Pace-Pacing and Clinical Electrophysiology最新文献

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.

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.

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.

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).

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.

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).

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.

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.