Pierre Ollitrault, Jonaz Font, Virginie Ferchaud, Mayane Al Khoury, Arnaud Pellissier, Paul Milliez, Laure Champ‐Rigot
{"title":"A highly symptomatic loss of CRT: What is the mechanism?","authors":"Pierre Ollitrault, Jonaz Font, Virginie Ferchaud, Mayane Al Khoury, Arnaud Pellissier, Paul Milliez, Laure Champ‐Rigot","doi":"10.1111/pace.14978","DOIUrl":"https://doi.org/10.1111/pace.14978","url":null,"abstract":"","PeriodicalId":19650,"journal":{"name":"Pacing and Clinical Electrophysiology","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140804509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christopher Sefton, Christine Tanaka‐Esposito, Thomas Dresing, Justin Lee, Roy Chung
IntroductionConcomitant left bundle branch area pacing (LBBAP) with atrioventricular (AV) nodal ablation is emerging as a viable management option in atrial fibrillation refractory to medical management. Its viability in patients with pulmonary disease and atrial fibrillation is unknown.Methods and resultsThis is a retrospective, observational cohort study in consecutive patients who underwent concomitant LBBAP with AV nodal ablation with advanced pulmonary disease at the Cleveland Clinic Fairview Hospital between January 2019 and January 2023. Patient characteristics, comorbidities, and medication use were extracted via chart review. Rates of hospitalizations, medication use, and structural disease seen on echocardiography were compared before and after the procedure. There were 27 patients with group 3 pulmonary hypertension who underwent the procedure. In the 24 months preprocedure, there were 114 admissions for heart failure or atrial fibrillation compared to 9 admissions postprocedure (p < .001). Mean follow up was 17.3 ± 12.1 months. There were no significant complications or lead dislodgements. Echocardiographic characteristics were similar prior to and after pacemaker implantation. Use of medications for rate and rhythm control was common preprocedure, and was reduced dramatically postprocedure.ConclusionThis small, retrospective cohort study suggests concomitant LBBAP with AV nodal ablation may be safe and efficacious for management of atrial fibrillation in patients with advanced pulmonary disease.
{"title":"Outcomes of combined left bundle branch area pacing with atrioventricular nodal ablation in patients with atrial fibrillation and pulmonary disease","authors":"Christopher Sefton, Christine Tanaka‐Esposito, Thomas Dresing, Justin Lee, Roy Chung","doi":"10.1111/pace.14990","DOIUrl":"https://doi.org/10.1111/pace.14990","url":null,"abstract":"IntroductionConcomitant left bundle branch area pacing (LBBAP) with atrioventricular (AV) nodal ablation is emerging as a viable management option in atrial fibrillation refractory to medical management. Its viability in patients with pulmonary disease and atrial fibrillation is unknown.Methods and resultsThis is a retrospective, observational cohort study in consecutive patients who underwent concomitant LBBAP with AV nodal ablation with advanced pulmonary disease at the Cleveland Clinic Fairview Hospital between January 2019 and January 2023. Patient characteristics, comorbidities, and medication use were extracted via chart review. Rates of hospitalizations, medication use, and structural disease seen on echocardiography were compared before and after the procedure. There were 27 patients with group 3 pulmonary hypertension who underwent the procedure. In the 24 months preprocedure, there were 114 admissions for heart failure or atrial fibrillation compared to 9 admissions postprocedure (<jats:italic>p</jats:italic> < .001). Mean follow up was 17.3 ± 12.1 months. There were no significant complications or lead dislodgements. Echocardiographic characteristics were similar prior to and after pacemaker implantation. Use of medications for rate and rhythm control was common preprocedure, and was reduced dramatically postprocedure.ConclusionThis small, retrospective cohort study suggests concomitant LBBAP with AV nodal ablation may be safe and efficacious for management of atrial fibrillation in patients with advanced pulmonary disease.","PeriodicalId":19650,"journal":{"name":"Pacing and Clinical Electrophysiology","volume":"93 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140628740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Francis Phan, Saket Sanghai, Uday Sandhu, Chris Verdick, Angela Krebsbach, Castigliano M. Bhamidipati, Frederick A. Tibayan, Peter Jessel, Charles A. Henrikson
BackgroundLead dwell time is the single strongest predictor of failure and complications in transvenous lead extraction.ObjectivesTo report the success rate and complications of transvenous lead extractions with implant dwell time of at least 15 years.MethodsProcedural and patient data were prospectively collected into a database. The excimer laser was the primary method for lead extraction with the use of mechanical rotational sheaths and femoral snares at operator discretion.ResultsA total of 442 patients between 2011 and 2020 underwent lead extraction (705 leads) primarily for infection or device failure at our high‐volume center. Forty‐one patients with 71 leads > 15 years old were included in this cohort. Mean patient age was 53.5 ± 18.5 years, 67.5% were male. Mean lead dwell time was 19.6 ± 4.4 years. Thirty‐six of 41 (88%) patients had successful extraction of all leads compared to 96% in the remaining 401 patients, p value.004. Of the five patients without fully successful extractions two of these patients had abandoned leads (three total) that were clinically significant. There were two (4.9%) major complications in the very old lead group and six (1.5%) in the other group. In the very old lead group, one patient experienced right atrial appendage perforation requiring surgical repair and recovered well. One patient experienced new complete heart block requiring 2 min of CPR but did well thereafter. There was no procedure‐related mortality.ConclusionsDespite challenges posed by older leads, very old leads can be safely and effectively extracted with low complication rates.
{"title":"Out with the old: Single center experience with transvenous extraction of leads older than 15 years","authors":"Francis Phan, Saket Sanghai, Uday Sandhu, Chris Verdick, Angela Krebsbach, Castigliano M. Bhamidipati, Frederick A. Tibayan, Peter Jessel, Charles A. Henrikson","doi":"10.1111/pace.14989","DOIUrl":"https://doi.org/10.1111/pace.14989","url":null,"abstract":"BackgroundLead dwell time is the single strongest predictor of failure and complications in transvenous lead extraction.ObjectivesTo report the success rate and complications of transvenous lead extractions with implant dwell time of at least 15 years.MethodsProcedural and patient data were prospectively collected into a database. The excimer laser was the primary method for lead extraction with the use of mechanical rotational sheaths and femoral snares at operator discretion.ResultsA total of 442 patients between 2011 and 2020 underwent lead extraction (705 leads) primarily for infection or device failure at our high‐volume center. Forty‐one patients with 71 leads > 15 years old were included in this cohort. Mean patient age was 53.5 ± 18.5 years, 67.5% were male. Mean lead dwell time was 19.6 ± 4.4 years. Thirty‐six of 41 (88%) patients had successful extraction of all leads compared to 96% in the remaining 401 patients, <jats:italic>p</jats:italic> value.004. Of the five patients without fully successful extractions two of these patients had abandoned leads (three total) that were clinically significant. There were two (4.9%) major complications in the very old lead group and six (1.5%) in the other group. In the very old lead group, one patient experienced right atrial appendage perforation requiring surgical repair and recovered well. One patient experienced new complete heart block requiring 2 min of CPR but did well thereafter. There was no procedure‐related mortality.ConclusionsDespite challenges posed by older leads, very old leads can be safely and effectively extracted with low complication rates.","PeriodicalId":19650,"journal":{"name":"Pacing and Clinical Electrophysiology","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140628956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BackgroundAtrial fibrillation (AF) is the most common sustained atrial arrhythmia. Accurate detection of the timing and possibility of AF termination is vital for optimizing rhythm and rate control strategies. The present study evaluated whether the ventricular response (VR) in AF offers a distinctive electrocardiographic indicator for predicting AF termination.MethodsPatients experiencing sustained paroxysmal AF for more than 3 h were observed using 24‐h ambulatory Holter monitoring. VR within 5 min before AF termination (VR 0–5 min, BAFT) was compared with VR observed during the 60th to 65th min (VR 60–65 min, BAFT) and the 120th to 125th min (VR 120–125 min, BAFT) before AF termination. Maximum and minimum VRs were calculated on the basis of the average of the highest and lowest VRs across 10 consecutive heartbeats.ResultsData from 37 episodes of paroxysmal AF revealed that the minimum VR0–5 min, BAFT (64 ± 20 bpm) was significantly faster than both the minimum VR120–125 min, BAFT (56 ± 15 bpm) and the minimum VR60–65 min, BAFT (57 ± 16 bpm, p < .05). Similarly, the maximum VR0–5 min, BAFT (158 ± 49 bpm) was significantly faster than the maximum VR120–125 min, BAFT (148 ± 45 bpm, p < .05). In the daytime, the minimum VR0–5 min, BAFT (66 ± 20 bpm) was significantly faster than both the minimum VR60–65 min, BAFT (58 ± 17 bpm) and minimum VR120–125 min, BAFT (57 ± 15 bpm, p < .05). However, the mean and maximum VR0–5 min, BAFT in the daytime were similar to the mean and maximum VR120–125 min in the daytime, respectively. At night, the minimum, mean, and maximum VR0–5 min, BAFT were similar to the minimum, mean, and maximum VR120–125 min, respectively.ConclusionsElevated VR rates during AF episodes may be predictors for the termination of AF, especially during the daytime and in patients with nondilated left atria. These findings may guide the development of clinical approaches to rhythm control in AF.
{"title":"Ventricular response as a predictor of the termination of sustained paroxysmal atrial fibrillation","authors":"Jen‐Hung Huang, Yung‐Kuo Lin, Ming‐Hsiung Hsieh, Shih‐Ann Chen, Yi‐Jen Chen","doi":"10.1111/pace.14985","DOIUrl":"https://doi.org/10.1111/pace.14985","url":null,"abstract":"BackgroundAtrial fibrillation (AF) is the most common sustained atrial arrhythmia. Accurate detection of the timing and possibility of AF termination is vital for optimizing rhythm and rate control strategies. The present study evaluated whether the ventricular response (VR) in AF offers a distinctive electrocardiographic indicator for predicting AF termination.MethodsPatients experiencing sustained paroxysmal AF for more than 3 h were observed using 24‐h ambulatory Holter monitoring. VR within 5 min before AF termination (VR <jats:sub>0–5 min, BAFT</jats:sub>) was compared with VR observed during the 60th to 65th min (VR <jats:sub>60–65 min, BAFT</jats:sub>) and the 120th to 125th min (VR <jats:sub>120–125 min, BAFT</jats:sub>) before AF termination. Maximum and minimum VRs were calculated on the basis of the average of the highest and lowest VRs across 10 consecutive heartbeats.ResultsData from 37 episodes of paroxysmal AF revealed that the minimum VR<jats:sub>0–5 min, BAFT</jats:sub> (64 ± 20 bpm) was significantly faster than both the minimum VR<jats:sub>120–125 min, BAFT</jats:sub> (56 ± 15 bpm) and the minimum VR<jats:sub>60–65 min, BAFT</jats:sub> (57 ± 16 bpm, <jats:italic>p</jats:italic> < .05). Similarly, the maximum VR<jats:sub>0–5 min, BAFT</jats:sub> (158 ± 49 bpm) was significantly faster than the maximum VR<jats:sub>120–125 min, BAFT</jats:sub> (148 ± 45 bpm, <jats:italic>p</jats:italic> < .05). In the daytime, the minimum VR<jats:sub>0–5 min, BAFT</jats:sub> (66 ± 20 bpm) was significantly faster than both the minimum VR<jats:sub>60–65 min, BAFT</jats:sub> (58 ± 17 bpm) and minimum VR<jats:sub>120–125 min, BAFT</jats:sub> (57 ± 15 bpm, <jats:italic>p</jats:italic> < .05). However, the mean and maximum VR<jats:sub>0–5 min, BAFT</jats:sub> in the daytime were similar to the mean and maximum VR<jats:sub>120–125 min</jats:sub> in the daytime, respectively. At night, the minimum, mean, and maximum VR<jats:sub>0–5 min, BAFT</jats:sub> were similar to the minimum, mean, and maximum VR<jats:sub>120–125 min</jats:sub>, respectively.ConclusionsElevated VR rates during AF episodes may be predictors for the termination of AF, especially during the daytime and in patients with nondilated left atria. These findings may guide the development of clinical approaches to rhythm control in AF.","PeriodicalId":19650,"journal":{"name":"Pacing and Clinical Electrophysiology","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140612541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ruina Zhang, Kabir V. Malkani, James K. Gabriels, Elizabeth Reznik, Han A. Li, Ari G. Mandler, Veronica Qu, James E. Ip, George Thomas, Christopher F. Liu, Steven M. Markowitz, Bruce B Lerman, Jim W. Cheung
BackgroundSeveral studies have demonstrated that females have a higher risk of arrhythmia recurrence after pulmonary vein (PV) isolation for atrial fibrillation (AF). There are limited data on sex‐based differences in PV reconnection rates at repeat ablation. We aimed to investigate sex‐based differences in electrophysiological findings and atrial arrhythmia recurrence after repeat AF ablationMethodsWe conducted a retrospective study of 161 consecutive patients (32% female, age 65 ± 10 years) who underwent repeat AF ablation after index PV isolation between 2010 and 2022. Demographics, procedural characteristics and follow‐up data were collected. Recurrent atrial tachycardia (AT)/AF was defined as any atrial arrhythmia ≥30 s in duration.ResultsCompared to males, females tended to be older and had a significantly higher prevalence of prior valve surgery (10 vs. 2%; P = .03). At repeat ablation, PV reconnection was found in 119 (74%) patients. Males were more likely to have PV reconnection at repeat ablation compared to females (81 vs. 59%; P = .004). Excluding repeat PV isolation, there were no significant differences in adjunctive ablation strategies performed at repeat ablation between females and males. During follow‐up, there were no significant differences in freedom from AT/AF recurrence between females and males after repeat ablation (63 vs. 59% at 2 years, respectively; P = .48).ConclusionsAfter initial PV isolation, significantly fewer females have evidence of PV reconnection at the time of repeat ablation for recurrent AF. Despite this difference, long‐term freedom from AT/AF was similar between females and males after repeat ablation.
{"title":"Rates of pulmonary vein reconnection at repeat ablation for recurrent atrial fibrillation and its impact on outcomes among females and males","authors":"Ruina Zhang, Kabir V. Malkani, James K. Gabriels, Elizabeth Reznik, Han A. Li, Ari G. Mandler, Veronica Qu, James E. Ip, George Thomas, Christopher F. Liu, Steven M. Markowitz, Bruce B Lerman, Jim W. Cheung","doi":"10.1111/pace.14984","DOIUrl":"https://doi.org/10.1111/pace.14984","url":null,"abstract":"BackgroundSeveral studies have demonstrated that females have a higher risk of arrhythmia recurrence after pulmonary vein (PV) isolation for atrial fibrillation (AF). There are limited data on sex‐based differences in PV reconnection rates at repeat ablation. We aimed to investigate sex‐based differences in electrophysiological findings and atrial arrhythmia recurrence after repeat AF ablationMethodsWe conducted a retrospective study of 161 consecutive patients (32% female, age 65 ± 10 years) who underwent repeat AF ablation after index PV isolation between 2010 and 2022. Demographics, procedural characteristics and follow‐up data were collected. Recurrent atrial tachycardia (AT)/AF was defined as any atrial arrhythmia ≥30 s in duration.ResultsCompared to males, females tended to be older and had a significantly higher prevalence of prior valve surgery (10 vs. 2%; <jats:italic>P</jats:italic> = .03). At repeat ablation, PV reconnection was found in 119 (74%) patients. Males were more likely to have PV reconnection at repeat ablation compared to females (81 vs. 59%; <jats:italic>P</jats:italic> = .004). Excluding repeat PV isolation, there were no significant differences in adjunctive ablation strategies performed at repeat ablation between females and males. During follow‐up, there were no significant differences in freedom from AT/AF recurrence between females and males after repeat ablation (63 vs. 59% at 2 years, respectively; <jats:italic>P</jats:italic> = .48).ConclusionsAfter initial PV isolation, significantly fewer females have evidence of PV reconnection at the time of repeat ablation for recurrent AF. Despite this difference, long‐term freedom from AT/AF was similar between females and males after repeat ablation.","PeriodicalId":19650,"journal":{"name":"Pacing and Clinical Electrophysiology","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140562382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Warren D. Backman, Michael V. DiCaro, Xintong Zuo, Adelqui Peralta, Ariela R. Orkaby
BackgroundPatients ≥80 with implantable cardioverter‐defibrillators (ICDs) have high rates of hospitalization and mortality, yet few have documented advance directives. We sought to determine the prevalence of advance directives in adults ≥80 years with ICDs, focusing on those with frailty and cognitive impairment.MethodsProspective cohort study (July 2016–May 2019) in an electrophysiology clinic. Presence of advance directives (health care proxies [HCP] and living wills [LW], or medical orders for life‐sustaining treatment [MOLST]) was determined by medical record review. Frailty and cognitive impairment were screened using 4‐m gait speed and Mini‐Cog.Results77 Veterans were evaluated. Mean age 84 years, 100% male, 70% frail. Overall, 52 (68%) had an HCP and 37 (48%) had a LW/MOLST. Of 67 with cognitive testing, 36% were impaired. HCP documentation was similar among frail and non‐frail (69% vs. 65%). LW/MOLST was more prevalent among frail versus non‐frail (52% vs. 39%). There was no difference in HCP documentation by cognitive status (67%). A LW/MOLST was more frequent for cognitively impaired versus non‐impaired (50% vs. 42%). Among 19 Veterans who were frail and cognitively impaired, 14 (74%) had an HCP and 11 (58%) had a LW/MOLST.ConclusionsMost Veterans had a documented advance directive, but a significant minority did not. Simple frailty and cognitive screening tools can rapidly identify patients for whom discussion of advance directives is especially important.
{"title":"Aligning goals with care: Advance directives in older adults with implantable cardioverter‐defibrillators","authors":"Warren D. Backman, Michael V. DiCaro, Xintong Zuo, Adelqui Peralta, Ariela R. Orkaby","doi":"10.1111/pace.14983","DOIUrl":"https://doi.org/10.1111/pace.14983","url":null,"abstract":"BackgroundPatients ≥80 with implantable cardioverter‐defibrillators (ICDs) have high rates of hospitalization and mortality, yet few have documented advance directives. We sought to determine the prevalence of advance directives in adults ≥80 years with ICDs, focusing on those with frailty and cognitive impairment.MethodsProspective cohort study (July 2016–May 2019) in an electrophysiology clinic. Presence of advance directives (health care proxies [HCP] and living wills [LW], or medical orders for life‐sustaining treatment [MOLST]) was determined by medical record review. Frailty and cognitive impairment were screened using 4‐m gait speed and Mini‐Cog.Results77 Veterans were evaluated. Mean age 84 years, 100% male, 70% frail. Overall, 52 (68%) had an HCP and 37 (48%) had a LW/MOLST. Of 67 with cognitive testing, 36% were impaired. HCP documentation was similar among frail and non‐frail (69% vs. 65%). LW/MOLST was more prevalent among frail versus non‐frail (52% vs. 39%). There was no difference in HCP documentation by cognitive status (67%). A LW/MOLST was more frequent for cognitively impaired versus non‐impaired (50% vs. 42%). Among 19 Veterans who were frail and cognitively impaired, 14 (74%) had an HCP and 11 (58%) had a LW/MOLST.ConclusionsMost Veterans had a documented advance directive, but a significant minority did not. Simple frailty and cognitive screening tools can rapidly identify patients for whom discussion of advance directives is especially important.","PeriodicalId":19650,"journal":{"name":"Pacing and Clinical Electrophysiology","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140562474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abhinav B. Anand, Ankita A. Kulkarni, Gaurav D. Jaju, Girish R. Sabnis, Ajay U. Mahajan
We present a case of a neonate who presented with worsening heart failure due to congenital complete atrioventricular (AV) block, secondary to maternal anti Ro/SSA and anti‐LA/SSB antibodies. The patient was implanted a temporary pacemaker in view of hemodynamic deterioration and subsequently was weaned off ionotropic support and referred for permanent epicardial pacemaker implantation. We report temporary pacemaker implantation in a neonate with hemodynamic instability as a stabilizing measure and discuss technical challenges for the same.
{"title":"Temporary pacing through umbilical venous route for neonatal heart failure due to complete atrioventricular block","authors":"Abhinav B. Anand, Ankita A. Kulkarni, Gaurav D. Jaju, Girish R. Sabnis, Ajay U. Mahajan","doi":"10.1111/pace.14986","DOIUrl":"https://doi.org/10.1111/pace.14986","url":null,"abstract":"We present a case of a neonate who presented with worsening heart failure due to congenital complete atrioventricular (AV) block, secondary to maternal anti Ro/SSA and anti‐LA/SSB antibodies. The patient was implanted a temporary pacemaker in view of hemodynamic deterioration and subsequently was weaned off ionotropic support and referred for permanent epicardial pacemaker implantation. We report temporary pacemaker implantation in a neonate with hemodynamic instability as a stabilizing measure and discuss technical challenges for the same.","PeriodicalId":19650,"journal":{"name":"Pacing and Clinical Electrophysiology","volume":"185 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140562651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pasquale Crea, Paolo Bellocchi, Federica Cocuzza, Antonino Micari, Lilia Oreto
A 16‐year‐old female with dual‐chamber pacemaker (Medtronic Azure XT DR), due to symptomatic third‐degree congenital atrioventricular (AV) block, presented to our ambulatory with dizziness and presyncopal episodes preceded by prodromes, occurring over the last few months. The device was programmed in DDD mode with an upper rate of 150 bpm. A head‐up Tilt Test (HUTT) revealed the unexpected emergence of 2:1 electronic AV block at a sinus rate of 130 bpm.
{"title":"2:1 electronic AV block due to inappropriate automatic post‐ventricular atrial refractory period extension","authors":"Pasquale Crea, Paolo Bellocchi, Federica Cocuzza, Antonino Micari, Lilia Oreto","doi":"10.1111/pace.14982","DOIUrl":"https://doi.org/10.1111/pace.14982","url":null,"abstract":"A 16‐year‐old female with dual‐chamber pacemaker (Medtronic Azure XT DR), due to symptomatic third‐degree congenital atrioventricular (AV) block, presented to our ambulatory with dizziness and presyncopal episodes preceded by prodromes, occurring over the last few months. The device was programmed in DDD mode with an upper rate of 150 bpm. A head‐up Tilt Test (HUTT) revealed the unexpected emergence of 2:1 electronic AV block at a sinus rate of 130 bpm.","PeriodicalId":19650,"journal":{"name":"Pacing and Clinical Electrophysiology","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140562465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hikmet Yorgun, Cem Coteli, Gül Sinem Kılıç, Kudret Aytemir
Atrial tachycardia (AT) is a common rhythm disorder, especially in patients with atrial structural abnormalities. Although voltage mapping can provide a general picture of structural alterations which are mainly secondary to prior ablations, surgery or pressure/volume overload, data is scarce regarding the functional characteristics of low voltage regions in the atrium to predict critical isthmus of ATs. Recently, functional substrate mapping (FSM) emerged as a potential tool to evaluate the functionality of structurally altered regions in the atrium to predict critical sites of reentry. Current evidence suggested a clear association between deceleration zones of isochronal late activation mapping (ILAM) during sinus/paced rhythm and critical isthmus of reentry in patients with left AT. Therefore, these areas seem to be potential ablation targets even not detected during AT. Furthermore, abnormal conduction detected by ILAM may also have a role to identify the potential substrate and predict atrial fibrillation outcome after pulmonary vein isolation. Despite these promising findings, the utility of such an approach needs to be evaluated in large‐scale comparative studies. In this review, we aimed to share our experience and review the current literature regarding the use of FSM during sinus/paced rhythm in the prediction of re‐entrant ATs and discuss future implications and potential use in patients with atrial low‐voltage areas.
房性心动过速（AT）是一种常见的心律失常，尤其是在心房结构异常的患者中。虽然电压图可以提供结构改变的总体情况，而结构改变主要是继发于先前的消融、手术或压力/容量超负荷，但有关心房低电压区域的功能特征以预测心房性心动过速临界峡部的数据却很少。最近，功能基质图（FSM）作为一种潜在的工具出现，用于评估心房结构改变区域的功能，以预测再通的临界点。目前的证据表明，左心房颤动患者在窦性/有节律节律期间的等时后期激活图（ILAM）减速区与再发临界峡部之间存在明显的关联。因此，这些区域似乎是潜在的消融目标，即使在 AT 期间未检测到。此外，ILAM 检测到的异常传导也可用于识别潜在的基底，并预测肺静脉隔离术后心房颤动的结果。尽管这些研究结果很有希望，但这种方法的实用性还需要在大规模的比较研究中进行评估。在这篇综述中，我们旨在分享我们的经验，并回顾有关在窦性/起搏节律期间使用 FSM 预测再电位 AT 的现有文献，讨论其未来的意义以及在心房低电压区患者中的潜在用途。
{"title":"Functional substrate mapping of atrium in patients with atrial scar: A novel method to predict critical isthmus of atrial tachycardia","authors":"Hikmet Yorgun, Cem Coteli, Gül Sinem Kılıç, Kudret Aytemir","doi":"10.1111/pace.14981","DOIUrl":"https://doi.org/10.1111/pace.14981","url":null,"abstract":"Atrial tachycardia (AT) is a common rhythm disorder, especially in patients with atrial structural abnormalities. Although voltage mapping can provide a general picture of structural alterations which are mainly secondary to prior ablations, surgery or pressure/volume overload, data is scarce regarding the functional characteristics of low voltage regions in the atrium to predict critical isthmus of ATs. Recently, functional substrate mapping (FSM) emerged as a potential tool to evaluate the functionality of structurally altered regions in the atrium to predict critical sites of reentry. Current evidence suggested a clear association between deceleration zones of isochronal late activation mapping (ILAM) during sinus/paced rhythm and critical isthmus of reentry in patients with left AT. Therefore, these areas seem to be potential ablation targets even not detected during AT. Furthermore, abnormal conduction detected by ILAM may also have a role to identify the potential substrate and predict atrial fibrillation outcome after pulmonary vein isolation. Despite these promising findings, the utility of such an approach needs to be evaluated in large‐scale comparative studies. In this review, we aimed to share our experience and review the current literature regarding the use of FSM during sinus/paced rhythm in the prediction of re‐entrant ATs and discuss future implications and potential use in patients with atrial low‐voltage areas.","PeriodicalId":19650,"journal":{"name":"Pacing and Clinical Electrophysiology","volume":"240 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140562480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rahul Dhawan, Mohamed Omer, Caitlin Carpenter, Paul A. Friedman, Xiaoke Liu
BackgroundLeft bundle branch block (LBBB) induced cardiomyopathy is an increasingly recognized disease entity. However, no clinical testing has been shown to be able to predict such an occurrence.Case reportA 70‐year‐old male with a prior history of LBBB with preserved ejection fraction (EF) and no other known cardiovascular conditions presented with presyncope, high‐grade AV block, and heart failure with reduced EF (36%). His coronary angiogram was negative for any obstructive disease. No other known etiologies for cardiomyopathy were identified. Artificial intelligence‐enabled ECGs performed 6 years prior to clinical presentation consistently predicted a high probability (up to 91%) of low EF. The patient successfully underwent left bundle branch area (LBBA) pacing with correction of the underlying LBBB. Subsequent AI ECGs showed a large drop in the probability of low EF immediately after LBBA pacing to 47% and then to 3% 2 months post procedure. His heart failure symptoms markedly improved and EF normalized to 54% at the same time.ConclusionsArtificial intelligence‐enabled ECGS may help identify patients who are at risk of developing LBBB‐induced cardiomyopathy and predict the response to LBBA pacing.
背景左束支传导阻滞（LBBB）诱发的心肌病是一种日益被认可的疾病实体。病例报告 一名 70 岁男性，既往有左束支传导阻滞病史，射血分数（EF）保留，无其他已知的心血管疾病，表现为晕厥前兆、高级别房室传导阻滞和 EF 值降低（36%）的心力衰竭。他的冠状动脉造影未发现任何阻塞性疾病。未发现其他已知的心肌病病因。临床表现前 6 年进行的人工智能心电图一直预测出低 EF 的可能性很高（高达 91%）。患者成功接受了左束支区（LBBA）起搏，并纠正了潜在的 LBBB。随后的 AI 心电图显示，LBBA 起搏后，低 EF 的概率立即大幅下降至 47%，术后 2 个月又降至 3%。结论人工智能支持的 ECGS 可帮助识别有患 LBBB 诱导的心肌病风险的患者，并预测对 LBBA 起搏的反应。
{"title":"Successful prediction of left bundle branch block‐induced cardiomyopathy and treatment effect by artificial intelligence‐enabled electrocardiogram","authors":"Rahul Dhawan, Mohamed Omer, Caitlin Carpenter, Paul A. Friedman, Xiaoke Liu","doi":"10.1111/pace.14980","DOIUrl":"https://doi.org/10.1111/pace.14980","url":null,"abstract":"BackgroundLeft bundle branch block (LBBB) induced cardiomyopathy is an increasingly recognized disease entity. However, no clinical testing has been shown to be able to predict such an occurrence.Case reportA 70‐year‐old male with a prior history of LBBB with preserved ejection fraction (EF) and no other known cardiovascular conditions presented with presyncope, high‐grade AV block, and heart failure with reduced EF (36%). His coronary angiogram was negative for any obstructive disease. No other known etiologies for cardiomyopathy were identified. Artificial intelligence‐enabled ECGs performed 6 years prior to clinical presentation consistently predicted a high probability (up to 91%) of low EF. The patient successfully underwent left bundle branch area (LBBA) pacing with correction of the underlying LBBB. Subsequent AI ECGs showed a large drop in the probability of low EF immediately after LBBA pacing to 47% and then to 3% 2 months post procedure. His heart failure symptoms markedly improved and EF normalized to 54% at the same time.ConclusionsArtificial intelligence‐enabled ECGS may help identify patients who are at risk of developing LBBB‐induced cardiomyopathy and predict the response to LBBA pacing.","PeriodicalId":19650,"journal":{"name":"Pacing and Clinical Electrophysiology","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140562732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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