Journal of Innovations in Cardiac Rhythm Management最新文献

Implantable cardiac monitors (ICMs) are useful in the detection of tachycardias, bradycardias, and atrial fibrillation. Undersensing and oversensing of events occur despite complex algorithms. The devices available have subtle differences, which may account for a difference in recorded characteristics. The electrocardiogram (ECG) characteristics of different monitors may influence their ability to correctly identify the events recorded. The objective is to compare the ECG characteristics of two commercially available implantable loop monitors and the ability to improve diagnostic accuracy. Two cohorts of patients were examined. Cohort 1 consisted of 30 patients with a Reveal LINQ I (Medtronic, Minneapolis, MN, USA) implanted, which was replaced with a BIOMONITOR III (Biotronik, Berlin, Germany) when the former had reached end of life. The new monitor was implanted at the same site in all patients. This provided a unique opportunity to compare ECGs obtained by both devices with no other confounding variable. Cohort 2 consisted of patients who had undergone implantation of either device at the discretion of the physician. This was therefore a retrospective analysis of 106 patients who had been implanted with one of the devices within a 2-year period. In both cohorts, we compared R-wave amplitude, the ability to accurately detect P-waves, and the frequency of undersensing and oversensing of events. In cohort 1, the mean R-wave was 0.35 ± 0.2 mV with the LINQ I as compared to 0.98 ± 0.4 with the BIOMONITOR III (P = .001). A P-wave in sinus rhythm was present in 19 (63%) subjects with the LINQ I implants versus 28 (93%) with the BIOMONITOR III implants (P = .004). Undersensing of events was noted in five (16%) patients with the LINQ I versus five (16%) with the BIOMONITOR III (P > .5). Oversensing was seen in 4 patients (13.33%) with the LINQ I versus 0 with the BIOMONITOR III (P = .012). In cohort 2, the mean R-wave with the BIOMONITOR III was significantly greater than with the LINQ I (0.65 ± 0.37 vs. 0.48 ± 0.38; P = .02). A visible P-wave was seen in 33 of 53 patients with the BIOMONITOR III as compared to 16 of 536 patients with the LINQ I monitor (P = .01). The number of patients identified as having under- or oversensing was, however, not significantly different (P = .08) in this cohort. In both patient cohorts, the BIOMONITOR III was noted to have significantly greater R-wave amplitude as compared with the LINQ I. A visible P-wave was also more commonly seen in patients with a BIOMONITOR III. In the paired cohort, but not in the unpaired cohort, the BIOMONITOR III was less likely to oversense R-waves. There was no significant difference in undersensing between the devices.

Empirical left atrial appendage isolation (eLAAi) using a cryoballoon reduces atrial tachyarrhythmia recurrences in persistent atrial fibrillation. Nonetheless, the most significant concern associated with this procedure is the risk of thromboembolic events, particularly without consistent oral anticoagulant (OAC) use. This case highlights a late thrombus formation post-eLAAi despite proper OAC adherence, raising questions about OAC's effectiveness in such scenarios. The case suggests considering percutaneous left atrial appendage closure after eLAAi, even in patients with thrombus and ongoing OAC therapy.

A 35-year-old man with congenitally corrected transposition of the great arteries (ccTGA) and prior ventricular septal defect repair developed pacing-induced cardiomyopathy after 30 years of single-chamber VVI pacemaker use. Right bundle branch area pacing (RBBAP) was chosen for device upgrade due to its potential benefits over conventional cardiac resynchronization therapy. Advanced three-dimensional electroanatomic mapping was employed to navigate a synthetic patch from previous surgery and guide mid-septal electrode placement. Successful RBBAP was achieved with optimal parameters, complemented by atrial and defibrillator lead implantation. At 12 months, the patient showed improved ejection fraction (from 30% to 40%) and stable electrocardiographic results. This case illustrates the role of RBBAP and advanced mapping in addressing complex structural and conduction abnormalities in ccTGA.

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.