Heart Rhythm O2最新文献

{"title":"Association of atrial fibrillation burden and clinical profile with blood biomarkers: Results from the ISOLATION Ablation Cohort","authors":"Zarina Habibi MD ,&nbsp;Dominique V.M. Verhaert MD, PhD ,&nbsp;Konstanze Betz MD ,&nbsp;Ben J.M. Hermans MD, PhD ,&nbsp;Joris Winters MD, PhD ,&nbsp;Suzanne A.M. Philippens ,&nbsp;Sevasti-Maria Chaldoupi MD, PhD ,&nbsp;Bart Maesen MD, PhD ,&nbsp;Jos G. Maessen MD, PhD ,&nbsp;Aaron Isaacs PhD ,&nbsp;Sjoerd W. Westra MD ,&nbsp;Robin Nijveldt MD, PhD ,&nbsp;Ludovic Gillet PhD ,&nbsp;Ursula-Henrike Wienhues-Thelen PhD ,&nbsp;Merlin Koehler ,&nbsp;Stef Zeemering PhD ,&nbsp;Kevin Vernooy MD, PhD ,&nbsp;Dominik Linz MD, PhD ,&nbsp;Ulrich Schotten MD, PhD","doi":"10.1016/j.hroo.2025.02.017","DOIUrl":"10.1016/j.hroo.2025.02.017","url":null,"abstract":"<div><h3>Background</h3><div>Advances have been made in identifying biomarkers for atrial fibrillation (AF) outcomes.</div></div><div><h3>Objective</h3><div>The link between clinical determinants, especially AF burden, and blood biomarkers remains underexplored.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional analysis of AF patients scheduled for catheter ablation in the ISOLATION study (July 2020–May 2022, NCT04342312). Patient characteristics and blood samples were collected before ablation. AF burden was assessed using hand-held electrocardiograms (ECGs) over 4 weeks. Blood samples were analyzed for biomarkers, including bone morphogenetic protein 10 (BMP10), angiopoietin-2 (Ang-2), fibroblast growth factor 23 (FGF23), and others. We trained elastic net regression models to identify the most important clinical determinants out of 64 available clinical features.</div></div><div><h3>Results</h3><div>We analyzed blood samples from 508 patients with a mean age of 63 ±9 years; 31.1% were female. Of these, 70% had paroxysmal AF and 30% persistent AF. Heart failure was present in 15% of patients. In 140 patients (28%), AF was observed during blood draw. AF burden before ablation was available in 389 patients. After multivariable analysis, the following clinical determinants were independently associated with biomarker levels: AF burden, AF during blood draw, age, heart failure, decreased kidney function, and female sex. Most notably, AF burden and AF rhythm at the time of sampling were strongly associated with various biomarker levels. Female sex was positively associated with BMP10 and FGF23, but negatively associated with high sensitive Troponin-T (hs-TNT).</div></div><div><h3>Conclusions</h3><div>AF burden is a strong determinant of many biomarkers, underpinning their relevance as covariates in biomarker studies. Pro-fibrotic biomarkers are increased in female patients, whereas male patients more often show elevated biomarkers of myocardial injury.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 5","pages":"Pages 661-670"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and socioeconomic factors associated with recurrent atrial fibrillation after catheter ablation or antiarrhythmic drug therapy","authors":"Jaejin An PhD ,&nbsp;Nisha Bansal MD ,&nbsp;Chengyi Zheng PhD ,&nbsp;Ming-Sum Lee MD, PhD ,&nbsp;Rong Wei MA ,&nbsp;Teresa N. Harrison SM ,&nbsp;Dongjie Fan MS ,&nbsp;Elisha Garcia MS ,&nbsp;Benjamin Lidgard MD ,&nbsp;Leila R. Zelnick PhD ,&nbsp;Daniel E. Singer MD ,&nbsp;Alan S. Go MD","doi":"10.1016/j.hroo.2025.02.007","DOIUrl":"10.1016/j.hroo.2025.02.007","url":null,"abstract":"<div><h3>Background</h3><div>Maintaining sinus rhythm after initiating rhythm control strategies in atrial fibrillation (AF) remains challenging.</div></div><div><h3>Objective</h3><div>The study sought to investigate risk factors associated with AF recurrence among patients with incident AF who underwent catheter ablation or received antiarrhythmic drugs (AADs).</div></div><div><h3>Methods</h3><div>We identified adults with incident AF from 2010 to 2017 who underwent catheter ablation or initiated AAD therapy from 2 U.S. healthcare systems and were followed through 2019. Using electronic health records and a validated natural language processing algorithm, we evaluated the 12-month cumulative incidence of recurrent AF and examined the associations between clinical and socioeconomic factors and AF recurrence using Fine-Gray subdistribution hazard models.</div></div><div><h3>Results</h3><div>Among 982 patients who underwent catheter ablation and 18,025 who initiated AAD therapy, the 12-month incidence of recurrent AF was 55.5% and 62.7%, respectively, with median times to AF recurrence of 168 and 24 days, respectively. Heart failure was associated with AF recurrence after catheter ablation (adjusted hazard ratio [aHR] 1.41, 95% confidence interval [CI] 1.09–1.81) and AAD therapy (aHR 1.30, 95% CI 1.25–1.36). Low educational attainment (aHR 1.42, 95% CI 1.04–1.95) and higher low-density lipoprotein cholesterol (for ≥100 mg/dL vs 70–99 mg/dL: aHR 1.26, 95% CI 1.02–1.57) were associated with AF recurrence following catheter ablation; obesity (for body mass index ≥40 kg/m² vs &lt;25 kg/m²: aHR 1.27, 95% CI 1.17–1.38), hypertension (aHR 1.08, 95% CI 1.03–1.14), and lower estimated glomerular filtration rate (for 45–59 mL/min/1.73 m² vs ≥60 mL/min/1.73 m²: aHR 1.08, 95% CI 1.03–1.14) were associated with AF recurrence following AAD initiation.</div></div><div><h3>Conclusion</h3><div>Heart failure, dyslipidemia, obesity, hypertension, reduced estimated glomerular filtration rate, and living in neighborhoods with low educational attainment were associated with higher risk for AF recurrence, emphasizing the importance of identifying and managing modifiable factors in AF.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 5","pages":"Pages 631-640"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144088904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and frequency of arrhythmias and electrocardiographic abnormalities in Pakistan: An outpatient ECG-based study","authors":"Aiysha Nasir MBBS, FCPS,&nbsp;Armughan Tauheed Farooqi MBBS,&nbsp;Saadia Sattar MSc,&nbsp;Yawer Saeed MRCP, PhD","doi":"10.1016/j.hroo.2024.12.017","DOIUrl":"10.1016/j.hroo.2024.12.017","url":null,"abstract":"<div><h3>Background</h3><div>Little is known about the prevalence of arrhythmias in Pakistan. We assessed the frequency of arrhythmias and electrocardiographic (ECG) abnormalities among the Pakistani population, attending the outpatient department, categorized by age, gender, and geographic region.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate variations in arrhythmia prevalence and ECG abnormalities across a large sample of a South Asian population.</div></div><div><h3>Methods</h3><div>This retrospective study analyzed 8746 ECGs from Aga Khan University Hospital in 2022. The ECGs were digitally saved, initially interpreted by an ECG-trained cardiac technician, reviewed by a junior cardiologist using the Minnesota Code, and validated by a senior cardiologist. An electrophysiologist resolved discrepancies to ensure accurate final results.</div></div><div><h3>Results</h3><div>A total of 8746 ECGs were analyzed (56.86% from men). The prevalences of common arrhythmia were sinus bradycardia 8.53%, sinus tachycardia 5.08%, atrial fibrillation (AF) (1.17%), atrial flutter (AFL) (0.18%), first-degree atrioventricular (AV) block (1.31%), and other AV blocks (0.14%). Women had more sinus tachycardia (6.44%, <em>P</em> &lt;.05), AF (1.59%, <em>P</em> &lt;.001), and poor R-wave progression (6.41%, <em>P</em> &lt;.005), whereas men had more sinus bradycardia (10.68%, <em>P</em> &lt;.05), left-anteiror fasicular block (8.32%, <em>P</em> &lt;.005), left ventricular hypertrophy (LVH) (2.59%, <em>P</em> &lt;.005), pathologic Q waves (3.86%, <em>P</em> &lt;.005), and early repolarization pattern (5.87%, <em>P</em> &lt;.05). Patients from Khyber Pakhtunkhwa region had higher rates of LVH (7.69%, <em>P</em> &lt;.005) and AF (3.85%, <em>P</em> &lt;.05). In contrast, patients from Gilgit-Baltistan had the highest rates of sinus bradycardia (28.57%, <em>P</em> &lt;.005). Right bundle branch block (10.61%, <em>P</em> &lt;.005) and long QT (3.79%, <em>P</em> &lt;.005) were more prevalent in the youngest population, whereas patients aged &gt;65 years had more AF (3.31%, <em>P</em> &lt;.005), AFL (0.59%, <em>P</em> &lt;.005), sinus bradycardia (10.71%, <em>P</em> &lt;.001), first-degree AV block (4.62%, <em>P</em> &lt;.005), left anterior fascicular block (13.08%, <em>P</em> &lt;.005), left bundle branch block (2.43%, <em>P</em> &lt;.005), poor R-wave progression (8.82%, <em>P</em> &lt;.005), and pathologic Q waves (5.98%, <em>P</em> &lt;.005).</div></div><div><h3>Conclusion</h3><div>This study details important information about arrhythmia prevalence in a large sample of a South Asian population. AF is more common in women, the elderly, and people from Khyber Pakhtunkhwa.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 4","pages":"Pages 489-498"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contrastive pretraining improves deep learning classification of endocardial electrograms in a preclinical model","authors":"Bram Hunt BS ,&nbsp;Eugene Kwan PhD ,&nbsp;Jake Bergquist PhD ,&nbsp;James Brundage MD ,&nbsp;Benjamin Orkild BS ,&nbsp;Jiawei Dong PhD ,&nbsp;Eric Paccione MS ,&nbsp;Kyoichiro Yazaki MD ,&nbsp;Rob S. MacLeod PhD ,&nbsp;Derek J. Dosdall PhD ,&nbsp;Tolga Tasdizen PhD ,&nbsp;Ravi Ranjan MD, PhD","doi":"10.1016/j.hroo.2025.01.008","DOIUrl":"10.1016/j.hroo.2025.01.008","url":null,"abstract":"<div><h3>Background</h3><div>Rotors and focal ectopies, or “drivers,” are hypothesized mechanisms of persistent atrial fibrillation (AF). Machine learning algorithms have been used to identify these drivers, but the limited size of current driver data sets constrains their performance.</div></div><div><h3>Objective</h3><div>We proposed that pretraining using unsupervised learning on a substantial data set of unlabeled electrograms could enhance classifier accuracy when applied to a smaller driver data set.</div></div><div><h3>Methods</h3><div>We used a SimCLR-based framework to pretrain a residual neural network on 113,000 unlabeled 64-electrode measurements from a canine model of AF. The network was then fine-tuned to identify drivers from intracardiac electrograms. Various augmentations, including cropping, Gaussian blurring, and rotation, were applied during pretraining to improve the robustness of the learned representations.</div></div><div><h3>Results</h3><div>Pretraining significantly improved driver detection accuracy compared with a non-pretrained network (80.8% vs 62.5%). The pretrained network also demonstrated greater resilience to reductions in training data set size, maintaining higher accuracy even with a 30% reduction in data. Gradient-weighted Class Activation Mapping analysis revealed that the network’s attention aligned well with manually annotated driver regions, suggesting that the network learned meaningful features for driver detection.</div></div><div><h3>Conclusion</h3><div>This study demonstrates that contrastive pretraining can enhance the accuracy of driver detection algorithms in AF. The findings support the broader application of transfer learning to other electrogram-based tasks, potentially improving outcomes in clinical electrophysiology.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 4","pages":"Pages 473-480"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simple electrocardiographic index for A4-wave amplitude of the VDD leadless pacemaker","authors":"Takafumi Oka MD, PhD ,&nbsp;Koki Tanabiki ,&nbsp;Takayuki Sekihara MD ,&nbsp;Akira Yoshida MD, PhD ,&nbsp;Kentaro Ozu MD ,&nbsp;Tomoaki Nakano MD ,&nbsp;Hibiki Mima MD ,&nbsp;Yasuhiro Akazawa MD, PhD ,&nbsp;Fusako Sera MD, PhD ,&nbsp;Shigetaka Kusumoto ,&nbsp;Masaki Takashina MD, PhD ,&nbsp;Tomohito Ohtani MD, PhD ,&nbsp;Yasushi Sakata MD, PhD","doi":"10.1016/j.hroo.2025.01.006","DOIUrl":"10.1016/j.hroo.2025.01.006","url":null,"abstract":"<div><h3>Background</h3><div>A4-wave amplitude (A4-amplitude) is a crucial factor determining the percentage of atrioventricular synchrony (%AVS) in a mechanical sensing–based VDD leadless pacemaker (VDD-LP). We hypothesized that 12-lead electrocardiographic (ECG) parameters related to right atrial (RA) excitation could predict A4-amplitude.</div></div><div><h3>Objectives</h3><div>We aimed to investigate the relationship between A4-amplitude and 12-lead ECG parameters reflecting RA excitation and assess its predictive power for achieving an appropriate A4-amplitude associated with high %AVS.</div></div><div><h3>Methods</h3><div>This single-center, retrospective, observational study enrolled consecutive patients undergoing VDD-LP implantation. The relationship between A4-amplitude and the positive peak amplitude of the P wave in lead II (P2), the positive peak amplitude of the P wave in lead V₁ (V1P), and the sum of P2 and V1P (V1PP2) were assessed.</div></div><div><h3>Results</h3><div>Of the 67 patients undergoing VDD-LP implantation, 46 without atrial fibrillation bradycardia were enrolled. They had a data set of manual atrial mechanical sensing tests and 12-lead ECG. Among P2, V1P, and V1PP2, only V1PP2 was correlated with A4-amplitude (<em>R</em>²=0.10; <em>P</em>=.029). In 30 patients in VDD pacing mode, the median %AVS was 67.8%. The A4-amplitude cutoff for %AVS ≥ 67.8% was 3.2 m/s² (area under the curve [AUC] 0.81; <em>P</em>=.002). For A4-amplitude ≥ 3.2 m/s², V1PP2 had moderate predictive power (AUC 0.72; <em>P</em>=.007). In 30 patients without sick sinus syndrome, the predictive power of V1PP2 for A4-amplitude ≥ 3.2 m/s² was increased (AUC 0.80; cutoff value 110 μV; sensitivity 83%; specificity 71%; <em>P</em>=.011).</div></div><div><h3>Conclusion</h3><div>V1PP2, reflecting RA excitation, was related to A4-amplitude and had moderate predictive power. Notably, its predictive power increased when limited to patients without sick sinus syndrome. V1PP2 is a simple ECG predictor of A4-amplitude.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 4","pages":"Pages 519-527"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transmural left atrial roofline block using rescue cryoballoon ablation after unsuccessful radiofrequency ablation","authors":"Hiroyuki Kato MD, PhD ,&nbsp;Satoshi Yanagisawa MD, PhD ,&nbsp;Kazumasa Suga MD ,&nbsp;Hisashi Murakami MD, PhD ,&nbsp;Yasuya Inden MD, PhD ,&nbsp;Toyoaki Murohara MD, PhD","doi":"10.1016/j.hroo.2025.01.010","DOIUrl":"10.1016/j.hroo.2025.01.010","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 4","pages":"Pages 546-550"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reaching the unreachable in left bundle branch area pacing","authors":"Antti Eranti MD, PhD","doi":"10.1016/j.hroo.2025.01.007","DOIUrl":"10.1016/j.hroo.2025.01.007","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 4","pages":"Page 554"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atrial FDG uptake and atrial fibrillation: A systematic review and meta-analysis","authors":"Ahmad Kassar MD ,&nbsp;Nadia Chamoun MD ,&nbsp;Romanos Haykal MD ,&nbsp;Yaacoub Chahine MD ,&nbsp;Miles Babb MD ,&nbsp;Hala Al Yasiri MD ,&nbsp;Tori Hensley BSc ,&nbsp;Efstathia Andrikopoulou MD ,&nbsp;Nazem Akoum MD, MS","doi":"10.1016/j.hroo.2025.01.002","DOIUrl":"10.1016/j.hroo.2025.01.002","url":null,"abstract":"<div><h3>Background</h3><div>Atrial inflammatory and metabolic derangements have been reported in patients with atrial fibrillation (AF).</div></div><div><h3>Objective</h3><div>We sought to evaluate the association of ¹⁸F-fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) in the left and right atria and AF.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis, using the PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, of studies involving patients undergoing FDG-PET scans with reported atrial or ventricular uptake and outcomes of AF. Data were pooled and analyzed, and FDG uptake in AF and non-AF patients was compared using odds ratios (ORs).</div></div><div><h3>Results</h3><div>Six studies (4 retrospective, 1 prospective, and 1 case-control) were included in the meta-analysis of studies on patients not meeting diagnostic criteria for cardiac sarcoidosis (CS): 832 patients with a mean age of 67 years, 62% male, and 53% with hypertension. AF patients demonstrated higher odds of FDG uptake in the left atrium (pooled OR 14.50, 95% confidence interval 6.78–31.02; <em>P</em> &lt; .0001, <em>I</em>² = 0) and right atrium (pooled OR 51.98, 95% confidence interval 22.77–118.63, <em>P</em> &lt; .0001, <em>I</em>² = 0). Two studies on patients met diagnostic criteria for CS: one did not report atrial uptake and the other did not demonstrate a statistically significant association between right or left atrial uptake in AF patients.</div></div><div><h3>Conclusion</h3><div>In patients undergoing FDG-PET without meeting CS diagnostic criteria, FDG uptake in the atria was strongly associated with AF, suggesting altered metabolism or inflammation in AF pathophysiology and risk assessment.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 4","pages":"Pages 417-423"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Permanent pacemaker insertion for bradyarrhythmias in a secondary health facility in sub-Saharan Africa","authors":"Tolulope Taiwo Shogade MBChB, MWACP, FMCP ,&nbsp;Ezekiel Olayiwola Ogunleye MBBS MSc, FWACP ,&nbsp;Catherine Eyo MBBS, FWACS ,&nbsp;Francis Aniefiok Akpan MBBCh, FWACS ,&nbsp;Ekikere Marcel Udoh MBBCh, MWACP ,&nbsp;Aquaowo Udosen MBBCh, FWACP ,&nbsp;Omolara Yewande Ukpong MBBS, MWACP ,&nbsp;Eyo Ekpe MBBS, FWACS, FMCS, FACS","doi":"10.1016/j.hroo.2025.01.011","DOIUrl":"10.1016/j.hroo.2025.01.011","url":null,"abstract":"<div><h3>Background</h3><div>Permanent cardiac pacemaker (PPM) insertion has been used clinically since 1960. It is a lifesaving procedure in symptomatic bradyarrhythmia. The experience of PPM implantation in non-Western countries has not been well characterized.</div></div><div><h3>Objective</h3><div>This study reports our experience in pacemaker insertion in the newly remodeled District General Hospital Awa. The Akwa Ibom state government fully sponsored the procedures with state funds; otherwise, patients would have to pay out of pocket.</div></div><div><h3>Methods</h3><div>The general hospital is fully equipped with an ultramodern theater with C-arm fluoroscopy and audiovisual facilities, and there is an anteroom in the procedural suite where people can watch for virtual learning. This is the first of its kind.</div></div><div><h3>Results</h3><div>A single-chamber (VVIR) pacemaker was implanted in all patients. There were no acute complications postsurgery. All patients were followed for at least 3 months. There were no deaths reported at the 3-month follow-up. Device interrogations were performed at the 3-month follow-up visit, and device parameters were all stable with excellent sensing thresholds. Routine follow-up for our center is a regular 2-monthly follow-up in the first year.</div></div><div><h3>Conclusion</h3><div>We conclude that permanent pacemakers can be safely carried out in a well-equipped district general hospital. Most needy patients are likely older, with complete heart block as the commonest indication. However, government and/or nongovernmental organizations need health insurance or subsidization to make it sustainable in low-income countries to which Nigeria belongs.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 4","pages":"Pages 537-541"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative durability of pacemaker leads in transvenous lead extraction: An evaluation through bench testing","authors":"Junji Morita MD ,&nbsp;Ayako Okada MD, PhD ,&nbsp;Fred Kusumoto MD, FHRS ,&nbsp;Kentaro Nakamura MD","doi":"10.1016/j.hroo.2025.01.015","DOIUrl":"10.1016/j.hroo.2025.01.015","url":null,"abstract":"<div><h3>Background</h3><div>Transvenous lead extraction (TLE) is a less invasive alternative to surgical removal, but leads may break during TLE.</div></div><div><h3>Objective</h3><div>The purpose of this study was to compare the tensile strength and behavior under stress of leads from different manufacturers during TLE using different extraction techniques.</div></div><div><h3>Methods</h3><div>Different lead types (Tendril STS, INGEVITY, INGEVITY+, Solia S, and CapSure Fix) were subjected to tensile testing using a testing machine. The leads were tested in up to 3 different configurations: terminal removed, terminal retained, and removal using a snare. Lead durability was assessed by increasing force and measuring elongation and the force required for complete disruption.</div></div><div><h3>Results</h3><div>The tensile strength of leads varied greatly based on the extraction technique and lead type. The INGEVITY leads showed improved durability when secured with a snare, despite weak performance when the terminal was removed or retained. The INGEVITY+ lead exhibited enhanced durability, particularly when removed using a snare. The Tendril STS lead exhibited the least durability when the terminal was removed but had comparable durability to the Solia S and CapSure Fix leads when the terminal was retained. The Solia S and CapSure Fix leads had consistent higher durability, irrespective of whether or not the terminal was removed.</div></div><div><h3>Conclusion</h3><div>This study found wide variability of lead behavior among manufacturers and with different extraction techniques. Terminal retention and snare usage enhanced lead durability, suggesting that these techniques should be considered depending on lead type and for leads with longer implantation periods or if higher extraction forces are anticipated.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 4","pages":"Pages 481-488"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}