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Lower Risk of New-Onset Atrial Fibrillation in Conduction System Pacing Compared With Right Ventricular Pacing. 传导系统起搏与右室起搏相比,新发心房颤动的风险更低。
IF 1.7 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-01 Epub Date: 2025-01-15 DOI: 10.1111/pace.15121
Feng Li, You Zhang, Jian Huang, Si-Liang Peng, Meng-Chao Jin, Chi Geng, Venkatesh Ravi, Parikshit S Sharma, Pugazhendhi Vijayaraman, Hui Li

Background: Conduction system pacing (CSP) has been reported to improve clinical outcomes in comparison of right ventricular pacing (RVP). However, the performance between CSP and RVP on the risk of new-onset atrial fibrillation (AF) remains elusive.

Methods: Four online databases were systematically searched up to July 1, 2024. Studies comprising the rate/risk of new-onset AF between CSP and RVP group were included. Subgroup analysis was performed to screen the potential determinants for the new-onset AF risk for CSP therapy. The pooled risk of new-onset AF based on ventricular pacing burden (Vp) between CSP and RVP group were evaluated.

Results: A total of six studies including 1577 patients requiring pacing therapy were eligible. The pooled new-onset AF rates for CSP and RVP group were 0.09 and 0.27, respectively. Compared with RVP group, CSP group showed a lower pooled risk (risk ratio [RR] 0.38, p = 0.000) and adjusted risk (hazard ratio [HR] 0.32, p = 0.000) of new-onset AF. Meanwhile, a significant intervention-covariate interaction for the adjusted risk of new-onset AF between CSP and RVP group was identified with Vp < 20% and Vp ≥ 20%.

Conclusions: Our study suggests that CSP is associate with a significantly lower occurrence of new-onset AF compared with RVP. The Vp ≥ 20% may be the key determinant on the lower risk of new-onset AF with CSP therapy.

Trial registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023492551, identifier (CRD42023492551).

背景:与右心室起搏(RVP)相比,传导系统起搏(CSP)已被报道可以改善临床结果。然而,CSP和RVP对新发心房颤动(AF)风险的影响尚不明确。方法:系统检索截至2024年7月1日的4个在线数据库。包括CSP组和RVP组之间新发房颤发生率/风险的研究。进行亚组分析以筛选CSP治疗新发房颤风险的潜在决定因素。评估CSP组和RVP组基于心室起搏负荷(Vp)的新发房颤合并风险。结果:共有6项研究包括1577例需要起搏治疗的患者符合条件。CSP组和RVP组的合并新发房颤发生率分别为0.09和0.27。与RVP组相比,CSP组新发房颤的合并风险(风险比[RR] 0.38, p = 0.000)和校正风险(风险比[HR] 0.32, p = 0.000)较低,且在Vp < 20%和Vp≥20%时,CSP组与RVP组新发房颤校正风险存在显著的干预协变量交互作用。结论:我们的研究表明,与RVP相比,CSP与新发房颤的发生率显著降低有关。血压≥20%可能是CSP治疗降低新发房颤风险的关键决定因素。试验注册:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023492551,标识符(CRD42023492551)。
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引用次数: 0
Inappropriate Shocks in Brugada Syndrome Patients With a Subcutaneous Implantable Cardioverter Defibrillator.
IF 1.7 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-01 Epub Date: 2025-01-27 DOI: 10.1111/pace.15151
Masaya Watanabe, Tadafumi Nanbu, Yuki Ishidoya, George Suzuki, Akihiko Yotsukura, Izumi Yoshida, Yoshitaka Tanaka, Kazushige Inoue, Junko Mitsuishi, Tomomi Kanno, Masayuki Sakurai, Toshihisa Anzai

Background: This study aimed to compare inappropriate shock (IAS) rates between subcutaneous implantable cardioverter-defibrillator (S-ICD) and transvenous ICD (TV-ICD) in Brugada syndrome (BrS) patients and identify risk factors for IAS in S-ICD use.

Methods: We enrolled consecutive patients with BrS who underwent ICD implantation between 2013 and 2023. Data on clinical characteristics, S-ICD screening test data, and IAS occurrence were retrospectively analyzed.

Results: In total, 74 patients (40 with S-ICDs and 34 with TV-ICD) were enrolled in the study. During a median follow-up of 4.6 years, IAS occurred in nine S-ICD and three TV-ICD patients, exhibiting a non-statistically significant trend (log-rank p = 0.103) toward a higher incidence in the S-ICD group. The incidence of IAS related to non-atrial tachyarrhythmia (non-AT) causes was significantly higher in the S-ICD group than in the TV-ICD group (log-rank p = 0.014). Fewer electrocardiography (ECG) sensing vectors passing the screening test at both the baseline and exercise test (hazard ratio [HR] 0.31, 95% confidence interval [CI] 0.09-0.85; p = 0.21) and detection of ATs (HR 5.25, 95% CI 1.15-24.05; p = -0.048) were associated with IAS in patients with S-ICD.

Conclusion: No significant difference was observed in the overall incidence of IAS between the S-ICD and TV-ICD groups; however, IAS due to non-AT causes occurred more frequently in the S-ICD group. Fewer ECG sensing vectors passing screening were significantly correlated with the IAS when exercise test results were considered. Therefore, ECG screening, including exercise testing, is preferable for S-ICD candidates.

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引用次数: 0
Early Improvement in Cardiac Function and Dyssynchrony After Physiological Upgrading in Pacing-Induced Cardiomyopathy. 起搏性心肌病生理升级后心功能和非同步化的早期改善。
IF 1.7 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-01 Epub Date: 2024-12-28 DOI: 10.1111/pace.15126
María Teresa Moraleda-Salas, Emilio Amigo-Otero, Irene Esteve-Ruiz, Álvaro Arce-León, José Miguel Carreño-Lineros, Elena Izaga Torralba, Francisco Navarro Roldan, Pablo Moriña-Vázquez

Background: Interventricular dyssynchrony derived from the classic non-physiological stimulation (n-PS) of the right ventricle (RV) is a known cause of left ventricular dysfunction (LVDys).

Methods: This was a prospective descriptive single-center study. We analyzed patients who develop LVDys with n-PS, and the results after upgrading to conduction system pacing (CSP). Ultra-high frequency electrocardiogram (UHF-ECG) was performed pre and post-implantation of the last patients included. ECG recordings in 16 frequency bands (150-1000 Hz) were used to create maps of ventricular depolarization. The maximum time difference between the centers of mass of the complex UHF QRS of leads V1-V6 (electrical dyssynchrony [DYS-e] 16) and V1-V8 (DYS-e 18) defined ventricular dyssynchrony. Data were expressed as mean ± standard deviation.

Results: 27 patients were upgraded to CSP from January 2022 to January 2024 after developing LVDys. Permanent His bundle pacing (p-HBP) was achieved in 63% (n = 17); in the other 10 patients left bundle branch area pacing (LBBAp) was performed. The average baseline LVEF improved from 34.5% (27-42) to 47.6% (38.2-57), p < 0.001. Telediastolic left ventricle diameter as well as QRS width also decreased. Thresholds remained stable at 6-month follow-up. The last eight patients included were studied in terms of ventricular synchrony parameters by UHF-ECG (VDI Technologies), both His bundle pacing (HBP) and the LBBAp achieved significant improvement with respect to baseline parameters.

Conclusions: LVEF improved in patients with previous n-PS-induced cardiomyopathy after upgrading to CSP. LVDys due to dyssynchronopathy is frequent and probably underdiagnosed. UHF-ECG provides useful new information about ventricular activation and will likely improve patient selection for cardiac resynchronization therapy (CRT).

背景:由典型的右心室非生理性刺激(n-PS)引起的室间非同步化是左心室功能障碍(LVDys)的已知原因。方法:这是一项前瞻性描述性单中心研究。我们分析了伴有n-PS的LVDys患者,以及升级到传导系统起搏(CSP)后的结果。最后一组患者在植入前和植入后进行超高频心电图(UHF-ECG)检查。使用16个频带(150-1000 Hz)的心电图记录来绘制心室去极化图。V1-V6导联(电不同步[dyse] 16)和V1-V8导联(dyse 18)的复杂UHF QRS质心的最大时间差定义了心室不同步。数据以均数±标准差表示。结果:2022年1月至2024年1月,27例患者在LVDys后升级为CSP。永久性His束起搏(p-HBP)达到63% (n = 17);其余10例患者行左束支区起搏(LBBAp)。平均基线LVEF从34.5%(27-42)提高到47.6% (38.2-57),p < 0.001。远舒张期左心室直径和QRS宽度也减小。6个月随访时阈值保持稳定。通过UHF-ECG (VDI Technologies)对最后8例患者进行心室同步参数研究,His束起搏(HBP)和LBBAp相对于基线参数均有显著改善。结论:升级到CSP后,先前n- ps诱导的心肌病患者的LVEF得到改善。由于同步障碍引起的lvdy是常见的,可能未被诊断。超高频心电图提供了有用的关于心室激活的新信息,可能会改善患者对心脏再同步化治疗(CRT)的选择。
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引用次数: 0
Meta-Analysis of Pulsed-Field Ablation Versus- High-Power Short-Duration Ablation for Atrial Fibrillation. 脉冲场消融与高功率短时消融治疗心房颤动的 Meta 分析。
IF 1.7 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-01 Epub Date: 2025-01-05 DOI: 10.1111/pace.15141
Jun Xue, Qunying Huang, Fuling Yu, Yinjun Mao

Purpose: To optimize the effectiveness and safety of pulmonary vein isolation, pulsed-field ablation (PFA) and high-power short-duration ablation (HPSD) have recently been incorporated into clinical practice. The objective of this study is to conduct a comparative analysis, focusing on the efficacy, safety, and procedural efficiency of PFA and HPSD in the treatment of atrial fibrillation (AF).

Methods: A thorough search was performed across multiple databases to identify trials that compared PFA with HPSD for AF from their inception until July 2024. The odds ratio (OR) and mean difference (MD), accompanied by a 95% confidence interval (CI), were employed as indicators of treatment efficacy.

Results: The analysis included six eligible trials, encompassing a total enrollment of 1382 patients. No statistically significant disparities were observed in terms of freedom from any atrial arrhythmia (OR 1.10; 95% CI 0.75, 1.63) or periprocedural complications (OR 1.04; 95% CI 0.52, 2.09) between the two ablation techniques. The likelihood of requiring a repeat ablation procedure was significantly reduced with PFA compared to HPSD (OR 0.63; 95% CI 0.41-0.97); however, there was no significant difference in the incidence of PV reconnection between patients initially treated with HPSD and those using PFA (OR 0.83; 95% CI 0.53-1.30). The PFA technique demonstrated significantly shorter procedure time (MD -34.58; 95% CI -45.20, -23.96) and left atrium (LA) dwell time (MD -34.52; 95% CI -58.42, -10.61), but longer fluoroscopy time (MD 8.81; 95% CI 6.25, 11.37). The subgroup analyses revealed that PFA continued to exhibit superior procedure time and LA dwell time but inferior fluoroscopy time.

Conclusion: The efficacy and safety profiles of both PFA and HPSD are comparable in patients undergoing ablation therapy for AF; however, PFA is associated with shorter procedural time and longer fluoroscopy time.

目的:为了优化肺静脉隔离的有效性和安全性,脉冲场消融(PFA)和高功率短时间消融(HPSD)最近被纳入临床实践。本研究的目的是对PFA和HPSD治疗心房颤动(AF)的疗效、安全性和程序效率进行比较分析。方法:在多个数据库中进行了彻底的搜索,以确定从开始到2024年7月,PFA与HPSD治疗AF的比较试验。采用优势比(OR)和平均差(MD),并伴有95%置信区间(CI)作为治疗效果的指标。结果:该分析包括6项符合条件的试验,共纳入1382例患者。在房性心律失常自由方面,没有统计学上的显著差异(OR 1.10;95% CI 0.75, 1.63)或术中并发症(or 1.04;95% CI 0.52, 2.09)。与HPSD相比,PFA患者需要重复消融的可能性显著降低(OR 0.63;95% ci 0.41-0.97);然而,在最初接受HPSD治疗的患者和接受PFA治疗的患者之间,PV重连的发生率没有显著差异(OR 0.83;95% ci 0.53-1.30)。PFA技术的手术时间明显缩短(MD -34.58;95% CI -45.20, -23.96)和左心房(LA)停留时间(MD -34.52;95% CI -58.42, -10.61),但透视时间较长(MD 8.81;95% ci 6.25, 11.37)。亚组分析显示PFA继续表现出较好的手术时间和LA停留时间,但较差的透视时间。结论:PFA和HPSD在房颤消融治疗患者中的疗效和安全性相当;然而,PFA与较短的手术时间和较长的透视时间有关。
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引用次数: 0
Managing a Mental Disorder With New Technologies: TheLeadless Pacemaker in Reel's Syndrome, a Case Report. 用新技术管理精神障碍:里尔综合征的无头起搏器,一个案例报告。
IF 1.7 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-01 Epub Date: 2024-12-28 DOI: 10.1111/pace.15131
P L Magliano, F Scotto Di Uccio, R Persico, C Provvisiero, P Ricciardi, V Ducceschi

Reel's syndrome (RS) is an unusual cause of pacemaker lead dislodgement. We present the case of a 59-year-old female patient with Down syndrome (DS) implanted with a dual-chamber endovascular pacemaker due to symptomatic sinus node disfunction, reporting several syncopal episodes in last days and showing abnormal electrical parameters at the 2-months follow-up due to RS. The malfunctioning device was removed and an endocardial leadless pacing system was implanted.

里尔综合征(RS)是一个不寻常的原因起搏器铅脱位。我们报告一例59岁的唐氏综合征(DS)女性患者,由于症状性窦结功能障碍植入了双腔血管内起搏器,在最后几天报告了几次晕厥发作,并在2个月的随访中由于RS显示出异常的电参数。
{"title":"Managing a Mental Disorder With New Technologies: TheLeadless Pacemaker in Reel's Syndrome, a Case Report.","authors":"P L Magliano, F Scotto Di Uccio, R Persico, C Provvisiero, P Ricciardi, V Ducceschi","doi":"10.1111/pace.15131","DOIUrl":"10.1111/pace.15131","url":null,"abstract":"<p><p>Reel's syndrome (RS) is an unusual cause of pacemaker lead dislodgement. We present the case of a 59-year-old female patient with Down syndrome (DS) implanted with a dual-chamber endovascular pacemaker due to symptomatic sinus node disfunction, reporting several syncopal episodes in last days and showing abnormal electrical parameters at the 2-months follow-up due to RS. The malfunctioning device was removed and an endocardial leadless pacing system was implanted.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"235-238"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Long-Term Outcomes of Inactive Pacemaker Lead Abandonment in Children and Dramatic Observation of Complications. 儿童失活起搏器导联放弃的长期结局及并发症的显著观察。
IF 1.7 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-01 Epub Date: 2024-12-28 DOI: 10.1111/pace.15137
Agnieszka Nowosielecka, Dorota Nowosielecka, Wojciech Jacheć, Radosław Pietura, Tomasz Smyk, Janusz Gozdek, Andrzej Kutarski

Transvenous extraction of the leads in children is associated with a higher risk of serious complications, that is why it is reluctantly performed. Unfortunately, this conservative approach has been associated with secondary complications (tricuspid valve dysfunction and bilateral venous obstruction), adverse events during lead removal procedure and recanalization and stenting of chest veins. We present a case of a 27-year-old female with a pacemaker and insertion of two new leads on the opposite side of the chest leaving the old ones in place.

儿童经静脉引线拔出与严重并发症的高风险相关,这就是为什么不情愿进行的原因。不幸的是,这种保守入路与继发性并发症(三尖瓣功能障碍和双侧静脉阻塞)、导联去除过程中的不良事件以及胸静脉再通和支架置入术有关。我们提出了一个27岁的女性与起搏器和插入两个新的导联在胸部的另一边留下旧的地方。
{"title":"The Long-Term Outcomes of Inactive Pacemaker Lead Abandonment in Children and Dramatic Observation of Complications.","authors":"Agnieszka Nowosielecka, Dorota Nowosielecka, Wojciech Jacheć, Radosław Pietura, Tomasz Smyk, Janusz Gozdek, Andrzej Kutarski","doi":"10.1111/pace.15137","DOIUrl":"10.1111/pace.15137","url":null,"abstract":"<p><p>Transvenous extraction of the leads in children is associated with a higher risk of serious complications, that is why it is reluctantly performed. Unfortunately, this conservative approach has been associated with secondary complications (tricuspid valve dysfunction and bilateral venous obstruction), adverse events during lead removal procedure and recanalization and stenting of chest veins. We present a case of a 27-year-old female with a pacemaker and insertion of two new leads on the opposite side of the chest leaving the old ones in place.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"239-244"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Improved Cardiac Physiological Pacing Implantation by Probe Method: A Case Report. 改良探针法心脏生理性起搏植入1例报告。
IF 1.7 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-01 Epub Date: 2024-12-31 DOI: 10.1111/pace.15123
Yuhang Yang, Xinmiao Huang, Zhaojun Wang
{"title":"Improved Cardiac Physiological Pacing Implantation by Probe Method: A Case Report.","authors":"Yuhang Yang, Xinmiao Huang, Zhaojun Wang","doi":"10.1111/pace.15123","DOIUrl":"10.1111/pace.15123","url":null,"abstract":"","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"245-248"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Dual Chamber Aveir Retrievable Leadless Pacemaker Implant via the Right Internal Jugular Vein in a 13-Year-Old With Congenital Complete Heart Block. 经右颈内静脉植入双腔Aveir可回收无铅起搏器治疗13岁先天性完全性心脏传导阻滞患者。
IF 1.7 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-01 Epub Date: 2024-12-18 DOI: 10.1111/pace.15129
Daniel Cortez

Introduction: Congenital complete heart block is a condition where there is a risk of Stokes Adam's attacks and sudden death may occur. Once the escape rate is too low, or other high-risk factors occur, these patients ultimately need pacemakers placed. Epicardial or transvenous pacemakers have typically been in employed dependent on size of the patient and other circumstances. We describe the first case of an implant via internal jugular vein (right) of a dual chamber leadless pacemaker implant in a symptomatic pediatric patient with congenital complete heart block.

Methods: The study was approved by the University of California and consent was waived due to retrospective nature of this case report.

Case: A 13-year-old presented with presyncope at rest after years of being followed for her congenital complete heart block. Her average rate on Holter monitoring was below 50 bpm, which coincided with her recent symptoms. After discussion with family, and our own cardiology/surgical team, she had a dual chamber leadless pacemaker implanted. Stable 3-month atrial parameters included an impedance of 340 Ω, sensing of 3.2 mV, and threshold of 0.25 V at 0.2 ms, while ventricular parameters showed an impedance of 780 Ω, sensing of 14.2  mV, and threshold of 0.5 V at 0.2 ms.

Conclusion: Dual chamber leadless pacemaker implant is feasible via right internal jugular vein access and in a pediatric patient.

简介:先天性完全性心脏传导阻滞是一种存在斯托克斯亚当发作和猝死风险的疾病。一旦逃逸率过低,或出现其他高危因素,这些患者最终需要放置起搏器。心外膜起搏器或经静脉起搏器通常根据患者的大小和其他情况而使用。我们描述了第一例通过颈内静脉植入双腔无铅起搏器的病例(右),这是一例有症状的先天性完全性心脏传导阻滞的儿童患者。方法:该研究得到了加州大学的批准,由于该病例报告的回顾性性质而放弃了同意。病例:一名13岁儿童,因先天性完全性心脏传导阻滞接受多年随访后,在休息时出现晕厥前症。她的动态心电图平均心率低于每分钟50次,这与她最近的症状相吻合。在与家人和我们自己的心脏科/外科团队讨论后,她植入了一个双室无铅起搏器。稳定的3个月心房参数阻抗为340 Ω,感应3.2 mV, 0.2 ms时阈值为0.25 V;心室参数阻抗为780 Ω,感应14.2 mV, 0.2 ms时阈值为0.5 V。结论:双室无铅起搏器经右颈内静脉通路植入小儿患者是可行的。
{"title":"Dual Chamber Aveir Retrievable Leadless Pacemaker Implant via the Right Internal Jugular Vein in a 13-Year-Old With Congenital Complete Heart Block.","authors":"Daniel Cortez","doi":"10.1111/pace.15129","DOIUrl":"10.1111/pace.15129","url":null,"abstract":"<p><strong>Introduction: </strong>Congenital complete heart block is a condition where there is a risk of Stokes Adam's attacks and sudden death may occur. Once the escape rate is too low, or other high-risk factors occur, these patients ultimately need pacemakers placed. Epicardial or transvenous pacemakers have typically been in employed dependent on size of the patient and other circumstances. We describe the first case of an implant via internal jugular vein (right) of a dual chamber leadless pacemaker implant in a symptomatic pediatric patient with congenital complete heart block.</p><p><strong>Methods: </strong>The study was approved by the University of California and consent was waived due to retrospective nature of this case report.</p><p><strong>Case: </strong>A 13-year-old presented with presyncope at rest after years of being followed for her congenital complete heart block. Her average rate on Holter monitoring was below 50 bpm, which coincided with her recent symptoms. After discussion with family, and our own cardiology/surgical team, she had a dual chamber leadless pacemaker implanted. Stable 3-month atrial parameters included an impedance of 340 Ω, sensing of 3.2 mV, and threshold of 0.25 V at 0.2 ms, while ventricular parameters showed an impedance of 780 Ω, sensing of 14.2  mV, and threshold of 0.5 V at 0.2 ms.</p><p><strong>Conclusion: </strong>Dual chamber leadless pacemaker implant is feasible via right internal jugular vein access and in a pediatric patient.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"224-226"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of Procedural Aspects on Early Complications After Permanent Cardiac Implantable Device Implantations. 程序方面对永久性心脏植入后早期并发症的影响。
IF 1.7 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-01 Epub Date: 2024-12-24 DOI: 10.1111/pace.15124
Joanna Popiolek-Kalisz, Tomasz Chrominski, Marcin Szczasny, Piotr Błaszczak

Background: Cardiac implantable devices (CIED) such as pacemakers, implantable cardioverter-defibrillators, or cardiac resynchronization devices are implanted in selected patients with bradyarrhythmia and advanced heart failure. The invasive character of these procedures poses a risk of early complications such as pneumothorax, bleeding, infections, or dislocations.

Aims: There are no available data that analyzed the impact of the organization of procedures on the early complications risk after permanent pacing procedures. The aim of this study was to investigate if organizational aspects can impact early complications risk in CIED implantations.

Methods: This retrospective study analyzed the medical records of 1673 patients who underwent CIED implantation at the Department of Cardiology of Cardinal Wyszynski Hospital in the years 2016-2020 (before the conduction system pacing era).

Results: The regression analysis revealed the predictive value of the number of leads on complication risk overall (β = 0.65, p < 0.001). Even though the significant differences in complications count were also observed for the consecutive days of the week (p = 0.002) and procedure order within the same day (p = 0.01), the regression analysis did not confirm their predictive value on complications' risk. However, the subgroup analysis regarding the device type revealed the significant predictive value of procedure order on complications in the single-chamber pacemaker subgroup (β = 1.10, p = 0.01). Moreover, the subgroup analysis confirmed the predictive value of the number of leads on pneumothorax (β = 0.89, p = 0.04) and dislocation (β = 0.67, p = 0.01), age of the patient, and the assist with the less experienced operator on hemopericardium (β = 0.11, p = 0.02, and β = 2.34, p = 0.04, respectively).

Conclusion: The study showed that the number of leads is the main factor of early complications after CIED implantations. In the simplest devices such as single-chamber pacemakers, the order of the procedure within the same day can also play a role in early complications risk.

背景:心脏植入式装置(CIED),如起搏器、植入式心律转复除颤器或心脏再同步装置被植入慢速心律失常和晚期心力衰竭患者。这些手术的侵入性特点带来了早期并发症的风险,如气胸、出血、感染或脱位。目的:目前尚无数据分析手术安排对永久性起搏术后早期并发症风险的影响。本研究的目的是调查组织因素是否会影响CIED植入的早期并发症风险。方法:回顾性分析2016-2020年(传导系统起搏时代前)在Cardinal Wyszynski医院心内科行CIED植入术的1673例患者病历。结果:回归分析显示导联数对并发症风险的总体预测价值(β = 0.65, p < 0.001)。尽管在连续几天的并发症数量(p = 0.002)和同一天内的手术顺序(p = 0.01)上也观察到显著差异,但回归分析并不能证实它们对并发症风险的预测价值。然而,关于器械类型的亚组分析显示,单室起搏器亚组手术顺序对并发症有显著的预测价值(β = 1.10, p = 0.01)。此外,亚组分析证实了导联数对气胸(β = 0.89, p = 0.04)和脱位(β = 0.67, p = 0.01)、患者年龄和辅助经验不足的心包手术(β = 0.11, p = 0.02, β = 2.34, p = 0.04)的预测价值。结论:导联数是影响CIED植入术早期并发症的主要因素。在单室起搏器等最简单的设备中,同一天内的手术顺序也可以在早期并发症风险中发挥作用。
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引用次数: 0
In Vivo Tissue Temperature Characteristics of Contact Force Catheter With a Mesh-Shaped Irrigation Tip: A Porcine Study.
IF 1.7 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-01 Epub Date: 2025-01-27 DOI: 10.1111/pace.15147
Masanaru Sawada, Naoto Otsuka, Koichi Nagashima, Ryuta Watanabe, Yuji Wakamatsu, Satoshi Hayashida, Shu Hirata, Moyuru Hirata, Sayaka Kurokawa, Yasuo Okumura, Kenta Uto, Hiroyuki Hao, Rie Takahashi, Yoshiki Taniguchi

Background: Neither the actual in vivo tissue temperatures reached with a novel contact force sensing catheter with a mesh-shaped irrigation tip (TactiFlex SE, Abbott) nor the safety profile has been elucidated.

Methods: In a porcine model (n = 8), thermocouples were implanted epicardially in the superior vena cava, right pulmonary vein, and esophagus close to the inferior vena cava following a right thoracotomy. After chest closure, endocardial ablation was conducted near the thermocouples under fluoroscopic guidance. We compared tissue temperatures during 50 W/13-s high-power short-duration (HPSD) and 30 W/30-s standard ablation.

Results: No steam pops were observed in 34 HPSD and 35 standard ablation applications. Tmax (maximum tissue temperature when the thermocouple was located ≤5 mm from the catheter tip) was modestly higher in HPSD compared to standard ablation (60.1°C ± 12.4°C vs. 57.8°C ± 12.9°C; p = 0.46). The peak tissue temperature correlated inversely with the catheter tip-to-thermocouple distance (HPSD: r = -0.40; standard: r = -0.57). Lethal temperatures (≥50°C) were reached faster with HPSD (6.5 ± 3.2 s vs. 10.3 ± 8.6 s; p = 0.04) and the distance from the catheter tip achieving a lethal tissue temperature ≥50°C (indicative of the lesion depth) was slightly shallower with HPSD (4.2 and 4.8 mm, respectively). The esophageal injury occurred superficially in both settings (0.98 ± 0.22 mm vs. 1.16 ± 0.18 mm; p = 0.29).

Conclusions: HPSD ablation produced a modestly higher and more rapid increase in the tissue temperature around the veno-atrial junction with a shorter catheter tip-to-thermocouple distance required to reach lethal temperatures. This data contributes to understanding effective lesion creation and collateral injury prevention with the TactiFlex catheter.

{"title":"In Vivo Tissue Temperature Characteristics of Contact Force Catheter With a Mesh-Shaped Irrigation Tip: A Porcine Study.","authors":"Masanaru Sawada, Naoto Otsuka, Koichi Nagashima, Ryuta Watanabe, Yuji Wakamatsu, Satoshi Hayashida, Shu Hirata, Moyuru Hirata, Sayaka Kurokawa, Yasuo Okumura, Kenta Uto, Hiroyuki Hao, Rie Takahashi, Yoshiki Taniguchi","doi":"10.1111/pace.15147","DOIUrl":"10.1111/pace.15147","url":null,"abstract":"<p><strong>Background: </strong>Neither the actual in vivo tissue temperatures reached with a novel contact force sensing catheter with a mesh-shaped irrigation tip (TactiFlex SE, Abbott) nor the safety profile has been elucidated.</p><p><strong>Methods: </strong>In a porcine model (n = 8), thermocouples were implanted epicardially in the superior vena cava, right pulmonary vein, and esophagus close to the inferior vena cava following a right thoracotomy. After chest closure, endocardial ablation was conducted near the thermocouples under fluoroscopic guidance. We compared tissue temperatures during 50 W/13-s high-power short-duration (HPSD) and 30 W/30-s standard ablation.</p><p><strong>Results: </strong>No steam pops were observed in 34 HPSD and 35 standard ablation applications. Tmax (maximum tissue temperature when the thermocouple was located ≤5 mm from the catheter tip) was modestly higher in HPSD compared to standard ablation (60.1°C ± 12.4°C vs. 57.8°C ± 12.9°C; p = 0.46). The peak tissue temperature correlated inversely with the catheter tip-to-thermocouple distance (HPSD: r = -0.40; standard: r = -0.57). Lethal temperatures (≥50°C) were reached faster with HPSD (6.5 ± 3.2 s vs. 10.3 ± 8.6 s; p = 0.04) and the distance from the catheter tip achieving a lethal tissue temperature ≥50°C (indicative of the lesion depth) was slightly shallower with HPSD (4.2 and 4.8 mm, respectively). The esophageal injury occurred superficially in both settings (0.98 ± 0.22 mm vs. 1.16 ± 0.18 mm; p = 0.29).</p><p><strong>Conclusions: </strong>HPSD ablation produced a modestly higher and more rapid increase in the tissue temperature around the veno-atrial junction with a shorter catheter tip-to-thermocouple distance required to reach lethal temperatures. This data contributes to understanding effective lesion creation and collateral injury prevention with the TactiFlex catheter.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"270-279"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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