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Shan Y, Lin M, Ye M, Shen X, Li D, Chen Z, Jiang H, Fu G, Zhang W, Wang M. Effects of coronary artery disease in patients with permanent left bundle branch area pacing: A retrospective study. Heliyon 2024; 10:e24226. [PMID: 38268827 PMCID: PMC10803899 DOI: 10.1016/j.heliyon.2024.e24226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 12/15/2023] [Accepted: 01/04/2024] [Indexed: 01/26/2024] Open
Abstract
Aims Myocardial ischemia can affect traditional right ventricular (RV) pacing parameters, but it is unclear whether coronary artery disease (CAD) impact the pacing parameters and electrophysiological characteristics of left bundle branch area pacing (LBBaP) as a physiological pacing representative. Methods Patients who underwent coronary angiography (CAG) after/before the LBBaP procedure and underwent percutaneous coronary intervention after LBBaP procedure were divided into CAD group and Non-CAD group according to visual CAG. Pacing parameters and electrophysiological characteristics were recorded at LBBaP implantation. Multivariate logistic regression analysis was implemented to evaluate the association between CAD and higher capture threshold. Sensitivity analyses were conducted to verify result stability. Results A total of 176 patients met inclusion criteria (115 Non-CAD patients and 61 CAD patients) with a mean age of 71.1 ± 9.0 years. Compared with the Non-CAD patients, CAD patients had the higher capture threshold (0.67 ± 0.22 V vs. 0.82 ± 0.28 V, P < 0.001) and lower R-wave amplitude (12.5 ± 4.8 mV vs. 10.1 ± 2.7 mV, P = 0.001). Moreover, CAD was independently associated with higher capture threshold (adjusted Odds ratio (OR) 3.418, 95% confidence interval (CI): 1.621-7.206, P = 0.001), which was further validated through sensitivity analyses. Conclusion Patients without CAD might have safer pacing parameters in the LBBaP procedure. Besides, CAD might be the risk factor of capture threshold increase during permanent LBBaP implantation.
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Affiliation(s)
- Yu Shan
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, No 3 East of Qinchun Road, Hangzhou, Zhejiang, 310000, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Maoning Lin
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, No 3 East of Qinchun Road, Hangzhou, Zhejiang, 310000, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Miao Ye
- Department of Electrocardiogram, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, No 3 East of Qinchun Road, Hangzhou, Zhejiang, 310000, China
| | - Xiaohua Shen
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, No 3 East of Qinchun Road, Hangzhou, Zhejiang, 310000, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Duanbin Li
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, No 3 East of Qinchun Road, Hangzhou, Zhejiang, 310000, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Zhezhe Chen
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, No 3 East of Qinchun Road, Hangzhou, Zhejiang, 310000, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Hangpan Jiang
- Department of Cardiology, The Fourth Affiliated Hospital, College of Medicine, Zhejiang University, No 1 Shangcheng Avenue, Yiwu, Zhejiang, 322000, China
| | - Guosheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, No 3 East of Qinchun Road, Hangzhou, Zhejiang, 310000, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Wenbin Zhang
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, No 3 East of Qinchun Road, Hangzhou, Zhejiang, 310000, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Min Wang
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, No 3 East of Qinchun Road, Hangzhou, Zhejiang, 310000, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
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Javid R, Wassef N, Wheatcroft SB, Tayebjee MH. Coronary Guidewires in Temporary Cardiac Pacing and Assessment of Myocardial Viability: Current Perspectives and Future Directions. J Clin Med 2023; 12:6976. [PMID: 38002591 PMCID: PMC10672001 DOI: 10.3390/jcm12226976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/14/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
Intracoronary guidewires used in percutaneous coronary intervention can also be configured to provide temporary ventricular pacing. Trans coronary electrophysiological parameters recorded by employing coronary guidewires may have a potential role in assessing myocardial viability and could provide a means to make an immediate on-table decision about revascularisation. To date, some small studies have demonstrated the safety of this technique in temporary cardiac pacing, but further research is required to refine this approach and establish its clinical utility in myocardial viability assessment. In this review we discuss the potential role of trans coronary electrophysiology in the assessment of myocardial viability.
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Affiliation(s)
- Rabeia Javid
- Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (R.J.); (S.B.W.)
- Leeds General Infirmary, Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, UK;
| | - Nancy Wassef
- Leeds General Infirmary, Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, UK;
| | - Stephen B. Wheatcroft
- Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (R.J.); (S.B.W.)
- Leeds General Infirmary, Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, UK;
| | - Muzahir H. Tayebjee
- Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (R.J.); (S.B.W.)
- Leeds General Infirmary, Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, UK;
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Cafaro A, Rizzo F, Fischetti D, Quarta L, Mussardo M, Mandurino-Mirizzi A, Tondo A, Ciccone MM, Iacovelli F, Colonna G. Intracoronary Pacing during "Chimney Technique" in Transcatheter Aortic Valve-in-Valve Implantation: An Alternative Temporary Rapid Ventricular Stimulation? J Cardiovasc Dev Dis 2023; 10:341. [PMID: 37623354 PMCID: PMC10455771 DOI: 10.3390/jcdd10080341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/19/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023] Open
Abstract
Temporary rapid ventricular pacing (TRVP) is required during transcatheter aortic valve implantation (TAVI) in order to reduce cardiac output and to facilitate balloon aortic valvuloplasty, prosthesis deployment, and post-deployment balloon dilation. The two most frequently used TRVP techniques are right endocardial (RE)-TRVP and retrograde left endocardial temporary rapid ventricular pacing (RLE)-TRVP. The first one could be responsible for cardiac tamponade, one of the most serious procedural complications during TAVI, while the second one could often be unsuccessful. Intracoronary (IC)-TRVP through a coronary guidewire has been described as a safe and efficient procedure that could avoid such complications. We describe two clinical cases in which IC-TRVP has been effectively used during valve-in-valve TAVI with coronary protection via the "chimney technique", after unsuccessful RLE-TRVP.
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Affiliation(s)
- Alessandro Cafaro
- Division of Cardiology, “V. Fazzi” Hospital, 73100 Lecce, Italy; (A.C.); (D.F.); (L.Q.); (M.M.); (A.M.-M.); (A.T.); (G.C.)
| | - Francesco Rizzo
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy; (M.M.C.); (F.I.)
| | - Dionigi Fischetti
- Division of Cardiology, “V. Fazzi” Hospital, 73100 Lecce, Italy; (A.C.); (D.F.); (L.Q.); (M.M.); (A.M.-M.); (A.T.); (G.C.)
| | - Luca Quarta
- Division of Cardiology, “V. Fazzi” Hospital, 73100 Lecce, Italy; (A.C.); (D.F.); (L.Q.); (M.M.); (A.M.-M.); (A.T.); (G.C.)
| | - Marco Mussardo
- Division of Cardiology, “V. Fazzi” Hospital, 73100 Lecce, Italy; (A.C.); (D.F.); (L.Q.); (M.M.); (A.M.-M.); (A.T.); (G.C.)
| | - Alessandro Mandurino-Mirizzi
- Division of Cardiology, “V. Fazzi” Hospital, 73100 Lecce, Italy; (A.C.); (D.F.); (L.Q.); (M.M.); (A.M.-M.); (A.T.); (G.C.)
| | - Antonio Tondo
- Division of Cardiology, “V. Fazzi” Hospital, 73100 Lecce, Italy; (A.C.); (D.F.); (L.Q.); (M.M.); (A.M.-M.); (A.T.); (G.C.)
| | - Marco Matteo Ciccone
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy; (M.M.C.); (F.I.)
| | - Fortunato Iacovelli
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy; (M.M.C.); (F.I.)
- Division of Cardiology, “SS. Annunziata” Hospital, 74121 Taranto, Italy
| | - Giuseppe Colonna
- Division of Cardiology, “V. Fazzi” Hospital, 73100 Lecce, Italy; (A.C.); (D.F.); (L.Q.); (M.M.); (A.M.-M.); (A.T.); (G.C.)
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Carey J, Buckley A, O'Connor S, Hensey M. The Wattson temporary pacing guidewire for transcatheter heart valve implantation. Future Cardiol 2021; 18:275-283. [PMID: 34875868 DOI: 10.2217/fca-2021-0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Transcatheter aortic valve implantation and implantation of other transcatheter heart valves, generally requires insertion of a temporary venous pacemaker. Implantation of a temporary venous pacemaker adds complexity, time and risk to the procedure. Guidewire modification to allow pacing is increasingly popular, however it requires technical expertise and provides unipolar pacing resulting in high thresholds and potential capture loss. The Wattson temporary pacing guidewire is a novel device which offers guidewire support for valve delivery and concomitant bipolar pacing. It may offer a safe and effective solution to guidewire pacing for transcatheter aortic valve implantation and other transcatheter heart valve implantations. Herein, we review the literature surrounding left ventricular guidewire pacing along with the features and clinical data of the Wattson wire.
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Affiliation(s)
- James Carey
- St James's Hospital, James St, Dublin 8, Ireland
| | | | | | - Mark Hensey
- St James's Hospital, James St, Dublin 8, Ireland
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Heinroth KM, Unverzagt S, Mahnkopf D, Horenburg C, Melnyk H, Sedding D, Prondzinsky R. Transcoronary pacing in an animal model : Second coated guidewire versus cutaneous patch as indifferent electrodes. Med Klin Intensivmed Notfmed 2021; 117:227-234. [PMID: 33787979 DOI: 10.1007/s00063-021-00806-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/03/2021] [Accepted: 02/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Transcoronary pacing is a seldom used treatment option for unheralded bradycardias in the setting of percutaneous coronary interventions (PCI). In the present study we compared a coated guidewire inserted proximally into a coronary artery with a cutaneous patch electrode as indifferent electrodes for transcoronary pacing in a porcine model. METHODS Transcoronary pacing was investigated in 7 adult pigs in an animal catheterization laboratory. A standard guidewire insulated by a monorail-balloon was advanced into the periphery of a coronary artery serving as the cathode. As the indifferent anode, a special guidewire with electrical insulated by a polytetrafluoroethylene (PTFE) coating was positioned into the proximal part of the same coronary vessel. Transcoronary pacing parameters (threshold and impedance data and the magnitude of the epicardial electrogram) were compared with unipolar transcoronary pacing using a cutaneous patch electrode. RESULTS Transcoronary pacing was successful against both indifferent electrodes. Pacing thresholds obtained with the coated guidewire technique (1.8 ± 1.3 V) were similar to those obtained by standard unipolar transcoronary pacing with a cutaneous patch electrode (1.8 ± 1.5 V). The impedance with the additional coated guidewire was 419 ± 144 Ω and thereby slightly higher compared to 320 ± 103 Ω obtained by pacing against the patch electrode (p < 0.05). Both settings yielded comparable R‑wave amplitudes (8.0 ± 5.1 mV vs. 7.1 ± 3.6 mV). CONCLUSIONS A second coated guidewire is as effective as a cutaneous patch electrode when added as an indifferent electrode in transcoronary pacing. This transcoronary pacing technique could replace temporary transvenous pacing in emergency situations during PCI, especially when using the radial approach.
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Affiliation(s)
- Konstantin M Heinroth
- Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle, Germany.
| | - Susanne Unverzagt
- Martin-Luther-University Halle-Wittenberg, Institute of General Practice and Family Medicine, Halle/Saale, Germany
| | | | - Charlotte Horenburg
- Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle, Germany
| | - Hannes Melnyk
- Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle, Germany
| | - Daniel Sedding
- Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle, Germany
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