Journal of Innovations in Cardiac Rhythm Management最新文献

{"title":"Impact of a Practice-wide Switch from Traditional Right Ventricular Pacing to Left Bundle Branch Area Pacing.","authors":"David Fritz, Ben Ose, Hannah Zerr, Maci Clark, Caroline Trupp, Amulya Gupta, Ahmed Shahab, Seth H Sheldon, Amit Noheria","doi":"10.19102/icrm.2025.16064","DOIUrl":"10.19102/icrm.2025.16064","url":null,"abstract":"<p><p>Left bundle branch area pacing (LBBAP) may mitigate pacing-induced cardiomyopathy (PICM) and is increasingly favored over traditional right ventricular pacing (RVP). We sought to evaluate the impact of a practice-wide switch from RVP to LBBAP. We switched practice from RVP to primarily LBBAP at our center in 2020. A retrospective review was conducted to compare patients who underwent LBBAP from 2020-2023 with controls who underwent RVP from 2018-2019. The LBBAP (n = 288; age, 73.3 ± 10.7 years; left ventricular ejection fraction [LVEF], 56.9% ± 11.4%) and RVP (n = 172) groups were similar in terms of age, body mass index, hypertension, diabetes, and LVEF. The LBBAP group as compared to the RVP group had fewer women (38% vs. 51%; <i>P</i> = .006) and longer intrinsic conducted QRS durations (117 ± 28 vs. 110 ± 30 ms; <i>P</i> = .04). LBBAP devices required longer implant (102 vs. 67 min) and fluoroscopy (9.3 vs. 6.9 min) times but resulted in shorter paced QRS durations (122 ± 20 vs. 145 ± 24 ms; all <i>P</i> < .0001). At 3 months, LBBAP patients had higher sensing (13.8 ± 6.1 vs. 12.0 ± 5.6 mV; <i>P</i> = .007), lower pacing impedance (543 ± 98 vs. 576 ± 150 Ω; <i>P</i> = .008), and similar capture threshold (0.78 ± 0.24 vs. 0.76 ± 0.35 V; <i>P</i> = .5) values. Device-related adverse events were similar between the groups (LBBAP 8.7% vs. RVP 8.8%; <i>P</i> = 1.0), which included ventricular lead dislodgement (2.1% vs. 0.6%; <i>P</i> = .3). There were no differences in hazard rates of all-cause mortality (<i>P</i> = .5) or heart failure (HF) hospitalizations (<i>P</i> = .07). In a subgroup of patients with ≥20% ventricular pacing, the average LVEF change during follow-up in the LBBAP group as opposed to the RVP group was +1.6% ± 12.9% versus -3.8% ± 12.0% (<i>P</i> = .03), the average left ventricular internal diameter at end-diastole change was -0.18 ± 0.73 cm versus +0.16 ± 0.45 cm (<i>P</i> = .006), and there were no differences in the hazard rate of all-cause mortality (<i>P</i> = .6) or HF hospitalizations (<i>P</i> = 1.0). Our results suggest there were no adverse consequences of the practice-wide switch from RVP to LBBAP. LBBAP was associated with longer procedure and fluoroscopy times but resulted in narrower paced QRS durations and less PICM.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 6","pages":"6297-6305"},"PeriodicalIF":0.0,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592506","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":"Comparison Between Efficacy and Safety of Remote Magnetic Navigation and Manual Catheter Navigation for Atrial Fibrillation Ablation: An Updated Meta-analysis and Systematic Review.","authors":"Rana Ijaz, Ajeet Singh, Maida Qazi, Meet Kachhadia, Laiba Qayoom, Sumaira Riaz, Hamza Nasir Chatha, Manahil Nazir, Zulekha Faisal, Muhammad Saqib, Iqra Yaseen Khan, Rimsha Bint-E-Hina, Arham Iqbal, Alina Sami Khan, Satesh Kumar, Mahima Khatri","doi":"10.19102/icrm.2025.16065","DOIUrl":"10.19102/icrm.2025.16065","url":null,"abstract":"<p><p>Atrial fibrillation (AF) ablation is a common treatment for symptomatic AF. Remote magnetic navigation (RMN) and manual catheter navigation (MCN) are two predominant techniques employed in this procedure, each with advantages and limitations. This meta-analysis compares the efficacy, safety, and procedural outcomes of RMN versus MCN for AF ablation. A comprehensive search was conducted across PubMed, Google Scholar, and Embase to identify relevant studies comparing RMN and MCN for AF ablation. Statistical pooling was done using Review Manager 5.4.1 (Cochrane Collaboration, London, UK). The Newcastle-Ottawa scale was used for the evaluation of bias in observational studies. We evaluated the robustness of the evidence following the guidelines outlined by the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) working group. The primary outcomes of the study included freedom from AF, procedure time, fluoroscopy time, and total complication rate in patients undergoing AF ablation either using the RMN or MCN technique. A total of 22 studies involving 5361 patients were included in the meta-analysis. The pooled analysis demonstrated comparable freedom from AF between RMN and MCN (relative risk [RR], 0.94; 95% confidence interval [CI], 0.84-1.04; <i>P</i> = .23). However, RMN was associated with a significantly prolonged procedure duration (mean difference [MD], 48.58; 95% CI, 31.49-65.66; <i>P</i> < .00001) and reduced fluoroscopy time (MD, -12.52; 95% CI, -17.84 to -7.20; <i>P</i> < .00001) compared to MCN. Additionally, RMN showed a trend toward lower total complication rates (RR, 0.63; 95% CI, 0.45-0.88; <i>P</i> = .007). In AF ablation, RMN and MCN exhibit comparable efficacy in achieving freedom from AF. However, RMN is associated with a prolonged procedure duration compared to MCN. Nonetheless, RMN offers advantages in terms of reduced fluoroscopy times and lower total complication rates, highlighting its potential for improving procedural safety. The choice between RMN and MCN should be made considering individual patient factors and procedural objectives.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 6","pages":"6307-6328"},"PeriodicalIF":0.0,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592504","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":"Letter from the Editor in Chief.","authors":"Devi Nair","doi":"10.19102/icrm.2025.16063","DOIUrl":"10.19102/icrm.2025.16063","url":null,"abstract":"","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 6","pages":"A7-A8"},"PeriodicalIF":0.0,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592507","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":"Double Trouble in a Patient with Ischemic Cardiomyopathy and Severe Mitral Regurgitation: A Case Report.","authors":"Ahmet Taha Sahin, Hasan Kan, Muhammet Fatih Kaleli, Ahmet Lutfu Sertdemir, Enes Elvin Gul","doi":"10.19102/icrm.2025.16061","DOIUrl":"10.19102/icrm.2025.16061","url":null,"abstract":"<p><p>Bidirectional ventricular tachycardia (VT) is a rare arrhythmia characterized by alternating QRS morphologies and axis changes. Atrial flutter (AFL) can coexist with ventricular arrhythmias, complicating diagnosis. We present a case of a 56-year-old man with a history of ischemic heart disease and severe mitral regurgitation admitted with palpitations who was diagnosed with dual tachycardia (bidirectional VT and AFL).</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 6","pages":"6342-6345"},"PeriodicalIF":0.0,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592505","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":"Racial/Ethnic Disparities in Anticoagulation for Atrial Fibrillation by Sex and Within High and Low Stroke Risk Populations.","authors":"William J Tate, Darius White, Grace Ha, James Alzate, Dolphurs Hayes, Leon M Ptaszek, Jeremy Ruskin, Joseph R Betancourt, Oyere Onuma, Jason H Wasfy, Malissa J Wood, Moussa Mansour","doi":"10.19102/icrm.2025.16062","DOIUrl":"10.19102/icrm.2025.16062","url":null,"abstract":"<p><p>Atrial fibrillation (AF) increases the risk of thromboembolic stroke, and oral anticoagulants (OACs) are an effective tool to reduce this risk. Previous studies have demonstrated that female, black, Hispanic, and Asian groups are less likely to be prescribed OACs. This study explores OAC rates by racial/ethnic group and assesses differences within sexes and between high and low CHA₂DS₂-VASc risk groups. Using a database of AF patients, we employed logistic regression models to assess the association between race/ethnicity and OAC rates among all individuals and according to CHA₂DS₂-VASc risk and sex subgroups. Black, Hispanic, and Asian individuals with AF had lower OAC rates compared to white individuals (adjusted odds ratio [aOR], 0.84; 95% confidence interval [CI], 0.77-0.91) (aOR, 0.92; 95% CI, 0.85-0.99) (aOR, 0.80; 95% CI, 0.72-0.88). Female patients with AF had lower OAC rates than male patients (aOR, 0.66; 95% CI, 0.64-0.68). Among male patients, black, Hispanic, and Asian patients had lower OAC rates while, among female patients, only black patients had a lower OAC rate. In the low-risk CHA₂DS₂-VASc group, only Asian individuals had a lower OAC rate compared to white individuals, while, in the high-risk group, this trend was observed only for black individuals. Women, particularly black women, are less likely to receive OACs compared to men and their white counterparts. High-risk black individuals face reduced OAC use, while low-risk white individuals have high OAC rates. Subjective decision-making may contribute to these disparities, with the most significant disparities observed in black individuals, particularly black women. This \"double hit\" affecting black women could be the target of equity-focused interventions.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 6","pages":"6330-6340"},"PeriodicalIF":0.0,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592508","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":"Letter from the Editor in Chief.","authors":"Devi Nair","doi":"10.19102/icrm.2025.16051","DOIUrl":"https://doi.org/10.19102/icrm.2025.16051","url":null,"abstract":"","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 5","pages":"A7-A8"},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144249982","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":"Migration of an Implantable Loop Recorder: A Meta-summary of Case Reports.","authors":"Alfredo Mauriello, Anna Rago, Dario Amore, Giacomo Sica, Antonello D'Andrea, Vincenzo Russo","doi":"10.19102/icrm.2025.16056","DOIUrl":"10.19102/icrm.2025.16056","url":null,"abstract":"<p><p>The migration of an implantable loop recorder (ILR) is a rare complication. We aimed to perform a meta-summary of case reports to characterize patients who experienced an ILR migration. We searched for case reports published in PubMed, Google Scholar, Scopus, and Embase from January 2017 to 2023 using the following keywords: \"migration ILR,\" \"migration loop recorder,\" \"complication loop recorder,\" and \"complication ILR.\" Seven case reports/case series reporting ILR migration were included. Data about patients' characteristics, ILR implantation, time of onset, management, and clinical outcome of this complication were collected. Seven patients who experienced the migration of an ILR were examined. All patients experienced migration within 35 days following ILR implantation. The clinical suspicion of ILR migration mainly arose from patients' symptomatology. The migration of the ILR was confirmed by a radiological scan in all cases, and surgical removal, preferably by video-assisted thoracic surgery, was required. In conclusion, intrapleural migration is a rare complication of ILR implantation. It may occur in the early postprocedural period. Clinical suspicion arises from symptoms, but a radiological scan is necessary to confirm the diagnosis. Surgical removal is mandatory.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 5","pages":"6292-6296"},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144249983","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":"Learning Curve for Left Bundle Branch Area Pacing Lead Implantation.","authors":"Maci Clark, Hannah Zerr, Ben Ose, David Fritz, Caroline Trupp, Amulya Gupta, Ahmed Shahab, Amit Noheria, Seth H Sheldon","doi":"10.19102/icrm.2025.16055","DOIUrl":"10.19102/icrm.2025.16055","url":null,"abstract":"<p><p>Left bundle branch area pacing (LBBAP) has shown promising outcomes at experienced centers; however, less is known about the learning curve with initial adoption of LBBAP implantation. We conducted a retrospective analysis (2020-2023) of the learning curve for LBBAP at an academic medical center. Procedural success and device-related adverse events in adult patients undergoing LBBAP by seven new operators with >5 years' experience in device implantation were compared between operators with a history of ≤10 (LBBAP_inexp) versus >10 (LBBAP_exp) LBBAP implant attempts. Successful LBBAP was defined as a left ventricular activation time (LVAT) of ≤80 ms. Seven operators implanted LBBAP devices in 288 patients (age, 73 ± 11 years; 38% women), including 68 (24%) in the LBBAP_inexp group versus 220 (76%) patients in the LBBAP_exp group with similar baseline characteristics. The median number of implants per operator was 22 (range, 8-83). Post-implant LVAT ≤ 80 ms was less frequent in LBBAP_inexp compared to LBBAP_exp (56.9% vs 72.4%; <i>P</i> = .04). There were no significant differences in paced QRS duration ≤ 130 ms (75.9% vs. 76.1%; <i>P</i> = 1.0) or operator self-identified success (85% vs. 91%; <i>P</i> = .2). With new single-/dual-chamber device implants, there was no difference in implant duration (103.4 ± 31.8 vs. 101.6 ± 38.5 min; <i>P</i> = .3), but there was longer fluoroscopy with LBBAP_inexp (12.6 ± 10.1 vs. 8.2 ± 8.0 min; <i>P</i> < .0001). The average number of attempts at LBBAP was lower with LBBAP_inexp versus LBBAP_exp (2.0 ± 1.5 vs. 2.9 ± 2.9; <i>P</i> = .03). There was no difference in device-related adverse events between the two groups (<i>P</i> = .3). Operators use less fluoroscopy, make more attempts at LBBAP, and more frequently achieve LVAT ≤ 80 ms after their first 10 implants.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 5","pages":"6284-6291"},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144249981","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":"An Antiquated Concept in the Novel Era of Ablation: Zero-fluoroscopy Pulsed Field Ablation for Treatment of Atrial Fibrillation.","authors":"Wissam Harmouch, Servando Cuellar, Arun Narayanan, Haider Al Taii, Muhie Dean Sabayon","doi":"10.19102/icrm.2025.16052","DOIUrl":"10.19102/icrm.2025.16052","url":null,"abstract":"<p><p>Intracardiac echocardiography (ICE) is a common tool that has real-time impact in novel pulsed-field ablation (PFA). It is a feasible and efficient option due to zero-fluoroscopy, real-time tissue visualization of procedural maneuvers, and for the assessment of potential procedural complications. We present a case of zero-fluoroscopy-based PFA using four-dimensional (4D) ICE in a 68-year-old man with symptomatic atrial fibrillation. Using 4D ICE, we were able to achieve procedural success by visualization of direct tissue contact with the Farawave™ catheter (Boston Scientific, Marlborough, MA, USA) with each rotation and application of the basket and flower configurations and no edema or color change in tissue morphology after applications. Overall, zero fluoroscopy in PFA is feasible and efficient.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 5","pages":"6268-6270"},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144249980","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":"Right-sided Cardiac Resynchronization Therapy via Left Bundle Branch Area Pacing in a Patient with Persistent Left Superior Vena Cava.","authors":"Can Menemencioglu, Uğur Canpolat","doi":"10.19102/icrm.2025.16054","DOIUrl":"10.19102/icrm.2025.16054","url":null,"abstract":"<p><p>Cardiac resynchronization therapy (CRT) via left bundle branch area pacing (LBBAP) has emerged as effective and safe as conventional CRT. Left-sided CRT implantation in patients with persistent left superior vena cava (PLSVC) is challenging and impossible in some patients. Right-sided CRT implantation, either conventional or LBBAP, is also tricky, as the delivery sheaths are feasible for left-sided implantations. Here, we present a patient with PLSVC who underwent successful right-sided CRT implantation via LBBAP.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 5","pages":"6278-6283"},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144249984","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}