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Complementary role of governments, non-governmental organizations, industry, and medical societies in expanding bradycardia therapy access. 政府、非政府组织、行业和医学协会在扩大获得心动过缓治疗方面的互补作用。
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-01 DOI: 10.1093/eurheartjsupp/suad124
Jitendra Singh Makkar, Goran Milasinovic, Chi Keong Ching

As the aging population continues to grow, so has the incidence of cardiovascular diseases, including bradycardia, with much of the burden falling on low- and middle-income countries (LMICs). Pacemaker therapy remains the only guideline-recommended therapy for symptomatic bradycardia, but due to the cost and expertise required for pacemaker implants, patients in LMICs have less access to pacemaker therapies. However, with the concerted effort of organizations (governments, non-governmental organizations, industry, and medical societies) strides can continue to be made in improving access to care. Governments play a role in extending health coverage to its citizens and improving their physical and digital healthcare infrastructure. Non-governmental organizations promote access and awareness through charity and advocacy programs. Industries can continue innovating technology that is both affordable and accessible. Medical societies provide guidelines for treatment and necessary educational and networking opportunities for physicians who serve in LMICs. All of these organizations have individual responsibilities and goals in expanding access to bradycardia therapy, which can be more easily realized by their continued collaboration.

随着老龄化人口的持续增长,包括心动过缓在内的心血管疾病的发病率也在不断增加,其中大部分负担落在了低收入和中等收入国家身上。起搏器治疗仍然是治疗症状性心动过缓的唯一指南推荐疗法,但由于起搏器植入所需的费用和专业知识,低收入国家的患者很少有机会接受起搏器治疗。但是,在各组织(政府、非政府组织、工业界和医学协会)的共同努力下,可以继续在改善获得保健的机会方面取得进展。政府在将医疗保险扩大到公民以及改善其实体和数字医疗基础设施方面发挥作用。非政府组织通过慈善和宣传项目促进获取和提高认识。工业可以继续创新既负担得起又容易获得的技术。医学协会为在低收入和中等收入国家服务的医生提供治疗指南和必要的教育和交流机会。所有这些组织在扩大心动过缓治疗的可及性方面都有各自的责任和目标,通过他们的持续合作可以更容易地实现这一目标。
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引用次数: 0
Conduction system pacing: overview, definitions, and nomenclature. 传导系统节奏:概述、定义和命名法。
IF 1.7 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-11-09 eCollection Date: 2023-11-01 DOI: 10.1093/eurheartjsupp/suad114
Marek Jastrzebski, Gopi Dandamudi, Haran Burri, Kenneth A Ellenbogen

Pacing from the right ventricle is associated with an increased risk of development of congestive heart failure, increases in total and cardiac mortality, and a worsened quality of life. Conduction system pacing has become increasingly realized as an alternative to right ventricular apical pacing. Conduction system pacing from the His bundle and left bundle branch area has been shown to provide physiologic activation of the ventricle and may be an alternative to coronary sinus pacing. Conduction system pacing has been studied as an alternative for both bradycardia pacing and for heart failure pacing. In this review, we summarize the clinical results of conduction system pacing under a variety of different clinical settings. The anatomic targets of conduction system pacing are illustrated, and electrocardiographic correlates of pacing from different sites in the conduction system are defined. Ultimately, clinical trials comparing conduction system pacing with standard right ventricular apical pacing and cardiac resynchronization therapy pacing will help define its benefit and risks compared with existing techniques.

右心室起搏与充血性心力衰竭的风险增加、总死亡率和心脏死亡率增加以及生活质量恶化有关。传导系统起搏已逐渐成为右室心尖起搏的替代方案。从他束和左束分支区开始的传导系统起搏已被证明可以提供心室的生理激活,可能是冠状动脉窦性起搏的替代方法。传导系统起搏已被研究作为心动过缓起搏和心力衰竭起搏的替代方法。在这篇综述中,我们总结了传导系统起搏在不同临床环境下的临床结果。说明了传导系统起搏的解剖目标,并定义了传导系统不同部位起搏的心电图相关性。最终,将传导系统起搏与标准右心室心尖起搏和心脏再同步化治疗起搏的临床试验将有助于确定其与现有技术相比的益处和风险。
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引用次数: 0
Frontiers in conduction system pacing: treatment of long PR in patients with heart failure. 传导系统起搏的前沿:心力衰竭患者长PR的治疗。
IF 1.7 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-11-09 eCollection Date: 2023-11-01 DOI: 10.1093/eurheartjsupp/suad116
Nandita Kaza, Daniel Keene, Pugazhendhi Vijayaraman, Zachary Whinnett

Patients with heart failure who have a prolonged PR interval are at a greater risk of adverse clinical outcomes than those with a normal PR interval. Potential mechanisms of harm relating to prolonged PR intervals include reduced ventricular filling and also the potential progression to a higher degree heart block. There has, however, been relatively little work specifically focusing on isolated PR prolongation as a therapeutic target. Secondary analyses of trials of biventricular pacing in heart failure have suggested that PR prolongation is both a prognostic marker and a promising treatment target. However, while biventricular pacing offers an improved activation pattern, it is nonetheless less physiological than native conduction in patients with a narrow QRS duration, and thus, may not be the ideal option for achieving therapeutic shortening of atrioventricular delay. Conduction system pacing aims to preserve physiological ventricular activation and may therefore be the ideal method for ventricular pacing in patients with isolated PR prolongation. Acute haemodynamic experiments and the recently reported His-optimized pacing evaluated for heart failure (HOPE HF) Randomised Controlled Trial demonstrates the potential benefits of physiological ventricular pacing on patient symptoms and left ventricular function in patients with heart failure.

PR间期延长的心衰患者比PR间期正常的心衰患者有更大的不良临床结果风险。与PR间隔延长相关的潜在危害机制包括心室充盈减少以及可能发展为更高程度的心脏传导阻滞。然而,相对较少的工作专门关注孤立的PR延长作为治疗目标。对心力衰竭双心室起搏试验的二次分析表明,PR延长既是一个预后指标,也是一个有希望的治疗目标。然而,尽管双心室起搏提供了一种改进的激活模式,但在QRS持续时间较短的患者中,双心室起搏的生理性不如天然传导,因此,可能不是实现治疗性缩短房室延迟的理想选择。传导系统起搏旨在保持生理性心室激活,因此可能是孤立性PR延长患者心室起搏的理想方法。急性血流动力学实验和最近报道的心衰his优化起搏评估(HOPE HF)随机对照试验表明,生理性心室起搏对心衰患者的症状和左心室功能有潜在的益处。
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引用次数: 0
A new era of physiologic cardiac pacing. 生理性心脏起搏的新时代。
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-11-09 eCollection Date: 2023-11-01 DOI: 10.1093/eurheartjsupp/suad120
Haran Burri, Pugazhendhi Vijayaraman
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引用次数: 0
Alternative atrial pacing site to improve cardiac function: focus on Bachmann's bundle pacing. 替代心房起搏部位改善心功能:关注巴赫曼束起搏。
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-11-09 eCollection Date: 2023-11-01 DOI: 10.1093/eurheartjsupp/suad118
Edmond M Cronin, Natasha Vedage, Carsten W Israel

Pacing from the right atrial appendage (RAA) prolongs the P wave duration and can induce interatrial and especially left-sided atrio-ventricular dyssynchrony. Pacing from Bachmann's bundle closely reproduces normal physiology and has the potential to avoid the electromechanical dysfunction associated with conventional RAA pacing. Interatrial conduction delay is associated with an increased risk of stroke, heart failure, and death. In addition to a reduction in atrial fibrillation, Bachmann's bundle pacing has emerging applications as a hemodynamic pacing modality. This review outlines the pathophysiology of atrial conduction disturbances and their potential remedies and provides the reader with a practical guide to implementing Bachmann's bundle pacing with an emphasis on the recapitulation of normal electrical and mechanical function.

右心耳起搏延长了P波持续时间,可引起房间尤其是左房室非同步化。巴赫曼氏束起搏近似地再现了正常的生理机能,并有可能避免与传统RAA起搏相关的机电功能障碍。房间传导延迟与卒中、心力衰竭和死亡风险增加有关。除了减少心房颤动外,巴赫曼束起搏作为一种血流动力学起搏方式也有了新的应用。这篇综述概述了心房传导障碍的病理生理学及其潜在的补救措施,并为读者提供了一个实用的指南,以实现巴赫曼束起搏,重点是正常的电和机械功能的再现。
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引用次数: 0
Role of conduction system pacing in ablate and pace strategies for atrial fibrillation. 传导系统起搏在心房颤动消融和起搏策略中的作用。
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-11-09 eCollection Date: 2023-11-01 DOI: 10.1093/eurheartjsupp/suad119
Roderick Tung, Haran Burri

With the advent of conduction system pacing, the threshold for performing 'ablate and pace' procedures for atrial fibrillation has gone down markedly in many centres due to the ability to provide a simple and physiological means of pacing the ventricles. This article reviews the technical considerations for this strategy as well as the current evidence, recognized indications, and future perspectives.

随着传导系统起搏的出现,由于能够提供一种简单而生理的心室起搏方法,许多中心对房颤进行“消融和起搏”手术的门槛已经显著降低。本文回顾了该策略的技术考虑因素,以及目前的证据、公认的适应症和未来的前景。
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引用次数: 0
Implant, assessment, and management of conduction system pacing. 传导系统起搏的植入、评估和管理。
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-11-09 eCollection Date: 2023-11-01 DOI: 10.1093/eurheartjsupp/suad115
Kevin Vernooy, Daniel Keene, Weijian Huang, Pugazhendhi Vijayaraman

His bundle pacing and left bundle branch pacing, together referred to as conduction system pacing, have (re)gained considerable interest over the past years as it has the potential to preserve and/or restore a more physiological ventricular activation when compared with right ventricular pacing and may serve as an alternative for cardiac resynchronization therapy. This review manuscript dives deeper into the implantation techniques and the relevant anatomy of the conduction system for both pacing strategies. Furthermore, the manuscript elaborates on better understanding of conduction system capture with its various capture patterns, its potential complications as well as appropriate follow-up care. Finally, the limitations and its impact on clinical care for both His bundle pacing and left bundle branch pacing are being discussed.

他的束起搏和左束支起搏,一起被称为传导系统起搏,在过去的几年里获得了相当大的兴趣,因为与右心室起搏相比,它有可能保持和/或恢复更生理的心室激活,并且可以作为心脏再同步化治疗的替代方案。这篇综述深入探讨了两种起搏策略的植入技术和相关的传导系统解剖。此外,手稿阐述了更好地理解传导系统捕获与各种捕获模式,其潜在的并发症以及适当的后续护理。最后,讨论了他束起搏和左束支起搏的局限性及其对临床护理的影响。
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引用次数: 1
Personalized accelerated physiologic pacing. 个性化加速生理起搏。
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-11-09 eCollection Date: 2023-11-01 DOI: 10.1093/eurheartjsupp/suad117
Markus Meyer, Margaret Infeld, Nicole Habel, Daniel Lustgarten

Heart failure with preserved ejection fraction (HFpEF) is increasingly prevalent with a high socioeconomic burden. Pharmacological heart rate lowering was recommended to improve ventricular filling in HFpEF. This article discusses the misperceptions that have resulted in an overprescription of beta-blockers, which in all likelihood have untoward effects on patients with HFpEF, even if they have atrial fibrillation or coronary artery disease as a comorbidity. Directly contradicting the lower heart rate paradigm, faster heart rates provide haemodynamic and structural benefits, amongst which lower cardiac filling pressures and improved ventricular capacitance may be most important. Safe delivery of this therapeutic approach is feasible with atrial and ventricular conduction system pacing that aims to emulate or enhance cardiac excitation to maximize the haemodynamic benefits of accelerated pacing. This conceptual framework was first tested in the myPACE randomized controlled trial of patients with pre-existing pacemakers and preclinical or overt HFpEF. This article provides the background and path towards this treatment approach.

保留射血分数心力衰竭(HFpEF)越来越普遍,具有很高的社会经济负担。建议通过药物降低心率来改善HFpEF患者的心室充盈。这篇文章讨论了导致过量使用-受体阻滞剂的误解,这很可能对HFpEF患者产生不良影响,即使他们有房颤或冠状动脉疾病作为合并症。与低心率模式直接矛盾的是,更快的心率提供血流动力学和结构上的好处,其中降低心脏充盈压力和改善心室电容可能是最重要的。这种治疗方法的安全交付是可行的,心房和心室传导系统起搏旨在模拟或增强心脏兴奋,以最大限度地提高加速起搏的血流动力学益处。这一概念框架首先在myPACE随机对照试验中得到验证,试验对象为已有起搏器和临床前或显性HFpEF患者。本文提供了这种治疗方法的背景和路径。
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引用次数: 0
Correction to: Diagnostic and prognostic electrocardiographic features in patients with hypertrophic cardiomyopathy. 更正:肥厚型心肌病患者的诊断和预后心电图特征。
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-09-18 eCollection Date: 2023-05-01 DOI: 10.1093/eurheartjsupp/suad121

[This corrects the article DOI: 10.1093/eurheartjsupp/suad074.].

[这更正了文章DOI:10.1093/eurheartjsupp/suad074.]。
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引用次数: 0
Corrigendum to: In pursuit of balance: RAASi and hyperkalemia treatment. 更正:追求平衡:RAASi和高钾血症治疗。
IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-09-15 eCollection Date: 2023-05-01 DOI: 10.1093/eurheartjsupp/suad122
Edoardo Sciatti, Emilia D'Elia, Giulio Balestrieri, Salvatore D'Isa, Attilio Iacovoni, Michele Senni

[This corrects the article DOI: 10.1093/eurheartjsupp/suad053.].

[这更正了文章DOI:10.1093/eurheartjsupp/suad053.]。
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引用次数: 0
期刊
European Heart Journal Supplements
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