Pace-Pacing and Clinical Electrophysiology最新文献

{"title":"Postmortem Removal of Submuscularly Placed Subcutaneous Implantable Cardioverter Defibrillator in the Obese.","authors":"Chu-Pak Lau","doi":"10.1111/pace.15189","DOIUrl":"10.1111/pace.15189","url":null,"abstract":"","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"649-650"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804537","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":"Management of an Exposed Cardiac Pacemaker Through the Surgical Rotational Flap.","authors":"Alessandro Sarai, Eleonora De Antoni, Bruna Bolzan, Luca Tomasi, Maurizio Governa, Flavio Ribichini, Giacomo Mugnai","doi":"10.1111/pace.15193","DOIUrl":"10.1111/pace.15193","url":null,"abstract":"<p><p>Pacemaker pocket erosion with exposure is a significant complication of cardiac implantable electronic devices, particularly in elderly patients with limited subcutaneous tissue. This case report details the successful management of a 93-year-old woman presenting with pacemaker extrusion, treated through antibiotic therapy, generator replacement, and covering with a rotation flap. This case underlines the importance of interdisciplinary collaboration and careful approaches in addressing dangerous device-related complications in fragile patients.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"603-606"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032645","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":"Noninvasive Impedance Analysis During S-ICD Insertion Provides Justification for Defibrillation Based Testing Deferment.","authors":"Andreas G Kontopidis, Mark É Czeisler, David H Yoo, Olivia Whittaker, Daniel C Pipilas, Theofanie Mela","doi":"10.1111/pace.15199","DOIUrl":"10.1111/pace.15199","url":null,"abstract":"<p><strong>Background: </strong>Following subcutaneous implantable cardioverter-defibrillator (S-ICD) insertion, induction of ventricular fibrillation (VF) and defibrillation threshold testing (DFT) is the standard of practice to assess system performance. In contrast, DFT testing is not routinely performed after transvenous ICD (T-ICD) insertion, supported by literature that emphasizes negative clinical repercussions and reliability of noninvasive predictors of successful defibrillation. There is a paucity of data for both the trajectory of noninvasive low voltage (LV) impedance measurements at S-ICD insertion through the time of potential DFT testing and for the proximity of LV impedance measurements and high voltage (HV) shock impedance from 65J DFT or 10J testing.</p><p><strong>Objective: </strong>We aim to characterize the trend in LV impedance from initial S-ICD connection (LV T0) to final intraprocedural impedance (LV T4) and to compare LV impedance with HV impedance.</p><p><strong>Methods: </strong>Data from patients who underwent S-ICD implantation between July 2022 and March 2024 were analyzed. LV impedance measurements were collected during implant and HV impedance measurements were collected if 65J DFT/10J testing was performed. Differences in mean impedances at each time point were evaluated using paired t-tests. For those who underwent 10J or 65J DFT testing, LV impedance was compared with HV impedance.</p><p><strong>Results: </strong>The primary analytic sample included 53 patients, with a mean age of 51 ± 15.7 years; 16 (30.2%) were female. LV impedance decreased by a mean of 14.5 ± 9.8 ohms (18.3%; p <0.001) from S-ICD connection (T0) to the final intraprocedural measurement, approximately 60 min postimplant (T4). Among 35 patients who underwent HV testing (65J DFT or 10J), LV impedance at T4 and HV impedance did not differ significantly (1.7 ± 6.3 ohms; p = 0.116).</p><p><strong>Conclusion: </strong>Our findings demonstrate a predictable reduction in LV impedance from S-ICD connection to subsequent intraprocedural measurements. We also found that LV impedance at LV T4, the final intraprocedural measurement, did not significantly differ from contemporaneous HV impedance. Together, these findings indicate that LV impedance at implant can be expected to decline, and that 60-min postimplant LV impedance may reliably approximate HV impedance. Evaluation of circumstances in which LV impedance could influence the decision to perform DFT testing is warranted.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"578-586"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12166533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low Voltage Area Modification in Older Patients With Atrial Fibrillation.","authors":"Ning Chen, Zhou Xu, Hongwu Chen, Gang Yang, Lei Wang, Youmei Shen, Nan Wu, Sion Ju, Weizhu Ju, Mingfang Li, Kai Gu, Hailei Liu, Minglong Chen","doi":"10.1111/pace.15203","DOIUrl":"https://doi.org/10.1111/pace.15203","url":null,"abstract":"<p><strong>Background: </strong>Age has been found as an important factor affecting the low voltage area (LVA) in patients with atrial fibrillation (AF). This study aims to investigate the potential benefit of LVA modification in older AF patients.</p><p><strong>Methods: </strong>This study constitutes a sub-analysis of the STABLE-SR-II and STABLE-SR-III trials, wherein patients with persistent AF (PeAF) or paroxysmal AF (PAF) were randomized to undergo either circumferential pulmonary vein isolation (CPVI) alone or additional LVA modification. Patients aged ≥65 years were analyzed. The primary outcome was freedom from atrial tachyarrhythmias (ATAs).</p><p><strong>Results: </strong>A total of 510 patients (mean age 70.2 ± 3.8 years, 264 male) were analyzed, comprising 96 PeAF and 414 PAF patients. Among patients without LVA, the risk of ATAs recurrence was similar between PeAF and PAF patients in the propensity score-matched model (adjusted HR, 1.49 [0.54-4.33]; p = 0.431). Both PeAF (adjusted HR, 0.35 [95% CI, 0.12-0.98]; p = 0.048) and PAF patients (adjusted HR, 0.41 [0.19-0.81]; p = 0.013) could benefit from additional LVA modification in the Cox proportional hazards model.</p><p><strong>Conclusions: </strong>In older patients with AF, the recurrence rate following CPVI alone is comparable between those with PAF and PeAF in the absence of LVA. However, the presence of LVA is associated with higher recurrence rates in both PAF and PeAF patients, while additional LVA modification effectively reduces recurrence irrespective of AF type.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128695","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":"Stylet-Driven Lead Vs. Lumenless Lead for Left Bundle Branch Area Pacing: Systematic Literature Review and Meta-Analysis.","authors":"Ga-In Yu, Tae-Hoon Kim, Yun-Ho Cho, Jae-Seok Bae, Jong-Hwa Ahn, Jeong Yoon Jang, Choong Hwan Kwak","doi":"10.1111/pace.15209","DOIUrl":"https://doi.org/10.1111/pace.15209","url":null,"abstract":"<p><strong>Background: </strong>Left bundle branch area pacing (LBBAP) offers cardiac synchrony benefits over conventional ventricular pacing. Although many studies on LBBAP have used lumenless pacing leads (LLLs), stylet-driven pacing leads (SDLs) can also be used. In this study, we compared LLLs and SDLs for LBBAP through a systematic review and meta-analysis of the literature.</p><p><strong>Methods: </strong>The PubMed, Embase, and Cochrane Library databases were searched for full-text articles on LBBAP from their respective inception dates to April 9, 2024. The studies comparing LLLs and SDLs were extracted, and electrophysiological characteristics and procedural outcomes were analyzed. Of 2201 articles on LBBAP, 7 met the inclusion criteria of comparing LLLs and SDLs as implanted pacing leads.</p><p><strong>Results: </strong>The overall pooled analysis showed noninferiority in implant success rates for SDLs compared with LLLs for LBBAP (89% vs. 94%, odds ratio: 0.80, 95% confidence interval [CI]: 0.37-1.72, p = 0.566). The paced QRS duration of LBBAP using SDLs was not significantly different from that using LLLs (standardized mean difference: -0.19 ms, 95% CI: -0.50 to 0.12, p = 0.239). There were no differences in the stimulus to the left ventricular activation time and paced QRS duration between the two groups. Follow-up pacing parameters were stable in both groups.</p><p><strong>Conclusion: </strong>LBBAP using SDLs is noninferior to that using LLLs in terms of implantation success. There were no differences in procedural and electrophysiological characteristics between the two groups.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128908","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":"Functional Substrate Mapping Using Atrial Decrement Evoked Potentials to Predict Critical Isthmus of Atrial Tachycardia.","authors":"Hikmet Yorgun, Cem Çöteli, Ahmet Haydar Keresteci, Mahmoud Obeidat, Kudret Aytemir","doi":"10.1111/pace.15205","DOIUrl":"https://doi.org/10.1111/pace.15205","url":null,"abstract":"<p><p>Recent reports highlighted the role of functional substrate mapping during sinus rhythm to predict the critical isthmus of left atrial tachycardias (AT). In this article, we reported a case of a 63-year-old female patient who was admitted with recurrent AT after pulmonary vein isolation. Although sinus rhythm revealed normal left atrium voltages, programmed stimulation with extrastimulus revealed decrement evoked potentials with prolongation in local electrograms on the anterior wall. Critical isthmus of AT was colocalized with deceleration zones during functional substrate mapping. Radiofrequency ablation successfully terminated AT.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112136","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":"Gastric Hypomotility After Pulmonary Vein Isolation With or Without Left Atrial Roof Ablation Using a Novel Cryoballoon.","authors":"Atsuhito Oda, Takatoshi Shigeta, Yuichiro Sagawa, Kazuya Murata, Hirofumi Arai, Yumi Yasui, Yuichi Fukami, Kaoru Okishige, Manabu Kurabayashi, Tetsuo Sasano, Yasuteru Yamauchi","doi":"10.1111/pace.15204","DOIUrl":"https://doi.org/10.1111/pace.15204","url":null,"abstract":"<p><strong>Background: </strong>The novel POLARx cryoballoon ablation (CBA) system offers enhanced cooling properties for the treatment of atrial fibrillation (AF); however, these capabilities may damage adjacent tissues. This study aimed to assess the prevalence and predictors of gastric hypomotility (GH) in patients undergoing pulmonary vein isolation (PVI) and left atrial (LA) roofline ablation using the POLARx.</p><p><strong>Methods: </strong>Patients who underwent CBA for PVI using the POLARx system were included in this study. Additional LA roofline ablation was performed in patients with non-paroxysmal AF and paroxysmal AF with LA enlargement. GH occurrence was assessed postoperatively by esophagogastroscopy, and the distance between the esophagus and surrounding tissues were measured.</p><p><strong>Results: </strong>Among the 61 patients who underwent PVI, 22 underwent additional LA roofline ablation. GH was confirmed in 12 patients (30.8%) who underwent PVI only and 12 patients (54.5%) who underwent additional LA roofline ablation. Symptomatic GH with acute gastric dilation occurred in three patients, all of whom had undergone roofline ablation. Multivariate analysis, a shorter distance between the esophagus and the midpoint of the vertebral body (odds ratio, 0.74; 95% confidence interval, 0.55-0.98; p = 0.04) was identified as the sole predictor of GH, with a cutoff of 20.0 mm (sensitivity, 80.0%; specificity, 81.8%).</p><p><strong>Conclusion: </strong>Adding LA roofline ablation to PVI using the POLARx may increase the risk of GH, particularly when the esophagus is in close proximity to the midpoint of the vertebral body.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112364","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":"Position-Dependent and Hidden Atrioventricular Dyssynchrony in Micra AV Leadless Pacemaker.","authors":"Yuta Sudo","doi":"10.1111/pace.15206","DOIUrl":"https://doi.org/10.1111/pace.15206","url":null,"abstract":"<p><p>Micra AV leadless pacemakers aim to maintain atrioventricular (AV) synchrony across various body positions. This report describes a case of position-dependent AV dyssynchrony in an 81-year-old man with nocturnal palpitations despite having normal routine evaluations. Rate histogram analysis revealed an unusual distribution pattern, and manual atrial mechanical (MAM) testing demonstrated an increased A3 signal amplitude in the left lateral position, which resulted in oversensing. Adjusting the A3 threshold and window end settings resolved the symptoms and normalized the rate histogram. This case highlights the importance of position-dependent signal variations and rate histogram analyses in patients with a Micra AV.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112463","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":"Thoracoacromial Artery Injury Causing Pacemaker Pocket Pseudoaneurysm: A Case Report.","authors":"Di Ding, Xusen Sun, Wei Wang, Zheng Zhang","doi":"10.1111/pace.15198","DOIUrl":"https://doi.org/10.1111/pace.15198","url":null,"abstract":"<p><strong>Background: </strong>Pacemaker pocket pseudoaneurysm is a rare complications after pacemaker implantation and often do not respond to conservative treatments.</p><p><strong>Case presentation: </strong>We present a case of a 93-year-old man who developed pocket swelling and a significant hemoglobin decrease one week after pacemaker implantation. Conservative management, including compression and blood transfusion, proved ineffective. Angiography identified bleeding from the thoracoacromial artery, which was successfully addressed with coil embolization. The patient exhibited a favorable recovery during follow-up.</p><p><strong>Conclusion: </strong>Arterial injury should be considered in cases of persistent hematoma after pacemaker implantation. Early imaging and embolization are crucial for effective management.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112583","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":"Interatrial Block and Atrial High-Rate Episodes.","authors":"Manuel Martínez-Sellés","doi":"10.1111/pace.15130","DOIUrl":"10.1111/pace.15130","url":null,"abstract":"","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"560-561"},"PeriodicalIF":1.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883665","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}