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Ikeda S, Sakamoto K, Sugawara M, Yakabe D, Nagaoka K, Kowase S, Inoue S, Morishige K, Mukai Y, Tsutsui H, Kinugawa S. Paced QRS morphology mimicking complete left bundle branch block induced by right ventricular pacing is associated with pacing-induced cardiomyopathy. J Cardiovasc Electrophysiol 2024; 35:906-915. [PMID: 38433355 DOI: 10.1111/jce.16229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/08/2024] [Accepted: 02/14/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Right ventricular (RV) pacing sometimes causes left ventricular (LV) systolic dysfunction, also known as pacing-induced cardiomyopathy (PICM). However, the association between specifically paced QRS morphology and PICM development has not been elucidated. This study aimed to investigate the association between paced QRS mimicking a complete left bundle branch block (CLBBB) and PICM development. METHODS We retrospectively screened 2009 patients who underwent pacemaker implantation from 2010 to 2020 in seven institutions. Patients who received pacemakers for an advanced atrioventricular block or bradycardia with atrial fibrillation, baseline LV ejection fraction (LVEF) ≥ 50%, and echocardiogram recorded at least 6 months postimplantation were included. The paced QRS recorded immediately after implantation was analyzed. A CLBBB-like paced QRS was defined as meeting the CLBBB criteria of the American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society in 2009. PICM was defined as a ≥10% LVEF decrease, resulting in an LVEF of <50%. RESULTS Among the 270 patients analyzed, PICM was observed in 38. Baseline LVEF was lower in patients with PICM, and CLBBB-like paced QRS was frequently observed in PICM. Multivariate analysis revealed that low baseline LVEF (odds ratio [OR]: 0.93 per 1% increase, 95% confidence interval [CI]: 0.89-0.98, p = 0.006) and CLBBB-like paced QRS (OR: 2.69, 95% CI: 1.25-5.76, p = 0.011) were significantly associated with PICM development. CONCLUSION CLBBB-like paced QRS may be a novel risk factor for PICM. RV pacing, which causes CLBBB-like QRS morphology, may need to be avoided, and patients with CLBBB-like paced QRS should be followed-up carefully.
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Affiliation(s)
- Shota Ikeda
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
- Department of Cardiology, Yokohama Rosai Hospital, Kohoku-ku, Yokohama, Japan
| | - Kazuo Sakamoto
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Masafumi Sugawara
- Department of Cardiology, Yokohama Rosai Hospital, Kohoku-ku, Yokohama, Japan
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Japan
| | - Daisuke Yakabe
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
- Department of Cardiovascular Medicine, National Hospital Organization Kyushu Medical Center, Clinical Research Institute, Chuo-ku, Fukuoka, Japan
| | | | - Shinya Kowase
- Department of Cardiology, Yokohama Rosai Hospital, Kohoku-ku, Yokohama, Japan
| | - Shujiro Inoue
- Department of Cardiology, Aso Iizuka Hospital, Iizuka, Japan
| | - Kunio Morishige
- Department of Cardiology, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Yasushi Mukai
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
- Division of Cardiology, Fukuoka Red Cross Hospital, Minami-ku, Fukuoka, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Shintaro Kinugawa
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
- Division of Cardiovascular Medicine, Research Institute of Angiocardiology, Faculty of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
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Franczyk B, Rysz J, Olszewski R, Gluba-Sagr A. Do Implantable Cardioverter-Defibrillators Prevent Sudden Cardiac Death in End-Stage Renal Disease Patients on Dialysis? J Clin Med 2024; 13:1176. [PMID: 38398488 PMCID: PMC10889557 DOI: 10.3390/jcm13041176] [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: 11/06/2023] [Revised: 01/23/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
Chronic kidney disease patients appear to be predisposed to heart rhythm disorders, including atrial fibrillation/atrial flutter, ventricular arrhythmias, and supraventricular tachycardias, which increase the risk of sudden cardiac death. The pathophysiological factors underlying arrhythmia and sudden cardiac death in patients with end-stage renal disease are unique and include timing and frequency of dialysis and dialysate composition, vulnerable myocardium, and acute proarrhythmic factors triggering asystole. The high incidence of sudden cardiac deaths suggests that this population could benefit from implantable cardioverter-defibrillator therapy. The introduction of implantable cardioverter-defibrillators significantly decreased the rate of all-cause mortality; however, the benefits of this therapy among patients with chronic kidney disease remain controversial since the studies provide conflicting results. Electrolyte imbalances in haemodialysis patients may result in ineffective shock therapy or the appearance of non-shockable underlying arrhythmic sudden cardiac death. Moreover, the implantation of such devices is associated with a risk of infections and central venous stenosis. Therefore, in the population of patients with heart failure and severe renal impairment, periprocedural risk and life expectancy must be considered when deciding on potential device implantation. Harmonised management of rhythm disorders and renal disease can potentially minimise risks and improve patients' outcomes and prognosis.
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Affiliation(s)
- Beata Franczyk
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-419 Lodz, Poland; (B.F.); (J.R.)
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-419 Lodz, Poland; (B.F.); (J.R.)
| | - Robert Olszewski
- Department of Gerontology, Public Health and Didactics, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland;
| | - Anna Gluba-Sagr
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-419 Lodz, Poland; (B.F.); (J.R.)
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Hopman LHGA, Beunder KP, Borodzicz-Jazdzyk S, Götte MJW, van Halm VP. Loss of capture of conduction system pacemaker caused by fibrosis surrounding the lead: a case report. BMC Cardiovasc Disord 2023; 23:621. [PMID: 38114911 PMCID: PMC10729341 DOI: 10.1186/s12872-023-03656-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Conduction system pacing (CSP) is a novel technique that involves pacing the His-Purkinje system instead of the traditional right ventricular (RV) apex. This technique aims to avoid the adverse effects of RV apical pacing, which can lead to ventricular dyssynchrony and heart failure over time. CSP is gaining popularity but its long-term efficacy and challenges remain uncertain. This report discusses a case where CSP was initially successful but faced complications due to an increasing pacing threshold. CASE PRESENTATION A 65-year-old female with total atrioventricular block was referred for brady-pacing. Due to the potential for chronic RV pacing, CSP was chosen. The CSP implantation involved subcutaneous device placement, with a CSP lead in the left bundle branch area (LBBA) and an RV backup lead. A year after successful implantation, the LBBA pacing threshold progressively increased. Subsequent efforts to correct it led to anodal capture and battery depletion. Cardiac magnetic resonance imaging (CMR) revealed mid-septal fibrosis at the area of LBBA lead placement and suggested cardiac sarcoidosis as a possible cause. CONCLUSION CSP is a promising technique for treating bradyarrhythmias, but this case underscores the need for vigilance in monitoring pacing thresholds. Increasing thresholds can render CSP ineffective, necessitating alternative pacing methods. The CMR findings of mid-septal fibrosis and the potential diagnosis of cardiac sarcoidosis emphasize the importance of pre-implantation assessment, as CSP may be compromised by underlying structural abnormalities. This report highlights the complexities of pacing strategy selection and the significance of comprehensive evaluation before adopting CSP.
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Affiliation(s)
- Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Kyle P Beunder
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sonia Borodzicz-Jazdzyk
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Vokko P van Halm
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
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Domenichini G, Le Bloa M, Teres Castillo C, Graf D, Carroz P, Ascione C, Porretta AP, Pascale P, Pruvot E. Conduction System Pacing versus Conventional Biventricular Pacing for Cardiac Resynchronization Therapy: Where Are We Heading? J Clin Med 2023; 12:6288. [PMID: 37834932 PMCID: PMC10573781 DOI: 10.3390/jcm12196288] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
Over the last few years, pacing of the conduction system (CSP) has emerged as the new standard pacing modality for bradycardia indications, allowing a more physiological ventricular activation compared to conventional right ventricular pacing. CSP has also emerged as an alternative modality to conventional biventricular pacing for the delivery of cardiac resynchronization therapy (CRT) in heart failure patients. However, if the initial clinical data seem to support this new physiological-based approach to CRT, the lack of large randomized studies confirming these preliminary results prevents CSP from being used routinely in clinical practice. Furthermore, concerns are still present regarding the long-term performance of pacing leads when employed for CSP, as well as their extractability. In this review article, we provide the state-of-the-art of CSP as an alternative to biventricular pacing for CRT delivery in heart failure patients. In particular, we describe the physiological concepts supporting this approach and we discuss the future perspectives of CSP in this context according to the implant techniques (His bundle pacing and left bundle branch area pacing) and the clinical data published so far.
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Affiliation(s)
- Giulia Domenichini
- Cardiology Service, University Hospital of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
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Marcantoni L, Zanon F, Anselmino M. Editorial: Conduction system pacing: What's missing for the paradigm shift? Front Cardiovasc Med 2023; 10:1163370. [PMID: 37034334 PMCID: PMC10080074 DOI: 10.3389/fcvm.2023.1163370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/14/2023] [Indexed: 04/11/2023] Open
Affiliation(s)
- Lina Marcantoni
- Arrhythmia and Electrophysiology Unit, Division of Cardiology, Santa Maria Della Misericordia General Hospital, Rovigo, Italy
| | - Francesco Zanon
- Arrhythmia and Electrophysiology Unit, Division of Cardiology, Santa Maria Della Misericordia General Hospital, Rovigo, Italy
| | - Matteo Anselmino
- Cardiology Division, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
- Correspondence: Matteo Anselmino
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Pacemaker Malfunction–Review of Permanent Pacemakers and Malfunctions Encountered in the Emergency Department. Emerg Med Clin North Am 2022; 40:679-691. [DOI: 10.1016/j.emc.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Translation of the document prepared by the Czech Society of Cardiology. COR ET VASA 2022. [DOI: 10.33678/cor.2022.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Incidence and predictors of pacemaker-induced cardiomyopathy with right ventricular pacing: a systematic review. Expert Rev Cardiovasc Ther 2022; 20:267-273. [PMID: 35365062 DOI: 10.1080/14779072.2022.2062323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION This systematic review aims to evaluate the incidence and predictors of PICM in patients undergoing right ventricular pacing. AREAS COVERED A literature review was conducted using Mesh terms (Right ventricular pacing, Pacemaker-related cardiomyopathy, Pacemaker-induced cardiomyopathy) in PubMed, EMBASE, Web of science CINAHL, and the Cochrane Library until October 2021. All data reporting the incidence of PICM after implantation of right-sided pacemakers or implantable cardioverter-defibrillator (ICD) were retrieved from the eligible studies. EXPERT OPINION Out of 3,625 articles, 20 studies met the inclusion criteria that included 5,381 patients with PICM. The mean age of the patients ranged between 55.8 ± 13.5 and 77.4 ± 10.8 years. The mean incidence of PICM was 25.7%. Mean EF at baseline ranged from 48 ± 1% and 62.1 ± 11.2%, while mean EF at follow up ranged between 33.7± 7.4% and 53.2 ± 8.2%. Three studies reported a decline of >20% EF at follow-up. RV pacing was associated with a considerable risk of PICM, with biological factors such as male gender, old age, increased QRS duration, and chronic RV pacing burden playing an important role in the development of disease.
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJ, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. Grupo de trabajo sobre estimulación cardiaca y terapia de resincronización cardiaca de la Sociedad Europea de Cardiología (ESC). Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM, Leyva F, Linde C, Abdelhamid M, Aboyans V, Arbelo E, Asteggiano R, Barón-Esquivias G, Bauersachs J, Biffi M, Birgersdotter-Green U, Bongiorni MG, Borger MA, Čelutkienė J, Cikes M, Daubert JC, Drossart I, Ellenbogen K, Elliott PM, Fabritz L, Falk V, Fauchier L, Fernández-Avilés F, Foldager D, Gadler F, De Vinuesa PGG, Gorenek B, Guerra JM, Hermann Haugaa K, Hendriks J, Kahan T, Katus HA, Konradi A, Koskinas KC, Law H, Lewis BS, Linker NJ, Løchen ML, Lumens J, Mascherbauer J, Mullens W, Nagy KV, Prescott E, Raatikainen P, Rakisheva A, Reichlin T, Ricci RP, Shlyakhto E, Sitges M, Sousa-Uva M, Sutton R, Suwalski P, Svendsen JH, Touyz RM, Van Gelder IC, Vernooy K, Waltenberger J, Whinnett Z, Witte KK. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Europace 2022; 24:71-164. [PMID: 34455427 DOI: 10.1093/europace/euab232] [Citation(s) in RCA: 140] [Impact Index Per Article: 70.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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11
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J 2021; 42:3427-3520. [PMID: 34455430 DOI: 10.1093/eurheartj/ehab364] [Citation(s) in RCA: 857] [Impact Index Per Article: 285.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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12
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Cano Ó, Dandamudi G, Schaller RD, Pérez-Roselló V, Ayala HD, Izquierdo M, Osca J, Sancho-Tello MJ, Rueda J, Ruiz E, Insa B, Martínez-Dolz L, Vijayaraman P. Safety and feasibility of conduction system pacing in patients with congenital heart disease. J Cardiovasc Electrophysiol 2021; 32:2692-2703. [PMID: 34405485 DOI: 10.1111/jce.15213] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/30/2021] [Accepted: 08/09/2021] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Conduction system pacing (CSP) has emerged as an ideal physiologic pacing strategy for patients with permanent pacing indications. We sought to evaluate the safety and feasibility of CSP in a consecutive series of unselected patients with congenital heart disease (CHD). METHODS Consecutive patients with CHD in which CSP was attempted were included. Safety and feasibility, implant tools and electrical parameters at implant and at follow-up were evaluated. RESULTS A total of 20 patients were included (10 with a previous device). A total of 10 patients had complex forms of CHD, 9 moderate defects and 1 a simple defect. CSP was achieved in 75% of cases (10 His bundle pacing, 5 left bundle branch pacing) with left ventricular septal pacing in the remaining 5 patients. Procedure times and fluoroscopy times were prolongued (126 ± 82 min and 27 ± 30 min, respectively). Ventricular lead implant times widely varied ranging from 4 to 115 min, (mean 31 ± 28 min) and the use of multiple delivery sheaths was frequent (50%). The QRS width was reduced from 145 ± 36 ms at baseline to 116 ± 18 ms with CSP. Implant electrical parameters included: CSP pacing threshold 0.95 ± 0.65 V; R wave amplitude 9.2 ± 8.8 mV and pacing impedance 632 ± 183 Ohms, and remained stable at a median follow-up of 478 days (interquartile range: 225-567). Systemic ventricle systolic function and NYHA class (1.50 ± 0.51 vs. 1.10 ± 0.31; p = .008) significantly improved at follow-up. Lead revision was required in one patient at Day 4. CONCLUSIONS Permanent CSP is safe and feasible in patients with CHD although implant technique is complex.
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Affiliation(s)
- Óscar Cano
- Electrophysiology Section, Adult Congenital Heart Disease Section and Paediatric Cardiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Gopi Dandamudi
- Division of Cardiovascular Medicine, Cardiovascular Service Line, Cardiology, CHI-Franciscan Health System, Tacoma, Washington, USA
| | - Robert D Schaller
- Electrophysiology Section, Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Víctor Pérez-Roselló
- Electrophysiology Section, Adult Congenital Heart Disease Section and Paediatric Cardiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Hebert D Ayala
- Electrophysiology Section, Adult Congenital Heart Disease Section and Paediatric Cardiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Maite Izquierdo
- Electrophysiology Section, Adult Congenital Heart Disease Section and Paediatric Cardiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Joaquín Osca
- Electrophysiology Section, Adult Congenital Heart Disease Section and Paediatric Cardiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - María-José Sancho-Tello
- Electrophysiology Section, Adult Congenital Heart Disease Section and Paediatric Cardiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Joaquín Rueda
- Electrophysiology Section, Adult Congenital Heart Disease Section and Paediatric Cardiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Eladio Ruiz
- Electrophysiology Section, Adult Congenital Heart Disease Section and Paediatric Cardiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Beatriz Insa
- Electrophysiology Section, Adult Congenital Heart Disease Section and Paediatric Cardiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Luis Martínez-Dolz
- Electrophysiology Section, Adult Congenital Heart Disease Section and Paediatric Cardiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Pugazhendhi Vijayaraman
- Division of Cardiovascular Medicine, Geisinger Heart Institute, Wilkes-Barre, Pennsylvania, USA
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Ko TY, Kao HL, Liu YJ, Yeh CF, Huang CC, Chen YH, Hung CS, Chan CY, Lin LC, Chen YS, Lin MS. Impact of conduction disturbances on left ventricular mass regression and geometry change following transcatheter aortic valve replacement. Sci Rep 2021; 11:16778. [PMID: 34408241 PMCID: PMC8373860 DOI: 10.1038/s41598-021-96297-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 08/09/2021] [Indexed: 11/23/2022] Open
Abstract
Our study aimed to compare the difference of LV mass regression and remodeling in regard of conduction disturbances (CD) following transcatheter aortic valve replacement (TAVR). A prospective analysis of 152 consecutive TAVR patients was performed. 53 patients (34.9%) had CD following TAVR, including 30 (19.7%) permanent pacemaker implantation and 23 (15.2%) new left bundle branch block. In 123 patients with 1-year follow-up, significant improvement of LV ejection fraction (LVEF) (baseline vs 12-month: 65.1 ± 13.2 vs 68.7 ± 9.1, P = 0.017) and reduced LV end-systolic volume (LVESV) (39.8 ± 25.8 vs 34.3 ± 17.1, P = 0.011) was found in non-CD group (N = 85), but not in CD group (N = 38). Both groups had significant decrease in LV mass index (baseline vs 12-month: 148.6 ± 36.9 vs. 136.4 ± 34.7 in CD group, p = 0.023; 153.0 ± 50.5 vs. 125.6 ± 35.1 in non-CD group, p < 0.0001). In 46 patients with 3-year follow-up, only non-CD patients (N = 28) had statistically significant decrease in LV mass index (Baseline vs 36-month: 180.8 ± 58.8 vs 129.8 ± 39.1, p = 0.0001). Our study showed the improvement of LV systolic function, reduced LVESV and LV mass regression at 1 year could be observed in patients without CD after TAVR. Sustained LV mass regression within 3-year was found only in patients without CD.
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Affiliation(s)
- Tsung-Yu Ko
- Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, Medical College, National Taiwan University, Taipei, Taiwan
| | - Hsien-Li Kao
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan
| | - Ying-Ju Liu
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Fan Yeh
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan
| | - Ching-Chang Huang
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan
| | - Ying-Hsien Chen
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan
| | - Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan
| | - Chih-Yang Chan
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Lung-Chun Lin
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan
| | - Yih-Sharng Chen
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Mao-Shin Lin
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan.
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Gupta H, Showkat HI, Aslam N, Tandon R, Wander GS, Gupta S, Anwar S, Sohil MM. Chronology of cardiac dysfunction after permanent pacemaker implantation: an observational 2 year prospective study in North India. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2021. [DOI: 10.1186/s42444-021-00040-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Abstract
Background
The purpose of this study is to evaluate cardiac functions using transthoracic echocardiography, change in lead parameters and electrocardiogram (ECG) morphology in patients undergoing permanent pacemaker implantation over a follow-up period of 6 months.
Methods
This is a prospective study in patients undergoing permanent pacemaker implantation in a tertiary care hospital. Patients undergoing permanent pacemaker implantation were enrolled for up to one year and Echocardiographic parameters (by 2 blind operators) and ECG parameters were recorded at admission (within 24 h), before discharge (within 7 days of pacemaker implantation), after 1 month (± 7 days) and after 6 months (± 7 days) of follow-up.
Results
A total of 96 patients (60.4% males and 39.6% female, mean age 66.65 years) were implanted with permanent pacemaker. The mean QRS duration was 133.18 ms and increased significantly to 146.03 ms by 6 months despite septal lead placement in majority (92%) of patients. The mean baseline ejection fraction of 51.47 decreased significantly to 47.83 by 6 months. Diastolic parameters like left atrial volume index, early to late diastolic transmitral flow velocity (E/A) and early diastolic mitral annular tissue velocity (E/e′) showed a significant increase (> 5%) from baseline by the end of first week. By the end of first month, systolic dysfunction of RV sets in with significant (> 5%) change from baseline in parameters like Right ventricle myocardial performance index, transannular plane systolic excursion and right ventricle systolic excursion velocity (RVS′).
Conclusion
We have observed that pacemaker recipients with baseline reduced left ventricle (LV) systolic functions perform significantly worse compared to those with baseline normal cardiac functions and had a higher rate of deterioration of LV function. RV dysfunction is the first abnormality that occurs, by 1 week followed by LV dysfunction which starts by 1 month and the diastolic dysfunctions precede the systolic dysfunction. QRS duration also showed a gradual increase despite septal lead placement in majority (92%) and lead parameters showed no significant change over 6 months.
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15
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Curila K, Jurak P, Halamek J, Prinzen F, Waldauf P, Karch J, Stros P, Plesinger F, Mizner J, Susankova M, Prochazkova R, Sussenbek O, Viscor I, Vondra V, Smisek R, Leinveber P, Osmancik P. Ventricular activation pattern assessment during right ventricular pacing: Ultra‐high‐frequency ECG study. J Cardiovasc Electrophysiol 2021; 32:1385-1394. [DOI: 10.1111/jce.14985] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/14/2021] [Accepted: 02/22/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Karol Curila
- Cardiocenter, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - Pavel Jurak
- Institute of Scientific Instruments, Czech Academy of Sciences Brno Czech Republic
| | - Josef Halamek
- Institute of Scientific Instruments, Czech Academy of Sciences Brno Czech Republic
| | - Frits Prinzen
- Department of Physiology Cardiovascular Research Institute Maastricht Maastricht the Netherlands
| | - Petr Waldauf
- Department of Anesthesia and Intensive Care Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - Jakub Karch
- Cardiocenter, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - Petr Stros
- Cardiocenter, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - Filip Plesinger
- Institute of Scientific Instruments, Czech Academy of Sciences Brno Czech Republic
| | - Jan Mizner
- Cardiocenter, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - Marketa Susankova
- Cardiocenter, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - Radka Prochazkova
- Cardiocenter, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - Ondrej Sussenbek
- Cardiocenter, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - Ivo Viscor
- Institute of Scientific Instruments, Czech Academy of Sciences Brno Czech Republic
| | - Vlastimil Vondra
- Institute of Scientific Instruments, Czech Academy of Sciences Brno Czech Republic
| | - Radovan Smisek
- Institute of Scientific Instruments, Czech Academy of Sciences Brno Czech Republic
- Department of Biomedical Engineering, Faculty of Electrical Engineering and Communication Brno University of Technology Brno Czech Republic
| | - Pavel Leinveber
- International Clinical Research Center St. Anne's University Hospital Brno Czech Republic
| | - Pavel Osmancik
- Cardiocenter, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic
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16
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Prinzen FW, Vernooy K. Do we need to pace the bundle? Editorial comment on: Nonselective versus selective His bundle pacing: An acute intrapatient speckle tracking strain echocardiographic study by Bednarek et al. J Cardiovasc Electrophysiol 2020; 32:126-128. [PMID: 33290636 DOI: 10.1111/jce.14832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.,Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.,Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
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17
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Liu Y, Sun JY, Zhu YS, Li ZM, Li KL, Wang RX. Association between CRT(D)/ICD and renal insufficiency: A systematic review and meta-analysis. Semin Dial 2020; 34:17-30. [PMID: 33296540 DOI: 10.1111/sdi.12937] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 08/27/2020] [Accepted: 10/21/2020] [Indexed: 12/27/2022]
Abstract
Cardiac resynchronization therapy with or without a defibrillator (CRT(D)) and implantable cardioverter defibrillator (ICD) may reduce the risk of arrhythmia or heart failure-specific mortality and improves the prognosis of patients with chronic kidney disease (CKD) or dialysis. The aim of this study was to perform a meta-analysis investigating the relationship between CRT(D)/ICD and renal insufficiency. Cochrane Library, Web of Science, Embase, and Pubmed were systematically searched from inception to 29 October 2019. We included studies that report all-cause mortality of patients with renal insufficiency who received CRT(D)/ICD therapy. Twenty-six studies (n = 119,263) were included, exploring the relationship between CRT(D)/ICD and renal insufficiency from two aspects: (1) Compared with ICD-only, CRT(D) was associated with lower risk of all-cause mortality in CKD patients (odds ratios (OR) = 0.67; 95% confidence interval (CI), 0.60 to 0.75). For non-primary prevention (secondary prevention or both), the analysis revealed a lower risk of all-cause mortality in the ICD group than in the no-ICD group (OR = 0.47; 95% CI, 0.40 to 0.55). (2) CKD increased all-cause mortality in comparison with control group (OR = 2.12; 95% CI, 1.85 to 2.44), and so did dialysis (OR = 2.53; 95% CI, 2.34 to 2.73). Furthermore, compared with CKD3 (eGFR: 30-59 ml/min/1.73 m2 ), CKD4/5 (eGFR <30 ml/min/1.73 m2 ) was observed to have a significantly higher risk of all-cause mortality (OR = 2.70; 95% CI, 1.93 to 3.80). This review shows a clear association between CRT(D)/ICD and renal insufficiency in the aspect of all-cause mortality, and may provide a reference for the clinical application of CRT(D)/ICD.
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Affiliation(s)
- Ying Liu
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Jin-Yu Sun
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China.,Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yu-Shan Zhu
- Department of Nephrology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Zi-Meng Li
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ku-Lin Li
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Ru-Xing Wang
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
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18
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Tham JLM, Adams H, Paleri S, Wright C, Dimitriou J, Newcomb A, MacIsaac AI, Whitbourn RJ, Palmer SC. Clinical outcomes of self-expandable vs. balloon-expandable TAVI for severe aortic stenosis. Acta Cardiol 2020; 75:218-225. [PMID: 30931804 DOI: 10.1080/00015385.2019.1572959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is an established therapy for patients with severe aortic stenosis (AS). There is limited data exploring differences in outcomes post-TAVI SEV vs. BEV. This study compared procedural success and 30-d clinical outcomes self-expandable valves (SEV), vs. balloon-expandable valves (BEV) for patients with severe AS.Methods: Retrospective analysis was undertaken of patients receiving TAVI at St Vincent's Hospital, Melbourne between August 2009 and May 2018. The primary endpoints included procedural success, clinical outcomes and complication rates at 30-d.Results: Out of 151 patients undergoing TAVI, 70 received (46.3%) SEV (Medtronic CoreValve & Evolut-R) and 81 (53.6%) BEV (Edwards SAPIEN-XT & S3). The mean Society of Thoracic Surgery (STS) risk score did not differ between the groups, SEV (83.6 ± 4.9 years, STS 4.4 ± 3.8) compared to BEV (82.3 ± 5.8 years, STS 4.9 ± 4.9). Procedural success was similar SEV 67 (95.7%) vs. BEV 78 (96.3%). Rates of ≥ moderate paravalvular aortic regurgitation (PAR) at 30-d were significantly higher in SEV compared to BEV (6.7 vs. 0.0%; p = .02). SEV patients had higher rates of pacemaker insertion (36.4 vs. 9.5%; p = .001) and stroke rates (12.4 vs. 1.4%; p = .04) compared to BEV patients. The difference in 30-d mortality between the two groups was similar (SEV 4.6% vs. BEV 1.3%; p = .23).Conclusions: This real-world retrospective analysis demonstrates higher rates of ≥ moderate PAR, stroke and pacemaker insertion with SEV compared to BEV at 30 d post-TAVI for severe symptomatic AS.
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Affiliation(s)
| | - Heath Adams
- Department of Cardiology, St Vincent’s Hospital Melbourne, Fitzroy, Australia
- School of Medicine, University of Tasmania, Hobart, Australia
| | - Sarang Paleri
- Department of Cardiology, St Vincent’s Hospital Melbourne, Fitzroy, Australia
| | - Christine Wright
- Department of Cardiology, St Vincent’s Hospital Melbourne, Fitzroy, Australia
| | - Jim Dimitriou
- Department of Cardiac Surgery, St Vincent’s Hospital Melbourne, Fitzroy, Australia
| | - Andrew Newcomb
- Department of Cardiac Surgery, St Vincent’s Hospital Melbourne, Fitzroy, Australia
| | - Andrew I. MacIsaac
- Department of Medicine, University of Melbourne, Fitzroy, Australia
- Department of Cardiology, St Vincent’s Hospital Melbourne, Fitzroy, Australia
| | - Robert J. Whitbourn
- Department of Medicine, University of Melbourne, Fitzroy, Australia
- Department of Cardiology, St Vincent’s Hospital Melbourne, Fitzroy, Australia
| | - Sonny C. Palmer
- Department of Medicine, University of Melbourne, Fitzroy, Australia
- Department of Cardiology, St Vincent’s Hospital Melbourne, Fitzroy, Australia
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19
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Zanon F, Marcantoni L, Zuin M, Pastore G, Baracca E, Tiribello A, Raffagnato P, Boaretto G, Roncon L, Vijayaraman P. Electrogram‐only guided approach to His bundle pacing with minimal fluoroscopy: A single‐center experience. J Cardiovasc Electrophysiol 2020; 31:805-812. [DOI: 10.1111/jce.14366] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 12/31/2019] [Accepted: 01/15/2020] [Indexed: 01/07/2023]
Affiliation(s)
- Francesco Zanon
- Arrhythmia and Electrophysiology Unit, Cardiology DepartmentSanta Maria Della Misericordia Hospital, Italy Rovigo
| | - Lina Marcantoni
- Arrhythmia and Electrophysiology Unit, Cardiology DepartmentSanta Maria Della Misericordia Hospital, Italy Rovigo
- Department of CardiologySanta Maria della Misericordia Hospital Rovigo Italy
| | - Marco Zuin
- Department of CardiologySanta Maria della Misericordia Hospital Rovigo Italy
- Section of Internal and Cardiopulmonary MedicineUniversity of Ferrara Ferrara Italy
| | - Gianni Pastore
- Arrhythmia and Electrophysiology Unit, Cardiology DepartmentSanta Maria Della Misericordia Hospital, Italy Rovigo
- Department of CardiologySanta Maria della Misericordia Hospital Rovigo Italy
| | - Enrico Baracca
- Arrhythmia and Electrophysiology Unit, Cardiology DepartmentSanta Maria Della Misericordia Hospital, Italy Rovigo
- Department of CardiologySanta Maria della Misericordia Hospital Rovigo Italy
| | - Antonella Tiribello
- Arrhythmia and Electrophysiology Unit, Cardiology DepartmentSanta Maria Della Misericordia Hospital, Italy Rovigo
| | - Paola Raffagnato
- Arrhythmia and Electrophysiology Unit, Cardiology DepartmentSanta Maria Della Misericordia Hospital, Italy Rovigo
| | - Graziano Boaretto
- Arrhythmia and Electrophysiology Unit, Cardiology DepartmentSanta Maria Della Misericordia Hospital, Italy Rovigo
| | - Loris Roncon
- Department of CardiologySanta Maria della Misericordia Hospital Rovigo Italy
| | - Pugazhendhi Vijayaraman
- Geisinger Heart Institute, Geisinger Commonwealth School of Medicine Wilkes‐Barre Pennsylvania
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20
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Algazzar AS, Elbably MM, Katta AA, Elmeligy N, Elrabbat K, Qutub MA. Merits of Different Ventricular Lead Locations on Left Ventricular Myocardial Strain and Dyssynchrony in Patients with Cardiac Resynchronization Therapy. Cardiology 2019; 145:13-20. [PMID: 31778999 DOI: 10.1159/000503953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 10/07/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The idea behind cardiac resynchronization therapy (CRT) is to pace both ventricles resulting in a synchronized electro-mechanical coupling of the left ventricle (LV), meaning every effort should be made to improve the percentage of CRT responders. OBJECTIVES This study aimed at demonstrating the short-term effect of right ventricular apical (RVA) and mid-septal (RVS) lead locations combined with different LV lead positions on LV myocardial strain, dyssynchrony, and clinical outcomes. METHODS We examined 60 patients with indication for CRT before and after 6 months of implantation for clinical outcome and CRT response (6-min walk test [6MWT], NYHA class, decrease in left ventricular end systolic volume [LVESV] by >15%), dyssynchrony, and myocardial strain. RESULTS After 6 months of follow-up, the two RV lead locations represented a significant improvement in 6MWT, left ventricular ejection fraction, and LVESV in comparison to baseline values, but no significant difference was found between both groups. With regards to NYHA class improvement, p values were insignificant between the groups (0.44 and 0.88) at baseline and 6 months after implantation, respectively. The mean 6MWT was 273.8 m in the RVA group compared to 279.0 m in the RVS group (p = 0.84) at baseline. After 6 months of CRT implantation, the 6MWT mean was 326.5 m in the RVA group compared to 316.2 m in the RVS group (p = 0.74). The posterolateral cardiac vein site showed a significant improvement when combined with RVS location in interventricular and intraventricular dyssynchrony, global longitudinal strain, global circumferential strain, and apical circumferential strain (p = 0.01 0.032, 0.02, 0.005, and 0.049), respectively. CONCLUSION RVS is not inferior and provides a good alternative to RVA pacing in short-term follow-up. However, the QRS duration, myocardial strain, and dyssynchrony varies depending on RV and LV stimulation sites. Long-term morbidity and mortality outcomes according to LV lead location in coronary sinus need more assessment.
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Affiliation(s)
- Alaa S Algazzar
- Division of Cardiology, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,
| | | | | | | | | | - Mohammed A Qutub
- Division of Cardiology, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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21
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Du F, Zhu Q, Jiang J, Chen H, Liu X, Wang J. Incidence and Predictors of Permanent Pacemaker Implantation in Patients Who Underwent Transcatheter Aortic Valve Replacement: Observation of a Chinese Population. Cardiology 2019; 145:27-34. [DOI: 10.1159/000502792] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 08/18/2019] [Indexed: 11/19/2022]
Abstract
Aims: Permanent pacemaker (PPM) implantation is one of the most common complications after transcatheter aortic valve replacement (TAVR). We studied the incidence of PPM implantation and identified the predictors in patients who underwent TAVR in a Chinese population. Methods and Results: A total of 256 patients who underwent TAVR with self-expandable valves were included. The incidence of PPM implantation in our study population was 14.8%. In patients who received PPM implantation, the proportion of bicuspid aortic valve (BAV) patients was much lower compared to tricuspid aortic valve (TAV) patients (18.4 vs. 81.6%, p < 0.05). Patients with BAV were associated with a significantly lower PPM implantation rate and shallower implantation depth compared to patients with TAV (6.4 vs. 21.7% and 4.2 ± 4.4 vs. 6.2 ± 5.0 mm, respectively, p < 0.05 for both). In the multivariable logistic regression analysis, prior right bundle branch block (RBBB; OR 8.3, 95% CI 2.2–32.1, p < 0.05), implantation depth (OR 1.3, 95% CI 1.1–1.5, p = 0.01), and TAV (OR 4.7, 95% CI 1.5–14.4, p < 0.05) were independent predictors of PPM implantation after TAVR. There was no difference in 30-day and 1-year all-cause mortality between the 2 groups. Conclusions: The incidence of PPM implantation in patients with self-expandable valves after TAVR was 14.8% in our cohort study. Independent predictors of PPM implantation included prior RBBB, TAV, and implantation depth at the noncoronary sinus side. TAVR in BAV with a supra-annular structure-based sizing strategy might decrease the risk of PPM implantation.
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22
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Kaye G. The desire for physiological pacing: Are we there yet? J Cardiovasc Electrophysiol 2019; 30:3025-3038. [DOI: 10.1111/jce.14248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/11/2019] [Accepted: 10/16/2019] [Indexed: 01/23/2023]
Affiliation(s)
- Gerry Kaye
- University of Queensland Medical School, Herston Brisbane Queensland Australia
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23
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay. Heart Rhythm 2019; 16:e128-e226. [DOI: 10.1016/j.hrthm.2018.10.037] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Indexed: 12/13/2022]
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24
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2019; 140:e382-e482. [DOI: 10.1161/cir.0000000000000628] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | | | - Kenneth A. Ellenbogen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- ACC/AHA Representative
| | - Michael R. Gold
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- HRS Representative
| | | | | | - José A. Joglar
- ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | | | | | | | | | | | | | - Cara N. Pellegrini
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- HRS Representative
- Dr. Pellegrini contributed to this article in her personal capacity. The views expressed are her own and do not necessarily represent the views of the US Department of Veterans Affairs or the US government
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25
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay. J Am Coll Cardiol 2019; 74:e51-e156. [DOI: 10.1016/j.jacc.2018.10.044] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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26
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary. J Am Coll Cardiol 2019; 74:932-987. [DOI: 10.1016/j.jacc.2018.10.043] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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27
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Khurwolah MR, Yao J, Kong XQ. Adverse Consequences of Right Ventricular Apical Pacing and Novel Strategies to Optimize Left Ventricular Systolic and Diastolic Function. Curr Cardiol Rev 2019; 15:145-155. [PMID: 30499419 PMCID: PMC6520581 DOI: 10.2174/1573403x15666181129161839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 11/20/2018] [Accepted: 11/22/2018] [Indexed: 11/25/2022] Open
Abstract
Several studies have focused on the deleterious consequences of Right Ventricular Apical (RVA) pacing on Left Ventricular (LV) function, mediated by pacing-induced ventricular dyssyn-chrony. Therapeutic strategies to reduce the detrimental consequences of RVA pacing have been pro-posed, that includes upgrading of RVA pacing to Cardiac Resynchronization Therapy (CRT), alterna-tive Right Ventricular (RV) pacing sites, minimal ventricular pacing strategies, as well as atrial-based pacing. In developing countries, single chamber RV pacing still constitutes a majority of cases of permanent pacing, and assessment of the optimal RV pacing site is of paramount importance. In chronically-paced patients, it is crucial to maintain as close and normal LV physiological function as possible, by minimizing ventricular dyssynchrony, reducing the chances for heart failure and other complications to develop. This review provides an analysis of the deleterious immediate and long-term consequences of RVA pacing, and the most recent available evidence regarding improvements in pacing options and strategies to optimize LV diastolic and systolic function. Furthermore, the place of advanced echocardiography in the identification of patients with pacing-induced LV dysfunction, the potential role of a new predictor of LV dysfunction in RV-paced subjects, and the long- term out-comes of patients with RV septal pacing will be explored
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Affiliation(s)
- Mohammad Reeaze Khurwolah
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Jing Yao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Xiang-Qing Kong
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
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28
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Evranos B, Craven P, Henderson R, Visvaratnam P, Jones S, Sarsam M, Gallagher MM. Half a century of continuous pacing: a living witness to the evolution of a technology. Europace 2019; 21:548-553. [PMID: 30839056 DOI: 10.1093/europace/euy218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/05/2018] [Indexed: 11/13/2022] Open
Abstract
To chart the development of pacing technology and its pitfalls we present the experience of a patient who has benefitted from it but also suffered as a result of it from its earliest days. A 53-year-old physician was referred to us with obstruction of the superior and inferior vena cava on a background of more than 50 years of continuous ventricular pacing and 24 previous pacemaker-related interventions. In a single surgical procedure, his existing pacing system and redundant leads were extracted, the superior vena cava was reconstructed, and a new biventricular pacing system with epicardial leads was implanted. Pacemakers can maintain life and preserve the quality of life for many decades. The quality of this therapy has improved due to advances in the technology and in techniques. Maintaining safe pacing in the very long term requires labour, patience, and ingenuity.
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MESH Headings
- Adolescent
- Adult
- Child
- Child, Preschool
- Humans
- Male
- Middle Aged
- Young Adult
- Atrioventricular Block/therapy
- Cardiac Pacing, Artificial/history
- Cardiac Pacing, Artificial/methods
- Cardiac Resynchronization Therapy/history
- Cardiac Resynchronization Therapy/methods
- Cardiac Resynchronization Therapy Devices/history
- Computed Tomography Angiography
- History, 20th Century
- History, 21st Century
- Imaging, Three-Dimensional
- Inventions
- Pacemaker, Artificial/history
- Plastic Surgery Procedures
- Postoperative Complications/diagnostic imaging
- Postoperative Complications/surgery
- Prosthesis Implantation
- Reoperation
- Superior Vena Cava Syndrome/surgery
- Vascular Surgical Procedures
- Vena Cava, Inferior/diagnostic imaging
- Vena Cava, Inferior/surgery
- Vena Cava, Superior/diagnostic imaging
- Vena Cava, Superior/surgery
- Venous Thrombosis/surgery
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Affiliation(s)
- Banu Evranos
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, UK
| | | | | | - Parthiepan Visvaratnam
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, UK
| | - Sue Jones
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, UK
| | - Mazin Sarsam
- Department of Cardiac Surgery, St George's Hospital, London, UK
| | - Mark M Gallagher
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, UK
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29
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Nakata TM, Kaji H, Matsuura N, Shimizu M, Tanaka R. Inotropic and lusitropic effects of incremental doses of dobutamine in dogs with right ventricular apical pacing-induced cardiac dysfunction. J Vet Pharmacol Ther 2019; 42:285-293. [PMID: 30724383 DOI: 10.1111/jvp.12752] [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: 10/30/2018] [Revised: 12/30/2018] [Accepted: 01/16/2019] [Indexed: 11/26/2022]
Abstract
This study aimed to assess the effects of incremental doses of dobutamine on diastolic function in healthy and rapid ventricular apical pacing (RVAP)-induced cardiac dysfunction anesthetized dogs. Inotropic and lusitropic effects of dobutamine (2, 4, 8, and 12 μg kg-1 min-1 ) were assessed through left ventricle (LV) pressure-volume relation and Doppler echocardiography in six female dogs before and after 8 weeks of RVAP. Peak rate of LV pressure fall (-dP/dtmin ) improved with doses >4 μg kg-1 min-1 in healthy (4,490 ± 970 vs. 3,265 ± 471 mmHg/s, p < 0.05) and >8 μg kg-1 min-1 in RVAP dogs (3,385 ± 1,122 vs. 1,864 ± 849 mmHg/s, p < 0.05) while the time constant of relaxation (tau) reduced with doses >4 μg kg-1 min-1 in both groups (healthy: 24.0 ± 3.7 vs. 28.2 ± 4.9 ms; RVAP: 32.6 ± 8.5 vs. 37.5 ± 11.4 ms, p < 0.05) comparing with baseline. Indices of relaxation (-dP/dtmin and tau) suggested preserved lusitropic response in contrast with markedly reduced indices of contractility in the RVAP group compared with healthy group at same infusion rates. Doppler echocardiography showed significant reduction of elastic recoil in failing hearts. The results of this study demonstrated maximal positive lusitropic effects of dobutamine at a dose of 8 μg kg-1 min-1 in ventricular pacing-induced cardiac dysfunction without further impairment of ventricular filling.
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Affiliation(s)
- Telma Mary Nakata
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu, Tokyo, Japan
| | - Hideki Kaji
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu, Tokyo, Japan
| | - Naoya Matsuura
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu, Tokyo, Japan
| | - Miki Shimizu
- Department of Veterinary Radiology, Tokyo University of Agriculture and Technology, Fuchu, Tokyo, Japan
| | - Ryou Tanaka
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu, Tokyo, Japan
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: Executive summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. Heart Rhythm 2018; 16:e227-e279. [PMID: 30412777 DOI: 10.1016/j.hrthm.2018.10.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Indexed: 12/22/2022]
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31
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. Circulation 2018; 140:e333-e381. [PMID: 30586771 DOI: 10.1161/cir.0000000000000627] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | | | | | | | - Kenneth A Ellenbogen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information.,ACC/AHA Representative
| | - Michael R Gold
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information.,HRS Representative
| | | | | | - José A Joglar
- ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | | | | | | | | | | | | | - Cara N Pellegrini
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information.,HRS Representative.,Dr. Pellegrini contributed to this article in her personal capacity. The views expressed are her own and do not necessarily represent the views of the US Department of Veterans Affairs or the US government
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Kato Y, Hayashi T, Kato R, Tanahashi N, Takao M. Ischemic Stroke with Cardiac Pacemaker Implantation: Comparison of Physiological and Ventricular Pacing Modes. J Stroke Cerebrovasc Dis 2017; 26:1948-1952. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 05/18/2017] [Accepted: 06/07/2017] [Indexed: 11/26/2022] Open
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Prominent differences in left ventricular performance and myocardial properties between right ventricular and left ventricular-based pacing modes in rats. Sci Rep 2017; 7:5931. [PMID: 28725029 PMCID: PMC5517524 DOI: 10.1038/s41598-017-06197-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 05/30/2017] [Indexed: 01/16/2023] Open
Abstract
Biventricular pacing is an important modality to improve left ventricular (LV) synchronization and long-term function. However, the biological effects of this treatment are far from being elucidated and existing animal models are limited and demanding. Recently, we introduced an implanted device for double-site epicardial pacing in rats and echocardiographically demonstrated favorable effects of LV and biventricular (LV-based) pacing modes typically observed in humans. Here, this new animal model was further characterized. Electrodes were implanted either on the right atria (RA) and right ventricle (RV) or on the RV and LV. Following recovery, rats were either used for invasive hemodynamic measurements (pressure-volume analysis) or exposed to sustained RV vs. biventricular tachypacing for 3 days. RV pacing compromised, while LV-based pacing modes markedly enhanced cardiac performance. Changes in LV performance were associated with prominent compensatory changes in arterial resistance. Sustained RV tachypacing increased the electrocardiogram QTc interval by 7.9 ± 3.1 ms (n = 6, p < 0.05), dispersed refractoriness between the right and left pacing sites and induced important molecular changes mainly in the early-activated septal tissue. These effects were not observed during biventricular tachypacing (n = 6). Our results demonstrate that the rat is an attractive new model to study the biological consequences of LV dyssynchrony and resynchronization.
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Osadchii OE. Role of abnormal repolarization in the mechanism of cardiac arrhythmia. Acta Physiol (Oxf) 2017; 220 Suppl 712:1-71. [PMID: 28707396 DOI: 10.1111/apha.12902] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
In cardiac patients, life-threatening tachyarrhythmia is often precipitated by abnormal changes in ventricular repolarization and refractoriness. Repolarization abnormalities typically evolve as a consequence of impaired function of outward K+ currents in cardiac myocytes, which may be caused by genetic defects or result from various acquired pathophysiological conditions, including electrical remodelling in cardiac disease, ion channel modulation by clinically used pharmacological agents, and systemic electrolyte disorders seen in heart failure, such as hypokalaemia. Cardiac electrical instability attributed to abnormal repolarization relies on the complex interplay between a provocative arrhythmic trigger and vulnerable arrhythmic substrate, with a central role played by the excessive prolongation of ventricular action potential duration, impaired intracellular Ca2+ handling, and slowed impulse conduction. This review outlines the electrical activity of ventricular myocytes in normal conditions and cardiac disease, describes classical electrophysiological mechanisms of cardiac arrhythmia, and provides an update on repolarization-related surrogates currently used to assess arrhythmic propensity, including spatial dispersion of repolarization, activation-repolarization coupling, electrical restitution, TRIaD (triangulation, reverse use dependence, instability, and dispersion), and the electromechanical window. This is followed by a discussion of the mechanisms that account for the dependence of arrhythmic vulnerability on the location of the ventricular pacing site. Finally, the review clarifies the electrophysiological basis for cardiac arrhythmia produced by hypokalaemia, and gives insight into the clinical importance and pathophysiology of drug-induced arrhythmia, with particular focus on class Ia (quinidine, procainamide) and Ic (flecainide) Na+ channel blockers, and class III antiarrhythmic agents that block the delayed rectifier K+ channel (dofetilide).
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Affiliation(s)
- O. E. Osadchii
- Department of Health Science and Technology; University of Aalborg; Aalborg Denmark
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Cui C, Geng L, Shi J, Zhu Y, Yang G, Wang Z, Wang J, Chen M. Structural and electrophysiological dysfunctions due to increased endoplasmic reticulum stress in a long-term pacing model using human induced pluripotent stem cell-derived ventricular cardiomyocytes. Stem Cell Res Ther 2017; 8:109. [PMID: 28490375 PMCID: PMC5426064 DOI: 10.1186/s13287-017-0566-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 04/16/2017] [Accepted: 04/26/2017] [Indexed: 01/15/2023] Open
Abstract
Background Long-term ventricular pacing has deleterious effects and becomes more significant when cumulative percent ventricular pacing (Cum%VP) exceeds 40% of time. However, cellular disturbances and pathways by which pacing leads to myocardial disorders are not well understood. Attempts to resolve these questions have been hampered by difficulties in obtaining human cardiac tissue and the inability to build a longer-lasting (lasting longer than weeks) pacing model in vitro. Methods Human induced pluripotent stem cell-derived ventricular cardiomyocytes (VCMs) were cultured in the presence of electrical stimulation for 2 weeks. Quantitative structural and electrophysiological analyses were used to define the functional disturbances of pacing. Results Compared to controls, paced VCMs exhibited a remarkable reduction in the contractile protein expression, an increased apoptosis ratio and electrophysiological remodelling in a Cum%VP-dependent manner. Investigation of the protein expression levels revealed that long-term pacing universally activated both ER stress and downstream calpain. Moreover, the inhibition of calpain attenuated the adverse effects on the structural remodelling and increased the ICa, L in paced VCMs. Conclusions The results demonstrated that pacing VCMs for 2 weeks in vitro led to a series of structural and electrophysiological dysfunctions. The increased ER stress and downstream calpain could be a central mechanism underlying the disease pathogenesis. This finding could represent a new therapeutic target in the management of long-term pacing patients. Electronic supplementary material The online version of this article (doi:10.1186/s13287-017-0566-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chang Cui
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Le Geng
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Jiaojiao Shi
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Yue Zhu
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Gang Yang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Zidun Wang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Jiaxian Wang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Minglong Chen
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
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DIRECT CONSTANT HIS BUNDLE PACING: HEMODYNAMIC BENEFIT AND LONG-TERM CLINICAL PROSPECT. КЛИНИЧЕСКАЯ ПРАКТИКА 2017. [DOI: 10.17816/clinpract8171-77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Analysing the example of unusual case of a successful direct constant His bundle pacing, we would like to draw specialist’s attention to details of procedure and some important electrophysiological particularities we have come across during operation. Long-term (7 years) results ( pacing options, ECG data, changes of left ventricle ejection fraction and patient’s quality of life) were considered too.
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Masarone D, Ammendola E, Rago A, Gravino R, Salerno G, Rubino M, Marrazzo T, Molino A, Calabrò P, Pacileo G, Limongelli G. Management of Bradyarrhythmias in Heart Failure: A Tailored Approach. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1067:255-269. [PMID: 29280096 DOI: 10.1007/5584_2017_136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Patients with heart failure (HF) may develop a range of bradyarrhythmias including sinus node dysfunction, various degrees of atrioventricular block, and ventricular conduction delay. Device implantation has been recommended in these patients, but the specific etiology should be sought as it may influence the choice of the type of device required (pacemaker vs. implantable cardiac defibrillator). Also, pacing mode must be carefully set in patients with heart failure (HF) and left ventricular systolic dysfunction.In this chapter, we summarize the knowledge required for a tailored approach to bradyarrhythmias in patients with heart failure.
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Affiliation(s)
- Daniele Masarone
- Cardiomyopathies and Heart Failure Unit-Monaldi Hospital, Naples, Italy.
| | - Ernesto Ammendola
- Cardiomyopathies and Heart Failure Unit-Monaldi Hospital, Naples, Italy
| | - Anna Rago
- Cardiomyopathies and Heart Failure Unit-Monaldi Hospital, Naples, Italy
| | - Rita Gravino
- Cardiomyopathies and Heart Failure Unit-Monaldi Hospital, Naples, Italy
| | - Gemma Salerno
- Cardiomyopathies and Heart Failure Unit-Monaldi Hospital, Naples, Italy
| | - Marta Rubino
- Cardiomyopathies and Heart Failure Unit-Monaldi Hospital, Naples, Italy
| | - Tommaso Marrazzo
- Cardiomyopathies and Heart Failure Unit-Monaldi Hospital, Naples, Italy
| | - Antonio Molino
- First Division of Pneumology Monaldi Hospital-University "Federico II", Naples, Italy.,UOC Pneumotisiologia - Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Paolo Calabrò
- Department of Cardiothoracic Sciences, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Pacileo
- Cardiomyopathies and Heart Failure Unit-Monaldi Hospital, Naples, Italy
| | - Giuseppe Limongelli
- Cardiomyopathies and Heart Failure Unit-Monaldi Hospital, Naples, Italy.,Department of Cardiothoracic Sciences, Università della Campania "Luigi Vanvitelli", Naples, Italy.,Institute of Cardiovascular Sciences - University College of London, London, UK
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Matthaios I, Kaladaridou A, Skaltsiotes E, Agrios J, Antoniou A, Georgiopoulos G, Papadopoulou E, Pamboucas C, Toumanidis S. Acute Haemodynamic and Echocardiographic Effects of Multiple Configurations of Left Ventricular Pacing Sites in Acute Myocardial Infarction: Experimental Study. Heart Lung Circ 2016; 26:383-394. [PMID: 27670586 DOI: 10.1016/j.hlc.2016.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/25/2016] [Accepted: 07/29/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Left ventricular (LV) pacing is unsuccessful in a significant number of patients, mainly due to sub-optimal LV pacing location. Nevertheless, data about the impact of different pacing sites on LV function in ischaemic myocardium are scarce. The purpose of this study was to investigate the effect of combinations of alternative LV pacing sites on LV mechanics after experimental acute anterior myocardial infarction (AMI), in order to define the optimal configuration. METHODS Atrioventricular epicardial pacing at alternative pacing sites was performed in 16 healthy pigs simultaneously, after experimental AMI. Standard right ventricular (RV) apical pacing was combined with: i) LV apex lateral wall; ii) LV basal posterior wall; iii) LV basal anterior wall, and; iv) LV basal anterior wall + LV basal posterior wall. Moreover the pacing configurations of, v) LV basal posterior wall + LV apex lateral wall; vi) LV basal posterior wall + LV basal anterior wall, and; vii) LV basal anterior wall + LV apex lateral wall were also investigated. Haemodynamic parameters, together with classic and novel echocardiographic indices were used, to evaluate the effect of each pacing combination. A speckle tracking technique using EchoPAC software was used. RESULTS After AMI, the pacing combination of LV apex lateral wall and LV basal posterior wall had the most favourable effect on LV function, leading to similar haemodynamic and torsional effects with sinus rhythm (all variables p>0.05). CONCLUSIONS In pig hearts after AMI, the combination of pacing LV apex lateral wall and LV basal posterior wall managed to maintain the LV function at a level comparable to the sinus rhythm.
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Affiliation(s)
- I Matthaios
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece.
| | - A Kaladaridou
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - E Skaltsiotes
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - J Agrios
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - A Antoniou
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - G Georgiopoulos
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - E Papadopoulou
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - C Pamboucas
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - S Toumanidis
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
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Das A, Kahali D. Physiological cardiac pacing: Current status. Indian Heart J 2016; 68:552-8. [PMID: 27543481 PMCID: PMC4990729 DOI: 10.1016/j.ihj.2016.03.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/09/2016] [Accepted: 03/28/2016] [Indexed: 11/16/2022] Open
Abstract
Adverse hemodynamics of right ventricular (RV) pacing is a well-known fact. It was believed to be the result of atrio-ventricular (AV) dyssynchrony and sequential pacing of the atrium and ventricle may solve these problems. However, despite maintenance of AV synchrony, the dual chamber pacemakers in different trials have failed to show its superiority over single chamber RV apical pacing in terms of death, progression of heart failure, and atrial fibrillation (AF). As a consequence, investigators searched for alternate pacing sites with a more physiological activation pattern and better hemodynamics. Direct His bundle pacing and Para-Hisian pacing are the most physiological ventricular pacing sites. But, this is technically difficult. Ventricular septal pacing compared to apical pacing results in a shorter electrical activation delay and consequently less mechanical dyssynchrony. But, the study results are heterogeneous. Selective site atria pacing (atrial septal) is useful for patients with atrial conduction disorders in prevention of AF.
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Affiliation(s)
- Asit Das
- RMO-cum-Clinical Tutor, Department of Cardiology, IPGME&R and SSKM Hospital, Kolkata, India.
| | - Dhiman Kahali
- Senior Interventional Cardiologist, B. M. Birla Heart Research Centre, Kolkata, India
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40
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Ebert M, Jander N, Minners J, Blum T, Doering M, Bollmann A, Hindricks G, Arentz T, Kalusche D, Richter S. Long-Term Impact of Right Ventricular Pacing on Left Ventricular Systolic Function in Pacemaker Recipients With Preserved Ejection Fraction: Results From a Large Single-Center Registry. J Am Heart Assoc 2016; 5:JAHA.116.003485. [PMID: 27444509 PMCID: PMC5015385 DOI: 10.1161/jaha.116.003485] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background There is limited evidence of long‐term impact of right ventricular pacing on left ventricular (LV) systolic function in pacemaker recipients with preserved LV ejection fraction (LVEF). The objective of the study was to evaluate the outcome and echocardiographic course of baseline preserved LVEF in a large cohort of pacemaker recipients with respect to pacing indication and degree of right ventricular pacing. Methods and Results We enrolled 991 patients (73±10 years, 54% male) with baseline normal (>55%) LVEF (n=791) or mildly reduced (41–55%) LVEF (n=200) who had paired echocardiographic data on LV systolic function recorded at implantation and last follow‐up. According to pacing indication, patients were divided into atrioventricular block group A (n=500) and sinus node disease group B (n=491). Main outcome measures were all‐cause mortality and deterioration of LV function ≥2 LVEF categories at last follow‐up. Patients were followed for an average of 44 months. Death from any cause occurred in 166 (17%), and deterioration of LV function ≥2 LVEF categories in 56 (6%) patients. There was no significant difference in outcome between group A and group B either in patients with normal LVEF or in those with mildly reduced LVEF. Mean percentage of right ventricular pacing was not predictive of outcome. Conclusions In a large cohort of pacemaker recipients with predominantly normal LVEF, clinically relevant LV dysfunction develops rather infrequently. No significant difference in all‐cause mortality and development of severe LV dysfunction is observed between patients with atrioventricular block and sinus node disease. Accordingly, de novo biventricular pacing cannot be recommended for patients with preserved LVEF.
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Affiliation(s)
- Micaela Ebert
- Department of Electrophysiology, Heart Center-University of Leipzig, Germany Department of Electrophysiology, University Heart Center Freiburg-Bad Krozingen, Germany
| | - Nikolaus Jander
- Department of Electrophysiology, University Heart Center Freiburg-Bad Krozingen, Germany
| | - Jan Minners
- Department of Electrophysiology, University Heart Center Freiburg-Bad Krozingen, Germany
| | - Thomas Blum
- Department of Electrophysiology, University Heart Center Freiburg-Bad Krozingen, Germany
| | - Michael Doering
- Department of Electrophysiology, Heart Center-University of Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center-University of Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center-University of Leipzig, Germany
| | - Thomas Arentz
- Department of Electrophysiology, University Heart Center Freiburg-Bad Krozingen, Germany
| | - Dietrich Kalusche
- Department of Electrophysiology, University Heart Center Freiburg-Bad Krozingen, Germany
| | - Sergio Richter
- Department of Electrophysiology, Heart Center-University of Leipzig, Germany
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41
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Ito BR, Covell JW, Curtis GP. Low Intensity Epicardial Pacing During the Absolute Refractory Period Augments Left Ventricular Function Mediated by Local Catecholamine Release. J Cardiovasc Electrophysiol 2016; 27:1102-9. [PMID: 27279561 DOI: 10.1111/jce.13027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 05/17/2016] [Accepted: 05/24/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Biventricular epicardial (Epi) pacing can augment left ventricular (LV) function in heart failure. We postulated that these effects might involve catecholamine release from local autonomic nerve activation. To evaluate this hypothesis we applied low intensity Epi electrical stimuli during the absolute refractory period (ARP), thus avoiding altered activation sequence. METHODS Anesthetized pigs (n = 6) were instrumented with an LV pressure (LVP) transducer, left atrial (LA) and LV Epi pacing electrodes, and sonomicrometer segment length (SL) gauges placed proximal and remote to the LV stimulation site. A catheter was placed into the great cardiac vein adjacent to the LV pacing site for norepinephrine (NE) analysis. During LA pacing at constant rate, 3 pulses (0.8 milliseconds, 2-3x threshold) were applied to the LV Epi electrodes during the ARP. An experimental run consisted of baseline, stimulation (10 minutes), and recovery (5 minutes), repeated 3 times before and after β1 - receptor blockade (BB, metoprolol). RESULTS ARP stimulation produced significant increases in cardiac function reflected by elevated LVP, LV, dP/dtmax , and reduced time to LV dP/dtmax . This was accompanied by increased coronary NE levels and increases in LVP versus SL loop area in the remote myocardial segment. In contrast, the proximal segment exhibited early shortening and decreased loop area. BB abolished the changes in SL and LV function despite continued NE release. CONCLUSION These results demonstrate that ARP EPI stimulation induces NE release mediating augmented global LV function. This effect may contribute to the beneficial effect of biventricular Epi pacing in heart failure in some patients.
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Affiliation(s)
- Bruce R Ito
- Donald P. Shiley Bioscience Center, San Diego State University, San Diego, California, USA. .,University of California, San Diego, California, USA.
| | | | - Guy P Curtis
- Scripps Clinic and Research, San Diego and La Jolla, California, USA
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Strik M, Defaye P, Eschalier R, Mondoly P, Frontera A, Ritter P, Haïssaguerre M, Ploux S, Ellenbogen KA, Bordachar P. Performance of a specific algorithm to minimize right ventricular pacing: A multicenter study. Heart Rhythm 2016; 13:1266-73. [DOI: 10.1016/j.hrthm.2016.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Indexed: 11/25/2022]
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43
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Choudhary D, Chaurasia AK, Kumar SM, Arulkumar A, Thajudeen A, Namboodiri N, Sanjay G, Abhilash SP, Ajitkumar VK, Ja T. Radial left ventricular dyssynchrony by speckle tracking in apical versus non apical right ventricular pacing- evidence of dyssynchrony on medium term follow up. J Cardiovasc Thorac Res 2016; 8:20-5. [PMID: 27069563 PMCID: PMC4827135 DOI: 10.15171/jcvtr.2016.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 01/09/2016] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION To study effects of various sites of right ventricular pacing lead implantation on left ventricular function by 2-dimensional (2D) speckle tracking for radial strain and LV dyssynchrony. METHODS This was retrospective prospective study. Fifteen patients each with right ventricular (RV) apical (RV apex and apical septum) and non-apical (mid septal and low right ventricular outflow tract [RVOT]) were programmed to obtain 100% ventricular pacing for evaluation by echo. Location and orientation of lead tip was noted and archived by fluoroscopy. Electrocardiography (ECG) was archived and 2D echo radial dyssynchrony was calculated. RESULTS The baseline data was similar between two groups. Intraventricular dyssynchrony was significantly more in apical location as compared to non-apical location (radial dyssynchrony: 108.2 ± 50.2 vs. 50.5 ± 24, P < 0.001; septal to posterior wall delay [SLWD] 63.5 ± 27.5 vs. 34 ± 10.7, P < 0.001, SPWD 112.5 ± 58.1 vs. 62.7 ± 12.1, P = 0.003). The left ventricular ejection fraction was decreased more in apical location than non apical location. Interventricular dyssynchrony was more in apical group but was not statistically significant. The QRS duration, QTc and lead thresholds were higher in apical group but not statistically significant. CONCLUSION Pacing in non apical location (RV mid septum or low RVOT) is associated with less dyssynchrony by specific measures like 2D radial strain and correlates with better ventricular function in long term.
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Affiliation(s)
- Dinesh Choudhary
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695 011, Kerala, India
| | - Amit Kumar Chaurasia
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695 011, Kerala, India
| | - S Mahesh Kumar
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695 011, Kerala, India
| | - Ajeet Arulkumar
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695 011, Kerala, India
| | - Anees Thajudeen
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695 011, Kerala, India
| | - Narayanan Namboodiri
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695 011, Kerala, India
| | - G Sanjay
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695 011, Kerala, India
| | - S P Abhilash
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695 011, Kerala, India
| | - V K Ajitkumar
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695 011, Kerala, India
| | - Tharakan Ja
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695 011, Kerala, India
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Boriani G, Ziacchi M, Diemberger I, Biffi M, Martignani C, Leyva F. BLOCK HF. J Cardiovasc Med (Hagerstown) 2016; 17:306-8. [DOI: 10.2459/jcm.0000000000000147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Chen D, Wei H, Tang J, Liu L, Wu S, Lin C, Zhang Q, Liang Y, Chen S. A randomized comparison of fluoroscopic techniques for implanting pacemaker lead on the right ventricular outflow tract septum. Int J Cardiovasc Imaging 2016; 32:721-8. [PMID: 26797500 PMCID: PMC4853443 DOI: 10.1007/s10554-016-0840-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 01/10/2016] [Indexed: 01/21/2023]
Abstract
Right ventricular outflow tract (RVOT) septal pacing is commonly performed under the standard fluoroscopic positions during procedure. The aim of the prospective, randomized study was to evaluate the accuracy of the combination of standard fluoroscopic and left lateral (LL) fluoroscopic views for determination of RVOT septal position compared with standard fluoroscopic views alone. We prospectively enrolled patients who had indications for implantation of a permanent pacemaker. Patients were randomly assigned into two groups based on intraoperative fluoroscopic views as follows: LL group (three standard fluoroscopic views + LL fluoroscopic view) or standard group (three standard fluoroscopic views). Transthoracic echocardiography (TTE) determination of pacing sites was applied in all patients 3 days after pacemaker implantation. The implantation success rate of RVOT septal pacing was compared between groups. A total of 143 patients (59 males, mean age 57.6 ± 16.3 years) with symptomatic bradyarrhythmia were studied, of whom, 72 patients were randomized to LL group and 71 to standard group. TTE determination of pacing sites was compared with two groups. In the LL group, 60 patients (83 %) were achieved in RVOT septal position. In the standard group, however, the position of RVOT septum was only observed in 48 patients (68 %). The success rate of RVOT septal position in LL group was significantly higher than standard group (p = 0.029). Comparing to traditional views, combining LL view in the procedure will approve the accuracy of RVOT septal pacing site.
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Affiliation(s)
- Dongli Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
| | - Huiqiang Wei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
| | - Jiaojiao Tang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China.
| | - Lie Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China.
| | - Shulin Wu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
| | - Chunying Lin
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
| | - Qianhuan Zhang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
| | - Yuanhong Liang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
| | - Silin Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
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Honing in on optimal ventricular pacing sites: an argument for his bundle pacing. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:372. [PMID: 25778424 DOI: 10.1007/s11936-015-0372-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OPINION STATEMENT Frequent ventricular pacing is often or completely unavoidable in patients with high-grade or complete heart block. Over time, patients with high-burden RV pacing are at risk for developing symptomatic cardiomyopathy due to pacing-induced ventricular dyssynchrony. Growing awareness of this concern has generated interest in alternative pacing sites like the septum and outflow tract, the thinking being that these sites will more closely mimic His-Purkinje-mediated ventricular activation. Numerous studies have met with mixed results likely due to the fact that-to quote Marvin Gaye-there ain't nothing like the real thing. Herein lies the advantage of His bundle pacing (HBP), as it is the only pacing modality capable of physiological ventricular activation. HBP has been demonstrated to be safe and reliable in various forms of AV block with minimal drawbacks, namely modestly higher pacing thresholds when compared with other RV sites. Additionally, HBP is a truly physiologic alternative to biventricular pacing to effect cardiac resynchronization therapy (CRT), a concept supported by small observational and prospective studies. In our view, His bundle pacing should be considered in nearly all patients requiring ventricular pacing.
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Lichtenberger J, Scollan KF, Bulmer BJ, Sisson DD. Long-term outcome of physiologic VDD pacing versus non-physiologic VVI pacing in dogs with high-grade atrioventricular block. J Vet Cardiol 2015; 17:42-53. [DOI: 10.1016/j.jvc.2014.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 12/17/2014] [Accepted: 12/23/2014] [Indexed: 10/24/2022]
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Mouillet G, Lellouche N, Yamamoto M, Oguri A, Dubois-Rande JL, Van Belle E, Gilard M, Laskar M, Teiger E. Outcomes following pacemaker implantation after transcatheter aortic valve implantation with CoreValve®devices: Results from the FRANCE 2 Registry. Catheter Cardiovasc Interv 2015; 86:E158-66. [DOI: 10.1002/ccd.25818] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 01/03/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Gauthier Mouillet
- Cardiology Department, Hôpital Henri Mondor, Assistance Publique Hôpitaux De Paris & INSERM U 955; Creteil France
| | - Nicolas Lellouche
- Cardiology Department, Hôpital Henri Mondor, Assistance Publique Hôpitaux De Paris & INSERM U 955; Creteil France
| | - Masanori Yamamoto
- Cardiology Department, Hôpital Henri Mondor, Assistance Publique Hôpitaux De Paris & INSERM U 955; Creteil France
| | - Atsushi Oguri
- Cardiology Department, Hôpital Henri Mondor, Assistance Publique Hôpitaux De Paris & INSERM U 955; Creteil France
| | - Jean-Luc Dubois-Rande
- Cardiology Department, Hôpital Henri Mondor, Assistance Publique Hôpitaux De Paris & INSERM U 955; Creteil France
| | - Eric Van Belle
- Cardiology Department; Centre Hospitalier Universitaire De Lille; Lille France
| | - Martine Gilard
- Cardiology Department; Centre Hospitalier Universitaire De Brest, Hôpital De La Cavale Blanche; Brest France
| | - Marc Laskar
- Cardiac Surgery Unit, Centre Hospitalier Universitaire De Limoges; Cedex France
| | - Emmanuel Teiger
- Cardiology Department, Hôpital Henri Mondor, Assistance Publique Hôpitaux De Paris & INSERM U 955; Creteil France
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Evaluation of left ventricular longitudinal function and synchrony after dual chamber pacemaker implantation. MEDICINA-LITHUANIA 2014; 50:340-4. [PMID: 25541267 DOI: 10.1016/j.medici.2014.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 11/18/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate left ventricular (LV) longitudinal function and dyssynchrony mechanisms after dual chamber pacemaker implantation. MATERIALS AND METHODS The speckle tracking imaging technique was used for quantification of global longitudinal function of the left ventricle and for dyssynchrony evaluation before pacemaker implantation and after 3-month follow-up. The study group consisted of 98 patients with conventional indications for dual chamber pacemaker implantation. RESULTS Speckle tracking echocardiographic methods and image postprocessing revealed impairment of global longitudinal strain and significant LV dyssynchrony derived from 12 basal and mid-septum segments usually untraceable with conventional echocardiographic methods. Despite good physical performance and ejection fraction, global longitudinal strain significantly decreased in all patients from -15.08±0.46 to -13.56±0.5 (P<0.05) as well as mitral annulus movement decreased from 11.57±2.41 to 8.46±1.74cm/s (P<0.001) and from 12.55±2.75 to 10.78±2.82mm (P<0.001). It was expected that patients with dual chamber pacemaker will develop inter- and intraventricular dyssynchrony, but our study showed that pacing lead position did not prevent from LV dysynchronisation and only changed the mechanism. CONCLUSIONS Global longitudinal strain and LV dyssynchrony assessment enables us to detect early signs of LV dysfunction. Mechanisms of dyssynchrony development will be useful for pacemaker programing choices in order to prevent further dyssynchronisation.
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Khairy P, Van Hare GF, Balaji S, Berul CI, Cecchin F, Cohen MI, Daniels CJ, Deal BJ, Dearani JA, Groot ND, Dubin AM, Harris L, Janousek J, Kanter RJ, Karpawich PP, Perry JC, Seslar SP, Shah MJ, Silka MJ, Triedman JK, Walsh EP, Warnes CA. PACES/HRS expert consensus statement on the recognition and management of arrhythmias in adult congenital heart disease: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology (ACC), the American Heart Association (AHA), the European Heart Rhythm Association (EHRA), the Canadian Heart Rhythm Society (CHRS), and the International Society for Adult Congenital Heart Disease (ISACHD). Can J Cardiol 2014; 30:e1-e63. [PMID: 25262867 DOI: 10.1016/j.cjca.2014.09.002] [Citation(s) in RCA: 151] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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