Pace-Pacing and Clinical Electrophysiology最新文献

{"title":"Topological Distribution of KCNH2 Variants and Genotype-Phenotype Relationship in Patients With Long QT Syndrome.","authors":"Hongyu Liu, Zhenhong Jiang, Yang Shen, Ying Shao, Yuhao Su, Daowu Wang, Ramon Brugada, Kui Hong","doi":"10.1111/pace.15145","DOIUrl":"10.1111/pace.15145","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to investigate the topological distribution of single nucleotide variants (SNVs) in the KCNH2 gene from patients with type 2 long QT syndrome (LQT2) and to explore the genotype-phenotype relationships.</p><p><strong>Methods: </strong>Information on KCNH2 variants in LQT2 patients was retrospectively obtained from the HGMD, ClinVar, and PubMed databases through October 2022. Pathogenicity of SNV was classified according to the American College of Medical Genetics and Genomics (ACMG) guidelines. Unpaired t-tests and Fisher's exacts were used to analyze the SNV distributions across structural and functional domains, and their correlation with clinical phenotypes.</p><p><strong>Results: </strong>A total of 2826 variants were obtained; 2152 were SNVs, 1328 of which were nonsynonymous SNVs (nsSNVs) associated with LQT2. Enrichment analysis revealed that 602 pathogenic (P) and likely pathogenic (LP) nsSNVs were significantly enriched at S5, H5, S6, Extra3, and Extra4. In addition, 759 nsSNVs and 289 P/LP nsSNVs within function domain were enriched at the per-arnt-sim (PAS) and selectivity filter (SF) functional domain. Clinical data revealed that patients with nsSNVs enriched at the N-terminal, S5-H5-S6 region and PAS domain were associated with an increased risk of syncope. Moreover, nsSNVs located at the N-terminal, S5-H5-S6 region, and PAS, SF domains were associated with an increased risk of life-threatening cardiac events, including Torsade de Pointes (TdP) and sudden cardiac death (SCD), and were predominantly female.</p><p><strong>Conclusion: </strong>KCNH2 nsSNVs located at the N-terminal, S5-H5-S6 region, and the PAS and SF functional domains are associated with an increased risk of life-threatening cardiac events in LQT2 patients.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"351-362"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257439","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":"Concurrent Micra Leadless Pacemaker Implantation and AVN Ablation: Computer Modeling of Novel Risk Mitigation Strategy.","authors":"Daniel Wetherbee Nelson, Lynn Erickson, Jodi L Zilinski, Yanzhu Zhao, Anna Karos, Teresa Whitman, Imran K Niazi","doi":"10.1111/pace.15149","DOIUrl":"10.1111/pace.15149","url":null,"abstract":"<p><strong>Background: </strong>Concurrent Micra leadless pacemaker (Medtronic, Minneapolis, Minnesota) implantation and atrioventricular node (AVN) ablation has been shown to be feasible and safe in patients with symptomatic, drug-refractory atrial fibrillation (AF). However, major complications within the 30 days after concurrent Micra implantation and AVN ablation have been reported. We evaluated the efficacy and safety of the concurrent procedure at our institution.</p><p><strong>Methods: </strong>We conducted a single-center, retrospective case series of patients who underwent concurrent Micra implantation and radiofrequency (RF) AVN ablation from January 2019 to May 2023. A simulated computer model was created to characterize the interaction between the dissipated power at the Micra cathodal electrode as a function of the distance between the RF ablation catheter and the location of the return electrode.</p><p><strong>Results: </strong>Fifteen patients were included. Most were elderly, White, female, and had persistent AF. One had transient, acute loss of ventricular capture that resulted in asystole and required emergent pacing from the ablation catheter. A proposed strategy of moving the RF return electrode to a cranial position from a caudal position was shown by computer modeling to direct more RF current away from the Micra and lower the dissipated power at the Micra cathodal electrode.</p><p><strong>Conclusion: </strong>Concurrent Micra implantation and AVN ablation is feasible and safe and has high procedural success. An acute rise in pacing threshold can occur from RF energy, resulting in asystole. Computer modeling showed that placing the RF return electrode in the cranial position resulted in lower dissipated power at the Micra cathodal electrode.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"287-293"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048462","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":"Pulsed Field Versus High-Power Short-Duration Radiofrequency Ablation in Atrial Fibrillation: A Meta-Analysis.","authors":"Muhammad Hassan Waseem, Zain Ul Abideen, Ayesha Ahmed, Barka Sajid, Ameer Haider Cheema, Noor Ul Huda Ramzan, Amina Tahir, Sania Aimen","doi":"10.1111/pace.15166","DOIUrl":"https://doi.org/10.1111/pace.15166","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation, which has increased in prevalence by 33% over the past two decades, affects 59 million people worldwide. It is treated using thermal and nonthermal techniques like radiofrequency, cryoballoon, laser, and pulsed-field ablation (PFA). This meta-analysis is the first to compare PFA with high-power short-duration radiofrequency ablation (HPSD-RFA).</p><p><strong>Methods: </strong>We comprehensively searched PubMed, Cochrane Central, and ScienceDirect from inception to August 2024. In Review Manager 5.4.1, we pooled risk ratios (RRs) and weighted mean difference (WMD) along with 95% confidence intervals for dichotomous and continuous outcomes, respectively, and employed a random effects model. Study quality was assessed via the Newcastle-Ottawa Scale, and funnel plots were used to evaluate the risk of publication bias.</p><p><strong>Results: </strong>Seven studies with a total of 1538 patients were analyzed in this meta-analysis. PFA was associated with a shorter total procedural time (MD = -36.39 min; 95% CI: [-46.23, -26.55]; p < 0.00001; I² = 90%), left atrial dwell time (MD = -33.22 min; 95% CI: [-53.21, -13.23]; p = 0.001; I² = 93%), and a longer fluoroscopy time compared to the HPSD-RFA (MD = 9.06 min; 95% CI: [6.13, 11.99]; p < 0.00001; I² = 96%). Other outcomes were comparable between the two arms.</p><p><strong>Conclusion: </strong>PFA outperforms HPSD ablation in terms of procedural efficiency outcomes except for the total fluoroscopy time. Still, both techniques are comparable regarding safety and arrhythmia control outcomes.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494843","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":"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}