Pub Date : 2024-12-01DOI: 10.1016/j.hroo.2024.09.012
David J. Slotwiner MD, FHRS , Gerald A. Serwer MD, FHRS , James D. Allred MD, FHRS , Deepak Bhakta MD, MBA, FHRS, CCDS , Richard Clark FHRS, CCDS , Julien Durand , Martha G. Ferrara DNP, FNP, FHRS, CCDS , Jason Hale , Chris Irving , Andy Iverson MSc , Maobing Jin , Jens B. Johansen MD, PhD , Matthew Kalscheur MD , Dennis Krisjnen , Robert Lerman MD , Neal Lippman MD, FHRS , G. Stuart Mendenhall MD , Ryan Michael , Steven Nichols , Ratika Parkash MD, MS, FHRS , Manish Wadhwa MD
Cardiac implantable electronic devices (CIEDs) generate substantial data, often stored in image or PDF formats. Remote monitoring, now an integral component of patient care, places considerable administrative burdens on clinicians and staff, in large part due to the challenge of integrating these data seamlessly into electronic health records. Since 2006, the Heart Rhythm Society, in collaboration with the CIED industry, has led an initiative to establish a unified standard nomenclature. This effort has harmonized terminology, aligning diverse terms with single terms approved by the Institute of Electrical and Electronics Engineers. With this foundational work complete, attention now turns to developing technical standards for interoperability, which would enable the smooth communication of CIED data between information technology systems used in clinical practice. In this article, by leveraging Health Level 7 Fast Healthcare Interoperability Resources, we present a road map for the technical committee to guide this endeavor. We identify critical data exchange points between remote transceivers, electronic health records, and third-party platforms commonly used for CIED patient data management. Our objective is to establish bidirectional communication among these resources, ensuring the accuracy, timeliness, and accessibility of clinical data for clinicians. We also anticipate substantial benefits for both clinical research and administrative efficiency through the implementation of this interoperability framework.
{"title":"2024 HRS perspective on advancing workflows for CIED remote monitoring","authors":"David J. Slotwiner MD, FHRS , Gerald A. Serwer MD, FHRS , James D. Allred MD, FHRS , Deepak Bhakta MD, MBA, FHRS, CCDS , Richard Clark FHRS, CCDS , Julien Durand , Martha G. Ferrara DNP, FNP, FHRS, CCDS , Jason Hale , Chris Irving , Andy Iverson MSc , Maobing Jin , Jens B. Johansen MD, PhD , Matthew Kalscheur MD , Dennis Krisjnen , Robert Lerman MD , Neal Lippman MD, FHRS , G. Stuart Mendenhall MD , Ryan Michael , Steven Nichols , Ratika Parkash MD, MS, FHRS , Manish Wadhwa MD","doi":"10.1016/j.hroo.2024.09.012","DOIUrl":"10.1016/j.hroo.2024.09.012","url":null,"abstract":"<div><div>Cardiac implantable electronic devices (CIEDs) generate substantial data, often stored in image or PDF formats. Remote monitoring, now an integral component of patient care, places considerable administrative burdens on clinicians and staff, in large part due to the challenge of integrating these data seamlessly into electronic health records. Since 2006, the Heart Rhythm Society, in collaboration with the CIED industry, has led an initiative to establish a unified standard nomenclature. This effort has harmonized terminology, aligning diverse terms with single terms approved by the Institute of Electrical and Electronics Engineers. With this foundational work complete, attention now turns to developing technical standards for interoperability, which would enable the smooth communication of CIED data between information technology systems used in clinical practice. In this article, by leveraging Health Level 7 Fast Healthcare Interoperability Resources, we present a road map for the technical committee to guide this endeavor. We identify critical data exchange points between remote transceivers, electronic health records, and third-party platforms commonly used for CIED patient data management. Our objective is to establish bidirectional communication among these resources, ensuring the accuracy, timeliness, and accessibility of clinical data for clinicians. We also anticipate substantial benefits for both clinical research and administrative efficiency through the implementation of this interoperability framework.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 12","pages":"Pages 845-853"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11721723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.hroo.2024.10.015
Reuben Mutagaywa, Moses Mlawa, Henry Mayala, Peter Kisenge
{"title":"VO-04 ATRIAL FIBRILLATION IS ASSOCIATED WITH COGNITIVE IMPAIRMENT AMONG PATIENTS WITH RHEUMATIC HEART DISEASE ATTENDED AT JAKAYA KIKWETE CARDIAC INSTITUTE, DAR ES SALAAM, TANZANIA","authors":"Reuben Mutagaywa, Moses Mlawa, Henry Mayala, Peter Kisenge","doi":"10.1016/j.hroo.2024.10.015","DOIUrl":"10.1016/j.hroo.2024.10.015","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 12","pages":"Page S4"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143179715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.hroo.2024.10.010
Jeanne E. Poole MD, FHRS
{"title":"Presenting the abstracts from Cardiorhythm-Virtual 2024","authors":"Jeanne E. Poole MD, FHRS","doi":"10.1016/j.hroo.2024.10.010","DOIUrl":"10.1016/j.hroo.2024.10.010","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 12","pages":"Page S2"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143180957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.hroo.2024.09.008
Jeffrey L. Williams MD, MS, FACC, FHRS , Ryoko Sato PhD , Caroline M. Jacobsen MPhil
Background
Cardiac resynchronization therapy-defibrillators (CRT-D) are devices established as treatment for symptomatic heart failure patients at risk of sudden cardiac death. Battery depletion poses a significant clinical and economic burden; extended service life may reduce costs because of generator changes and associated complications.
Objective
This study estimated cost-savings associated with extended battery longevity in Medicare patients receiving CRT-D implantation.
Methods
A decision tree was used to explore 3 battery capacities: 1.0 ampere-hours (Ah), 1.6Ah, and 2.1Ah. Yearly risk of all-cause mortality, device-related complications, and end of battery life were estimated. Over 6 years, estimated costs included device implantation, replacement, follow-up appointments, and complications.
Results
The average total costs to Medicare over 6 years were $41,527, $48,515, and $56,647 per person (USD 2023) for the 2.1 Ah, 1.6 Ah, and 1.0 Ah, respectively. The total per-person replacement cost for the 1.0-Ah devices was more than 4 times that of the 2.1-Ah devices ($20,126 vs $5,006). When extrapolated to the total number of CRT-D implants over a 6-year period, the difference in costs between 2.1-Ah and 1.0-Ah battery capacity exceeded $500 million.
Conclusion
Extended longevity CRT-D batteries demonstrate significant cost savings to Medicare over 6 years. These data indicate long-term economic considerations should be included in device selection.
{"title":"Cost savings associated with extended battery longevity in cardiac resynchronization therapy defibrillators","authors":"Jeffrey L. Williams MD, MS, FACC, FHRS , Ryoko Sato PhD , Caroline M. Jacobsen MPhil","doi":"10.1016/j.hroo.2024.09.008","DOIUrl":"10.1016/j.hroo.2024.09.008","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac resynchronization therapy-defibrillators (CRT-D) are devices established as treatment for symptomatic heart failure patients at risk of sudden cardiac death. Battery depletion poses a significant clinical and economic burden; extended service life may reduce costs because of generator changes and associated complications.</div></div><div><h3>Objective</h3><div>This study estimated cost-savings associated with extended battery longevity in Medicare patients receiving CRT-D implantation.</div></div><div><h3>Methods</h3><div>A decision tree was used to explore 3 battery capacities: 1.0 ampere-hours (Ah), 1.6Ah, and 2.1Ah. Yearly risk of all-cause mortality, device-related complications, and end of battery life were estimated. Over 6 years, estimated costs included device implantation, replacement, follow-up appointments, and complications.</div></div><div><h3>Results</h3><div>The average total costs to Medicare over 6 years were $41,527, $48,515, and $56,647 per person (USD 2023) for the 2.1 Ah, 1.6 Ah, and 1.0 Ah, respectively. The total per-person replacement cost for the 1.0-Ah devices was more than 4 times that of the 2.1-Ah devices ($20,126 vs $5,006). When extrapolated to the total number of CRT-D implants over a 6-year period, the difference in costs between 2.1-Ah and 1.0-Ah battery capacity exceeded $500 million.</div></div><div><h3>Conclusion</h3><div>Extended longevity CRT-D batteries demonstrate significant cost savings to Medicare over 6 years. These data indicate long-term economic considerations should be included in device selection.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 11","pages":"Pages 755-761"},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142704739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.hroo.2024.09.005
Alex D. Pacheco-Bouthillier MD , Jorge Javier Miguel-González MD , Adriana González-Martínez MD, PhD , Anna G. Everding-Rodríguez MD , Silvia S. Gómez-Delgadillo MD , Ángel E. Chávez-Torres MD , Angélica Fregoso-Sánchez MD , Benigno Ferreira-Piña MD , Óscar S. Lomelí-Sánchez MD, MSc , Hugo E. Coutiño-Moreno MD, PhD , Vitelio A. Mariona-Montero MD
Background
Left atrial catheterization is a common procedure in electrophysiology labs to treat arrhythmogenic substrates on the left side of the heart. Needle transseptal puncture is the standard approach, but it can lead to complications related to device design or operator technique. To reduce these complications, needle-free alternatives have been explored.
Objective
This study aims to report the first multicenter application of the needle-free transseptal access (NeFTA) approach, assessing its safety and efficacy in patients undergoing electrophysiological procedures.
Methods
This retrospective, observational multicenter study evaluated the safety and efficacy of the NeFTA approach in patients undergoing ablation of left arrhythmogenic substrates across 3 electrophysiology centers in Mexico. NeFTA uses only a guidewire, without a needle or sharp guidewire. The sheath, with a dilator, is guided into the fossa ovalis under fluoroscopic guidance, using anterior force and clockwise torque to allow the guidewire to puncture the septum with minimal risk.
Results
The NeFTA technique was used in 366 patients. Most sheaths were deflectable, with nondeflectable sheaths in 43.4% of cases. Left atrial access via NeFTA was successful in 96.18% of cases, with pericardial effusion as the only complication (0.55% rate).
Conclusion
This technique was reproducible and safe, achieving successful access on the first or second attempt in 96.18% of cases, regardless of the operator.
{"title":"Needle-free atrial transseptal access: A safe and reproducible alternative for left atrial catheterization","authors":"Alex D. Pacheco-Bouthillier MD , Jorge Javier Miguel-González MD , Adriana González-Martínez MD, PhD , Anna G. Everding-Rodríguez MD , Silvia S. Gómez-Delgadillo MD , Ángel E. Chávez-Torres MD , Angélica Fregoso-Sánchez MD , Benigno Ferreira-Piña MD , Óscar S. Lomelí-Sánchez MD, MSc , Hugo E. Coutiño-Moreno MD, PhD , Vitelio A. Mariona-Montero MD","doi":"10.1016/j.hroo.2024.09.005","DOIUrl":"10.1016/j.hroo.2024.09.005","url":null,"abstract":"<div><h3>Background</h3><div>Left atrial catheterization is a common procedure in electrophysiology labs to treat arrhythmogenic substrates on the left side of the heart. Needle transseptal puncture is the standard approach, but it can lead to complications related to device design or operator technique. To reduce these complications, needle-free alternatives have been explored.</div></div><div><h3>Objective</h3><div>This study aims to report the first multicenter application of the needle-free transseptal access (NeFTA) approach, assessing its safety and efficacy in patients undergoing electrophysiological procedures.</div></div><div><h3>Methods</h3><div>This retrospective, observational multicenter study evaluated the safety and efficacy of the NeFTA approach in patients undergoing ablation of left arrhythmogenic substrates across 3 electrophysiology centers in Mexico. NeFTA uses only a guidewire, without a needle or sharp guidewire. The sheath, with a dilator, is guided into the fossa ovalis under fluoroscopic guidance, using anterior force and clockwise torque to allow the guidewire to puncture the septum with minimal risk.</div></div><div><h3>Results</h3><div>The NeFTA technique was used in 366 patients. Most sheaths were deflectable, with nondeflectable sheaths in 43.4% of cases. Left atrial access via NeFTA was successful in 96.18% of cases, with pericardial effusion as the only complication (0.55% rate).</div></div><div><h3>Conclusion</h3><div>This technique was reproducible and safe, achieving successful access on the first or second attempt in 96.18% of cases, regardless of the operator.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 11","pages":"Pages 788-795"},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142704647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.hroo.2024.09.003
Marwin Bannehr MD , Christian Georgi MD , Christoph Edlinger MD , Vera Paar PhD , Paulina Jankowska MD , Michael Lichtenauer MD , Anja Haase-Fielitz PhD , Martin Seifert MD , Christian Butter MD
Background
Atrial fibrillation (AF) is a progressively developing arrhythmia. Electroanatomic remodeling may play an important role, both in the development of the disease and in the perpetuation and thus in the recurrence of AF.
Objective
This study aimed to investigate potential biomarkers myeloperoxidase (MPO), N-terminal proatrial natriuretic peptide (NT-proANP), intercellular adhesion molecule-1, and matrix metalloproteinase-2 and their predictive value for AF recurrence in patients undergoing redo ablation.
Methods
In this single-center prospective cohort study, 50 consecutive patients underwent ultra high-density mapping and redo ablation. Biomarkers were determined before ablation and at 6-month follow-up. Seven-day Holter was conducted to check for AF recurrence (>30 seconds).
Results
Eleven (22%) patients showed AF recurrence after redo ablation. Receiver-operating characteristic curve analysis revealed venous MPO and NT-proANP (area under the curve [AUC] 0.755, 95% CI 0.599–0.912, P = .010; and AUC 0.752, 95% CI 0.551–0.953, P = .011) as acceptable predictors for intermediate AF recurrence, whereas matrix metalloproteinase-2, intercellular adhesion molecule-1, and established cardiovascular biomarkers such as N-terminal pro–B-type natriuretic peptide, troponin T, and C-reactive protein were not (all AUC <0.600). MPO and NT-proANP correlated with AF burden (ρ = 0.365, P = .005; and ρ = 0.362, P = .005). While MPO was associated with atrial fibrosis in the endocardial map (ρ = 0.280, P = .024), NT-proANP correlated with left atrial volume index (ρ = 0.256, P = .037). There were no significant differences in biomarkers concentrations with regard to venous and coronary sinus samples.
Conclusion
MPO and NT-proANP are of predictive value for AF recurrence in patients undergoing redo ablation. While MPO correlated with endocardial fibrosis, NT-proANP was associated with left atrial volume.
背景心房颤动（房颤）是一种逐渐发展的心律失常。电解剖重塑可能在房颤的发病、持续和复发中发挥重要作用。本研究旨在探讨潜在的生物标志物髓过氧化物酶（MPO）、N-末端前房性钠肽（NT-proANP）、细胞间粘附分子-1 和基质金属蛋白酶-2 及其对接受再次消融术患者房颤复发的预测价值。在消融前和随访 6 个月时测定了生物标志物。结果7名患者（22%）在重新消融术后出现房颤复发。接收者工作特征曲线分析显示静脉 MPO 和 NT-proANP（曲线下面积 [AUC] 0.755，95% CI 0.599-0.912，P = .010；AUC 0.752，95% CI 0.551-0.953，P = .011）为可接受的中度房颤复发预测指标，而基质金属蛋白酶-2、细胞间粘附分子-1 和 N 端前 B 型利钠肽，肌钙蛋白 T 和 C 反应蛋白等成熟的心血管生物标记物则不是（所有 AUC 均为 0.600）。MPO和NT-proANP与房颤负荷相关（ρ = 0.365，P = .005；ρ = 0.362，P = .005）。MPO与心内膜图中的心房纤维化相关（ρ = 0.280，P = .024），而NT-proANP与左心房容积指数相关（ρ = 0.256，P = .037）。结论MPO和NT-proANP对接受重做消融术的患者房颤复发具有预测价值。MPO与心内膜纤维化相关，而NT-proANP与左心房容积相关。
{"title":"Myeloperoxidase and N-terminal proatrial natriuretic peptide as predictors for atrial fibrillation recurrence in patients undergoing redo ablation","authors":"Marwin Bannehr MD , Christian Georgi MD , Christoph Edlinger MD , Vera Paar PhD , Paulina Jankowska MD , Michael Lichtenauer MD , Anja Haase-Fielitz PhD , Martin Seifert MD , Christian Butter MD","doi":"10.1016/j.hroo.2024.09.003","DOIUrl":"10.1016/j.hroo.2024.09.003","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation (AF) is a progressively developing arrhythmia. Electroanatomic remodeling may play an important role, both in the development of the disease and in the perpetuation and thus in the recurrence of AF.</div></div><div><h3>Objective</h3><div>This study aimed to investigate potential biomarkers myeloperoxidase (MPO), N-terminal proatrial natriuretic peptide (NT-proANP), intercellular adhesion molecule-1, and matrix metalloproteinase-2 and their predictive value for AF recurrence in patients undergoing redo ablation.</div></div><div><h3>Methods</h3><div>In this single-center prospective cohort study, 50 consecutive patients underwent ultra high-density mapping and redo ablation. Biomarkers were determined before ablation and at 6-month follow-up. Seven-day Holter was conducted to check for AF recurrence (>30 seconds).</div></div><div><h3>Results</h3><div>Eleven (22%) patients showed AF recurrence after redo ablation. Receiver-operating characteristic curve analysis revealed venous MPO and NT-proANP (area under the curve [AUC] 0.755, 95% CI 0.599–0.912, <em>P =</em> .010; and AUC 0.752, 95% CI 0.551–0.953, <em>P =</em> .011) as acceptable predictors for intermediate AF recurrence, whereas matrix metalloproteinase-2, intercellular adhesion molecule-1, and established cardiovascular biomarkers such as N-terminal pro–B-type natriuretic peptide, troponin T, and C-reactive protein were not (all AUC <0.600). MPO and NT-proANP correlated with AF burden (ρ = 0.365, <em>P =</em> .005; and ρ = 0.362, <em>P =</em> .005). While MPO was associated with atrial fibrosis in the endocardial map (ρ = 0.280, <em>P =</em> .024), NT-proANP correlated with left atrial volume index (ρ = 0.256, <em>P =</em> .037). There were no significant differences in biomarkers concentrations with regard to venous and coronary sinus samples.</div></div><div><h3>Conclusion</h3><div>MPO and NT-proANP are of predictive value for AF recurrence in patients undergoing redo ablation. While MPO correlated with endocardial fibrosis, NT-proANP was associated with left atrial volume.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 11","pages":"Pages 770-777"},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142704744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Traditional pacemaker implantation often poses risks, such as perforation when positioning atrial leads at the right atrial appendage (RAA). Recent advancements in delivery catheters have enabled atrial lead placement in the right atrial septum, potentially mitigating RAA-related complications. However, the performance of lumenless leads in this context remains unclear.
Objective
This study was performed to assess the performance of lumenless leads as atrial leads.
Methods
Forty-four consecutive patients undergoing pacemaker implantation with lumenless atrial leads were enrolled. Lead implantation was performed using a 3830 SelectSecure lead and C315HIS-sheath. Pacing parameters were collected immediately after screwing, 3 and 5 minutes later, at the end of the procedure, and at every 6-month follow-up.
Results
Lead parameters including P-wave, pacing threshold, and impedance significantly improved over time. The threshold levels from 2.00 ± 0.72 V/0.4 msec immediately after screwing to 1.45 ± 0.57 V/0.4 msec at 5 minutes, 0.95 ± 0.38 V/0.4 msec at the end of the procedure, and 0.78 ± 0.39 V/0.4 msec at discharge. Initially, threshold levels were >2.5 V/0.4 msec in 15 cases; however, they decreased to <2 V/0.4 msec by the end of the procedure. At discharge, 13 of the 15 cases showed a threshold decrease to <1 V/0.4 msec. During follow-up, no threshold increase (>1 V), lead revision, or battery depletion was observed.
Conclusion
Lumenless lead placement in the right atrium results in threshold decrease over time. Therefore, allowing a waiting period instead of immediately repositioning the lead may be more effective when thresholds are high after screwing.
{"title":"Time-dependent improvements in pacing thresholds with lumenless leads placed in the right atrium","authors":"Yasumasa Nohno MD , Ryosuke Kozu MD , Shusaku Maruyama MD , Tomoya Hasegawa MD , Hiromi Tsuchiya MD , Takahiro Tachibana MD , Hikaru Kimura MD , Yoshikazu Yazaki MD, PhD , Katsuhito Fujiu MD, PhD","doi":"10.1016/j.hroo.2024.09.009","DOIUrl":"10.1016/j.hroo.2024.09.009","url":null,"abstract":"<div><h3>Background</h3><div>Traditional pacemaker implantation often poses risks, such as perforation when positioning atrial leads at the right atrial appendage (RAA). Recent advancements in delivery catheters have enabled atrial lead placement in the right atrial septum, potentially mitigating RAA-related complications. However, the performance of lumenless leads in this context remains unclear.</div></div><div><h3>Objective</h3><div>This study was performed to assess the performance of lumenless leads as atrial leads.</div></div><div><h3>Methods</h3><div>Forty-four consecutive patients undergoing pacemaker implantation with lumenless atrial leads were enrolled. Lead implantation was performed using a 3830 SelectSecure lead and C315HIS-sheath. Pacing parameters were collected immediately after screwing, 3 and 5 minutes later, at the end of the procedure, and at every 6-month follow-up.</div></div><div><h3>Results</h3><div>Lead parameters including P-wave, pacing threshold, and impedance significantly improved over time. The threshold levels from 2.00 ± 0.72 V/0.4 msec immediately after screwing to 1.45 ± 0.57 V/0.4 msec at 5 minutes, 0.95 ± 0.38 V/0.4 msec at the end of the procedure, and 0.78 ± 0.39 V/0.4 msec at discharge. Initially, threshold levels were >2.5 V/0.4 msec in 15 cases; however, they decreased to <2 V/0.4 msec by the end of the procedure. At discharge, 13 of the 15 cases showed a threshold decrease to <1 V/0.4 msec. During follow-up, no threshold increase (>1 V), lead revision, or battery depletion was observed.</div></div><div><h3>Conclusion</h3><div>Lumenless lead placement in the right atrium results in threshold decrease over time. Therefore, allowing a waiting period instead of immediately repositioning the lead may be more effective when thresholds are high after screwing.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"5 11","pages":"Pages 764-769"},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142704743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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