JACC. Clinical electrophysiology最新文献

英文中文

Left Bundle Branch Area Pacing With or Without Conduction System Capture in Heart Failure Models 在心衰模型中进行有或无传导系统捕获的左束支区起搏

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology

Pub Date : 2024-10-01 DOI: 10.1016/j.jacep.2024.05.007

Background

Left bundle branch area pacing includes left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP), which is effective in patients with dyssynchronous heart failure (DHF). However, the basic mechanisms are unknown.

Objectives

This study aimed to compare LBBP with LVSP and explore potential mechanisms underlying the better clinical outcomes of LBBP.

Methods

A total of 24 beagles were assigned to the following groups: 1) control group; 2) DHF group, left bundle branch ablation followed by 6 weeks of AOO pacing at 200 ppm; 3) LBBP group, DHF for 3 weeks followed by 3 weeks of DOO pacing at 200 ppm; and 4) LVSP with the same interventions in the LBBP group. Metrics of electrocardiogram, echocardiography, hemodynamics, and expression of left ventricular proteins were evaluated.

Results

Compared with LVSP, LBBP had better peak strain dispersion (44.67 ± 1.75 ms vs 55.50 ± 4.85 ms; P < 0.001) and hemodynamic effect (dP/dtmax improvement: 27.16% ± 7.79% vs 11.37% ± 4.73%; P < 0.001), whereas no significant differences in cardiac function were shown. The altered expressions of proteins in the lateral wall vs septum in the DHF group were partially reversed by LBBP and LVSP, which was associated with the contraction and adhesion process, separately.

Conclusions

The animal study demonstrated that LBBP offered better mechanical synchrony and improved hemodynamics than LVSP, which might be explained by the reversed expression of contraction proteins. These results supported the potential superiority of left bundle branch area pacing with the capture of the conduction system in DHF model.

背景：左束支区起搏包括左束支起搏（LBBP）和左室间隔起搏（LVSP），对非同步性心力衰竭（DHF）患者有效。然而，其基本机制尚不清楚：本研究旨在比较 LBBP 和 LVSP，并探索 LBBP 临床疗效更好的潜在机制：共将 24 只猎兔犬分为以下几组：1）对照组；2）DHF 组，左束支消融术后以 200 ppm 进行为期 6 周的 AOO 起搏；3）LBBP 组，DHF 3 周后以 200 ppm 进行为期 3 周的 DOO 起搏；4）LVSP，LBBP 组采取相同的干预措施。对心电图、超声心动图、血液动力学和左心室蛋白表达等指标进行了评估：结果：与 LVSP 相比，LBBP 的峰值应变弥散（44.67 ± 1.75 ms vs 55.50 ± 4.85 ms; P < 0.001）和血流动力学效果（dP/dtmax 改善：27.16% ± 7.79% vs 11.37% ± 4.73%; P < 0.001）更好，而心功能无显著差异。LBBP和LVSP可部分逆转DHF组侧壁与室间隔蛋白质表达的改变，这分别与收缩和粘附过程有关：动物研究表明，LBBP比LVSP能提供更好的机械同步性和改善血液动力学，这可能与收缩蛋白的逆转表达有关。这些结果支持了左束支区起搏在 DHF 模型中捕捉传导系统的潜在优势。

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引用次数: 0

Long-Term Safety and Efficacy of Intraoperative Leadless Pacemaker Implantation During Valve Surgery 瓣膜手术期间术中植入无引线起搏器的长期安全性和有效性

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology

Pub Date : 2024-10-01 DOI: 10.1016/j.jacep.2024.06.018

Background

Intraoperative implantation of leadless cardiac pacemakers (LCPs) under direct visualization during cardiac surgery is a novel strategy to provide pacing to patients with an elevated risk of postoperative conduction disorders or with a preexisting pacing indication undergoing valve surgery.

Objectives

This study sought to evaluate the long-term safety and efficacy of intraoperative LCP implantation in 100 consecutive patients.

Methods

Retrospective single-center cohort study of consecutive patients (n = 100) who underwent intraoperative LCP implantation during valve surgery. Safety and efficacy were assessed at implantation and follow-up visits.

Results

A total of 100 patients (age 68 ± 13 years, 47% female) underwent intraoperative LCP implantation. The surgery involved the tricuspid valve in 99 patients (99%), including tricuspid valve repair in 59 (59%) and tricuspid valve replacement in 40 (40%). Most of the patients (78%) underwent multivalve surgery. The indication for LCP implantation was elevated risk of postoperative atrioventricular block in 54% and preexisting bradyarrhythmias in 46%. LCP implantation was successful in all patients. During a median of 10.6 months (IQR: 2.0-22.7 months) of follow-up, no device-related complications occurred. At 12-month follow-up, the pacing thresholds were acceptable (≤2.0 V at 0.24 milliseconds) in 95% of patients.

Conclusions

Intraoperative LCP implantation under direct visualization is a safe strategy to provide permanent pacing in patients undergoing valve surgery, with a postoperative electrical performance comparable to percutaneously placed LCPs.

背景：在心脏手术直视下术中植入无导联心脏起搏器（LCP）是一种新策略，可为术后传导障碍风险较高或已有起搏指征的瓣膜手术患者提供起搏：本研究旨在评估 100 例连续患者术中植入 LCP 的长期安全性和有效性：方法：对在瓣膜手术中接受术中 LCP 植入的连续患者（n = 100）进行回顾性单中心队列研究。结果：共有 100 名患者（年龄 68 岁）接受了瓣膜手术术中 LCP 植入：共有 100 名患者（年龄为 68 ± 13 岁，47% 为女性）接受了术中 LCP 植入术。99名患者（99%）的手术涉及三尖瓣，包括59名患者（59%）的三尖瓣修复术和40名患者（40%）的三尖瓣置换术。大多数患者（78%）接受了多瓣膜手术。LCP 植入术的适应症是术后房室传导阻滞风险升高（54%）和原有缓慢性心律失常（46%）。所有患者都成功植入了 LCP。在中位 10.6 个月（IQR：2.0-22.7 个月）的随访期间，没有发生与设备相关的并发症。随访12个月时，95%的患者起搏阈值合格（0.24毫秒时≤2.0 V）：结论：在直视下进行术中 LCP 植入是一种为接受瓣膜手术的患者提供永久起搏的安全策略，术后的电气性能与经皮放置的 LCP 不相上下。

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引用次数: 0

Coronary Vasospasm During Pulse-Field Focal Ablation of the Cavotricuspid Isthmus Observed With Intravascular Ultrasound 通过血管内超声观察脉冲场聚焦消融腔静脉峡过程中的冠状动脉血管痉挛

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology

Pub Date : 2024-10-01 DOI: 10.1016/j.jacep.2024.06.032

引用次数: 0

Outcomes of Pacemaker Implantation During Pregnancy 妊娠期植入起搏器的结果

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology

Pub Date : 2024-10-01 DOI: 10.1016/j.jacep.2024.06.033

引用次数: 0

Standard Defibrillator Leads for Left Bundle Branch Area Pacing 用于左束支区起搏的标准除颤器导线：首次使用经验和短期随访。

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology

Pub Date : 2024-10-01 DOI: 10.1016/j.jacep.2024.07.011

The authors report for the first time to their knowledge, implantation of a standard implantable cardioverter-defibrillator lead for permanent delivery of left bundle branch area pacing. Implantation was successful and safe in 11 of 12 patients, with adequate defibrillation testing, good electrical and electrocardiographic parameters, and uneventful device-related short-term follow-up.

据作者所知，他们首次报告了植入标准植入式心律转复除颤器导联用于永久性左束支区起搏的情况。12 位患者中有 11 位植入成功且安全，除颤测试充分，电学和心电图参数良好，设备相关的短期随访顺利。

引用次数: 0

Rate-Dependent Pacemap Matching in Scar-Related Ventricular Tachycardia 瘢痕相关性室性心动过速的心率依赖性起搏图匹配：TR 融合 "现象的影响。

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology

Pub Date : 2024-10-01 DOI: 10.1016/j.jacep.2024.06.034

Background

The impact of varying rates of pacemapping (PM) rates on QRS morphology and PM score matching in patients with scar-related ventricular tachycardia (VT) has not been systematically assessed.

Objectives

In this study, the authors sought to assess the variability in PM score matching at different pacing rates.

Methods

During substrate mapping for VT ablation, PM was performed at cycle lengths (CLs) of 600 ms, 500 ms, 400 ms, 300 ms, and VT CL. PM scores were compared for the entire QRS, the first half (H1) of QRS, and the second half (H2) of QRS to examine the influence of the preceding T-wave superimposed into the onset of paced QRS complex (TR fusion).

Results

A total of 269 PMs in 40 patients undergoing scar-related VT ablation were systematically analyzed. The PM score improved at rates closer to VT with a median difference of 6% (Q1-Q3: 4%-10%; range: 0%-33%) between the lowest and the highest PM scores at a given site. Greater slurring of the QRS onset was observed at faster-paced CL, corresponding to a superimposition of the preceding T-wave into QRS onset, with significant differences in H1 but not H2 of the QRS complex. At faster PM rates, 32% of overall sites developed pseudo delta wave and 69% of endocardial pacing sites fulfilled epicardial criteria.

Conclusions

The rate of pacemapping can significantly alter morphologic score matching, with the most optimal match observed closest to VT CL. The onset of QRS complex morphology is influenced by superimposition of the preceding T-wave at faster rates, resulting in an underrecognized TR fusion phenomenon that may confound epicardial electrocardiographic criteria predicated upon the initial QRS slope and vector.

背景尚未系统评估不同起搏率的起搏图（PM）对瘢痕相关室速（VT）患者 QRS 形态和 PM 评分匹配的影响。目的在本研究中，我们试图评估不同起搏率下 PM 评分匹配的可变性。方法在 VT 消融的基底映射期间，分别在周期长度（CL）为 600 ms、500 ms、400 ms、300 ms 和 VT CL 时进行 PM。对整个 QRS、QRS 的前半部分（H1）和 QRS 的后半部分（H2）的 PM 评分进行了比较，以检查前 T 波叠加到起搏 QRS 复极（TR 融合）的影响。结果系统分析了 40 名接受瘢痕相关 VT 消融术患者的 269 个 PM。PM 评分的改善率更接近 VT，特定部位最低和最高 PM 评分之间的中位差异为 6%（Q1-Q3：4%-10%；范围：0-33%）。在较快节奏的 CL 中观察到 QRS 起始点更加模糊，这与之前的 T 波叠加到 QRS 起始点有关，QRS 复极的 H1 有显著差异，但 H2 没有。结论：起搏频率可显著改变形态学评分匹配，最接近 VT CL 时可观察到最佳匹配。QRS 波群形态的起始受到前 T 波叠加的影响，导致 TR 融合现象未得到充分认识，这可能会混淆基于初始 QRS 斜率和矢量的心外膜心电图标准。

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引用次数: 0

Insights Into Left Bundle Branch Area Pacing: Important Lessons Learned. 左束支区起搏的启示：重要经验

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology

Pub Date : 2024-10-01 DOI: 10.1016/j.jacep.2024.09.014

Kenneth A Ellenbogen, Pranav Mankad

引用次数: 0

Very Late Atrial Arrhythmia Recurrence After Initial Successful AF Ablation 首次成功房颤消融后极晚的房性心律失常复发：连续监测的启示

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology

Pub Date : 2024-10-01 DOI: 10.1016/j.jacep.2024.07.006

引用次数: 0

Successful Implantation of Defibrillator Leads for Left Bundle Branch Pacing 为左束支起搏成功植入除颤器导线

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology

Pub Date : 2024-10-01 DOI: 10.1016/j.jacep.2024.08.011

引用次数: 0

Optimal Threshold and Interpatient Variability in Left Atrial Ablation Scar Assessment by Dark-Blood LGE CMR 通过暗血 LGE CMR 评估左心房消融瘢痕的最佳阈值和患者间变异性

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology

Pub Date : 2024-10-01 DOI: 10.1016/j.jacep.2024.05.017

Background

Dark-blood late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) has better correlation with bipolar voltage (BiV) to define ablation scar in the left atrium (LA) compared to conventional bright-blood LGE CMR.

Objectives

This study sought to determine the optimal signal intensity threshold of dark-blood LGE CMR to identify LA ablation scar.

Methods

In 54 patients scheduled for atrial fibrillation ablation, image intensity ratios (IIRs) were derived from preprocedural dark-blood LGE CMR. In 26 patients without previous ablation, the upper limit of normal was derived from the 95th and 98th percentiles of pooled IIR values. In 28 patients with previous atrial fibrillation ablation, BiV was compared with the corresponding IIR. Receiver-operating characteristics analyses were employed to determine the optimal IIR threshold (ie, the point with the smallest distance to the upper left corner of the receiver-operating characteristics) for LA ablation scar (BiV ≤0.15 mV).

Results

Upper limit of normal corresponded to IIR values 1.16 and 1.21, yielding low sensitivities of 0.32 and 0.09 to detect LA ablation scar. Receiver-operating characteristics analysis of IIR and BiV comparison achieved a median area under the curve of 0.77. Median optimal IIR threshold for LA ablation scar was 1.09, with an average sensitivity of 0.73, specificity of 0.75, and accuracy of 0.71. Median IIR thresholds of 1.00 and 1.10 corresponded to 80% sensitivity and 80% specificity, respectively. There was considerable interpatient variability: optimal IIR thresholds per patient ranged from 1.01 to 1.22.

Conclusions

The optimal IIR threshold to identify LA ablation scar by dark-blood LGE CMR is 1.09. Because of interpatient variability, the investigators recommend using a lower (1.00) and upper (1.10) threshold to prevent over- or underestimation of ablation scar.

背景：与传统的亮血 LGE CMR 相比，暗血晚期钆增强（LGE）心脏磁共振（CMR）与双极电压（BiV）在确定左心房（LA）消融瘢痕方面具有更好的相关性：本研究旨在确定暗血 LGE CMR 识别 LA 消融瘢痕的最佳信号强度阈值：方法：在 54 名计划接受心房颤动消融术的患者中，通过术前暗血 LGE CMR 得出图像强度比 (IIR)。在 26 名既往未接受过消融术的患者中，正常值的上限来自于综合 IIR 值的第 95 和第 98 百分位数。在 28 位既往接受过心房颤动消融术的患者中，BiV 与相应的 IIR 进行了比较。采用接收器操作特征分析确定 LA 消融瘢痕的最佳 IIR 阈值（即与接收器操作特征左上角距离最小的点）（BiV ≤0.15 mV）：正常值上限对应的 IIR 值为 1.16 和 1.21，检测 LA 消融瘢痕的灵敏度较低，分别为 0.32 和 0.09。对 IIR 和 BiV 比较进行的接收方操作特征分析得出的中位曲线下面积为 0.77。检测 LA 消融瘢痕的最佳 IIR 阈值中位数为 1.09，平均灵敏度为 0.73，特异度为 0.75，准确度为 0.71。中位 IIR 阈值 1.00 和 1.10 分别对应 80% 的灵敏度和 80% 的特异性。患者之间的差异很大：每位患者的最佳 IIR 阈值从 1.01 到 1.22 不等：结论：通过暗血 LGE CMR 识别 LA 消融瘢痕的最佳 IIR 阈值为 1.09。由于患者之间存在差异，研究者建议使用较低（1.00）和较高（1.10）的阈值，以防止过高或过低估计消融瘢痕。

{"title":"Optimal Threshold and Interpatient Variability in Left Atrial Ablation Scar Assessment by Dark-Blood LGE CMR","authors":"","doi":"10.1016/j.jacep.2024.05.017","DOIUrl":"10.1016/j.jacep.2024.05.017","url":null,"abstract":"<div><h3>Background</h3><div>Dark-blood late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) has better correlation with bipolar voltage (BiV) to define ablation scar in the left atrium (LA) compared to conventional bright-blood LGE CMR.</div></div><div><h3>Objectives</h3><div>This study sought to determine the optimal signal intensity threshold of dark-blood LGE CMR to identify LA ablation scar.</div></div><div><h3>Methods</h3><div>In 54 patients scheduled for atrial fibrillation ablation, image intensity ratios (IIRs) were derived from preprocedural dark-blood LGE CMR. In 26 patients without previous ablation, the upper limit of normal was derived from the 95th and 98th percentiles of pooled IIR values. In 28 patients with previous atrial fibrillation ablation, BiV was compared with the corresponding IIR. Receiver-operating characteristics analyses were employed to determine the optimal IIR threshold (ie, the point with the smallest distance to the upper left corner of the receiver-operating characteristics) for LA ablation scar (BiV ≤0.15 mV).</div></div><div><h3>Results</h3><div>Upper limit of normal corresponded to IIR values 1.16 and 1.21, yielding low sensitivities of 0.32 and 0.09 to detect LA ablation scar. Receiver-operating characteristics analysis of IIR and BiV comparison achieved a median area under the curve of 0.77. Median optimal IIR threshold for LA ablation scar was 1.09, with an average sensitivity of 0.73, specificity of 0.75, and accuracy of 0.71. Median IIR thresholds of 1.00 and 1.10 corresponded to 80% sensitivity and 80% specificity, respectively. There was considerable interpatient variability: optimal IIR thresholds per patient ranged from 1.01 to 1.22.</div></div><div><h3>Conclusions</h3><div>The optimal IIR threshold to identify LA ablation scar by dark-blood LGE CMR is 1.09. Because of interpatient variability, the investigators recommend using a lower (1.00) and upper (1.10) threshold to prevent over- or underestimation of ablation scar.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":null,"pages":null},"PeriodicalIF":8.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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