Pace-Pacing and Clinical Electrophysiology最新文献

{"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":"https://doi.org/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":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-29","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":"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":"https://doi.org/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":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-29","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":"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":"https://doi.org/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":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","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":"https://doi.org/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":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-26","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":"Postmortem Removal of Submuscularly Placed Subcutaneous Implantable Cardioverter Defibrillator in the Obese.","authors":"Chu-Pak Lau","doi":"10.1111/pace.15189","DOIUrl":"https://doi.org/10.1111/pace.15189","url":null,"abstract":"","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-08","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":"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":"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":"397-401"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","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":"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":"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":"377-385"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","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":"Exertional Intolerance After a Leadless Pacemaker Implant: What Is the Mechanism?","authors":"James E Ip","doi":"10.1111/pace.15160","DOIUrl":"10.1111/pace.15160","url":null,"abstract":"","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"394-396"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","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":"Unveiling the Reason for Syncope Associated With Cardiac Nodules.","authors":"Fangdi Zha, Jianfan Wen, Liangping Wang, Shusheng Liao, Lei Xu, Xiao Chen, Weijian Huang, Lan Su","doi":"10.1111/pace.15161","DOIUrl":"10.1111/pace.15161","url":null,"abstract":"<p><p>Behcet's disease is a systemic immune-mediated vasculitis predominantly affecting males. Cardiac involvement, termed cardiac Behcet's disease, is rare but potentially fatal, often mimicking infective endocarditis. This case presented with syncope as the initial symptom, leading to the identification of a non-coronary aortic sinus nodule, suspected as the cause of intermittent complete atrioventricular block. After pacemaker implantation, no recurrent syncope occurred, and immunosuppressive therapy reduced nodule size. This case underscores the importance of maintaining a high suspicion for cardiac Behcet's disease, as early diagnosis and intervention can be lifesaving.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"433-435"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626946","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":"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":"436-442"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","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}