Pace-Pacing and Clinical Electrophysiology最新文献

{"title":"Defibrillation Testing in Patients Undergoing Replacement of the S-ICD Generator: Is There Still a Need?","authors":"Benedikt Biller, Florian Reinke, Katharina Biller, Julia Köbe, Benjamin Rath, Lars Eckardt, Gerrit Frommeyer","doi":"10.1111/pace.15139","DOIUrl":"10.1111/pace.15139","url":null,"abstract":"<p><strong>Background: </strong>Noninferiority of omitting intraoperative defibrillation threshold (DFT) testing has been documented for transvenous implantable cardioverter defibrillators (ICD) whereas data for the subcutaneous-ICD (S-ICD) regarding the need for DFT testing, especially during S-ICD generator replacement, is not available.</p><p><strong>Methods: </strong>A total of 112 consecutive patients who underwent S-ICD generator replacement and routine testing were included in this retrospective single-center study and analyzed regarding the outcome of intraoperative DFT.</p><p><strong>Results: </strong>The majority of patients (87.3%) were successfully tested during generator replacement with no major adverse events. PREATORIAN score was generally lower, while high voltage (HV) impedance increased compared to first implantation. The risk of conversion failure increased with the PRAETORIAN risk class, whereas patient characteristics did not impact conversion rates. PRAETORIAN score and HV impedance were shown to be the most accurate factors when predicting conversion failure. In all patients with an HV impedance <70 Ohm and a PREATORIAN score < 90 at the time of initial implantation DFT was successfully performed during generator replacement.</p><p><strong>Conclusion: </strong>General omittance of DFT in S-ICD generator replacement is not advisable. New algorithms for low impedance DFT measurements during S-ICD query and PREATORIAN score at first implantation can be used to predict conversion failure. An impedance <70 Ohm and a PRAETORIAN score < 90 show a very low risk of conversion failure. In patients with a PRAETORIAN score > 150 DFT testing should be performed when the S-ICD generator is replaced until randomized data is available.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"3-8"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900484","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":"Minimizing for Maximum Benefit: An Illustrative Case-Series of Atrial Only Leadless Pacing.","authors":"James E Ip","doi":"10.1111/pace.15138","DOIUrl":"10.1111/pace.15138","url":null,"abstract":"<p><p>Leadless pacing technology now includesdedicated atrial helix-fixation leadless pacemakers (LPs), expanding theapplication of leadless devices for patients with sinus node dysfunction andatrioventricular block during sinus rhythm. This first reportedcase-series of atrial LPs describes and discusses the potential use-casescenarios of recently approved helix-fixation atrial LPs. The article highlights important concepts regarding their use, including implantationtechniques, programming, battery conservation, and the low rate of progressionof AV block in patients implanted with AAI(R) pacemakers.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"137-144"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900491","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":"Determining the Relationship Between Sleep Problems, Shock Pain, and Shock Anxiety in Patients With ICD.","authors":"Esra Buyruk, Eylem Topbaş, Gökhan Keskin","doi":"10.1111/pace.15102","DOIUrl":"10.1111/pace.15102","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to determine the relationship between sleep problems, shock pain, and shock anxiety in patients with implantable cardioverter defibrillator (ICD) and the affecting factors.</p><p><strong>Methods and results: </strong>The population of this descriptive cross-sectional study consisted of all patients who underwent ICD implantation in university hospital (N = 200), and the sample consisted of patients who met the inclusion criteria of the study (n = 132). Data were obtained using a \"General Information Form\", the \"Florida Shock Anxiety Scale (FSAS)\", the \"Epworth Sleepiness Scale (ESS)\", the \"Pittsburgh Sleep Quality Index (PSQI)\", and the \"Visual Pain Scale (VPS)\". The mean age of the patients was 66.13 years. The VPS was 6.40 ± 3.36; the mean FSAS score was 29.98 ± 8.46; the mean PSQI score was 8.02 ± 3.81; the mean ESS score was 7.59 ± 4.10. PSQI had a statistically significant correlation with the total FSAS score (p < 0.001) and a statistically insignificant correlation with ESS (p > 0.001). Age, sex, marital status, smoking status, cohabitants, previous ICD shocks, the status of lying on ICD, and fear of dislocation of ICD affected the total FSAS score; sex, employment status, history of heart attack, defined sleep disorder, awakening from sleep due to nightmares, and cessation of breathing during sleep affected the total PSQI score; history of previously defined sleep disorder, history of heart attack, use of medication for a sleep disorder, the pain felt when lying on ICD, and pain experienced during ICD shocks affected the total ESS score. The mean shock VPS scores differed between patients who received an ICD shock during sleep and those who were awakened by nightmares.</p><p><strong>Conclusions: </strong>It was found that the shock anxiety and shock pain scores of ICD patients were above average, that they had poor sleep quality, and that their sleepiness was at the level of \"normal but increased daytime sleepiness\".</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"95-105"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645218","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":"Electrophysiological Characteristics and Mechanism of His-Bundle Pacing Guided by Electrocardiograms in Uninterrupted Real-Time Monitoring Technique.","authors":"Jinyan Zhong, Longfu Jiang, Yuelin Zhang, Nan Zheng, Hengdong Li","doi":"10.1111/pace.15106","DOIUrl":"10.1111/pace.15106","url":null,"abstract":"<p><strong>Background: </strong>His-bundle pacing (HBP) is a pacing mode that provides near-physiological pacing and has more advantages over standard right ventricle (RV) septum pacing in positive clinical results. However, traditional HBP cannot accurately and stably place the lead tip into the His-Purkinje system. Hence, this study aimed to establish a novel strategy for HBP to strike a balance between an excellent pacing threshold and minor injuries to the conduction system.</p><p><strong>Methods: </strong>HBP, using continuous and real-time monitoring of unipolar His-bundle (HB) electrograms along with electrocardiograms, was performed in 29 consecutive atrial fibrillation patients. We analyzed the unipolar HB intracardiac electrogram (EGM) and electrophysiological characteristics during HBP using John Jiang's connecting cable and an electrophysiology recording system. All patients were followed up for 12 months.</p><p><strong>Results: </strong>Of the 29 patients, 28 (96.55%) successfully received HBP. Twenty-one (75%) patients were confirmed to have the negative deflection of His potential with a negative amplitude of ≥ 0.1 mV in HB EGM. The subgroup with a deep negative deflection was recorded with an HBP threshold (0.71 ± 0.41 V), significantly lower than those thresholds with no deep negative deflection (1.83 ± 0.76 V) (p < 0.05). The selective HBP rate was significantly different between the two groups: 20 (95.24%) in the deep negative deflection group and three (42.86%) in the non-deep negative deflection group (p < 0.05); five (17.24%) patients presented right bundle branch block (RBBB) during the lead placement.</p><p><strong>Conclusions: </strong>This study supports the safety and feasibility of using an uninterrupted real-time monitoring technique for HBP. An uninterrupted real-time monitoring technique can guide the accurate placement of the HB lead and may provide a balance between an excellent pacing threshold and minor injury to the conduction system.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"87-94"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645219","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":"Interatrial Block and Atrial High-Rate Episodes.","authors":"Manuel Martínez-Sellés","doi":"10.1111/pace.15130","DOIUrl":"https://doi.org/10.1111/pace.15130","url":null,"abstract":"","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-24","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}

{"title":"Atrioventricular Block in the Setting of Immune Myocarditis: A Pragmatic Approach to Diagnosis and Treatment.","authors":"Muhammet Gürdoğan, Gökay Taylan, Uğur Özkan, Mustafa Ebik, Nilay Solak, Yekta Gürlertop, Kenan Yalta","doi":"10.1111/pace.15108","DOIUrl":"10.1111/pace.15108","url":null,"abstract":"<p><p>Immunotherapy has revolutionized cancer treatment in the last decade and has significantly improved patient survival. However, immunotherapy is associated with serious cardiac adverse events including myocarditis and conduction disturbances. In the literature, the mortality rate in patients with immunotherapy-associated myocarditis and complete AV block is reported to be approximately 60%. Current cardio-oncology guidelines provide a series of recommendations for the management of immune myocarditis (IM). However, there is no recommendation on whether or when pacemaker implantation should be performed in the setting of complete AV block associated with myocarditis. This gap in the literature has led to a trend in cardio-oncology practice to implant permanent pacemakers (PPMs) in a significant proportion of patients without waiting for a response to immunosuppressive therapy. However, in a significant proportion of patients undergoing PPM implantation, complete AV block resolves after immunosuppressive therapy. This suggests that in cases of complete AV block in the setting of IM, more robust clues are needed for PPM implantation. This review aims to present algorithms for the management of myocarditis and complete AV block, one of the most lethal complications of immunotherapy, to help fill this gap in the literature.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1617-1626"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645217","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":"Substrate Modification for Atrial Fibrillation Induced by Mechanical Irritation That May Be Associated With Non-Pulmonary Vein Foci.","authors":"Koichiro Sonoda, Shunpei Hyakutake, Kentaro Furukawa, Kaishi Otsuka, Asumi Takei, Koji Maemura","doi":"10.1111/pace.15073","DOIUrl":"10.1111/pace.15073","url":null,"abstract":"<p><p>The importance of treating non-pulmonary vein (PV) foci is increasing with improvements in the durability of PV isolation. We describe two cases wherein non-PV foci were induced by mechanical irritation and conventional induction in the same area, which was impossible to induce after ablation, suggesting a relationship between mechanical irritation and induction of non-PV foci. In a recurrent case of non-PV foci, atrial fibrillation (AF) was induced only by mechanical irritation. No recurrence has been observed since the ablation of the area. Thus, treatment of the AF induction site with mechanical irritation could be considered an effective therapy for non-PV foci.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1632-1636"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11630806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301151","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":"Unique Tachycardia Recorded on a Cardiac Implantable Electronic Device: What is the Mechanism?","authors":"Yuta Sudo","doi":"10.1111/pace.15088","DOIUrl":"10.1111/pace.15088","url":null,"abstract":"<p><p>In a 55-year-old man with nonischemic cardiomyopathy, a unique tachycardia was recorded on a dual-chamber implantable cardioverter defibrillator (St. Jude Medical [Abbott]) as an automatic mode switch episode. This case report discusses the mechanism of tachycardia, how it can be differentiated from similar rhythms, and its clinical implications. The report explores device limitations in managing such tachycardias and presents reprograming strategies to prevent recurrence. This case emphasizes the importance of careful analysis of device-mediated arrhythmias and appropriate programming.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1614-1616"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481120","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":"His-Bundle Pacing for Pulmonary Hypertension With Bradycardia in Congenital Heart Disease: A Case Report.","authors":"Daiji Takeuchi, Takashi Fujii, Tomomi Nishimura, Kei Inai, Morio Shoda","doi":"10.1111/pace.15098","DOIUrl":"10.1111/pace.15098","url":null,"abstract":"<p><p>Bradycardia, atrial tachyarrhythmia, heart failure, residual shunts, and pulmonary hypertension (PH) are significant problems after congenital heart disease surgery. We performed His-bundle pacing (HBP) for drug-resistant PH with bradycardia in a woman post-total anomalous pulmonary venous return repair complicated by bradycardia, hypertension, PH, residual atrial shunts, and heart failure. Significant improvement in PH post-HBP was achieved without exacerbation of left ventricular function. We successfully closed the atrial shunts 12 months after HBP.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1637-1641"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513118","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":"Comparing Low-to-Zero Fluoroscopic Navigation Systems for AVNRT Catheter Ablation: A Network Meta-Analysis.","authors":"Akaravit Thamthanaruk, Vanit Nokkhuntong, Patavee Pajareya, Noppachai Siranart, Daniel Martin Simadibrata, Witina Techasatian, Ronpichai Chokesuwattanaskul, Krit Jongnarangsin, Eugene Ho-Joon Chung","doi":"10.1111/pace.15096","DOIUrl":"10.1111/pace.15096","url":null,"abstract":"<p><strong>Background: </strong>Low-to-zero fluoroscopic navigation systems lower radiation exposure which improves health outcomes. Conventional x-ray fluoroscopy (CF) has long been the standard to guide to catheter location for cardiac ablation. With advancements in technology, alternative safety navigation systems have been developed. Three primary modalities commonly utilized are three-dimensional electroanatomic mapping (3D-EAM), magnetic navigation system (MNS), and intracardiac echocardiography (ICE), all of which can reduce radiation exposure during the procedure.</p><p><strong>Objective: </strong>We aim to compare the efficacy and safety among ICE, EAM, MNS, and CF in ablation of atrioventricular nodal reentrant tachycardia (AVNRT).</p><p><strong>Methods: </strong>This is a meta-analysis consisting of observational studies and randomized controlled trials, which evaluated the performance of navigation systems of catheter ablation in AVNRT patients. Primary endpoint was to access the AVNRT recurrence after the procedure during follow-up periods. Secondary endpoints were technical success, fluoroscopic time, fluoroscopic dose area product, radiofrequency ablation time, and adverse events. Random-effect model was applied for pooled estimated effects of included studies.</p><p><strong>Results: </strong>A total of 21 studies (21 CF, 2 ICE, 9 EAM, 11 MNS) including 1716 patients who underwent catheter ablation for AVNRT treatment were analyzed. Of these, 16 were observational studies and 5 were randomized controlled trials.</p><p><strong>Primary outcome: </strong>Point estimation of AVNRT recurrence showed ICE exhibited a pooled odds ratio (ORs) of 1.06 (95% confidence interval [CI]: 0.064-17.322), MNS with ORs of 0.51 (95% CI: 0.214-1.219], and EAM with ORs of 0.394 (95% CI: 0.119-1.305) when compared to CF.</p><p><strong>Secondary outcomes: </strong>EAM had significant higher technical success with ORs of 2.781 (95% CI: 1.317-5.872) when compared to CF. Regarding fluoroscopy time, EAM showed the lowest time with mean differences (MD) of -10.348 min (95% CI: -13.385 to -7.3101) and P-score of 0.998. It was followed by MNS with MD of -3.712 min (95% CI: -7.128 to -0.295) and P-score of 0.586, ICE with MD of -1.150 min (95% CI: -6.963 to 4.662) with a P-score of 0.294 compared to CF, which has a P-score of 0.122. There were insignificant adverse events across the procedures.</p><p><strong>Conclusion: </strong>AVNRT ablation navigated by low-to-zero fluoroscopic navigation systems achieves higher efficacy and comparable safety to conventional fluoroscopywhile also reducing risk of radiation exposure time.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1574-1585"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513116","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}