Pace-Pacing and Clinical Electrophysiology最新文献

{"title":"Catheter Ablation of Tachycardia Involving Twin/Single Atrioventricular Node in Patients With Right Isomerism.","authors":"Eiko Terashi, Tsugutoshi Suzuki, Yoko Yoshida, Keisuke Fukudome, Yoshihide Nakamura","doi":"10.1111/pace.15091","DOIUrl":"10.1111/pace.15091","url":null,"abstract":"<p><strong>Aims: </strong>In addition to well-documented tachycardias involving twin atrioventricular (AV) nodes, tachycardias involving a single node have been clinically experienced in right atrial isomerism (RAI). This study aimed to characterize the AV node involvement patterns and evaluate the outcome of ablation therapy in RAI patients with tachycardias.</p><p><strong>Methods: </strong>We retrospectively analyzed the medical records of 16 RAI patients who underwent catheter ablation of tachycardias involving twin or single AV nodes at our center between April 2006 and March 2020.</p><p><strong>Results: </strong>A total of 22 ablation procedures were performed in 16 patients. The median age and body weight were 2 years (range 20 months-31 years) and 11.2 kg (range 7.4-42 kg), respectively. Two QRS complexes were confirmed in 11/16 patients, and a single QRS complex in 5/16. The dominant AV node was anterior in 7/16. Four patterns of tachycardias were identified: tachycardias reciprocating between two AV nodes with retrograde conduction through the anterior AV node (3/16) or through the posterior AV node (4/16); and reentrant tachycardias involving the anterior AV node only (3/16) or posterior AV node only (6/16). Ablation successfully eliminated the tachycardias in 15/16 patients (93.8%). Recurrence was reported in 7/16 (44%) during a median follow-up period of 96.5 months. Five of those 7 patients underwent additional ablation, and the tachycardias were eliminated in 3/5 patients. None of the patients developed ventricular asynchrony after ablation.</p><p><strong>Conclusion: </strong>Transcatheter ablation was effective in RAI patients with tachycardias involving twin or single AV nodes, and deterioration of the cardiac function was rare.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1660-1669"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481114","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":"Submyocardial Pacing Threshold Distribution During Cold Saline Application; Exploring Reversible Arrhythmia Inhibition.","authors":"Osamu Saitoh, Takumi Kasai, Ayaka Oikawa, Yuki Hasegawa, Sou Otsuki, Minoru Tagawa, Hiroshi Furushima, Takayuki Inomata, Masaomi Chinushi","doi":"10.1111/pace.15104","DOIUrl":"10.1111/pace.15104","url":null,"abstract":"<p><strong>Introduction: </strong>Cold saline application through an irrigation catheter may induce reversible inhibition of submyocardial excitation, which may be used to identify in advance an ideal site for radiofrequency (RF) energy delivery around delicate areas.</p><p><strong>Methods: </strong>An open irrigation catheter was positioned vertically or parallel with 10-g contact on coronary perfusing porcine hearts and the contacted myocardium was cooled by cold saline at 4°C (20 mL/min). A temperature electrode was inserted 2 mm below the myocardial surface (intra-myocardial temperature at approximately 2 mm below the surface [Temp-BS]). Pacing threshold inside the ventricular wall was measured using an eight-pole electrode plunge needle inserted 5-8 mm close to the ablation catheter, and percent increase of the pacing threshold by the cold saline application (%increase-PT) was calculated.</p><p><strong>Results: </strong>During cooling, pacing at 10 V from the myocardial surface interrupted constant capture in 7/10 experiments in vertical and in 9/10 experiments in parallel ablation catheter contact. Minimum Temp-BS was not different in both catheter contact positions (25.9 ± 4.0°C in vertical vs. 25.4 ± 2.6°C in parallel). Large % increase-PT on the surface myocardium decreased as the myocardial depth became deeper, and > 150% increase was at a depth approximately 2-3 mm from the surface and > 120% increase around 6-7 mm from the surface. After cessation of cold saline application, the increased %increase-PT recovered to the pre-cooling values.</p><p><strong>Conclusions: </strong>Cold saline application through an irrigation catheter reversibly inhibited submyocardial excitation. This simple method may have the potential to pre-determine the ideal ablation site in sensitive areas of the heart, although further studies and technological adjustments are required before clinical use.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1698-1707"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645221","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":"Recalled But Responsive: Easier Extraction of Recalled Leads.","authors":"Raffael Mishaev, Marissa Frazer, Francis Phan, Ryle Przybylowicz, Frederick Tibayan, Castigliano Bhamidipati, Peter M Jessel, Charles A Henrikson","doi":"10.1111/pace.15100","DOIUrl":"10.1111/pace.15100","url":null,"abstract":"","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1708-1710"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570331","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":"How to Demonstrate Clinical Implication of Non-Elective Ventricular Tachycardia Catheter Ablation in the Presence of Intra-cardiac Thrombus.","authors":"Naoya Kataoka, Teruhiko Imamura","doi":"10.1111/pace.15109","DOIUrl":"10.1111/pace.15109","url":null,"abstract":"","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1711-1712"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645220","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":"Caught in the Act: A Detailed Analysis of Cardiac Event Monitoring in a Cohort of Pediatric and ACHD Patients.","authors":"Ashwin Srivatsav, Zachery J Thompson, Michael A Bruno, Sara B Stephens, Maria Elena Gutierrez, Christina Y Miyake, Shaine A Morris, Tam Dan Pham, Santiago O Valdes, Jeffrey J Kim, Taylor S Howard","doi":"10.1111/pace.15087","DOIUrl":"10.1111/pace.15087","url":null,"abstract":"<p><strong>Background: </strong>Event monitors are being increasingly used in pediatric and adult congenital heart disease (ACHD) patients for arrhythmia evaluation. Data on their diagnostic yield are limited.</p><p><strong>Objectives: </strong>To evaluate the diagnostic yield of event monitors, patient characteristics associated with critical events, and clinical response to events.</p><p><strong>Methods: </strong>We retrospectively assessed event monitors prescribed to patients at our institution's Heart Center from 2017 to 2020. Thirty-day event monitor tracings were reviewed by an electrophysiologist (EP) to identify critical events defined as supraventricular tachycardia (SVT, re-entrant, atrial tachycardia, atrial flutter, and atrial fibrillation), ventricular tachycardia (VT), atrioventricular block, and pauses greater than 3 s. Patient characteristics and treatment data were collected. Characteristics associated with events were assessed using multivariable logistic regression. Trends in monitor prescription over time, diagnostic yield, and clinical response to events were analyzed.</p><p><strong>Results: </strong>204/2330 (8.8%) event monitors had EP-confirmed critical events. Critical events included SVT (51.5%), VT (38.5%), atrioventricular block (4%), and pauses (6%). 129/198 (65%) patients with critical events underwent treatment. Event monitoring usage increased by 52% between 2017 and 2020 (p < 0.0001). Complex CHD (OR 2.1, 95% CI 1.3-3.4, p = 0.004), cardiomyopathy (OR 2.9, 95% CI 1.5-4.8, p < 0.001), and EP-ordered monitors (OR 1.6, 95% CI 1.2-2.1, p = 0.001) were more highly associated with critical events.</p><p><strong>Conclusion: </strong>Event monitor use is common, and critical events were captured in 8.8% of patients. The majority of patients with critical events underwent treatment. Factors associated with critical events include EPs as ordering providers, complex CHD, and cardiomyopathy.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1593-1603"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481115","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":"Prognostic Value of Burst Pacing Inducibility Post-Radiofrequency Versus Cryoablation for Paroxysmal Atrial Fibrillation.","authors":"Satoru Sekimoto, Kenta Hachiya, Taku Ichihashi, Takayuki Yoshida, Yasuaki Wada, Yoshimasa Murakami, Yoshihiro Seo","doi":"10.1111/pace.15092","DOIUrl":"10.1111/pace.15092","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) inducibility with burst pacing (BP) after radiofrequency ablation (RFA) has been reported to be associated with AF recurrence. In contrast, the relevance of inducibility and recurrence after cryoablation (CRA) is unclear.</p><p><strong>Methods: </strong>We investigated 367 patients undergoing initial ablation for paroxysmal AF (RFA: 174, CRA: 193). Propensity score matching was conducted, retaining 134 patients in each group. Following pulmonary vein isolation (PVI), the inducibility by BP was tested. Inductions at 250 ppm were defined as low-frequency burst pacing (LFBP) positive, and those at 300 ppm were classified as medium-frequency burst pacing (MFBP) positive. They were followed for 600 days.</p><p><strong>Results: </strong>Forty-eight patients (18%) had AF recurrence. There was no significant difference in the recurrence rate between RFA and CRA (17% vs. 19%, Log-rank p = 0.79). In RFA, significant differences were observed for both LFBP (Log-rank p < 0.001) and MFBP (Log-rank p < 0.001). In contrast, in CRA, there were no significant differences for either LFBP (Log-rank p = 0.39) or MFBP (Log-rank p = 0.19). Multivariable analysis revealed that LFBP-positive (hazards ratio [HR] = 5.75, 95% confidence interval [CI] 2.41-13.7, p < 0.001) was an independent predictor for recurrence with RFA. Acute reconnection (HR = 2.73, 95% CI 1.13-6.56, p = 0.025) was an independent predictor for recurrence with CRA.</p><p><strong>Conclusion: </strong>The inducibility by BP after RFA predicted recurrence at both low and medium frequencies. LFBP-positive was an independent predictor of recurrence in multivariable analysis. In contrast, the inducibility by BP after CRA was not a predictor of recurrence.</p><p><strong>Trail registration: </strong>This study did not require clinical trial registration.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1650-1659"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481117","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":"Spontaneous Conversion of a Long RP to Short RP Tachycardia: What Is the Mechanism?","authors":"Suresh Allamsetty, Chin-Yu Lin, Yenn-Jiang Lin, Shih-Ann Chen","doi":"10.1111/pace.15094","DOIUrl":"10.1111/pace.15094","url":null,"abstract":"","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1611-1613"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11630807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513120","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":"The Role of Atrial Premature Complexes in Exercise Test in Predicting Atrial Fibrillation in Patients Without Obstructive Coronary Artery Disease.","authors":"Ozan Tezen, Levent Pay, Ahmet Çağdaş Yumurtaş, Tuğba Çetin, Semih Eren, Melih Öz, Cahit Coşkun, Cemre Karabacak, Birkan Yenitürk, Tufan Çınar, Mert İlker Hayıroğlu","doi":"10.1111/pace.15090","DOIUrl":"10.1111/pace.15090","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is usually triggered by frequent atrial premature complexes (APC) and atrial tachycardias originated in the pulmonary veins. The aim of the current study is to clarify the relationship between AF and APCs observed during treadmill exercise testing through long-term patient follow-up.</p><p><strong>Material and methods: </strong>Our study only examined the data of patients who did not have any obstructive coronary artery disease and had an exercise test. In total, 1559 patients were included in this research. The study data were divided into two groups according to the development of AF during follow-up. The patients who developed any type of AF during the follow-up period were classified as AF (+). Mean follow-up time for AF (+) and (-) groups were 48 and 47 months, respectively.</p><p><strong>Results: </strong>In the univariable analysis, age, LAAP, and the presence of APCs (HR: 3.906, 95% CI: 2.848-5.365, p < 0.001) during the treadmill exercise test were significantly associated with the development of AF. In the multivariable analysis, age (adjusted HR: 1.063, 95% CI: 1.043-1.083, p < 0.001) and the presence of APCs during the treadmill exercise test (adjusted HR: 2.504, 95% CI: 1.759-3.565, p < 0.001) emerged as independent risk factors for the development of AF. The AF-free survival was significantly lower in the APCs (+) patients compared with the APCs (-) patients (log rank p < 0.001).</p><p><strong>Conclusion: </strong>Our study revealed that individuals without obstructive CAD who exhibited frequent APCs during treadmill exercise tests were more likely to develop AF.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1586-1592"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481119","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":"Relationship Between Electrical Parameters and Cardiac Synchrony in Patients Underwent Left Bundle Branch Area Pacing.","authors":"Manxin Lin, Shufen Huang, Xinyi Huang, Jincun Guo, Linlin Li, Simei Chen, Guiyang Li, Qiang Li, Dong Chang, Maolong Su, Binni Cai","doi":"10.1111/pace.15095","DOIUrl":"10.1111/pace.15095","url":null,"abstract":"<p><strong>Purpose: </strong>The study aims to assess cardiac synchrony under different left bundle branch area pacing (LBBAP) and evaluate the relationship between different surface or intracardiac electrical parameters and mechanical synchrony.</p><p><strong>Methods: </strong>Eighty-two patients with successful LBBAP were recruited. The electrical synchrony, evaluated by paced QRS duration (pQRSD) and Stim-LVAT (stimulus to left ventricular activation time), and mechanical synchrony, evaluated by the standard deviation of the time-to-peak contraction velocity in 12 left ventricular segments (Tsd-12-LV), were compared between groups in patients underwent LBBAP. To investigate the relationship between different electrical parameters with mechanical synchrony under LBBAP, patients were divided into subgroups according to left ventricular activation time (LVAT, < 60, 60-70, and > 70 ms), presence of left bundle branch (LBB) potential (positive, negative), QRS axis (normal, left axis deviation [LAD]), and potential to ventricular interval (PVI, < 20 and > 20 ms). Mechanical synchrony was compared among the subgroups respectively 3 days post LBBAP procedure.</p><p><strong>Results: </strong>No statistically significant differences were documented in electrical synchrony, evaluated by pQRSD, and mechanical synchrony, evaluated by Tsd-12-LV among the subgroups divided by the stim-LVAT, LBB potential, PVI duration, or paced QRS axis in the LBBAP group.</p><p><strong>Conclusions: </strong>LBB potential, PVI, or normal paced QRS axis is not the prerequisite for successful LBBAP and optimal cardiac synchrony. Adopting a Stim-LVAT value of less than 75 ms to attain ideal electrical and mechanical synchrony during the LBBAP procedure may be applicable.</p><p><strong>Trial registration: </strong>http://www.chictr.org.cn/index.aspx.</p><p><strong>Clinicaltrials: </strong>gov identifier: ChiCTR1800021104.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1679-1687"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11630808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513119","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":"Effectiveness of a Triple Antiarrhythmic Drug Strategy for Arrhythmia Recurrence after Persistent Atrial Fibrillation Ablation.","authors":"Shuyu Jin, Haowei Chen, Xianhong Fang, Hongtao Liao, Xianzhang Zhan, Lu Fu, Junrong Jiang, Xingdong Ye, Huiyi Liu, Yanlin Chen, Sijia Pu, Shulin Wu, Hai Deng, Weidong Lin, Yumei Xue","doi":"10.1111/pace.15083","DOIUrl":"10.1111/pace.15083","url":null,"abstract":"<p><strong>Background and objective: </strong>Treating recurrent atrial arrhythmias after persistent atrial fibrillation (PeAF) ablation is often challenging. This single-center, prospective study aimed to observe the effectiveness of different combinations of oral antiarrhythmic drugs (AADs) in reverting to sinus rhythm (SR) in patients with recurrent atrial arrhythmias after PeAF ablation.</p><p><strong>Methods: </strong>Forty-five patients who experienced recurrent atrial arrhythmias after PeAF ablation were included. Based on their medication regimens, patients were divided into two groups, with the study group being a triple-drug group (digoxin combined with amiodarone/ propafenone and β-blocker), and the control group being a non-triple-drug group.</p><p><strong>Results: </strong>The rate of reversion to SR was significantly higher in the study group (n = 29) than in the control group (n = 16) at 3 weeks (34.48% vs. 0%, p < 0.01) and 1 month (44.84% vs. 6.25%, p = 0.02) after initiating AADs. No patients with asymptomatic bradycardia were observed in either group.</p><p><strong>Conclusions: </strong>For patients with recurrent atrial arrhythmias after PeAF ablation, a regimen of low-dose digoxin combined with amiodarone/propafenone and β-blocker may effectively improve short-term reversion rates.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1642-1649"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395326","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}