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Kamalathasan S, Paton M, Gierula J, Straw S, Witte KK. Is conduction system pacing a panacea for pacemaker therapy? Expert Rev Med Devices 2024; 21:613-623. [PMID: 38913600 PMCID: PMC11346388 DOI: 10.1080/17434440.2024.2370827] [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: 04/04/2024] [Accepted: 06/18/2024] [Indexed: 06/26/2024]
Abstract
INTRODUCTION While supported by robust evidence and decades of clinical experience, right ventricular apical pacing for bradycardia is associated with a risk of progressive left ventricular dysfunction. Cardiac resynchronization therapy for heart failure with reduced ejection fraction can result in limited electrical resynchronization due to anatomical constraints and epicardial stimulation. In both settings, directly stimulating the conduction system below the atrio-ventricular node (either the bundle of His or the left bundle branch area) has potential to overcome these limitations. Conduction system pacing has met with considerable enthusiasm in view of the more physiological electrical conduction pattern, is rapidly becoming the preferred option of pacing for bradycardia, and is gaining momentum as an alternative to conventional biventricular pacing. AREAS COVERED This article provides a review of the current efficacy and safety data for both people requiring treatment for bradycardia and the management of heart failure with conduction delay and discusses the possible future roles for conduction system pacing in routine clinical practice. EXPERT OPINION Conduction system pacing might be the holy grail of pacemaker therapy without the disadvantages of current approaches. However, hypothesis and enthusiasm are no match for robust data, demonstrating at least equivalent efficacy and safety to standard approaches.
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Affiliation(s)
- Stephe Kamalathasan
- Cardiology Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Cardiometabolic Medicine, University of Leeds, Leeds, UK
| | - Maria Paton
- Cardiology Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Cardiometabolic Medicine, University of Leeds, Leeds, UK
| | - John Gierula
- Leeds Institute of Cardiometabolic Medicine, University of Leeds, Leeds, UK
| | - Sam Straw
- Leeds Institute of Cardiometabolic Medicine, University of Leeds, Leeds, UK
| | - Klaus K. Witte
- Leeds Institute of Cardiometabolic Medicine, University of Leeds, Leeds, UK
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2
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Zhang Z, Xiao Y, Dai Y, Lin Q, Liu Q. Device therapy for patients with atrial fibrillation and heart failure with preserved ejection fraction. Heart Fail Rev 2024; 29:417-430. [PMID: 37940727 PMCID: PMC10943171 DOI: 10.1007/s10741-023-10366-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2023] [Indexed: 11/10/2023]
Abstract
Device therapy is a nonpharmacological approach that presents a crucial advancement for managing patients with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF). This review investigated the impact of device-based interventions and emphasized their potential for optimizing treatment for this complex patient demographic. Cardiac resynchronization therapy, augmented by atrioventricular node ablation with His-bundle pacing or left bundle-branch pacing, is effective for enhancing cardiac function and establishing atrioventricular synchrony. Cardiac contractility modulation and vagus nerve stimulation represent novel strategies for increasing myocardial contractility and adjusting the autonomic balance. Left ventricular expanders have demonstrated short-term benefits in HFpEF patients but require more investigation for long-term effectiveness and safety, especially in patients with AF. Research gaps regarding complications arising from left ventricular expander implantation need to be addressed. Device-based therapies for heart valve diseases, such as transcatheter aortic valve replacement and transcatheter edge-to-edge repair, show promise for patients with AF and HFpEF, particularly those with mitral or tricuspid regurgitation. Clinical evaluations show that these device therapies lessen AF occurrence, improve exercise tolerance, and boost left ventricular diastolic function. However, additional studies are required to perfect patient selection criteria and ascertain the long-term effectiveness and safety of these interventions. Our review underscores the significant potential of device therapy for improving the outcomes and quality of life for patients with AF and HFpEF.
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Affiliation(s)
- Zixi Zhang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan Province, People's Republic of China
| | - Yichao Xiao
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan Province, People's Republic of China.
| | - Yongguo Dai
- Department of Pharmacology, Wuhan University TaiKang Medical School (School of Basic Medical Sciences), Wuhan, 430071, Hubei Province, People's Republic of China
| | - Qiuzhen Lin
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan Province, People's Republic of China
| | - Qiming Liu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan Province, People's Republic of China.
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Andreas M, Burri H, Praz F, Soliman O, Badano L, Barreiro M, Cavalcante JL, de Potter T, Doenst T, Friedrichs K, Hausleiter J, Karam N, Kodali S, Latib A, Marijon E, Mittal S, Nickenig G, Rinaldi A, Rudzinski PN, Russo M, Starck C, von Bardeleben RS, Wunderlich N, Zamorano JL, Hahn RT, Maisano F, Leclercq C. Tricuspid valve disease and cardiac implantable electronic devices. Eur Heart J 2024; 45:346-365. [PMID: 38096587 PMCID: PMC10834167 DOI: 10.1093/eurheartj/ehad783] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 02/03/2024] Open
Abstract
The role of cardiac implantable electronic device (CIED)-related tricuspid regurgitation (TR) is increasingly recognized as an independent clinical entity. Hence, interventional TR treatment options continuously evolve, surgical risk assessment and peri-operative care improve the management of CIED-related TR, and the role of lead extraction is of high interest. Furthermore, novel surgical and interventional tricuspid valve treatment options are increasingly applied to patients suffering from TR associated with or related to CIEDs. This multidisciplinary review article developed with electrophysiologists, interventional cardiologists, imaging specialists, and cardiac surgeons aims to give an overview of the mechanisms of disease, diagnostics, and proposes treatment algorithms of patients suffering from TR associated with CIED lead(s) or leadless pacemakers.
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Affiliation(s)
- Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Level 7C, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Haran Burri
- Cardiac Pacing Unit, Cardiology Departement, University Hospital of Geneva, Geneva, Switzerland
| | - Fabien Praz
- Bern University Hospital, University of Bern, Bern, Switzerland
| | - Osama Soliman
- Discipline of Cardiology, SAOLTA Healthcare Group, Galway University Hospital, Health Service Executive, and University of Galway, Galway H91 YR71, Ireland
| | - Luigi Badano
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Manuel Barreiro
- Cardiology Department, Hospital Universitario Alvaro Cunqueiro, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Spain
| | - João L Cavalcante
- Cardiac MR and Structural CT lab, Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | | - Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena University Hospital, Jena, Germany
| | - Kai Friedrichs
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Center North Rine Westphalia, Bad Oeynhausen, Germany
| | - Jörg Hausleiter
- Medizinische Klinik I, Ludwig-Maximilians-University, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Nicole Karam
- Cardiology Department, European Hospital Georges Pompidou, Université Paris Cité, Paris, France
| | - Susheel Kodali
- Division of Cardiology, Department of Medicine, New York-Presbyterian/Columbia University Irving Medical Center, NewYork, NY, USA
| | - Azeem Latib
- Montefiore Einstein Center for Heart and Vascular Care, Montefiore Medical Center, NewYork, NY, USA
| | - Eloi Marijon
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
| | - Suneet Mittal
- Department of Cardiology, The Valley Health System, the Synder Comprehensive Center for Atrial Fibrillation, Ridgewood, NJ, USA
| | - Georg Nickenig
- Herzzentrum Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn, Germany
| | - Aldo Rinaldi
- Department of Cardiology, Guy’s & St Thomas’ NHS Trust, London, UK
| | - Piotr Nikodem Rudzinski
- Department of Coronary and Structural Heart Diseases, National Institute of Cardiology in Warsaw, Warsaw, Poland
| | - Marco Russo
- Department of Cardiac Surgery and Heart Transplantation, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center of Charité, Berlin, Germany
| | - Ralph Stephan von Bardeleben
- Department of Cardiology, Universitätsmedizin Mainz of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Nina Wunderlich
- Department of Cardiology/Angiology, Asklepios Klinik Langen, Langen, Germany
| | - José Luis Zamorano
- Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain
| | - Rebecca T Hahn
- Division of Cardiology, Department of Medicine, New York-Presbyterian/Columbia University Irving Medical Center, NewYork, NY, USA
| | - Francesco Maisano
- Heart Valve Center, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Christophe Leclercq
- Department of Cardiology, University of Rennes, CHU Rennes, lTSI-UMR1099, Rennes F-35000, France
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Vajapey R, Chung MK. Emerging Technologies in Cardiac Pacing. Annu Rev Med 2024; 75:475-492. [PMID: 37989145 PMCID: PMC11062889 DOI: 10.1146/annurev-med-051022-042616] [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: 11/23/2023]
Abstract
Cardiac pacing to treat bradyarrhythmias has evolved in recent decades. Recognition that a substantial proportion of pacemaker-dependent patients can develop heart failure due to electrical and mechanical dyssynchrony from traditional right ventricular apical pacing has led to development of more physiologic pacing methods that better mimic normal cardiac conduction and provide synchronized ventricular contraction. Conventional biventricular pacing has been shown to benefit patients with heart failure and conduction system disease but can be limited by scarring and fibrosis. His bundle pacing and left bundle branch area pacing are novel techniques that can provide more physiologic ventricular activation as an alternative to conventional or biventricular pacing. Leadless pacing has emerged as another alternative pacing technique to overcome limitations in conventional transvenous pacemaker systems. Our objective is to review the evolution of cardiac pacing and explore these new advances in pacing strategies.
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Affiliation(s)
- Ramya Vajapey
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA;
| | - Mina K Chung
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA;
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Somani S, Rogers AJ. Advances in cardiac pacing with leadless pacemakers and conduction system pacing. Curr Opin Cardiol 2024; 39:1-5. [PMID: 37751365 DOI: 10.1097/hco.0000000000001092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
PURPOSE OF REVIEW The field of cardiac pacing has undergone significant evolution with the introduction and adoption of conduction system pacing (CSP) and leadless pacemakers (LLPMs). These innovations provide benefits over conventional pacing methods including avoiding lead related complications and achieving more physiological cardiac activation. This review critically assesses the latest advancements in CSP and LLPMs, including their benefits, challenges, and potential for future growth. RECENT FINDINGS CSP, especially of the left bundle branch area, enhances ventricular depolarization and cardiac mechanics. Recent studies show CSP to be favorable over traditional pacing in various patient populations, with an increase in its global adoption. Nevertheless, challenges related to lead placement and long-term maintenance persist. Meanwhile, LLPMs have emerged in response to complications from conventional pacemaker leads. Two main types, Aveir and Micra, have demonstrated improved outcomes and adoption over time. The incorporation of new technologies allows LLPMs to cater to broader patient groups, and their integration with CSP techniques offers exciting potential. SUMMARY The advancements in CSP and LLPMs present a transformative shift in cardiac pacing, with evidence pointing towards enhanced clinical outcomes and reduced complications. Future innovations and research are likely to further elevate the clinical impact of these technologies, ensuring improved patient care for those with conduction system disorders.
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Affiliation(s)
- Sulaiman Somani
- Department of Medicine
- Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Albert J Rogers
- Department of Medicine
- Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
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Moriña-Vázquez P, Esteve-Ruiz I, Moraleda-Salas MT, Arce-León Á, Manovel-Sánchez AJ, Venegas-Gamero J, Lluch-Requerey C, López-Masjuán-Ríos Á, Gómez-Menchero AE. His bundle pacing success and electrical parameter stability regardless of three-dimensional transthoracic echocardiography lead localization. J Interv Card Electrophysiol 2023; 66:1867-1876. [PMID: 36763211 DOI: 10.1007/s10840-023-01503-1] [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: 11/28/2022] [Accepted: 02/01/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND OR PURPOSE His bundle pacing (HBP) is the most physiological form of ventricular pacing. Few prospective studies have analyzed lead localization using imaging techniques and its relationship with electrical parameters and capture patterns. The objective of this study is to examine the correlation between electrical parameters and lead localization using three-dimensional transthoracic echocardiography (3D TTE). METHODS This single-center, prospective, nonrandomized clinical research study (January 2018 to June 2020) included patients with an indication of permanent pacing, in whom 3D TTE was performed to define lead localization as supravalvular or subvalvular. RESULTS A total of 92 patients were included: 56.5% of leads were supravalvular, and 43.5% were subvalvular, which resembles previous anatomic descriptions of autopsied hearts of His bundle localization within the triangle of Koch (ToK). R-wave sensing was higher when the His lead was localized subvalvular instead of supravalvular. His lead localization was not associated with HBP threshold or impedance differences, nor with the two different HBP patterns of capture, or with the ability of HBP to correct baseline BBB. The thresholds remained stable during follow-up visits, regardless of His lead localization. Higher R-wave sensing was observed during follow-up than at baseline, mainly in the subvalvular His leads. However, lead impedances in both positions decreased during follow-up. CONCLUSIONS Lead localization in relation to the tricuspid valve did not influence the electrical performance of HBPs. Wide anatomical variations of the His bundle within the ToK explain our findings, reinforcing the idea that the technique for HBP should be fundamentally guided by electrophysiological and not anatomical parameters.
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Affiliation(s)
- Pablo Moriña-Vázquez
- Arrhythmia Unit, Department of Cardiology, Hospital Universitario Juan Ramón Jiménez (HJRJ), Ronda Exterior Norte, s/n, 21005, Huelva, Spain
| | - Irene Esteve-Ruiz
- Arrhythmia Unit, Department of Cardiology, Hospital Universitario Juan Ramón Jiménez (HJRJ), Ronda Exterior Norte, s/n, 21005, Huelva, Spain
| | - María Teresa Moraleda-Salas
- Arrhythmia Unit, Department of Cardiology, Hospital Universitario Juan Ramón Jiménez (HJRJ), Ronda Exterior Norte, s/n, 21005, Huelva, Spain.
| | - Álvaro Arce-León
- Arrhythmia Unit, Department of Cardiology, Hospital Universitario Juan Ramón Jiménez (HJRJ), Ronda Exterior Norte, s/n, 21005, Huelva, Spain
| | | | - José Venegas-Gamero
- Arrhythmia Unit, Department of Cardiology, Hospital Universitario Juan Ramón Jiménez (HJRJ), Ronda Exterior Norte, s/n, 21005, Huelva, Spain
| | - Carmen Lluch-Requerey
- Department of Cardiology, Hospital Universitario Juan Ramón Jiménez (HJRJ), Huelva, Spain
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Lu W, Lin J, Li Y, Hu Q, Cheng C, Chen R, Dai Y, Chen K, Zhang S. Quantitative analysis reveals influencing factors to facilitate successful anodal-ring capture in left bundle branch pacing. Europace 2023; 25:euad172. [PMID: 37337705 PMCID: PMC10292952 DOI: 10.1093/europace/euad172] [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] [Received: 04/07/2023] [Accepted: 06/12/2023] [Indexed: 06/21/2023] Open
Abstract
AIMS Left bundle branch pacing (LBBP) maintains left ventricular synchrony but induces right ventricular conduction delay (RVCD). Although anodal-ring capture (ARC) during bipolar LBBP improves RVCD, it is not achieved in all patients receiving LBBP. This study aimed to analyze the factors influencing ARC implementation. METHODS AND RESULTS Patients receiving LBBP with intraoperative ARC testing were enrolled. Electrocardiographic parameters were measured, including stimulus-to-QRS duration (stim-QRSd), stimulus-to-left/right ventricular activation time (stim-LVAT/RVAT), and V6-V1 interpeak interval. The distribution of lead-tip sites was described as the corrected longitudinal and lateral distance (longit-/lat-dist). Relative angles of the LBBP lead were measured. Echocardiography in short-axis view was used to measure the intraseptal lead length. Intergroup comparisons, correlation analysis, and stepwise logistic regression were performed. In total, 105 patients were included, among which 65 (62%) patients achieved ARC at a pacing output ≤ 5.0 V/0.5 ms (average 3.1 V/0.5 ms). Anodal-ring capture further shortened the stim-QRSd by 13.1 ± 7.5 ms. Better unipolar-ring (cathodal) threshold and R-wave sensing in LBBP-ARC group indicated the critical role of ring-septum contact in ARC. Longer corrected longit-dist and shorter corrected lat-dist of lead-tip sites were positively correlated with higher success likelihood of ARC, likely due to the greater relative angle in which the lead enters the septum and consequently the longer intraseptal lead length and better ring-septum contact. CONCLUSION This study elucidated the factors affecting the success likelihood of LBBP-ARC. These findings improve the understanding of LBBP-ARC, providing references for future research and clinical practice.
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Affiliation(s)
- Wenzhao Lu
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing 100037, China
| | - Jinxuan Lin
- Department of Cardiovascular Diseases, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Yao Li
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing 100037, China
| | - Qingyun Hu
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing 100037, China
| | - Chendi Cheng
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing 100037, China
| | - Ruohan Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing 100037, China
| | - Yan Dai
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing 100037, China
| | - Keping Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing 100037, China
| | - Shu Zhang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing 100037, China
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Wijesuriya N, Mehta V, De Vere F, Strocchi M, Behar JM, Niederer SA, Rinaldi CA. The role of conduction system pacing in patients with atrial fibrillation. Front Cardiovasc Med 2023; 10:1187754. [PMID: 37304966 PMCID: PMC10248047 DOI: 10.3389/fcvm.2023.1187754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/24/2023] [Indexed: 06/13/2023] Open
Abstract
Conduction system pacing (CSP) has emerged as a promising novel delivery method for Cardiac Resynchronisation Therapy (CRT), providing an alternative to conventional biventricular epicardial (BiV) pacing in indicated patients. Despite increasing popularity and widespread uptake, CSP has rarely been specifically examined in patients with atrial fibrillation (AF), a cohort which forms a significant proportion of the heart failure (HF) population. In this review, we first examine the mechanistic evidence for the importance of sinus rhythm (SR) in CSP by allowing adjustment of atrioventricular delays (AVD) to achieve the optimal electrical response, and thus, whether the efficacy of CSP may be significantly attenuated compared to conventional BiV pacing in the presence of AF. We next evaluate the largest clinical body of evidence in this field, related to patients receiving CSP following atrioventricular nodal ablation (AVNA) for AF. Finally, we discuss how future research may be designed to address the vital question of how effective CSP in AF patients is, and the potential hurdles we may face in delivering such studies.
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Affiliation(s)
- Nadeev Wijesuriya
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Vishal Mehta
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Felicity De Vere
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Marina Strocchi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Jonathan M. Behar
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Steven A. Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Research and Innovation Cluster, Alan Turing Institute, London, United Kingdom
| | - Christopher A. Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
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da Silva Menezes Junior A, Melo MGZ, Barreto LP. Meta-analysis of clinical outcomes in cardiac resynchronisation therapy: His Bundle Pacing vs biventricular pacing. Expert Rev Med Devices 2023; 20:505-515. [PMID: 37045603 DOI: 10.1080/17434440.2023.2202816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
INTRODUCTION AND OBJECTIVE Cardiac resynchronization may treat severe heart failure (HF) with pharmacological optimization, left branch block, and an ejection fraction < 35%. However, 30-40% of patients fail therapy. HBP could replace biventricular pacing (BiV). We compared the effectiveness of HBP versus BiV in HF patients. METHODS We searched PubMed, Embase, and Cochrane for studies on QRS, left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) functional class, left ventricular end-systolic volume (LVESV), and 6-minute walk test. RESULTS Six publications included 774 patients (mean [± standard deviation] age: 66.9 [14.0] years; 484 (62.5%) were males; 408 [52.71%] underwent HBP; the mean follow-up was 6-12 months. The HBP group had a higher QRS reduction in the meta-analysis (median: -17.54 [-20.46, -14.62]; I2 = 89%). LVEF showed a median of 8.48 (7.55, 9.41) and I2 of 98%, with a higher mean in HBP. The LVESV median was -18.89 (-30.03, -7.75) and I2 was 0%, and the HBP group had a lower mean. HBP had a lower NYHA functional class (median= -0.20 [-0.28, -0.12]). CONCLUSION After implantation, HBP demonstrated bigger QRS shortening, increased LVEF, lower LVES volume, and lower NYHA class than BiV pacing.
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Affiliation(s)
- Antonio da Silva Menezes Junior
- Pontifical Catholic University of Goiás, Goiânia, GO, Brazil
- Faculty of Medicine, Federal University of Goiás, Goiânia, GO, Brasil
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Yang W, Wu T, Wu Y, Xu J, Jiang Z, Zhou X, Shan Q. Left Bundle Branch Pacing for Bradycardia in Non-obstructive Hypertrophic Cardiomyopathy Patients: Feasibility, Safety, and Effect. Cardiovasc Drugs Ther 2023:10.1007/s10557-023-07440-5. [PMID: 36847900 DOI: 10.1007/s10557-023-07440-5] [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] [Accepted: 02/02/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Left bundle branch pacing (LBBP) is as an innovative physiological pacing approach. The research on LBBP in non-obstructive hypertrophic cardiomyopathy (NOHCM) patients is scarce. This study aimed to assess the feasibility, safety, and effect of LBBP in bradycardia NOHCM patients with permanent pacemaker (PPM) implantation indication. METHODS Thirteen consecutive patients with NOHCM who received LBBP were retrospectively enrolled as a hypertrophic cardiomyopathy (HCM) group. Following 1:3 matching, 39 patients without HCM were randomly matched as a control group. Echocardiographic index and pacing parameters were collected. RESULTS The successful LBBP was achieved in 96.2% of all cases (50/52), and the success rate of the HCM group was 92.3% (12/13). In the HCM group, the paced QRS duration (from the pacing stimulus to QRS end) was 145.6±20.8 ms. The stimulus to left ventricular activation time (s-LVAT) was 87.4±15.2 ms. In the control group, the paced QRS duration was 139.4±17.2 ms, and the s-LVAT was 79.9±14.1 ms. During the implantation, R-wave sensing and the pacing threshold of the HCM group were significantly higher than the control group (20.2±10.5 vs 12.5±5.9 mV, P < 0.05; 0.8±0.3 vs 0.6±0.2V/0.4 ms, P < 0.05). In addition, the fluoroscopic duration and procedural duration were longer in the HCM group (14.8±8.3 vs 10.3±6.6min, P = 0.07; 131.8±50.5 vs 101.4±41.6 min, P < 0.05). The lead insertion depth was 15±2 mm in the HCM group, and no procedure-related complications occurred. During the 12-month follow-up, pacing parameters remained stable and were of no significance in the two groups. The cardiac function did not deteriorate, and the left ventricular outflow tract gradient (LVOTG) did not increase in the follow-up. CONCLUSION LBBP might be feasible and safe for NOHCM patients with conventional bradycardia pacing indication, and there is no deterioration in cardiac function and LVOTG of patients with NOHCM.
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Affiliation(s)
- Wen Yang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), 300, Guangzhou Road, Nanjing, 210029, China
| | - Tian Wu
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), 300, Guangzhou Road, Nanjing, 210029, China
| | - Yixian Wu
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), 300, Guangzhou Road, Nanjing, 210029, China
| | - Jiayi Xu
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), 300, Guangzhou Road, Nanjing, 210029, China
| | - Zhixin Jiang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), 300, Guangzhou Road, Nanjing, 210029, China
| | - Xiujuan Zhou
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), 300, Guangzhou Road, Nanjing, 210029, China.
| | - Qijun Shan
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), 300, Guangzhou Road, Nanjing, 210029, China.
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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
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12
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Mei Y, Han R, Cheng L, Li R, He Y, Xie J, Wang Z, Wu Y. Assessment of Cardiac Function and Ventricular Mechanical Synchronization in Left Bundle Branch Area Pacing by Speckle Tracking and Three-Dimensional Echocardiography. Am J Cardiol 2023; 187:1-9. [PMID: 36459730 DOI: 10.1016/j.amjcard.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/26/2022] [Accepted: 10/06/2022] [Indexed: 12/03/2022]
Abstract
Real-time 3-dimensional echocardiography combined with speckle tracking was used in this study. A total of 90 patients with normal left ventricular ejection fraction were divided into 3 groups according to the pacing site: left bundle branch area pacing (LBBAP), right ventricular septal pacing (RVSP) or right ventricular apical pacing (RVAP). Procedure duration (90 ± 18 vs 61 ± 6.6 vs 58 ± 5.6 minutes, p = 0.015), Fluoroscopy duration (15.5 ± 5.4 vs 4.8 ± 2.2 vs 4 ± 1.9 minutes, p = 0.004), and ventricular capture threshold at implantation (0.8 ± 0.3 vs 0.6 ± 0.2 vs 0.6 ± 0.1 V, p = 0.002) were significantly increased in patients that received LBBAP compared with RVSP or RVAP. At 4 weeks of follow-up, brain natriuretic peptide levels were significantly lower (22 [12 to 59] vs 135 [86 to 231] vs 235 [147 to 428] pg/ml, p = 0.04), paced QRS duration was significantly shorter (115 ± 26 vs 134 ± 28 vs 157 ± 29 ms, p = 0.012), and global longitudinal strain (-19.4 ± 2.4 vs -19.3 ± 3.4 vs -17.3 ± 3.5%, p = 0.026) and systolic dyssynchrony index (2.5 ± 0.3 vs 5.9 ± 0.9 vs 7.7 ± 1.2, p = 0.001), longitudinal absolute maximum difference of time to peak strain (17 [6 to 68] vs 117 [71 to 173] vs 126 [79 to 178] ms, p <0.0001), and circumferential absolute maximum difference of time to peak strain (76 [32 to 129] vs 148 [117 to 208] vs 161 [118 to 266] ms, p = 0.005) were significantly lower in patients that received LBBAP compared with RVSP or RVAP. In conclusion, LBBAP can provide a more physiological ventricular activation pattern than RVSP or RVAP and results in good left ventricular electrical and mechanical synchronization.
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Affiliation(s)
- Yingchen Mei
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Department of Cardiology, Beijing Jishuitan Hospital, Beijing, China
| | - Rui Han
- Department of Cardiology, Beijing Jishuitan Hospital, Beijing, China
| | - Liting Cheng
- School of Medicine, Nankai University, Tianjin, China
| | - Rongjuan Li
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yihua He
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jinjie Xie
- Department of Cardiology, Jiahui International Hospital, Shanghai, China
| | - Zefeng Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yongquan Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
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13
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Zhang J, Zhang Y, Sun Y, Chen M, Wang Z, Ma C. Success rates, challenges and troubleshooting of left bundle branch area pacing as a cardiac resynchronization therapy for treating patients with heart failure. Front Cardiovasc Med 2023; 9:1062372. [PMID: 36704478 PMCID: PMC9872722 DOI: 10.3389/fcvm.2022.1062372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/28/2022] [Indexed: 01/11/2023] Open
Abstract
Cardiac resynchronization therapy (CRT) is an important treatment of heart failure patients with reduced left ventricular ejection fraction (LVEF) and asynchrony of cardiac electromechanical activity. Left bundle branch area pacing (LBBaP) is a novel physiological pacing modality that appears to be an effective method for CRT. LBBaP has several advantages over the traditional biventricular-CRT (BiV-CRT), including a low and stable pacing capture threshold, a high success rate of implantation, a short learning curve, and high economic feasibility. However, LBBaP is not suitable for all heart failure patients needing a CRT and the success rates of LBBaP in heart failure patients is lower because of myocardial fibrosis, non-specific intraventricular conduction disturbance (IVCD), enlargement of the right atrium or right ventricle, etc. In this literature review, we summarize the success rates, challenges, and troubleshooting of LBBaP in heart failure patients needing a CRT.
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Affiliation(s)
- Junmeng Zhang
- Department of Cardiology, Beijing Huaxin Hospital, Tsinghua University, Beijing, China
| | - Yimin Zhang
- Department of Cardiology, Beijing Huaxin Hospital, Tsinghua University, Beijing, China
| | - Yaxun Sun
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengna Chen
- Department of Cardiology, Beijing Huaxin Hospital, Tsinghua University, Beijing, China
| | - Zefeng Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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14
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Hua W, Gu M, Niu H, Gold MR. Advances of Implantation Techniques for Conduction System Pacing. JACC Clin Electrophysiol 2022; 8:1587-1598. [PMID: 36543514 DOI: 10.1016/j.jacep.2022.09.022] [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: 08/12/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 12/05/2022]
Abstract
Conduction system pacing (CSP), including His bundle and left bundle branch pacing are physiological pacing modalities, but lead deployment is often difficult mainly due to a lack of anatomical landmark for lead tip location. Several implantation techniques for CSP implantation have been developed including 3-dimensional electroanatomical mapping, placing a second lead as a reference (dual-lead method technique), and using fluoroscopic imaging (9-partition and visualization techniques). In this review, the authors summarize the implantation techniques for CSP and compare the different methods.
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Affiliation(s)
- Wei Hua
- Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Min Gu
- Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongxia Niu
- Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Michael R Gold
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA.
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15
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Right-sided approach to left bundle branch area pacing combined with atrioventricular node ablation in a patient with persistent left superior vena cava and left bundle branch block: a case report. BMC Cardiovasc Disord 2022; 22:467. [PMID: 36335296 PMCID: PMC9636621 DOI: 10.1186/s12872-022-02914-0] [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: 02/23/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
Abstract
Background Left bundle branch area pacing (LBBAP) is an alternative to right ventricular (RV) and biventricular (BiV) pacing in patients scheduled for pace and ablate treatment strategy. However, current delivery sheaths are designed for left-sided implantation, making the right-sided LBBAP lead implantation challenging. Case presentation We report a case of a right-sided LBBAP approach via right subclavian vein in a heart failure patient with a persistent left superior vena cava scheduled for pace and ablate treatment of refractory atrial flutter. To enable adequate lead positioning and support for transseptal screwing, the delivery sheath was manually modified with a 90-degree curve at the right subclavian vein and superior vena cava junction to allow right-sided implantation. The distance between the reshaping point and the presumed septal region was estimated by placing the sheath on the body surface under fluoroscopy. With the reshaping of the delivery sheath, we were able to achieve LBBAP with relatively minimal torque. Radiofrequency ablation of the atrioventricular node was performed the next day and the pacing parameters remained stable in short-term follow-up. Conclusion With the modification of currently available tools, LBBAP can be performed with the right-sided approach.
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17
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Gelves-Meza J, Lang RM, Valderrama-Achury MD, Zamorano JL, Vargas-Acevedo C, Medina HM, Salazar G. Tricuspid Regurgitation Related to Cardiac Implantable Electronic Devices: An Integrative Review. J Am Soc Echocardiogr 2022; 35:1107-1122. [PMID: 35964911 DOI: 10.1016/j.echo.2022.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 10/15/2022]
Abstract
The use of cardiac implantable electronic devices, including permanent pacemakers, implantable cardiac defibrillators and cardiac resynchronization therapy, has dramatically increased in recent years. The interaction between the device lead and tricuspid valve leaflets is a potential cause of tricuspid regurgitation which in turn has an impact on morbidity and mortality. Echocardiography is necessary for grading of tricuspid regurgitation severity. The use of three-dimensional imaging helps determine whether the device lead is interfering with normal leaflet coaptation. Early identification of lead-related tricuspid regurgitation is critical to select the optimal treatment, which may include lead extraction or even tricuspid valve repair/replacement in severe cases. This review aims to provide a thorough assessment of the evidence about lead-associated tricuspid regurgitation, the benefits of using 3D echocardiography with some technical considerations, and finally, propose a treatment algorithm.
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Affiliation(s)
- Julián Gelves-Meza
- Cardiologist, Echocardiography Laboratory, Fundación Cardioinfantil - Instituto de Cardiología. Universidad del Rosario, Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia.
| | - Roberto M Lang
- Section of Cardiology, Department of Medicine, Cardiac Imaging Center, the University of Chicago Medicine, Chicago, Illinois, USA
| | | | | | - Catalina Vargas-Acevedo
- Pediatrician, Research Assistant, Institute of Congenital Heart Disease. Fundación Cardioinfantil - Instituto de Cardiología. Bogotá, Colombia
| | - Hector Manuel Medina
- Cardiologist, Section Head, Cardiac Imaging. Fundación Cardioinfantil - Instituto de Cardiología. Bogotá, Colombia
| | - Gabriel Salazar
- Cardiologist, Section Head, Echocardiography Laboratory. Fundación Cardioinfantil - Instituto de Cardiología. Bogotá, Colombia
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Aryanti RR, Hermanto DY, Yuniadi Y. Dynamic changes of atrioventricular conduction during Covid-19 infection: Does inflammation matter? INTERNATIONAL JOURNAL OF ARRHYTHMIA 2022; 23:20. [PMID: 35937564 PMCID: PMC9340682 DOI: 10.1186/s42444-022-00072-0] [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: 03/11/2022] [Accepted: 06/23/2022] [Indexed: 11/30/2022] Open
Abstract
Background The primary manifestation of COVID-19 infection was pulmonary involvement. However, it can also manifest as a cardiovascular problem.
Methods We report a case of 82-year-old male COVID-19 patient who experienced atrioventricular (AV) conduction disturbance. Results The rhythm was degenerated from sinus rhythm to complete AV block. We observe dynamic AV node dysfunction associated with inflammatory response. His bundle pacing successfully captured distal His region. Conclusion The severe inflammatory response during COVID-19 infection might permanently damage cardiac conduction system resulted in a complete AV node block.
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Affiliation(s)
- Risca Rini Aryanti
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia and Arrhythmia Division, National Cardiovascular Center Harapan Kita, Jalan S Parman Kav 87 Slipi, Jakarta, 11420 Indonesia
| | - Dony Yugo Hermanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia and Arrhythmia Division, National Cardiovascular Center Harapan Kita, Jalan S Parman Kav 87 Slipi, Jakarta, 11420 Indonesia
| | - Yoga Yuniadi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia and Arrhythmia Division, National Cardiovascular Center Harapan Kita, Jalan S Parman Kav 87 Slipi, Jakarta, 11420 Indonesia
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A Case Report of a Wenckebach Phenomenon Occurring during a His-Bundle Pacing Procedure: Is It Atrioventricular Node Pacing? J Cardiovasc Dev Dis 2022; 9:jcdd9070231. [PMID: 35877593 PMCID: PMC9319595 DOI: 10.3390/jcdd9070231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/06/2022] [Accepted: 07/14/2022] [Indexed: 02/05/2023] Open
Abstract
A 70-year-old man with severe valvular cardiomyopathy, permanent atrial fibrillation (AF) with a slow ventricular response, and transient atrioventricular (AV) block, was admitted to our center for severe heart failure and recurrent presyncope. While hospitalized, the coronary computed tomography angiography (CTA) showed huge atriums. We tried His bundle pacing (HBP). HB potential was observed at site A, and the His-ventricular (HV) interval was 68 ms. The duration from the stimulus signal to the onset of paced QRS (S-QRSonset) at site A was 232 ms when pacing at 60 beats per minute (BPM) with the pacing threshold of 2.0 V/0.5 ms. The S-QRSonset was longer than the HV interval and had a notable and progressive prolongation from 252 ms to 456 ms during the pacing at 90 BPM. Then, we pushed another lead a little forward, and the S-QRSonset shortened back to 68 ms, and the paced QRS morphology was the same as the intrinsic QRS morphology with the pacing threshold of 1.5 V/0.5 ms. The progressively prolonged S-QRSonset demonstrated a Wenckebach phenomenon (WP), a well-known electrophysiological characteristic of the AV node (AVN). It is the first time to report an intraoperative AVN-pacing related-WP in a patient with persistent AF. The enlarged atrium might be convenient for capturing the AVN. There are some other potential explanations for this phenomenon. The diameters of atriums decreased significantly, and the symptoms improved after the procedure. This is the first reported case in which we might achieve AVN capture in a patient with persistent AF. Although we ultimately chose HBP for better long-term pacing thresholds, the result of this case suggested that AVN pacing may be possible.
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20
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Richter S. ESC-Leitlinien 2021: Conduction System Pacing. AKTUELLE KARDIOLOGIE 2022. [DOI: 10.1055/a-1737-1476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungDie aktuellen ESC-Leitlinien von 2021 bezüglich des direkten Pacings an den Strukturen des ventrikulären myokardialen Erregungsleitungssystems sind sehr defensiv ausgelegt. Verglichen mit
den Leitlinienempfehlungen aus Japan oder USA wird diese Art der „physiologischen Stimulation“ in Europa eher in den Schatten gestellt. Auch wenn randomisierte Studien mit harten Endpunkten
zur His-Bündel- und Linksschenkelstimulation fehlen, konnten doch in einer Vielzahl von Untersuchungen die Sicherheit, Effektivität und auch klinische Überlegenheit gegenüber einer
klassischen rechtsventrikulären oder biventrikulären Stimulation gezeigt werden. Die vorliegende Leitlinienfassung der ESC zur Herzschrittmachertherapie ist in diesem Punkt daher durchaus
diskutabel.
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Affiliation(s)
- Sergio Richter
- Sektion Elektrophysiologie, Klinik für Innere Medizin und Kardiologie, Herzzentrum Dresden, Technische Universität Dresden, Dresden, Deutschland
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21
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Yoshiyama T, Shimeno K, Hayashi Y, Ito A, Iwata S, Matsumura Y, Izumiya Y, Abe Y, Ehara S, Naruko T. Risk factors of pacing-induced cardiomyopathy-Insights from lead position. J Arrhythm 2022; 38:408-415. [PMID: 35785399 PMCID: PMC9237288 DOI: 10.1002/joa3.12712] [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: 10/20/2021] [Revised: 02/20/2022] [Accepted: 03/28/2022] [Indexed: 11/09/2022] Open
Abstract
There was no significant difference in the incidence of pacing-induced cardiomyopathy between right ventricular apex pacing group and OpenCurlyQuote;true CloseCurlyQuote; mid-right ventricular septum pacing group. The preoperative left ventricular end-systolic diameter and paced QRS duration were independent predictors of PICM.
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Affiliation(s)
- Tomotaka Yoshiyama
- Department of Cardiovascular MedicineOsaka City University Graduate School of MedicineOsakaJapan
| | - Kenji Shimeno
- Department of CardiologyOsaka City General HospitalOsakaJapan
| | - Yusuke Hayashi
- Department of CardiologyOsaka City General HospitalOsakaJapan
| | - Asahiro Ito
- Department of Cardiovascular MedicineOsaka City University Graduate School of MedicineOsakaJapan
| | - Shinichi Iwata
- Department of Cardiovascular MedicineOsaka City University Graduate School of MedicineOsakaJapan
| | | | - Yasuhiro Izumiya
- Department of Cardiovascular MedicineOsaka City University Graduate School of MedicineOsakaJapan
| | - Yukio Abe
- Department of CardiologyOsaka City General HospitalOsakaJapan
| | - Shoichi Ehara
- Department of Cardiovascular MedicineOsaka City University Graduate School of MedicineOsakaJapan
| | - Takahiko Naruko
- Department of CardiologyOsaka City General HospitalOsakaJapan
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22
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Zanon F, Marcantoni L, Centioni M, Pastore G, Baracca E. His Bundle Pacing: My Experience, Tricks, and Tips. Card Electrophysiol Clin 2022; 14:141-149. [PMID: 35715073 DOI: 10.1016/j.ccep.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
His Bundle Pacing (HBP) is a form of physiologic pacing achieved through implantation of a pacing electrode into the His bundle. HBP began 20 years ago without any dedicated tools. As specific tools became available HBP quickly spread and proved to be a viable alternative to traditional right ventricle pacing. HBP is reliable and effective in preserving the physiologic ventricular synchrony with clinical benefits particularly evident when a high percentage of pacing is required. Unipolar signals from the lead tip guide the implant. 3D electroanatomical mapping could further assist the procedure.
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Affiliation(s)
- Francesco Zanon
- Arrhythmia and Electrophysiology Unit, Division of Cardiology, Department of Specialistic Medicine, Santa Maria Della Misericordia General Hospital, Viale Tre Martiri 177, 45100 Rovigo, Italy.
| | - Lina Marcantoni
- Arrhythmia and Electrophysiology Unit, Division of Cardiology, Department of Specialistic Medicine, Santa Maria Della Misericordia General Hospital, Viale Tre Martiri 177, 45100 Rovigo, Italy. https://twitter.com/@LinaMarcantoni
| | - Marco Centioni
- Arrhythmia and Electrophysiology Unit, Division of Cardiology, Department of Specialistic Medicine, Santa Maria Della Misericordia General Hospital, Viale Tre Martiri 177, 45100 Rovigo, Italy
| | - Gianni Pastore
- Arrhythmia and Electrophysiology Unit, Division of Cardiology, Department of Specialistic Medicine, Santa Maria Della Misericordia General Hospital, Viale Tre Martiri 177, 45100 Rovigo, Italy
| | - Enrico Baracca
- Arrhythmia and Electrophysiology Unit, Division of Cardiology, Department of Specialistic Medicine, Santa Maria Della Misericordia General Hospital, Viale Tre Martiri 177, 45100 Rovigo, Italy
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23
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Chen X, Zhou X, Wang Y, Jin Q, Chen Y, Wang J, Qin S, Bai J, Wang W, Liang Y, Chen H, Su Y, Ge J. Evaluation of electrophysiological characteristics and ventricular synchrony: An intrapatient-controlled study during His-Purkinje conduction system pacing versus right ventricular pacing. Clin Cardiol 2022; 45:723-732. [PMID: 35502628 PMCID: PMC9286324 DOI: 10.1002/clc.23837] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/24/2022] [Accepted: 03/29/2022] [Indexed: 12/17/2022] Open
Abstract
Objectives to Background To compare electromechanical ventricular synchrony when pacing from different sites, including right ventricular apex pacing (RVAP), right ventricular septum pacing (RVSP), His bundle pacing (HBP), left bundle branch pacing (LBBP), and RVSP during unipolar pacing from the ring electrode of LBBP lead (RVSPring) in each patient and evaluate the correlations between electrophysiological characteristics and ventricular synchrony. Methods Twenty patients with complete atrioventricular block indicated for dual‐chamber pacemaker implantation were included in the study. Unipolar pacing at different sites, including RVAP, RVSP, HBP, LBBP, and RVSPring, was successively performed in each patient. The pacing characteristics and echocardiogram parameters were collected and compared among intrinsic rhythm and pacing at different sites. Results Similar to HBP (114.84 ± 18.67 ms), narrower paced QRSd was found in LBBP (116.15 ± 11.60 ms) as compared to RVSPring (135.11 ± 13.68 ms), RVSP (141.65 ± 14.26 ms), and RVAP (160.15 ± 19.35 ms) (p < .001). LBBP showed comparable pacing parameters to RVAP or RVSP and was significantly better than HBP, with maintained cardiac function. TS‐12‐SD was significantly improved in LBBP (41.80 ± 20.97 ms) than RVAP (69.70 ± 32.42 ms, p = .003) and RVSP (63.30.56 ± 32.53 ms, p = .018) but similar to HBP (51.50 ± 25.67 ms, p = .283) or RVSPring (57.80 ± 25.65 ms, p = .198). Among these pacing strategies, negative values of interventricular mechanical delay (IVMD) were only identified in LBBP (−19.25 ± 18.43 ms), significantly different from RVAP (35.00 ± 30.72 ms), RVSP (22.85 ± 22.05 ms), HBP (5.20 ± 18.64 ms), and RVSPring (16.00 ± 26.76 ms (all p < .05). Using Pearson's analysis, Sti‐LVAT was positively correlated with QRS duration, IVMD, TS‐12‐SD, LVEDV, and LVESV, while a negative relationship could be observed for left ventricular ejection fraction. Conclusions His‐Purkinje conduction system pacing (HPCSP) achieved better electrical and mechanical synchrony than conventional RV pacing. For interventricular synchrony, only LBBP initiated earlier LV activation than RV, in accordance with the right bundle branch block (RBBB) pattern of paced QRS during LBBP. Sti‐LVAT might be a good parameter correlating with LV systolic function and mechanical synchrony.
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Affiliation(s)
- Xueying Chen
- Department of Cardiology, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Xiaolan Zhou
- Huashan Worldwide Medical Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Yanan Wang
- Department of Echocardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qinchun Jin
- Department of Cardiology, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Yufei Chen
- Department of Echocardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jingfeng Wang
- Department of Cardiology, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Shengmei Qin
- Department of Cardiology, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Jin Bai
- Department of Cardiology, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Wei Wang
- Department of Cardiology, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Yixiu Liang
- Department of Cardiology, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Haiyan Chen
- Department of Echocardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yangang Su
- Department of Cardiology, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital of Fudan University, Shanghai, China
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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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Effect of left bundle branch pacing on left ventricular systolic function and synchronization in patients with third-degree atrioventricular block, assessment by 3- dimensional speckle tracking echocardiography. J Electrocardiol 2022; 72:61-65. [DOI: 10.1016/j.jelectrocard.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 02/17/2022] [Accepted: 02/25/2022] [Indexed: 11/24/2022]
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Fan L, Yao J, Wang L, Xu D, Tang D. Optimization of Left Ventricle Pace Maker Location Using Echo-Based Fluid-Structure Interaction Models. Front Physiol 2022; 13:843421. [PMID: 35250642 PMCID: PMC8892190 DOI: 10.3389/fphys.2022.843421] [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: 12/25/2021] [Accepted: 01/26/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Cardiac pacing has been an effective treatment in the management of patients with bradyarrhythmia and tachyarrhythmia. Different pacemaker location has different responses, and pacemaker effectiveness to each individual can also be different. A novel image-based ventricle animal modeling approach was proposed to optimize ventricular pacemaker site for better cardiac outcome. METHOD One health female adult pig (weight 42.5 kg) was used to make a pacing animal model with different ventricle pacing locations. Ventricle surface electric signal, blood pressure and echo image were acquired 15 min after the pacemaker was implanted. Echo-based left ventricle fluid-structure interaction models were constructed to perform ventricle function analysis and investigate impact of pacemaker location on cardiac outcome. With the measured electric signal map from the pig associated with the actual pacemaker site, electric potential conduction of myocardium was modeled by material stiffening and softening in our model, with stiffening simulating contraction and softening simulating relaxation. Ventricle model without pacemaker (NP model) and three ventricle models with the following pacemaker locations were simulated: right ventricular apex (RVA model), posterior interventricular septum (PIVS model) and right ventricular outflow tract (RVOT model). Since higher peak flow velocity, flow shear stress (FSS), ventricle stress and strain are linked to better cardiac function, those data were collected for model comparisons. RESULTS At the peak of filling, velocity magnitude, FSS, stress and strain for RVOT and PIVS models were 13%, 45%, 18%, 13% and 5%, 30%, 10%, 5% higher than NP model, respectively. At the peak of ejection, velocity magnitude, FSS, stress and strain for RVOT and PIVS models were 50%, 44%, 54%, 59% and 23%, 36%, 39%, 53% higher than NP model, respectively. RVA model had lower velocity, FSS, stress and strain than NP model. RVOT model had higher peak flow velocity and stress/strain than PIVS model. It indicated RVOT pacemaker site may be the best location. CONCLUSION This preliminary study indicated that RVOT model had the best performance among the four models compared. This modeling approach could be used as "virtual surgery" to try various pacemaker locations and avoid risky and dangerous surgical experiments on real patients.
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Affiliation(s)
- Longling Fan
- Faculty of Science, Kunming University of Science and Technology, Kunming, China
- School of Mathematics, Southeast University, Nanjing, China
| | - Jing Yao
- Department of Ultrasound Medicine, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Liang Wang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Di Xu
- Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Dalin Tang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
- Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, MA, United States
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Richter S. Permanent His bundle pacing: adopt, adapt, and improve. Europace 2022; 24:530-532. [PMID: 35152288 DOI: 10.1093/europace/euab325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sergio Richter
- Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
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Gui Y, Ye L, Wu L, Mai H, Yan Q, Wang L. Clinical Outcomes Associated With His-Purkinje System Pacing vs. Biventricular Pacing, in Cardiac Resynchronization Therapy: A Meta-Analysis. Front Cardiovasc Med 2022; 9:707148. [PMID: 35224028 PMCID: PMC8873383 DOI: 10.3389/fcvm.2022.707148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 01/13/2022] [Indexed: 11/13/2022] Open
Abstract
AimsHis-Purkinje system pacing has recently emerged as an alternative to biventricular pacing (BIVP) in cardiac resynchronization therapy (CRT). The aim of this study was to conduct a meta-analysis comparing the clinical outcomes associated with His-Purkinje system pacing (HPSP) vs. BIVP in patients with heart failure. There is also a comparison of clinical outcomes of His-bundle pacing (HBP) and left bundle branch pacing (LBBP) in the His-Purkinje system.MethodsWe searched the Cochrane Library, Embase, and PubMed, for studies published between January 2010 and October 2021 that compared the clinical outcomes associated with HPSP vs. BIVP and HBP vs. LBBP in HPSP in patients who underwent CRT. The pacing threshold, R-wave amplitudes, QRS duration, New York Heart Association functional (NYHA), left ventricular ejection fraction (LVEF), and LV end-diastolic diameter (LVEDD) of heart failure, at follow-up, were extracted and summarized for meta-analysis.ResultsA total of 18 studies and 1517 patients were included in our analysis. After a follow-up period of 9.3 ± 5.4 months, the HPSP was found to be associated with shorter QRS duration in the CRT population compared to that in the BIVP (SMD, −1.17; 95% CI, −1.56 to −0.78; P < 0.00001; I2 = 74%). No statistical difference was verified between HBP and LBBP on QRS duration (SMD, 0.04; 95% CI, −0.32 to 0.40; P = 0.82; I2 = 84%). In the comparison of HPSP and BIVP, the LBBP subgroup showed improved LVEF (SMD, 0.67; 95% CI, 0.42–0.91; P < 0.00001; I2 = 0%), shorter LVEDD (SMD, 0.59; 95% CI, 0.93–0.26; P = 0.0005; I2 = 0%), and higher New York Heart Association functional class (SMD, −0.65; 95% CI, −0.86 to −0.43; P < 0.00001; I2 = 45%). In terms of pacing threshold and R-wave amplitude clinical outcomes, LBBP has a lower pacing threshold (SMD, 1.25; 95% CI, 1.12–1.39; P < 0.00001; I2 = 47%) and higher R-wave amplitude (MD, −7.88; 95% CI, −8.46 to −7.31; P < 0.00001; I2 = 8%) performance compared to HBP.ConclusionOur meta-analysis showed that the HPSP produced higher LVEF, shorter QRS duration, and higher NYHA functional class in the CRT population than the BIVP as observed on follow-up. LBBP has a lower pacing threshold and higher R-wave amplitude. HPSP may be a new and promising alternative to BIVP in the future.
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Affiliation(s)
- Yang Gui
- BengBu Medical College, Bengbu, China
| | - Lifang Ye
- Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Liuyang Wu
- Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Haohui Mai
- Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Qiqi Yan
- Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Lihong Wang
- Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
- *Correspondence: Lihong Wang
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Meta-Analysis Comparing Safety and Efficacy of Left Bundle Branch Area Pacing Versus His Bundle Pacing. Am J Cardiol 2022; 164:64-72. [PMID: 34887071 DOI: 10.1016/j.amjcard.2021.10.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/06/2021] [Accepted: 10/12/2021] [Indexed: 11/22/2022]
Abstract
Although His bundle pacing (HBP) can provide a physiologic ventricular activation pattern, it has disadvantages such as the difficulty of lead implantation, reduced R wave amplitudes, and high and unstable pacing thresholds. Recent studies have demonstrated that left bundle branch area pacing (LBBaP) might overcome these deficiencies. A total of 7 nonrandomized controlled studies including 786 patients (n = 442 receiving LBBaP and n = 344 receiving HBP) with bradyarrhythmia were evaluated. Compared with HBP, LBBaP appeared to result in increased R wave amplitudes (at implant: MD 9.84 mV, 95% confidence interval [CI] 7.61 to 12.06 mV; at follow-up: MD 7.62 mV, 95% CI 6.73 to 8.50 mV), lowered capture thresholds (at implant: MD -0.73 V, 95% CI -0.81 to -0.64 V; at follow-up: MD -0.71 V, 95% CI -0.92 to -0.50 V), shortened procedure times (MD -16.70 minutes, 95% CI -26.51 to -6.90 minutes) and fluoroscopic durations (MD -6.16 min, 95% CI -8.28 to -4.03 minutes), and increased success rates (odds ratio 2.14, 95% CI 1.23 to 3.74); all of these differences were significant. However, paced QRS durations, the lead impedance at implantation and follow-up, and incidence of lead-related complications such as lead dislodgement did not significantly differ between LBBaP and HBP. In conclusion, current evidence suggests that LBBaP is a potential alternative to HBP as a pacing modality with which to maintain an ideal physiologic pattern of ventricular activation through native His-Purkinje system stimulation.
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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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Zhang C, Wang XY, Lou L, Zhang X, Chen LL, Chen YX, Yang J. Pacemaker and Atrioventricular Junction Ablation in Patients With Atrial Fibrillation—A Systematic Review of Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 8:587297. [PMID: 35127840 PMCID: PMC8810654 DOI: 10.3389/fcvm.2021.587297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/20/2021] [Indexed: 11/25/2022] Open
Abstract
Background Cardiac resynchronization therapy (CRT) could be considered for heart failure (HF) patients with atrial fibrillation (AF) unless a potent ventricular capture strategy is conducted. However, the benefit of a pacemaker (PM; as part of CRT) in patients with AF and whether atrioventricular junction (or nodal) ablation (AVAB) can improve the prognosis of these patients compared with those treated medically to support ventricular capture are unclear. Methods and Results Systematic reviews and meta-analyses investigating the roles of PMs and AVAB in patients with AF were obtained in a search of the PubMed, Embase, and Medline databases and then analyzed with respect to the following outcomes: mortality, left ventricular ejection fraction, and clinical findings including the New York Heart Association class, 6-min walk distance (6MWD), quality of life as assessed in a specific questionnaire, and response to CRT. The quality of the included reviews was assessed using the Assessing the Methodological Quality of Systematic Reviews 2 tool, which includes 16 items. This study was finally based on 13 systematic reviews or meta-analyses. The results showed that patients with AF have higher all-cause mortality rates compared with patients with sinus rhythm and that AVAB can reduce all-cause mortality in patients with AF. Although the functional improvement was better in sinus rhythm than in patients with AF, in the latter, AVAB increased the 6MWD and reduced the CRT nonresponse rate in patients with AF. Conclusion Atrial fibrillation is associated with a higher all-cause mortality rate in patients with CRT implantation. AVAB, by increasing the 6MWD and survival, can improve the prognosis of these patients.
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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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Gupta A, Pavri BB. Conduction system pacing versus biventricular pacing: Reduced repolarization heterogeneity in addition to improved depolarization. J Cardiovasc Electrophysiol 2021; 33:287-295. [PMID: 34911154 DOI: 10.1111/jce.15329] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/01/2021] [Accepted: 11/15/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION His-bundle pacing (HBP) and left-bundle-area pacing (LBAP) are conduction system pacing (CSP) modalities increasingly used as alternatives to conventional biventricular pacing (BiVP). While effects of CSP on ventricular depolarization have been reported, effects on ventricular repolarization have not. METHODS QRS duration (QRSd) and validated ECG parameters of ventricular repolarization associated with arrhythmic risk (T-peak-to-T-endTransmural , T-peak-to-T-endTotal , T-peak dispersion, QTc, QTc dispersion) were analyzed post-implant in 107 patients: 60 with CSP (HBP: n = 35, LBAP: n = 25) and 47 with BiVP. T-wave memory resolution and QTc shortening were analyzed on ECGs obtained ≥25 days post-implant. Twenty blinded measurements were obtained by both authors to assess Interobserver variability. RESULTS Although QRSd was shorter with HBP versus LBAP (119 ± 7 ms vs. 132 ± 9 ms, p = .02), there were no significant differences in any repolarization parameters between these methods of CSP. However, when comparing CSP (HBP + LBAP) to BiVP, both QRSd (125 ± 5 ms vs. 147 ± 7 ms, p < .0001) and repolarization parameters (T-peak-to-T-endTransmural : 83 ± 5 ms vs. 107 ± 8 ms; T-peak-to-T-endTotal : 110 ± 7 ms vs. 137 ± 10 ms; QTc: 470 ± 12 ms vs. 506 ± 12 ms; all p ≤ .0001) were significantly shorter with CSP. Improved T-peak-to-T-end values were unrelated to pre-implant QRSd or LV function. Interobserver variability was 4.6 ± 1.9 ms. Frontal QRS-T angle narrowing (132° to 104°, p = .001) and QTc shortening (483 ± 13 ms to 464 ± 12 ms, p = .008) were seen only with CSP. CONCLUSIONS In addition to improved depolarization, CSP reduced repolarization heterogeneity and provided greater T-wave memory resolution as compared to BiVP. Both modalities of CSP (HBP + LBAP) resulted in comparably reduced repolarization heterogeneity regardless of baseline QRSd and LV function. These observations may confer lower arrhythmogenic risk and warrant further study.
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Affiliation(s)
- Anshul Gupta
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Behzad B Pavri
- Division of Cardiology, Section of Cardiac Electrophysiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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His Bundle Pacing: A promising alternative strategy for Antibradycardic-pacing. Report of a single center-experience. Hellenic J Cardiol 2021; 64:77-86. [PMID: 34843996 DOI: 10.1016/j.hjc.2021.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/26/2021] [Accepted: 10/07/2021] [Indexed: 11/21/2022] Open
Abstract
His Bundle Pacing (HBP) is proven to be a safe and effective alternative pacing modality that, in addition, avoids Pacemaker-induced Cardiomyopathy (PICM) by achieving a ''physiological'' ventricular stimulation, via the native conduction system. Indications include various causes of bradycardia requiring antibradycardic pacing, inadequately controlled Atrial Fibrillation requiring AV node ablation and established PICM. In addition, HBP may also be used as an alternative therapy for patients with Heart Failure (HF) and an indication for Cardiac Resynchronization Therapy. Available data show a benefit from HBP with regard to preservation or restoration of intra- and inter-ventricular synchronization, improvement in Left Ventricular Ejection Fraction, functional status and Quality of Life, decrease in atrial fibrillation incidence and improvement in HF hospitalization rates, compared to conventional pacing. Nevertheless, superiority in terms of mortality rates has not been consistently demonstrated and long-term efficacy and safety remains to be proven. In the present manuscript, we review the status of HBP and we present our current experience with this novel pacing modality.
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Salden FCWM, Huntjens PR, Schreurs R, Willemen E, Kuiper M, Wouters P, Maessen JG, Bordachar P, Delhaas T, Luermans J, Meine M, Allaart CP, van Stipdonk AMW, Prinzen FW, Lumens J, Vernooy K. Pacing therapy for atrioventricular dromotropathy: a combined computational-experimental-clinical study. Europace 2021; 24:784-795. [PMID: 34718532 PMCID: PMC9071072 DOI: 10.1093/europace/euab248] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/11/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS Investigate haemodynamic effects, and their mechanisms, of restoring atrioventricular (AV)-coupling using pacemaker therapy in normal and failing hearts in a combined computational-experimental-clinical study. METHODS AND RESULTS Computer simulations were performed in the CircAdapt model of the normal and failing human heart and circulation. Experiments were performed in a porcine model of AV dromotropathy. In a proof-of-principle clinical study, left ventricular (LV) pressure and volume were measured in 22 heart failure (HF) patients (LV ejection fraction <35%) with prolonged PR interval (>230 ms) and narrow or non-left bundle branch block QRS complex. Computer simulations and animal studies in normal hearts showed that restoring of AV-coupling with unchanged ventricular activation sequence significantly increased LV filling, mean arterial pressure, and cardiac output by 10-15%. In computer simulations of failing hearts and in HF patients, reducing PR interval by biventricular (BiV) pacing (patients: from 300 ± 61 to 137 ± 30 ms) resulted in significant increases in LV stroke volume and stroke work (patients: 34 ± 40% and 26 ± 31%, respectively). However, worsening of ventricular dyssynchrony by using right ventricular (RV) pacing abrogated the benefit of restoring AV-coupling. In model simulations, animals and patients, the increase of LV filling and associated improvement of LV pump function coincided with both larger mitral inflow (E- and A-wave area) and reduction of diastolic mitral regurgitation. CONCLUSION Restoration of AV-coupling by BiV pacing in normal and failing hearts with prolonged AV conduction leads to considerable haemodynamic improvement. These results indicate that BiV or physiological pacing, but not RV pacing, may improve cardiac function in patients with HF and prolonged PR interval.
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Affiliation(s)
- Floor C W M Salden
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands.,Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Peter R Huntjens
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.,Department of Cardiology, Washington University in Saint Louis, Saint Louis, MO, USA
| | - Rick Schreurs
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.,Department of Cardiothoracic Surgery, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
| | - Erik Willemen
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Marion Kuiper
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Philippe Wouters
- Department of Cardiology, University Medical Centre Utrecht (UMC Utrecht), Utrecht, The Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
| | - Pierre Bordachar
- Department of Cardiology, Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France
| | - Tammo Delhaas
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Justin Luermans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
| | - Mathias Meine
- Department of Cardiology, University Medical Centre Utrecht (UMC Utrecht), Utrecht, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam University Medical Centre (Amsterdam UMC), Amsterdam, The Netherlands
| | - Antonius M W van Stipdonk
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Joost Lumens
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.,Department of Cardiology, Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands.,Department of Cardiology, Radboud University Medical Centre (RadboudUMC), Nijmegen, The Netherlands
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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: 865] [Impact Index Per Article: 288.3] [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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38
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Hasumi E, Fujiu K. Tripartite Left Bundle Branch Area Pacing. Int Heart J 2021; 62:1-3. [PMID: 33518650 DOI: 10.1536/ihj.20-771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Eriko Hasumi
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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Senes J, Mascia G, Bottoni N, Oddone D, Donateo P, Grimaldi T, Minneci C, Bertolozzi I, Brignole M, Puggioni E, Coluccia G. Is His-optimized superior to conventional cardiac resynchronization therapy in improving heart failure? Results from a propensity-matched study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1532-1539. [PMID: 34374444 DOI: 10.1111/pace.14336] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 07/25/2021] [Accepted: 08/08/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND His bundle pacing (HBP), alone or optimized in association with coronary sinus pacing (HBP+LV) has recently been proposed as an alternative to conventional cardiac resynchronization therapy (CRT). However, there is lack of controlled studies that assessed clinical outcome. METHODS We did a single-center, propensity-score matched, case-control study of comparison of HBP and HBP+LV versus conventional CRT in patients with heart failure (HF) and standard indications for CRT. The study group patients were consecutively enrolled in the year 2019. The control group patients were selected, by propensity score matching, among those CRT implantations performed in the years 2015-2018. RESULTS There were 27 patients in each group. In the active group, 12 (44%) patients received HBP alone and 12 (44%) patients HBP+LV pacing. HBP failed in three (11%) patients. In the control group, conventional CRT was achieved in 26 (96%) patients and failed in one. Paced QRS width was shorter in the active than in the control group (128 ± 18 vs. 148 ± 27 ms, p = .004). During a mean of 9.6 months of follow-up, a composite clinical outcome of death, hospitalization for HF or worsening HF occurred in three (11%) in the active group and in four (15%) in the control group, p = .58. No difference was also observed with softer endpoints: NYHA class (1.9 ± 0.7 vs. 2.1 ± 0.7), subjective improvement (74% vs. 74%) and LV ejection fraction (40.7% vs. 40.7%). CONCLUSION Compared with conventional CRT, a shorter QRS width can be obtained with HBP alone or in association with coronary sinus pacing but we were unable to show a better clinical outcome. There is urgent need for large, randomized trials.
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Affiliation(s)
- Jacopo Senes
- Department of Cardiology, Arrhythmology Center, ASL 4 Chiavarese, Lavagna-Genova, Italy
| | - Giuseppe Mascia
- Cardiothoracovascular Department, Ospedale Policlinico San Martino Istituto di Ricovero e Cura a Carattere Scientifico per l'Oncologia, Electrophysiology Unit, Genova, Italy
| | - Nicola Bottoni
- Department of Cardiology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Daniele Oddone
- Department of Cardiology, Arrhythmology Center, ASL 4 Chiavarese, Lavagna-Genova, Italy
| | - Paolo Donateo
- Department of Cardiology, Arrhythmology Center, ASL 4 Chiavarese, Lavagna-Genova, Italy
| | - Teresa Grimaldi
- Department of Cardiology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Calogero Minneci
- Department of Cardiology, Ospedale San Giovanni di Dio, Firenze, Italy
| | - Iacopo Bertolozzi
- Department of Cardiology, Ospedale San Giovanni di Dio, Firenze, Italy
| | - Michele Brignole
- Department of Cardiology, Arrhythmology Center, ASL 4 Chiavarese, Lavagna-Genova, Italy
| | - Enrico Puggioni
- Department of Cardiology, Arrhythmology Center, ASL 4 Chiavarese, Lavagna-Genova, Italy
| | - Giovanni Coluccia
- Department of Cardiology, Arrhythmology Center, ASL 4 Chiavarese, Lavagna-Genova, Italy
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Ma PP, Yang YH, Dai BL, Zhang RF, Wang N, Li DN, Yin XM, Gao LJ, Xia YL, Yang YZ, Dong YX. Brady-arrhythmias in patients with atrial fibrillation and heart failure of reduced ejection fraction: is his-bundle pacing superior to biventricular pacing?. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1193-1199. [PMID: 34080696 DOI: 10.1111/pace.14289] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 04/19/2021] [Accepted: 05/30/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the efficacy and safety of His-bundle pacing (HBP) compared with the traditional biventricular pacing (BVP) on patients with brady-arrhythmias, who suffer from permanent atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF). METHODS All patients with brady-arrhythmias, permanent AF and HFrEF were continuously enrolled from January 2017 to July 2019 and followed up for at least 12 months. The differences in QRS duration (QRSd), New York Heart Association (NYHA) classification, left ventricular ejection fraction (LVEF), tricuspid regurgitation grade, mitral regurgitation grade, left ventricular end-diastolic diameter (LVEDD), and left atrial size were compared. RESULTS A total of 52 patients were enrolled: 37 patients were with HBP and 15 patients with BVP. There was no electrode dislodged, perforation, infection or thrombosis during the follow-up of 18.12 ± 4.45 months. The success rate for HBP implantation was 88.10%. The capture threshold of his-bundle and the threshold of the left ventricular lead remained stable during follow-up. LVEF increased to higher than 50% in 11 patients with HBP (29.73%). The NYHA classification (both p < .001), LVEF (both p < .001) and LVEDD improved significantly during the follow-up in both groups. NYHA (p = .030), LVEF (p = .013), and LVEDD (p = .003) improved in patients with HBP compared with BVP. CONCLUSION HBP was safe and more effective in improving the cardiac function and remodeling in patients with brady-arrhythmias, permanent AF and HFrEF compared with BVP.
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Affiliation(s)
- Pei-Pei Ma
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yi-Heng Yang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Bai-Ling Dai
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Rong-Feng Zhang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Nan Wang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Dan-Na Li
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Xiao-Meng Yin
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Lian-Jun Gao
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yun-Long Xia
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yan-Zong Yang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Ying-Xue Dong
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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41
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A novel and practical technique to facilitate lead insertion at the His bundle region. J Interv Card Electrophysiol 2021; 66:531-537. [PMID: 34013426 DOI: 10.1007/s10840-021-00941-z] [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: 08/07/2020] [Accepted: 01/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND His bundle (HB) pacing techniques are challenging and time-consuming. This is primarily due to the limitations in locating the relatively small area of the HB body for pacing. METHODS Permanent HB pacing was performed in 133 consecutive patients with symptomatic bradycardia. A right atrial septo-gram (RAS) was performed in all patients to locate the HB. Briefly, 8-10 cc of contrast was injected through the Medtronic C315HIS delivery sheath while fluoroscopy cine runs were obtained in the RAO 15-20° projection. The images obtained provided the visualization of an approximately 90° angle composed by the medial aspect of the tricuspid valve annulus (TVA) anteriorly and the superior aspect of the interatrial septum superiorly. The apex of this angle coincides with the tip of the triangle of Koch (TK), where the HB body is usually located. A Medtronic SelectSecure™ MRI SureScan™ Model 3830 lead was then advanced and directed towards this area. The HB was mapped using pace mapping and unipolar recordings from the lead tip. RESULTS Localization of the apex of the TK/HB body with the RAS was successful in all patients. The overall acute success of inserting the lead at the HB was 95%. CONCLUSION This study demonstrated that our method of utilizing a RAS to facilitate the localization the HB body proved to be safe and efficient in achieving permanent HB pacing with a success rate higher than previously reported.
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42
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Acosta H, Acosta NJ, Lopera G. Representation of the His Bundle Cloud on a Three-dimensional Electroanatomical Map and Its Implications for His Bundle Pacing. J Innov Card Rhythm Manag 2021; 12:4498-4499. [PMID: 34035981 PMCID: PMC8139304 DOI: 10.19102/icrm.2021.120507] [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: 10/13/2020] [Accepted: 12/04/2020] [Indexed: 11/06/2022] Open
Abstract
His bundle pacing has been proposed as a more physiologic approach to chronic ventricular stimulation, yet the achievement of permanent His bundle pacing can be challenging.
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Affiliation(s)
| | | | - Gustavo Lopera
- Orlando Veterans Affairs Medical Center, Orlando, FL, USA.,University of Central Florida College of Medicine, Orlando, FL, USA
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43
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Grieco D, Bressi E, Curila K, Padala SK, Sedlacek K, Kron J, Fedele E, Ionita O, Giannuzzi S, Fagagnini A, Panattoni G, De Ruvo E, Ellenbogen KA, Calò L. Impact of His bundle pacing on right ventricular performance in patients undergoing permanent pacemaker implantation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:986-994. [PMID: 33890685 DOI: 10.1111/pace.14249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/11/2021] [Accepted: 04/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND His-Bundle pacing (HBP) is an emerging technique for physiological pacing. However, its effects on right ventricle (RV) performance are still unknown. METHODS We enrolled consecutive patients with an indication for pacemaker (PM) implantation to compare HBP versus RV pacing (RVP) effects on RV performance. Patients were evaluated before implantation and after 6 months by a transthoracic echocardiogram. RESULTS A total of 84 patients (age 75.1±7.9 years, 64% male) were enrolled, 42 patients (50%) underwent successful HBP, and 42 patients (50%) apical RVP. At follow up, we found a significant improvement in RV-FAC (Fractional Area Change)% [baseline: HBP 34 IQR (31-37) vs. RVP 33 IQR (29.7-37.2),p = .602; 6-months: HBP 37 IQR (33-39) vs. RVP 30 IQR (27.7-35), p < .0001] and RV-GLS (Global Longitudinal Strain)% [baseline: HBP -18 IQR (-20.2 to -15) vs. RVP -16 IQR (-18.7 to -14), p = .150; 6-months: HBP -20 IQR(-23 to -17) vs. RVP -13.5 IQR (-16 to -11), p < .0001] with HBP whereas RVP was associated with a significant decline in both parameters. RVP was also associated with a significant worsening of tricuspid annular plane systolic excursion (TAPSE) (p < .0001) and S wave velocity (p < .0001) at follow up. Conversely from RVP, HBP significantly improved pulmonary artery systolic pressure (PASP) [baseline: HBP 38 IQR (32-42) mmHg vs. RVP 34 IQR (31.5-37) mmHg,p = .060; 6-months: HBP 32 IQR (26-38) mmHg vs. RVP 39 IQR (36-41) mmHg, p < .0001] and tricuspid regurgitation (p = .005) irrespectively from lead position above or below the tricuspid valve. CONCLUSIONS In patients undergoing PM implantation, HBP ensues a beneficial and protective impact on RV performance compared with RVP.
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Affiliation(s)
- Domenico Grieco
- Department of Cardiology, Policlinico Casilino of, Rome, Rome, Italy
| | - Edoardo Bressi
- Department of Cardiology, Policlinico Casilino of, Rome, Rome, Italy.,Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Karol Curila
- Department of Cardiology, Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Santosh K Padala
- Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kamil Sedlacek
- 1st Department of Internal Medicine - Cardiology and Angiology, University Hospital and Charles University Medical Faculty, Hradec Kralove, Czech Republic
| | - Jordana Kron
- Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Elisa Fedele
- Department of Cardiology, Policlinico Casilino of, Rome, Rome, Italy
| | - Oana Ionita
- Department of Cardiology, Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Sara Giannuzzi
- Department of Cardiology, Policlinico Casilino of, Rome, Rome, Italy
| | | | - Germana Panattoni
- Department of Cardiology, Policlinico Casilino of, Rome, Rome, Italy
| | | | - Kenneth A Ellenbogen
- Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Leonardo Calò
- Department of Cardiology, Policlinico Casilino of, Rome, Rome, Italy
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Kawashima T, Sato F. First in situ 3D visualization of the human cardiac conduction system and its transformation associated with heart contour and inclination. Sci Rep 2021; 11:8636. [PMID: 33883659 PMCID: PMC8060315 DOI: 10.1038/s41598-021-88109-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/08/2021] [Indexed: 02/07/2023] Open
Abstract
Current advanced imaging modalities with applied tracing and processing techniques provide excellent visualization of almost all human internal structures in situ; however, the actual 3D internal arrangement of the human cardiac conduction system (CCS) is still unknown. This study is the first to document the successful 3D visualization of the CCS from the sinus node to the bundle branches within the human body, based on our specialized physical micro-dissection and its CT imaging. The 3D CCS transformation by cardiac inclination changes from the standing to the lying position is also provided. Both actual dissection and its CT image-based simulation identified that when the cardiac inclination changed from standing to lying, the sinus node shifted from the dorso-superior to the right outer position and the atrioventricular conduction axis changed from a vertical to a leftward horizontal position. In situ localization of the human CCS provides accurate anatomical localization with morphometric data, and it indicates the useful correlation between heart inclination and CCS rotation axes for predicting the variable and invisible human CCS in the living body. Advances in future imaging modalities and methodology are essential for further accurate in situ 3D CCS visualization.
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Affiliation(s)
- Tomokazu Kawashima
- Department of Anatomy, School of Medicine, Toho University, 5-21-16 Omori-Nishi, Ota-ku, Tokyo, 143-8540, Japan.
| | - Fumi Sato
- Department of Anatomy, School of Medicine, Toho University, 5-21-16 Omori-Nishi, Ota-ku, Tokyo, 143-8540, Japan
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Abstract
Bradyarrhythmias represent a common pathology in the intensive care unit (ICU) with etiologies of varying severity. Treatment has often been focused on correcting underlying causes and may require pacing for urgent hemodynamic support. In recent years, there has been interest in physiologic pacing modalities which avoid the dyssynchrony from right ventricular (RV) only pacing. Cardiac resynchronization therapy (CRT) through biventricular pacing is a well-established device-based electrical therapy in patients with wide QRS and heart failure. Recently, it has been shown that biventricular pacing may also be pursued for hemodynamic rescue in the ICU setting. Efforts to re-engage the conduction system with His bundle pacing or further downstream have also emerged as alternative means to deliver resynchronization, with early applications in the ICU now being reported. The goal of the review is to examine bradyarrhythmia causes and management in the ICU as well as investigate new approaches in physiologic pacing and their potential roles in critically ill patients.
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Affiliation(s)
- Jonathan Lattell
- Center for Arrhythmia Care
- Heart and Vascular Institute, University of Chicago Pritzker School of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - Gaurav A Upadhyay
- Center for Arrhythmia Care
- Heart and Vascular Institute, University of Chicago Pritzker School of Medicine, The University of Chicago Medicine, Chicago, IL, USA
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46
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Sidhu BS, Gould J, Elliott MK, Mehta V, Niederer S, Rinaldi CA. Leadless Left Ventricular Endocardial Pacing and Left Bundle Branch Area Pacing for Cardiac Resynchronisation Therapy. Arrhythm Electrophysiol Rev 2021; 10:45-50. [PMID: 33936743 PMCID: PMC8076968 DOI: 10.15420/aer.2020.46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 12/31/2020] [Indexed: 12/02/2022] Open
Abstract
Cardiac resynchronisation therapy is an important intervention to reduce mortality and morbidity, but even in carefully selected patients approximately 30% fail to improve. This has led to alternative pacing approaches to improve patient outcomes. Left ventricular (LV) endocardial pacing allows pacing at site-specific locations that enable the operator to avoid myocardial scar and target areas of latest activation. Left bundle branch area pacing (LBBAP) provides a more physiological activation pattern and may allow effective cardiac resynchronisation. This article discusses LV endocardial pacing in detail, including the indications, techniques and outcomes. It discusses LBBAP, its potential benefits over His bundle pacing and procedural outcomes. Finally, it concludes with the future role of endocardial pacing and LBBAP in heart failure patients.
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Affiliation(s)
- Baldeep S Sidhu
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Guy's and St Thomas' Hospital, London, UK
| | - Justin Gould
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Guy's and St Thomas' Hospital, London, UK
| | - Mark K Elliott
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Guy's and St Thomas' Hospital, London, UK
| | - Vishal Mehta
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Guy's and St Thomas' Hospital, London, UK
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Guy's and St Thomas' Hospital, London, UK
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47
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Abstract
Cardiac implantable electronic devices (CIEDs) are essential for the management of a variety of cardiac conditions, including tachyarrhythmias, bradyarrhythmias, and medically refractory heart failure (HF). Recent advancements in CIED technology have led to innovative solutions that overcome shortcomings associated with traditional devices or address unmet needs. Leadless pacemakers, subcutaneous implantable cardioverter defibrillators (ICDs), and extravascular ICDs eliminate lead-related complications common with conventional pacemakers or ICDs. Conduction system pacing (His bundle pacing and left bundle branch pacing) is a more physiologic method of pacing and avoids the deleterious consequences associated with long-term right ventricular pacing. For HF-related devices, cardiac contractility modulation is an emerging therapy that bridges a gap for many patients ineligible for cardiac resynchronization therapy and has been shown to improve HF symptoms and decrease hospitalizations and mortality in select patients. Implantable pulmonary artery pressure monitors help guide HF management and reduce hospitalizations. Lastly, new phrenic nerve stimulating devices are being utilized to treat central sleep apnea, a common comorbidity associated with HF. While further long-term studies are still underway for many of these new technologies, it is anticipated that these devices will become indispensable therapeutics in the expanding cardiovascular armamentarium.
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48
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Liu X, Gu M, Hua W, Hu Y, Niu HX, Cai M, Zhang N, Zhang S. Comparison of electrical characteristics and pacing parameters of pacing different parts of the His-Purkinje system in bradycardia patients. J Interv Card Electrophysiol 2021; 63:175-183. [PMID: 33616880 DOI: 10.1007/s10840-021-00962-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/07/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE We aimed to evaluate the electrical characteristics and pacing parameters at different locations of His-Purkinje system pacing. METHODS Patients who successfully underwent His-Purkinje system pacing with bradycardia indications from April 2018 to August 2019 were retrospectively analyzed according to the lead location confirmed by visualization of the tricuspid value annulus, postoperative echocardiography, and pacing electrocardiogram. The electrical characteristics and pacing parameters were compared among these patients. RESULTS A total of 135 patients were retrospectively analyzed. Among them, 30 patients received atrial side HBP (aHBP group), 52 received ventricular side HBP (vHBP group), and 53 received left bundle branch pacing (LBBP group). The proportion of non-selective pacing was significantly lower in aHBP group (30.0%) than in vHBP (75.0%) and LBBP group (90.6%). LBBP had significantly shorter procedural and fluoroscopic duration than aHBP and vHBP. The capture threshold was significantly higher (1.07 ± 0.26 V/1.0 ms vs. 0.89 ± 0.22 V/1.0 ms vs. 0.77 ± 0.18 V/0.4 ms, P < 0.01, respectively), and the R-wave amplitude was significantly lower (3.71 ± 1.72 mV vs. 5.81 ± 2.37 mV vs. 10.27 ± 4.71 mV, P < 0.05 respectively) in aHBP group than those in the other two groups at implantation and during 3-month follow-up. No significant differences were observed in complications among groups during 3-month follow-up. CONCLUSION VHBP and LBBP had better pacing performances than aHBP and might be more ideal pacing methods for bradycardia patients.
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Affiliation(s)
- Xi Liu
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Bei Li Shi Road, Xicheng District, Beijing, China
| | - Min Gu
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Bei Li Shi Road, Xicheng District, Beijing, China
| | - Wei Hua
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Bei Li Shi Road, Xicheng District, Beijing, China.
| | - Yiran Hu
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Bei Li Shi Road, Xicheng District, Beijing, China
| | - Hong-Xia Niu
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Bei Li Shi Road, Xicheng District, Beijing, China
| | - Minsi Cai
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Bei Li Shi Road, Xicheng District, Beijing, China
| | - Nixiao Zhang
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Bei Li Shi Road, Xicheng District, Beijing, China
| | - Shu Zhang
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Bei Li Shi Road, Xicheng District, Beijing, China
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Kothari P, Poorsattar SP, Graul T, Cody J, Steinhorn R, Choi C, Essandoh MK, Cronin B, Dalia A. The Year in Electrophysiology: Selected Highlights From 2020. J Cardiothorac Vasc Anesth 2021; 35:1942-1952. [PMID: 33602638 DOI: 10.1053/j.jvca.2021.01.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 11/11/2022]
Abstract
This article is the third in an annual series for the Journal of Cardiothoracic and Vascular Anesthesia. The authors thank the Editor-in-Chief Dr. Kaplan, the Associate Editor-in-Chief Dr. Augoustides, and the editorial board for the opportunity to continue this series; namely, the highlights of the year that pertain to electrophysiology in relation to cardiothoracic and vascular anesthesia. This third article focuses on the convergent procedure, His-bundle pacing, a comparison of subcutaneous and transvenous defibrillator therapies, the 2020 practice advisory update for the perioperative management of patients with cardiac implantable electronic devices, and a technology update regarding the Micra AV (Medtronic, Moundsview, MN), the EMPOWER leadless pacemaker (Boston Scientific, Marlborough, MA), WiSE-CRT (EBR Systems, Sunnyvale, CA), the Extravascular Implantable Cardioverter Defibrillator (Medtronic, Moundsview, MN), and the BAROSTIM NEO (CVRx Inc, Minneapolis, MN).
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Affiliation(s)
- Perin Kothari
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Sophia P Poorsattar
- Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, CA
| | - Thomas Graul
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Joseph Cody
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Rachel Steinhorn
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital-Harvard Medical School, Boston, MA
| | - Christine Choi
- Department of Anesthesiology, University of California, San Diego, CA
| | - Michael K Essandoh
- Cardiovascular Anesthesiology, Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Brett Cronin
- Clinical Department of Anesthesiology, University of California, San Diego, CA.
| | - Adam Dalia
- Division of Cardiac Anesthesiology, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital-Harvard Medical School, Boston, MA
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Hua W, Zhang S, Huang D. The implantation technique in His-bundle pacing: evolution and perspectives. Europace 2020; 22:ii3-ii9. [PMID: 33370796 DOI: 10.1093/europace/euaa331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Wei Hua
- The Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing 100037, China
| | - Shu Zhang
- The Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing 100037, China
| | - Dejia Huang
- Department of Cardiology, Huaxi Hospital of Sichuan University, Chengdu 610041, China
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