Indian Pacing and Electrophysiology Journal最新文献

英文中文

Left conduction system pacing – An Ocean of opportunity 左传导系统起搏--充满机遇的海洋。

Q3 Medicine

Indian Pacing and Electrophysiology Journal

Pub Date : 2024-09-01 DOI: 10.1016/j.ipej.2024.09.008

Shunmuga Sundaram Ponnusamy, Pugazhendhi Vijayaraman

引用次数: 0

Longitudinal reduction in fluoroscopy with continued use of 3-dimensional electroanatomic mapping systems in catheter ablation of supraventricular tachycardia – then and now 在室上性心动过速导管消融术中持续使用三维电解剖图系统，纵向减少了透视 - 当时和现在。

Q3 Medicine

Indian Pacing and Electrophysiology Journal

Pub Date : 2024-09-01 DOI: 10.1016/j.ipej.2024.06.010

Background

Catheter ablation is a first-line treatment for symptomatic, recurrent supraventricular tachycardia (SVT). This study aims to demonstrate if 3D-electroanatomic mapping (EAM) during SVT ablation reduces fluoroscopy time (FT) and determine if further reductions in FT are observed longitudinally.

Methods

All cases of SVT ablation between May 2011–May 2022 at a single tertiary centre were prospectively recruited. FT between the cohorts with and without EAM were compared. Within the EAM subset, the trend of FT across the years was analysed.

Results

There were 1758 cases included, 563 without EAM, 1195 with EAM. EAM was associated with a longer procedure time (mean + 8.8 min, p = 0.001), but with mean reductions in FT and dose area product (DAP) by 19.6 min and 18 621 mGy*cm2 respectively (p < 0.001). There was comparable efficacy without any increase in complication rates. Over time (2011–2022), further reduction in FT of 0.9 min year on year was observed (p = 0.001). Between 2011 and 2017, there was a significant reduction in FT of 1.1 min year on year (p = 0.019), which was not observed from 2017 onwards (p = 0.061). The greatest reduction in FT was after the first year of adoption.

Conclusion

EAM in SVT ablation reduces fluoroscopy use. FT was initially observed to reduce further over time before plateauing, likely due to increased operator experience. While there is increased interest in zero fluoroscopy SVT ablation, complementary use of fluoroscopy may still be necessary in complex cases.

背景：导管消融是治疗症状性、复发性室上性心动过速（SVT）的一线疗法。本研究旨在证明 SVT 消融过程中的三维电子解剖图（EAM）是否能缩短透视时间（FT），并确定是否能纵向观察到 FT 的进一步缩短：前瞻性地招募了 2011 年 5 月至 2022 年 5 月期间在一家三级中心进行 SVT 消融的所有病例。比较了有 EAM 和无 EAM 组群之间的 FT。在 EAM 子集中，分析了 FT 在不同年份的变化趋势：结果：共纳入 1758 例病例，其中 563 例未使用 EAM，1195 例使用了 EAM。EAM与手术时间延长（平均+8.8分钟，p = 0.001）有关，但FT和剂量面积乘积（DAP）分别平均减少了19.6分钟和18 621 mGy*cm2（p 结论：EAM在SVT消融术中的应用与手术时间延长有关，但FT和剂量面积乘积（DAP）分别平均减少了19.6分钟和18 621 mGy*cm2：SVT 消融术中的 EAM 可减少透视的使用。最初观察到，随着时间的推移，FT 进一步减少，然后趋于平稳，这可能是由于操作者经验的增加。虽然人们对零透视 SVT 消融术的兴趣日益浓厚，但在复杂病例中仍有必要辅助使用透视。

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引用次数: 0

Erratum regarding missing Ethical statements in previously published articles 关于以前发表的文章中缺少伦理声明的更正。

Q3 Medicine

Indian Pacing and Electrophysiology Journal

Pub Date : 2024-09-01 DOI: 10.1016/j.ipej.2024.08.001

引用次数: 0

Analysis of intracardiac electrocardiogram during ill-sustained tachycardia – Door to a successful troubleshooting of ‘unnecessary’ defibrillator discharge 分析病态持续性心动过速时的心电图--成功排除 "不必要的 "除颤器放电故障之门。

Q3 Medicine

Indian Pacing and Electrophysiology Journal

Pub Date : 2024-09-01 DOI: 10.1016/j.ipej.2024.07.004

Debabrata Bera , Kuntal Bhattacharyya , Suchit Majumder , Rakesh Sarkar

A 50-year-old gentleman with old anterior wall myocardial infarction with implantable cardioverter defibrillator (ICD, Abbott Medical, Fortify ST VR 1235-40) presented with recurrent appropriate ICD shock. The ICD stored EGM indicated a possibility of supraventricular tachycardia (SVT) rather than ventricular tachycardia (VT) when the morphology match was found high. Bundle brunch re-entry (BBR) VT was another differential. An EP study conducted on antiarrhythmic drugs (AAD) induced reproducible but only ill-sustained tachycardia too short to perform any SVT maneuvers during tachycardia. However, critical analysis of the tachycardia electrograms suggested atypical AVNRT as the most likely mechanism. The other differentials were atrial tachycardia (AT) and BBR VT. Manoeuvres during sinus rhythm and ventricular pacing excluded other diagnosis. A single point radiofrequency ablation (RFA) near the SP region cured the arrhythmia. The reason for misclassification of SVT as VT was also sought for. It was found that the shocks were received due to fulfilment of 2/3 criteria (sudden onset and regular tachycardia). Hence, he received therapy despite an appropriate morphology match favouring SVT. This is one of the known limitations of ICDs where regular SVTs (AVNRT/AVRT or AT) may receive inappropriate ICD therapies. After slow pathway modification there was no further recurrence of either SVT or VT; hence, a substrate modification was deferred.

一名 50 岁的男性患者患有陈旧性前壁心肌梗死，并安装了植入式心律转复除颤器（ICD，雅培医疗，Fortify ST VR 1235-40），但反复出现适当的 ICD 电击。当发现形态匹配度较高时，ICD 存储的 EGM 显示可能是室上性心动过速 (SVT)，而不是室性心动过速 (VT)。束束束再入（BBR）VT 是另一种鉴别方法。一项使用抗心律失常药物（AAD）进行的 EP 研究诱发了可重现的、但仅是持续时间不长的心动过速，在心动过速期间无法进行任何 SVT 操作。然而，对心动过速电图的批判性分析表明，最有可能的机制是非典型房室性心律失常。其他可鉴别的机制是房性心动过速（AT）和 BBR VT。窦性心律和心室起搏时的操作排除了其他诊断。靠近 SP 区的单点射频消融术（RFA）治愈了心律失常。我们还寻找了将 SVT 误诊为 VT 的原因。结果发现，电击是由于符合 2/3 标准（突发和规律性心动过速）。因此，尽管适当的形态匹配有利于 SVT，他还是接受了治疗。这是 ICD 众所周知的局限性之一，常规 SVT（AVNRT/AVRT 或 AT）可能会接受不适当的 ICD 治疗。经过慢速通路改造后，SVT 或 VT 均未再复发；因此，底物改造被推迟。

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引用次数: 0

Antiarrhythmic therapy for narrow QRS supraventricular tachyarrhythmias in newborns and infants in the first year of life: Potent tools to be handled with care 新生儿和出生后第一年婴儿窄 QRS 室上性快速性心律失常的抗心律失常治疗：需谨慎使用的有效工具。

Q3 Medicine

Indian Pacing and Electrophysiology Journal

Pub Date : 2024-09-01 DOI: 10.1016/j.ipej.2024.07.005

Giovanni Domenico Ciriello , Davide Sorice , Antonio Orlando , Giovanni Papaccioli , Diego Colonna , Anna Correra , Emanuele Romeo , Raffaella Esposito , Marina De Marco , Veronica Diana , Mario Giordano , Ludovica Spinelli Barrile , Maria Giovanna Russo , Berardo Sarubbi

Supraventricular tachyarrhythmias pose a significant challenge in neonates and infants, particularly within the first year of life, where prompt and effective management is crucial. By synthesizing available evidence and clinical experience, this review aims to provide a comprehensive overview of antiarrhythmic therapy in this vulnerable population, with a focus on narrow QRS supraventricular tachyarrhythmias. This review examines the current understanding of supraventricular tachyarrhythmia management and discusses the challenges associated with antiarrhythmic therapy in newborns and infants during the critical first year of life, evaluating the efficacy and safety of various antiarrhythmic agents commonly utilized in this population, including dosing considerations, adverse effects, and strategies for acute management and prophylactic long-term antiarrhythmic treatment.

室上性快速性心律失常是新生儿和婴儿面临的重大挑战，尤其是在出生后的第一年内，及时有效的治疗至关重要。通过综合现有证据和临床经验，本综述旨在全面概述针对这一易患人群的抗心律失常治疗，重点关注窄 QRS 室上性心动过速。本综述探讨了目前对室上性快速性心律失常治疗的理解，并讨论了新生儿和婴儿在生命关键的第一年中与抗心律失常治疗相关的挑战，评估了这一人群中常用的各种抗心律失常药物的疗效和安全性，包括剂量注意事项、不良反应以及急性治疗和预防性长期抗心律失常治疗的策略。

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引用次数: 0

Arrhythmogenic or dilated or desmoplakin cardiomyopathy? A challenging case managed by our multidisciplinary cardiogenetic team 致心律失常型心肌病、扩张型心肌病还是脱髓鞘型心肌病？我们的多学科心脏遗传学团队处理的一个具有挑战性的病例。

Q3 Medicine

Indian Pacing and Electrophysiology Journal

Pub Date : 2024-09-01 DOI: 10.1016/j.ipej.2024.07.002

Arrhythmogenic cardiomyopathy (ACM), characterized by fibro or fibrofatty infiltration of the myocardium with a predominant arrhythmic presentation, is a genetically mediated cause of sudden cardiac death in the young and athletic individuals. We report a case of a severe form of biventricular ACM in a middle-aged man with a family history of cardiomyopathy-related young death. The proband was identified to harbor two novel mutations in the DES and DOLK genes and was managed comprehensively with a multidisciplinary team approach. This report reinforces the need for a dedicated cardiovascular genetics program as well as a population-specific genetic database in developing countries.

心律失常性心肌病（ACM）以心肌纤维或纤维脂肪浸润为特征，以心律失常为主要表现形式，是导致年轻人和运动员心脏性猝死的遗传因素之一。我们报告了一例严重的双心室 ACM 病例，患者是一名中年男子，有心肌病相关的年轻死亡家族史。经鉴定，该原发性患者携带 DES 和 DOLK 基因的两个新型突变，并通过多学科团队的方法进行了综合治疗。该报告进一步说明，发展中国家需要专门的心血管遗传学项目以及特定人群的遗传学数据库。

引用次数: 0

Feasibility of using chest strap and dry electrode system for longer term cardiac arrhythmia monitoring: Results from a pilot observational study 使用胸带和干电极系统进行长期心律失常监测的可行性：试点观察研究的结果。

Q3 Medicine

Indian Pacing and Electrophysiology Journal

Pub Date : 2024-09-01 DOI: 10.1016/j.ipej.2024.08.003

Daljeet Kaur Saggu , Madappa Nagamalesh Udigala , Shantanu Sarkar , Arunkumar Sathiyamoorthy , Satyaprakash Dash , V.R. Mohan P , Vinayakrishnan Rajan , Narasimahan Calambur

Background and aim

Cardiac arrhythmia diagnostic yield improves with increased duration of monitoring. We investigated patient comfort, diagnostic quality of ECG, and arrhythmia diagnostic yield using a single lead longer term external cardiac monitor (ECM).

Methods

The observational ECM feasibility study enrolled patients with increased risk of cardiac arrhythmia. The ECM investigational prototype was designed using a chest strap with dry electrodes connected to module capable of triggered loop recording of ECG, and automatic detection of arrhythmia. In group-A of study (24-h inpatient), patients wore ECM and Holter that recorded ECG from the ECM and adhesive electrodes. In group-B of study (12-weeks ambulatory), at monthly follow-ups patients filled out a comfort survey and device stored arrhythmia episodes were reviewed.

Results

The study enrolled 34 patients (38 % females, average age 57.5 years, 65 % had palpitations, 12 % had syncope). Diagnostic quality ECG was recorded on 76.5 % of the monitoring duration in 12 of 20 patients with reviewable data in group-A, with motion artifacts causing loss in ECG signal for 18.7 % of the time. In 14 patients in group-B, 94.9 % of the survey responses indicated that ECM was comfortable to wear. Cardiac arrhythmia was observed in 4 of 17 patients (24 %) in group-A and 9 of 14 patients (64 %) in group-B in device recorded episodes. All ECM detected pause and tachycardia were inappropriate detections due to motion artifacts and temporary device removal.

Conclusion

The chest strap-based ECM device was mostly comfortable to wear and recorded diagnostic quality ECG in three-fourth of monitoring period. Cardiac arrhythmia was observed in 64 % of patients over 3-month monitoring along with large number of motion artifact induced inappropriate detections.

背景和目的：心律失常诊断率随着监护时间的延长而提高。我们研究了使用单导联长期体外心脏监护仪（ECM）的患者舒适度、心电图诊断质量和心律失常诊断率：观察性 ECM 可行性研究招募了心律失常风险较高的患者。ECM 的研究原型设计使用胸带，胸带上的干电极与模块相连，能够触发循环记录心电图并自动检测心律失常。在研究的 A 组（24 小时住院患者）中，患者佩戴 ECM 和 Holter，通过 ECM 和粘性电极记录心电图。在研究 B 组（12 周非卧床）中，患者在每月随访时填写舒适度调查表，并对设备存储的心律失常事件进行复查：研究共招募了 34 名患者（38% 为女性，平均年龄 57.5 岁，65% 有心悸症状，12% 有晕厥症状）。在 20 名患者中，A 组有 12 人在 76.5%的监测时间内记录到了高质量的心电图，其中 18.7%的时间因运动伪影导致心电图信号丢失。在 B 组的 14 名患者中，94.9% 的受访者表示 ECM 佩戴舒适。在设备记录的事件中，A 组 17 名患者中有 4 人（24%）观察到心律失常，B 组 14 名患者中有 9 人（64%）观察到心律失常。所有 ECM 检测到的暂停和心动过速都是由于运动伪影和临时移除设备造成的不恰当检测：结论：胸带式 ECM 设备佩戴舒适，在四分之三的监测时间内记录到诊断质量的心电图。临床试验注册：临床试验注册号：CTRI/2020/02/023576。

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引用次数: 0

Atrial placement of Aveir-VR leadless pacemaker in a patient with complex cardiac anatomy 为一名心脏解剖结构复杂的患者在心房置入 Aveir-VR 无导联起搏器。

Q3 Medicine

Indian Pacing and Electrophysiology Journal

Pub Date : 2024-07-01 DOI: 10.1016/j.ipej.2024.04.009

Leadless pacemakers have provided new treatment modalities that can be especially useful in patients with complex cardiac anatomy and contraindications toward other pacemaker approaches. The Aveir™ single-chamber (VR) leadless pacemaker (LP) (Abbott Laboratories, Chicago, IL) is a recently approved device that can be placed in the right ventricle for patients with bradycardia. In this case, we present a novel use for the device through placement in the atrium to control atrial flutter in a patient with a hypoplastic right ventricle.

无导联起搏器提供了新的治疗模式，尤其适用于心脏解剖结构复杂且有其他起搏器禁忌症的患者。Aveir™ 单腔（VR）无引线起搏器（LP）（雅培实验室，芝加哥，伊利诺斯州）是最近获得批准的一种设备，可以放置在右心室，用于治疗心动过缓患者。在本病例中，我们介绍了该装置的一种新用途，即通过在心房放置该装置来控制右心室发育不良患者的心房扑动。

引用次数: 0

A case report of right ventricular defibrillator and left bundle branch area leads placement and atrioventricular node ablation with chronic right ventricular thrombus 右心室除颤器和左束支区导联置入术及房室结消融术合并慢性右心室血栓的病例报告。

Q3 Medicine

Indian Pacing and Electrophysiology Journal

Pub Date : 2024-07-01 DOI: 10.1016/j.ipej.2024.06.001

Despite lack of concrete evidence, right ventricular thrombus is generally considered to be a contraindication for intracardiac lead placement. We present a case of successful placement of a right ventricular defibrillator lead and left bundle branch pacing lead and atrioventricular node ablation in a patient with chronic right ventricle thrombus.

尽管缺乏具体证据，但右室血栓通常被认为是心内导联置入的禁忌症。我们介绍了一例在慢性右室血栓患者中成功置入右室除颤导联和左束支起搏导联以及房室结消融术的病例。

引用次数: 0

Multiple ventricular fibrillation therapy triggered at slower ventricular tachycardia rate – What is the mechanism? 以较慢的室性心动过速触发的多重室颤治疗--其机制是什么？

Q3 Medicine

Indian Pacing and Electrophysiology Journal

Pub Date : 2024-07-01 DOI: 10.1016/j.ipej.2024.04.010

引用次数: 0

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Indian Pacing and Electrophysiology Journal

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