could improve symptoms, exercise capacity and LVSV in patients with severe first-degree AV block., (© 2024 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.)
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- 2024
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25. Significant Mitral Regurgitation After Permanent Right Ventricular Pacemaker Implantation: Prognostic Implications.
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Nabeta T, Galloo X, Tops L, Stassen J, Marsan NA, van der Bijl P, and Bax JJ
- Subjects
- Humans, Male, Female, Aged, Prognosis, Retrospective Studies, Follow-Up Studies, Middle Aged, Cardiac Pacing, Artificial, Risk Factors, Aged, 80 and over, Echocardiography, Prevalence, Mitral Valve Insufficiency epidemiology, Pacemaker, Artificial, Heart Ventricles diagnostic imaging, Heart Ventricles physiopathology
- Abstract
The underlying mechanisms leading to the development of mitral regurgitation (MR) after right ventricular (RV) pacemaker (PM) implantation and its prognostic value have yet to be fully understood. The purpose of this study was to evaluate the prevalence and clinical variables associated with the development of MR after RV pacing and its association with outcomes. A total of 451 patients (mean age 69 ± 15 years, 61% male) who underwent de novo RV PM implantation were included. The development of significant MR, defined as ≥moderate from mild or none/trace at baseline, occurred in 131 (29%) patients at a median of 2.4 years (interquartile range: 1.0 to 3.8 years) after PM implantation. Multivariate logistic regression analysis demonstrated that implantation of a single-chamber PM, left ventricular end-systolic volume index, and the presence of mild MR (vs no MR) at baseline were independently associated with the development of significant MR post-implant. Cardiac events, defined as the composite of all-cause mortality or heart failure hospitalization, occurred in 143 patients (31.7%) during a median follow-up of 5.4 years (interquartile range: 3.0 to 8.1 years). Multivariate Cox regression analysis demonstrated that the development of significant MR was independently related to the occurrence of cardiac events. In conclusion, the development of significant MR after PM implantation is seen in about one-third of recipients and is independently associated with adverse cardiac events., Competing Interests: Declaration of competing interest Nina Ajmone Marsan received speaker fees from Abbott Vascular and GE Healthcare. Jeroen J. Bax received speaker fees from Abbott Vascular, Edwards Lifesciences, and Omron. The remaining authors have no competing interests to declare., (Copyright © 2024. Published by Elsevier Inc.)
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- 2024
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26. Result of the left bundle branch area pacing data collection registry, an international multicenter study of conduction system pacing with a Tendril STS 2088 stylet-driven lead.
- Author
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Vijayaraman P, Foo D, Lim TSE, Diamantakos E, Verma S, Hourdain J, Pandurangi U, Bhargava K, Zanon F, Stone J, Lee K, and Nair D
- Subjects
- Humans, Female, Male, Aged, Retrospective Studies, Time Factors, Middle Aged, Treatment Outcome, Aged, 80 and over, Bradycardia physiopathology, Bradycardia therapy, Bradycardia diagnosis, Bundle of His physiopathology, Heart Failure physiopathology, Heart Failure diagnosis, Heart Failure therapy, Risk Factors, Equipment Design, Registries, Cardiac Pacing, Artificial, Action Potentials, Heart Rate, Pacemaker, Artificial
- Abstract
Introduction: Left bundle branch area (LBBA) pacing (LBBAP) has been proposed as an alternative therapy option in patients indicated for cardiac pacing to treat bradycardia or heart failure. The aim of the study was to evaluate the safety and effectiveness of LBBAP in patients implanted with a Tendril 2088 stylet-driven lead., Methods: The international retrospective data collection registry included 11 sites from 5 countries globally. Patients with attempted implants of the Tendril lead in the LBBA were followed for at least 6 months post the implant attempt. The primary safety and efficacy endpoints were freedom from LBBAP lead-related serious adverse events and the composite of LBBA capture threshold of ≤2.0 V and R-wave amplitudes ≥5 mV (or ≥value at implant), respectively., Results: Of 221 patients with attempted implants of the Tendril 2088 lead in the LBBA, 91.4% (202/221) had successful implants for LBBAP. Regardless of the LBBAP implant success, all patients were followed for at least 6 months (8.7 ± 7.3 months). Baseline characteristics: 44% female, 84% ≥65 years old, 34% coronary artery disease, and 86% of primary indications for pacemaker implant. Both primary safety and effectiveness endpoints were met (freedom from LBBAP lead-related serious adverse device effects of 99.5% and electrical performance composite success rate of 93%). The capture thresholds in LBBAP at implant and 6 months were 0.8 ± 0.3 V@0.4 ± 0.1 ms and 0.8 ± 0.3 V@0.4 ± 0.1 ms. The rate of patients with capture threshold rise ≥1 V was 1.5% through 6 months. The R-wave amplitudes in LBBAP at implant and 6 months were 9.3 ± 3.2 mV and 10.6 ± 3.0 mV., Conclusions: This large multicenter study demonstrates that the stylet-driven Tendril™ STS 2088 lead is safe and effective for LBBAP with high success and low complication rates., (© 2024 The Author(s). Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.)
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- 2024
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27. The world's longest lasting VVI pacemaker device for over 40 years.
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Papasteriadis E and Margos NP
- Subjects
- Humans, Time Factors, Cardiac Pacing, Artificial, Male, Equipment Design, Aged, Female, Pacemaker, Artificial, Electrocardiography, Ambulatory instrumentation, Heart Rate
- Abstract
Introduction: Implantable permanent pacemaker function is supported by their energy sources for a mean period of 8.8-12.4 years. We previously published this case of a patient with a normally functioning VVI pacemaker, 31 years after implantation., Methods and Results: In this report, we state that the device is still functioning normally 40 years after implantation. The most recent device interrogation revealed pacing threshold of 0.9 V/0.5 ms. Holter monitoring for 24 hours recorded a total of 98.707 beats with 97.78% paced beats, without any indication of pacemaker malfunction and with stable heart rate at 70-71 bpm., Conclusion: Most patients with implantable devices have the appropriate follow-up and settings of low energy consumption. Manufacturing companies should focus on prolonging device longevity, to produce future devices with higher energy capacity., (© 2024 Wiley Periodicals LLC.)
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- 2024
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28. The utility and impact of outpatient telemetry monitoring in post-transcatheter aortic valve replacement patients.
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Beccarino N, Epstein LM, Khodak A, Mihelis E, Pagan E, Kliger C, Pirelli L, Bhasin K, Maniatis G, Kowalski M, Kalimi R, Gandotra P, Chinitz J, Esposito R, and Rutkin BJ
- Subjects
- Humans, Male, Female, Aged, 80 and over, Aged, Time Factors, Treatment Outcome, Risk Factors, Ambulatory Care, Heart Rate, Retrospective Studies, Patient Discharge, Action Potentials, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement instrumentation, Telemetry instrumentation, Cardiac Pacing, Artificial, Pacemaker, Artificial, Arrhythmias, Cardiac diagnosis, Arrhythmias, Cardiac physiopathology, Arrhythmias, Cardiac therapy, Arrhythmias, Cardiac etiology, Aortic Valve Stenosis surgery, Aortic Valve Stenosis physiopathology, Predictive Value of Tests, Aortic Valve surgery, Aortic Valve physiopathology
- Abstract
Background: Conduction disturbances are a common complication of transcatheter aortic valve replacement (TAVR). Mobile Cardiac Telemetry (MCT) allows for continuous monitoring with near "real time" alerts and has allowed for timely detection of conduction abnormalities and pacemaker placement in small trials. A standardized, systematic approach utilizing MCT devices post TAVR has not been widely implemented, leading to variation in use across hospital systems., Objectives: Our aim was to evaluate the utility of a standardized, systematic approach utilizing routine MCT to facilitate safe and earlier discharge by identifying conduction disturbances requiring permanent pacemaker (PPM) placement. We also sought to assess the occurrence of actionable arrhythmias in post-TAVR patients., Methods: Using guidance from the JACC Scientific Expert Panel, a protocol was implemented starting in December 2019 to guide PPM placement post-TAVR across our health system. All patients who underwent TAVR from December 2019 to June 2021 across four hospitals within Northwell Health, who did not receive or have a pre-existing PPM received an MCT device at discharge and were monitored for 30 days. Clinical and follow-up data were collected and compared to pre initiative patients., Results: During the initiative 693 patients were monitored with MCT upon discharge, 21 of whom required PPM placement. Eight of these patients had no conduction abnormality on initial or discharge ECG. 59 (8.6 %) patients were found to have new atrial fibrillation or flutter via MCT monitoring. There were no adverse events in the initiative group. Prior to the initiative, 1281 patients underwent TAVR over a one-year period. The initiative group had significantly shorter length of stay than pre-initiative patients (2.5 ± 4.5 vs 3.0 ± 3.8 days, p < 0.001) and lower overall PPM placement rate within 30 days post-TAVR (16 % vs 20.5 %, P = 0.0125)., Conclusions: In our study, implementation of a standardized, systematic approach utilizing MCT in post-TAVR patients was safe and allowed for timely detection of conduction abnormalities requiring pacemaker placement. This strategy also detected new atrial fibrillation and flutter. Reduction in post TAVR pacemaker rate and length of stay were also noted although this effect is multifactorial., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Bruce Rutkin reports a relationship with Edwards Lifesciences Corporation that includes: consulting or advisory. Bruce Rutkin reports a relationship with Medtronic Inc. that includes: consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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29. Morbidity, Mortality and Gender Differences in Patients With Pacemakers
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Mariann Gyongyosi, Cardiologist, Assoc. Prof. Univ.-Doz. Dr.
- Published
- 2018
30. Incidentally detected anomalous left atrial fibromuscular band
- Author
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Mansi Verma, Niraj Nirmal Pandey, Sanjeev Kumar, and Rakesh Yadav
- Subjects
Atrial Fibrillation ,Cardiac Pacing, Artificial ,Humans ,Atrial Appendage ,General Medicine ,Heart Atria - Published
- 2024
31. Robust, stretchable bioelectronic interfaces for cardiac pacing enabled by interfacial transfer of laser-induced graphene via water-response, nonswellable PVA gels.
- Author
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Zhao L, Chang Z, Guo B, Lu Y, Lu X, Ren Q, Lv A, Nie J, Ji D, Rotenberg MY, Wang B, Zhang Y, and Fang Y
- Subjects
- Animals, Rats, Electric Conductivity, Water chemistry, Pacemaker, Artificial, Cardiac Pacing, Artificial, Gels chemistry, Rats, Sprague-Dawley, Graphite chemistry, Polyvinyl Alcohol chemistry, Biosensing Techniques, Lasers
- Abstract
Implantable cardiac pacemakers are crucial therapeutic tools for managing various cardiac conditions. For effective pacing, electrodes should exhibit flexibility, deformability, biocompatibility, and high conductivity/capacitance. Laser-induced graphene (LIG) shows promise due to its exceptional electrical and electrochemical properties. However, the fragility of LIG and the non-stretchability of polyimide substrates pose challenges when interfacing with the beating heart. Here, we present a simple method for fabricating robust, flexible, and stretchable bioelectronic interfaces by transferring LIG via water-responsive, nonswellable polyvinyl alcohol (PVA) gels. PVA solution penetrates the porous structure of LIG and solidifies into PVA xerogel as the solvent evaporates. The robust PVA xerogel enables the smooth transfer of LIG and prevents stretching of the LIG network during this process, which helps maintain its conductivity. When hydrated, the xerogel becomes a stable, nonswellable hydrogel. This gives the LIG-PVA hydrogel (LIG-PVA-H) composites with excellent conductivity (119.7 ± 4.3Ω sq
-1 ), high stretchability (up to 420%), reliability (cyclic stretch under 15% strain, with ∼ 1-time resistance increase), and good stability in phosphate buffered saline. The LIG-PVA-H composites were used as biointerfaces for electrocardiogram signal recording and electrical pacing on rat hearts ex vivo and in vivo, using commercial setups and a custom-built implantable wireless device. This work expands the application of LIG in bioelectronic interfaces and facilitates the development of electrotherapy for cardiac diseases., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024. Published by Elsevier B.V.)- Published
- 2024
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32. Does Pacing Affect Lifetime Pace?: The Elusive Clinical Impact of New Pacemaker Implantation After TAVR.
- Author
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Saia F
- Subjects
- Humans, Treatment Outcome, Time Factors, Aortic Valve Stenosis surgery, Aortic Valve Stenosis physiopathology, Aortic Valve Stenosis diagnostic imaging, Risk Factors, Heart Rate, Aortic Valve surgery, Aortic Valve physiopathology, Aortic Valve diagnostic imaging, Heart Valve Prosthesis, Arrhythmias, Cardiac physiopathology, Arrhythmias, Cardiac therapy, Arrhythmias, Cardiac diagnosis, Arrhythmias, Cardiac etiology, Transcatheter Aortic Valve Replacement adverse effects, Cardiac Pacing, Artificial, Pacemaker, Artificial
- Abstract
Competing Interests: Funding Support and Author Disclosures Dr Saia has received advisory board and lecture fees from Abbott, Boston Scientific, Edwards Lifesciences, and Medtronic.
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- 2024
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33. Predictors and 5-Year Clinical Outcomes of Pacemaker After TAVR: Analysis From the PARTNER 2 SAPIEN 3 Registries.
- Author
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Chen S, Dizon JM, Hahn RT, Pibarot P, George I, Zhao Y, Blanke P, Kapadia S, Babaliaros V, Szeto WY, Makkar R, Thourani VH, Webb JG, Mack MJ, Leon MB, Kodali S, and Nazif TM
- Subjects
- Humans, Male, Female, Risk Factors, Aged, Time Factors, Aged, 80 and over, Treatment Outcome, Risk Assessment, Arrhythmias, Cardiac therapy, Arrhythmias, Cardiac diagnosis, Arrhythmias, Cardiac physiopathology, Arrhythmias, Cardiac etiology, Arrhythmias, Cardiac mortality, United States epidemiology, Registries, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement mortality, Transcatheter Aortic Valve Replacement instrumentation, Pacemaker, Artificial, Cardiac Pacing, Artificial, Heart Valve Prosthesis, Aortic Valve Stenosis surgery, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis physiopathology, Aortic Valve Stenosis mortality, Aortic Valve surgery, Aortic Valve physiopathology, Aortic Valve diagnostic imaging, Prosthesis Design
- Abstract
Background: Conduction disturbances requiring a permanent pacemaker (PPM) are a frequent complication of transcatheter aortic valve replacement (TAVR) with few reports of rates, predictors, and long-term clinical outcomes following implantation of the third-generation, balloon-expandable SAPIEN 3 (S3) transcatheter heart valve (THV)., Objectives: The aim of this study was to investigate the rates, predictors, and long-term clinical outcomes of PPM implantation following TAVR with the S3 THV., Methods: The current study included 857 patients in the PARTNER 2 S3 registries with intermediate and high surgical risk without prior PPM, and investigated predictors and 5-year clinical outcomes of new PPM implanted within 30 days of TAVR., Results: Among 857 patients, 107 patients (12.5%) received a new PPM within 30 days after TAVR. By multivariable analysis, predictors of PPM included increased age, pre-existing right bundle branch block, larger THV size, greater THV oversizing, moderate or severe annulus calcification, and implantation depth >6 mm. At 5 years (median follow-up 1,682.0 days [min 2.0 days, max 2,283.0 days]), new PPM was not associated with increased rates of all-cause mortality (Adj HR: 1.20; 95% CI: 0.85-1.70; P = 0.30) or repeat hospitalization (Adj HR: 1.22; 95% CI: 0.67-2.21; P = 0.52). Patients with new PPM had a decline in left ventricular ejection fraction at 1 year that persisted at 5 years (55.1 ± 2.55 vs 60.4 ± 0.65; P = 0.02)., Conclusions: PPM was required in 12.5% of patients without prior PPM who underwent TAVR with a SAPIEN 3 valve in the PARTNER 2 S3 registries and was not associated with worse clinical outcomes, including mortality, at 5 years. Modifiable factors that may reduce the PPM rate include bioprosthetic valve oversizing, prosthesis size, and implantation depth., Competing Interests: Funding Support and Author Disclosures The PARTNER 2 trial was funded by Edwards Lifesciences. Dr R.T. Hahn reports speaker fees from Abbott Structural, Baylis Medical, Edwards Lifesciences, Medtronic and Philips Healthcare, Siemens Healthineers; she has institutional consulting contracts for which she receives no direct compensation with Abbott Structural, Anteris, Edwards Lifesciences, Medtronic and Novartis; she is Chief Scientific Officer for the Echocardiography Core Laboratory at the Cardiovascular Research Foundation for multiple industry-sponsored valve trials, for which she receives no direct industry compensation. P Pibarot has received institutional funding from Edwards Lifesciences, Medtronic, Pi-Cardia, Cardiac Success, Roche Diagnostics for echocardiography core laboratory analyses, blood biomarker analyses, and research studies in the field of interventional and pharmacologic treatment of valvular heart diseases, for which he received no personal compensation. Dr George has received consulting fees from Edwards Lifesciences. Dr Zhao is an employee of Edwards Lifesciences. Dr Blanke has institutional core laboratory contracts with Edwards Lifesciences, Medtronic, Boston Scientific, Abbott, PI Cardia, and Conformal; he is a Consultant for Edwards Lifesciences and Laralab Imaging. Dr Babaliaros has received consulting fees from Abbott and Edwards Lifesciences. Dr Szeto has received grant support from Edwards Lifesciences and Medtronic; and is a consultant for MicroInterventional Devices. Dr Makkar has received research support from Edwards Lifesciences and Abbott; and consultant fees/honoraria from Abbott, Cordis Corporation, and Medtronic. Dr Thourani serves on advisory boards for Edwards Lifesciences, Abbott Vascular, Atricure, Cryolife, Jenavalve, Shockwave, and Boston Scientific. Dr Webb is a consultant for Edwards Lifesciences. Michael Mack served as co-primary investigator for the PARTNER Trial for Edwards Lifesciences and COAPT trial for Abbott; and served as study chair for the APOLLO trial for Medtronic (all activities unpaid). Dr Leon serves on the PARTNER Trial Executive Committee for Edwards Lifesciences (unpaid); has received institutional research grants from Abbott, Boston Scientific, and Medtronic; has been an unpaid advisor for Abbott, Boston Scientific, Sinomed, and Medtronic; and holds equity in Medinol. Dr Kodali has received institutional research grants from Edwards Lifesciences, Medtronic, and Abbott; has received consulting fees from Abbott, Admedus, and Meril Lifesciences; and has equity options from Biotrace Medical and Thubrikar Aortic Valve Inc. Dr Nazif has received consulting fees from Edwards Lifesciences, Medtronic, Boston Scientific, and Teleflex. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024. Published by Elsevier Inc.)
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- 2024
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34. Response to "Clinical advantage and disadvantage of trans-thoracic echocardiography guidance during left bundle branch pacing": Addressing key aspects of our study.
- Author
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Yang Z and Liu Z
- Subjects
- Humans, Echocardiography, Bundle-Branch Block physiopathology, Bundle-Branch Block diagnostic imaging, Bundle-Branch Block therapy, Bundle of His physiopathology, Bundle of His diagnostic imaging, Predictive Value of Tests, Ultrasonography, Interventional, Treatment Outcome, Action Potentials, Cardiac Pacing, Artificial
- Published
- 2024
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35. Nonpharmacologic rate control of postoperative atrial fibrillation in the canine sterile pericarditis model.
- Author
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Lee S, Wallick D, Khrestian C, Juzbasich D, Laurita D, Rushing G, and Sahadevan J
- Subjects
- Animals, Dogs, Cardiac Pacing, Artificial, Atrioventricular Node physiopathology, Atrioventricular Node surgery, Male, Time Factors, Cardiac Surgical Procedures adverse effects, Adipose Tissue physiopathology, Postoperative Complications etiology, Atrial Fibrillation physiopathology, Atrial Fibrillation diagnosis, Disease Models, Animal, Pericarditis physiopathology, Pericarditis diagnosis, Heart Rate
- Abstract
Introduction: Postoperative atrial fibrillation (POAF) is common following open heart surgery, and is associated with significant morbidity. Medications used for ventricular rate control of POAF may not be effective in controlling rapid ventricular rates during the postoperative period because of increased sympathetic tone. The purpose of this study was to develop nonpharmacologic rate control of POAF by atrioventricular node (AVN) fat pad stimulation using clinically available temporary pacing wires in the canine sterile pericarditis model., Methods: We studied 10 sterile pericarditis dogs in the closed-chest state on postoperative days 1-3. The AVN fat pad stimulation (amplitude 2-15 mA; frequency 20 Hz; pulse width 0.03-0.2 ms) was performed during sustained POAF (>5 min). We measured ventricular rate and inefficient ventricular contractions during sustained POAF and compared it with and without AVN fat pad stimulation. Also, the parameters of AVN fat pad stimulation to achieve a rate control of POAF were measured over the postoperative days., Results: Eleven episodes of sustained POAF were induced in 5/10 sterile pericarditis dogs in the closed-chest state on postoperative days 1-2. During POAF, the AVN fat pad stimulation decreased the ventricular rate from 178 ± 52 bpm to 100 ± 8 bpm in nine episodes. Nonpharmacologic rate control therapy successfully controlled the ventricular rate and eliminated inefficient ventricular contractions during POAF for the duration of the AVN fat pad stimulation. The AVN fat pad stimulation output remained relatively stable over the postoperative days., Conclusion: During sustained POAF, nonpharmacologic rate control by AVN fat pad stimulation effectively and safely controlled rapid ventricular rates throughout the postoperative period., (© 2024 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.)
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- 2024
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36. First in man right atrial appendage implantation of a Micra leadless pacemaker.
- Author
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Pinon P, Iserin L, Hachem F, and Waldmann V
- Subjects
- Humans, Sick Sinus Syndrome therapy, Sick Sinus Syndrome physiopathology, Sick Sinus Syndrome diagnosis, Ebstein Anomaly surgery, Ebstein Anomaly physiopathology, Treatment Outcome, Male, Equipment Design, Pacemaker, Artificial, Atrial Appendage physiopathology, Atrial Appendage surgery, Atrial Appendage diagnostic imaging, Cardiac Pacing, Artificial
- Abstract
Introduction: Pacemaker implantation can be challenging in patients with congenital heart disease., Methods and Results: In a patient with Ebstein disease and symptomatic sinus node dysfunction, despite multiple attempts, the Micra® pacemaker could not be implanted in the severely dilated right ventricle. In that context, and after iodine injection to confirm the appropriate location, the Micra® pacemaker was successfully implanted in the right appendage at the first attempt., Conclusion: Despite the recent development of dedicated dual-chamber leadless pacemaker, to the best of our knowledge, this case is the first off-label Micra® implantation in a right appendage., (© 2024 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.)
- Published
- 2024
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37. Transcatheter valve-in-valve interventions after aortic root replacement: A systematic review.
- Author
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Baudo M, Cuko B, Ternacle J, Sicouri S, Torregrossa G, Pernot M, Busuttil O, Beurton A, Alaux A, Ouattara A, Lafitte S, Bonnet G, Leroux L, De Vincentiis C, Labrousse L, Ramlawi B, and Modine T
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Aortic Valve Insufficiency diagnostic imaging, Aortic Valve Insufficiency physiopathology, Aortic Valve Insufficiency surgery, Aortic Valve Insufficiency etiology, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation instrumentation, Blood Vessel Prosthesis Implantation adverse effects, Cardiac Pacing, Artificial, Heart Valve Prosthesis Implantation instrumentation, Heart Valve Prosthesis Implantation adverse effects, Prosthesis Failure, Recovery of Function, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Aortic Valve surgery, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Heart Valve Prosthesis, Transcatheter Aortic Valve Replacement instrumentation, Transcatheter Aortic Valve Replacement adverse effects
- Abstract
Structural valve deterioration after aortic root replacement (ARR) surgery may be treated by transcatheter valve-in-valve (ViV-TAVI) intervention. However, several technical challenges and outcomes are not well described. The aim of the present review was to analyze the outcomes of ViV-TAVI in deteriorated ARR. This review included studies reporting any form of transcatheter valvular intervention in patients with a previous ARR. All forms of ARR were considered, as long as the entire root was replaced. Pubmed, ScienceDirect, SciELO, DOAJ, and Cochrane library databases were searched until September 2023. Overall, 86 patients were included from 31 articles that met our inclusion criteria out of 741 potentially eligible studies. In the entire population, the mean time from ARR to reintervention was 11.0 years (range: 0.33-22). The most frequently performed techniques/grafts for ARR was homograft (67.4%) and the main indication for intervention was aortic regurgitation (69.7%). Twenty-three articles reported no postoperative complications. Six (7.0%) patients required permanent pacemaker implantation (PPI) after the ViV-TAVI procedure, and 4 (4.7%) patients had a second ViV-TAVI implant. There were three device migrations (3.5%) and 1 stroke (1.2%). Patients with previous ARR present a high surgical risk. ViV-TAVI can be considered in selected patients, despite unique technical challenges that need to be carefully addressed according to the characteristics of the previous surgery and on computed tomography analysis., (© 2024 Wiley Periodicals LLC.)
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- 2024
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38. Computational Modelling Enabling In Silico Trials for Cardiac Physiologic Pacing.
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Strocchi M, Wijesuriya N, Mehta V, de Vere F, Rinaldi CA, and Niederer SA
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- Humans, Heart Rate, Heart Conduction System physiopathology, Cardiac Resynchronization Therapy adverse effects, Animals, Treatment Outcome, Models, Cardiovascular, Computer Simulation, Cardiac Pacing, Artificial, Action Potentials
- Abstract
Conduction system pacing (CSP) has the potential to achieve physiological-paced activation by pacing the ventricular conduction system. Before CSP is adopted in standard clinical practice, large, randomised, and multi-centre trials are required to investigate CSP safety and efficacy compared to standard biventricular pacing (BVP). Furthermore, there are unanswered questions about pacing thresholds required to achieve optimal pacing delivery while preventing device battery draining, and about which patient groups are more likely to benefit from CSP rather than BVP. In silico studies have been increasingly used to investigate mechanisms underlying changes in cardiac function in response to pathologies and treatment. In the context of CSP, they have been used to improve our understanding of conduction system capture to optimise CSP delivery and battery life, and noninvasively compare different pacing methods on different patient groups. In this review, we discuss the in silico studies published to date investigating different aspects of CSP delivery., (© 2023. The Author(s).)
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- 2024
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39. Impact of omitting the intravenous heparin bolus on outcomes of leadless pacemaker implantation.
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Huang J, Bhatia NK, Lloyd MS, Westerman S, Shah A, Delurgio D, Patel AM, Tompkins C, El-Chami MF, and Merchant FM
- Subjects
- Humans, Male, Aged, Female, Treatment Outcome, Retrospective Studies, Time Factors, Risk Factors, Aged, 80 and over, Middle Aged, Drug Administration Schedule, Prosthesis Implantation instrumentation, Prosthesis Implantation adverse effects, Prosthesis Design, Heparin administration & dosage, Heparin adverse effects, Pacemaker, Artificial, Anticoagulants administration & dosage, Anticoagulants adverse effects, Cardiac Pacing, Artificial
- Abstract
Background: Early guidance recommended a bolus of intravenous heparin at the beginning of leadless pacemaker (LP) implantation procedures. However, due to concern about bleeding complications, more recent practice has tended toward omitting the bolus and only running a continuous heparin infusion through the introducer sheath. The impact of omitting the heparin bolus on procedural outcomes is not clear., Methods: We reviewed all Medtronic Micra LP implants at our institution from 9/2014 to 9/2022. The decision to bolus with heparin was at operator discretion., Results: Among 621 LP implants, 326 received an intravenous heparin bolus, 243 did not, and 52 patients were excluded because heparin bolus status could not be confirmed. There was a trend toward more frequent omission of the heparin bolus with more recent implants. Median follow-up after LP implant was 14.3 (interquartile range [IQR]: 8.4-27.9) months. There was no difference between heparin bolus and no bolus groups in the number of device deployments/recaptures (1.42 ± 0.81 vs. 1.31 ± 0.66, p = .15). Implant-related adverse events were also similar between heparin bolus and no bolus groups: access-site hematoma requiring intervention (7 vs. 5, p = .99), pseudoaneurysm (1 vs. 1, p = .99), cardiac perforation (1 vs. 1, p = .99), intraprocedural device thrombus formation (2 vs. 4, p = .41), 30-day rehospitalization (21 vs. 15, p = .98), and 30-day all-cause mortality (16 vs. 14, p = .70). There was one additional nonfatal cardiac perforation in a patient who was excluded due to unknown heparin bolus status. Regarding device electrical parameters between heparin bolus and no bolus groups, there were no significant differences at the time of implant: pacing capture threshold 0.5 ± 0.4 vs. 0.5 ± 0.3, p = .10; pacing impedance 739.9 ± 226.4 vs. 719.1 ± 215.4, p = .52; R wave sensing 11.7 ± 5.7 vs. 12.0 ± 5.4, p = .34). Long-term device performance was also similar between groups., Conclusion: Omission of the systemic heparin bolus at the time of LP implantation appears safe in appropriately selected patients. Heparin bolus may still be considered in long cases requiring multiple device deployments or in patients at high risk for thrombotic complications., (© 2024 Wiley Periodicals LLC.)
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- 2024
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40. Pacemaker implantation associated with tricuspid repair in the setting of mitral valve surgery: Insights from a Cardiothoracic Surgical Trials Network randomized trial.
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Ailawadi G, Voisine P, Raymond S, Gelijns AC, Moskowitz AJ, Falk V, Overbey JR, Chu MWA, Mack MJ, Bowdish ME, Krane M, Yerokun B, Conradi L, Bolling SF, Miller MA, Taddei-Peters WC, Fenton KN, Jeffries NO, Kramer RS, Geirsson A, Moquete EG, O'Sullivan K, Hupf J, Hung J, Beyersdorf F, Bagiella E, Gammie JS, O'Gara PT, Iribarne A, Borger MA, and Gillinov M
- Subjects
- Humans, Female, Male, Aged, Risk Factors, Middle Aged, Treatment Outcome, Time Factors, Cardiac Pacing, Artificial, Heart Valve Prosthesis Implantation adverse effects, Cardiac Valve Annuloplasty adverse effects, Cardiac Valve Annuloplasty mortality, Cardiac Valve Annuloplasty methods, Tricuspid Valve Insufficiency surgery, Tricuspid Valve Insufficiency physiopathology, Mitral Valve Insufficiency surgery, Mitral Valve Insufficiency physiopathology, Mitral Valve Insufficiency mortality, Pacemaker, Artificial, Tricuspid Valve surgery, Tricuspid Valve physiopathology, Mitral Valve surgery, Mitral Valve physiopathology
- Abstract
Objectives: In a recent trial, tricuspid annuloplasty (TA) during mitral valve surgery (MVS) for degenerative mitral regurgitation and moderate or less tricuspid regurgitation (TR) reduced the composite rate of death, reoperation for TR, or TR progression at 2 years. However, this benefit was counterbalanced by an increase in implantation of permanent pacemakers (PPMs). In this study, we analyzed the timing, indications, and risk factors for these implantations., Methods: We randomized 401 patients (MVS alone = 203; MVS + TA = 198). Potential risk factors for PPMs were assessed using multivariable time-to-event models with death and PPM implantation for heart failure indications as competing risks., Results: A PPM was implanted in 36 patients (9.6; 95% CI, 6.8-13.0) within 2 years of randomization, with 30/187 (16.0%) in the MVS + TA and 6/188 (3.2%) in the MVS groups (rate ratio, 5.08; 95% CI, 2.16-11.94; P < .001). Most (29/36; 80.6%) implantations occurred within 30 days postoperatively. Independent risk factors for PPM implantation within 2 years were TA (hazard ratio [HR], 5.94; 95% CI, 2.27-15.53; P < .001), increasing age (5 years, HR, 1.23; 95% CI, 1.01-1.52; P = .04), and left ventricular ejection fraction (LVEF; HR, 0.96; 95% CI, 0.92-0.99; P = .02). In the subset of TA recipients (n = 197), age (5 years, HR, 1.05; 95% CI, 1.00-1.10; P = .04) and LVEF (HR, 0.95; 95% CI, 0.91-0.99; P = .01) were associated with PPM within 2 years., Conclusions: Concomitant TA, age, and baseline LVEF were risk factors for PPM implantation in patients who underwent MVS for degenerative mitral regurgitation. Although TA was effective in preventing progression of TR, innovation is needed to identify ways to decrease PPM implantation rates., (Copyright © 2022 The American Association for Thoracic Surgery. All rights reserved.)
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- 2024
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41. Clinical advantage and disadvantage of trans-thoracic echocardiography guidance during left bundle branch pacing.
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Kataoka N and Imamura T
- Subjects
- Humans, Action Potentials, Bundle of His physiopathology, Bundle of His diagnostic imaging, Bundle-Branch Block physiopathology, Bundle-Branch Block diagnostic imaging, Bundle-Branch Block therapy, Echocardiography, Heart Rate, Predictive Value of Tests, Treatment Outcome, Ultrasonography, Interventional, Cardiac Pacing, Artificial
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- 2024
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42. Predictive Value of CTA-Derived Extracellular Volume for Pacemaker Implantation Post-TAVR in Low-Flow Low-Gradient Aortic Stenosis.
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Malhotra P, Han D, Chen B, Siegel R, Friedman J, Dey D, Makkar R, Berman DS, and Tamarappoo B
- Subjects
- Humans, Treatment Outcome, Female, Male, Cardiac Pacing, Artificial, Severity of Illness Index, Aged, Aged, 80 and over, Risk Factors, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis physiopathology, Aortic Valve Stenosis surgery, Predictive Value of Tests, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement instrumentation, Computed Tomography Angiography, Pacemaker, Artificial, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Aortic Valve surgery, Aortic Valve pathology
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- 2024
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43. Comparison of clinical outcomes between transthoracic echocardiography and X-ray guided left bundle branch pacing for bradycardia: A randomized control trial.
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Naraen A
- Subjects
- Humans, Male, Treatment Outcome, Female, Aged, Bundle of His physiopathology, Bundle of His diagnostic imaging, Heart Rate, Middle Aged, Radiography, Interventional, Predictive Value of Tests, Bradycardia therapy, Bradycardia physiopathology, Bradycardia diagnosis, Cardiac Pacing, Artificial, Echocardiography
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- 2024
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44. Impact of weight adjusted high frequency low tidal volume ventilation and atrial pacing in lesion metrics in high-power short-duration ablation: Results of a pilot study.
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Vassallo F, Volponi C, Cunha C, Corcino L, Serpa E, Simoes A Jr, Gasparini D, Barbosa LF, and Schmidt A
- Subjects
- Humans, Female, Pilot Projects, Male, Prospective Studies, Middle Aged, Aged, Treatment Outcome, Time Factors, Heart Rate, Cardiac Pacing, Artificial, Body Weight, Atrial Fibrillation physiopathology, Atrial Fibrillation surgery, Atrial Fibrillation diagnosis, Catheter Ablation adverse effects, Tidal Volume
- Abstract
Introduction: Lesion size index (LSI) was introduced with the use of Tacticath™ and as a surrogate of lesion quality. The metric used to achieve the predetermined values involves combined information of contact force (CF), power and radiofrequency time. Rapid atrial pacing (RAP) and high-frequency low-tidal volume ventilation (HFLTV) independently or in combination improve catheter stability and CF and quality of lesions. Data of the impact of body weight adjusted HFLTV ventilation strategy associated with RAP in the lesion metrics still lacking. The study aimed to compare the results of high-power short-duration (HPSD) atrial fibrillation ablation using simultaneous weight adjusted HFLTV and RAP and standard ventilation (SV) protocol., Methods: Prospective, nonrandomized study with 136 patients undergoing de novo ablation divided into two groups; 70 in RAP (100 ppm) + HFLTV with 4 mL/kg of tidal volume and 25 breaths/min (group A) and 66 patients with SV in intrinsic sinus rhythm (group B). Ablation using 50 W, CF of 5-10 g/10-20 g and 40 mL/minute flow rate on the posterior and anterior left atrial wall, respectively., Results: No procedure-related complications. Group A: Mean LSI points 70 ± 16.5, mean total lower LSI 3.4 ± 0.5, mean total higher LSI 8.2 ± 0.4 and mean total LSI 5.6 ± 0.6. Anterior and posterior wall mean total LSI was 6.0 ± 0.4 and 4.2 ± 0.3, respectively. Mean local impedance drop (LID) points were 118.8 ± 28.4, mean LID index (%) 12.9 ± 1.5, and mean LID < 12% points 55.9 ± 23.8. Anterior and posterior wall mean total LID index were 13.6 ± 2.0 and 11.9 ± 1.7, respectively. Recurrence in 11 (15.7%) patients. Group B: Mean LSI points 56 ± 2.7, mean total lower LSI 2.9 ± 0.7, mean total higher LSI 6.9 ± 0.9, and mean total LSI 4.8 ± 0.8. Anterior and posterior wall mean total LSI was 5.1 ± 0.3 and 3.5 ± 0.5, respectively. Mean LID points were 111.4 ± 21.5, mean LID index (%) 11.4 ± 1.2, and mean LID < 12% points 54.9 ± 25.2. Anterior and posterior wall mean total LID index were 11.8 ± 1.9 and 10.3 ± 1.7, respectively. Recurrence in 14 (21.2%) patients. Mean follow up was 15.2 ± 4.4 months., Conclusion: Weight adjusted HFLTV ventilation with RAP HPSD ablation produced lower recurrence rate and better LSI and LID parameters in comparison to SV and intrinsic sinus rhythm., (© 2024 Wiley Periodicals LLC.)
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- 2024
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45. Pacemaker lead dislocation during TricValve procedure with an extremely small superior vena cava.
- Author
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Chen M, Moschovitis A, and Taramasso M
- Subjects
- Humans, Treatment Outcome, Heart Valve Prosthesis Implantation instrumentation, Heart Valve Prosthesis Implantation adverse effects, Prosthesis Design, Male, Cardiac Pacing, Artificial, Device Removal, Female, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement instrumentation, Aged, Aortic Valve Stenosis surgery, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis physiopathology, Aged, 80 and over, Pacemaker, Artificial, Vena Cava, Superior diagnostic imaging, Vena Cava, Superior surgery, Heart Valve Prosthesis, Foreign-Body Migration etiology, Foreign-Body Migration diagnostic imaging, Foreign-Body Migration surgery, Foreign-Body Migration therapy
- Published
- 2024
- Full Text
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46. Atrioventricular conduction disorders in aortic valve infective endocarditis.
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Philip M, Hourdain J, Resseguier N, Gouriet F, Casalta JP, Arregle F, Hubert S, Riberi A, Mouret JP, Mardigyan V, Deharo JC, and Habib G
- Subjects
- Humans, Male, Female, Middle Aged, Aged, Risk Factors, Time Factors, Endocarditis mortality, Endocarditis diagnosis, Endocarditis complications, Cardiac Pacing, Artificial, Retrospective Studies, Adult, Risk Assessment, Electrocardiography, Heart Rate, Aged, 80 and over, Heart Conduction System physiopathology, Atrioventricular Block physiopathology, Atrioventricular Block diagnosis, Atrioventricular Block etiology, Atrioventricular Block therapy, Atrioventricular Block mortality, Aortic Valve surgery, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Aortic Valve microbiology, Pacemaker, Artificial, Hospital Mortality
- Abstract
Background: Aortic valve infective endocarditis may be complicated by high-degree atrioventricular block in up to 10-20% of cases., Aim: To assess high-degree atrioventricular block occurrence, contributing factors, prognosis and evolution in patients referred for aortic infective endocarditis., Methods: Two hundred and five patients referred for aortic valve infective endocarditis between January 2018 and March 2021 were included in this study. A comprehensive assessment of clinical, electrocardiographic, biological, microbiological and imaging data was conducted, with a follow-up carried out over 1 year., Results: High-degree atrioventricular block occurred in 22 (11%) patients. In univariate analysis, high-degree atrioventricular block was associated with first-degree heart block at admission (odds ratio 3.1; P=0.015), periannular complication on echocardiography (odds ratio 6.9; P<0.001) and severe biological inflammatory syndrome, notably C-reactive protein (127 vs 90mg/L; P=0.011). In-hospital mortality (12.7%) was higher in patients with high-degree atrioventricular block (odds ratio 4.0; P=0.011) in univariate analysis. Of the 16 patients implanted with a permanent pacemaker for high-degree atrioventricular block and interrogated, only four (25%) were dependent on the pacing function at 1-year follow-up., Conclusions: High-degree atrioventricular block is associated with high inflammation markers and periannular complications, especially if first-degree heart block is identified at admission. High-degree atrioventricular block is a marker of infectious severity, and tends to raise the in-hospital mortality rate. Systematic assessment of patients admitted for infective endocarditis suspicion, considering these contributing factors, could indicate intensive care unit monitoring or even temporary pacemaker implantation in those at highest risk., (Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)
- Published
- 2024
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47. Characteristics of Right-Sided Accessory Pathways Associated With Right Cardiac Veins.
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Lai Y, Gao M, Li Q, Li M, Zhang J, Li X, Guo Q, Huang L, Jiang C, Li S, Guo X, Zuo S, Liu N, Wang W, Zhao X, Sang C, Tang R, Long D, Dong J, and Ma C
- Subjects
- Humans, Male, Adult, Female, Middle Aged, Adolescent, Young Adult, Child, Electrophysiologic Techniques, Cardiac, Coronary Vessels physiopathology, Coronary Vessels diagnostic imaging, Action Potentials, Heart Rate, Cardiac Pacing, Artificial, Accessory Atrioventricular Bundle physiopathology, Accessory Atrioventricular Bundle surgery, Catheter Ablation, Phlebography
- Abstract
Background: The anatomy of myocardial fibers around the right cardiac veins (RCVs) and their roles in accessory pathways (APs) are rarely reported., Methods: Six RCV-APs were identified from 566 patients with right-sided APs. Mapping of retrograde atrial activation was performed using CARTO 3 system under orthodromic tachycardia or right ventricular pacing. Venography of RCVs was acquired at the earliest retrograde atrial activation., Results: Patients enrolled had a median age of 30 (11-51) years, 5 of them were male. Venography of RCVs could be classified into 3 distinct patterns based on the identified ventricular branches, right marginal vein only (type I; n=3), both right marginal vein and anterior cardiac veins (type II; n=2), and anterior cardiac vein only (type III; n=1). Patients with type I venography had rS QRS pattern in lead V
1 , negative delta wave in lead III and negative or isoelectric delta wave in lead aVF. However, patients with type II and III venography had QS QRS patterns in lead V1 and variable patterns of delta wave in inferior leads. Earliest retrograde atrial activation was found at a median of 16.75 (14.60-20.00) mm away from the tricuspid annulus, all with A larger than V. At the earliest retrograde atrial activation, far-field ventricular electrogram was found 30 ms later than QRS onset in 1 patient under sinus rhythm. AP conduction was eliminated by mechanical pressure in 2 and by radiofrequency ablation in 4 at the ostium of the veins colocalizing with the earliest retrograde activation of the right atrium. No recurrence was observed during 36 (10-60) months follow-up., Conclusions: The RCV-AP is a rare form of right-sided APs characterized by atrial insertions distant from the annulus. ECG-speculated ventricular insertion sites conformed to the location of identified RCVs., Competing Interests: Disclosures Dr Ma has received honoraria from Bristol Myers Squibb, Pfizer, Johnson & Johnson, Boehringer Ingelheim, and Bayer for giving lectures. Dr Dong has received honoraria from Johnson & Johnson for giving lectures. The other authors report no conflicts.- Published
- 2024
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48. First-in-man report of transsubclavian venous implantation of the Aveir leadless cardiac pacing system.
- Author
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Balanescu DV, Ward RC, Amin H, Noseworthy PA, Asirvatham SJ, Friedman PA, and Mulpuru SK
- Subjects
- Humans, Male, Middle Aged, Female, Aged, Treatment Outcome, Equipment Design, Prosthesis Implantation instrumentation, Prosthesis Implantation adverse effects, Pacemaker, Artificial, Cardiac Pacing, Artificial, Jugular Veins surgery
- Abstract
Introduction: Transsubclavian venous implantation of the Aveir leadless cardiac pacemaker (LCP) has not been previously reported., Methods and Results: Three cases of transsubclavian implantation of the Aveir LCP are reported. Two cases were postbilateral orthotopic lung transplant, without appropriate femoral or jugular access due to recent ECMO cannulation and jugular central venous catheters. In one case, there was strong patient preference for same-day discharge. Stability testing confirmed adequate fixation and electrical testing confirmed stable parameters in all cases. All patients tolerated the procedure well without significant immediate complications., Conclusions: We demonstrate the feasibility of transsubclavian implantation of the Aveir LCP., (© 2024 Wiley Periodicals LLC.)
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- 2024
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49. Endocardial repolarization dispersion in BrS: A novel automatic algorithm for mapping activation recovery interval.
- Author
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Latrofa S, Hartwig V, Bachi L, Notarstefano P, Garibaldi S, Panchetti L, Nesti M, Seghetti P, Startari U, Mirizzi G, Morelli MS, Modena M, Mazzanti A, Emdin M, Giannoni A, and Rossi A
- Subjects
- Humans, Male, Female, Middle Aged, Adult, Time Factors, Case-Control Studies, Ajmaline administration & dosage, Automation, Ventricular Function, Right, Cardiac Pacing, Artificial, Aged, Signal Processing, Computer-Assisted, Action Potentials, Brugada Syndrome physiopathology, Brugada Syndrome diagnosis, Endocardium physiopathology, Heart Rate, Electrophysiologic Techniques, Cardiac, Predictive Value of Tests, Algorithms, Electrocardiography
- Abstract
Introduction: Repolarization dispersion in the right ventricular outflow tract (RVOT) contributes to the type-1 electrocardiographic (ECG) phenotype of Brugada syndrome (BrS), while data on the significance and feasibility of mapping repolarization dispersion in BrS patients are scarce. Moreover, the role of endocardial repolarization dispersion in BrS is poorly investigated. We aimed to assess endocardial repolarization patterns through an automated calculation of activation recovery interval (ARI) estimated on unipolar electrograms (UEGs) in spontaneous type-1 BrS patients and controls; we also investigated the relation between ARI and right ventricle activation time (RVAT), and T-wave peak-to-end interval (Tpe) in BrS patients., Methods: Patients underwent endocardial high-density electroanatomical mapping (HDEAM); BrS showing an overt type-1 ECG were defined as OType1, while those without (latent type-1 ECG and LType1) received ajmaline infusion. BrS patients only underwent programmed ventricular stimulation (PVS). Data were elaborated to obtain ARI corrected with the Bazett formula (ARIc), while RVAT was derived from activation maps., Results: 39 BrS subjects (24 OType1 and 15 LTtype1) and 4 controls were enrolled. OType1 and post-ajmaline LType1 showed longer mean ARIc than controls (306 ± 27.3 ms and 333.3 ± 16.3 ms vs. 281.7 ± 10.3 ms, p = .05 and p < .001, respectively). Ajmaline induced a significant prolongation of ARIc compared to pre-ajmaline LTtype1 (333.3 ± 16.3 vs. 303.4 ± 20.7 ms, p < .001) and OType1 (306 ± 27.3 ms, p < .001). In patients with type-1 ECG (OTtype1 and post-ajmaline LType1) ARIc correlated with RVAT (r = .34, p = .04) and Tpec (r = .60, p < .001), especially in OType1 subjects (r = .55, p = .008 and r = .65 p < .001, respectively)., Conclusion: ARIc mapping demonstrates increased endocardial repolarization dispersion in RVOT in BrS. Endocardial ARIc positively correlates with RVAT and Tpec, especially in OType1., (© 2024 Wiley Periodicals LLC.)
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- 2024
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50. Tricuspid regurgitation and infective endocarditis as a cause of lead dislodgement in left bundle branch area pacing.
- Author
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Ekinci S
- Subjects
- Humans, Male, Pacemaker, Artificial adverse effects, Endocarditis complications, Endocarditis etiology, Aged, Bundle-Branch Block etiology, Electrodes, Implanted adverse effects, Cardiac Pacing, Artificial, Female, Equipment Failure, Tricuspid Valve Insufficiency etiology, Tricuspid Valve Insufficiency surgery
- Abstract
Background: According to the current literature, there is no difference between left bundle brunch area pacing (LBBAP) and right ventricular apical pacing in terms of lead dislodgement and capture threshold elevation. However, there are no large-scale studies reporting the data about long-term lead stability in patients with severe tricuspid regurgitation., Methods and Results: We present a case of lead dislodgement with possible infective endocarditis six months after implantation in a patient with severe tricuspid regurgitation who underwent LBBAP., Conclusions: We concluded that severe preoperative tricuspid regurgitation may cause lead dislodgement, and infective endocarditis may be a facilitator or main reason of lead dislodgement in cases of LBBAP., (© 2023 Wiley Periodicals LLC.)
- Published
- 2024
- Full Text
- View/download PDF
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