Pace-Pacing and Clinical Electrophysiology最新文献

{"title":"Does a Smartphone-Based ECG Recording System in Pediatric Patients With Palpitations Improve Diagnostic Yield?","authors":"Hilal Al Riyami, Sultan Zamzami, Lisa K Hornberger, Yashu Coe, Shubhayan Sanatani, Francesca de la Cruz, Joseph Atallah, Carolina A Escudero","doi":"10.1111/pace.15190","DOIUrl":"10.1111/pace.15190","url":null,"abstract":"<p><strong>Introduction: </strong>Palpitations in children are common and obtaining symptom-rhythm correlation is diagnostic, but challenging to obtain. The AliveCor KardiaMobile monitor is a smartphone-based single-lead ECG event recorder with limited study in children. We compared using this smartphone recorder to a conventional (Cardiocall) event recorder.</p><p><strong>Methods: </strong>We performed a prospective, randomized study of children presenting to pediatric cardiology for investigation of palpitations who require an event recorder for symptom-rhythm correlation. Patients were randomized to the smartphone or conventional recorder for rhythm documentation for 3 months or 4 weeks, respectively. Diagnostic tracings were defined as one pathologic arrhythmia or three sinus rhythm tracings. We assessed tracing quality, diagnoses obtained, and time to diagnosis between groups. Patients were surveyed to assess perceptions of using the devices.</p><p><strong>Results: </strong>One hundred participants were enrolled and randomized to 50 in each group. Diagnostic tracings were achieved in 51% versus 44% (p = 0.525) in the smartphone versus conventional group at means of 23.7 (SD 36.4) versus 11.5 (SD 15.2) days, p = 0.181. Participants who used the smartphone monitor were more likely to transmit recordings (70% vs. 49%, p = 0.037) and more often willing to use the device again (87% vs. 42%, p = 0.015), with no differences between groups in finding episodes easy to record (74% vs. 100%, p = 0.15), easy to transmit (70% vs. 46%, p = 0.26), or overall satisfaction (83% vs. 58%, p = 0.13).</p><p><strong>Conclusion: </strong>Smartphone monitor devices provided similar diagnostic yield to conventional monitors in children. Families who used the smartphone monitor were more willing to use the device again.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"615-622"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12166532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006163","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":"Left Atrial Size and Left Atrial Volume Index as Predictors of Atrial High-Rate Episodes.","authors":"Phuuwadith Wattanachayakul, Thitiphan Srikulmontri, Narathorn Kulthamrongsri, Kevin Bryan Lo, Jakrin Kewcharoen, Sumeet Mainigi","doi":"10.1111/pace.15197","DOIUrl":"10.1111/pace.15197","url":null,"abstract":"<p><strong>Background: </strong>Recent studies have shown that atrial high-rate episodes (AHREs) are associated with adverse cardiovascular outcomes, including an increased risk of stroke, cardiovascular mortality, and future atrial fibrillation. Despite efforts to identify predictors for AHRE, the relationship between left atrial morphology and AHRE remains unclear.</p><p><strong>Methods: </strong>We systematically reviewed MEDLINE and EMBASE from inception to May 2024 to assess the association between left atrial morphology, measured as left atrial diameter (mm) and left atrial volume index (LAVI, mL/m²) via transthoracic echocardiography, and the occurrence of AHRE in patients without a prior history of atrial fibrillation at device implantation. Means and standard deviations of LAD and LAVI were extracted to calculate pooled mean differences using the generic inverse variance method.</p><p><strong>Results: </strong>A total of 18 cohort studies were included in the meta-analysis. The results showed that patients with AHRE had significantly higher left atrial diameter and LAVI compared to those without AHRE. The pooled mean difference for left atrial diameter was 2.19 mm (95% CI: 1.11-3.28; I² = 80%, p < 0.001), while for LAVI, it was 4.88 mL/m² (95% CI: 2.55-7.21; I² = 55%, p < 0.001).</p><p><strong>Conclusions: </strong>Our study demonstrated that patients with AHRE had greater left atrial diameter and LAVI than those without AHRE. Further research is needed to clarify the underlying mechanism.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"569-577"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065289","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":"Impact of High-Density Mapping on Pulmonary Vein Isolation Durability: A Randomized, Single-Center Study.","authors":"Nina Kajdič, Tine Prolič Kalinšek, Bor Antolič, David Žižek, Jernej Štublar, Jure Demšar, Dimitrij Kuhelj, Matevž Jan","doi":"10.1111/pace.15196","DOIUrl":"10.1111/pace.15196","url":null,"abstract":"<p><strong>Background: </strong>Despite technical progress and novel ablation strategies, pulmonary vein (PV) reconnection still occurs in a substantial proportion of patients. The aim of the study was to determine the impact of the elimination of antral low-voltage, fragmented electrograms (LFEGMs) identified by high-density (HD) mapping on the rate of pulmonary vein isolation (PVI) durability.</p><p><strong>Methods: </strong>Sixty patients with paroxysmal atrial fibrillation (PAF) were randomly assigned to a verification of PV entrance block and presence of LFEGMs on antral isolation lines with an HD mapping catheter (HD group) or to a verification of PV entrance block with a circumferential mapping catheter alone (CM group). In the HD group, LFEGMs were additionally ablated. Mandatory reassessment procedure to assess PVI durability and the presence of LFEGMs was performed 12 months after the index procedure or earlier in case of arrhythmia recurrence.</p><p><strong>Results: </strong>A total of 107 out of 116 (92.2%) PVs were found durably isolated in the HD group, and 97 out of 120 (80.8%) PVs in the CM group (p = 0.02). At the reassessment procedure, a total of 7 [3, 12] and 34 [24, 44] LFEGMs were found in the HD and CM groups, respectively (p = 0.00002). Elimination of LFEGMs at the index procedure reduced the likelihood of antral conduction gaps in the same segments at the reassessment. Arrhythmia recurrence rate was similar between the HD and the CM group (7/29, 24.1% vs. 10/30, 33.3%), p = 0.62, respectively.</p><p><strong>Conclusion: </strong>Additional elimination of LFEGMs identified by HD mapping of antral isolation lines after PVI resulted in a significantly higher rate of PVI durability.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: (NCT04466358).</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"587-597"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058396","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":"Paced QRS Duration and Morphology by Right Ventricular Inflow Tract Mid-Septal Lead Placement Using a 3D Stylet.","authors":"Tomomasa Takamiya, Akihiro Sato, Kensuke Fujiwara, Takashi Miyamoto, Makoto Mutoh, Shinsuke Miyazaki, Tetsuo Sasano","doi":"10.1111/pace.15201","DOIUrl":"10.1111/pace.15201","url":null,"abstract":"<p><p>Paced QRS duration ≥150 ms is associated with pacing-induced cardiomyopathy (PICM). However, there is no established method for conventional stylet-driven pacing lead placement to achieve a narrow QRS duration. We placed a pacing lead on the right ventricular inflow tract (RVIT) mid-septum using a manually shaped three-dimensional (3D) stylet and three-directional fluoroscopic guidance in 9 consecutive patients with complete or advanced atrioventricular block and normal left ventricular systolic function. The median paced QRS duration was 140 (range, 122-153) ms, with a paced QRS duration <150 ms in 8 patients. The left superior axis and transitional zone of lead-V5 or lead-V6 were the most paced QRS morphologies. RVIT mid-septal lead placement using a 3D stylet with three-directional fluoroscopic guidance may reduce the incidence of PICM.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"644-648"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034698","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":"Arrhythmic Syncope After Aortic Valve Replacement.","authors":"Roberto Alvarez Coello, Muhieddine Omar Chokr, Rodrigo Melo Kulchetscki, Hugo Cardoso de Souza Falcon, Victor Hugo Dos Santos Sousa, Mauricio I Scanavacca","doi":"10.1111/pace.15192","DOIUrl":"10.1111/pace.15192","url":null,"abstract":"<p><p>We present the case of a young man who suffered from severe aortic valve insufficiency and subsequently underwent mechanical aortic prosthesis replacement. One month post-surgery, he presented with syncope and incessant ventricular tachycardia (VT), progressing to cardiogenic shock, which required emergency intra-aortic balloon pump (IABP) support. The VT proved refractory to standard clinical management and demonstrated responsiveness only after IABP support. An electrophysiological study was conducted; however, VT could not be induced during the procedure. Through electrophysiological maneuvers, we suspected bundle branch reentrant ventricular tachycardia (BBR-VT), and successful treatment was achieved via right bundle branch (RBB) ablation.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"598-602"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040985","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":"Indication of Implantable Cardioverter Defibrillators for Ventricular Arrhythmias in Coronary Spastic Angina.","authors":"Kenichi Tani, Mitsuru Takami, Kimitake Imamura, Hideya Suehiro, Atsusuke Yatomi, Hidehiro Iwai, Yusuke Nakanishi, Mitsuhiko Shoda, Atsushi Murakami, Shogo Yonehara, Hiroyuki Asada, Takahiro Kunigita, Mari Yamamoto, Tomofumi Doi, Ken-Ichi Hirata, Hiromasa Otake, Koji Fukuzawa","doi":"10.1111/pace.15194","DOIUrl":"10.1111/pace.15194","url":null,"abstract":"<p><strong>Background: </strong>Coronary spastic angina (CSA) sometimes complicates ventricular arrhythmias (VAs) leading to sudden death. The appropriate secondary prevention strategy remains to be discussed. Recently, the relationship between J waves and VAs in CSA has been reported.</p><p><strong>Objectives: </strong>We aimed to investigate the incidence of VAs, J waves, the spatial relationship between J waves and culprit coronary spasm lesions, and VA recurrences in CSA.</p><p><strong>Methods: </strong>The patient characteristics, including the presence of J waves, were assessed in 130 CSA patients, and the spatial relationship between J waves and ischemic lesions was analyzed; a concordant pattern was defined when the localization of electrical and coronary blood supply abnormalities matched.</p><p><strong>Results: </strong>Thirty one patients (24%) had VAs (VA group) and 99 (76%) did not (non-VA group). More J waves were observed in the VA group than the non-VA group (19 of 31 patients [61%] vs. 16 of 99 patients [16%], p = 0.00003). A concordant pattern between the J waves and culprit coronary spasm lesions was significantly observed greater in the VA group than the non-VA group (14 of 19 patients [74%] vs. 5 of 16 patients [31%], p = 0.019). VAs reoccurred in 6 of 31 patients (19%) despite adequate medication during a mean of 4.6 years of follow-up and were not predictable.</p><p><strong>Conclusions: </strong>VAs occurred in one-quarter of the CSA patients and were closely related to J waves. The spatial concordance between coronary ischemia and electrical abnormalities might be a risk of a VA occurrence. VA recurrences are highly observed and unpredictable, justifying the indication of an implantable cardioverter defibrillator as secondary prevention.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"623-629"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049879","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":"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":"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":"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}