Heart Rhythm O2Pub Date : 2024-09-01DOI: 10.1016/j.hroo.2024.06.005
{"title":"A model for the development of cardiac implantable electronic device services in countries lacking such services","authors":"","doi":"10.1016/j.hroo.2024.06.005","DOIUrl":"10.1016/j.hroo.2024.06.005","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 9","pages":"Pages 601-605"},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666501824001831/pdfft?md5=8a6e6d8263015c4e46db46af6941c91c&pid=1-s2.0-S2666501824001831-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141406490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Influence of time to ablation on outcomes among patients with atrial fibrillation with pre-existing heart failure","authors":"Adi Lador MD , Sonia Maccioni MPH , Rahul Khanna PhD , Dongyu Zhang PhD, MD","doi":"10.1016/j.hroo.2024.07.016","DOIUrl":"10.1016/j.hroo.2024.07.016","url":null,"abstract":"<div><h3>Background</h3><p>Atrial fibrillation (AF) and heart failure (HF) are cardiac disorders that often coexist.</p></div><div><h3>Objective</h3><p>This study aimed to investigate how time to ablation could influence the outcomes of AF patients with pre-existing HF.</p></div><div><h3>Methods</h3><p>Using the 2013 to 2022 Optum Clinformatics database, AF patients with pre-existing HF were classified into 2 groups: early ablation (ablation within 6 months of AF diagnosis) and late ablation (ablation in the 6- to 24-month period after AF diagnosis). Outcomes including AF-related hospitalization, electrical cardioversion, repeat ablation, antiarrhythmic drug (AAD) use, and AF recurrence (a composite outcome of the aforementioned events) were assessed in the postblanking 24-month period. Inverse probability of treatment weighted Poisson regression estimated risk ratio (RR) and 95% confidence interval (CI) for each outcome.</p></div><div><h3>Results</h3><p>Overall, 601 patients were identified (early ablation: 347; late ablation: 254). In 24 months, the weighted data suggested that patients in the early ablation cohort had significantly lower rate of composite outcome (49.32% vs 61.39%, <em>P =</em> .01), repeat ablation (8.56% vs 17.35%, <em>P <</em> .01), and AAD use (35.95% vs 47.92%, <em>P =</em> .01). Early ablation was associated with a 20%, 51%, and 25% lower risk of composite outcome (RR 0.80, 95% CI 0.69–0.94), repeat ablation (RR 0.49, 95% CI 0.31–0.79), and AAD use (RR 0.75, 95% CI 0.61–0.92), respectively. No significant difference in AF-related hospitalization and electrical cardioversion were observed.</p></div><div><h3>Conclusion</h3><p>AF patients with pre-existing HF undergoing ablation within 6 months of AF diagnosis have a lower risk of AF recurrence than those undergoing late ablation, which was evidenced by a lower rate of repeat ablation and AAD use.</p></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 9","pages":"Pages 606-613"},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666501824002563/pdfft?md5=1eea12f675a47690735a3f0607acfa3c&pid=1-s2.0-S2666501824002563-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heart Rhythm O2Pub Date : 2024-09-01DOI: 10.1016/j.hroo.2024.07.015
Lin Li MD , Anna Busija MD, PhD , Han Feng PhD , Amitabh C. Pandey MD , Thierry Le Jemtel MD , Bassam G. Wanna MD
{"title":"Effective and safe mechanical transvenous lead extraction in a low-volume center","authors":"Lin Li MD , Anna Busija MD, PhD , Han Feng PhD , Amitabh C. Pandey MD , Thierry Le Jemtel MD , Bassam G. Wanna MD","doi":"10.1016/j.hroo.2024.07.015","DOIUrl":"10.1016/j.hroo.2024.07.015","url":null,"abstract":"<div><h3>Background</h3><p>Transvenous lead extraction (TLE) of cardiac implantable electronic devices was once deemed highly risky by high-volume centers. However, advancements in technology have significantly reduced the risk, making TLE a safer procedure in electrophysiology.</p></div><div><h3>Objective</h3><p>The purpose of this study was to examine the efficacy and safety of mechanical TLEs in a low-volume center with a single operator.</p></div><div><h3>Methods</h3><p>This study retrospectively accessed electronic medical records from the Tulane University School of Medicine system in New Orleans, Louisiana, and included patients who received mechanical TLE from 2016 to 2023. We analyzed the indications for TLE, patient characteristics, lead characteristics, success rate, and complications.</p></div><div><h3>Results</h3><p>We included 149 consecutive mechanical TLEs with an average implant duration of 105 months. A total of 53.7% (80) of TLEs were indicated for infectious reasons, and 37.6% (56) were high-voltage leads. Clinical success and complete procedural success rates were both 94.6% with no procedure-related mortality or major complications. The periprocedural mortality rate was 1.25% (1). Minor complications included a left chest pocket hematoma, a left groin hematoma, and urinary retention.</p></div><div><h3>Conclusion</h3><p>The efficacy and safety of mechanical TLEs performed in a low-volume center are comparable with those in high-volume centers.</p></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 9","pages":"Pages 639-643"},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666501824002551/pdfft?md5=57482ff4bec85f7213cb9c46be6e46c1&pid=1-s2.0-S2666501824002551-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heart Rhythm O2Pub Date : 2024-08-01DOI: 10.1016/j.hroo.2024.07.001
Janneke C. Burger BSc , Luuk H.G.A. Hopman PhD , Michiel J.B. Kemme MD, PhD , Wiert Hoeksema MD , Richard A.P. Takx MD, PhD , Rosa M. Figueras I Ventura PhD , Fernando O. Campos PhD , Gernot Plank PhD , R. Nils Planken MD, PhD , Cornelis P. Allaart MD, PhD , Vokko P. van Halm MD, PhD , Pieter G. Postema MD, PhD , Marco J.W. Götte MD, PhD , Martin J. Bishop PhD , Pranav Bhagirath MD, PhD
{"title":"Optimizing ventricular tachycardia ablation through imaging-based assessment of arrhythmic substrate: A comprehensive review and roadmap for the future","authors":"Janneke C. Burger BSc , Luuk H.G.A. Hopman PhD , Michiel J.B. Kemme MD, PhD , Wiert Hoeksema MD , Richard A.P. Takx MD, PhD , Rosa M. Figueras I Ventura PhD , Fernando O. Campos PhD , Gernot Plank PhD , R. Nils Planken MD, PhD , Cornelis P. Allaart MD, PhD , Vokko P. van Halm MD, PhD , Pieter G. Postema MD, PhD , Marco J.W. Götte MD, PhD , Martin J. Bishop PhD , Pranav Bhagirath MD, PhD","doi":"10.1016/j.hroo.2024.07.001","DOIUrl":"10.1016/j.hroo.2024.07.001","url":null,"abstract":"<div><p>Ventricular tachycardia (VT) is a life-threatening heart rhythm and has long posed a complex challenge in the field of cardiology. Recent developments in advanced imaging modalities have aimed to improve comprehension of underlying arrhythmic substrate for VT. To this extent, high-resolution cardiac magnetic resonance (CMR) and cardiac computed tomography (CCT) have emerged as tools for accurately visualizing and characterizing scar tissue, fibrosis, and other critical structural abnormalities within the heart, providing novel insights into VT triggers and substrate. However, clinical implementation of knowledge derived from these advanced imaging techniques in improving VT treatment and guiding invasive therapeutic strategies continues to pose significant challenges. A pivotal concern lies in the absence of standardized imaging protocols and analysis methodologies, resulting in a large variance in data quality and consistency. Furthermore, the clinical significance and outcomes associated with VT substrate characterization through CMR and CCT remain dynamic and subject to ongoing evolution. This highlights the need for refinement of these techniques before their reliable integration into routine patient care can be realized. The primary objectives of this study are twofold: firstly, to provide a comprehensive overview of the studies conducted over the last 15 years, summarizing the current available literature on imaging-based assessment of VT substrate. Secondly, to critically analyze and evaluate the selected studies, with the aim of providing valuable insights that can inform current clinical practice and future research.</p></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 8","pages":"Pages 561-572"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666501824002186/pdfft?md5=0fe924ff6cc1bb814a2e6916836ec031&pid=1-s2.0-S2666501824002186-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141697720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heart Rhythm O2Pub Date : 2024-08-01DOI: 10.1016/j.hroo.2024.07.005
Gesa von Olshausen MD , Nikola Drca MD, PhD , Astrid Paul-Nordin MD, PhD , Tara Bourke MD , Hamid Bastani MD, PhD , Serkan Saygi MD , Emma Svennberg MD, PhD , Finn Åkerström MD , Ott Saluveer MD, PhD , Mats Jensen-Urstad MD, PhD , Frieder Braunschweig MD, PhD
{"title":"Incidence of atrial fibrillation in patients with atrioventricular nodal re-entrant tachycardia and its association with long-term outcome","authors":"Gesa von Olshausen MD , Nikola Drca MD, PhD , Astrid Paul-Nordin MD, PhD , Tara Bourke MD , Hamid Bastani MD, PhD , Serkan Saygi MD , Emma Svennberg MD, PhD , Finn Åkerström MD , Ott Saluveer MD, PhD , Mats Jensen-Urstad MD, PhD , Frieder Braunschweig MD, PhD","doi":"10.1016/j.hroo.2024.07.005","DOIUrl":"10.1016/j.hroo.2024.07.005","url":null,"abstract":"<div><h3>Background</h3><p>Atrioventricular nodal re-entrant tachycardia (AVNRT) is the most common paroxysmal supraventricular tachycardia. We sought to investigate the incidence of atrial fibrillation in patients with electrophysiologically confirmed/ablated AVNRT and its association with transient ischemic attack (TIA)/stroke as well as mortality during long-term follow-up.</p></div><div><h3>Methods</h3><p>From the Karolinska Ablation Registry, 2855 consecutive patients with a first-time ablation for AVNRT between 2005 and 2018 were analyzed.</p></div><div><h3>Results</h3><p>Patients were 52.1 ± 15.9 years old and 59.3% were women. During follow-up of up to 10 years (median 6.0 years; interquartile range 3.3 to 9.2 years), new onset or recurrence of atrial fibrillation occurred in 317 (11.1%) patients (incidence rate 19 cases per 1000 person-years). Excluding those with history of atrial fibrillation, new onset of atrial fibrillation occurred in 153 (6.1%) patients. In multivariable analysis, history of atrial fibrillation, arterial hypertension, history of TIA/stroke, and heart failure remained independently associated with new onset or recurrence of atrial fibrillation during follow-up. Death of any cause and TIA/stroke occurred in 141 (4.9%) patients and 107 (3.7%) patients, respectively. In multivariable analysis, occurrence of atrial fibrillation during follow-up remained independently associated with both outcomes. The prevalence of atrial fibrillation according to age at the end of follow-up was high among young patients (<60 years of age: 12.7%; 60–69 years of age: 10.6%).</p></div><div><h3>Conclusion</h3><p>In this large cohort of patients with diagnosed AVNRT, the incidence of atrial fibrillation was high (11.1%) during long-term follow-up. Occurrence of atrial fibrillation during follow-up remained independently associated with death for any cause as well as with TIA/stroke. Therefore, a closer monitoring for atrial fibrillation in patients with AVNRT including those at young age is advisable.</p></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 8","pages":"Pages 538-542"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666501824002241/pdfft?md5=8c3bcfef8a6d2d68b943492082f9afac&pid=1-s2.0-S2666501824002241-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141694895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heart Rhythm O2Pub Date : 2024-08-01DOI: 10.1016/j.hroo.2024.07.006
Wenjing Zhu BS , Xueyan Bian BS , Jianli Lv PhD
{"title":"From genes to clinical management: A comprehensive review of long QT syndrome pathogenesis and treatment","authors":"Wenjing Zhu BS , Xueyan Bian BS , Jianli Lv PhD","doi":"10.1016/j.hroo.2024.07.006","DOIUrl":"10.1016/j.hroo.2024.07.006","url":null,"abstract":"<div><h3>Background</h3><p>Long QT syndrome (LQTS) is a rare cardiac disorder characterized by prolonged ventricular repolarization and increased risk of ventricular arrhythmias. This review summarizes current knowledge of LQTS pathogenesis and treatment strategies.</p></div><div><h3>Objectives</h3><p>The purpose of this study was to provide an in-depth understanding of LQTS genetic and molecular mechanisms, discuss clinical presentation and diagnosis, evaluate treatment options, and highlight future research directions.</p></div><div><h3>Methods</h3><p>A systematic search of PubMed, Embase, and Cochrane Library databases was conducted to identify relevant studies published up to April 2024.</p></div><div><h3>Results</h3><p>LQTS involves mutations in ion channel–related genes encoding cardiac ion channels, regulatory proteins, and other associated factors, leading to altered cellular electrophysiology. Acquired causes can also contribute. Diagnosis relies on clinical history, electrocardiographic findings, and genetic testing. Treatment strategies include lifestyle modifications, β-blockers, potassium channel openers, device therapy, and surgical interventions.</p></div><div><h3>Conclusion</h3><p>Advances in understanding LQTS have improved diagnosis and personalized treatment approaches. Challenges remain in risk stratification and management of certain patient subgroups. Future research should focus on developing novel pharmacological agents, refining device technologies, and conducting large-scale clinical trials. Increased awareness and education are crucial for early detection and appropriate management of LQTS.</p></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 8","pages":"Pages 573-586"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666501824002253/pdfft?md5=f0307968991239424851a67493dc7a49&pid=1-s2.0-S2666501824002253-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141709785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heart Rhythm O2Pub Date : 2024-08-01DOI: 10.1016/j.hroo.2024.07.008
Jeremy Kleiman MD, Dimitrios Varrias MD, Ashwin Varkey MD, Alexandra Young MD, Elliot Wolf BA, Christopher Gasparis BA, Jonas Leavitt BS, Kristie M. Coleman BSN, Laurence M. Epstein MD, FHRS, Stavros E. Mountantonakis MD, MBA, FHRS
{"title":"Incidence and predictors of cardiomyopathy after implantation of leadless pacemakers: A comparative analysis with patients with transvenous systems","authors":"Jeremy Kleiman MD, Dimitrios Varrias MD, Ashwin Varkey MD, Alexandra Young MD, Elliot Wolf BA, Christopher Gasparis BA, Jonas Leavitt BS, Kristie M. Coleman BSN, Laurence M. Epstein MD, FHRS, Stavros E. Mountantonakis MD, MBA, FHRS","doi":"10.1016/j.hroo.2024.07.008","DOIUrl":"10.1016/j.hroo.2024.07.008","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 8","pages":"Pages 597-600"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666501824002277/pdfft?md5=072478a054de896321c14a161ad3a5e2&pid=1-s2.0-S2666501824002277-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141851410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Impact of different energy sources on coagulation biomarkers and silent cerebral events in balloon-based ablation for atrial fibrillation","authors":"Masayuki Koshikawa MD, PhD , Masahide Harada MD, PhD , Yoshihiro Nomura MD , Asuka Nishimura MD , Yuji Motoike MD, PhD , Eiichi Watanabe MD, PhD , Yukio Ozaki MD, PhD , Hideo Izawa MD, PhD","doi":"10.1016/j.hroo.2024.06.009","DOIUrl":"10.1016/j.hroo.2024.06.009","url":null,"abstract":"<div><h3>Background</h3><p>Different energy sources of balloon-based ablation for pulmonary vein isolation cause different kinds of endothelial damage and coagulation responses associated with thromboembolic risk.</p></div><div><h3>Objectives</h3><p>The study sought to compare the impact of different balloon-based ablation, cryoballoon ablation (CBA) and laser balloon ablation (LBA), on coagulation/fibrinolysis biomarkers and silent cerebral events (SCEs) in paroxysmal atrial fibrillation.</p></div><div><h3>Methods</h3><p>Paroxysmal atrial fibrillation patients who underwent pulmonary vein isolation using either CBA (n = 52) or LBA (n = 53) without radiofrequency touch-up ablation were eligible. Time course (day 0 [before ablation], day 1, day 2, and day 28) of myocardial enzymes and inflammatory and coagulation/fibrinolysis biomarkers was evaluated during the perioperative period. Brain magnetic resonance imaging was performed within 2 days after the procedure to evaluate SCEs.</p></div><div><h3>Results</h3><p>There was no difference in patient characteristics between CBA and LBA.CBA had greater myocardial injury (troponin I and creatine kinase-MB) and lower inflammatory reaction (white blood cell count and neutrophil/lymphocyte ratio) than LBA. The coagulation biomarkers maximally increased by day 2 and then decreased in both groups. In day 28, the serum prothrombin fragment 1+2 and D-dimer levels in LBA were significantly higher than the values in CBA. The fibrinolysis biomarker (plasmin-α2 plasmin inhibitor complex) did not increase after the procedure in either group. The incidence of SCEs was comparable between CBA and LBA (11% vs 15%; <em>P =</em> .591). No thromboembolic event was observed.</p></div><div><h3>Conclusion</h3><p>CBA and LBA had different effects on myocardial injury, inflammatory reaction, and coagulation activity but did not affect the incidence of thromboembolic events. LBA had significantly higher coagulation activity in day 28 and may require more careful postprocedural anticoagulation than CBA.</p></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 8","pages":"Pages 520-528"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666501824001880/pdfft?md5=94804cafd76e32de73f22c1d48669cf0&pid=1-s2.0-S2666501824001880-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142020853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heart Rhythm O2Pub Date : 2024-08-01DOI: 10.1016/j.hroo.2024.07.004
Nadeev Wijesuriya MBBS , Marina Strocchi PhD , Mark Elliott MBBS, PhD , Vishal Mehta MBBS , Felicity De Vere MBBS , Sandra Howell MBBS , Nilanka Mannakkara MBBS , Baldeep S. Sidhu MBBS, PhD , Jane Kwan MSc , Paolo Bosco MBBS , Steven A. Niederer DPhil , Christopher A. Rinaldi MBBS, MD, FHRS
{"title":"Optimizing electrical efficacy of leadless cardiac resynchronization therapy and leadless left ventricular septal pacing: Insights on left and right ventricular activation from electrocardiographic imaging","authors":"Nadeev Wijesuriya MBBS , Marina Strocchi PhD , Mark Elliott MBBS, PhD , Vishal Mehta MBBS , Felicity De Vere MBBS , Sandra Howell MBBS , Nilanka Mannakkara MBBS , Baldeep S. Sidhu MBBS, PhD , Jane Kwan MSc , Paolo Bosco MBBS , Steven A. Niederer DPhil , Christopher A. Rinaldi MBBS, MD, FHRS","doi":"10.1016/j.hroo.2024.07.004","DOIUrl":"10.1016/j.hroo.2024.07.004","url":null,"abstract":"<div><h3>Background</h3><p>Leadless cardiac resynchronization therapy (CRT) is an emerging heart failure treatment. An implanted electrode delivers lateral or septal endocardial left ventricular (LV) pacing (LVP) upon detection of a right ventricular (RV) pacing stimulus from a coimplanted device, thus generating biventricular pacing (BiVP). Electrical efficacy data regarding this therapy, particularly leadless LV septal pacing (LVSP) for potential conduction system capture, are limited.</p></div><div><h3>Objectives</h3><p>The purpose of this study was to evaluate the acute performance of leadless CRT using electrocardiographic imaging (ECGi) and assess the optimal pacing modality (OPM) of LVSP on the basis of RV and LV activation.</p></div><div><h3>Methods</h3><p>Ten WiSE-CRT recipients underwent an ECGi study testing: RV pacing, BiVP, LVP only, and LVP with an optimized atrioventricular delay (LV-OPT). BiV, LV, and RV activation times (shortest time taken to activate 90% of the ventricles [BIVAT-90], shortest time taken to activate 95% of the LV, and shortest time taken to activate 90% of the RV) plus LV and BiV dyssynchrony index (standard deviation of LV activation times and standard deviation of all activation times) were calculated from reconstructed epicardial electrograms. The individual OPM yielding the greatest improvement from baseline was determined.</p></div><div><h3>Results</h3><p>BiVP generated a 23.7% improvement in BiVAT-90 (<em>P</em> = .002). An improvement of 43.3% was observed at the OPM (<em>P</em> = .0001), primarily through reductions in shortest time taken to activate 90% of the RV. At the OPM, BiVAT-90 improved in patients with lateral (43.3%; <em>P</em> = .0001; n = 5) and septal (42.4%; <em>P</em> = .009; n = 5) LV implants. The OPM varied by individual. LVP and LV-OPT were mostly superior in patients with LVSP, and in those with sinus rhythm and left bundle branch block (n = 4).</p></div><div><h3>Conclusion</h3><p>Leadless CRT significantly improves acute ECGi-derived activation and dyssynchrony metrics. Using an individualized OPM improves efficacy in selected patients. Effective LVSP is feasible, with fusion pacing at LV-OPT mitigating the potential deleterious effects on RV activation.</p></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 8","pages":"Pages 551-560"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666501824002216/pdfft?md5=24bfc7b836daa1bb78f9e661a1efc301&pid=1-s2.0-S2666501824002216-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141710607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Role of cardiac event monitor in the detection of delayed high-grade atrioventricular block after negative electrophysiological study in patients with post–transcatheter aortic valve replacement","authors":"Mohammad Sabra MD , Saad Kabani BS , Waddah Maskoun MD, FHRS","doi":"10.1016/j.hroo.2024.07.002","DOIUrl":"10.1016/j.hroo.2024.07.002","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 8","pages":"Pages 587-591"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666501824002198/pdfft?md5=bd58632e859724bf34889ed05309865f&pid=1-s2.0-S2666501824002198-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142021065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}