Pace-Pacing and Clinical Electrophysiology最新文献

Background: Following subcutaneous implantable cardioverter-defibrillator (S-ICD) insertion, induction of ventricular fibrillation (VF) and defibrillation threshold testing (DFT) is the standard of practice to assess system performance. In contrast, DFT testing is not routinely performed after transvenous ICD (T-ICD) insertion, supported by literature that emphasizes negative clinical repercussions and reliability of noninvasive predictors of successful defibrillation. There is a paucity of data for both the trajectory of noninvasive low voltage (LV) impedance measurements at S-ICD insertion through the time of potential DFT testing and for the proximity of LV impedance measurements and high voltage (HV) shock impedance from 65J DFT or 10J testing.

Objective: We aim to characterize the trend in LV impedance from initial S-ICD connection (LV T0) to final intraprocedural impedance (LV T4) and to compare LV impedance with HV impedance.

Methods: Data from patients who underwent S-ICD implantation between July 2022 and March 2024 were analyzed. LV impedance measurements were collected during implant and HV impedance measurements were collected if 65J DFT/10J testing was performed. Differences in mean impedances at each time point were evaluated using paired t-tests. For those who underwent 10J or 65J DFT testing, LV impedance was compared with HV impedance.

Results: The primary analytic sample included 53 patients, with a mean age of 51 ± 15.7 years; 16 (30.2%) were female. LV impedance decreased by a mean of 14.5 ± 9.8 ohms (18.3%; p <0.001) from S-ICD connection (T0) to the final intraprocedural measurement, approximately 60 min postimplant (T4). Among 35 patients who underwent HV testing (65J DFT or 10J), LV impedance at T4 and HV impedance did not differ significantly (1.7 ± 6.3 ohms; p = 0.116).

Conclusion: Our findings demonstrate a predictable reduction in LV impedance from S-ICD connection to subsequent intraprocedural measurements. We also found that LV impedance at LV T4, the final intraprocedural measurement, did not significantly differ from contemporaneous HV impedance. Together, these findings indicate that LV impedance at implant can be expected to decline, and that 60-min postimplant LV impedance may reliably approximate HV impedance. Evaluation of circumstances in which LV impedance could influence the decision to perform DFT testing is warranted.

Purpose: Left atrial appendage (LAA) closure has become the standard of care for patients with atrial fibrillation (AF) at high risk of thromboembolism who are intolerant or unwilling to take anticoagulants. LAA occlusion device infection is a challenging complication, and there is a paucity of data on the management and outcomes of LAA occlusion device infection. We aimed to summarize the existing literature and highlight the knowledge gap in this area.

Methods: A detailed search was conducted through the databases PubMed/MEDLINE, EMBASE, Web of Science, CINAHL, and Cochrane Central using the relevant keywords. All cases with presented data regarding diagnosis, treatment, and outcome were included from the reports.

Results: The analysis included 12 case reports encompassing a total of 12 patients. The mean age was 73.6 ± 11.0 years, and 50% of the cases were male. The most commonly implanted device was the Watchman (in eight of the 12 cases). The median time between LAA closure and infection was 6.6 (0.2-36) months. Transesophageal echocardiography was diagnostic in all cases, and positron emission tomography/computed tomography (PET/CT) was useful in diagnosis in three cases. The most common pathogen was Staphylococcus aureus (n = 7). The LAAC device was removed in seven cases; one patient refused surgery, and in the other three cases, removal of the device was not considered appropriate due to the patient's poor condition. Data on whether the device was removed could not be retrieved for one patient. Mortality occurred in three cases (25%), and all deaths occurred during hospitalization.

Conclusion: LAA closure device infections are rare but carry a high risk of complications and mortality. Treatment should include device removal in appropriate cases, and antibiotherapy alone should be considered only in selected cases. Further studies are needed to clarify diagnostic and treatment strategies based on the causative pathogens and patient status.

Introduction: Left bundle branch area pacing (LBBAP) has emerged as a novel physiological pacing strategy. The purpose of this study was to evaluate the long-term effect of LBBAP in ventricular pacing-dependent patients and baseline normal cardiac function.

Methods: This retrospective observational study included patients who underwent LBBAP or RVP for bradycardia indications between January 2018 and July 2021. Baseline characteristics and electrophysiological, pacing and echocardiographic data were collected.

Results: Sixty patients with VP% ≥ 40% were enrolled, including 30 patients in the LBBAP group and 30 patients in the RVP group. The mean follow-up time was 53.03 ± 8.10 months in the LBBAP group and 51.87 ± 11.68 months in the RVP group. No ventricular septum perforation was observed during the procedure or follow-up. The R-wave amplitudes did not differ between the two groups at implantation, but the R-wave amplitude in the LBBAP group at last follow-up was higher than that in the RVP group (17.67 ± 7.50 mV vs. 12.38 ± 5.36 mV, p = 0.003). Paced QRS duration in the LBBAP group was significantly shorter than that in the RVP group (138.93 ± 15.36 ms vs. 164.30 ± 19.48 ms, p < 0.0001). The LBBAP group had a higher LVEF (64.81 ± 5.49 vs. 60.44 ± 9.28, p = 0.041) and lower LVESD (29.70 ± 4.59 mm vs. 32.03 ± 3.97 mm, p = 0.039) than the RVP group at last follow-up.

Conclusion: This study found LBBAP electrodes had a stable anatomic position, better pacing parameters, and better maintaining cardiac performances than RVP in patients with normal cardiac function and bradyarrhythmia indications.

Background: The effectiveness of continuous anti-arrhythmic drugs (AAD) therapy during the 3-month blanking period following repeat catheter ablation to prevent atrial fibrillation (AF) recurrence remains unclear. To evaluate the impact of continuous AAD therapy during the blanking period on AF recurrence in patients with paroxysmal atrial fibrillation (PAF) undergoing repeat ablation.

Methods: Patients with PAF who underwent repeat ablation from the China-AF Registry (2011-2022) were included in this study and categorized into two groups based on AAD use during the 3-month blanking period. The AF recurrence was defined as recurrent atrial tachyarrhythmias lasting for >30 s following the blanking period. Cox proportional hazard models were performed to assess the association between AAD status in the blanking period and AF recurrence at 12 months.

Results: The study included 740 PAF patients (mean age 59.4 ± 10.6 years, 36.1% female) who underwent repeat ablation, with 289 patients in the on-AAD group and 451 in the off-AAD group. At 12 months post-ablation, 258 patients (34.9%) experienced AF recurrence. After adjusting for confounders, AAD use during the blanking period did not significantly associate with AF recurrence within 12 months after this period (HR = 1.07; 95% CI: 0.83-1.37; p = 0.599). Consistent results were found in different age, sex, body mass index, left atrial diameter, and CHA₂DS₂-VASc score subgroups.

Conclusions: There was no significant relationship between AAD therapy during the blanking period after repeat ablation and AF recurrence at 12 months in patients with PAF.

Herein, we propose a novel approach examining intra-spline bipolar potentials-rather than conventional cross-spline potentials-using the FARAWAVE catheter to assess pulmonary vein isolation in the FARAPULSE pulsed field ablation system. The novel intra-spline bipolar electrograms on the FARAWAVE catheter are useful for reducing far potentials during confirmation of the pulmonary vein isolation line.

Severe vascular complications associated with pacemaker implantation rarely occur and then might be misjudged. We presented a case with an atypical and confusing presentation of arteriovenous fistulae after pacemaker implantation that was relatively late recognized post-procedure. Endovascular repairment was performed and a good clinical outcome was reached.

Introduction: Physician burnout is a common problem across the field of medicine, resulting in significant negative personal and work-related consequences. We set out to explore the prevalence of burnout in cardiac electrophysiologists (EPs).

Methods: A national registry of EPs (N = 112) was sent a two-item questionnaire, established and validated to assess the experience of Burnout. In total, 51 EPs completed the questionnaire from 2020 to 2023.

Results: 36% of the sampled cardiac electrophysiologists reported burnout, and 26% reported feelings of callousness.

Conclusion: This significant number of EPs experiencing symptoms of burnout underscores the critical need for enhanced focus on the EP workforce.