Pub Date : 2024-11-01Epub Date: 2024-09-11DOI: 10.1016/j.ipej.2024.09.004
Rabbia Siddiqi, Anas Fares, Mona Mahmoud, Kanwal Asghar, Ragheb Assaly, Ehab Eltahawy, Blair Grubb, George V Moukarbel
Patients with concurrent heart failure (HF) and atrial fibrillation (AF) have poor outcomes. Randomized clinical trials comparing rhythm control approaches to rate control of AF have yielded conflicting results and there is a paucity of updated and comprehensive evidence summaries to inform best practice in HF patients. We therefore conducted a systematic review and meta-analysis to compare outcomes with rhythm versus rate control of AF in various subgroups of HF patients. In HF patients overall, we found high certainty evidence that rhythm control decreased all-cause and cardiovascular mortality (hazard ratio [HR, 95 % confidence interval] 0.64 [0.43-0.94]) and HR 0.50 [0.34-0.74] respectively). Rhythm control was associated with decreased HF hospitalization (risk ratio [RR] 0.79 [0.63-0.99], moderate certainty), but did not significantly decrease thromboembolic events (RR 0.67 [0.32-1.39], low certainty). The mean difference in left ventricular ejection fraction [LVEF] from baseline to last follow-up was greater in rhythm control group by 6.01 % [2.73-9.28 %] compared with rate control. Subgroup analyses by age, HF etiology (ischemic or non-ischemic), LVEF, presence of diabetes and hypertension did not reveal any significant differences in treatment effect. The survival and hospitalization reduction benefit of rhythm control of AF in HF patients likely reflects the success of catheter ablation especially in HF with reduced ejection fraction. These data are important to guide shared decision-making when managing AF in HF patients.
{"title":"Comparison of rhythm versus rate control of atrial fibrillation in heart failure subgroups: Systematic review and meta-analysis of randomized controlled trials.","authors":"Rabbia Siddiqi, Anas Fares, Mona Mahmoud, Kanwal Asghar, Ragheb Assaly, Ehab Eltahawy, Blair Grubb, George V Moukarbel","doi":"10.1016/j.ipej.2024.09.004","DOIUrl":"10.1016/j.ipej.2024.09.004","url":null,"abstract":"<p><p>Patients with concurrent heart failure (HF) and atrial fibrillation (AF) have poor outcomes. Randomized clinical trials comparing rhythm control approaches to rate control of AF have yielded conflicting results and there is a paucity of updated and comprehensive evidence summaries to inform best practice in HF patients. We therefore conducted a systematic review and meta-analysis to compare outcomes with rhythm versus rate control of AF in various subgroups of HF patients. In HF patients overall, we found high certainty evidence that rhythm control decreased all-cause and cardiovascular mortality (hazard ratio [HR, 95 % confidence interval] 0.64 [0.43-0.94]) and HR 0.50 [0.34-0.74] respectively). Rhythm control was associated with decreased HF hospitalization (risk ratio [RR] 0.79 [0.63-0.99], moderate certainty), but did not significantly decrease thromboembolic events (RR 0.67 [0.32-1.39], low certainty). The mean difference in left ventricular ejection fraction [LVEF] from baseline to last follow-up was greater in rhythm control group by 6.01 % [2.73-9.28 %] compared with rate control. Subgroup analyses by age, HF etiology (ischemic or non-ischemic), LVEF, presence of diabetes and hypertension did not reveal any significant differences in treatment effect. The survival and hospitalization reduction benefit of rhythm control of AF in HF patients likely reflects the success of catheter ablation especially in HF with reduced ejection fraction. These data are important to guide shared decision-making when managing AF in HF patients.</p>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":"321-329"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297255","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}
Pub Date : 2024-11-01Epub Date: 2024-09-04DOI: 10.1016/j.ipej.2024.09.002
Sergei Viktorovich Nemtsov, Roman Borisovich Tatarskiy, Sergei Arturovich Termosesov, Dmitriy Sergeevich Lebedev
We present a case of successful implantation of a cardioverter-defibrillator (ICD) using combined technique in a child with Timothy's syndrome. Due to high risk of sudden cardiac death (SCD) such patients often need ICD for primary or secondary prevention but implantation technique in young children remains controversial. The subcutaneous cardioverter-defibrillators could be an option in some cases, however, reliable cardiac pacing should be implemented for patients with bradyarrhythmias. An ICD implantation technique with the epicardial pacing lead placement and subcutaneous tunnel formation for endocardial defibrillation lead seems to be promising in SCD prevention also providing the opportunity for permanent pacing.
{"title":"A case report of a combined implantation technique of a cardioverter-defibrillator in an infant with long QT syndrome type 8 (Timothy's syndrome).","authors":"Sergei Viktorovich Nemtsov, Roman Borisovich Tatarskiy, Sergei Arturovich Termosesov, Dmitriy Sergeevich Lebedev","doi":"10.1016/j.ipej.2024.09.002","DOIUrl":"10.1016/j.ipej.2024.09.002","url":null,"abstract":"<p><p>We present a case of successful implantation of a cardioverter-defibrillator (ICD) using combined technique in a child with Timothy's syndrome. Due to high risk of sudden cardiac death (SCD) such patients often need ICD for primary or secondary prevention but implantation technique in young children remains controversial. The subcutaneous cardioverter-defibrillators could be an option in some cases, however, reliable cardiac pacing should be implemented for patients with bradyarrhythmias. An ICD implantation technique with the epicardial pacing lead placement and subcutaneous tunnel formation for endocardial defibrillation lead seems to be promising in SCD prevention also providing the opportunity for permanent pacing.</p>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":"351-354"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146466","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}
Pub Date : 2024-11-01Epub Date: 2024-08-31DOI: 10.1016/j.ipej.2024.08.005
Devendra S Bisht, Kamal Kishor
In the setting of ischemic heart disease (IHD), ventricular tachycardia (VT) commonly originates from areas of incomplete scar tissue. High-density electroanatomic mapping has enhanced our understanding of VT circuits, predominantly characterised by dense scar and surviving myocyte bundles. We present a case of a 58-year-old male with IHD and sustained monomorphic VT, successfully treated with radiofrequency ablation following high-density mapping and entrainment techniques. Two inducible VT phenotypes were identified, with ablation at one site effectively terminating both VT morphologies. This case illustrates the importance of precise circuit localisation and targeted ablation in managing post-infarction VT, leading to a satisfactory patient outcome.
{"title":"The Janus Heads of ventricular Tachycardia: Single-circuit with dual exits.","authors":"Devendra S Bisht, Kamal Kishor","doi":"10.1016/j.ipej.2024.08.005","DOIUrl":"10.1016/j.ipej.2024.08.005","url":null,"abstract":"<p><p>In the setting of ischemic heart disease (IHD), ventricular tachycardia (VT) commonly originates from areas of incomplete scar tissue. High-density electroanatomic mapping has enhanced our understanding of VT circuits, predominantly characterised by dense scar and surviving myocyte bundles. We present a case of a 58-year-old male with IHD and sustained monomorphic VT, successfully treated with radiofrequency ablation following high-density mapping and entrainment techniques. Two inducible VT phenotypes were identified, with ablation at one site effectively terminating both VT morphologies. This case illustrates the importance of precise circuit localisation and targeted ablation in managing post-infarction VT, leading to a satisfactory patient outcome.</p>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":"337-346"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112966","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}
Pub Date : 2024-11-01Epub Date: 2024-10-24DOI: 10.1016/j.ipej.2024.10.006
Benedikt Seither, Alexander Schober, Raphael Allgaier, Christine Meindl, Michael Paulus, Ute Hubauer, Andreas Schober, Ekrem Ücer, Sabine Fredersdorf, Petra Lehn, Andreas Keyser, Andreas Luchner, Lars Maier, Stefan Wallner, Carsten Jungbauer
Aims: Plasma NT-proBNP is an established marker of heart failure. Previous studies suggested urinary NT-proBNP has potential as marker of chronic heart failure as well. The objective of this study was to compare urinary NT-proBNP to plasma NT-proBNP in a real-life collective of patients with an ICD, especially regarding ICD-therapies.
Methods & results: NT-proBNP was assessed in plasma and fresh spot urine (the latter related to urinary creatinine) from 322 patients of our ICD outpatient clinic. 54 healthy individuals served as a control group. Follow-up regarding mortality and ICD therapies was performed after 32 months (IQR 5-35 months). Plasma and urinary NT-proBNP was positively correlated (r = 0.89, p < 0,001). According to ROC analysis urinary NT-proBNP detected LV dysfunction (EF<35 % vs. healthy CTRL) with very satisfying predictive values (AUC 0.95), but plasma NT-proBNP showed slightly better values (AUC 0.99). Patients who received appropriate ICD-shock-therapies showed significantly higher plasma (p < 0.001) as well as urinary NT-proBNP levels (p = 0.011) compared to patients without shock-therapy. In Kaplan-Meier analysis, plasma as well as urinary NT-proBNP levels > Youden-Index showed significantly higher event rates for appropriate ICD-shock therapies (p < 0.001 and p = 0.016) and the combined endpoint of all-cause-mortality and shock therapies (each p < 0.001). Urinary and plasma NT-proBNP were independent predictors for appropriate ICD-shock-therapies and for the combined endpoint of all-cause mortality and appropriate ICD-shock-therapies (each p < 0.001).
Conclusion: Urinary NT-proBNP as a marker for LV dysfunction and symptomatic heart failure showed promising predictive values. Associations between plasma as well as urinary NT-proBNP and ICD shock-therapies could be shown.
{"title":"Urinary NT-proBNP compared head-to-head to plasmatic NT-proBNP in a real life collective with an ICD.","authors":"Benedikt Seither, Alexander Schober, Raphael Allgaier, Christine Meindl, Michael Paulus, Ute Hubauer, Andreas Schober, Ekrem Ücer, Sabine Fredersdorf, Petra Lehn, Andreas Keyser, Andreas Luchner, Lars Maier, Stefan Wallner, Carsten Jungbauer","doi":"10.1016/j.ipej.2024.10.006","DOIUrl":"10.1016/j.ipej.2024.10.006","url":null,"abstract":"<p><strong>Aims: </strong>Plasma NT-proBNP is an established marker of heart failure. Previous studies suggested urinary NT-proBNP has potential as marker of chronic heart failure as well. The objective of this study was to compare urinary NT-proBNP to plasma NT-proBNP in a real-life collective of patients with an ICD, especially regarding ICD-therapies.</p><p><strong>Methods & results: </strong>NT-proBNP was assessed in plasma and fresh spot urine (the latter related to urinary creatinine) from 322 patients of our ICD outpatient clinic. 54 healthy individuals served as a control group. Follow-up regarding mortality and ICD therapies was performed after 32 months (IQR 5-35 months). Plasma and urinary NT-proBNP was positively correlated (r = 0.89, p < 0,001). According to ROC analysis urinary NT-proBNP detected LV dysfunction (EF<35 % vs. healthy CTRL) with very satisfying predictive values (AUC 0.95), but plasma NT-proBNP showed slightly better values (AUC 0.99). Patients who received appropriate ICD-shock-therapies showed significantly higher plasma (p < 0.001) as well as urinary NT-proBNP levels (p = 0.011) compared to patients without shock-therapy. In Kaplan-Meier analysis, plasma as well as urinary NT-proBNP levels > Youden-Index showed significantly higher event rates for appropriate ICD-shock therapies (p < 0.001 and p = 0.016) and the combined endpoint of all-cause-mortality and shock therapies (each p < 0.001). Urinary and plasma NT-proBNP were independent predictors for appropriate ICD-shock-therapies and for the combined endpoint of all-cause mortality and appropriate ICD-shock-therapies (each p < 0.001).</p><p><strong>Conclusion: </strong>Urinary NT-proBNP as a marker for LV dysfunction and symptomatic heart failure showed promising predictive values. Associations between plasma as well as urinary NT-proBNP and ICD shock-therapies could be shown.</p>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":"315-320"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509593","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}
Pub Date : 2024-11-01Epub Date: 2024-10-09DOI: 10.1016/j.ipej.2024.10.003
Hinpetch Daungsupawong, Viroj Wiwanitkit
{"title":"Feasibility of a using chest strap and dry electrode system for longer term cardiac arrhythmia monitoring: Correspondence.","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.1016/j.ipej.2024.10.003","DOIUrl":"10.1016/j.ipej.2024.10.003","url":null,"abstract":"","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":"373"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401514","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}
Pub Date : 2024-11-01Epub Date: 2024-11-08DOI: 10.1016/j.ipej.2024.11.002
Daljeet Kaur Saggu, Madappa Nagamalesh Udigala, Shantanu Sarkar, Arunkumar Sathiyamoorthy, Satyaprakash Dash, P V R Mohan, Vinayakrishnan Rajan, Calambur Narasimahan
{"title":"Feasibility of using chest strap and dry electrode system for longer term cardiac arrhythmia monitoring: Response to Correspondence to the Editor.","authors":"Daljeet Kaur Saggu, Madappa Nagamalesh Udigala, Shantanu Sarkar, Arunkumar Sathiyamoorthy, Satyaprakash Dash, P V R Mohan, Vinayakrishnan Rajan, Calambur Narasimahan","doi":"10.1016/j.ipej.2024.11.002","DOIUrl":"10.1016/j.ipej.2024.11.002","url":null,"abstract":"","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":"374-375"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629642","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}
Pub Date : 2024-11-01Epub Date: 2024-08-22DOI: 10.1016/j.ipej.2024.08.004
Suresh Kumar Sukumaran, Anish Bhargav, Sridhar Balaguru, Raja J Selvaraj
{"title":"Conflicting responses with simultaneous atrioventricular pacing. What is the mechanism?","authors":"Suresh Kumar Sukumaran, Anish Bhargav, Sridhar Balaguru, Raja J Selvaraj","doi":"10.1016/j.ipej.2024.08.004","DOIUrl":"10.1016/j.ipej.2024.08.004","url":null,"abstract":"","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":"334-336"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142047292","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}
Pub Date : 2024-11-01Epub Date: 2024-09-11DOI: 10.1016/j.ipej.2024.09.005
Yuta Sudo
A patient with a dual-chamber pacemaker for sick sinus syndrome was hospitalized for heart failure. The electrocardiography (ECG) during hospitalization displayed seemingly abnormal pacing artifacts. This report focuses on the problem-solving of an abnormal-looking paced ECG and identifies the pacemaker's operational behavior as the underlying reason.
{"title":"Transient pacing pulse on the T-wave: What is the mechanism?","authors":"Yuta Sudo","doi":"10.1016/j.ipej.2024.09.005","DOIUrl":"10.1016/j.ipej.2024.09.005","url":null,"abstract":"<p><p>A patient with a dual-chamber pacemaker for sick sinus syndrome was hospitalized for heart failure. The electrocardiography (ECG) during hospitalization displayed seemingly abnormal pacing artifacts. This report focuses on the problem-solving of an abnormal-looking paced ECG and identifies the pacemaker's operational behavior as the underlying reason.</p>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":"358-360"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297258","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}
Pub Date : 2024-11-01Epub Date: 2024-08-22DOI: 10.1016/j.ipej.2024.08.002
Than Htike, Saroj Choudhury, Debabrata Bera
Introduction: The causes of atrial undersensing in a dual chamber pacemaker include true undersensing (low amplitude electrogram), functional undersensing (related to the effect of special timing cycles in the presence of an adequate signal) and paradoxical undersensing. This case report describes paradoxical atrial undersensing at a higher programmed atrial sensitivity and with the return of normal atrial sensing at a lower programmed sensitivity.
{"title":"Paradoxical under-sensing of atrial lead at high sensitivity setting in dual chamber pacemaker during atrial flutter - What is the mechanism?","authors":"Than Htike, Saroj Choudhury, Debabrata Bera","doi":"10.1016/j.ipej.2024.08.002","DOIUrl":"10.1016/j.ipej.2024.08.002","url":null,"abstract":"<p><strong>Introduction: </strong>The causes of atrial undersensing in a dual chamber pacemaker include true undersensing (low amplitude electrogram), functional undersensing (related to the effect of special timing cycles in the presence of an adequate signal) and paradoxical undersensing. This case report describes paradoxical atrial undersensing at a higher programmed atrial sensitivity and with the return of normal atrial sensing at a lower programmed sensitivity.</p>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":"330-333"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056738","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}
Pub Date : 2024-11-01Epub Date: 2024-09-25DOI: 10.1016/j.ipej.2024.09.009
Gala Caixal, Paz Garre, Lluis Mont, Ivo Roca-Luque
A 53-year-old patient with a history of heart transplant is referred for atrial tachycardia ablation. Two dissociated concomitant rhythms are observed: a focal atrial tachycardia in the donor atrium and atrial fibrillation in the remaining recipient atrium.
{"title":"Late onset of two concurrent and dissociated arrhythmias in a transplanted heart.","authors":"Gala Caixal, Paz Garre, Lluis Mont, Ivo Roca-Luque","doi":"10.1016/j.ipej.2024.09.009","DOIUrl":"10.1016/j.ipej.2024.09.009","url":null,"abstract":"<p><p>A 53-year-old patient with a history of heart transplant is referred for atrial tachycardia ablation. Two dissociated concomitant rhythms are observed: a focal atrial tachycardia in the donor atrium and atrial fibrillation in the remaining recipient atrium.</p>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":"366-369"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355627","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}