Pacing and clinical electrophysiology : PACE最新文献

{"title":"Role of Autonomic Dysfunction in Initiating Postoperative Atrial Fibrillation in a Canine Sterile Pericarditis Model.","authors":"Seungyup Lee, Don W Wallick, Celeen Khrestian, Dragan Juzbasich, Daniel Laurita","doi":"10.1111/pace.15220","DOIUrl":"https://doi.org/10.1111/pace.15220","url":null,"abstract":"<p><strong>Background: </strong>Autonomic dysfunction plays a significant role in initiating postoperative atrial fibrillation (POAF) by causing atrial ectopic triggers, potentially through mechanisms such as increased sympathetic activity and altered vagal tone. These atrial ectopic triggers can easily induce POAF, especially in the presence of vulnerable substrates such as pericardial inflammation or structural remodeling.</p><p><strong>Objective: </strong>To test the hypothesis that autonomic dysfunction causes atrial ectopic triggers or POAF in the canine sterile pericarditis model.</p><p><strong>Methods: </strong>Ten sterile pericarditis dogs were studied on postoperative Days 2-3. Autonomic dysfunction was induced by stellate ganglion nerve stimulation (SNS, 5-15 mA; 4-10 Hz; pulse width 0.5-5 ms) with or without vagus nerve stimulation (VNS, 15 mA; 20 Hz; pulse width 0.5-2 ms) performed during sinus rhythm for up to 2 h. Atrial ectopic triggers and heart rate (HR) were assessed during autonomic dysfunction.</p><p><strong>Results: </strong>Sustained POAF by burst pacing was induced in 5 of 10 animals (50%). During sinus rhythm (HR 109 ± 14 bpm), autonomic dysfunction using SNS (±VNS) changed the HR from 151 ± 18 bpm (SNS alone) to 72 ± 10 bpm (SNS+VNS) (mean HR fluctuation 79 ± 16 bpm). Atrial ectopic triggers were observed in 1 of 10 animals (10%), originating from either right or left atrium, yet these triggers did not induce POAF.</p><p><strong>Conclusion: </strong>Atrial ectopic triggers associated with autonomic dysfunction were observed in only 10% of animals in the postoperative period and did not induce POAF. The low incidence of atrial ectopic triggers in this model may provide mechanistic insights into the lower observed incidence of POAF in patients undergoing coronary artery bypass grafting (CABG) compared to those undergoing valvular heart surgery.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259935","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":"Dual Tachycardia Followed by Tachycardia With Atrioventricular Block: What Is the Mechanism and What Does It Prove?","authors":"Leonel Slanovic, Sergiy Bereza, Moti Haim, Yuval Konstantino","doi":"10.1111/pace.15222","DOIUrl":"https://doi.org/10.1111/pace.15222","url":null,"abstract":"","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259933","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":"Shortening of Stimulus-Atrial Interval Without Change in QRS Morphology During Parahisian Pacing. What Is the Mechanism?","authors":"Anish Bhargav, Ramanathan Velayutham, Raja J Selvaraj","doi":"10.1111/pace.15212","DOIUrl":"https://doi.org/10.1111/pace.15212","url":null,"abstract":"","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228421","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":"Mid-Term Cardiac Outcomes in Prosthetic Valve Surgery and HF Patients Across EF After CSP.","authors":"Peng Li, Xiao-Xiao Jiang, Yi-Heng Yang, Wan-Xuan Ding, Ying Chen, Tian-Zhu Li, Xiao-Lei Yang, Yun-Long Xia, Ying-Xue Dong","doi":"10.1111/pace.15213","DOIUrl":"https://doi.org/10.1111/pace.15213","url":null,"abstract":"<p><strong>Objective: </strong>Clinical outcomes of conduction system pacing (CSP) in patients with prosthetic valve surgery (PVS) and heart failure (HF) remain unclear. This study evaluated the feasibility, safety, and clinical impact of CSP in this population.</p><p><strong>Methods: </strong>Consecutive patients with atrioventricular block post-PVS and HF history undergoing CSP from January 2018 to December 2022 were enrolled. Exclusions included prior pacemaker implantation, biventricular pacing, or ventricular pacing <40%. Outcomes were assessed by left ventricular ejection fraction (LVEF) categories: reduced (HFrEF, LVEF ≤40%), mildly reduced (HFmrEF, 41%-49%), and preserved (HFpEF, ≥50%).</p><p><strong>Results: </strong>CSP succeeded in 90/96 patients (93.75%): 34 HFrEF (37.78%), 11 HFmrEF (12.22%), and 45 HFpEF (50.00%). All cohorts showed improved left ventricular end-diastolic diameter (LVEDD) (HFrEF: 56.35 ± 10.01 vs. 60.76 ± 8.36 mm, p < 0.001; HFmrEF: 52.54 ± 5.01 vs. 56.73 ± 4.10 mm, p = 0.017; HFpEF: 48.07 ± 4.22 vs. 48.80 ± 3.99 mm, p = 0.035). The HFrEF cohort demonstrated significant improvements in LVEF (44.15 ± 12.23% vs. 31.26 ± 5.98%, p < 0.001), left atrial diameter (50.12 ± 13.91 vs. 54.00 ± 17.14 mm, p = 0.006), and New York Heart Association class (2.63 ± 0.85 vs. 3.13 ± 0.78, p = 0.002). No deterioration occurred in HFmrEF/HFpEF. Complete LVEF/LVEDD normalization was achieved in 26.47% of HFrEF patients (9/34), with absence of rheumatic heart disease (RHD) as an independent predictor (HR = 8.851, 95% CI 1.336-58.646, p = 0.024). Over 25.49 ± 9.4 months, no cardiac perforation, thrombosis, pacemaker-induced cardiomyopathy (PICM), or infections occurred.</p><p><strong>Conclusions: </strong>CSP is feasible and safe, promoting cardiac reverse remodeling and mitigating PICM risk in PVS patients with HF across LVEF categories. Over 25% of HFrEF patients achieved complete normalization, predicted by non-RHD etiology.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228419","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":"Characterization of Septal Scar After Left Bundle Branch Area Pacemaker Implantation.","authors":"Ilya Y Shadrin, David C Wendell, Fawaz Alenezi, Sara A Coles, Sana M Al-Khatib, Zak Loring, Jonathan P Piccini, Albert Y Sun, Donald D Hegland, Daniel J Friedman","doi":"10.1111/pace.15211","DOIUrl":"https://doi.org/10.1111/pace.15211","url":null,"abstract":"<p><strong>Background: </strong>Left bundle branch area pacing (LBBAP) is increasingly used in patients with a ventricular pacing indication but necessitates precise septal localization. The resulting effects of intraoperative lead repositioning on septal fibrosis remain unknown.</p><p><strong>Objective: </strong>To assess the safety of cardiac magnetic resonance imaging (cMRI) in patients with LBBAP pacemakers and evaluate the septal myocardium via cMRI following LBBAP implantation compared with standard RV endocardial pacing (RVP).</p><p><strong>Methods: </strong>Patients aged > 18 y.o. with bradycardia, LBBAP or RVP implant from 2021 to 2023, and at least one cMRI after implant were identified. LBBAP versus RVP was verified per established criteria. Delayed-enhancement cMRI and native T1 relaxation times were used to characterize myocardial scar.</p><p><strong>Results: </strong>A total of 34 patients were identified-20 with LBBAP implants (9 with matched pre-implant cMRI) and 14 with RVP implants (3 with matched pre-implant cMRI)-with no evidence of ventricular septal defects post-implant. LBBAP lead parameters were stable pre-/post-cMRI and out to 9 months. Comparing pre- versus post-implant cMRIs (median 579 days apart), 1/9 patients following LBBAP showed a new scar on the RV inferoseptal side directly adjacent to the pacing lead on post-implant cMRI, suggestive of potential implant-related scarring with LBBAP.</p><p><strong>Conclusion: </strong>CMRI appears safe for patients with LBBAP pacemakers, with stable short- and long-term device parameters. In patients with matched pre/post-implant cMRIs, the new septal scar can be identified with LBBAP implantation, raising the possibility of lead-related fibrosis. Larger studies are required to substantiate whether the single case of lead-related fibrosis is an exception or occurs more frequently.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228417","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":"Lead Perforation in Cardiac Implantable Electronic Devices: Incidence, Diagnosis, and Management.","authors":"Olayiwola A Bolaji, Favour E Markson, Kevin F Kwaku, Robert D Schaller","doi":"10.1111/pace.15210","DOIUrl":"https://doi.org/10.1111/pace.15210","url":null,"abstract":"<p><p>The implantation of cardiac implantable electronic devices (CIEDs) has steadily increased due to an aging population, advancements in diagnostic techniques, and technological improvements. However, the risk of cardiac perforation following lead implantation, though low, remains a critical concern. Understanding the clinical presentations of this complication is essential for effective prevention, recognition, and management. This review explores the prevalence, clinical presentations, risk factors, diagnosis, management strategies, and future perspectives related to cardiac perforation caused by CIED leads.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228418","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":"Optimal Thromboembolism Prevention for Patients With Atrial Fibrillation on Long-Term Dialysis.","authors":"Kenji Hashimoto, Tomohiro Fujisaki, Tadao Aikawa, Masao Iwagami, Yoshihisa Miyamoto, Leandro Slipczuk, Luigi Di Biase, Alexandros Briasoulis, Jun Yasuhara, Hisato Takagi, Toshiki Kuno","doi":"10.1111/pace.15208","DOIUrl":"https://doi.org/10.1111/pace.15208","url":null,"abstract":"<p><strong>Background: </strong>Optimal strategies for thromboembolism prevention, including vitamin K antagonists (VKA), direct oral anticoagulants (DOAC), and left atrial appendage occlusion (LAAO), for patients with atrial fibrillation (AF) and on dialysis have not been fully investigated. We aimed to investigate the efficacy and safety of thromboembolism prevention strategies in AF patients on dialysis through a network meta-analysis.</p><p><strong>Methods: </strong>Multiple databases were searched through January 2024. The primary efficacy endpoint was thrombotic events, defined as ischemic stroke or systemic thromboembolism, whereas the primary safety endpoint was major bleeding. These strategies were ranked using P-scores.</p><p><strong>Results: </strong>Our study identified 28 eligible studies (including 3 randomized controlled trials) that enrolled 144,630 AF patients on dialysis. The risks of thrombotic events in any DOAC and VKA were comparable to no-anticoagulant, whereas LAAO was associated with a lower risk of thrombotic events (HR [95% CI]: 0.19 [0.06-0.60]). Compared to no-anticoagulant, VKA, regular-dose rivaroxaban, and dabigatran were associated with a higher risk of major bleeding, but rivaroxaban 10 mg daily, and apixaban 2.5 or 5 mg twice daily were not. LAAO, rivaroxaban 10 mg daily and apixaban 2.5 or 5 mg twice daily were highly ranked in efficacy and safety outcomes.</p><p><strong>Conclusions: </strong>LAAO may possibly be the reasonable therapeutic option for AF patients on dialysis, but rivaroxaban 10 mg daily and apixaban 2.5 or 5 mg twice daily can also be considered. Further studies are warranted to confirm these findings.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228420","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":"Should Ivabradine be First-Line Therapy for Inappropriate Sinus Tachycardia?","authors":"Asif Khan, Joanne Ling, Valay K Parikh, Soad Bekheit","doi":"10.1111/pace.15214","DOIUrl":"https://doi.org/10.1111/pace.15214","url":null,"abstract":"<p><p>Inappropriate sinus tachycardia (IST) is a rare syndrome characterized by a persistent daytime resting heart rate (HR) >100 beats per minute, a mean 24-h HR of >90 beats per minute, with P wave morphology and axis characteristics similar to that of sinus rhythm. IST is associated with symptomatic palpitation described as an abrupt transient acceleration of HR at rest or minimal activity and is often associated with multiple psychosomatic symptoms. Self-sustained contractile activity, i.e., pace-making, is the basic physiological process characterizing the sinus node. The funny current (I_f) initially described in sinus node myocytes is a mixed Na/K cation channel that is slowly activated upon the hyperpolarization of the sinoatrial node's myocytes. This inward current generates repetitive activity responsible for the rhythmic pacemaker activity. The higher the activation of I_f current, the steeper will be phase 4 hence greater the frequency of action potential firing, i.e., HR. Dysfunctional funny channels have been identified as playing a critical role in the development of IST, alongside the external influences stemming from modulatory actions of the autonomic nervous and humoral systems. Beta-blockers and calcium channel blockers are current first-line therapies that often require high doses, but are usually inefficient and poorly tolerated. Ivabradine has been shown to have unique properties of blocking I_f current at low concentration with a use-dependent way, which manifests as a slowly progressing accumulation of the drug during repetitive channel activation/deactivation cycles. Thus, unlike beta-blockers, Ivabradine, in smaller doses, results in a more substantial blocking effect at higher tachycardic rates and, therefore, more successful in the treatment of IST. The current literature review, which includes a small number of patients, has shown that Ivabradine lowered basal, mean, and maximal HR and was associated with symptomatic improvement. We have described the unique and specific mechanism of action, along with its safety profile, which supports Ivabradine's role as the first-line therapy for the resolution of IST.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210718","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":"Case of Frozen Leads: An Old but Persistent Challenge.","authors":"Takamasa Ishikawa, Yuya Nakamura, Yosuke Kai, Rimpei Ueno, Yoshikazu Suzuki, Masaya Ochiai, Hiroto Sugiyama, Yoshimi Onishi, Taku Asano, Toshiro Shinke","doi":"10.1111/pace.15218","DOIUrl":"https://doi.org/10.1111/pace.15218","url":null,"abstract":"<p><p>Frozen leads are a rare but clinically relevant complication during cardiac device replacement. A 77-year-old man undergoing pacemaker upgrade had atrial and ventricular leads firmly adhered to the generator header despite set screw removal and ethanol application. As specialized extraction tools were unavailable, an orthopedic nipper and forceps were used as a locking mechanism to dismantle the header, successfully freeing the leads without damage. This is the first reported case in which fully exposed lead pins could not be extracted. While adhesion limited to the pin port may be addressed with ethanol or fine needles, adhesion from the lead base requires header destruction, increasing damage risk. Specialized tools may not always be available, and in such scenarios, the described method may serve as a practical alternative. Thus, this case underscores the critical importance of meticulous blood and fluid removal during cardiac implantable electronic device (CIED) implantation to prevent frozen leads.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201357","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":"Feasibility and Mid-Term Outcomes of Cardiac Total Electrical Resynchronization Therapy.","authors":"Shunmuga Sundaram Ponnusamy, Selvaganesh Mariappan, Habibullah Moghal, Saravana Kumar, Ramvivek Ramamoorthy, Mariappan Murugan, Vithiya Ganesan","doi":"10.1111/pace.15216","DOIUrl":"https://doi.org/10.1111/pace.15216","url":null,"abstract":"","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201359","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}