Journal of Innovations in Cardiac Rhythm Management最新文献

Following a non-ST-elevation myocardial infarction (MI), a 68-year-old hypertensive, severely obese woman with 45% left ventricular ejection fraction underwent an implantable cardiac monitor (ICM) insertion. After 8 months, the ICM remotely transmitted multiple non-sustained ventricular tachycardia episodes. Symptomatic during these events, the patient underwent an invasive electrophysiologic stimulation, which induced ventricular arrhythmia. Subsequently, implantable cardioverter-defibrillator implantation was recommended. Continuous remote monitoring via an ICM detected critical arrhythmias in this post-MI patient, facilitating timely intervention.

Atrial fibrillation (AF) affects around 33 million people worldwide, rendering it a common cardiac arrhythmia. Catheter ablation (CA) has evolved as a leading therapeutic intervention for symptomatic AF. This umbrella review systematically evaluates existing systematic reviews and meta-analyses to assess the safety, efficacy, and potential of high-power, short-duration (HPSD) ablation as an alternative therapy option for AF. A thorough exploration was undertaken across PubMed, the Cochrane Library, and Embase to identify pertinent studies for inclusion in this umbrella review. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method was employed to assess the overall certainty of the evidence comprehensively, and the quality of the incorporated reviews was meticulously evaluated through use of the AMSTAR 2 tool, the Cochrane Collaboration tool, and the Newcastle-Ottawa scale. In this study, we initially identified 35 systematic reviews and meta-analyses, narrowing them down to a final selection of 11 studies, which collectively integrated data from 6 randomized controlled trials and 26 observational studies. For primary efficacy outcomes, the HPSD approach led to a non-significant decrease in the risk of atrial tachyarrhythmia recurrence (risk ratio [RR], 0.88; 95% confidence interval [CI], 0.70-1.12; I ² = 90%; P = .31) and a significantly reduced risk of AF recurrence (RR, 0.53; 95% CI, 0.42-0.67; I ² = 0%; P < .00001) compared to the low-power, long-duration (LPLD) approach. In terms of primary safety outcomes, the HPSD approach significantly reduced the risk of esophageal thermal injury (ETI) (RR, 0.71; 95% CI, 0.61-0.83; I ² = 0%; P < .00001) and facilitated a non-significant decrease in the risk of other major complications (RR, 0.87; 95% CI, 0.73-1.03; I ² = 0%; P = .10). In conclusion, HPSD therapy is safer and more effective than LPLD therapy, facilitating decreased AF recurrence rates along with reductions in ETI, total procedure duration, ablation number, ablation time, fluoroscopy time, and acute pulmonary vein reconnection.

Current leadless pacemaker (LP) systems, which have been developed and used in patients with normal cardiac anatomy, are rare and technically even more challenging to implant in patients with congenital heart diseases, especially with univentricular physiology and Fontan palliation. We report two cases of percutaneous LP implantation in an adult and a child, respectively, highlighting the unconventional approaches, different challenges, and use of multimodality imaging in patients who underwent a Fontan operation.

Conduction system pacing (CSP) has emerged as an alternative to cardiac resynchronization therapy (CRT); however, there is limited experience with CSP using implantable cardiac defibrillator (ICD) leads. The achievement of CSP with an ICD lead may yield comparable results to cardiac resynchronization therapy defibrillator (CRT-D) therapy using fewer leads. We implanted the Biotronik Linox DX "VDD"-programmable ICD lead in a swine model to investigate the feasibility of "single-lead" CRT-D implantation. With the lead embedded in the basal right ventricular septum, morphologic criteria for CSP were achieved, and successful defibrillation was performed while maintaining atrial sensing. Future work may assure reproducibility of these findings and further determine the feasibility of a single-lead CRT-D.

Telemetry monitoring (conventional cardiac monitoring system [CCMS]) is a universal method for postoperative arrhythmia detection; however, the clinical challenge of alarm fatigue, primarily associated with noise or cable disconnections, persists. The introduction of wireless continuous cardiac monitoring (WCCM) represents a potential solution to enhance recording fidelity. Patients were simultaneously outfitted with both a monitoring device considered the standard of care and a novel adhesive wireless patch. A 48-h cardiac monitoring session with the two devices occurred after cardiac surgery in a unit equipped with a telemetry system. A total of 53 patients with a mean age of 60 ± 17 years were included in the trial. The number of events detected by the two systems was significantly different at 190 versus 174 for the CCMS and the WCCM system, respectively (P < .05). However, the percentage of agreement was not significantly different at 91% versus 88% (P = .37). Events were classified as follows: pause (2 events, 1%), atrial or premature ventricular contractions (18 events, 11%), atrial flutter or fibrillation (76 events, 45%), bradycardia (12 events, 7%), and tachycardia (61 events, 36%). False alarms were significantly more frequent with the CCMS (n = 21) than with the WCCM system (n = 5; P = .002). The study successfully demonstrated the feasibility and usability of wireless monitoring for patients requiring telemetry. The overall results are compelling, as the WCCM system performed satisfactorily, achieving results comparable to those obtained with the CCMS, even with significantly fewer false alarms.

The coronavirus disease 2019 (COVID-19) pandemic affected many aspects of health care and continues to have an impact as waves of COVID-19 cases re-emerge. Many procedures were negatively impacted by the pandemic, and management was primarily focused on limiting exposure to the virus. We present an analysis of the National Inpatient Sample (NIS) to delineate how COVID-19 affected atrial fibrillation (AF) ablation. The NIS was analyzed from 2017-2020 in order to determine the pre- and intra-pandemic impacts on AF ablation procedures. Admissions were identified using the International Classification of Diseases, 10th Revision, Clinical Modification codes with a primary diagnosis of AF (ICD-10 CM code I48.0, I48.1, I48.2, or I48.91). Admissions were also assessed for the use of cardiac ablation therapy. Comorbidity diagnoses were identified using the Elixhauser comorbidity software (Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, Rockville, MD, USA); additional ICD-10 codes for diagnoses and procedures used are also provided. The primary outcome of our study was the trend in ablation therapy during AF admissions. Secondary outcomes included health care disparities, inpatient mortality, and length of stay. Ablation therapy was used in 18,885 admissions in 2020, compared to the preceding 3-year average of 20,103 (adjusted Wald test, P = .002). Multivariate logistic regression revealed a greater likelihood of undergoing ablation therapy (odds ratio, 1.24; 95% confidence interval, 1.10-1.40; P < .001) among 2020 admissions compared to 2017 admissions. Inpatient mortality increased in 2020 compared to the preceding average; however, the difference was not significant. The procedural volume of ablation for AF saw a decrease in 2020; however, surprisingly, more patients were likely to undergo ablation during 2020.

The effect of irradiation during computed tomography (CT) imaging on implantable cardioverter-defibrillators (ICDs) has not been fully evaluated in various settings. The purposes of this study were to evaluate the occurrence of electromagnetic interference (EMI) during CT irradiation in various clinically available ICDs with phantom experiments and to determine the potential risks related to irradiation during CT imaging. Five types of clinically available ICDs from five manufacturers were tested. An ICD was combined with an electrocardiogram (ECG) simulator, mounted in a chest phantom, and subjected to CT imaging. Each ICD was irradiated at the maximal power level (tube voltage, 135 kVp; tube current, 510 mA; rotation time, 1.5 s). EMI was defined as oversensing, ventricular tachycardia/ventricular fibrillation (VT/VF) detection, noise, or shock delivery during CT imaging. For ICDs in which EMI was observed, EMI was then evaluated under 144 different irradiation conditions (tube voltage [four patterns from 80-135 kVp], tube current [six patterns from 50-550 mA], and rotation time [six patterns from 0.35-1.5 s]). Testing was also performed during irradiation at the typical doses in three clinical settings and in two settings with inappropriate irradiation of ICDs due to incorrect setup. Among the five ICDs, a shock was delivered by one ICD manufactured by Medtronic (Minneapolis, MN, USA) due to oversensing during irradiation, which occurred at the maximal power level. No oversensing was observed in other ICDs. In the malfunctioned ICD, oversensing was observed in 134 of 144 irradiation patterns, even at a low power in the ICD. The VF-detection criterion was fulfilled in 20 of 134 tests and was significantly associated with tube voltage, tube current, ration time, and tube voltage × rotation time interaction. Although oversensing was observed in three clinical settings (typical chest CT, CT coronary angiography after coronary artery bypass graft, and dynamic assessment for pleural tumors) and one situation during an incorrect scan range on the chest for head perfusion CT, they were not recognized as tachycardia beats. Oversensing was observed when scans were incorrectly set over the ICD during bolus tracking of contrast-enhanced CT. Maximal power CT imaging induced VT/VF detection and shock delivery in one model of ICD placed in a chest phantom. VT/VF detection was observed when tube voltages were high and irradiation times were longer. Oversensing can occur during inappropriate CT imaging, particularly when slices are positioned over the ICD.