Pace-Pacing and Clinical Electrophysiology最新文献

{"title":"The Automated Subcutaneous Implantable Cardioverter-Defibrillator Screening in Patients With Leadless Pacemakers.","authors":"Maciej Dyrbuś, Joanna Machowicz, Anna Kurek, Mariusz Gąsior, Mateusz Tajstra","doi":"10.1111/pace.15165","DOIUrl":"https://doi.org/10.1111/pace.15165","url":null,"abstract":"<p><strong>Background: </strong>The number of leadless pacemakers (LPMs) implantations has seen a major growth in recent years. Indications for LPMs often overlap with indications for subcutaneous implantable cardioverter-defibrillators (sICDs), as they are mostly recommended in patients in whom transvenous devices are deemed ineligible or contraindicated. Before sICD implantation, the patient should pass screening to verify the stability of QRS morphology in intrinsic and paced rhythms. The aim of this study was to evaluate the percentage of positive sICD screening in patients with a previously implanted LPM and evaluate the concordance between the vectors during the intrinsic and paced rhythm.</p><p><strong>Methods: </strong>Twenty-two patients who underwent implantation of the ventricular LPM from May to October 2024 were included in the present study. After the implantation, automated sICD screening was performed using the dedicated system, across 2-4 body positions, both during intrinsic and paced rhythms, in nominal, and emergency output.</p><p><strong>Results: </strong>All patients had the devices implanted in the interventricular septal location. Screening for QRS indicated that 94.1% of patients fulfilled the criterion for implantation of sICD in at least one vector during intrinsic rhythm, while only 23.8% and 28.5% passed screening during nominal and emergency pacing outputs, respectively. Positive screening concordance in at least one vector was observed in 23.5% of patients.</p><p><strong>Conclusions: </strong>Despite almost all patients having undergone successful screening during intrinsic rhythm, the low rates of positive QRS assessment were observed during pacing, what might raise potential concerns for an optimal coexistence of LPM and sICD in daily clinical practice.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473239","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":"Exertional Intolerance After a Leadless Pacemaker Implant: What Is the Mechanism?","authors":"James E Ip","doi":"10.1111/pace.15160","DOIUrl":"https://doi.org/10.1111/pace.15160","url":null,"abstract":"","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384010","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":"Late Sustained Ventricular Arrhythmias After Left Ventricular Assist Device Implantation: Outcomes and Predictors.","authors":"Suganya Karikalan, Justin Z Lee, Min-Choon Tan, Nan Zhang, Ammar M Killu, Abhishek J Deshmukh, Christopher J McLeod, Dan Sorajja, Hicham El-Masry, Siva K Mulpuru, Yong-Mei Cha, Luis Scott","doi":"10.1111/pace.15158","DOIUrl":"https://doi.org/10.1111/pace.15158","url":null,"abstract":"<p><strong>Background: </strong>The factors contributing to sustained ventricular arrhythmias (VAs) >30 days after left ventricular assist device (LVAD) implantation are not well-established.</p><p><strong>Objectives: </strong>This study aimed to predict the factors associated with late sustained VAs after LVAD implantation and develop a predictive score to identify patients with an increased risk of late sustained VAs after the procedure.</p><p><strong>Methods: </strong>We performed a retrospective cohort study on a training cohort of 623 patients and a validation cohort of 157 patients who underwent LVAD implantation at the Mayo Clinic (Rochester, Phoenix, and Jacksonville) from January 1, 2000, to December 30, 2020. Late sustained VAs were defined as ventricular tachycardia (VT) and ventricular fibrillation (VF) occurring >30 days after the LVAD procedure. Detailed chart reviews of the electronic health records within the Mayo Clinic and outside medical records were performed.</p><p><strong>Results: </strong>A total of 780 patients were included in our study. Late sustained VAs occurred in 30% (n = 232) of the patients. The significant factors associated with late sustained VAs after LVAD were the history of VAs prior to LVAD (34.1% vs. 23.0%, p < 0.01), implantable cardiac defibrillator (ICD) (87.9% vs. 77.6%, p < 0.01) or cardiac resynchronization therapy (CRT) in situ (43.5% vs. 33.6%, p = 0.008), VT ablation prior to LVAD (5.2% vs. 1.8%, p = 0.010), use of amiodarone (49.1% vs. 38.7%, p = 0.007), use of mexiletine (15.5% vs. 5.7%, p < 0.01), and higher left ventricular end-diastolic diameter (LVEDD) on echocardiography prior to LVAD implantation (71.4 vs. 68.7 mm, p = 0.002). During follow-up, the patients who developed late sustained VAs after LVAD had lower survival than those who did not (HR = 1.96, 95% CI:156-2.4, p < 0.001). The average time from LVAD to orthotopic heart transplant was longer among late sustained VAs patients (23 vs. 14 months, p < 0.01). The \"VIN\" risk score was created to identify four risk groups: low (scores 0), intermediate (score 1), high (score 2), and very high (score 3). The rates of late VA's in the training cohort at 1 year were 9.5%, 14%, 18%, and 25% which was almost similar to the risk of late VA's at validation cohort 10%, 12%, 20%, and 63%, respectively.</p><p><strong>Conclusions: </strong>Late sustained VAs occurred in 30% of the patients who received LVAD and were associated with lower survival. The VIN risk score was developed and validated to stratify patients into low, intermediate, high, and very high risk of late sustained VAs.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384014","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":"Role of Routine Electrophysiological Study Performed During Transcatheter Aortic Valve Replacement to Predict AV Block.","authors":"Mattia Pagnoni, David Meier, Adrian Luca, Stephane Fournier, Farhang Aminfar, Christelle Haddad, Niccolo Maurizi, Giulia Domenichini, Mathieu Le Bloa, Claudia Herrera Siklody, Cheryl Teres, Stephane Cook, Jean-Jacques Goy, Mario Togni, Christan Roguelov, Grégoire Girod, Vladimir Rubimbura, Marion Dupré, Eric Eeckhout, Etienne Pruvot, Olivier Muller, Patrizio Pascale","doi":"10.1111/pace.15159","DOIUrl":"https://doi.org/10.1111/pace.15159","url":null,"abstract":"<p><strong>Background: </strong>Periprocedural electrophysiological (EP) testing may be useful to predict high degree atrioventricular block (HAVB) risk in patients undergoing transcatheter aortic valve replacement (TAVR).</p><p><strong>Objective: </strong>To determine whether pre- and immediate post-TAVR ECG and HV interval findings are predictive of HAVB.</p><p><strong>Methods: </strong>Consecutive TAVR patients without prior pacemaker (PM) implantation underwent ECG and standardized HV interval measurements pre- and post-TAVR using the quadripolar catheter for rapid pacing. The primary outcome was HAVB >24 h after TAVR or ventricular pacing need RESULTS: Out of 97 included patients, 8 experienced the primary outcome (7 with HAVB and 1 with PM need). On univariate analysis, pre- and post-TAVR PR, post-TAVR HV, and Delta-HV intervals were predictors of the primary outcome. A Delta-HV interval ≥18 ms predicted HAVB with sensitivity = 50% and specificity = 90% (AUC = 0.708, PPV = 31%), while an HV interval ≥60 ms after TAVR had sensitivity = 63% and specificity = 79% (AUC = 0.681, PPV = 21%). None of the patients with a PR interval ≤180 ms post-TAVR experienced the primary outcome. Among patients with new-onset LBBB, an HV interval post-TAVR >65 ms was the only predictor of HAVB (AUC = 0.776, PPV = 33%, and NPV = 97%).</p><p><strong>Conclusion: </strong>The yield of periprocedural EP assessment during TAVR is limited considering that about half of the at-risk patients fail to be identified. However, early periprocedural risk stratification may be more useful in the subset of patients with new-onset LBBB. Among ECG findings, a post-TAVR PR interval ≤180 ms identifies a subgroup at very low risk, independently of QRS interval and morphology.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257435","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":"Multicentric Experience With the Use of Short 13Fr Mechanical Rotating Dilator Sheath for Transvenous Lead Extraction.","authors":"Alberto Preda, Francesco Melillo, Matteo Baroni, Alessandra Marzi, Vincenzo Schillaci, Sara Vargiu, Andrea Caccia, Fabrizio Guarracini, Lorenzo Gigli, Gabriele Paglino, Giulia Massaro, Igor Diemberger, Giosuè Mascioli, Francesco Solimene, Patrizio Mazzone","doi":"10.1111/pace.15146","DOIUrl":"https://doi.org/10.1111/pace.15146","url":null,"abstract":"<p><strong>Background: </strong>The need for transvenous lead extraction (TLE) is increasing worldwide. Since the course of the subclavian vein until the junction with the superior vena cava is a frequent place of lead adherences, we aim to assess the safety and efficacy of a short 13Fr bidirectional rotational mechanical sheath as first choice.</p><p><strong>Methods and results: </strong>In this multicentric study, 202 carriers of a cardiac implantable electronic device (CIED) undergoing TLE using a short 13 Fr bidirectional rotational mechanical sheath were prospectively enrolled. All procedures were performed using a stepwise approach. The indication for TLE were infection (62%), malfunction (32%), and upgrade (6%). Overall, 471 leads were extracted: 65% pacing leads, 20% defibrillator leads, 9% coronary sinus leads, and 6% abandoned leads. Clinical success and complete lead extraction have been achieved in 97% and 95% of cases, respectively. The short sheath was always effective in gaining venous access at the start of the procedure and was sufficient for complete TLE in 67% of cases. Lead dwell time, defibrillator lead, number of leads per patient, and lead malfunction were predicting factors of long bidirectional rotational mechanical sheath use. There were no cases of intraprocedural death, and major complications were reported in 2% of patients. Overall survival was 97% at 1-year follow-up.</p><p><strong>Conclusion: </strong>This multicentric experience using a short 13Fr bidirectional rotational mechanical sheath reported high safety and efficacy, demonstrating the utility of routine use of short extraction sheaths of higher caliper as the first choice.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257416","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":"Fundamentals of System Design for Cardiac Pulsed Field Ablation: Optimization of Safety, Efficacy, and Usability.","authors":"Brendan Koop","doi":"10.1111/pace.15120","DOIUrl":"https://doi.org/10.1111/pace.15120","url":null,"abstract":"<p><p>The goal of a cardiac pulsed field ablation (PFA) system is to provide safe, effective, and usable therapy for the treatment of cardiac arrhythmias. Achieving this goal is a complex exercise in system design, requiring optimization of catheter, waveform, and dosing. This optimization is often iterative, as myriad design factors are balanced to achieve the goal while making use of computational modeling, bench testing, preclinical animal studies, and human clinical studies to evaluate system performance. It is important for both engineers and clinicians to understand the fundamentals of cardiac PFA system design in order to partner to continuously improve performance of this expanding ablation modality.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257414","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":"Factors Associated With LVEF Improvement Following Arrhythmia Management in Patients With Tachycardiomyopathy.","authors":"Naoya Kataoka, Teruhiko Imamura","doi":"10.1111/pace.15157","DOIUrl":"https://doi.org/10.1111/pace.15157","url":null,"abstract":"","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257410","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":"Progressed Atrioventricular Block in Immune Checkpoint Inhibitor Induced Myocarditis: A Case Report.","authors":"Dongmei Xie, Ting Yan, Xin Zhang, Xingbin Liu","doi":"10.1111/pace.15155","DOIUrl":"https://doi.org/10.1111/pace.15155","url":null,"abstract":"<p><p>Immune checkpoint inhibitor (ICI) has demonstrated promising results in treating various cancers, but its associated cardiotoxicity, especially ICI-associated myocarditis, presents a serious concern. We reported a case of a 63-year-old male who complained of progressive dyspnea after tislelizumab, a novel humanized anti-PD-1 monoclonal antibody, for hepatocellular carcinoma. Upon diagnosing ICI-related myocarditis, corticosteroid therapy was initiated immediately. The elevated biomarkers quickly decreased, but the atrioventricular block progressed from first-degree to third-degree, necessitating pacemaker implantation. This is the first report of complete AVB consecutive to tislelizumab-induced myocarditis, highlighting the importance of early corticosteroid therapy and continuous electrocardiography monitoring.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257424","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":"Temporary Transvenous Pacing Performed in the Intensive Care Unit or in the Catheterization Laboratory.","authors":"Julie Bastide, Francis Bessière, Antoine Delinière, Thomas Bochaton, Kévin Gardey, Arnaud Dulac, Christelle Haddad, Cyril Prieur, Danka Tomasevic, Gilles Rioufol, Eric Bonnefoy-Cudraz, Geoffroy Ditac","doi":"10.1111/pace.15140","DOIUrl":"10.1111/pace.15140","url":null,"abstract":"<p><strong>Background: </strong>Temporary transvenous pacing (TTP) is a common procedure, predominantly performed in the catheterization laboratory (cath lab) because of presumed lower complication rate. This study aims to evaluate the efficacy and safety of TTP placement in the ICU compared to TTP placement in the cath lab.</p><p><strong>Methods: </strong>This retrospective, real-life study included all patients requiring TTP in a tertiary care ICU between 2019 and 2022. Patients' characteristics, TTP-related data, outcomes, and complications were compared between groups (ICU vs. cath lab).</p><p><strong>Results: </strong>Data from 193 patients receiving TTP were analyzed; 68.4% received TTP in the ICU and 31.6% in the cath lab. The main indication was atrioventricular block in 154 patients (79.8%). The operator was less frequently an interventional cardiologist in the ICU (12.1%) compared to the cath lab (100%, p < 0.001). TTP in the ICU was more frequently performed using a jugular access (72.0% vs. 1.6%), a right-sided laterality (88.7% vs. 43.6%), and a balloon-tipped catheter (100% vs. 0%, p < 0.001 for all comparisons). Success was 100% in both groups. The overall complication rate was 16.6%, with no significant difference between both groups (14.4% ICU vs. 21.3% cath lab, p = 0.13), but a tendency toward higher complications in the cath lab group (especially tamponade, lead displacement, and CIED infection).</p><p><strong>Conclusion: </strong>In a daily clinical scenario, TTP placement appears as safe in the ICU than in the cath lab, regardless of the operator's level of expertise when performed in accordance with best practices. Nevertheless, TTP complications remain high, and alternatives should be used whenever possible.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"262-269"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959086","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":"Nonocclusive Ablation Technique Using a Novel Cryoballoon for Failed Left Superior Pulmonary Vein Isolation Despite Complete Occlusion.","authors":"Kazuya Murata, Yasuteru Yamauchi, Yumi Yasui, Atsuhito Oda, Hirofumi Arai, Yuichiro Sagawa, Hideki Arima, Manabu Kurabayashi, Shinsuke Miyazaki, Tetsuo Sasano","doi":"10.1111/pace.15136","DOIUrl":"10.1111/pace.15136","url":null,"abstract":"<p><strong>Background: </strong>An indicator of successful cryoballoon (CB)-assisted pulmonary vein (PV) isolation is complete PV occlusion. However, CBs may exhibit a weaker freezing effect on the equatorial plane. This study investigates the predictors of failed left superior PV (LSPV) isolation despite complete occlusion with novel CBs.</p><p><strong>Methods: </strong>This retrospective analysis enrolled 300 consecutive patients who underwent first-time ablation with POLARx or POLARxFIT between November 2021 and October 2023. Of the total, complete occlusion of the LSPV was achieved in 200 patients. Patients in whom LSPV isolation was achieved with additional nonocclusive freezing of the LSPV roof due to nonisolation of LSPV despite complete occlusion (Group A) were compared with those in whom isolation was achieved with complete PV occlusion alone (Group B).</p><p><strong>Results: </strong>Group A had a larger LSPV diameter (21.5 ± 4.6 mm vs. 18.8 ± 3.3 mm, p = 0.052), larger left atrial volume on CT (142.3 ± 47.8 cc vs. 117.8 ± 39.0 cc, p = 0.028), higher nadir temperature (-54.1 ± 5.1°C vs. -60.2 ± 4.4°C, p < 0.001), and smaller northern latitude of the balloon contact site on the LSPV roof side (20.9° ± 3.8° vs. 38.9° ± 6.7°, p < 0.001) compared with Group B. A 27.5° north latitude was observed in most of Group A (sensitivity, 100%; specificity, 96%).</p><p><strong>Conclusions: </strong>Adequate contact positioning of the northern hemisphere to the LSPV is critical for effective isolation, particularly when isolation is challenging despite complete occlusion. In such cases, nonocclusive cryoablation against the LSPV roof might be effective.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"192-201"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933696","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}