Pace-Pacing and Clinical Electrophysiology最新文献

Immune checkpoint inhibitor (ICI) has demonstrated promising results in treating various cancers, but its associated cardiotoxicity, especially ICI-associated myocarditis, presents a serious concern. We reported a case of a 63-year-old male who complained of progressive dyspnea after tislelizumab, a novel humanized anti-PD-1 monoclonal antibody, for hepatocellular carcinoma. Upon diagnosing ICI-related myocarditis, corticosteroid therapy was initiated immediately. The elevated biomarkers quickly decreased, but the atrioventricular block progressed from first-degree to third-degree, necessitating pacemaker implantation. This is the first report of complete AVB consecutive to tislelizumab-induced myocarditis, highlighting the importance of early corticosteroid therapy and continuous electrocardiography monitoring.

Aims: The aim of this study was to investigate the topological distribution of single nucleotide variants (SNVs) in the KCNH2 gene from patients with type 2 long QT syndrome (LQT2) and to explore the genotype-phenotype relationships.

Methods: Information on KCNH2 variants in LQT2 patients was retrospectively obtained from the HGMD, ClinVar, and PubMed databases through October 2022. Pathogenicity of SNV was classified according to the American College of Medical Genetics and Genomics (ACMG) guidelines. Unpaired t-tests and Fisher's exacts were used to analyze the SNV distributions across structural and functional domains, and their correlation with clinical phenotypes.

Results: A total of 2826 variants were obtained; 2152 were SNVs, 1328 of which were nonsynonymous SNVs (nsSNVs) associated with LQT2. Enrichment analysis revealed that 602 pathogenic (P) and likely pathogenic (LP) nsSNVs were significantly enriched at S5, H5, S6, Extra3, and Extra4. In addition, 759 nsSNVs and 289 P/LP nsSNVs within function domain were enriched at the per-arnt-sim (PAS) and selectivity filter (SF) functional domain. Clinical data revealed that patients with nsSNVs enriched at the N-terminal, S5-H5-S6 region and PAS domain were associated with an increased risk of syncope. Moreover, nsSNVs located at the N-terminal, S5-H5-S6 region, and PAS, SF domains were associated with an increased risk of life-threatening cardiac events, including Torsade de Pointes (TdP) and sudden cardiac death (SCD), and were predominantly female.

Conclusion: KCNH2 nsSNVs located at the N-terminal, S5-H5-S6 region, and the PAS and SF functional domains are associated with an increased risk of life-threatening cardiac events in LQT2 patients.

Background: Temporary transvenous pacing (TTP) is a common procedure, predominantly performed in the catheterization laboratory (cath lab) because of presumed lower complication rate. This study aims to evaluate the efficacy and safety of TTP placement in the ICU compared to TTP placement in the cath lab.

Methods: This retrospective, real-life study included all patients requiring TTP in a tertiary care ICU between 2019 and 2022. Patients' characteristics, TTP-related data, outcomes, and complications were compared between groups (ICU vs. cath lab).

Results: Data from 193 patients receiving TTP were analyzed; 68.4% received TTP in the ICU and 31.6% in the cath lab. The main indication was atrioventricular block in 154 patients (79.8%). The operator was less frequently an interventional cardiologist in the ICU (12.1%) compared to the cath lab (100%, p < 0.001). TTP in the ICU was more frequently performed using a jugular access (72.0% vs. 1.6%), a right-sided laterality (88.7% vs. 43.6%), and a balloon-tipped catheter (100% vs. 0%, p < 0.001 for all comparisons). Success was 100% in both groups. The overall complication rate was 16.6%, with no significant difference between both groups (14.4% ICU vs. 21.3% cath lab, p = 0.13), but a tendency toward higher complications in the cath lab group (especially tamponade, lead displacement, and CIED infection).

Conclusion: In a daily clinical scenario, TTP placement appears as safe in the ICU than in the cath lab, regardless of the operator's level of expertise when performed in accordance with best practices. Nevertheless, TTP complications remain high, and alternatives should be used whenever possible.

Background: An indicator of successful cryoballoon (CB)-assisted pulmonary vein (PV) isolation is complete PV occlusion. However, CBs may exhibit a weaker freezing effect on the equatorial plane. This study investigates the predictors of failed left superior PV (LSPV) isolation despite complete occlusion with novel CBs.

Methods: This retrospective analysis enrolled 300 consecutive patients who underwent first-time ablation with POLARx or POLARxFIT between November 2021 and October 2023. Of the total, complete occlusion of the LSPV was achieved in 200 patients. Patients in whom LSPV isolation was achieved with additional nonocclusive freezing of the LSPV roof due to nonisolation of LSPV despite complete occlusion (Group A) were compared with those in whom isolation was achieved with complete PV occlusion alone (Group B).

Results: Group A had a larger LSPV diameter (21.5 ± 4.6 mm vs. 18.8 ± 3.3 mm, p = 0.052), larger left atrial volume on CT (142.3 ± 47.8 cc vs. 117.8 ± 39.0 cc, p = 0.028), higher nadir temperature (-54.1 ± 5.1°C vs. -60.2 ± 4.4°C, p < 0.001), and smaller northern latitude of the balloon contact site on the LSPV roof side (20.9° ± 3.8° vs. 38.9° ± 6.7°, p < 0.001) compared with Group B. A 27.5° north latitude was observed in most of Group A (sensitivity, 100%; specificity, 96%).

Conclusions: Adequate contact positioning of the northern hemisphere to the LSPV is critical for effective isolation, particularly when isolation is challenging despite complete occlusion. In such cases, nonocclusive cryoablation against the LSPV roof might be effective.

Background: The IntellaNav MiFi OI catheter (MiFi) is equipped with a sensor for local impedance (LI) monitoring and three mini-electrodes. In this study, we investigated the target LI values for a successful pulmonary vein isolation (PVI) under the pacing and ablation technique using the MiFi catheter.

Methods: Twenty-seven patients underwent PVI using the MiFi catheter under mini electrode pacing from the MiFi catheter. The local impedance (LI) changes, generator impedance (GI) changes, and the time to capture loss were evaluated.

Results: First-pass isolations were obtained in 15 patients (57.7 %) for right PVs and in 22 patients (84.6 %) for left PVs. At gap sites, the impedance decrease was smaller than at non-gap sites (non-gap sites vs. gap sites; LI drop, 23.2 [±10.3] vs. 15.6 [±7.7] Ω, p < 0.0001; GI drop, 4.8 [±4.1] vs. 2.7 [3.9] Ω, p = 0.0026; %LI drop, -19.3 [±7.4] vs. -13.1 [±6.1] %, p < 0.0001; % GI drop, -5.1 [±4.2] vs. -2.9 [±4.2] %, p = 0.0020), suggesting that changes in impedance could be useful for predicting gaps. The cutoff values for predicting no gaps were identified as 15.0 Ω for the LI drop and -13.74% for the %LI drop.

Conclusion: The LI showed greater changes than the GI and was also useful for predicting gaps. The cutoff values of 15.0 Ω for the LI drop and -13.74% for the %LI drop could predict conduction gaps. Under the monitoring of the LI, the pacing and ablation technique proved useful for PVI, even though the MiFi catheter does not have a CF sensor or ablation indices.

The use of conduction system pacing (CSP) in adults with congenital heart disease (CHD) is growing, however data remain limited. In patients with congenitally corrected transposition of the great arteries following the double switch operation, existing CSP tools and techniques require modification to allow for the anterior displacement of the atrioventricular node and proximal conduction system in addition to navigating the tortuous route of the atrial redirection. We report the successful use of CSP focusing on the technique of delivery tool modification to allow stability on the basal septum for deployment to the area of the distal His bundle and proximal left bundle branch.

This case report presents the management of tachycardiomyopathy (TCM) in a patient with Friedreich ataxia, a hereditary disorder characterized by progressive neurodegeneration and associated cardiac complications. The patient exhibited severe tachycardia-induced cardiac dysfunction, complicating the clinical picture due to the overlapping neurological symptoms of Friedreich ataxia. Utilizing a 3D mapping system, catheter ablation was performed to accurately identify and target the arrhythmogenic foci contributing to the patient's TCM. The procedure resulted in significant symptom relief and improvement in cardiac function, underscoring the potential benefits of advanced electrophysiological techniques in managing complex cases. This report highlights the importance of a multidisciplinary approach in diagnosing and treating cardiac manifestations in patients with Friedreich ataxia, as well as the efficacy of 3D mapping technology in guiding successful ablation therapies.

Background: Globally, the number of cardiac implantable electronic devices (CIEDs) is increasing. In our study, we aimed to investigate whether CHA₂DS₂-VASc and R₂CHA₂DS₂-VASc scores are predictive of CIED-related complications.

Methods: Our investigation was carried out with a multicenter retrospective design. Patients who underwent CIED surgery at two cardiac centers in Turkey between January 2011 and May 2023, 1676, were evaluated. The patients were divided into two groups according to their R₂CHA₂DS₂-VASc scores. Patients with R₂CHA₂DS₂-VASc ≥ 5 were included in group 1 (380 patients), and patients with R₂CHA₂DS₂-VASc < 5 (1296 patients) were included in group 2. The primary outcome was defined as the cumulative events. Each component of cumulative events, such as hematoma, pericardial effusion, pneumothorax, and infection, was also defined as a secondary outcome.

Results: The study's patient population had an average age of 62.9 ± 14 years. Pneumothorax (1.8% vs. 1.3%, p = 0.444), pericardial effusion or tamponade (0.35% vs. 0.2%, p = 0.659), and clinically significant hematoma (1.1% vs. 0.6%, p = 0.376) were comparable between the groups. Infection-related devices and cumulative events classified as primary outcomes were higher in the R₂CHA₂DS₂-VASc ≥ 5 group (6.1% vs. 1.2%, p < 0.001; 7.6% vs. 3.2%, p < 0.001, respectively). Modeling analyses showed that the CHA₂DS₂-VASc score and HT were also independent predictors of device-related infection and cumulative events.

Conclusion: In the R₂CHA₂DS₂-VASc ≥ 5 groups, infection related to the device system and cumulative events were higher. Patients with an R₂CHA₂DS₂-VASc score of 5 or more and a high CHA₂DS₂-VASc score should be evaluated more carefully regarding infection and cumulative events before and after the operation.