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Vijayaraman P, Chelu MG, Curila K, Dandamudi G, Herweg B, Mori S, Jastrzebski M, Sharma PS, Shivkumar K, Tung R, Upadhyay G, Vernooy K, Welter-Frost A, Whinnett Z, Zanon F, Ellenbogen KA. Cardiac Conduction System Pacing: A Comprehensive Update. JACC Clin Electrophysiol 2023; 9:2358-2387. [PMID: 37589646 DOI: 10.1016/j.jacep.2023.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/10/2023] [Accepted: 06/02/2023] [Indexed: 08/18/2023]
Abstract
The field of cardiac pacing has changed rapidly in the last several years. Since the initial description of His bundle pacing targeting the conduction system, recent advances in pacing the left bundle branch and its fascicles have evolved. The field and investigators' knowledge of conduction system pacing including relevant anatomy and physiology has advanced significantly. The aim of this review is to provide a comprehensive update on recent advances in conduction system pacing.
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Affiliation(s)
- Pugazhendhi Vijayaraman
- Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania, USA.
| | - Mihal G Chelu
- Division of Cardiology, Baylor College of Medicine and Baylor St. Luke's Medical Center and Texas Heart Institute, Houston, Texas, USA
| | - Karol Curila
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Gopi Dandamudi
- Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Bengt Herweg
- University of South Florida Morsani College of Medicine, Department of Cardiovascular Sciences, Tampa, Florida, USA
| | - Shumpei Mori
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Marek Jastrzebski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
| | - Parikshit S Sharma
- Department of Cardiology, Rush University School of Medicine, Chicago, Illinois, USA
| | - Kalyanam Shivkumar
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Roderick Tung
- Division of Cardiology, University of Arizona College of Medicine-Phoenix, Banner-University Medical Center, Phoenix, Arizona, USA
| | - Gaurav Upadhyay
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Kevin Vernooy
- Center for Arrhythmia Care, Heart and Vascular Center, University of Chicago, Chicago, Illinois, USA
| | - Allan Welter-Frost
- Cleveland Clinic Indian River Hospital, Heart Vascular and Thoracic Institute, Vero Beach, Florida, USA
| | - Zachary Whinnett
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | - Kenneth A Ellenbogen
- Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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Moustafa AT, Tang ASL, Khan HR. Conduction system pacing on track to replace CRT? Review of current evidence and prospects of conduction system pacing. Front Cardiovasc Med 2023; 10:1220709. [PMID: 37649666 PMCID: PMC10463741 DOI: 10.3389/fcvm.2023.1220709] [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: 05/11/2023] [Accepted: 07/31/2023] [Indexed: 09/01/2023] Open
Abstract
Conduction system pacing (CSP) has been emerging over the last decade as a pacing option instead of conventional right ventricular (RV) pacing and biventricular (BiV) pacing. Numerous case reports, some observational studies and a few randomized control trials have looked at optimum pacing strategies for heart failure (HF) with left bundle branch block (LBBB) or cases where left ventricular (LV) dysfunction is anticipated due to chronic RV pacing (RVP). Evolution of pacing strategies from standard RVP to septal RVP, BiV pacing and now CSP have shown improving hemodynamic responses and possible ease of implantation of CSP systems. In this review article, we review the literature on the evolution of CSP and common scenarios where it might be beneficial.
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Affiliation(s)
| | | | - Habib Rehman Khan
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
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3
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Prinzen FW, Lumens J, Duchenn J, Vernooy K. Electro-energetics of Biventricular, Septal and Conduction System Pacing. Arrhythm Electrophysiol Rev 2021; 10:250-257. [PMID: 35106177 PMCID: PMC8785089 DOI: 10.15420/aer.2021.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/27/2021] [Indexed: 11/10/2022] Open
Abstract
Abnormal electrical activation of the ventricles creates abnormalities in cardiac mechanics. Local contraction patterns, as reflected by strain, are not only out of phase, but also show opposing length changes in early and late activated regions. Consequently, the efficiency of cardiac pump function (the amount of stroke work generated by a unit of oxygen consumed), is approximately 30% lower in dyssynchronous than in synchronous hearts. Maintaining good cardiac efficiency appears important for long-term outcomes. Biventricular, left ventricular septal, His bundle and left bundle branch pacing may minimise the amount of pacing-induced dyssynchrony and efficiency loss when compared to conventional right ventricular pacing. An extensive animal study indicates maintenance of mechanical synchrony and efficiency during left ventricular septal pacing and data from a few clinical studies support the idea that this is also the case for left bundle branch pacing and His bundle pacing. This review discusses electro-mechanics and mechano-energetics under the various paced conditions and provides suggestions for future research.
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Affiliation(s)
- Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands
| | - Joost Lumens
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands
| | - J�rgen Duchenn
- Department of Cardiovascular Sciences, KU Leuven, Belgium
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+ (MUMC+), the Netherlands
- Department of Cardiology, Radboud University Medical Centre (Radboudumc), Nijmegen, the Netherlands
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Hemodynamic Effects of Permanent His Bundle Pacing Compared to Right Ventricular Pacing Assessed by Two-Dimensional Speckle-Tracking Echocardiography. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111721. [PMID: 34770235 PMCID: PMC8583013 DOI: 10.3390/ijerph182111721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/04/2021] [Accepted: 11/06/2021] [Indexed: 11/29/2022]
Abstract
We compared the effects of right ventricular (RVP; n = 26) and His bundle (HBP; n = 24) pacing in patients with atrioventricular conduction disorders and preserved LVEF. Postoperatively (1D), and after six months (6M), the patients underwent global longitudinal strain (GLS) and peak systolic dispersion (PSD) evaluation with 2D speckle-tracking echocardiography, assessment of left atrial volume index (LAVI) and QRS duration (QRSd), and sensing/pacing parameter testing. The RVP threshold was lower than the HBP threshold at 1D (0.65 ± 0.13 vs. 1.05 ± 0.20 V, p < 0.001), and then it remained stable, while the HBP threshold increased at 6M (1.05 ± 0.20 vs. 1.31 ± 0.30 V, p < 0.001). The RVP R-wave was higher than the HBP R-wave at 1D (11.52 ± 2.99 vs. 4.82 ± 1.41 mV, p < 0.001). The RVP R-wave also remained stable, while the HBP R-wave decreased at 6M (4.82 ± 1.41 vs. 4.50 ± 1.09 mV, p < 0.02). RVP QRSd was longer than HBP QRSd at 6M (145.0 ± 11.1 vs. 112.3 ± 9.3 ms, p < 0.001). The absolute value of RVP GLS decreased at 6M (16.32 ± 2.57 vs. 14.03 ± 3.78%, p < 0.001), and HBP GLS remained stable. Simultaneously, RVP PSD increased (72.53 ± 24.15 vs. 88.33 ± 30.51 ms, p < 0.001) and HBP PSD decreased (96.28 ± 33.99 vs. 84.95 ± 28.98 ms, p < 0.001) after 6 months. RVP LAVI increased (26.73 ± 5.7 vs. 28.40 ± 6.4 mL/m2, p < 0.05), while HBP LAVI decreased at 6M (30.03 ± 7.8 vs. 28.73 ± 8.7 mL/m2, p < 0.01). These results confirm that HBP does not disrupt ventricular synchrony and provides advantages over RVP.
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Jastrzębski M, Moskal P, Kukla P, Bednarek A, Kiełbasa G, Rajzer M, Curila K, Vijayaraman P. Novel approach to diagnosis of His bundle capture using individualized left ventricular lateral wall activation time as reference. J Cardiovasc Electrophysiol 2021; 32:3010-3018. [PMID: 34455648 DOI: 10.1111/jce.15233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/28/2021] [Accepted: 08/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND During nonselective His bundle (HB) pacing, it is clinically important to confirm His bundle capture versus right ventricular septal (RVS) capture. The present study aimed to validate the hypothesis that during HB capture, left ventricular lateral wall activation time, approximated by the V6 R-wave peak time (V6 RWPT), will not be longer than the corresponding activation time during native conduction. METHODS Consecutive patients with permanent HB pacing were recruited; cases with abnormal His-ventricle interval or left bundle branch block were excluded. Two corresponding intervals were compared: stimulus-V6 RWPT and native HB potential-V6 RWPT. The difference between these two intervals (delta V6 RWPT), which was diagnostic of lack of HB capture, was identified using receiver operating characteristic (ROC) curve analysis. RESULTS A total of 723 electrocardiograms (ECGs) (219 with native rhythm, 172 with selective HB, 215 with nonselective HB, and 117 with RVS capture) were obtained from 219 patients. The native HB-V6 RWPT, nonselective-, and selective-HB paced V6 RWPT were nearly equal, while RVS V6 RWPT was 32.0 (±9.5) ms longer. The ROC curve analysis indicated delta V6 RWPT > 12 ms as diagnostic of lack of HB capture (specificity of 99.1% and sensitivity of 100%). A blinded observer correctly diagnosed 96.7% (321/332) of ECGs using this criterion. CONCLUSIONS We validated a novel criterion for HB capture that is based on the physiological left ventricular activation time as an individualized reference. HB capture can be diagnosed when paced V6 RWPT does not exceed the value obtained during native conduction by more than 12 ms, while longer paced V6 RWPT indicates RVS capture.
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Affiliation(s)
- Marek Jastrzębski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Paweł Moskal
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Piotr Kukla
- Department of Cardiology, H. Klimontowicz Specialistic Hospital, Gorlice, Poland
| | - Agnieszka Bednarek
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Grzegorz Kiełbasa
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Marek Rajzer
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Karol Curila
- Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Pugazhendhi Vijayaraman
- Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania, USA
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Jastrzębski M, Curila K. "Selective" or "exclusive" His bundle capture. J Cardiovasc Electrophysiol 2021; 32:2609. [PMID: 34288229 DOI: 10.1111/jce.15165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/07/2021] [Accepted: 07/11/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Marek Jastrzębski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Karol Curila
- Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
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Coluccia G, Accogli M, Palmisano P. Selective versus exclusive: A matter of clearness in His bundle pacing. J Cardiovasc Electrophysiol 2021; 32:2608. [PMID: 34260120 DOI: 10.1111/jce.15166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 06/02/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | - Michele Accogli
- Cardiology Unit, "Card. Giovanni Panico" Hospital, Tricase, Italy
| | - Pietro Palmisano
- Cardiology Unit, "Card. Giovanni Panico" Hospital, Tricase, Italy
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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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Curila K, Jurak P, Halamek J, Prinzen F, Waldauf P, Karch J, Stros P, Plesinger F, Mizner J, Susankova M, Prochazkova R, Sussenbek O, Viscor I, Vondra V, Smisek R, Leinveber P, Osmancik P. Ventricular activation pattern assessment during right ventricular pacing: Ultra‐high‐frequency ECG study. J Cardiovasc Electrophysiol 2021; 32:1385-1394. [DOI: 10.1111/jce.14985] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/14/2021] [Accepted: 02/22/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Karol Curila
- Cardiocenter, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - Pavel Jurak
- Institute of Scientific Instruments, Czech Academy of Sciences Brno Czech Republic
| | - Josef Halamek
- Institute of Scientific Instruments, Czech Academy of Sciences Brno Czech Republic
| | - Frits Prinzen
- Department of Physiology Cardiovascular Research Institute Maastricht Maastricht the Netherlands
| | - Petr Waldauf
- Department of Anesthesia and Intensive Care Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - Jakub Karch
- Cardiocenter, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - Petr Stros
- Cardiocenter, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - Filip Plesinger
- Institute of Scientific Instruments, Czech Academy of Sciences Brno Czech Republic
| | - Jan Mizner
- Cardiocenter, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - Marketa Susankova
- Cardiocenter, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - Radka Prochazkova
- Cardiocenter, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - Ondrej Sussenbek
- Cardiocenter, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - Ivo Viscor
- Institute of Scientific Instruments, Czech Academy of Sciences Brno Czech Republic
| | - Vlastimil Vondra
- Institute of Scientific Instruments, Czech Academy of Sciences Brno Czech Republic
| | - Radovan Smisek
- Institute of Scientific Instruments, Czech Academy of Sciences Brno Czech Republic
- Department of Biomedical Engineering, Faculty of Electrical Engineering and Communication Brno University of Technology Brno Czech Republic
| | - Pavel Leinveber
- International Clinical Research Center St. Anne's University Hospital Brno Czech Republic
| | - Pavel Osmancik
- Cardiocenter, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic
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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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