Background: The deleterious effects of right ventricular (RV) apical pacing promoted the need for more physiological pacing techniques, such as conduction system, His bundle area, and mid-septal ventricular pacing. We aimed to compare permanent mid-septal and His bundle area pacing (HBAP) vs RV apical pacing to determine which is more physiological and to assess lead stability and pacing thresholds. Methods: We retrospectively analyzed 137 consecutive patients undergoing permanent pacing (63% men, mean age 61 ± 24 years). Seventy-one (52%) had a baseline QRS of < 120 ms, with no evidence of intraventricular conduction abnormalities, 37 (27%) had right bundle branch block, and 29 (21%) had left bundle branch block. The ventricular lead was implanted at the RV apex in 54 patients, at the His bundle area in 66, and at the mid interventricular septum in 17. Twelve-lead electrocardiogram was recorded, and electrical synchrony was assessed using the Synchromax® crosscorrelation cardiac synchrony index (CSI). Results: QRS duration was prolonged in all pacing sites. There was no correlation between QRS duration and the CSI (r = 0.028, p = 0.79). The CSI was significantly improved only in patients undergoing HBAP, despite a slight widening of the QRS complex. There was no difference in pacing thresholds and sensed R wave voltage. Lead dislodgment occurred in only 1 lead implanted at the His bundle area. Conclusions: HBAP successfully captures the conduction system, normalizing the CSI despite producing a wider QRS, meaning that coordination is more important than duration for achieving optimal cardiac synchrony
{"title":"Safety and Efficacy of His Bundle Area (Para-Hisian) Pacing Using a Mathematical Cross-Correlation Cardiac Synchrony Index","authors":"","doi":"10.33140/coa.09.01.03","DOIUrl":"https://doi.org/10.33140/coa.09.01.03","url":null,"abstract":"Background: The deleterious effects of right ventricular (RV) apical pacing promoted the need for more physiological pacing techniques, such as conduction system, His bundle area, and mid-septal ventricular pacing. We aimed to compare permanent mid-septal and His bundle area pacing (HBAP) vs RV apical pacing to determine which is more physiological and to assess lead stability and pacing thresholds. Methods: We retrospectively analyzed 137 consecutive patients undergoing permanent pacing (63% men, mean age 61 ± 24 years). Seventy-one (52%) had a baseline QRS of < 120 ms, with no evidence of intraventricular conduction abnormalities, 37 (27%) had right bundle branch block, and 29 (21%) had left bundle branch block. The ventricular lead was implanted at the RV apex in 54 patients, at the His bundle area in 66, and at the mid interventricular septum in 17. Twelve-lead electrocardiogram was recorded, and electrical synchrony was assessed using the Synchromax® crosscorrelation cardiac synchrony index (CSI). Results: QRS duration was prolonged in all pacing sites. There was no correlation between QRS duration and the CSI (r = 0.028, p = 0.79). The CSI was significantly improved only in patients undergoing HBAP, despite a slight widening of the QRS complex. There was no difference in pacing thresholds and sensed R wave voltage. Lead dislodgment occurred in only 1 lead implanted at the His bundle area. Conclusions: HBAP successfully captures the conduction system, normalizing the CSI despite producing a wider QRS, meaning that coordination is more important than duration for achieving optimal cardiac synchrony","PeriodicalId":512891,"journal":{"name":"Cardiology: Open Access","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140510329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The HANDs are muscle-specific bHLH TFs crucial for proper cardiac and extra-embryonic development. The eHAND and dHAND functioned in developing ventricular chambers (right and left ventricle), aortic arch arteries, cardiac neural crest, endocardium and epicardium. The down-regulated response of the eHAND and dHAND genes reflects permissiveness. A recent report suggested that cardiac hypertrophy intimate eHAND corresponds to cardiomyopathy and dHAND in the atrium. Those reports supported the cardiac muscles may re-initiate a fetal gene result and initiate physiological changes, which allow the heart to recompense. Objective: In this study, the objective is an investigation of the HAND subclass bHLH transcription factors in mammals. I like to classify the bHLH TFs and discuss the genetic evidence of both eHAND and dHAND genes in cardiogenesis. So, perform bioinformatics and computational tools and techniques to the current knowledge of the HAND subclass bHLH transcription factor in the mammalian genome. This application may be valuable for future functional analysis of particular TFs in different organisms. Results: The observation data demonstrated that the heart and neural crest derivative transcription factors are present in mammals. The two mammalian genomes' likelihood of Homo sapiens and Mus musculus perform for comparative analysis. Analysis data suggested the eHAND and dHAND genes and a total number of bHLH domains in Homo sapiens and Mus musculus. Also, the conserved domain, motifs, phylogeny, gene expression and chromosome location analysis demonstrated the heart and neural crest derivative factors associated with cardiogenesis. Conclusion: Over the last decades, a wealth of new reports has been composed of unique genetic and phenotypic characteristics of cardiac morphogenesis. The mutational analysis of the eHAND and dHAND transcription factors enabled precise resolution of specialized function during the developing myocardium. Also, analysis data concluded the muscle-specific transcription factors eHAND and dHAND are associated with cardiac disease and development. In contrast, the tissue-specific bHLH and other TFs lead to the development of myogenesis and vasculogenesis.
{"title":"In-Silico Analysis of Heart and Neural Crest Derivatives (HAND) Subclass Basic Helix-Loop-Helix (bHLH) Transcription Factor in Cardiogenesis","authors":"","doi":"10.33140/coa.09.01.02","DOIUrl":"https://doi.org/10.33140/coa.09.01.02","url":null,"abstract":"Background: The HANDs are muscle-specific bHLH TFs crucial for proper cardiac and extra-embryonic development. The eHAND and dHAND functioned in developing ventricular chambers (right and left ventricle), aortic arch arteries, cardiac neural crest, endocardium and epicardium. The down-regulated response of the eHAND and dHAND genes reflects permissiveness. A recent report suggested that cardiac hypertrophy intimate eHAND corresponds to cardiomyopathy and dHAND in the atrium. Those reports supported the cardiac muscles may re-initiate a fetal gene result and initiate physiological changes, which allow the heart to recompense. Objective: In this study, the objective is an investigation of the HAND subclass bHLH transcription factors in mammals. I like to classify the bHLH TFs and discuss the genetic evidence of both eHAND and dHAND genes in cardiogenesis. So, perform bioinformatics and computational tools and techniques to the current knowledge of the HAND subclass bHLH transcription factor in the mammalian genome. This application may be valuable for future functional analysis of particular TFs in different organisms. Results: The observation data demonstrated that the heart and neural crest derivative transcription factors are present in mammals. The two mammalian genomes' likelihood of Homo sapiens and Mus musculus perform for comparative analysis. Analysis data suggested the eHAND and dHAND genes and a total number of bHLH domains in Homo sapiens and Mus musculus. Also, the conserved domain, motifs, phylogeny, gene expression and chromosome location analysis demonstrated the heart and neural crest derivative factors associated with cardiogenesis. Conclusion: Over the last decades, a wealth of new reports has been composed of unique genetic and phenotypic characteristics of cardiac morphogenesis. The mutational analysis of the eHAND and dHAND transcription factors enabled precise resolution of specialized function during the developing myocardium. Also, analysis data concluded the muscle-specific transcription factors eHAND and dHAND are associated with cardiac disease and development. In contrast, the tissue-specific bHLH and other TFs lead to the development of myogenesis and vasculogenesis.","PeriodicalId":512891,"journal":{"name":"Cardiology: Open Access","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140512499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Ectopic atrial tachycardia (EAT) is an unusual and potentially risky arrhythmia that can result in left ventricular dysfunction if not properly managed. In adults, EAT is mainly caused by diseased atrial myocardium and responds poorly to antiarrhythmic drugs. The characteristics of EAT in children might be different from those in adults because of their immature myocardium and the different electrophysiologic characteristics of their conduction tissue. Purpose: To present the data on the natural history and treatment of EAT in children. Material and method: The study material consisted of reviewed articles on the topic found on the globally accepted electronic databases, PubMed, Medline and Google Scholar regarding the Ectopic atrial tachycardia in children and its treatment. Results: The diagnosis of atrial ectopic tachycardia is based on the presence of a narrow complex tachycardia (in the absence of aberrancy or pre-existing bundle branch block) with visible P waves at an inappropriately rapid rate. The rates range from 120 to 300 beats per minute (bpm) and are typically higher than 200 bpm, although physiologic rates may be observed. EAT in children without underlying heart disease can be effectively treated using antiarrhythmic drugs. Spontaneous resolution of EAT after medication in children was frequent (75%). Conclusion: EAT in children without underlying heart disease can be effectively treated using antiarrhythmic drugs. The results of studies suggest that a stepwise approach using digoxin, a beta-blocker, and a class I antiarrhythmic drug may be the most effective treatment for EAT
简介：异位房性心动过速（EAT）是一种不常见且具有潜在风险的心律失常，如果处理不当，会导致左心室功能障碍。在成人中，EAT 主要由病变的心房心肌引起，对抗心律失常药物的反应较差。由于儿童心肌尚未发育成熟，其传导组织的电生理特征也与成人不同，因此儿童 EAT 的特征可能与成人不同。目的：介绍儿童 EAT 的自然病史和治疗方法。材料和方法：研究材料包括在全球公认的电子数据库 PubMed、Medline 和 Google Scholar 中找到的有关儿童异位房性心动过速及其治疗的综述文章。研究结果心房异位性心动过速的诊断依据是出现窄复律心动过速（在无异常或原有束支传导阻滞的情况下），并伴有可见 P 波，心率过快。心率范围在 120 至 300 次/分（bpm）之间，通常高于 200 bpm，但也可能出现生理性心率。对于没有潜在心脏病的儿童，使用抗心律失常药物可有效治疗 EAT。儿童在服药后，EAT 通常会自然缓解（75%）。结论：使用抗心律失常药物可有效治疗无基础心脏病的儿童 EAT。研究结果表明，使用地高辛、β-受体阻滞剂和 I 类抗心律失常药物进行分步治疗可能是治疗 EAT 的最有效方法。
{"title":"Ectopic Atrial Tachycardia in Children: A Literature Review","authors":"","doi":"10.33140/coa.09.01.01","DOIUrl":"https://doi.org/10.33140/coa.09.01.01","url":null,"abstract":"Introduction: Ectopic atrial tachycardia (EAT) is an unusual and potentially risky arrhythmia that can result in left ventricular dysfunction if not properly managed. In adults, EAT is mainly caused by diseased atrial myocardium and responds poorly to antiarrhythmic drugs. The characteristics of EAT in children might be different from those in adults because of their immature myocardium and the different electrophysiologic characteristics of their conduction tissue. Purpose: To present the data on the natural history and treatment of EAT in children. Material and method: The study material consisted of reviewed articles on the topic found on the globally accepted electronic databases, PubMed, Medline and Google Scholar regarding the Ectopic atrial tachycardia in children and its treatment. Results: The diagnosis of atrial ectopic tachycardia is based on the presence of a narrow complex tachycardia (in the absence of aberrancy or pre-existing bundle branch block) with visible P waves at an inappropriately rapid rate. The rates range from 120 to 300 beats per minute (bpm) and are typically higher than 200 bpm, although physiologic rates may be observed. EAT in children without underlying heart disease can be effectively treated using antiarrhythmic drugs. Spontaneous resolution of EAT after medication in children was frequent (75%). Conclusion: EAT in children without underlying heart disease can be effectively treated using antiarrhythmic drugs. The results of studies suggest that a stepwise approach using digoxin, a beta-blocker, and a class I antiarrhythmic drug may be the most effective treatment for EAT","PeriodicalId":512891,"journal":{"name":"Cardiology: Open Access","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140513850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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