Optimal site of pacemaker lead implantation for persistent atrial standstill guided by electroanatomical mapping following a cox-maze procedure: a case report.

IF 0.8 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS European Heart Journal: Case Reports Pub Date : 2024-12-02 eCollection Date: 2024-12-01 DOI:10.1093/ehjcr/ytae647
Sae Ujiro, Soichiro Yamashita, Makoto Takemoto, Masanori Okuda
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Abstract

Background: Atrial standstill is characterized by the absence of atrial activity. We report a case of a patient with extensive atrial fibrosis who underwent electrophysiologic study (EPS) and electroanatomical mapping (EAM) to identify surviving atrial sites amenable for pacemaker lead implantation.

Case summary: A 72-year-old man with persistent atrial fibrillation (AF) and atrial functional mitral regurgitation/tricuspid regurgitation (MR/TR) underwent a Cox-Maze surgery, mitral and tricuspid valve repair, and biatrial plication. He was referred because of post-operative presyncope symptoms. Electrocardiography revealed atrial standstill and junctional rhythm (JR); however, EAM revealed that both atria were almost entirely scarred and isolated fibrillation in left pulmonary veins and coronary sinus. Junctional rhythm retrogradely conducted around an atrioventricular (AV) node and pacing at this area could conduct to the ventricle through the AV node. An atrial pacing lead was implanted at this area, which yielded a QRS wave similar to the own beat. However, the atrial lead voltage was quite low; hence, ventricular pacing lead was implanted to avoid a future occurrence of pacing failure.

Discussion: This report demonstrates the benefits of EPS and EAM in informing optimal pacemaker implantation for patients with extensive scar in atrium.

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考克斯迷宫手术后,在电解剖图的指导下,起搏器导联植入的最佳位置用于治疗持续性心房停搏:病例报告。
背景:心房停滞的特征是心房没有活动。我们报告了一例患有广泛心房纤维化的患者,该患者接受了电生理学研究(EPS)和电解剖图绘制(EAM),以确定适合植入起搏器导联的心房存活部位。病例摘要:一名 72 岁的男性患者患有持续性心房颤动(房颤)和心房功能性二尖瓣反流/三尖瓣反流(MR/TR),接受了 Cox-Maze 手术、二尖瓣和三尖瓣修复术以及双心房成形术。他因术后出现晕厥症状而被转诊。心电图显示心房静止和交界性心律(JR);然而,心电图显示两个心房几乎完全瘢痕化,左肺静脉和冠状窦有孤立的纤颤。交界性心律在房室结周围逆行传导,该区域的起搏可通过房室结传导至心室。在这一区域植入了一个心房起搏导联,产生了与自身搏动相似的 QRS 波。但是,心房起搏导联的电压很低;因此植入了心室起搏导联,以避免将来发生起搏失败:本报告显示了 EPS 和 EAM 在为心房有广泛瘢痕的患者提供最佳起搏器植入信息方面的优势。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
European Heart Journal: Case Reports
European Heart Journal: Case Reports Medicine-Cardiology and Cardiovascular Medicine
CiteScore
1.30
自引率
10.00%
发文量
451
审稿时长
14 weeks
期刊最新文献
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