Pacing and clinical electrophysiology : PACE最新文献

{"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":"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":"874-885"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","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":"Multiple Arterial Embolisms After Radiofrequency Ablation of Focal Atrial Tachycardia in the Left Atrium: A Case Report.","authors":"Yan Zhang, Jun-Tao Wang, Ming-Jie Lin, Xin-Yan Yang, Jing-Quan Zhong","doi":"10.1111/pace.15219","DOIUrl":"10.1111/pace.15219","url":null,"abstract":"<p><p>We report a relatively rare case of multiple arterial embolisms after radiofrequency ablation for focal atrial tachycardia in the left atrium. The source of the emboli was not detected by transthoracic echocardiography. Enhanced CT of the left atrium confirmed that the emboli originated from the left atrium. After 2 months of anticoagulant treatment, a reexamination with enhanced CT of the left atrium showed that no thrombus was found in the left atrium.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"890-893"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259934","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":"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":"886-889"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201357","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":"Does Surgical Treatment With Uvulopalatopharyngoplasty for Obstructive Sleep Apnea Prevent Future Arrhythmic Events?","authors":"Lae-Young Jung, Sunhwa Kim, Yisik Kim, Sung-Won Kim, Donghyun Kim, Hoseob Kim, Yoonjong Bae","doi":"10.1111/pace.15202","DOIUrl":"10.1111/pace.15202","url":null,"abstract":"<p><strong>Introduction: </strong>Obstructive sleep apnea (OSA) is a known risk factor for cardiac arrhythmia. The impact of surgical OSA treatment on the future occurrence of arrhythmic disease in young patients remains insufficiently studied.</p><p><strong>Purpose: </strong>This study aimed to determine if surgical OSA treatment reduces future arrhythmic events (atrial fibrillation [AF], premature beats, ventricular arrhythmias, and sudden cardiac arrest [SCA]) and if these effects persist over time.</p><p><strong>Methods: </strong>This study was a retrospective cohort data analysis of the dataset from the Korean National Health Insurance Service system (2009-2020) on 359,851 OSA patients. Propensity score matching (PSM) compared surgical treatment with uvulopalatopharyngoplasty (UPPP) and a control group, resulting in a cohort of 117,665 participants (85.4% men, average age 45.5 ±14.0). Over 5 years, occurrences of AF, premature beats, ventricular arrhythmias, and SCA were evaluated.</p><p><strong>Results: </strong>The control group showed a linear increase in arrhythmic disease. The surgical treatment group had a lower incidence of arrhythmias. PSM showed significant reductions in AF, premature beats, ventricular arrhythmias, and SCA in the surgical treatment group. AF incidence was 5 times higher in the control group (HR 5.384), premature beats were 4 times higher (HR 4.284), ventricular arrhythmias were 11 times higher (HR 11.758), and SCA was over 24 times higher (HR 24.089).</p><p><strong>Conclusion: </strong>Young patients with OSA exhibited a progressively increasing trend in arrhythmic events over time. Surgical treatment with UPPP in a similar patient population was associated with a reduction in the incidence of these conditions.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"897-905"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478558","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":"3D Electroanatomical Mapping for Complex Atrial Arrhythmias in Adult Congenital Heart Disease-A Single Center Experience.","authors":"Nili Schamroth Pravda, Ofir Brem, Alon Barsheshet, Kirill Buturlin, Aharon Erez, Ehud Kadmon, Gustavo Goldenberg, Ran Kornowski, Rafael Hirsch, Gregory Golovchiner","doi":"10.1111/pace.70012","DOIUrl":"10.1111/pace.70012","url":null,"abstract":"<p><strong>Introduction: </strong>Adult Congenital Heart Disease (ACHD) patients suffer from multiple, and often atypical, atrial arrhythmias. 3D electro-anatomical mapping systems assist in the identification and ablation of arrhythmogenic substrates critical to the initiating of theses arrhythmias.</p><p><strong>Methods: </strong>We report on patients with ACHD and atrial arrhythmias treated at our center using the high density Rhythmia (Boston Scientific. Marlborough, MA) mapping system. Procedural success was defined as no sustained arrhythmia inducible at the end of the procedure. Partial success was defined as non-inducibility of the clinical arrhythmia.</p><p><strong>Results: </strong>Our cohort included 16 patients in whom 21 electro-anatomical mapping and ablations were performed. Most patients were female (13 patients, 87%) and the average age was 43.5 ± 10.3 years. The congenital heart disease diagnosis was varied, including Fontan circulation and atrial switch palliation for Transposition of the great arteries. The identified arrhythmias included 21 intra-atrial re-entrant tachycardias and nine focal atrial tachycardias. In 14 cases (66.6%) the procedure was successful, in five cases (23.8%) the procedure was partially successful, and two cases (9.5%) were unsuccessful. There were no procedure-related major adverse events reported. At mean follow up of 15.3 ± 12.6 months, there were four cases of recurrent arrhythmias (44% of patients), four re-do procedures, three patients (18.8%) were discontinued from their antiarrhythmic medications.</p><p><strong>Conclusion: </strong>Electro-anatomical mapping is useful in the identification and treatment of complex atrial arrhythmias in patients with ACHD. In this cohort, mapping-assisted ablation of complex atrial arrhythmias in patients with ACHD was safe, feasible, and demonstrated an acceptable success rate.</p><p><strong>Condensed abstract: </strong>Patients with ACHD have anomalous cardiac anatomy and atrial arrhythmias can often be atypical. Electro-anatomical mapping is useful in the identification and treatment of complex atrial arrhythmias among patients with ACHD. We found that the use of a high-resolution 3D electro-anatomic mapping is safe, feasible and effective for the treatment of complex atrial arrhythmias in ACHD.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"917-924"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661751","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":"Safety of Same-Day Discharge Following Pulsed-Field Ablation Versus Radiofrequency Ablation: A Comparative Analysis.","authors":"Adele Watfa, Arwa Younis, Mohamad Mdaihly, Joe Demian, Chadi Tabaja, Pasquale Santangeli, Bryan Baranowski, Hiroshi Nakagawa, Tyler Louis Taigen, Koji Higuchi, Thomas D Callahan, Shady Nakhla, Mohamed Kanj, Mina K Chung, Jakub Sroubek, Justin Z Lee, Mandeep Bhargava, Walid I Saliba, Oussama M Wazni, Ayman A Hussein","doi":"10.1111/pace.70005","DOIUrl":"10.1111/pace.70005","url":null,"abstract":"<p><strong>Background: </strong>Same-day discharge (SDD) after catheter ablation is increasingly adopted to improve patient convenience and reduce healthcare costs. While SDD following radiofrequency ablation (RFA) is well-documented, no data exist on SDD in patients undergoing pulsed-field ablation (PFA) for atrial fibrillation (AF).</p><p><strong>Objective: </strong>To evaluate the safety of SDD in patients undergoing PFA and RFA for AF, with an exploratory comparison of practice patterns and outcomes.</p><p><strong>Methods: </strong>From a prospectively maintained registry, we included all consecutive patients undergoing PFA for AF (FARAWAVE catheter) since its FDA approval and patients undergoing AF RFA between March and October 2023 (comparison group). Outcomes included rates of major complications (vascular complications, cerebrovascular accidents, transient ischemic attacks (TIA), phrenic nerve injury, and pericardial effusion requiring intervention), minor complications, readmissions within 30 days, and all-cause mortality.</p><p><strong>Results: </strong>The study included 955 PFA patients, of whom 207 (21.7%) were discharged the same day, and 1072 RFA patients, of whom 127 (11.8%) were discharged the same day. Vascular closure modalities differed significantly across groups (p < 0.001). Major complications, including stroke and TIA, occurred in 0.5% of PFA non-SDD and 1.1% of RFA non-SDD patients (p = 0.29, p = 0.24), with no major complications in SDD groups and no deaths across all groups. Minor complications were 0.5% for PFA SDD versus 1.1% for PFA non-SDD (p = 0.44) and 1.6% for both RFA SDD and RFA non-SDD (p = 0.99), and not significantly different between PFA SDD and RFA SDD (p = 0.31). Readmission rates (UTI, AF, aspiration pneumonia) were similar between SDD patients at 1.4% for PFA and 2.4% for RFA (p = 0.54). A lower CHA2DS2-VASc score predicted the practice pattern of SDD in the PFA cohort (OR = 0.754, 95% CI: 0.663-0.858, p < 0.001), while being octogenarian reduced the likelihood of SDD (OR = 0.265, 95% CI: 0.105-0.666, p = 0.005).</p><p><strong>Conclusion: </strong>In this cohort, SDD was found to be a safe and viable option for both PFA and RFA. In this practice, the rates of same-day discharge were higher in the PFA group versus the RFA group and is being increasingly adopted.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"852-858"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144763053","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":"Cardiac Resynchronization Therapy Pacing Interruption: From Early Challenges to Cutting-Edge Solutions.","authors":"Hermine Poghosyan","doi":"10.1111/pace.70015","DOIUrl":"10.1111/pace.70015","url":null,"abstract":"<p><strong>Background/purpose: </strong>In the current era of pacing, the loss of cardiac resynchronization therapy (CRT) pacing remains a significant challenge, especially in patients with heart failure (HF). Some manufacturers, such as Biotronik (Berlin, Germany), offer left ventricular (LV) sensing options to avoid pacing during vulnerable periods. However, even in the absence of LV sensing (LVs), CRT interruptions can still occur, though they often go unnoticed without this additional feature. When LVs is used, interruptions in biventricular pacing can sometimes lead even to device-induced ventricular tachycardia (VT).</p><p><strong>Results: </strong>A careful review of all CRT pacing interruption episodes reveals the precise causes of these interruptions. Although interruptions may exist even in devices without LVs, grouping the causes allows for a clearer understanding of the phenomenon and its potential adverse effects. Furthermore, recent advancements in CRT algorithms could reduce these interruptions and improve device performance, ultimately leading to better clinical outcomes.</p><p><strong>Conclusion: </strong>LVs plays a crucial role in identifying pacing interruptions, though it has its limitations. Even in the absence of LVs, interruptions may still occur, and minor algorithm adjustments can enhance the device's overall effectiveness and predictability. Careful analysis of each interruption episode provides valuable clinical insights that will help inform future management strategies aimed at achieving uninterrupted CRT pacing. Additionally, we are preparing two more studies to explore the clinical implications of CRT interruptions in HF management and propose new algorithms designed to minimize these interruptions.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"827-835"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144763050","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":"Relationship Between Left Atrial Coupling Index and Atrial High-Rate Episodes.","authors":"Ayca Arslan, Dogan Ilis, Inanç Artac, Muammer Karakayali, Timor Omar, Yuksel Erata, Yavuz Karabag, Ibrahim Rencuzogullari","doi":"10.1111/pace.70004","DOIUrl":"10.1111/pace.70004","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to explore the role and compare the accuracy of the left atrial coupling index (LACI) with other efficient traditional parameters for predicting atrial high-rate episodes (AHREs) in patients with cardiac implantable electronic devices (CIEDs).</p><p><strong>Methods: </strong>This retrospective study included 203 patients with CIEDs whose echocardiographic data were recorded at least 6 months ago. The study population was divided into two groups based on whether the patients had developed AHRE. Subsequently, patients in the two groups were compared in terms of echocardiographic measurements, including left atrial functions, LACI, left atrial volume index (LAVI), left ventricle end-diastolic diameter (LVEDD), and lower left ventricle ejection fraction (LVEF).</p><p><strong>Results: </strong>AHRE was observed in 42.8% (n = 87) of the 203 patients. Those with AHRE had a higher mean mitral E/Em, LAVI, LACI, LVEDD, and lower LVEF. LACI (OR: 1.752, 95% CI: 1.356-2.263; p < 0.001), LAVI, and age were found to be independent predictors of AHREs. A receiver operating characteristic (ROC) curve comparison demonstrated that the LACI was a better predictor of AHRE than the LAVI.</p><p><strong>Conclusion: </strong>AHRE often progresses to atrial fibrillation, which has unfavorable consequences; therefore, predicting AHRE becomes vital. LACI, an easily accessible echocardiographic parameter, is a more robust predictor of AHRE than traditional parameters such as LAVI.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"813-820"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144513072","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":"First Reported Case of Chest Varicosities Prior to Permanent Pacemaker Implantation.","authors":"Daniel W Nelson, Timothy Sauld, Mohamed Djelmami-Hani","doi":"10.1111/pace.70009","DOIUrl":"10.1111/pace.70009","url":null,"abstract":"<p><p>Upper chest and shoulder varicosities, although uncommon compared with lower extremity varicosities, are a harbinger of venous obstruction and should expedite the use of contrast venography in patients undergoing cardiac device implantation. We present the first reported case, to our knowledge, of a patient having isolated left upper chest and shoulder varicosities prior to permanent pacemaker implantation.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"894-896"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586213","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":"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":"10.1111/pace.15222","url":null,"abstract":"","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"870-873"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259933","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}