1
|
Cho JY, Kim SS, Jeong HK, Choi IY, Kim HK, Ki YJ, Choi DH, Park KH. Pacing-induced cardiomyopathy in patients with preserved ejection fraction undergoing permanent cardiac pacemaker placement. J Interv Card Electrophysiol 2024; 67:363-369. [PMID: 37726570 DOI: 10.1007/s10840-023-01650-5] [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: 05/25/2023] [Accepted: 09/14/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Chronic right-ventricular (RV) pacing can worsen heart failure in patients with a low ejection fraction (EF), but little is known about pacing-induced cardiomyopathy (PICM) in patients with preserved EF. We aimed to investigate risk factors of PICM in these patients during long-term follow-up. METHODS The prospective registry at Chosun University Hospital, South Korea, included de novo patients with preserved EF undergoing transvenous permanent pacemaker (PPM) implantation for atrioventricular blockage from 2017 to 2021. Patients with EF ≥ 50% and expected ventricular pacing ≥ 40% were included. Composite outcomes were cardiac death (pump failure), hospitalization because of heart failure, PICM, and biventricular pacing (BVP) upgrade. RESULTS A total of 168 patients (69 men, 76.3 ± 10.4 years) were included. During three years of follow-up, one patient died, 14 were hospitalized, 16 suffered PICM, and two underwent BVP upgrade. PICM were associated with reduced global longitudinal strain (GLS), prolonged paced QRS duration (pQRSd) and diastolic variables (E/e', LAVI). Cox regression analysis identified pQRSd (hazard ratio [HR], 1.111; 95% confidence interval [CI], 1.011-1.222; P = 0.03) and reduced GLS (HR, 1.569; 95% CI, 1.163-2.118; P = 0.003) as independent predictors of PICM. GLS showed high predictive accuracy for PICM, with an area under the curve of 0.84 (95% CI 0.779-0.894; P < 0.001) [GLS -12.0, 62.5% sensitivity, and 86.1% specificity]. CONCLUSION RV pacing increased the risk of PICM in patients with preserved EF. Reduced GLS and prolonged pQRSd could help identify individuals at high risk of PICM even with preserved EF.
Collapse
Affiliation(s)
- Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Sung Soo Kim
- Department of Cardiovascular Medicine, Chosun University Medical School, Gwangju, South Korea.
| | - Hyung Ki Jeong
- Department of Cardiovascular Medicine, Won Kwang University Medical School, Iksan, South Korea
| | - In Young Choi
- Department of Cardiovascular Medicine, Chosun University Medical School, Gwangju, South Korea
| | - Hyun Kuk Kim
- Department of Cardiovascular Medicine, Chosun University Medical School, Gwangju, South Korea
| | - Young Jae Ki
- Department of Cardiovascular Medicine, Chosun University Medical School, Gwangju, South Korea
| | - Dong Hyun Choi
- Department of Cardiovascular Medicine, Chosun University Medical School, Gwangju, South Korea
| | - Keun Ho Park
- Department of Cardiovascular Medicine, Chosun University Medical School, Gwangju, South Korea
| |
Collapse
|
2
|
Merkely B, Hatala R, Wranicz JK, Duray G, Földesi C, Som Z, Németh M, Goscinska-Bis K, Gellér L, Zima E, Osztheimer I, Molnár L, Karády J, Hindricks G, Goldenberg I, Klein H, Szigeti M, Solomon SD, Kutyifa V, Kovács A, Kosztin A. Upgrade of right ventricular pacing to cardiac resynchronization therapy in heart failure: a randomized trial. Eur Heart J 2023; 44:4259-4269. [PMID: 37632437 PMCID: PMC10590127 DOI: 10.1093/eurheartj/ehad591] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/20/2023] [Accepted: 08/23/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND AND AIMS De novo implanted cardiac resynchronization therapy with defibrillator (CRT-D) reduces the risk of morbidity and mortality in patients with left bundle branch block, heart failure and reduced ejection fraction (HFrEF). However, among HFrEF patients with right ventricular pacing (RVP), the efficacy of CRT-D upgrade is uncertain. METHODS In this multicentre, randomized, controlled trial, 360 symptomatic (New York Heart Association Classes II-IVa) HFrEF patients with a pacemaker or implantable cardioverter defibrillator (ICD), high RVP burden ≥ 20%, and a wide paced QRS complex duration ≥ 150 ms were randomly assigned to receive CRT-D upgrade (n = 215) or ICD (n = 145) in a 3:2 ratio. The primary outcome was the composite of all-cause mortality, heart failure hospitalization, or <15% reduction of left ventricular end-systolic volume assessed at 12 months. Secondary outcomes included all-cause mortality or heart failure hospitalization. RESULTS Over a median follow-up of 12.4 months, the primary outcome occurred in 58/179 (32.4%) in the CRT-D arm vs. 101/128 (78.9%) in the ICD arm (odds ratio 0.11; 95% confidence interval 0.06-0.19; P < .001). All-cause mortality or heart failure hospitalization occurred in 22/215 (10%) in the CRT-D arm vs. 46/145 (32%) in the ICD arm (hazard ratio 0.27; 95% confidence interval 0.16-0.47; P < .001). The incidence of procedure- or device-related complications was similar between the two arms [CRT-D group 25/211 (12.3%) vs. ICD group 11/142 (7.8%)]. CONCLUSIONS In pacemaker or ICD patients with significant RVP burden and reduced ejection fraction, upgrade to CRT-D compared with ICD therapy reduced the combined risk of all-cause mortality, heart failure hospitalization, or absence of reverse remodelling.
Collapse
Affiliation(s)
- Béla Merkely
- Heart and Vascular Center, Semmelweis University, Varosmajor 68, H-1122 Budapest, Hungary
| | - Robert Hatala
- Department of Cardiology and Angiology, National Institute of Cardiovascular Diseases and Slovak Medical University, Bratislava, Slovakia
| | - Jerzy K Wranicz
- Department of Electrocardiology, Medical University of Lodz, Lodz, Poland
| | - Gábor Duray
- Department of Cardiology, Central Hospital of Northern Pest—Military Hospital, Budapest, Hungary
| | - Csaba Földesi
- Gottsegen National Cardiovascular Center, Budapest, Hungary
| | - Zoltán Som
- Gottsegen National Cardiovascular Center, Budapest, Hungary
| | - Marianna Németh
- Heart and Vascular Center, Semmelweis University, Varosmajor 68, H-1122 Budapest, Hungary
- Heart Institute, University of Pécs, Pécs, Hungary
| | - Kinga Goscinska-Bis
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - László Gellér
- Heart and Vascular Center, Semmelweis University, Varosmajor 68, H-1122 Budapest, Hungary
| | - Endre Zima
- Heart and Vascular Center, Semmelweis University, Varosmajor 68, H-1122 Budapest, Hungary
| | - István Osztheimer
- Heart and Vascular Center, Semmelweis University, Varosmajor 68, H-1122 Budapest, Hungary
| | - Levente Molnár
- Heart and Vascular Center, Semmelweis University, Varosmajor 68, H-1122 Budapest, Hungary
| | - Júlia Karády
- Heart and Vascular Center, Semmelweis University, Varosmajor 68, H-1122 Budapest, Hungary
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gerhard Hindricks
- Department of Cardiology and Electrophysiology, German Heart Center of the Charite Berlin, Berlin, Germany
| | - Ilan Goldenberg
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, NY, USA
| | - Helmut Klein
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, NY, USA
| | - Mátyás Szigeti
- Heart and Vascular Center, Semmelweis University, Varosmajor 68, H-1122 Budapest, Hungary
- Imperial Clinical Trials Unit, Imperial College London, London, UK
- Physiological Controls Research Center, Budapest, Hungary
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Valentina Kutyifa
- Heart and Vascular Center, Semmelweis University, Varosmajor 68, H-1122 Budapest, Hungary
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, NY, USA
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Varosmajor 68, H-1122 Budapest, Hungary
| | - Annamária Kosztin
- Heart and Vascular Center, Semmelweis University, Varosmajor 68, H-1122 Budapest, Hungary
| |
Collapse
|
3
|
Katritsis DG, Calkins H. Septal and Conduction System Pacing. Arrhythm Electrophysiol Rev 2023; 12:e25. [PMID: 37860698 PMCID: PMC10583155 DOI: 10.15420/aer.2023.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/18/2023] [Indexed: 10/21/2023] Open
|
4
|
de Zuloaga C, Ferrari A. Electrophysiological demonstration of nonselective His-Purkinje system capture with para-Hisian pacing. J Electrocardiol 2023; 79:38-45. [PMID: 36934491 DOI: 10.1016/j.jelectrocard.2023.03.006] [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: 01/21/2023] [Revised: 02/24/2023] [Accepted: 03/02/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND The adverse effects of conventional right ventricular (RV) apical pacing prompted the search for more physiological pacing sites, such as selective and nonselective His bundle pacing (HBP), a variant of nonselective HBP (para-Hisian pacing), and mid-septal pacing. However, knowledge of their true benefit on the physiology of ventricular activation, lead stability, and pacing thresholds is limited. METHODS AND RESULTS We included 152 consecutive patients (mean age 61 ± 24, 63% men) in this retrospective study. Of these, 137 patients with different bradyarrhythmias underwent active fixation lead implantation at the RV apex (n = 54), para-Hisian region (n = 66), or mid interventricular septum (n = 17). Fifteen patients with ventricular preexcitation due to an accessory pathway not undergoing pacing were included as controls. A 12‑lead ECG was recorded in all patients, and cardiac electrical synchrony was assessed using the Synchromax® cross-correlation cardiac synchrony index (CSI). RESULTS QRS duration was prolonged in all pacing sites: from 114 ± 28 to 160 ± 29 (RV apex), from 110 ± 28 to 122 ± 29 (para-Hisian), and from 121 ± 24 to 154 ± 30 (mid interventricular septum). The CSI was significantly improved only in patients undergoing para-Hisian pacing, despite a slight widening of the QRS interval. There was no difference in pacing thresholds and sensed R-wave voltage between pacing sites. Only 1 lead, implanted at the para-Hisian region (1.5%), was dislodged towards the mid septum 48 h after implantation but did not require repositioning. CONCLUSIONS QRS duration was not associated with changes in CSI, meaning that QRS width does not significantly affect electrical synchrony.
Collapse
Affiliation(s)
- Claudio de Zuloaga
- Hospital Nacional Profesor Alejandro Posadas, Ecuador 1449 10ª "B" (CABA), Buenos Aires, Argentina.
| | - Andrés Ferrari
- Arrhythmias and Cardiac Pacing Unit, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Av. Ipiranga, Porto Alegre 6690, RS, Brazil
| |
Collapse
|
5
|
Feasibility and safety of both His bundle pacing and left bundle branch area pacing in atrial fibrillation patients: intermediate term follow-up. J Interv Card Electrophysiol 2023; 66:271-280. [PMID: 33723691 DOI: 10.1007/s10840-021-00964-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 02/07/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE His bundle pacing (HBP) improves heart failure (HF) in atrial fibrillation (AF) pacing-dependent patients with a potential for a progressively increased threshold. HBP with right ventricular pacing (RVP) as a backup is always the preferred choice; however, RVP may induce HF. His Purkinje system pacing (HPSP) includes HBP and left bundle branch area pacing (LBBAP). LBBAP maintains left ventricular synchrony but has not been proven to be safe over the long term. We assessed the feasibility and safety of both HBP and LBBAP in AF pacing-dependent patients and compared the parameters of both leads at baseline and at the 6-month follow-up. METHODS A total of 16 AF patients in our center, who successfully attempted both HBP and LBBAP, were prospectively enrolled unless only one of these treatment statuses was attained. The electrocardiogram characteristics, leading parameters, echocardiography results, and clinical outcomes were assessed. RESULTS Thirteen out of 16 patients achieved both HBP and LBBAP successfully in the same AF pacing-dependent patients. In symptomatic HF patients with preserved left ventricular ejection fraction (LVEF) (n = 10), the left ventricular end-diastolic diameter (LVEDD) was reduced from 51.8 ± 4.4 to 48.3 ± 3.1 mm (p = 0.01) with the use of diuretics, either reduced or stopped (n = 7). During the follow-up, one patient in the group without HF had an increased HBP threshold and developed HF symptoms. His HF symptoms disappeared when switched into LBBAP mode. Another patient in the group with HF got his LVEF elevated by HBP for 3 months by utilizing left bundle branch block(LBBB)correction and continued to increase when switched into LBBAP for another 3 months due to an increased HBP correction threshold. The average unipolar pacing threshold of LBBAP was lower than that of HBP. No perforation or dislodgement occurred in our study. CONCLUSION Both HBP and LBBAP could be attempted successfully in the same AF patients when one of the two modes could be adopted and switched according to the clinical feasibility. Compared with HBP, LBBAP yielded better and more stable parameters but showed comparable effects during the 6-month follow-up.
Collapse
|
6
|
Teixeira RA, Fagundes AA, Baggio Junior JM, Oliveira JCD, Medeiros PDTJ, Valdigem BP, Teno LAC, Silva RT, Melo CSD, Elias Neto J, Moraes Júnior AV, Pedrosa AAA, Porto FM, Brito Júnior HLD, Souza TGSE, Mateos JCP, Moraes LGBD, Forno ARJD, D'Avila ALB, Cavaco DADM, Kuniyoshi RR, Pimentel M, Camanho LEM, Saad EB, Zimerman LI, Oliveira EB, Scanavacca MI, Martinelli Filho M, Lima CEBD, Peixoto GDL, Darrieux FCDC, Duarte JDOP, Galvão Filho SDS, Costa ERB, Mateo EIP, Melo SLD, Rodrigues TDR, Rocha EA, Hachul DT, Lorga Filho AM, Nishioka SAD, Gadelha EB, Costa R, Andrade VSD, Torres GG, Oliveira Neto NRD, Lucchese FA, Murad H, Wanderley Neto J, Brofman PRS, Almeida RMS, Leal JCF. Brazilian Guidelines for Cardiac Implantable Electronic Devices - 2023. Arq Bras Cardiol 2023; 120:e20220892. [PMID: 36700596 PMCID: PMC10389103 DOI: 10.36660/abc.20220892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | - Rodrigo Tavares Silva
- Universidade de Franca (UNIFRAN), Franca, SP - Brasil
- Centro Universitário Municipal de Franca (Uni-FACEF), Franca, SP - Brasil
| | | | - Jorge Elias Neto
- Universidade Federal do Espírito Santo (UFES), Vitória, ES - Brasil
| | - Antonio Vitor Moraes Júnior
- Santa Casa de Ribeirão Preto, Ribeirão Preto, SP - Brasil
- Unimed de Ribeirão Preto, Ribeirão Preto, SP - Brasil
| | - Anisio Alexandre Andrade Pedrosa
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Luis Gustavo Belo de Moraes
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | - Mauricio Pimentel
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | - Eduardo Benchimol Saad
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Hospital Samaritano, Rio de Janeiro, RJ - Brasil
| | | | | | - Mauricio Ibrahim Scanavacca
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Martino Martinelli Filho
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Batista de Lima
- Hospital Universitário da Universidade Federal do Piauí (UFPI), Teresina, PI - Brasil
- Empresa Brasileira de Serviços Hospitalares (EBSERH), Brasília, DF - Brasil
| | | | - Francisco Carlos da Costa Darrieux
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Sissy Lara De Melo
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Eduardo Arrais Rocha
- Hospital Universitário Walter Cantídio, Universidade Federal do Ceará (UFC), Fortaleza, CE - Brasil
| | - Denise Tessariol Hachul
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Silvana Angelina D'Orio Nishioka
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Roberto Costa
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Gustavo Gomes Torres
- Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN - Brasil
| | | | | | - Henrique Murad
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | - Rui M S Almeida
- Centro Universitário Fundação Assis Gurgacz, Cascavel, PR - Brasil
| | | |
Collapse
|
7
|
Abdin A, Aktaa S, Vukadinović D, Arbelo E, Burri H, Glikson M, Meyer C, Munyombwe T, Nielsen JC, Ukena C, Vernooy K, Gale CP. Outcomes of conduction system pacing compared to right ventricular pacing as a primary strategy for treating bradyarrhythmia: systematic review and meta-analysis. Clin Res Cardiol 2022; 111:1198-1209. [PMID: 34410461 PMCID: PMC9622534 DOI: 10.1007/s00392-021-01927-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 08/16/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Right ventricular pacing (RVP) may cause electrical and mechanical desynchrony leading to impaired left ventricular ejection fraction (LVEF). We investigated the outcomes of RVP with His bundle pacing (HBP) and left bundle branch pacing (LBBP) for patients requiring a de novo permanent pacemaker (PPM) for bradyarrhythmia. METHODS AND RESULTS Systematic review of randomized clinical trials and observational studies comparing HBP or LBP with RVP for de novo PPM implantation between 01 January 2013 and 17 November 2020 was performed. Random and fixed effects meta-analyses of the effect of pacing technology on outcomes were performed. Study outcomes included all-cause mortality, heart failure hospitalization (HFH), LVEF, QRS duration, lead revision, atrial fibrillation, procedure parameters, and pacing metrics. Overall, 9 studies were included (6 observational, 3 randomised). HBP compared with RVP was associated with decreased HFH (risk ratio [RR] 0.68, 95% confidence interval [CI] 0.49-0.94), preservation of LVEF (mean difference [MD] 0.81, 95% CI - 1.23 to 2.85 vs. - 5.72, 95% CI - 7.64 to -3.79), increased procedure duration (MD 15.17 min, 95% CI 11.30-19.04), and increased lead revisions (RR 5.83, 95% CI 2.17-15.70, p = 0.0005). LBBP compared with RVP was associated with shorter paced QRS durations (MD 5.6 ms, 95% CI - 6.4 to 17.6) vs. (51.0 ms, 95% CI 39.2-62.9) and increased procedure duration (MD 37.78 min, 95% CI 20.04-55.51). CONCLUSION Of the limited studies published, this meta-analysis found that HBP and LBBP were superior to RVP in maintaining physiological ventricular activation as an initial pacing strategy.
Collapse
Affiliation(s)
- Amr Abdin
- Cardiology, Angiology and Intensive Care Medicine, Internal Medicine Clinic III, Saarland University Hospital, Kirrberger Street 100, 66421, Homburg, Saarland, Germany.
| | - Suleman Aktaa
- Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX, UK
| | - Davor Vukadinović
- Cardiology, Angiology and Intensive Care Medicine, Internal Medicine Clinic III, Saarland University Hospital, Kirrberger Street 100, 66421, Homburg, Saarland, Germany
| | - Elena Arbelo
- Cardiology Department, Arrhythmia Section, Hospital Clínic, Universitat de Barcelona, C. Villarroel 170, Esc 3, Planta 6, 08036, Barcelona, Spain
- IDIBAPS, Institut D'Investigació August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Harran Burri
- Cardiology Department, Geneva University Hospital, Geneva, Switzerland
| | - Michael Glikson
- Cardiology Department, Shaare Zedek Hospital, affiliated to the Hebrew University, Jerusalem, Israel
| | - Christian Meyer
- University Heart Center, Hamburg, Cardiac Neuro- and Electrophysiology Research Consortium, EVK Düsseldorf, Düsseldorf, Germany
| | - Theresa Munyombwe
- Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christian Ukena
- Cardiology, Angiology and Intensive Care Medicine, Internal Medicine Clinic III, Saarland University Hospital, Kirrberger Street 100, 66421, Homburg, Saarland, Germany
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX, UK
| |
Collapse
|
8
|
Jeong HK, Kim HW, Kim SS, Kim HK, Ki YJ, Choi DH, Park KH, Lee KH, Yoon N, Park HW, Cho JG. Impact of diastolic dysfunction in patients with preserved ejection fraction undergoing permanent cardiac pacemaker placement. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2022. [DOI: 10.1186/s42444-022-00078-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Abstract
Background
Chronic right-ventricular (RV) pacing can exacerbate heart failure in patients with a low ejection fraction (EF). There is little information on the effects of diastolic dysfunction (DD) in patients with preserved EF undergoing permanent pacemaker (PPM) placement. We aimed to investigate the clinical outcomes in these patients.
Methods
This multicenter, retrospective analysis of PPM use in Chonnam, South Korea, included all patients with preserved EF undergoing transvenous PPM implantation for atrioventricular blockage from 2017 to 2019. Patients were divided into two groups according to DD, which were assessed by including mitral flow velocities (E′ velocity, E/E′ ratio), peak velocity of the tricuspid regurgitant, and left atrial maximum volume index. Composite outcomes were defined as (1) cardiovascular death, and (2) hospitalization by heart failure during the follow-up period.
Results
One hundred sixty-seven patients (66 men; overall mean age, 75.3 ± 11.9 years) were divided into two groups: 125 normal versus 42 DD. Compared with normal subjects, the DD group included older patients (mean age, 79.1 ± 9.9 vs. 74.0 ± 12.3; p = 0.016), and had longer paced QTc interval (pQTc, 168.5 ± 20.1 vs. 159.1 ± 16.3 ms; p < 0.001). Fifteen patients were hospitalized and two died. In a Cox proportional regression analysis, DD (hazard ratio [HR], 7.343; 95% confidence interval [CI], 2.035–26.494; p = 0.002) and pQRSd (HR, 1.046; 95% CI, 1.004–1.091; p = 0.033) were independent predictors of composite outcomes.
Conclusion
In patients with DD, RV pacing raised the risk of pacing-induced heart failure despite preserved left-ventricular function. Thus, patients with DD should be monitored intensively.
Collapse
|
9
|
Yu TP, Chen JY. Unexplained Left Ventricular Hypertrophy with Symptomatic High-Grade Atrioventricular Block in Elderly Patients: A Case Report. J Clin Med 2022; 11:jcm11123522. [PMID: 35743592 PMCID: PMC9225472 DOI: 10.3390/jcm11123522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/09/2022] [Accepted: 06/14/2022] [Indexed: 11/18/2022] Open
Abstract
Left ventricular hypertrophy (LVH) is common among older adults. Amidst all causes, Fabry disease (FD) should be considered when LVH occurs with family history, specific clinical manifestations, or cardiac alert signs. Here, we report a case of a 76-year-old male who presented late onset concentric LVH with symptomatic high-grade atrioventricular (AV) block. After dual-chamber pacemaker implantation, interrogation revealed frequent right ventricular (RV) pacing with a wide QRS duration. The patient developed heart failure symptoms with rapid deterioration of LV systolic function. Pacing-induced cardiomyopathy (PICM) was suspected, and the pacemaker was upgraded to biventricular pacing. Further FD surveys were performed, including biochemical examinations, cardiac biopsies, and genetic sequencing, and the patient was ultimately diagnosed with a cardiac variant of FD. Particularly, we strongly suggest that physiologic pacing should be initially considered for patients with FD who have symptomatic high-grade AV block, rather than traditional RV pacing to prevent PICM.
Collapse
|
10
|
Kaza N, Keene D, Whinnett ZI. Generating Evidence to Support the Physiologic Promise of Conduction System Pacing: Status and Update on Conduction System Pacing Trials. Card Electrophysiol Clin 2022; 14:345-355. [PMID: 35715090 DOI: 10.1016/j.ccep.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Conduction system pacing avoids the potential deleterious effects of right ventricular pacing in patients with bradycardia and provides an alternative approach to cardiac resynchronization therapy. We focus on the available observational and randomized evidence and review studies supporting the safety, feasibility, and physiologic promise of conduction system approaches. We evaluate the randomized data generated from the available clinical trials of conduction system pacing, which have led to the recent inclusion of CSP in international guidelines. The scope for future randomized trials will building on the physiologic promise of conduction system approaches and offering information on clinical end points is explored.
Collapse
Affiliation(s)
- Nandita Kaza
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London W12 0HS, UK
| | - Daniel Keene
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London W12 0HS, UK.
| | - Zachary I Whinnett
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London W12 0HS, UK
| |
Collapse
|
11
|
[His bundle and left bundle branch pacing]. Herz 2021; 46:499-512. [PMID: 34766195 DOI: 10.1007/s00059-021-05080-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 10/19/2022]
Abstract
Cardiac pacemakers are an extremely effective treatment for bradycardia but can, however, cause desynchronization of ventricular contraction leading to cardiomyopathy. Pacing of the conduction system can prevent and even reverse desynchronization, which is impressively visible in echocardiography with speckle tracing. His' bundle and left bundle branch pacing requires a specific implantation technique, sheaths and leads which can achieve successful stimulation of the conduction system in up to 98% of cases. Data on conduction system pacing have been acquired in numerous studies but only a few randomized outcome studies. Therefore, in the current European guidelines His' bundle and left bundle branch pacing only have a low level recommendation. The guidelines recommend His' bundle pacing in patients in whom a coronary sinus lead cannot be implanted and in patients with permanent atrial fibrillation and planned atrioventricular (AV) node ablation for heart rate control. Additionally, conduction system pacing appears to be meaningful in patients with an AV block who require pacing of the ventricle for ≥20% of the time or who already show a slightly or moderately reduced left ventricular ejection fraction (36-50%). Even in patients scheduled for generator replacement who have developed a cardiac pacemaker-induced cardiomyopathy, the opportunity should not be missed to upgrade the system by implantation of a His' bundle electrode.
Collapse
|
12
|
Mastoris I, Spall HGCV, Sheldon SH, Pimentel RC, Steinkamp L, Shah Z, Al-Khatib SM, Singh JP, Sauer AJ. Emerging Implantable Device Technology for Patients at the Intersection of Electrophysiology and Heart Failure Interdisciplinary Care. J Card Fail 2021; 28:991-1015. [PMID: 34774748 DOI: 10.1016/j.cardfail.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/01/2021] [Accepted: 11/05/2021] [Indexed: 01/01/2023]
Abstract
Cardiac implantable electronic devices (CIEDs), including implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT), are part of guideline- indicated treatment for a subset of patients with heart failure with reduced ejection fraction (HFrEF). Current technological advancements in CIEDs have allowed the detection of specific patient physiologic parameters used for forecasting clinical decompensation through algorithmic, multiparameter remote monitoring. Other recent emerging technologies, including cardiac contractility modulation (CCM) and baroreflex activation therapy (BAT), may provide symptomatic or physiologic benefit in patients without an indication for CRT. Our goal in this state-of-the-art review is to describe the commercially available new technologies, purported mechanisms of action, evidence surrounding their clinical role, limitations, and future directions. Finally, we underline the need for standardized workflow and close interdisciplinary management of this population to ensure the delivery of high-quality care.
Collapse
Affiliation(s)
- Ioannis Mastoris
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, Kansas
| | - Harriette G C Van Spall
- Department of Medicine, Department of Health Research Methods, Evidence, and Impact, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Seth H Sheldon
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, Kansas
| | - Rhea C Pimentel
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, Kansas
| | - Leslie Steinkamp
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, Kansas
| | - Zubair Shah
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, Kansas
| | - Sana M Al-Khatib
- Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Jagmeet P Singh
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew J Sauer
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, Kansas.
| |
Collapse
|
13
|
Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto S, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias. J Arrhythm 2021; 37:709-870. [PMID: 34386109 PMCID: PMC8339126 DOI: 10.1002/joa3.12491] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
|
14
|
Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto SI, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J 2021; 85:1104-1244. [PMID: 34078838 DOI: 10.1253/circj.cj-20-0637] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | - Toshiyuki Ishikawa
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery, Kure Medical Center and Chugoku Cancer Center
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kaoru Okishige
- Department of Cardiology, Yokohama City Minato Red Cross Hospital
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Yoshihiro Seo
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | | | - Yuji Nakazato
- Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital
| | - Takashi Nishimura
- Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | - Yuji Murakawa
- Fourth Department of Internal Medicine, Teikyo University Hospital Mizonokuchi
| | - Teiichi Yamane
- Department of Cardiology, Jikei University School of Medicine
| | - Takeshi Aiba
- Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koichi Inoue
- Division of Arrhythmia, Cardiovascular Center, Sakurabashi Watanabe Hospital
| | - Yuki Iwasaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kikuya Uno
- Arrhythmia Center, Chiba Nishi General Hospital
| | - Michio Ogano
- Department of Cardiovascular Medicine, Shizuoka Medical Center
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine
| | | | - Shingo Sasaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | | | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University
| | - Tsugutoshi Suzuki
- Departments of Pediatric Electrophysiology, Osaka City General Hospital
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Kyoko Soejima
- Arrhythmia Center, Second Department of Internal Medicine, Kyorin University Hospital
| | - Masahiko Takagi
- Division of Cardiac Arrhythmia, Department of Internal Medicine II, Kansai Medical University
| | - Masaomi Chinushi
- School of Health Sciences, Faculty of Medicine, Niigata University
| | - Nobuhiro Nishi
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Hachiya
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | | | | | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital
| | - Aya Miyazaki
- Department of Pediatric Cardiology, Congenital Heart Disease Center, Tenri Hospital
| | - Tomoshige Morimoto
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | | | - Takeshi Kimura
- Department of Cardiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
| | | | | | | |
Collapse
|
15
|
Yanase T, Sakakura K, Jinnouchi H, Taniguchi Y, Yamamoto K, Tsukui T, Seguchi M, Wada H, Fujita H. Factors associated with temporary pacing insertion in patients with inferior ST-segment elevation myocardial infarction. PLoS One 2021; 16:e0251124. [PMID: 33939766 PMCID: PMC8092657 DOI: 10.1371/journal.pone.0251124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/20/2021] [Indexed: 12/02/2022] Open
Abstract
Background High-degree atrioventricular block (HAVB) is a prognostic factor for survival in patients with inferior ST-segment elevation myocardial infarction (STEMI). However, there is little information about factors associated with temporary pacing (TP). The aim of this study was to find factors associated with TP in patients with inferior STEMI. Methods We included 232 inferior STEMI patients, and divided those into the TP group (n = 46) and the non-TP group (n = 186). Factors associated with TP were retrospectively investigated using multivariate logistic regression model. Results The incidence of right ventricular (RV) infarction was significantly higher in the TP group (19.6%) than in the non-TP group (7.5%) (p = 0.024), but the incidence of in-hospital death was similar between the 2 groups (4.3% vs. 4.8%, p = 1.000). Long-term major adverse cardiovascular events (MACE), which were defined as a composite of all-cause death, non-fatal myocardial infarction (MI), target vessel revascularization (TVR) and readmission for heart failure, were not different between the 2 groups (p = 0.100). In the multivariate logistic regression analysis, statin at admission [odds ratio (OR) 0.230, 95% confidence interval (CI) 0.062–0.860, p = 0.029], HAVB at admission (OR 9.950, 95% CI 4.099–24.152, p<0.001), and TIMI-thrombus grade ≥3 (OR 10.762, 95% CI 1.385–83.635, p = 0.023) were significantly associated with TP. Conclusion Statin at admission, HAVB at admission, and TIMI-thrombus grade ≥3 were associated with TP in patients with inferior STEMI. Although the patients with TP had the higher incidence of RV infarction, the incidence of in-hospital death and long-term MACE was not different between patients with TP and those without.
Collapse
Affiliation(s)
- Tomonobu Yanase
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
- * E-mail:
| | - Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| |
Collapse
|
16
|
Chan JK, Mostafa S, Kumar N. His Bundle Pacing – Stand-alone or adjunctive physiological pacing: a systematic review. HEART, VESSELS AND TRANSPLANTATION 2021; 5:51. [DOI: 10.24969/hvt.2021.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
His-bundle pacing (HBP) appears to be a viable stand-alone or adjunctive physiological pacing therapy in pacemaker dependent patients. It could also serve as an effective adjunct or alternative pacing therapy for heart failure patients who require cardiac resynchronization therapy or pacemaker upgrade. His-bundle pacing has demonstrated improvement of His-Purkinje conduction, left ventricular electrical / mechanical synchronization, and left ventricular ejection fraction (LVEF) compared with right ventricle pacing. Patients who have high pacing dependence and/or LVEF impairment would benefit most from HBP in terms of heart failure hospitalization and LVEF improvement. Mortality benefit has not been consistently demonstrated in latest meta-analysis. The long-term clinical benefit and safety profile of HBP remains to be explored in future studies.
Key words: His bundle pacing, physiologic pacing, upgrade pacing
Collapse
|
17
|
Chen AY, Upadhyay GA. Current Treatment Options in Cardiovascular Medicine Arrhythmia Section From the His Bundle to the Left Bundle: Clinical Applications of Conduction System Pacing. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-020-00880-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
18
|
Ravi V, Hanifin JL, Larsen T, Huang HD, Trohman RG, Sharma PS. Pros and Cons of Left Bundle Branch Pacing: A Single-Center Experience. Circ Arrhythm Electrophysiol 2020; 13:e008874. [PMID: 33198496 DOI: 10.1161/circep.120.008874] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left bundle branch pacing (LBBP) has recently emerged as a promising alternative modality for conduction system pacing. However, limited real-world data exists on the advantages and complications associated with LBBP. We analyzed the Rush conduction system pacing registry on LBBP to assess the success rates and complications associated with LBBP. METHODS All patients with an indication for permanent pacemaker or cardiac resynchronization therapy that underwent LBBP for various reasons from June 2018 to April 2020 were included in the analysis. RESULTS A total of 57 of 59 patients underwent successful LBBP (success rate 97%). The average follow-up duration was 6.2±5 months. The implanted devices included 38 dual-chamber pacemakers, 17 cardiac resynchronization therapy defibrillators, and 2 cardiac resynchronization therapy pacing systems. The most common reason for performing LBBP was a high His-Bundle pacing threshold (n=23) at implant. The mean LBBP capture threshold at implant was 0.62±0.21 V at 0.4 ms which remained stable during follow-up at 0.65±0.68 V at 0.4ms. In 21 patients with cardiomyopathy, there was a significant improvement in left ventricle ejection fraction from 30±11% to 42±15%. A total of 7 lead-related complications (12.3%) were noted in the follow-up period. Three patients (5.3%) required lead revision during the follow-up period. Interventricular septal perforation occurred (as late sequela) after 2 weeks in one patient. CONCLUSIONS LBBP can be achieved with a high success rate and low capture thresholds. Left ventricular dysfunction improved significantly during follow-up. Lead-related complications were relatively common occurring in 12.3% of initially successful implants. Lead revision was required in 3 (5%) of patients.
Collapse
Affiliation(s)
- Venkatesh Ravi
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL
| | - Jillian L Hanifin
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL
| | - Timothy Larsen
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL
| | - Henry D Huang
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL
| | - Richard G Trohman
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL
| | - Parikshit S Sharma
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL
| |
Collapse
|
19
|
Kumar V, Ryu AJ, Manduca A, Rao C, Gibbons RJ, Gersh BJ, Chandrasekaran K, Asirvatham SJ, Araoz PA, Oh JK, Egbe AC, Behfar A, Borlaug BA, Anavekar NS. Cardiac MRI demonstrates compressibility in healthy myocardium but not in myocardium with reduced ejection fraction. Int J Cardiol 2020; 322:278-283. [PMID: 32871188 DOI: 10.1016/j.ijcard.2020.08.087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/04/2020] [Accepted: 08/26/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The professional guidelines assume that the myocardial volume in systole (MVs) is equal to that in diastole (MVd), despite some limited evidence that points to the contrary. The aim of this manuscript is to determine whether this is true in healthy myocardium using gold standard cardiac MRI, as well as transthoracic echocardiography (TTE). The secondary aim is to determine whether there are similar MV changes in patients with heart failure with reduced ejection fraction (HFrEF). METHOD A prospectively derived cohort at Mayo Clinic of 115 adult subjects (mean age 42.8 years, 58% female) with no cardiac risk factors was identified. Cardiac MRI was obtained on all 115 patients, 51 of whom also consented to a TTE. MRI from a retrospectively derived cohort of 50 HFrEF patients was also collected. MVs and MVd was calculated using standard approaches with inclusion of the papillary muscles. RESULTS In the healthy population, MRI demonstrated MVs/MVd = 0.87 (SD 0.04) and TTE demonstrated MVs/MVd = 0.79 (SD 0.07), suggesting compressibility (p < 0.0001). In the 51 healthy patients who received both imaging modalities, MVs/MVd was 8.0% higher in MRI than TTE (p < 0.0001), but both modalities had MVs/MVd < 1 (p < 0.0001). A Bland-Altman plot demonstrated that as the mean MVs/MVd increases, the difference in MVs/MVd MRI-TTE declines (r = -0.53, p < 0.0001). However, in HFrEF populations, MVs/MVd = 1.01 (0.03), suggesting myocardial incompressibility. CONCLUSION Contrary to currently accepted standards, healthy myocardium is compressible but HFrEF myocardium is incompressible. The ratio MVs/MVd merits further study in an expanded normal cohort and in disease states.
Collapse
Affiliation(s)
- Vinayak Kumar
- Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States of America.
| | - Alexander J Ryu
- Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Armando Manduca
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Chaitanya Rao
- Electrical Engineering, self-employed, United States of America
| | - Raymond J Gibbons
- Department of Cardiology, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Bernard J Gersh
- Department of Cardiology, Mayo Clinic, Rochester, MN 55905, United States of America
| | | | - Samuel J Asirvatham
- Department of Cardiology, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Philip A Araoz
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Jae K Oh
- Department of Cardiology, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Alexander C Egbe
- Department of Cardiology, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Atta Behfar
- Department of Cardiology, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Barry A Borlaug
- Department of Cardiology, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Nandan S Anavekar
- Department of Cardiology, Mayo Clinic, Rochester, MN 55905, United States of America; Department of Radiology, Mayo Clinic, Rochester, MN 55905, United States of America
| |
Collapse
|
20
|
Ravi V, Larsen T, Ooms S, Trohman R, Sharma PS. Late-onset interventricular septal perforation from left bundle branch pacing. HeartRhythm Case Rep 2020; 6:627-631. [PMID: 32983881 PMCID: PMC7498514 DOI: 10.1016/j.hrcr.2020.06.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
| | | | - Sara Ooms
- Rush University Medical Center, Chicago, Illinois
| | | | | |
Collapse
|
21
|
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]
|
22
|
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]
|
23
|
Bianco F, Cicchitti V, Bucciarelli V, Chandra A, Di Girolamo E, Pedrizzetti G, Tonti G, Romano S, De Caterina R, Gallina S. Intraventricular flow patterns during right ventricular apical pacing. Open Heart 2019; 6:e001057. [PMID: 31168394 PMCID: PMC6519401 DOI: 10.1136/openhrt-2019-001057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/07/2019] [Accepted: 04/14/2019] [Indexed: 11/10/2022] Open
Abstract
Objectives To assess differences in blood flow momentum (BFM) and kinetic energy (KE) dissipation in a model of cardiac dyssynchrony induced by electrical right ventricular apical (RVA) stimulation compared with spontaneous sinus rhythm. Methods We cross-sectionally enrolled 12 consecutive patients (mean age 74±8 years, 60% male, mean left ventricular ejection fraction 58%±6 %), within 48 hours from pacemaker (PMK) implantation. Inclusion criteria were: age>18 years, no PMK-dependency, sinus rhythm with a spontaneous narrow QRS at the ECG, preserved ejection fraction (>50%) and a low percentage of PMK-stimulation (<20%). All the participants underwent a complete echocardiographic evaluation, including left ventricular strain analysis and particle image velocimetry. Results Compared with sinus rhythm, BFM shifted from 27±3.3 to 34±7.6° (p=0.016), while RVA-pacing was characterised by a 35% of increment in KE dissipation, during diastole (p=0.043) and 32% during systole (p=0.016). In the same conditions, left ventricle global longitudinal strain (LV GLS) significantly decreased from 17±3.3 to 11%±2.8% (p=0.004) during RVA-stimulation. At the multivariable analysis, BFM and diastolic KE dissipation were significantly associated with LV GLS deterioration (Beta Coeff.=0.54, 95% CI 0.07 to 1.00, p=0.034 and Beta Coeff.=0.29, 95% CI 0.02 to 0.57, p=0.049, respectively). Conclusions In RVA-stimulation, BFM impairment and KE dissipation were found to be significantly associated with LV GLS deterioration, when controlling for potential confounders. Such changes may favour the onset of cardiac remodelling and sustain heart failure.
Collapse
Affiliation(s)
- Francesco Bianco
- Institute of Cardiology, “G. d’Annunzio” University, Chieti, Italy
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Alvin Chandra
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Gianni Pedrizzetti
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Gianni Tonti
- Institute of Cardiology, “G. d’Annunzio” University, Chieti, Italy
| | - Silvio Romano
- Institute of Cardiology, University of L’Aquila, L’Aquila, Italy
| | | | - Sabina Gallina
- Institute of Cardiology, “G. d’Annunzio” University, Chieti, Italy
| |
Collapse
|
24
|
Affiliation(s)
- Pugazhendhi Vijayaraman
- Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, MC 36-10, 1000 E Mountain Blvd, Wilkes-Barre, PA, USA
| | | |
Collapse
|
25
|
Qian Z, Zou F, Wang Y, Qiu Y, Chen X, Jiang H, Hou X. Permanent His bundle pacing in heart failure patients: A systematic review and meta-analysis. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 42:139-145. [PMID: 30515877 DOI: 10.1111/pace.13565] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is the standard-of-care therapy for the patients with heart failure and left ventricular (LV) dyssynchrony. However, approximately 30% of the patients show no response. Recent studies have shown that His bundle pacing (HBP) could be an alternative for the patients with CRT indications. The purpose of this study was to evaluate the efficacy of HBP in patients with heart failure. METHODS We searched PubMed and Embase databases for studies evaluating HBP in patients with heart failure and LV dyssynchrony. The successful rate of implantation, QRS duration, pacing threshold, LV function at baseline and follow-up, and mortality rates were extracted and summarized. RESULTS Eleven studies including 494 patients were included in this analysis. The overall successful rate for implantation was 82.4%. The main indications for HBP were CRT candidates and cardiomyopathy with atrial fibrillation undergoing atrioventricular node ablation. Permanent HBP resulted in narrow QRS duration of 116.3 ± 13.9 ms after implantation. LV functions, including echocardiographic parameters and clinical outcomes, significantly improved at follow-up (P < 0.001). However, there was a trend of increased capture and bundle branch block correction thresholds at follow-up compared to baseline (P = 0.01 and 0.02, respectively). During a mean follow-up of 23.7 months, 5.9% of the patients experienced heart failure-related hospitalization and the mortality rate was 9.1%. CONCLUSION Permanent HBP has shown promising results for heart failure patients in small observational studies. Randomized controlled trials are needed to assess the efficacy of HBP in these patients.
Collapse
Affiliation(s)
- Zhiyong Qian
- Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing
| | - Fengwei Zou
- Georgetown University School of Medicine, Washington, Washington D.C
| | - Yao Wang
- Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing
| | - Yuanhao Qiu
- Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing
| | - Xing Chen
- Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing
| | - Hai Jiang
- Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing
| | - Xiaofeng Hou
- Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing
| |
Collapse
|