Journal of Innovations in Cardiac Rhythm Management最新文献

Leadless pacemakers (LPs) are emerging options for bradyarrhythmias. However, extraction can be risky if the device is in an unfavorable position. We present a challenging case of a Nanostim LP (NLP) (Abbott Medical Inc., Abbott Park, IL, USA) placed 8 years prior to removal and subsequent replacement with an AVEIR LP (ALP) (Abbott). A 72-year-old man received an NLP in 2015 for persistent atrial fibrillation with bradycardia. The NLP could not be interrogated in our office. An external event monitor demonstrated persistent atrial fibrillation with bradycardia and pauses. A premature battery depletion of the NLP was suspected. An ALP was chosen for replacement. On a computed tomography scan of the chest, the NLP was seen in the mid-free wall of the right ventricle, and its proximal portion abutted the tricuspid annulus. The AVEIR retrieval catheter (ARC) was used for retrieval. Multiple attempts were made to snare the device, yet it proved difficult due to poor placement and button tissue formation. The snare became damaged, and a second ARC was needed. On the successful attempt, the NLP was snared proximally and permitted docking. We advanced the protective sleeve over the NLP body, but resistance was observed due to tissue growth. Counterclockwise torsion was applied, and the device disconnected. Once the NLP was in linear orientation, the protective sleeve was eventually positioned over its body, allowing removal. The ALP was then installed without difficulty or structural complications. This report shows the importance of proper LP placement in the right ventricular septal wall. LP removal can be performed safely, yet complications can arise based on the age and location of the LP. The ARC can be successfully used to extract non-AVEIR LPs with evidence of docking button tissue growth. Similar interventions should exercise caution when attempting extraction and subsequent implantation.

This double-blind randomized controlled trial investigated the effects of osteopathic manipulative treatment (OMT) on cardiac arrhythmias in patients with cardiac implantable electronic devices (CIEDs). Participants (n = 41) with CIEDs were randomly assigned to either the OMT group or the control group (light touch/sham) and received a one-time intervention. No significant change in arrhythmia burden was found in the 1 month following intervention (P = .14). Discrete heart rate (HR), HR variability (HRV), and activity data were obtained from CIEDs in 17 of 41 subjects 1, 3, 7, 14, and 30 days prior to and after intervention. No significant difference was observed. An additional short-term substudy was performed on 20 subjects at the time of the intervention (5 min prior to and after intervention), and HR, respiratory rate, blood pressure, blood oxygen saturation (SpO₂), and 1-min short-term HRV were compared. This study did not demonstrate an effect of OMT on arrhythmias, HR, respiratory rate, blood pressure, and blood SpO₂. However, differences in OMT versus sham were observed for short-term HRV (P = .022) and a trend for long-term HRV. Importantly, there were no reported adverse effects with either intervention. OMT appears to be safe in cardiac patients.

Device infection remains a dreaded and increasingly common complication of pacemaker procedures, often mandating removal of all implanted materials. Intensive wound management may be necessary following extraction, requiring multiple follow-up encounters in the outpatient setting. Here, a case of pacemaker pocket infection necessitating complete system extraction is presented. A cutaneous phototherapy device (X39^®; LifeWave, Inc., San Diego, CA, USA) was used to facilitate wound closure. Healing was found to occur 40%-50% faster with this adjunctive therapy, reducing the number of follow-up visits by half. These adhesive patches contain natural compounds that reflect back infrared frequencies emitted by the skin. Biologic activity includes elevation of glycyl-L-histidyl-L-lysine levels, with a plethora of effects. This non-pharmacological wellness device may be useful to hasten wound healing and recovery from pocket infection.

Our study evaluated the efficacy and feasibility of left bundle branch area pacing (LBBAP) compared to right ventricular outflow tract septal pacing (RVOSP). We conducted a prospective, single-center, observational study involving 200 consecutive patients who required pacemaker implantation. The patients were divided into two groups (LBBAP and RVOSP), with 100 patients in each group. We aimed to compare the safety and efficacy, as well as the procedure and fluoroscopy times, between the two groups. Additionally, we aimed to describe the learning curve for the LBBAP group. The success and acute complication rates were similar (P = .56 vs. P = .65). The procedure time was longer in the LBBAP group compared to the RVOSP group (18 [13-28] vs. 11 [7-17] min; P < .001), while the fluoroscopy time was shorter in the LBBAP group compared to the RVOSP group (2.8 [1.3-3.7] vs. 3.1 [2-5.9] min; P = .02). The paced QRS interval was narrower in the LBBAP group (123.77 ± 10.25 vs. 159.79 ± 17.0 ms; P = .001). There were no significant differences in pacing parameters like R-wave sensing (9.6 ± 5.2 vs. 9.1 ± 4.7 mV; P = .91), bipolar impedance (685.9 ± 151.8 vs. 686.5 ± 158.6 Ω; P = .98), or pacing threshold (0.70 ± 0.29 vs. 0.64 ± 0.26 V @ 0.4 ms; P = .63). In the LBBAP group, both the procedure time (12 [10.5-15] vs. 32 [28.5-38.5] min; P < .001) and the fluoroscopy time (2 [1-4.6] vs. 5.1 [3.4-12] min; P < .01) were shorter in the last quartile (Q4) compared to the first quartile (Q1). The procedure time was similar between LBBAP Q4 and RVOSP (12 [10.5-15] vs. 11 [7-17] min; P = .33). LBBAP is as safe as RVOSP and achieves a narrower paced QRS compared to RVOSP. After a rapid learning curve, a shorter fluoroscopy time and a similar procedure time can be achieved.

High-risk cardiac patients undergoing complex electrophysiology procedures face potential hemodynamic instability, necessitating effective mechanical circulatory support. The catheter-based Impella^® ventricular assist device (Abiomed, Danvers, MA, USA) is crucial to stabilizing hemodynamics by improving the flow of blood from the left ventricle to the aorta. Its automated controller ensures cerebral hemodynamic stability, allowing for bedside adjustments. Herein, we present a case series illustrating the versatility of the Impella^® device in managing patients during complex electrophysiology procedures and highlighting its role in mitigating hemodynamic compromise.

Oversensing of extra-cardiac noise may inhibit delivery of subcutaneous cardiac implantable defibrillator (S-ICD) therapy. We report a case of diaphragmatic tetany resulting in the inhibition of S-ICD therapy at the time of defibrillator testing without the use of muscle relaxants. Clinicians should be aware of this phenomenon.

Sarcoidosis is a complex disease characterized by inflammatory granulomas that can affect various organs, including the heart. The diagnosis of cardiac sarcoidosis poses challenges, and current criteria involve the use of advanced imaging techniques and histological confirmation. Clinical manifestations of cardiac sarcoidosis vary widely, ranging from heart block to ventricular tachycardia and heart failure. Sudden cardiac death (SCD) is a significant concern, and implantable cardioverter-defibrillators (ICDs) are recommended for preventing SCD in high-risk cases. However, some patients with cardiac sarcoidosis do not meet the current guidelines for ICD implantation, leaving them at risk. Traditional transvenous ICDs are associated with complications, especially in immunosuppressed patients. The subcutaneous implantable cardioverter-defibrillator (S-ICD) offers a potential solution, as it avoids vascular complications and reduces the risk of infections. However, concerns regarding inappropriate shocks and the lack of pacing therapy limit its widespread use. Leadless pacing combined with S-ICD represents a potential novel approach to managing cardiac sarcoidosis patients. Ongoing human clinical trials are expected to shed light on the safety and efficacy of this combined therapy. Cardiac sarcoidosis patients, who have been underserved by traditional device therapies, may benefit from this personalized approach. Further research is needed to guide the management of SCD risk in this population.