Pace-Pacing and Clinical Electrophysiology最新文献

Background: Transvenous lead extraction (TLE) is recognized as an effective method of lead extraction, but can be challenging with old and tined pacemaker leads.

Case summary: We present the case of a 44-year-old male with cardiovascular implantable electronic device (CIED) infection who underwent TLE of his 15-year-old tined pacemaker leads using a novel approach. A carotid shuttle sheath with the tip fashioned into a bevel shape was used as a makeshift dilator to dissect and free the leads from adhesions. A bioptome, introduced through the TightRail sheath, was employed to dislodge the right ventricular (RV) lead tip, while a snare introduced subsequently through the same access was used to grip the distal end of the RV lead. The lead was extracted using the snare without the need for additional femoral or jugular access.

Conclusion: To the best of our knowledge, the use of this bioptome and snare technique, through the TightRail sheath, without employing femoral or jugular access for lead extraction, has not been previously reported. This case highlights the importance of innovative techniques in successfully addressing challenging TLE cases.

Background: Texture analysis (TA) is a powerful tool for extracting quantitative information, assessing myocardial heterogeneity, evaluating therapeutic efficacy, and predicting outcomes in heart disease. This study investigated whether TA based on gated single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI) can enhance the prediction of response to cardiac resynchronization therapy (CRT).

Methods: A total of 165 patients who underwent gated SPECT MPI and received CRT were enrolled in the study. Quantitative analysis of SPECT imaging generated 1225 TA features. Phase analysis of resting gated short-axis SPECT myocardial perfusion images was utilized to assess left ventricular (LV) systolic and diastolic mechanical dyssynchrony (LVMD), including phase standard deviation (PSD), phase bandwidth (PBW), and entropy. Patients were categorized into CRT response and non-response groups based on a ≥5% improvement in LV ejection fraction (LVEF) measured by echocardiography at the 6-month follow-up. Variables with a p-value <0.05 in the univariate logistic regression analysis were incorporated into a backward stepwise multivariate logistic regression model for further analysis.

Results: During follow-up, 60.0% (99 of 165 patients) demonstrated a response to CRT. Univariate logistic regression analysis revealed that CRT response was significantly associated with N-terminal pro-brain natriuretic peptide (NT-proBNP), non-sustained ventricular tachycardia (NS-VT), LV end-diastolic diameter (LVEDD), LV end-systolic diameter (LVESD), scar burden, systolic and diastolic PSD, PBW, entropy, and 51 TA parameters. In the backward stepwise multivariate regression analysis, inverse difference moment normalized (IDMN), NS-VT, NT-proBNP, diastolic PSD, and LVEDD emerged as independent predictors of CRT response.

Conclusion: TA based on gated SPECT MPI provides independent prognostic predictor for CRT response in medically treated Heart failure patients.

Introduction: Palpitations in children are common and obtaining symptom-rhythm correlation is diagnostic, but challenging to obtain. The AliveCor KardiaMobile monitor is a smartphone-based single-lead ECG event recorder with limited study in children. We compared using this smartphone recorder to a conventional (Cardiocall) event recorder.

Methods: We performed a prospective, randomized study of children presenting to pediatric cardiology for investigation of palpitations who require an event recorder for symptom-rhythm correlation. Patients were randomized to the smartphone or conventional recorder for rhythm documentation for 3 months or 4 weeks, respectively. Diagnostic tracings were defined as one pathologic arrhythmia or three sinus rhythm tracings. We assessed tracing quality, diagnoses obtained, and time to diagnosis between groups. Patients were surveyed to assess perceptions of using the devices.

Results: One hundred participants were enrolled and randomized to 50 in each group. Diagnostic tracings were achieved in 51% versus 44% (p = 0.525) in the smartphone versus conventional group at means of 23.7 (SD 36.4) versus 11.5 (SD 15.2) days, p = 0.181. Participants who used the smartphone monitor were more likely to transmit recordings (70% vs. 49%, p = 0.037) and more often willing to use the device again (87% vs. 42%, p = 0.015), with no differences between groups in finding episodes easy to record (74% vs. 100%, p = 0.15), easy to transmit (70% vs. 46%, p = 0.26), or overall satisfaction (83% vs. 58%, p = 0.13).

Conclusion: Smartphone monitor devices provided similar diagnostic yield to conventional monitors in children. Families who used the smartphone monitor were more willing to use the device again.

Background: Recent studies have shown that atrial high-rate episodes (AHREs) are associated with adverse cardiovascular outcomes, including an increased risk of stroke, cardiovascular mortality, and future atrial fibrillation. Despite efforts to identify predictors for AHRE, the relationship between left atrial morphology and AHRE remains unclear.

Methods: We systematically reviewed MEDLINE and EMBASE from inception to May 2024 to assess the association between left atrial morphology, measured as left atrial diameter (mm) and left atrial volume index (LAVI, mL/m²) via transthoracic echocardiography, and the occurrence of AHRE in patients without a prior history of atrial fibrillation at device implantation. Means and standard deviations of LAD and LAVI were extracted to calculate pooled mean differences using the generic inverse variance method.

Results: A total of 18 cohort studies were included in the meta-analysis. The results showed that patients with AHRE had significantly higher left atrial diameter and LAVI compared to those without AHRE. The pooled mean difference for left atrial diameter was 2.19 mm (95% CI: 1.11-3.28; I² = 80%, p < 0.001), while for LAVI, it was 4.88 mL/m² (95% CI: 2.55-7.21; I² = 55%, p < 0.001).

Conclusions: Our study demonstrated that patients with AHRE had greater left atrial diameter and LAVI than those without AHRE. Further research is needed to clarify the underlying mechanism.

Background: Despite technical progress and novel ablation strategies, pulmonary vein (PV) reconnection still occurs in a substantial proportion of patients. The aim of the study was to determine the impact of the elimination of antral low-voltage, fragmented electrograms (LFEGMs) identified by high-density (HD) mapping on the rate of pulmonary vein isolation (PVI) durability.

Methods: Sixty patients with paroxysmal atrial fibrillation (PAF) were randomly assigned to a verification of PV entrance block and presence of LFEGMs on antral isolation lines with an HD mapping catheter (HD group) or to a verification of PV entrance block with a circumferential mapping catheter alone (CM group). In the HD group, LFEGMs were additionally ablated. Mandatory reassessment procedure to assess PVI durability and the presence of LFEGMs was performed 12 months after the index procedure or earlier in case of arrhythmia recurrence.

Results: A total of 107 out of 116 (92.2%) PVs were found durably isolated in the HD group, and 97 out of 120 (80.8%) PVs in the CM group (p = 0.02). At the reassessment procedure, a total of 7 [3, 12] and 34 [24, 44] LFEGMs were found in the HD and CM groups, respectively (p = 0.00002). Elimination of LFEGMs at the index procedure reduced the likelihood of antral conduction gaps in the same segments at the reassessment. Arrhythmia recurrence rate was similar between the HD and the CM group (7/29, 24.1% vs. 10/30, 33.3%), p = 0.62, respectively.

Conclusion: Additional elimination of LFEGMs identified by HD mapping of antral isolation lines after PVI resulted in a significantly higher rate of PVI durability.

Trial registration: ClinicalTrials.gov identifier: (NCT04466358).

Paced QRS duration ≥150 ms is associated with pacing-induced cardiomyopathy (PICM). However, there is no established method for conventional stylet-driven pacing lead placement to achieve a narrow QRS duration. We placed a pacing lead on the right ventricular inflow tract (RVIT) mid-septum using a manually shaped three-dimensional (3D) stylet and three-directional fluoroscopic guidance in 9 consecutive patients with complete or advanced atrioventricular block and normal left ventricular systolic function. The median paced QRS duration was 140 (range, 122-153) ms, with a paced QRS duration <150 ms in 8 patients. The left superior axis and transitional zone of lead-V5 or lead-V6 were the most paced QRS morphologies. RVIT mid-septal lead placement using a 3D stylet with three-directional fluoroscopic guidance may reduce the incidence of PICM.

We present the case of a young man who suffered from severe aortic valve insufficiency and subsequently underwent mechanical aortic prosthesis replacement. One month post-surgery, he presented with syncope and incessant ventricular tachycardia (VT), progressing to cardiogenic shock, which required emergency intra-aortic balloon pump (IABP) support. The VT proved refractory to standard clinical management and demonstrated responsiveness only after IABP support. An electrophysiological study was conducted; however, VT could not be induced during the procedure. Through electrophysiological maneuvers, we suspected bundle branch reentrant ventricular tachycardia (BBR-VT), and successful treatment was achieved via right bundle branch (RBB) ablation.

Background: Coronary spastic angina (CSA) sometimes complicates ventricular arrhythmias (VAs) leading to sudden death. The appropriate secondary prevention strategy remains to be discussed. Recently, the relationship between J waves and VAs in CSA has been reported.

Objectives: We aimed to investigate the incidence of VAs, J waves, the spatial relationship between J waves and culprit coronary spasm lesions, and VA recurrences in CSA.

Methods: The patient characteristics, including the presence of J waves, were assessed in 130 CSA patients, and the spatial relationship between J waves and ischemic lesions was analyzed; a concordant pattern was defined when the localization of electrical and coronary blood supply abnormalities matched.

Results: Thirty one patients (24%) had VAs (VA group) and 99 (76%) did not (non-VA group). More J waves were observed in the VA group than the non-VA group (19 of 31 patients [61%] vs. 16 of 99 patients [16%], p = 0.00003). A concordant pattern between the J waves and culprit coronary spasm lesions was significantly observed greater in the VA group than the non-VA group (14 of 19 patients [74%] vs. 5 of 16 patients [31%], p = 0.019). VAs reoccurred in 6 of 31 patients (19%) despite adequate medication during a mean of 4.6 years of follow-up and were not predictable.

Conclusions: VAs occurred in one-quarter of the CSA patients and were closely related to J waves. The spatial concordance between coronary ischemia and electrical abnormalities might be a risk of a VA occurrence. VA recurrences are highly observed and unpredictable, justifying the indication of an implantable cardioverter defibrillator as secondary prevention.

Pacemaker pocket erosion with exposure is a significant complication of cardiac implantable electronic devices, particularly in elderly patients with limited subcutaneous tissue. This case report details the successful management of a 93-year-old woman presenting with pacemaker extrusion, treated through antibiotic therapy, generator replacement, and covering with a rotation flap. This case underlines the importance of interdisciplinary collaboration and careful approaches in addressing dangerous device-related complications in fragile patients.