Pace-Pacing and Clinical Electrophysiology最新文献

{"title":"Long-Term Follow-Up of the S-ICD: A 10-Years Follow-Up Study of a Large Single Center Cohort.","authors":"Gerrit Frommeyer, Florian Reinke, Benjamin Rath, Julian Wolfes, Kevin Willy, Felix K Wegner, Julia Köbe, Lars Eckardt","doi":"10.1111/pace.15173","DOIUrl":"https://doi.org/10.1111/pace.15173","url":null,"abstract":"<p><strong>Background: </strong>The subcutaneous implantable defibrillator (S-ICD) is an alternative to transvenous implantable defibrillators. The present analysis presents real-world data from patients with S-ICD and a follow-up duration of 10 years or more.</p><p><strong>Methods and results: </strong>Between July 2010 and November 2013 76 S-ICD systems were implanted. After a follow-up duration of 10 years, data from 67 patients (88.1%) was available. Mean follow-up duration was 10.7 ± 1.3 years. Forty-seven patients (70.2%) were still alive with active S-ICD therapy. Eight patients (11.9%) died during follow-up. In eight patients (11.9%), conversion to a transvenous ICD system was necessary. This was either due to heart failure with indication for biventricular pacing (n = 2), bradycardia (n = 3), oversensing that could not be solved (n = 2), or pocket infection (n = 1). In four patients (6%), the S-ICD system was explanted without replacement for individual reasons. Sixteen patients already underwent two generator replacements, while one generator replacement was performed in the rest of the cohort. Therefore, generator longevity was documented to be within the predicted values. In 10 patients (14.9%), appropriate therapy delivery for ventricular arrhythmias was delivered. In 12 patients (17.9%), inappropriate shock delivery due to oversensing occurred. Of note, this could be resolved in all but two patients. Furthermore, the majority of these episodes occurred in the early years before the implementation of the Smart Pass algorithm.</p><p><strong>Conclusion: </strong>S-ICD therapy can be successfully maintained over a long time. Incidence of oversensing significantly decreased with the implementation of novel algorithms and the new S-ICD generation. However, the present data also points out that in selected individuals conversion to transvenous systems is required.</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":"143626945","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":"Burden of Atrial Fibrillation and Atrial Flutter From 1990 to 2021 in China: Global Burden of Disease Study 2021 Update.","authors":"Xiangyi Kong, Mingxiao Li, Liu He, Yiwei Lai, Jue Wang, Sitong Li, Xiaodong Peng, Manlin Zhao, Qifan Li, Zixu Zhao, Le Zhou, Zejun Yang, Ting Shen, Meiqi Zhao, Zhixian Wang, Enze Li, Yize Zhao, Wenyu Wang, Shijun Xia, Chao Jiang, Xueyuan Guo, Ning Zhou, Xin Du, Caihua Sang, Jianzeng Dong, Changsheng Ma","doi":"10.1111/pace.15175","DOIUrl":"https://doi.org/10.1111/pace.15175","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) and atrial flutter (AFL) represent increasingly significant health burden globally. We aimed to systematically evaluate the status and trends of AF/AFL burden and attributable risk factors in China.</p><p><strong>Methods: </strong>We assessed the burden of AF/AFL measured as prevalence, incidence, mortality, and disability-adjusted life years (DALYs), by sex and age groups in China based on the Global Burden of Diseases Study (GBD) 2021 project.</p><p><strong>Results: </strong>In China, there were 10,775.72 thousand AF/AFL prevalent cases, 916.18 thousand AF/AFL incident cases, and 64.73 thousand AF/AFL mortality cases, contributing to 1653.12 thousand DALYs due to AF/AFL in 2021. Trend analysis indicated that the AAPC of number and crude rates of prevalence, incidence, mortality, and DALYs all escalated from 1990 to 2021. The current AF/AFL burden and temporal trend between 1990 and 2021 displayed heterogeneity based on sex and age groups. The spectrum for risk factors attributed for DALYs due to AF/AFL presented sex- and age-specific manifestation. High systolic blood pressure served as the emerging leading contributor to DALYs due to AF/AFL in China.</p><p><strong>Conclusion: </strong>A significant increase in the burden of AF/AFL underscores the enduring public health burden of AF/AFL in China, marked by profound sex and age-related variations. There is a pressing imperative to adopt tailored strategies to attenuate increasing burden of AF/AFL and combat alongside high complication burden due to AF/AFL in China.</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":"143626936","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":"Intermediate Atrial Tachycardia During Persistent Atrial Fibrillation Ablation: A Sub-analysis of the Extent-AF Trial.","authors":"Kaige Li, Bosheng Xu, Yang Liu, Xinhua Wang, Bing Han, Ping Ye, Weifeng Jiang, Shaohui Wu, Kai Xu, Zheng Qidong, Yanzhe Wang, Mu Qin, Xu Liu, Xumin Hou","doi":"10.1111/pace.15180","DOIUrl":"https://doi.org/10.1111/pace.15180","url":null,"abstract":"<p><strong>Background: </strong>The evidence supporting additional linear ablation for persistent atrial fibrillation (PerAF) remains limited. This study investigates the mechanisms of intermediate atrial tachycardia (AT), a transient state between PerAF and sinus rhythm (SR), during PerAF termination by catheter ablation, and provides evidence for these mechanisms.</p><p><strong>Methods: </strong>We analyzed 136 patients who converted to organized AT after PerAF termination in the Extent-AF study. Bi-atrial activation mapping combined with entrainment mapping was used to identify the mechanisms and critical isthmus of these ATs.</p><p><strong>Results: </strong>A total of 164 ATs were identified in 136 patients (average 1.2 per patient), with 143 (87%) ATs successfully mapped in 113 patients (average 1.3 per patient). The mechanisms of intermediate ATs included macro-reentry in 110 (77%), micro-reentry in 21 (15%), and focal AT in 12 (8%). Among the macro-reentrant ATs, the most common were perimitral ATs (PM-AT) in 52 (47%), followed by roof-dependent ATs (RF-AT) in 40 (36%) and typical atrial flutter (AFL) in 18 (16%). A total of 98 (72%) patients successfully underwent ablation for intermediate ATs. Of these, 88 (90%) required at least one of the perimitral line, roofline, or peritricuspid line to finally restore SR. After 12 months of follow-up, 63 (64.3%) of the patients with successfully ablated ATs were remained free of arrhythmia.</p><p><strong>Conclusions: </strong>The majority of intermediate ATs after PerAF termination were macro-reentrant ATs. Linear ablation targeting the mitral isthmus, roof, and tricuspid isthmus was crucial for restoring SR in up to 90% of patients, suggesting the importance of additional linear ablation in PerAF ablation.</p><p><strong>Trial registration: </strong>Optimization of intervention strategies for persistent atrial fibrillation: ChiCTR2200060075; chictr.org.cn.</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":"143626941","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":"Implantation and Follow-Up of an Extravascular ICD After a Challenging Transvenous System Extraction: A Case Report.","authors":"Domenico M Carretta, Rossella Troccoli, Gianluca Epicoco, Ilenia Pastore, Nicola Di Bari, Carlo D'Agostino, Tomaso Bottio","doi":"10.1111/pace.15170","DOIUrl":"https://doi.org/10.1111/pace.15170","url":null,"abstract":"<p><p>The Extravascular ICD (EV-ICD) is implanted outside of the patient's heart and vascular system. The defibrillation lead is tunneled in the substernal space, very close to the surface of the heart, thus allowing for additional pacing capabilities such as Post Shock Pacing, Anti-Tachycardia Pacing (ATP), and Pause Prevention Pacing. Early studies demonstrated the safety and efficacy profile of the EV-ICD, but patients with previous or existing cardiac devices or leads were excluded. In this case report we describe the implantation of an EV-ICD in a 68-year-old male patient, who had undergone a challenging extraction of a previous transvenous system due to infection and screened negative for a subcutaneous ICD (S-ICD). Given the lack of upper and lower venous accesses, it was also necessary to implant an epicardial bipolar lead connected to a single-chamber pacemaker as a backup during extraction, which also remained in place chronically. Follow-up was uneventful through the following 10 months, with stable system parameters and no infection relapse.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586906","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":"Unexpected Non-Tracking of P Wave After Double-Switch Surgery.","authors":"Swasthi S Kumar, Sudipta Mondal, Manish Choudhary, Narayanan Namboodiri","doi":"10.1111/pace.15167","DOIUrl":"https://doi.org/10.1111/pace.15167","url":null,"abstract":"<p><p>Intermittent P-wave non-tracking in pacemaker electrograms is an infrequent observation in routine clinical practice. While this finding may suggest significant device malfunction, it can also represent a benign response to advanced pacemaker algorithms. This article presents a differential diagnosis of intermittent P-wave non-tracking, with the aim of facilitating accurate interpretation and minimizing unnecessary diagnostic procedures.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538096","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":"Superior Mesenteric Artery Syndrome Resulting From Gastric Dilatation After Catheter Ablation of Atrial Fibrillation.","authors":"Jichun Liu, Yang Ling, Ping Fang, Youquan Wei, Jinfeng Wang, Hao Yang, Xianghai Wang","doi":"10.1111/pace.15152","DOIUrl":"https://doi.org/10.1111/pace.15152","url":null,"abstract":"<p><p>Catheter ablation (CA) is a recognized treatment for people experiencing symptomatic paroxysmal or persistent atrial fibrillation (AF). Pulmonary vein isolation (PVI) is the predominant therapeutic intervention for AF globally. According to PVI, some individuals may require supplementary ablation interventions. Literature has shown that the closeness of the esophagus to the posterior wall of the left atrium might result in injury to the vagal nerve branches during CA, causing conditions such as \"gastroparesis\" or \"pyloric spasms.\" This report details a case of superior mesenteric artery compression syndrome following AF ablation, which did not improve with conservative management and was ultimately addressed by surgical procedure.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537999","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":"Progressive Anatomical Evolution Leading to Loss of S-ICD Eligibility in Hypertrophic Cardiomyopathy: A Case Report.","authors":"Luca Avolio, Paolo Zappulla, Daniela Dugo, Maria Teresa Cannizzaro, Angelo Di Grazia, Davide Capodanno","doi":"10.1111/pace.15169","DOIUrl":"https://doi.org/10.1111/pace.15169","url":null,"abstract":"<p><p>Subcutaneous implantable cardioverter defibrillators (S-ICDs) are designed to avoid complications from transvenous leads, but patient selection requires careful screening, especially in conditions like hypertrophic cardiomyopathy (HCM) with frequent conduction abnormalities. A 27-year-old male with HCM underwent S-ICD implantation in 2015 after successful screening. In 2020, inappropriate shocks due to T-wave oversensing led to vector adjustments. By 2022, further shocks and failed re-screening revealed ineligibility for S-ICD due to low R/T ratios in multiple vectors. Imaging and ECG comparisons from 2015 to 2022 showed disease progression, with increased fibrosis and conduction abnormalities. As a result, a transvenous ICD was implanted. This case underscores how HCM progression, associated with fibrosis and ECG changes, can render S-ICD unsuitable over time. It highlights the importance of periodic reassessment in high-risk patients, as disease progression can compromise S-ICD eligibility, necessitating alternative solutions for inappropriate shocks.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544423","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":"Advanced Atrioventricular Block in a Young Patient: Pacemaker Implantation Is No Longer the Only Choice.","authors":"Bruna Miers May, Eduardo Bartholomay, Adriano Nunes Kochi, Karina de Andrade, Thaís Coutinho Nicola, Giulia Bonatto Reichert","doi":"10.1111/pace.15153","DOIUrl":"10.1111/pace.15153","url":null,"abstract":"<p><p>A 40-year-old woman with symptomatic advanced atrioventricular (AV) block underwent cardioneuroablation (CNA) for the treatment of functional bradyarrhythmia, following the exclusion of reversible causes and intrinsic disease of the conduction system. Selective ablation of ganglia related to the AV node, performed exclusively in the left atrium, restored AV conduction, which has remained unchanged with 2 years of follow-up. CNA is a viable and effective option with low risk for the treatment of functional bradyarrhythmias, regardless of their severity.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"325-328"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257408","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":"Feasibility and Safety of Pulsed-Field Ablation for Persistent Atrial Fibrillation: A Prospective Study.","authors":"Guocai Chen, Mingyang Gao, Yiwei Lai, Lihong Huang, Shijun Xia, Song Zuo, Xueyuan Guo, Nian Liu, Deyong Long, Jianzeng Dong, Liu He, Xin Du, Songnan Li, Caihua Sang, Changsheng Ma","doi":"10.1111/pace.15162","DOIUrl":"10.1111/pace.15162","url":null,"abstract":"<p><strong>Introduction: </strong>Pulsed-field ablation (PFA) is a novel nonthermal ablation approach using rapid electrical pulses to cause cardiac cell apoptosis via electroporation. Our study aims to investigate the feasibility and safety of PFA for persistent atrial fibrillation (PeAF).</p><p><strong>Methods: </strong>Thirty-two consecutive patients diagnosed with PeAF were enrolled in our study. All patients underwent PFA treatment using the strategy including pulmonary vein isolation (PVI), left atrial posterior wall (LAPW) isolation, cavotricuspid isthmus (CTI) block, and mitral isthmus (MI) block. Acute and follow-up procedure outcomes were evaluated, and adverse events related to the ablation procedure were also observed.</p><p><strong>Results: </strong>One-year survival free from atrial tachyarrhythmia post-ablation was 65.6%. Acute success rates for PVI, LAPW isolation, CTI block, and MI block were 100%, 100%, 96.9%, and 81.3%, respectively. Eleven cases (34.4%) experienced atrial tachyarrhythmia recurrence, with eight cases being atrial fibrillation (AF) recurrence and three cases being atrial flutter recurrence. Three patients underwent repeat ablation. Minor complications were encountered in four patients with asymptomatic cerebral lesions. Vagal responses were commonly observed during the procedure. No severe coronary vasospasm or severe hemolysis occurred in our cohort.</p><p><strong>Conclusion: </strong>PFA with the strategy including PVI, LAPW isolation, CTI block, and MI block is feasible, safe, and associated with a high rate of freedom from atrial tachyarrhythmia recurrence at 1 year in patients with PeAF.</p><p><strong>Trial registration: </strong>This study registered at the Chinese Clinical Trial Registry (ChiCTR2300068980).</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"302-310"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257412","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 Sheath Perfused With High Concentration Heparinized Saline for Reducing Sheath-Associated Thrombus.","authors":"Juan Xu, Shi Peng, Yuanjun Sun, Zhenning Nie, Ya Zhen, Xiaomeng Yin, Xiaofeng Lu, Yan Liu, Xiaoyu Zhang, Dayang Huang, Shuai Guo, Yong Wei, Genqing Zhou, Yunlong Xia, Jun Li, Shaowen Liu, Songwen Chen","doi":"10.1111/pace.15115","DOIUrl":"10.1111/pace.15115","url":null,"abstract":"<p><strong>Background: </strong>Transseptal catheterization is critical for atrial fibrillation (AF) ablation but risks thromboembolism. Transseptal sheaths (TSS) were suggested for continuous heparinized saline solution flush. The safety and effectiveness of a simple TSS management to reduce sheath-associated thrombus development risk was investigated.</p><p><strong>Methods: </strong>AF patients who underwent radiofrequency ablation with the simple TSS management were studied under a retrospective multi-center observation study and a prospective single-center observation study. TSS and dilators were washed and perfused with high concentration heparinized saline (20 u/mL). Immediately after two successful transseptal punctures, activated clotting time ≥300 s was maintained by heparin infusion. TSS aspiration with negative suction and re-perfusion with high concentration heparinized saline (20 u/mL) was performed for the remaining procedure before and after catheter withdrawal.</p><p><strong>Results: </strong>A total of 4765 AF patients underwent 5367 ablation procedures were enrolled in the retrospective study, involving 156 (2.9% per procedure) complications. No acute stroke occurred during all the procedures. Perioperative thromboembolic complications occurred in 10 (0.21%) patients and in 10 (0.19%) procedures. Thromboembolic complications occurred within 24 h, between 24-48 h, and after 48 h post-procedure in six, two, and two patients, respectively. In the prospective observation study, neither sheath- nor catheter-associated thrombus were detected by the intracardiac echocardiography during all 127 procedures, without any perioperative thromboembolic complications. No hemorrhagic cerebrovascular complication was encountered in both observational studies.</p><p><strong>Conclusion: </strong>For AF radiofrequency ablation, it was safe and effective for TSS high concentration heparinized saline infusion only. This approach could avoid sheath-associated thrombus for interventional procedures.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"334-342"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803518","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}