Pacing and clinical electrophysiology : PACE最新文献

{"title":"Micra-AV leadless pacemaker and atrioventricular (dys)synchrony: A stepwise process.","authors":"Gianfranco Mitacchione,&nbsp;Marco Schiavone,&nbsp;Alessio Gasperetti,&nbsp;Diego Ruggiero,&nbsp;Marialessia Denora,&nbsp;Maurizio Viecca,&nbsp;Giovanni Battista Forleo","doi":"10.1111/pace.14352","DOIUrl":"https://doi.org/10.1111/pace.14352","url":null,"abstract":"<p><p>Leadless pacemakers have become a major breakthrough in the management of bradyarrhythmia as an attractive alternative to the standard transvenous pacemakers, but safety and long-term outcomes of the new Micra-AV, which is capable guarantee atrioventricular (AV) synchrony, have been poorly described. Hence, we describe how we managed a 57-year-old patient who developed pacemaker syndrome due to significant Micra-AV dyssynchrony. This case emphasizes how leadless pacemaker AV synchrony could be overestimated, thereby requiring a stepwise process leading to adequate device reprogramming. Holter-ECG monitoring and exercise test resulted to be valuable tools for an early detection of inadequate AV synchrony, integrating and completing device reports.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1738-1742"},"PeriodicalIF":1.8,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/pace.14352","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39370228","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":"In vivo biophysical characterization of very high power, short duration, temperature-controlled lesions.","authors":"Giuseppe Stabile,&nbsp;Vincenzo Schillaci,&nbsp;Teresa Strisciuglio,&nbsp;Alberto Arestia,&nbsp;Alessia Agresta,&nbsp;Gergana Shopova,&nbsp;Antonio De Simone,&nbsp;Francesco Solimene","doi":"10.1111/pace.14358","DOIUrl":"https://doi.org/10.1111/pace.14358","url":null,"abstract":"<p><strong>Introduction: </strong>A very high-power short-duration (vHPSD) strategy of radiofrequency (RF) ablation aims to minimize conductive heating and increase resistive heating. This study aimed to clarify the contribution of contact force (CF) and temperature and their interrelationship in making an adequate lesion with the vHPSD catheter.</p><p><strong>Methods: </strong>We enrolled 46 consecutive patients undergoing first catheter ablation for atrial fibrillation (AF). The vHPSD ablation was performed applying 90 W, for 4 s, with an irrigation of 8 ml/min. During an application, an impedance drop (ID) ≥10 Ω was regarded as an adequate lesion formation.</p><p><strong>Results: </strong>The mean procedural time was 95 ± 15 min. First-pass isolation was reached in 89% of patients and at the end of the procedure all pulmonary veins were isolated. No steam pop nor procedural complication occurred. A total of 3829 qualified RF points were analyzed and the median values of ID, CF and maximum temperature were respectively 10.6 (IQR 8.6-13.1) Ohm, 9 (5.8-13.8) g, 46.8 (44.1-49.8) °C. The mean ID significantly increased in parallel with the increasing CF as well as with the increasing maximum temperature. In the multivariable analysis only the CF and the maximum temperature were independent predictors of ID. From receiver operating characteristic curve analysis, a CF of 8 g and a maximum temperature of 47°C are the optimal cutoff discriminatory value for adequate lesion formation.</p><p><strong>Conclusions: </strong>The vHPSD ablation is highly effective and safe. The CF and the maximum temperature are independent predictors of adequate lesion formation assessed by means of ID.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1717-1723"},"PeriodicalIF":1.8,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/pace.14358","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39397693","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":"Severity of spleep apnea syndrome and life-threatening tachyarrhythmias in patients with implantable cardioverter defibrillator.","authors":"Gianluigi Bencardino,&nbsp;Nicola Vitulano,&nbsp;Antonio Bisignani,&nbsp;Francesca Augusta Gabrielli,&nbsp;Gemma Pelargonio,&nbsp;Maria Lucia Narducci,&nbsp;Francesco Perna,&nbsp;Gaetano Pinnacchio,&nbsp;Gianluca Comerci,&nbsp;Gaetano Antonio Lanza,&nbsp;Massimo Massetti,&nbsp;Filippo Crea","doi":"10.1111/pace.14328","DOIUrl":"https://doi.org/10.1111/pace.14328","url":null,"abstract":"<p><strong>Background: </strong>Sleep apnea syndrome (SAS) has been reported to be associated with a higher incidence of ventricular arrhythmias. The aim of this study was twofold: (1) to investigate whether in SAS patients receiving an implantable cardioverter defibrillator (ICD) the severity of SAS was associated with the occurrence of ventricular arrhythmias; (2) to assess whether changes in nocturnal apnoic/hypopnoic episodes may favor the occurrence of life-threatening arrhythmias, that is, sustained ventricular tachycardia (VT)/fibrillation (VF), requiring ICD intervention.</p><p><strong>Methods: </strong>We enrolled 46 patients with documented SAS at polysomnography (apnea/hypopnea index [AHI] > 5) who also had a left ventricle ejection fraction (LVEF) < 35% and, according to primary prevention indications, implanted an ICD (Boston Scientific Incepta) able to daily monitor apnoic/hypopnoic episodes occurring during sleep. Patients were followed at 3-month intervals.</p><p><strong>Results: </strong>At a mean follow-up of 18 months, 21 episodes of sustained VT/FV requiring ICD intervention were documented in eight patients (17.4%). Baseline AHI was significantly higher in patients with compared to those without ICD intervention. ICD interventions, however, were not preceded by any worsening of apnoic/hypopnoic episodes. The respiratory disturbance index (RDI) of the week during the event, indeed, was not different from that recorded during the previous 2 weeks (25.4 ± 11, 25.6 ± 10 and 25.1 ± 10, respectively; p = .9).</p><p><strong>Conclusions: </strong>In patients with SAS who received an ICD for primary prevention of sudden death, those with ICD interventions showed a more severe form of the disease at baseline. ICD interventions, however, were not preceded by any significant changes in SAS severity.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1657-1662"},"PeriodicalIF":1.8,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/pace.14328","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39226065","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":"Telltale termination of an A-on-V tachycardia with two blocked atrial activations: What is the mechanism?","authors":"Bulent Deveci,&nbsp;Meryem Kara,&nbsp;Ahmet Lutfu Sertdemir,&nbsp;Serdal Bastug,&nbsp;Ahmet Korkmaz,&nbsp;Ozcan Ozeke,&nbsp;Serkan Cay,&nbsp;Firat Ozcan,&nbsp;Serkan Topaloglu,&nbsp;Dursun Aras","doi":"10.1111/pace.14343","DOIUrl":"https://doi.org/10.1111/pace.14343","url":null,"abstract":"<p><p>The termination of tachycardia may provide important clues toward the mechanism of the tachycardia and that close vigilance may clinch the diagnosis before proceeding to other pacing maneuvers.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1733-1734"},"PeriodicalIF":1.8,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/pace.14343","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39324275","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":"Quality of life outcomes in cryoablation of atrial fibrillation-A literature review.","authors":"Bert Vandenberk,&nbsp;Laurens Lauwers,&nbsp;Tomas Robyns,&nbsp;Christophe Garweg,&nbsp;Rik Willems,&nbsp;Joris Ector,&nbsp;Peter Haemers","doi":"10.1111/pace.14341","DOIUrl":"https://doi.org/10.1111/pace.14341","url":null,"abstract":"<p><strong>Background: </strong>Cryoballoon ablation (CRYO) for pulmonary vein isolation (PVI) in atrial fibrillation (AF) has become an established treatment option as alternative for radiofrequency catheter ablation (RFCA). As symptom relief is still the main indication for PVI, quality of life (QoL) is a key outcome parameter. This review summarizes the evidence about the evolution of QoL after CRYO.</p><p><strong>Methods: </strong>A search for clinical studies reporting QoL outcomes after CRYO was performed on PUBMED and COCHRANE. A total of 506 publications were screened and 10 studies met the in- and exclusion criteria.</p><p><strong>Results: </strong>All studies considered QoL as a secondary endpoint and reported significant improvement in QoL between baseline and 12 months follow-up, independent of the QoL instruments used. The effect size of CRYO on QoL was comparable between studies and present in both paroxysmal and persistent AF. Direct comparison between CRYO and RFCA was limited to two studies, there was no difference between ablation modalities after 12 months FU. Two studies in paroxysmal AF reported outcome beyond 12 months follow-up and QoL improvement was maintained up to 36 months after ablation. There were no long-term data available for persistent AF.</p><p><strong>Conclusion: </strong>CRYO of AF significantly improves QoL. The scarce amount of data with direct comparison between subgroups limits further exploration. Assessment of QoL should be considered a primary outcome parameter in future trials with long-term follow-up.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1756-1768"},"PeriodicalIF":1.8,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/pace.14341","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39324280","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":"Distribution of triggers foci and outcomes of catheter ablation in atrial fibrillation patients in different age groups.","authors":"Chung-Hsing Lin,&nbsp;Shih-Lin Chang,&nbsp;Yenn-Jiang Lin,&nbsp;Li-Wei Lo,&nbsp;Yu-Feng Hu,&nbsp;Fa-Po Chung,&nbsp;Tze-Fan Chao,&nbsp;Chin-Yu Lin,&nbsp;Ta-Chuan Tuan,&nbsp;Jo-Nan Liao,&nbsp;Ling Kuo,&nbsp;Ting-Yung Chang,&nbsp;Hsing-Yuan Li,&nbsp;Ting-Chung Huang,&nbsp;Chieh-Mao Chuang,&nbsp;Jennifer Jeanne Vicera,&nbsp;Shih-Ann Chen","doi":"10.1111/pace.14347","DOIUrl":"https://doi.org/10.1111/pace.14347","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) prevalence increases with age. Aging affects the substrate properties of the left atrium (LA) and the outcomes of catheter ablation for treating AF. We investigated the AF trigger distribution and catheter ablation outcomes in patients of different ages with AF.</p><p><strong>Methods: </strong>1585 patients with AF (1181 paroxysmal and 404 non- paroxysmal AF) who had undergone catheter ablation were enrolled. The patients were divided into young (20-40 year-old, n = 175), middle-aged (41-64 year-old, n = 1134), and old (≥ 65 year-old, n = 276) groups. Electrophysiological characteristics and AF trigger sites were recorded.</p><p><strong>Result: </strong>The incidence of AF with only non-pulmonary vein (non-PV) foci was higher in the young group than in the other groups (8.6% vs. 3.6% vs. 3.3%, p < 0.01). Non-PV foci were more commonly located in the superior vena cava (SVC) in the young group than in the other groups (13.1% vs. 7.8% vs. 6.5%, p = 0.03). The left atrium (LA) mean voltage was higher and the incidence of very late recurrence after AF ablation was lower in the young group than in the other groups. However, the final AF recurrence rate after multiple procedures and complication rates were similar among all the groups at a mean follow-up of 5.6 years.</p><p><strong>Conclusion: </strong>The young patients with AF had a higher incidence of only non-PV foci, mostly located in SVC, than the middle-aged and old patients. Our study highlights the importance of identifying the non-PV foci in catheter ablation of young patients with AF.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1724-1732"},"PeriodicalIF":1.8,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/pace.14347","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39358214","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":"New method and electrophysiological characteristics of LA posterior wall isolation in persistent atrial fibrillation.","authors":"Zhuo Liang,&nbsp;Lifeng Liu,&nbsp;Liting Cheng,&nbsp;Zefeng Wang,&nbsp;Junmeng Zhang,&nbsp;Wenxue Yang,&nbsp;Yunlong Wang,&nbsp;Yongquan Wu","doi":"10.1111/pace.14220","DOIUrl":"https://doi.org/10.1111/pace.14220","url":null,"abstract":"<p><strong>Background: </strong>Left atrial posterior wall isolation (PWI) is commonly used with persistent atrial fibrillation (AF) ablation. However, potentials are often still recorded in the posterior wall after pulmonary vein isolation (PVI), roof linear ablation, and bottom linear ablation in clinical practice. We aimed to explore the methodological approach and electrophysiological characteristics of PWI.</p><p><strong>Methods: </strong>A total of 36 patients who attended our center with long-standing persistent AF were retrospectively analyzed. After routine PVI and roof and bottom linear ablation, complete PWI was confirmed in sinus rhythm by voltage mapping and high-output pacing. Otherwise, activation mapping and voltage mapping were used to guide ablation on the line or inside the posterior wall until bidirectional block was achieved.</p><p><strong>Results: </strong>The first-pass success rate of PWI was 39%. In the remaining 61% of patients with posterior wall electrograms, activation mapping in sinus rhythm showed that the earliest activation point was not on the ablation line but in a relatively dispersed focal area, possibly related to epicardial muscular sleeve insertion. Voltage mapping revealed a focal high-voltage area in the posterior wall matching the relatively dispersed earliest activation site, in which an average of five points of ablation achieved complete PWI without serious esophageal injury. The middle zone contained 80% of the additional posterior wall ablation points.</p><p><strong>Conclusions: </strong>PWI was performed safely and effectively with an average of five additional ablation points in the posterior wall in 61% of patients under the guidance of voltage mapping.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1691-1700"},"PeriodicalIF":1.8,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/pace.14220","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25500721","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":"MultiPole pacing in non-responders to cardiac resynchronization therapy: Results from the QP ExCELs/MPP sub-study.","authors":"Michael N Drucker,&nbsp;Harish Manyam,&nbsp;Gurjit Singh,&nbsp;Dennis N Glascock,&nbsp;Shane Gillett,&nbsp;Crystal Miller,&nbsp;Kazi Sharmin,&nbsp;Kimberly A Parks","doi":"10.1111/pace.14339","DOIUrl":"https://doi.org/10.1111/pace.14339","url":null,"abstract":"<p><strong>Background: </strong>Multisite LV stimulation therapy allows for stimulation of two different left ventricular pacing vectors within a single LV lead and may improve responsiveness to cardiac resynchronization therapy (CRT). This study prospectively evaluated the safety and efficacy of the MultiPole Pacing (MPP) feature in CRT non-responder patients.</p><p><strong>Methods and results: </strong>CRT non-responders with a standard CRT-D indication were eligible for enrollment into the MPP Sub-Study. Patient status, NYHA classification, Patient Global Assessment (PGA), and adverse events were collected at follow-up. A clinical composite score (CCS) was determined at the 6 month follow-up visit. The primary objective was defined as the proportion of patients with an improved CCS. Safety was evaluated as freedom from MPP system related adverse events requiring additional invasive intervention to resolve. A total of 53 patients were enrolled across 26 U.S. centers. The cumulative follow-up duration was 24.1 years. CCS was improved in 35.6% of patients (p < .0001 when compared to a performance goal of 3%) after 6 months of MPP therapy. When incorporating patient feedback into a modified CCS, 60.0% of patients showed an improvement. Three patients (5.7%) experienced hospitalization for heart failure, and three patient deaths occurred over the follow-up period. No MPP system-related events were reported for an AE-free rate of 100% (95% CI 93.28% to 100.0%).</p><p><strong>Conclusions: </strong>The results of this small, non-randomized study suggest that the MPP feature is safe, and may be effective at converting a percentage of CRT non-responders to responders. Larger, randomized studies are needed to confirm this result.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1683-1690"},"PeriodicalIF":1.8,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/pace.14339","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39321244","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":"His-bundle pacing following transcatheter aortic valve replacement.","authors":"Jalaj Garg,&nbsp;Siddharth Shah,&nbsp;Kuldeep Shah,&nbsp;Mohit K Turagam,&nbsp;Andrea Natale,&nbsp;Dhanunjaya Lakkireddy","doi":"10.1111/pace.14351","DOIUrl":"https://doi.org/10.1111/pace.14351","url":null,"abstract":"1 Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA 2 Division of Cardiology, State University of NewYork UpstateMedical University, Syracuse, New York, USA 3 Department of CardiovascularMedicine, Beaumont Hospital, Oakland UniversityWilliam Beaumont School ofMedicine, Royal Oak,Michigan, USA 4 Helmsley Electrophysiology Center, Icahn School ofMedicine atMount Sinai, New York, New York, USA 5 Texas Cardiac Arrhythmia Institute at St. David’sMedical Center, Austin, Texas, USA 6 Kansas City Heart Rhythm Institute and Research Foundation, Kansas City, Kansas, USA","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1786-1789"},"PeriodicalIF":1.8,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39345333","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":"Powered sheaths for lead extraction.","authors":"Gianluigi Bencardino,&nbsp;Eleonora Ruscio,&nbsp;Roberto Scacciavillani","doi":"10.1111/pace.14350","DOIUrl":"https://doi.org/10.1111/pace.14350","url":null,"abstract":"<p><p>Transvenous lead extraction (TLE) has seen a rapid expansion in the past 20 years. The procedure has changed from early techniques involving simple manual traction that frequently proved themselves ineffective for chronically implanted leads, and carried significant periprocedural risks including death, to the availability of a wide range of more efficacious techniques and tools, providing the skilled extractor with a well-equipped armamentarium. The reduction in morbidity and mortality associated with these new extraction techniques has widened indications to TLE from prevalent use in life-threatening situations, such as infection and sepsis, to a more widespread use even in noninfectious situations such as malfunctioning leads. Powered sheaths have been a remarkable step forward in this improvement in TLE procedures and recent registries at high-volume centers report high success rates with exceedingly low complication rates. This review is aimed at describing technical features of powered sheaths as well as reported performance during TLE procedures.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1769-1780"},"PeriodicalIF":1.8,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/pace.14350","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39387505","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}