Journal of Cardiovascular Electrophysiology最新文献

Background: Accessory pathways (APs) from the atrial appendage are uncommon and primarily described on the right side. Furthermore, connections involving the left atrial appendage (LAA) are even rarer.

Methods and results: This case report describes a 27-year-old female with recurrent supraventricular tachycardia (SVT) due to Wolff-Parkinson-White (WPW) syndrome. Electrophysiological evaluation identified dual atrioventricular (AV) connections: one from the LAA and another from the left coronary cusp (LCC).

Conclusion: The electrical characteristics of WPW syndrome need a deeper understanding. The retrograde conduction can persist even after successfully eliminating the antegrade conduction.

Introduction: The Aveir Dual-Chamber (DR) is the first entirely intracardiac dual-chamber leadless pacing system. Implantation of this device is typically achieved via femoral access, which may be a significant obstacle in patients with complex femoral vasculature or contraindications to femoral access.

Methods and results: This report describes the world's first three cases of dual-chamber leadless pacemaker implantation via the right internal jugular vein.

Conclusions: The intrajugular approach is a feasible, safe, and efficient alternative to femoral access for any patient receiving or upgrading to an Aveir DR.

Background: Recent advancements in ultra-high-density mapping (UHDM) featuring automated functionalities have enhanced our understanding of micro-reentrant atrial tachycardias (mAT) circuits and the precise localization of the origin.

Purpose: To evaluate the diagnostic support provided by an automated UHDM algorithm in guiding the ablation of mATs.

Methods: Consecutive patients eligible for AT ablation in 22 Italian centers were prospectively enrolled. All ATs were comprehensively mapped in either the left or right atrium utilizing the RHYTHMIA mapping system. The LUMIPOINT tool was systematically employed to confirm electrogram fragmentation within this defined area.

Results: Among 159 ATs analyzed, 97 (61.0%) were identified as macro-reentrant ATs, 50 (31.4%) as focal ATs and 12 (7.5%) as mATs. Concerning the mAT group, the targeted activity was localized in the anterior wall in 4 cases (33.3%), in proximity to PVs in 3 cases (25%), along the left ridge in 2 cases (16.6%), and at the roof, in the free wall and along the CTI in 1 case (8.3%), respectively. Low voltage areas (< 0.1 mV) were detected in all mAT cases and colocalized with the origin site. Over a median of 288 [248-349] days of follow-up, 5 (3.1%) patients suffered from an AT/AF arrhythmia recurrence: 3 (3.1%) were in the MAT group, 1 (2%) in the focal AT and 1 (8.3%) in the mAT group.

Conclusion: A novel automated algorithm for mAT identification, coupled with ORION catheter, enables mAT description and transcatheter ablation of the localized origin of this rare form of AT results in a satisfactory procedural success rate.

Trial registration: Catheter Ablation of Arrhythmias With High-Density Mapping System in the Real World Practice (CHARISMA). http://clinicaltrials.gov/ Identifier: NCT03793998.

Aims: This project aimed to evaluate current practices of trained nurses performing implantable cardiac monitor (ICM) implantations and remote follow-ups in Italy, assessing hospital protocols and nurses' perceptions.

Methods: An anonymous survey was conducted among 163 trained nurses across 75 Italian hospitals, focusing on their ICM implantation and remote monitoring practices. Data collected included hospital characteristics and protocols, barriers to implementation, and nurses' feedback on their experiences.

Results: Of the 112 respondents (69% response rate), 60% reported that nurses in their hospitals are authorized to perform ICM implantations, and 70% said that they can manage all remote monitoring tasks. Thirty-three (29%) nurses manage all aspects of ICM patient care, including implantation, programming, enrollment in remote monitoring, training, data review, and follow-up. Fifty-five percent of nurses perform a part of ICM implants outside the EP/Cath lab, and for 31%, this is the primary location. 84% of implanter nurses achieved autonomy after < 10 supervised implants. More than 90% of implanter nurses consider ICM implantation rewarding and 96% find it safe and easy with the provided kit. However, only 33% and 17% of nurses had written protocols at their hospital, to guide ICM implantation and remote monitoring, respectively.

Conclusions: Nurse-led ICM implantation and remote follow-up are becoming established practices in Italy, with many nurses operating independently. Despite this progress, the absence of standard operating procedures limits the widespread adoption of these practices. Clear national and international protocols are essential to enhance nurse training, ensure safe practices, and ultimately improve patient care in ICM management.

Background: Left bundle branch pacing (LBBP) emerged as a novel physiological pacing modality that improves clinical outcomes. This study aimed to explore the impact of LBBP on QRS wave amplitude (RWA).

Methods: This prospective observational study included patients with complete left bundle branch block (CLBBB) and cardiac resynchronization therapy (CRT) indication, as well as patients with QRSd < 120 ms and pacemaker indication. During the procedure, when the LBBP lead reached the target site, 12-lead ECGs at baseline and 1, 2, 3, 4, and 5 times the pacing thresholds and 3.5 V (pacemaker default value) pacing were recorded, and RWA values were measured accordingly. The absolute values of I + aVL, II + III+ aVF, and V1 + V2 + V3 + V4 + V5 + V6 RWA were defined as X-, Y-, and Z-axis ΣRWA.

Results: A total of 195 consecutive patients (50 CLBBB and 145 narrow QRS) were enrolled (69.7 ± 10.3 years, 52.3% male). Compared with the baseline, LBBP significantly increased X- and Y-axis ΣRWA independent of pacing voltage in CLBBB (ΔX/Y-axis 0.49 ± 0.78 mV, p < 0.0001/0.61 ± 1.24 mV, p = 0.001) and narrow QRS group (ΔX/Y-axis 0.88 ± 0.61 mV, p < 0.0001/0.91 ± 1.05 mV, p < 0.0001); LBBP significantly reduced Z-axis ΣRWA in CLBBB patients (ΔZ-axis -2.64 ± 3.67 mV, p < 0.0001) but not in narrow QRS group (ΔZ-axis -0.14 ± 1.87 mV, p = 0.36). LBBP significantly improved cardiac function at 1 week of follow-up.

Conclusions: LBBP significantly increased X/Y-axis ΣRWA independent of pacing voltage in CLBBB and narrow QRS patients. LBBP significantly reduced Z-axis ΣRWA in CLBBB but not in narrow QRS patients. Whether these ΣRWA changes, through enhancing whole myocardial contractility, have a synergistic effect with LBBP synchronization to further improve cardiac function remains to be investigated.

Background: The majority of data on left bundle branch area pacing (LBBAP) are on a lumenless lead. Data on the safety and effectiveness of stylet driven leads are comparatively lacking.

Methods: We retrospectively analyzed 265 patients who underwent attempted LBBAP with an 7842 (Boston Scientific, Marlborough, MA) lead in the Duke University Health System between 1/1/2020 and 9/1/2023. Outcomes of interest included post-operative 7842 helix extension (≥2 helix rotations beyond the lead tip), complications, and lead parameters. A nested analysis of single and dual chamber LBBAP attempts was performed to compare outcomes among similar patients who underwent attempted LBBAP with the lumenless 3830 (Medtronic, Mineappolis, MN) lead.

Results: LBBAP success with 7842 was 89.8%. Characteristics were similar among patients with (n = 238) and without (n = 27) successful implants. Helix extension was evaluable for 222 of 238 successful 7842 implants. Of evaluable leads, helix extension was complete for 174 leads (78%), and partial for 48 (21.6%). A trend towards lower dislodgement rates was observed in patients with full versus partial extension (2.9% vs. 8.3%, p = 0.0895) and the rate of full helix extension increased over time (64.1% over 24 months vs. 81.4% over 21 months, p = 0.0162). The success rate of 3830 LBBAP implants (n = 140) was 92.8% (p = 0.069 vs. 7842). At implant, R waves were similar for 7842 and 3830 leads but were greater for 7842 during follow-up (14.4 + /-0.77 vs. 11.3 + /-0.68, p = 0.004). Pacing impedances were higher with 7842 compared with 3830 at baseline (838 + /-10.44 ohms vs. 772 + /-14.58 ohms, p < 0.001) and during follow-up (652 + /-11.0 ohms vs. 513 + /-9.18 ohms, p < 0.001); similarly, 7842 pacing thresholds (@ 0.4 ms) were slightly higher at baseline (0.85 V + /-0.03 vs. 0.68 V + /-0.03, p < 0.001) and 6 months (0.95 V + /-0.03 vs. 0.80 V + /-0.03, p < 0.001) compared with those for the lumenless 3830.

Conclusion: LBBAP implant success rates, complications, and pacing parameters using the 7842 lead are stable over time, and appeared overall similar to the 3830 lead. Incomplete 7842 helix extension is a modifiable risk factor for lead dislodgement.