Journal of Innovations in Cardiac Rhythm Management最新文献

Cardiovascular laser application (CVLA) is an innovative approach in the field of cardiology aimed at treating various cardiovascular diseases, including cardiac arrhythmias, cardiomyopathies, systemic and pulmonary resistant hypertension, and varicose leg veins, by using a key technology, the laser. Tissue-selective photon absorption of the 1064-nm wavelength induces tissue-selective irreversible lesions of arrhythmogenic myocardium, modulation of retrocardiac ganglion plexi, and renal and pulmonary perivascular innervation. This review summarizes the development and the experimental and clinical results of the CVLA, highlighting its potential advantages over other catheter ablation methods. Based on its unique characteristics, laser treatment has the potential to become an all-pervasive, safe, and effective procedure for the benefit of countless patients.

Transcatheter tricuspid valve (TV) interventions (TTVIs), which include transcatheter TV replacement (TTVR) and transcatheter tricuspid edge-to-edge repair (T-TEER), represent a natural evolution in percutaneous valve therapy. However, TTVIs face distinct challenges, chief among them being the frequent presence of transvenous cardiac implantable electronic device (CIED) leads crossing the TV. This review investigates contemporary CIED strategies that eliminate the need for transvenous leads crossing the TV, thereby facilitating safer and more durable integration of device therapy with emerging TTVI technologies.

Experience with the Aurora extravascular (EV) implantable cardioverter-defibrillator (ICD) (Medtronic, Minneapolis, MN, USA) remains limited among pediatric centers in contrast to its broader implantation in adults. We evaluated our single-center experience with the EV ICD as part of our standard ICD options for treatment of malignant ventricular arrhythmias in pediatric subjects. Following approval for EV ICD implantation at our center, five consecutive adolescent patients underwent implantation over a 7-month period. Patient characteristics, qualification for EV ICD placement, nuances in EV ICD implantation in each patient, and post-implant follow-up were reviewed. A total of six out of eight consecutive ICD candidates were identified as potential EV ICD candidates, with five patients undergoing eventual EV ICD implantation (average age, 16.8 years [range, 14-19 years]; four males). Indications for ICD included genetic arrhythmias (n = 3) and hypertrophic cardiomyopathy (n = 2). All patients underwent successful implantation without intraoperative or early postoperative complications. No lead dislodgement, device migration, infection, or inappropriate shocks were observed. All patients demonstrated appropriate R-wave sensing and stable lead parameters at early (4- to 6-week) and mid-term (>3- to 6-month) follow-up. Post-implant exercise testing in two patients showed no significant P- or T-wave oversensing. EV ICD implantation is feasible and well tolerated in appropriately selected pediatric patients. Most pediatric ICD referrals were candidates for EV ICD implant when integrating the EV ICD in regular practice. Implant indications differ among pediatric versus adult EV ICD recipients. While early outcomes are favorable, long-term performance and applicability in smaller patients require further investigation.

Cardiac imaging is crucial in the electrophysiology field, not only as a diagnostic tool but also to expand and guide interventional cardiac electrophysiology procedures. With this consideration in mind, this article aims to review the critical role of cardiac imaging in stratifying patients' risk profiles and assisting the electrophysiological procedure in various scenarios. This article also highlights the future direction within the cardiac electrophysiology field with digital twins, which incorporate cardiac imaging and clinical data to build physiologically accurate cardiac replicas to assist electrophysiological procedural planning.

Patients with heart failure (HF) may experience depression or anxiety due to various reasons associated with their or caregivers' characteristics. The purpose of this study was to explore patients' and caregivers' characteristics associated with hospitalized HF patients' anxiety and depression. A total of 300 hospitalized HF patients with their caregivers were enrolled in the study. Data were collected using the Hospital Anxiety and Depression Scale, which also included patients' and caregivers' characteristics. The statistical significance level was set at P < .05. A statistically significant association was observed between patients' anxiety and age (P = .044), level of education (P = .015), type of diagnosis (P = .001), New York Heart Association (NYHA) class (P = .001), prior hospitalization within the current year (P = .013), current smoking (P = .001), frequency of physical exercise (P = .001), and their self-reported ability for symptom management after hospital discharge (P = .001). A statistically significant association was observed between patients' depression and age (P = .018), type of diagnosis (P = .001), NYHA class (P = .001), prior hospitalization within the current year (P = .004), current smoking (P = .001), occasional alcohol consumption (P = .026), frequency of physical exercise (P = .001), and their self-reported ability for symptom management after hospital discharge (P = .001). In terms of caregivers' characteristics, a statistically significant association was observed between patients' anxiety/depression and the relationship with caregivers (P = .006 and P = .001, respectively), whether caregivers declared added responsibilities among family members (P = .041 and P = .002, respectively), and whether they felt uncertain about patients' clinical outcome (P = .001 and P = .001, respectively). Finally, a statistically significant association was observed between patients' depression and the occupation of their caregivers (P = .038). Patients' characteristics associated with anxiety/depression were demographic and clinical, while caregivers' characteristics associated with patients' anxiety/depression were their self-reports and demographic characteristics. Knowledge of factors that influence anxiety and depression can enable health care professionals to offer appropriate interventions tailored to their needs.

Navik 3D (APN Health, Waukesha, WI, USA) is a navigation software program that uses two-dimensional (2D) fluoroscopy images to provide three-dimensional (3D) information. Left bundle branch area (LBBA) pacing (LBBAP) is a novel physiologic pacing technique where the lead is placed in the right ventricular (RV) basal septum to capture the left bundle branch (LBB). Precise lead placement in this region can be challenging using 2D fluoroscopy. We studied the feasibility of using Navik 3D to identify the location, plane, and depth of the lead in the septum to assist with LBBAP procedures. This observational, prospective single-center study included 14 patients undergoing LBBAP. Navik 3D was used to identify the LBBA, RV septum, RV apex, and lead position in three dimensions using two orthogonal 2D views. The 3D images were overlaid on real-time, gated fluoroscopic images for navigation of the lead. Images of the 3D locations and successful or unsuccessful lead locations were projected onto 2D fluoroscopic images, allowing for repositioning if necessary. All attempted patients had successful LBBA lead implants. An LBB potential was recorded in 61.5% of the patients. Selective LBBAP was achieved in 85% of the patients. The mean QRS duration postimplant was 129.8 ± 13.1 ms. The mean left ventricular activation time (stimulus R-wave peak in V6) postimplant was 75 ± 12 ms. No acute complications were recorded. 3D localization of the LBBA using the Navik 3D mapping system was feasible and may assist with more appropriate LBBA lead placement.

Right ventricular pacing can cause electrical and mechanical dyssynchrony, potentially leading to pacemaker-induced cardiomyopathy (PICM). This pilot study evaluates speckle tracking echocardiography for the early detection of subclinical left ventricular dysfunction in pediatric and congenital heart disease patients with Micra™ leadless pacemakers (Medtronic, Minneapolis, MN, USA). We analyzed echocardiograms of eight patients (mean age, 15 years; 63% women) with Micra™ pacemakers at implant and 1 month and 1 year post-implant. Data of interest included demographics, pacemaker position, ejection fraction (EF), shortening fraction, and global longitudinal strain (GLS). The pacing percentages varied from <0.1% to 100%, with three patients having burdens of >20%. The mean GLS was -17.99, and the mean EF was 59.6%. A higher EF correlated mildly with more-negative GLS values (r = 0.288; P = .218), and greater pacing percentages correlated with poorer GLS values (r = -0.381; P = .097). In summary, GLS has the potential to identify myocardial dyssynchrony, which may have the potential to support the early detection of PICM. Further research with larger cohorts and longer follow-up is needed to validate these findings.