Pace-Pacing and Clinical Electrophysiology最新文献

Introduction: Implantable cardioverter defibrillators (ICDs) lead fractures are rare but serious complications, often leading to inappropriate shocks. The early occurrence of such fractures post-implantation is exceptionally uncommon.

Methods and results: We present a case of a 53-year-old male with hypertrophic cardiomyopathy who experienced an inappropriate shock due to a lead fracture just 4 days after ICD implantation. The fractured lead was successfully extracted and replaced using a gooseneck snare passed through an oversized TightRail with no immediate complications.

Conclusion: Early lead fractures can occur shortly after ICD implantation, leading to inappropriate shocks. Successful management, including extraction and reimplantation, is possible even in these early cases. Clinicians should remain vigilant, and remote monitoring can play a crucial role in the timely detection of such complications.

Introduction: Right ventricular (RV) pacing can impair left ventricular function and cause heart failure, known as pacing-induced cardiomyopathy (PICM). Upgrade to cardiac resynchronization (CRT) is its usual treatment; recently left bundle branch area pacing (LBBAP) has emerged as a potential alternative. Deep septal pacing (DSP), a simplified alternative to LBBAP, is still able to achieve narrower paced QRS than during conventional RV pacing. The aim of this study was to assess the effect of DSP in a cohort of patients with PICM.

Methods and results: Consecutive patients diagnosed with PICM were included. The aim was to upgrade patients to DSP. The procedure was considered successful if a paced QRS duration ≤140 ms was obtained, in the absence of a terminal R wave in V1. Twelve patients were included. The mean baseline LVEF was 33% (SD 4%), and the mean percentage of RV pacing was 99% (SD 1%). All patients had symptomatic heart failure. The mean paced QRS duration was 172 ms (SD 14 ms) with RV pacing, and 130 ms (SD 7 ms) with DSP (mean difference 42 ms, p < 0.001). At 6 months, the mean LVEF after the upgrade was 46% (SD 9%), significantly superior to LVEF with RV pacing (p = 0.001), a mean improvement of 13% (SD 10%). All patients except one experienced an improvement in LVEF of at least 5%.

Conclusions: Our data suggest that DSP may be an effective and simpler alternative to biventricular or LBBAP in patients with PICM. Narrower paced QRS complexes can be achieved, which may lead to an improvement in left ventricular function.

An 80-year-old patient, previously implanted for idiopathic sustained ventricular tachycardia with a Rivacor VR-T DX implantable cardioverter defibrillator (ICD Biotronik, Berlin, Germany), came to our pacemaker clinic for palpitations. Electrocardiogram (ECG) showed sinus bradycardia with interpolated ventricular ectopic beats. A ventricular-paced event occurred with a coupling interval shorter than the expected one suggesting ventricular undersensing. The phenomenon can be explained by the default ICD sensitivity setting proposed by the manufacturer.

Background: Pacemaker recipients demonstrate a higher prevalence of atrial fibrillation (AF), yet the regular ventricular activation in pacemaker-dependent patients with AF presents a substantial diagnostic challenge.

Methods: A total of 310 medical practitioners completed a brief, validated survey consisting of three electrocardiograms displaying AF with ventricular pacing. Participants were instructed to identify the underlying rhythm.

Results: Cardiologists outperformed all other groups with 69% correct responses, followed by emergency physicians (33%) and internists (24%). The poorest performance was observed among primary care physicians (14%) and medical interns (12%) (p < 0.0001). The comparison between groups revealed a statistically significant difference between cardiologists and non-cardiologists (p < 0.001).

Conclusion: The detection of AF in patients with ventricular-paced rhythm remains a significant diagnostic challenge, with notable gaps even among cardiologists. It is imperative to educate physicians that AF in this context may not present with the typical irregular rhythm. Routine interrogation of cardiac devices in cases where the rhythm is unclear can facilitate a timely and accurate diagnosis of this concealed arrhythmia.

Background: Noninferiority of omitting intraoperative defibrillation threshold (DFT) testing has been documented for transvenous implantable cardioverter defibrillators (ICD) whereas data for the subcutaneous-ICD (S-ICD) regarding the need for DFT testing, especially during S-ICD generator replacement, is not available.

Methods: A total of 112 consecutive patients who underwent S-ICD generator replacement and routine testing were included in this retrospective single-center study and analyzed regarding the outcome of intraoperative DFT.

Results: The majority of patients (87.3%) were successfully tested during generator replacement with no major adverse events. PREATORIAN score was generally lower, while high voltage (HV) impedance increased compared to first implantation. The risk of conversion failure increased with the PRAETORIAN risk class, whereas patient characteristics did not impact conversion rates. PRAETORIAN score and HV impedance were shown to be the most accurate factors when predicting conversion failure. In all patients with an HV impedance <70 Ohm and a PREATORIAN score < 90 at the time of initial implantation DFT was successfully performed during generator replacement.

Conclusion: General omittance of DFT in S-ICD generator replacement is not advisable. New algorithms for low impedance DFT measurements during S-ICD query and PREATORIAN score at first implantation can be used to predict conversion failure. An impedance <70 Ohm and a PRAETORIAN score < 90 show a very low risk of conversion failure. In patients with a PRAETORIAN score > 150 DFT testing should be performed when the S-ICD generator is replaced until randomized data is available.

Leadless pacing technology now includesdedicated atrial helix-fixation leadless pacemakers (LPs), expanding theapplication of leadless devices for patients with sinus node dysfunction andatrioventricular block during sinus rhythm. This first reportedcase-series of atrial LPs describes and discusses the potential use-casescenarios of recently approved helix-fixation atrial LPs. The article highlights important concepts regarding their use, including implantationtechniques, programming, battery conservation, and the low rate of progressionof AV block in patients implanted with AAI(R) pacemakers.

Aims: This study aimed to determine the relationship between sleep problems, shock pain, and shock anxiety in patients with implantable cardioverter defibrillator (ICD) and the affecting factors.

Methods and results: The population of this descriptive cross-sectional study consisted of all patients who underwent ICD implantation in university hospital (N = 200), and the sample consisted of patients who met the inclusion criteria of the study (n = 132). Data were obtained using a "General Information Form", the "Florida Shock Anxiety Scale (FSAS)", the "Epworth Sleepiness Scale (ESS)", the "Pittsburgh Sleep Quality Index (PSQI)", and the "Visual Pain Scale (VPS)". The mean age of the patients was 66.13 years. The VPS was 6.40 ± 3.36; the mean FSAS score was 29.98 ± 8.46; the mean PSQI score was 8.02 ± 3.81; the mean ESS score was 7.59 ± 4.10. PSQI had a statistically significant correlation with the total FSAS score (p < 0.001) and a statistically insignificant correlation with ESS (p > 0.001). Age, sex, marital status, smoking status, cohabitants, previous ICD shocks, the status of lying on ICD, and fear of dislocation of ICD affected the total FSAS score; sex, employment status, history of heart attack, defined sleep disorder, awakening from sleep due to nightmares, and cessation of breathing during sleep affected the total PSQI score; history of previously defined sleep disorder, history of heart attack, use of medication for a sleep disorder, the pain felt when lying on ICD, and pain experienced during ICD shocks affected the total ESS score. The mean shock VPS scores differed between patients who received an ICD shock during sleep and those who were awakened by nightmares.

Conclusions: It was found that the shock anxiety and shock pain scores of ICD patients were above average, that they had poor sleep quality, and that their sleepiness was at the level of "normal but increased daytime sleepiness".

Background: His-bundle pacing (HBP) is a pacing mode that provides near-physiological pacing and has more advantages over standard right ventricle (RV) septum pacing in positive clinical results. However, traditional HBP cannot accurately and stably place the lead tip into the His-Purkinje system. Hence, this study aimed to establish a novel strategy for HBP to strike a balance between an excellent pacing threshold and minor injuries to the conduction system.

Methods: HBP, using continuous and real-time monitoring of unipolar His-bundle (HB) electrograms along with electrocardiograms, was performed in 29 consecutive atrial fibrillation patients. We analyzed the unipolar HB intracardiac electrogram (EGM) and electrophysiological characteristics during HBP using John Jiang's connecting cable and an electrophysiology recording system. All patients were followed up for 12 months.

Results: Of the 29 patients, 28 (96.55%) successfully received HBP. Twenty-one (75%) patients were confirmed to have the negative deflection of His potential with a negative amplitude of ≥ 0.1 mV in HB EGM. The subgroup with a deep negative deflection was recorded with an HBP threshold (0.71 ± 0.41 V), significantly lower than those thresholds with no deep negative deflection (1.83 ± 0.76 V) (p < 0.05). The selective HBP rate was significantly different between the two groups: 20 (95.24%) in the deep negative deflection group and three (42.86%) in the non-deep negative deflection group (p < 0.05); five (17.24%) patients presented right bundle branch block (RBBB) during the lead placement.

Conclusions: This study supports the safety and feasibility of using an uninterrupted real-time monitoring technique for HBP. An uninterrupted real-time monitoring technique can guide the accurate placement of the HB lead and may provide a balance between an excellent pacing threshold and minor injury to the conduction system.

Background: Transseptal catheterization is critical for atrial fibrillation (AF) ablation but risks thromboembolism. Transseptal sheaths (TSS) were suggested for continuous heparinized saline solution flush. The safety and effectiveness of a simple TSS management to reduce sheath-associated thrombus development risk was investigated.

Methods: AF patients who underwent radiofrequency ablation with the simple TSS management were studied under a retrospective multi-center observation study and a prospective single-center observation study. TSS and dilators were washed and perfused with high concentration heparinized saline (20 u/mL). Immediately after two successful transseptal punctures, activated clotting time ≥300 s was maintained by heparin infusion. TSS aspiration with negative suction and re-perfusion with high concentration heparinized saline (20 u/mL) was performed for the remaining procedure before and after catheter withdrawal.

Results: A total of 4765 AF patients underwent 5367 ablation procedures were enrolled in the retrospective study, involving 156 (2.9% per procedure) complications. No acute stroke occurred during all the procedures. Perioperative thromboembolic complications occurred in 10 (0.21%) patients and in 10 (0.19%) procedures. Thromboembolic complications occurred within 24 h, between 24-48 h, and after 48 h post-procedure in six, two, and two patients, respectively. In the prospective observation study, neither sheath- nor catheter-associated thrombus were detected by the intracardiac echocardiography during all 127 procedures, without any perioperative thromboembolic complications. No hemorrhagic cerebrovascular complication was encountered in both observational studies.

Conclusion: For AF radiofrequency ablation, it was safe and effective for TSS high concentration heparinized saline infusion only. This approach could avoid sheath-associated thrombus for interventional procedures.