Pace-Pacing and Clinical Electrophysiology最新文献

{"title":"A Current Perspective on Left Atrial Appendage Closure Device Infections: A Systematic Review.","authors":"Yusuf Ziya Sener, Sumeyye Fatma Ozer, Gizem Karahan","doi":"10.1111/pace.15184","DOIUrl":"https://doi.org/10.1111/pace.15184","url":null,"abstract":"<p><strong>Purpose: </strong>Left atrial appendage (LAA) closure has become the standard of care for patients with atrial fibrillation (AF) at high risk of thromboembolism who are intolerant or unwilling to take anticoagulants. LAA occlusion device infection is a challenging complication, and there is a paucity of data on the management and outcomes of LAA occlusion device infection. We aimed to summarize the existing literature and highlight the knowledge gap in this area.</p><p><strong>Methods: </strong>A detailed search was conducted through the databases PubMed/MEDLINE, EMBASE, Web of Science, CINAHL, and Cochrane Central using the relevant keywords. All cases with presented data regarding diagnosis, treatment, and outcome were included from the reports.</p><p><strong>Results: </strong>The analysis included 12 case reports encompassing a total of 12 patients. The mean age was 73.6 ± 11.0 years, and 50% of the cases were male. The most commonly implanted device was the Watchman (in eight of the 12 cases). The median time between LAA closure and infection was 6.6 (0.2-36) months. Transesophageal echocardiography was diagnostic in all cases, and positron emission tomography/computed tomography (PET/CT) was useful in diagnosis in three cases. The most common pathogen was Staphylococcus aureus (n = 7). The LAAC device was removed in seven cases; one patient refused surgery, and in the other three cases, removal of the device was not considered appropriate due to the patient's poor condition. Data on whether the device was removed could not be retrieved for one patient. Mortality occurred in three cases (25%), and all deaths occurred during hospitalization.</p><p><strong>Conclusion: </strong>LAA closure device infections are rare but carry a high risk of complications and mortality. Treatment should include device removal in appropriate cases, and antibiotherapy alone should be considered only in selected cases. Further studies are needed to clarify diagnostic and treatment strategies based on the causative pathogens and patient status.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First Experience Using a Novel Variable Loop Catheter for Mapping and Pulsed Field Ablation of Atrial Fibrillation.","authors":"Thomas Fink, Vanessa Sciacca, Kevin Bannmann, Maximilian Moersdorf, Sebastian Beyer, Alessandro Parlato, Denise Guckel, Mustapha El Hamriti, Moneeb Khalaph, Martin Braun, Maxim Didenko, Guram Imnadze, Dominik Linz, Kevin Vernooy, Philipp Sommer, Christian Sohns","doi":"10.1111/pace.15177","DOIUrl":"https://doi.org/10.1111/pace.15177","url":null,"abstract":"<p><strong>Background and aims: </strong>A novel multielectrode variable loop catheter (VLC) has been introduced for atrial fibrillation (AF) ablation enabling 3D electroanatomic mapping and concomitant pulsed field ablation (PFA). This study sought to investigate the VLC under routine clinical conditions for AF ablation.</p><p><strong>Methods: </strong>Consecutive patients with symptomatic AF undergoing first-time AF ablation were prospectively enrolled. All procedures were carried out using the VLC. Electroanatomic mapping pre and post-ablation was conducted with the VLC and a high-density multipolar mapping catheter. The general ablation protocol consisted of four ablation pulses per pulmonary vein (PV). All procedures were conducted in conscious sedation.</p><p><strong>Results: </strong>Forty-five patients (mean age 66.3 ± 6.1 years, 68.9% paroxysmal AF) were analyzed. Procedure duration was 66.3 ± 13.1 min. Acute pulmonary vein isolation (PVI) was achieved in 45 patients without periprocedural complications. Remapping after the initial 16 ablation pulses revealed sustained electrical conduction to at least one PV in six patients (13.3%). Repeat ablation was conducted and with an average of 7.5 ± 4.5 additional pulses. PV intubation during mapping was achieved in 168/180 PVs with the VLC (93.3%) and in 180/180PVs (100%) with the high-density mapping catheter (p < 0.001). Incomplete PV intubation during mapping did not result in incomplete PVI, as demonstrated by remapping utilizing the high-density mapping catheter. Adequate correlation between left atrial post-ablation remapping of low voltage areas and ablated regions was demonstrated in all patients.</p><p><strong>Conclusion: </strong>PFA-guided AF ablation using the novel VLC is safe and effective. The integration into a 3D-electroanatomic mapping system enables adequate mapping during PFA procedures.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Atrial Fibrillation Burden and Ischemic Stroke Incidence: A Case-Control Study on the CABANA Trial.","authors":"En-Ze Li, Zhen Cao, Xiao-Xia Liu, Chang-Sheng Ma","doi":"10.1111/pace.15186","DOIUrl":"https://doi.org/10.1111/pace.15186","url":null,"abstract":"<p><strong>Background: </strong>The relationship between the burden of atrial fibrillation (AF) and the risk of ischemic stroke is crucial yet complex. This study examines this relationship to enhance stroke prediction in patients with AF.</p><p><strong>Methods: </strong>The CABANA trial study from 2009 to 2016 analyzed the relationship between AF load, stroke, and anticoagulation. We matched age, gender, and race, as well as the control and case groups, at 1:4. Non-invasive electrocardiogram monitoring recorded load events and included the total cumulative load in the calculation. Next, we compared the net load between the stroke and control groups, and the relationship between net AF load and stroke was analyzed using univariate and multivariate logistic regression. This study also explored the interplay between stroke, AF load, and anticoagulation.</p><p><strong>Results: </strong>The first independent predictor of ischemic stroke risk is the net AF load (OR = 8.72, 95% CI: 3.11-24.4, p < 0.001). Stratified by the CHA2DS2VASc score, no significant change in net AF load between the high-risk and low-risk groups was observed (p = 0.96). Finally, we categorized all patients into adequate and inadequate anticoagulation groups based on whether they received adequate anticoagulation. The net AF load in the adequate anticoagulation group was higher than in the inadequate anticoagulation group (p < 0.001).</p><p><strong>Conclusion: </strong>AF burden is significantly associated with the risk of ischemic stroke. Determining the threshold of AF burden can improve stroke prevention strategies, indicating the need for targeted research on risk stratification and management of patients with AF.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Right Bundle Branch Block After Transvenous Lead Extraction: An Unreported Complication With Potentially Severe Outcomes.","authors":"Karanjeet Chauhan, Alistair Royse, Colin Royse, Joseph Morton, Gareth Wynn","doi":"10.1111/pace.15182","DOIUrl":"https://doi.org/10.1111/pace.15182","url":null,"abstract":"<p><strong>Introduction: </strong>Right bundle branch block (RBBB) following cardiac device extraction has not been previously reported but may have catastrophic consequences.</p><p><strong>Methods and results: </strong>We present two cases of young male patients who developed RBBB following the extraction of single chamber TV ICD systems where the coil was adherent close to the superior tricuspid valve annulus. Both patients had a subcutaneous ICD (SICD) implanted but suffered an inappropriate shock due to T-wave oversensing, requiring very early SICD removal for one patient.</p><p><strong>Conclusion: </strong>The development of RBBB following the extraction of a TV ICD is a previously unreported complication and may cause significant sensing problems if an SICD is implanted subsequently. Placement of the ICD lead tip in the right ventricular outflow tract or high on the intraventricular septum may predispose to this complication.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iatrogenic Arteriovenous Fistula After Pacemaker Implantation: A Rare Case Report and Literature Review.","authors":"Xiaofei Li, Xiaohan Fan, Chen He, Bowen Fan, Lingan Liu, Haojie Zhu, Zhicheng Hu, Limin Liu, Tao Zhang, Yan Xiao, Kun Fang, Yan Yao","doi":"10.1111/pace.15174","DOIUrl":"https://doi.org/10.1111/pace.15174","url":null,"abstract":"<p><p>Severe vascular complications associated with pacemaker implantation rarely occur and then might be misjudged. We presented a case with an atypical and confusing presentation of arteriovenous fistulae after pacemaker implantation that was relatively late recognized post-procedure. Endovascular repairment was performed and a good clinical outcome was reached.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Pulmonary Vein Isolation by Local Potentials in FARAPULSE Pulsed Field Ablation System.","authors":"Saki Yamano, Tetsuma Kawaji, Misaki Naka, Kaisei Yanada, Yuki Ueda, Ryuta Ishida, Masashi Kato, Takafumi Yokomatsu, Shinji Miki","doi":"10.1111/pace.15176","DOIUrl":"https://doi.org/10.1111/pace.15176","url":null,"abstract":"<p><p>Herein, we propose a novel approach examining intra-spline bipolar potentials-rather than conventional cross-spline potentials-using the FARAWAVE catheter to assess pulmonary vein isolation in the FARAPULSE pulsed field ablation system. The novel intra-spline bipolar electrograms on the FARAWAVE catheter are useful for reducing far potentials during confirmation of the pulmonary vein isolation line.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lead Performance and Echocardiographic Outcomes for Delayed Bundle Capture Loss During Conduction System Pacing.","authors":"Shengjie Wu, Lan Su, Yuchao Fang, Wenxuan Shang, Xinxin Wang, Junwei Wang, Lei Xu, Songjie Wang, Weijian Huang","doi":"10.1111/pace.15178","DOIUrl":"https://doi.org/10.1111/pace.15178","url":null,"abstract":"<p><strong>Background: </strong>Conduction system pacing (CSP) is increasingly recognized for mitigating the adverse hemodynamic effects commonly associated with conventional ventricular pacing. However, there is limited data on the lead performance and echocardiographic outcomes for delayed bundle capture loss during CSP.</p><p><strong>Objective: </strong>To evaluate the rate of complete loss of bundle capture/correction during CSP and assess the subsequent clinical outcomes.</p><p><strong>Method: </strong>Patients who underwent successful CSP lead implantation with indications for ventricular pacing or cardiac resynchronization therapy (CRT) were screened. The reasons for complete loss of capture or failed LBBB correction were identified, and subsequent clinical outcomes were analyzed.</p><p><strong>Result: </strong>Out of 2636 patients screened, nine experienced complete loss of bundle capture or LBBB correction during follow-up. Loss of capture was attributed to unexplained causes (n = 6), near-complete electrode dislodgement (n = 1), surgical damage (n = 1), and electrode malfunction (n = 1). The six patients with CRT indication and declining cardiac function underwent lead revision, with left ventricular ejection fraction (LVEF) improving from 40.6 ± 17.3% to 59.1 ± 6.0% at the last follow-up with the bundle capture threshold of 0.63 ± 0.14 V/0.5 ms. The remaining 3 atrioventricular block patients with stable cardiac function did not undergo lead revision and the local myocardium threshold of 0.58± 0.31 V/0.5 ms.</p><p><strong>Conclusion: </strong>The incidence of complete capture loss during CSP is low recapturing/recorrecting the bundle significantly improves cardiac function in patients with CRT indications.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transseptal Puncture in Children Weighing Less than 20 kg in Invasive Cardiac Catheterization and Electrophysiology.","authors":"Merve Maze Aydemir, Bekir Yukcu, Hasan Candas Kafali, Sezen Gulumser Sisko, Hacer Kamali, Alper Guzeltas, Yakup Ergul","doi":"10.1111/pace.15179","DOIUrl":"https://doi.org/10.1111/pace.15179","url":null,"abstract":"<p><strong>Background: </strong>Transseptal puncture (TSP) is a widely utilized technique for left-sided electrophysiological studies (EPS), interventions in left heart lesions, or creating interatrial shunts in congenital heart diseases (CHD). This study aims to evaluate the outcome of TSP in children under 20 kg.</p><p><strong>Methods: </strong>This retrospective study analyzed TSP procedures in infants and children <20 kg between December 2015 and January 2023. TSPs were performed with a biplane angiography system in the catheter angiography laboratory. A Brockenbrough needle (BRK Transseptal Needle; Abbott/St. Jude Medical, Inc.) was used for TSP. In patients whose Brockenbrough needles could not cross the interatrial septum, TSP was performed by applying cautery energy over the Brockenbrough needle.</p><p><strong>Results: </strong>Nineteen patients were studied (seven females, median age 2.3 years, median weight 10.3 kg), and 63% required TSP for CHD. The CHD group had younger patients (median age: 6.25 months) with smaller weights (median: 5.3 kg) than the catheter ablation group. There was no difference between groups in terms of gender and success rates. Procedure and fluoroscopy times were shorter in the ablation group (p < 0.05). Radiofrequency energy was used without complications in three cases when traditional methods failed. In four patients, the septum could not be traversed. The median weight of patients in whom TSP failed was 2.9 kg. The only major complication was pericardial tamponade developed in two patients diagnosed with hypoplastic left heart syndrome.</p><p><strong>Conclusion: </strong>TSP is a safe option when carefully selected but carries higher risks in complex CHD with abnormal cardiac anatomy compared to patients with normal anatomy used for electrophysiology procedures.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling the Reason for Syncope Associated With Cardiac Nodules.","authors":"Fangdi Zha, Jianfan Wen, Liangping Wang, Shusheng Liao, Lei Xu, Xiao Chen, Weijian Huang, Lan Su","doi":"10.1111/pace.15161","DOIUrl":"https://doi.org/10.1111/pace.15161","url":null,"abstract":"<p><p>Behcet's disease is a systemic immune-mediated vasculitis predominantly affecting males. Cardiac involvement, termed cardiac Behcet's disease, is rare but potentially fatal, often mimicking infective endocarditis. This case presented with syncope as the initial symptom, leading to the identification of a non-coronary aortic sinus nodule, suspected as the cause of intermittent complete atrioventricular block. After pacemaker implantation, no recurrent syncope occurred, and immunosuppressive therapy reduced nodule size. This case underscores the importance of maintaining a high suspicion for cardiac Behcet's disease, as early diagnosis and intervention can be lifesaving.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrocardiographic Imaging: A New Tool to Ensure Cardiac Resynchronization During Left Bundle Branch Pacing Implant.","authors":"Margarida Pujol-Lopez, Mariona Regany-Closa, Berta Pellicer-Sendra, Marta Martínez-Pérez, Rubén Molero, Freddy R Graterol, María S Guillem, Eduard Guasch, José M Tolosana, Lluís Mont","doi":"10.1111/pace.15172","DOIUrl":"https://doi.org/10.1111/pace.15172","url":null,"abstract":"","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}