Pace-Pacing and Clinical Electrophysiology最新文献

{"title":"Safety and efficacy of orthodromic snare technique in left ventricular lead delivery in cardiac resynchronization implantation.","authors":"Sutopa Purkayastha, Olga Reynbakh, Suraj Krishnan, Nils Guttenplan","doi":"10.1111/pace.15066","DOIUrl":"10.1111/pace.15066","url":null,"abstract":"<p><strong>Background: </strong>Cardiac resynchronization therapy (CRT) improves ventricular function, but a positive response to CRT is often limited due to left ventricular (LV) lead placement in a suboptimal position. Complex coronary venous anatomy can hinder the placement of an LV lead in the target vessel, leading to poor CRT response.</p><p><strong>Objective: </strong>To report experience with snare-assisted LV lead delivery in CRT and compare outcomes with the conventional LV lead delivery.</p><p><strong>Methods: </strong>This is a single-center retrospective case-control study of CRT implants between 2016 and 2021. Snare-assisted lead delivery was performed in cases where conventional lead placement failed or when a preferred target vessel had anatomy amenable to the technique. Safety and outcomes were compared to conventional LV lead placement cases.</p><p><strong>Results: </strong>Among 180 CRT cases, 33 were snare-assisted, and 147 were conventional LV lead placements. Median follow-up was 924 days in the snare and 618.5 days in the control group. The lead placement was successful in 28/33 snare and 138/147 control cases. A mid-vessel segment was attained in 89.3% of snare and 72.5% of control cases(p = .03). The apical position was more frequently observed in the control group (26.8% vs. 7.1%, p = .03). All-cause mortality trended lower in the snare group (6.1%) compared to (17.1%) in the control group (p = .13).</p><p><strong>Conclusion: </strong>Snare-assisted LV lead delivery is a safe and effective technique that can be utilized for overcoming complex venous anatomy.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1317-1325"},"PeriodicalIF":1.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114839","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 impact of His bundle location and direction on the efficacy and safety of ablation.","authors":"Bangjiaxin Ren, Ying Cao, Jing Li, Fanghui Li, Chuanyun Wang, Meng Xiao, Xianjin Hu, Rui Zeng","doi":"10.1111/pace.15053","DOIUrl":"10.1111/pace.15053","url":null,"abstract":"<p><strong>Background: </strong>The impact of the His bundle location and distance from the ablation site on ablation efficacy and complication risk remains unexplored. We determined the correlation between age, height, body mass index (BMI), and the His bundle location, and whether the distance between the His bundle and ablation target (D_HIS-ABL) affects ablation safety and efficacy.</p><p><strong>Methods: </strong>Overall, 346 patients with atrioventricular nodal re-entrant tachycardia (AVNRT) and 96 with atrioventricular re-entrant tachycardia (AVRT) were retrospectively analyzed. The distance between the His bundle and the coronary sinus ostium (D_His-CS), the height of the His bundle (H_HIS), and D_HIS-ABL were measured. Electrocardiograms were obtained 3 months post-ablation to assess recurrence and complications.</p><p><strong>Results: </strong>Multiple linear regression showed that H_HIS was negatively correlated with age in both groups. In AVNRT patients, D_HIS-ABL was associated with age, height, and BMI; D_HIS-CS was only negatively correlated with age. In AVRT patients, there was no significant correlation between the D_HIS-ABL and age, height, or BMI. The recurrence rates in the AVNRT and AVRT groups were 0.9% and 8.7%, respectively. Subgroup analysis showed that patients with D_HIS-ABL ≤ 10 mm had a higher recurrence rate than those with D_HIS-ABL> 10 mm (p = .013). The incidence of third-degree atrioventricular block (AVB) complications was 0.2%.</p><p><strong>Conclusions: </strong>H_HIS was negatively correlated with age but not with height and BMI. The D_HIS-ABL correlated with age, height, and BMI in AVNRT patients. A short D_HIS-ABL led to a higher rate of supraventricular tachycardia recurrence; whether this affects AVB risk warrants further studies with larger sample sizes.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1338-1345"},"PeriodicalIF":1.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141918117","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":"Predictors of functional mitral regurgitation improvement in patients with left bundle branch block treated with left bundle branch area pacing.","authors":"Huazhong Miao, Zenghong Chen, Yushi Luo, Yandi Cheng, P L R Krisunika Cooray, Tian Wu, Wen Yang, Xiujuan Zhou, Qijun Shan, Zhixin Jiang","doi":"10.1111/pace.15059","DOIUrl":"10.1111/pace.15059","url":null,"abstract":"<p><strong>Background: </strong>Functional mitral regurgitation (FMR) and its severity are associated with adverse outcomes in heart failure patients. This study aims to analyze the predictors of FMR improvement after successful left bundle branch area pacing (LBBAP) in patients with LVEF < 50% and complete left bundle branch block (CLBBB).</p><p><strong>Methods: </strong>Consecutive patients with LVEF < 50% and CLBBB who underwent successful LBBAP from July 2018 to July 2023 were retrospectively identified. Significant MR was defined as regurgitation of moderate severity or greater. Patients with significant FMR were included in the analysis. FMR improvement (FMRI) was defined as a reduction of at least one grade in regurgitation severity compared to baseline at 3 months or longer follow-up.</p><p><strong>Results: </strong>Among the 81 identified patients, 42 patients with significant FMR preoperatively were included. After LBBAP, QRS duration significantly shortened from 170.6 ± 18.8 ms to 114.5 ± 20.2 ms (p < .001). Significant FMR improves in approximately 76.2%, and the patients were divided into an FMRI group (n = 32) and a non-FMRI group (n = 10). Univariate analysis showed that absence of persistent atrial fibrillation, typical CLBBB, and left atrium diameter at baseline were associated with improvement of FMR after LBBAP. Of these variables, only absence of persistent atrial fibrillation remains an independent predictor in the multivariate model (OR 12.436, p = .009).</p><p><strong>Conclusion: </strong>LBBAP is able to improve FMR in heart failure patients who had CLBBB with LVEF < 50%. Meanwhile, the absence of persistent atrial fibrillation is an independent predictor of FMR improvement.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1412-1417"},"PeriodicalIF":1.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989577","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":"Implantable cardioverter defibrillator explantation upon patient request: Clinical and ethical considerations.","authors":"Massimo Romanò","doi":"10.1111/pace.15057","DOIUrl":"10.1111/pace.15057","url":null,"abstract":"<p><strong>Background: </strong>Implantable Cardioverter Defibrillator (ICD) implantation has significantly modified the natural history of patients at high risk of sudden cardiac death (SCD) in various types of heart diseases. However there is a high rate of psychological distress and reduced quality of life in patients with an ICD, more evident in younger individuals. The ICD removal upon patient request is a very rare event and causes many clinical and ethical issues.</p><p><strong>Methods: </strong>The article discusses the case of a young patient affected by hypertrophic obstructive cardiomyopathy, who underwent implantable cardioverter defibrillator (ICD) implantation as a primary prevention of sudden cardiac death (SCD). Two years after the implantation, the patient repeatedly requested removal of the ICD due to of a significant and untreatable psychological device intolerance.</p><p><strong>Results: </strong>Intervention became possible only after extensive psychological evaluation, which excluded specific pathology, and the ratification of Italian law 219/2017 on informed consent and advance directives, which guarantees the patient's independent decisions on current and future medical treatment. The explantation was performed 7 years after the implant. The patient is alive and in good health.</p><p><strong>Conclusions: </strong>The paper debates the issues related to establishing a patient-physician relationship based on respect for the patient's autonomy and experience of illness, in reference to principles such as beneficence and non-maleficence, and the conflicts that sometimes arise between them. If a paternalistic approach in the patient-physician relationship evolves into a patient-centered model, it is more certain that the patient's choice is realistically known and shared, and that it is consistent with the patient's values and life goals. The shared decision making (SDM) process and the use of pathology-specific decision aids are able to transform the informed consent tool, usually related to medical-legal issues, into an aid for true partnership between the patient and the medical care team.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1308-1316"},"PeriodicalIF":1.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142005946","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":"Outcome of transvenous lead extraction in nonagenarians: A single-center retrospective study.","authors":"Toshinori Komatsu, Ayako Okada, Morio Shoda, Kiu Tanaka, Hideki Kobayashi, Yasutaka Oguchi, Tatsuya Saigusa, Soichiro Ebisawa, Hirohiko Motoki, Koichiro Kuwahara","doi":"10.1111/pace.15062","DOIUrl":"10.1111/pace.15062","url":null,"abstract":"<p><strong>Background: </strong>Transvenous lead extraction (TLE) for cardiovascular implantable electronic device (CIED)-related infections has increased. The incidence of TLE in nonagenarians is low, with limited reports outlining the outcomes of this procedure. Therefore, in this study, we aimed to clarify the outcomes of TLE in nonagenarians.</p><p><strong>Methods: </strong>Patients with TLE treated at our hospital between 2014 and 2023 were retrospectively examined; patient characteristics, device type, indications, procedures, complications, and clinical data of nonagenarians were analyzed.</p><p><strong>Results: </strong>Of 12 patients with 24 leads (active fixation lead, n = 11; passive fixation lead, n = 13) who underwent TLE, the indication for TLE was infection (pocket infection, n = 8; sepsis, n = 4). Methicillin-resistant Staphylococcus epidermidis was the most frequently identified causative agent (n = 4). The median patient age was 91 years; five patients were female. The median lead dwell time was 9 years. Excimer laser sheath (16 leads), mechanical sheath (five leads), Evolution RL (one lead), and manual traction (two leads) were employed in TLE. The procedure was successful in all patients, and only one had a minor complication. Six patients required CIED re-implantation, and leadless pacemakers were selected for five patients. The 30-day mortality after TLE was 0%.</p><p><strong>Conclusion: </strong>TLE can be safely performed in nonagenarians. The decision to perform TLE should not be based on old age alone; the suitability of removing infected CIEDs should be determined based on each patient's condition.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1293-1299"},"PeriodicalIF":1.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142005947","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":"Elucidating left atrial electrical potential with microelectrode catheter: A case of coronary sinus ostial atresia with small persistent left superior vena cava.","authors":"Kohki Kimura, Takeshi Harita, Tetsuya Haruna","doi":"10.1111/pace.14977","DOIUrl":"10.1111/pace.14977","url":null,"abstract":"<p><p>A 51-year-old woman presented with recurring palpitations. Electrocardiography revealed narrow QRS tachycardia with short RP configuration. Computed tomography showed coronary sinus (CS) ostial atresia along with a small persistent left superior vena cava (PLSVC). Electrophysiological study identified the retrograde earliest atrial activation site (EAAS) at the CS ostium without decremental properties, and para-Hisian pacing suggested retrograde atrioventricular nodal conduction. Using a 1.6-Fr microelectrode catheter distally placed in the CS via the PLSVC, EAAS was confirmed within the left atrium, not the CS ostium. Transseptal approach revealed a left lateral accessory pathway, which was successfully eliminated.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1373-1376"},"PeriodicalIF":1.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140327425","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":"Observational study on the identification of left atrial tachycardia circuits using Local Activation Time Histogram.","authors":"Daisuke Yamagishi, Koichi Kanazawa, Kazuki Saito, Tsunesuke Kono","doi":"10.1111/pace.15040","DOIUrl":"10.1111/pace.15040","url":null,"abstract":"<p><strong>Background: </strong>Mapping of atypical atrial arrythmias arising in the left atrium is often challenging. The Local Activation Time (LAT) Histogram, a new function of the 3D color mapping system CARTO version 7, may help improve identification of atrial tachycardia circuits. We aimed to assess the effectiveness of the LAT Histogram for identification of left atrial tachycardia circuits.</p><p><strong>Methods: </strong>This retrospective study compared 25 consecutive cases of left atrial tachycardia that were treated before use of LAT Histogram (unused group) and 25 consecutive cases that were treated after introduction of LAT Histogram (used group) at Nagano Chuo Hospital. We evaluated whether we could identify the circuit of left atrial tachycardia from the electrophysiology lab data during ablation and the CARTO system data and whether we could perform effective ablation.</p><p><strong>Results: </strong>Door-to-door time, skin-to-skin time, and fluoroscopy time (p ≤ .011) were all shorter in the LAT Histogram used group versus unused group, while mapping analysis times were longer in the used group (p ≤ .019). A significantly greater number of cases in the LAT Histogram used compared with the unused group had ablation for entrance or exit points (19 vs. 10 cases; p = .001 for first map). Ablation resulted in a return to sinus rhythm and changed cycle length at the first mapping in 20 cases (80%) in the LAT Histogram unused group and in 24 cases (96%) in the used group.</p><p><strong>Conclusions: </strong>LAT Histogram may provide a simple and effective method to identify entrance and exit locations in left atrial tachycardia.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1266-1275"},"PeriodicalIF":1.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141604540","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":"A case of atrial tachycardia originating from the left atrial roof successfully ablated via the pulmonary artery approach.","authors":"Wenwu Liu, Qitong Zhang, Xiaoyu Wu, Longzhe Gao, Yong Wei, Shaowen Liu, Genqing Zhou","doi":"10.1111/pace.14937","DOIUrl":"10.1111/pace.14937","url":null,"abstract":"<p><p>A 60-year-old male patient suffered from frequent episodes of atrial tachycardia (AT), after the index procedure of catheter ablation for paroxysmal atrial fibrillation. During the repeat procedure, the activation map showed that the earliest activation site was located at the roof of left atrium. Multiple ablations at the earliest activation site on the roof failed to terminate the AT; however, ablation within the pulmonary artery at an adjacent anatomical site successfully eliminated the AT, even without recording distinct near-field potential.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1194-1197"},"PeriodicalIF":1.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139693549","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":"A manual synchronous low energy shock impedance as a predictor of successful defibrillation testing during subcutaneous ICD implantation.","authors":"Naiara Calvo, Carlos Rubén López-Perales, Teresa Olóriz, Francisco Díaz-Cortegana, Beatriz Jáuregui, Nina Soto, Pilar Rodríguez, Eva Santamaría, M Rosario Ortas, Antonio Asso","doi":"10.1111/pace.15055","DOIUrl":"10.1111/pace.15055","url":null,"abstract":"<p><strong>Background: </strong>Guidelines recommend defibrillation testing (DFT) during subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation. Implant position, patient characteristics and device factors, such as shock impedance, influence defibrillation success. To evaluate the shock impedance, a manual synchronous 10J shock (low energy synchronous shock [LESS]) can be delivered, without the need to induce ventricular fibrillation (VF).</p><p><strong>Objective: </strong>To compare LESS and DFT impedance values and to evaluate the diagnostic accuracy of LESS impedance for predicting a successful DFT during S-ICD implantation.</p><p><strong>Methods: </strong>Consecutive S-ICD implantations were included. Shock impedances were compared by paired t-tests. Univariate analysis was performed to investigate factors associated with successful DFT. A prediction model of successful DFT based on LESS impedance was assessed by logistic regression. Receiver operating characteristic (ROC) curve, area under the ROC curve and the Hosmer-Lemeshow tests were used to evaluate the accuracy of LESS impedance.</p><p><strong>Results: </strong>Sixty patients were included (52 ± 14 years; 69% male). LESS and DFT impedance values were highly correlated (r² = 0.97, p < .01). Patients with a failed first shock had higher body mass index (BMI) (30 ± 3 vs. 25.7 ± 4.3, p = .014), higher mean LESS (120 ± 35Ω vs. 86. ± 23Ω, p = .0013) and DFT impedance (122 ± 33Ω vs. 87 ± 24Ω, p = .0013). ROC analysis showed that LESS impedance had a good diagnostic performance in predicting a successful conversion test (AUC 84% [95% CI: 0.72-0.92]) with a cutoff value of <94Ω to identify a successful DFT (sensitivity 71%, specificity 73%).</p><p><strong>Conclusion: </strong>LESS impedance values without the need to induce VF can intraoperatively predict a successful DFT.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1185-1191"},"PeriodicalIF":1.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890968","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 evidence of right atrial epicardial connections in a case with recurrent common atrial flutter.","authors":"Masaya Shinohara, Tadashi Fujino, Hosei Kikushima, Ryo Wada, Shintaro Yao, Kensuke Yano, Katsuya Akitsu, Takanori Ikeda","doi":"10.1111/pace.14958","DOIUrl":"10.1111/pace.14958","url":null,"abstract":"<p><p>The majority of the cavotricuspid isthmus (CTI) region consists of discretely arranged muscle bundles separated by connective tissue. Heterogeneity in the anatomic arrangement of the muscle bundles results in differences in the endocardial and epicardial activation patterns. We present a case of recurrent atrial flutter (AFL) despite the presence of a complete endocardial CTI block. We found epicardial-endocardial breakthrough (EEB) sites on the right atrial high septum. In addition, the epicardial excitation confirmed by endocardial activation mapping was detected as far-field potentials. Radiofrequency ablation was performed at the EEB site. No AFL has recurred for 12 months after the present procedure.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1213-1216"},"PeriodicalIF":1.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140013761","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}