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Michalik J, Moroz R, Szołkiewicz M, Dąbrowska-Kugacka A, Daniłowicz-Szymanowicz L. Left Bundle Branch Area Pacing to Overcome Coronary Sinus Anatomy-Related Technical Problems Encountered during Implantation of Biventricular CRT-A Case Report. J Clin Med 2024; 13:3307. [PMID: 38893018 PMCID: PMC11172450 DOI: 10.3390/jcm13113307] [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: 04/24/2024] [Revised: 05/16/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
The results of clinical trials show that up to one-third of patients who are eligible for cardiac resynchronization therapy (CRT) do not benefit from biventricular pacing. The reasons vary, including technical problems related to left ventricle pacing lead placement in the appropriate branch of the coronary sinus. Herein, we present a case report of a patient with heart failure with reduced ejection fraction and left bundle branch block, in whom a poor coronary sinus bed made implantation of classic biventricular CRT impossible, but in whom, alternatively, rescue-performed left bundle branch area pacing allowed effective electrical and mechanical cardiac resynchronization. The report confirms that left bundle branch area pacing may be a rational alternative in such cases.
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Affiliation(s)
- Jędrzej Michalik
- Department of Cardiology and Interventional Angiology, Kashubian Center for Heart and Vascular Diseases, Pomeranian Hospitals, 84-200 Wejherowo, Poland; (J.M.); (R.M.)
| | - Roman Moroz
- Department of Cardiology and Interventional Angiology, Kashubian Center for Heart and Vascular Diseases, Pomeranian Hospitals, 84-200 Wejherowo, Poland; (J.M.); (R.M.)
| | - Marek Szołkiewicz
- Department of Cardiology and Interventional Angiology, Kashubian Center for Heart and Vascular Diseases, Pomeranian Hospitals, 84-200 Wejherowo, Poland; (J.M.); (R.M.)
| | - Alicja Dąbrowska-Kugacka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, 80-214 Gdansk, Poland; (A.D.-K.); (L.D.-S.)
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Dell'Era G, Baroni M, Frontera A, Ghiglieno C, Carbonaro M, Penela D, Romano C, Giordano F, Del Monaco G, Galimberti P, Mazzone P, Patti G. Left bundle branch area versus conventional pacing after transcatheter valve implant for aortic stenosis: the LATVIA study. J Cardiovasc Med (Hagerstown) 2024; 25:450-456. [PMID: 38625833 DOI: 10.2459/jcm.0000000000001619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
BACKGROUND Atrioventricular block (AVB) is a frequent complication in patients undergoing transcatheter aortic valve implantation (TAVI). Right apex ventricular pacing (RVP) represents the standard treatment but may induce cardiomyopathy over the long term. Left bundle branch area pacing (LBBAP) is a promising alternative, minimizing the risk of desynchrony. However, available evidence with LBBAP after TAVI is still low. OBJECTIVE To assess the feasibility and safety of LBBAP for AVB post-TAVI compared with RVP. METHODS Consecutive patients developing AVB early after TAVI were enrolled between 1 January 2022 and 31 December 2022 at three high-volume hospitals and received LBBAP or RVP. Data on procedure and at short-term follow-up (at least 3 months) were collected. RESULTS A total of 38 patients (61% men, mean age 83 ± 6 years) were included; 20 patients (53%) received LBBAP. Procedural success was obtained in all patients according to chosen pacing strategy. Electrical pacing performance at implant and after a mean follow-up of 4.2 ± 2.8 months was clinically equivalent for both pacing modalities. In the LBBAP group, procedural time was longer (70 ± 17 versus 58 ± 15 min in the RVP group, P = 0.02) and paced QRS was shorter (120 ± 19 versus 155 ± 12 ms at implant, P < 0.001; 119 ± 18 versus 157 ± 9 ms at follow-up, P < 0.001). Complication rates did not differ between the two groups. CONCLUSION In patients with AVB after TAVI, LBBAP is feasible and safe, resulting in a narrow QRS duration, either acutely and during the follow-up, compared with RVP. Further studies are needed to evaluate if LBBAP reduces pacing-induced cardiomyopathy in this clinical setting.
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Affiliation(s)
- Gabriele Dell'Era
- Clinica Cardiologica, Dipartimento Toraco-Cardio-Vascolare, Ospedale Maggiore della Carità, Novara
| | - Matteo Baroni
- Cardiologia 3. A. De' Gasperis Cardio Center, ASST GOM Niguarda Hospital
| | - Antonio Frontera
- Cardiologia 3. A. De' Gasperis Cardio Center, ASST GOM Niguarda Hospital
| | - Chiara Ghiglieno
- Clinica Cardiologica, Dipartimento Toraco-Cardio-Vascolare, Ospedale Maggiore della Carità, Novara
| | - Marco Carbonaro
- Cardiologia 3. A. De' Gasperis Cardio Center, ASST GOM Niguarda Hospital
| | | | - Carmine Romano
- Università del Piemonte Orientale Amedeo Avogadro, Italy
| | - Federica Giordano
- Cardiologia 3. A. De' Gasperis Cardio Center, ASST GOM Niguarda Hospital
| | | | | | - Patrizio Mazzone
- Cardiologia 3. A. De' Gasperis Cardio Center, ASST GOM Niguarda Hospital
| | - Giuseppe Patti
- Clinica Cardiologica, Dipartimento Toraco-Cardio-Vascolare, Ospedale Maggiore della Carità, Novara
- Università del Piemonte Orientale Amedeo Avogadro, Italy
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3
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Dell'Era G, Ghiglieno C, Degiovanni A, De Vecchi F, Porcellini S, Santagostino M, Veroli A, D'Amico A, Spinoni EG, Patti G. Early effects of left bundle branch area pacing on ventricular activation by speckle tracking echocardiography. J Interv Card Electrophysiol 2024; 67:341-351. [PMID: 37599321 DOI: 10.1007/s10840-023-01616-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/01/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Left bundle branch area pacing (LBBAP) is an emerging cardiac pacing modality that preserves fast electrical activation of the ventricles and provides very good electrical measures. Little is known on mechanical ventricular activation during this pacing modality. METHODS We prospectively enrolled patients receiving LBBAP. Electrocardiographic and electrical parameters were evaluated at implantation, < 24 h and 3 months. Transthoracic echocardiography with strain analysis was performed at baseline and after 3 months, when ventricular mechanical activation and synchrony were analyzed by time-to-peak standard deviation (TPSD) of strain curves for both ventricles. Intraventricular left ventricular (LV) dyssynchrony was investigated by LV TPSD and interventricular dyssynchrony by left ventricle-right ventricle TPSD (LV-RV TPSD). RESULTS We screened 58 patients with permanent pacing indication who attempted LBBAP. Procedural success was obtained in 56 patients (97%). Strain data were available in 50 patients. QRS duration was 124.1 ± 30.7 ms at baseline, while paced QRS duration was 107.7 ± 13.6 ms (p < 0.001). At 3 months after LBBAP, left ventricular ejection fraction (LVEF) increased from 52.9 ± 10.6% at baseline to 56.9 ± 8.4% (p = 0.004) and both intraventricular LV dyssynchrony and interventricular dyssynchrony significantly improved (LV TPSD reduction from 38.2 (13.6-53.9) to 15.1 (8.3-31.5), p < 0.001; LV-RV TPSD from 27.9 (10.2-41.5) to 13.9 (4.3-28.7), p = 0.001). Ameliorations with LBBAP were consistent in all subgroups, irrespective of baseline QRS duration, types of intraventricular conduction abnormalities, and LVEF. CONCLUSIONS Echocardiographic strain analysis shows that LBBAP determines a fast and synchronous biventricular contraction with a stereotype mechanical activation, regardless of baseline QRS duration, pattern, and LV function.
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Affiliation(s)
- Gabriele Dell'Era
- Clinica Cardiologica, Dipartimento Toraco-Cardio-Vascolare, Ospedale Maggiore Della Carità Di Novara, Corso Mazzini 18, 28100, Novara, Italy.
| | - Chiara Ghiglieno
- Clinica Cardiologica, Dipartimento Toraco-Cardio-Vascolare, Ospedale Maggiore Della Carità Di Novara, Corso Mazzini 18, 28100, Novara, Italy
- Università del Piemonte Orientale Amedeo Avogadro, Vercelli, Italy
| | - Anna Degiovanni
- Clinica Cardiologica, Dipartimento Toraco-Cardio-Vascolare, Ospedale Maggiore Della Carità Di Novara, Corso Mazzini 18, 28100, Novara, Italy
| | - Federica De Vecchi
- Clinica Cardiologica, Dipartimento Toraco-Cardio-Vascolare, Ospedale Maggiore Della Carità Di Novara, Corso Mazzini 18, 28100, Novara, Italy
| | - Stefano Porcellini
- Clinica Cardiologica, Dipartimento Toraco-Cardio-Vascolare, Ospedale Maggiore Della Carità Di Novara, Corso Mazzini 18, 28100, Novara, Italy
| | - Matteo Santagostino
- Clinica Cardiologica, Dipartimento Toraco-Cardio-Vascolare, Ospedale Maggiore Della Carità Di Novara, Corso Mazzini 18, 28100, Novara, Italy
| | - Alessandro Veroli
- Clinica Cardiologica, Dipartimento Toraco-Cardio-Vascolare, Ospedale Maggiore Della Carità Di Novara, Corso Mazzini 18, 28100, Novara, Italy
- Università del Piemonte Orientale Amedeo Avogadro, Vercelli, Italy
| | - Anthea D'Amico
- Clinica Cardiologica, Dipartimento Toraco-Cardio-Vascolare, Ospedale Maggiore Della Carità Di Novara, Corso Mazzini 18, 28100, Novara, Italy
- Università del Piemonte Orientale Amedeo Avogadro, Vercelli, Italy
| | - Enrico Guido Spinoni
- Clinica Cardiologica, Dipartimento Toraco-Cardio-Vascolare, Ospedale Maggiore Della Carità Di Novara, Corso Mazzini 18, 28100, Novara, Italy
- Università del Piemonte Orientale Amedeo Avogadro, Vercelli, Italy
| | - Giuseppe Patti
- Clinica Cardiologica, Dipartimento Toraco-Cardio-Vascolare, Ospedale Maggiore Della Carità Di Novara, Corso Mazzini 18, 28100, Novara, Italy
- Università del Piemonte Orientale Amedeo Avogadro, Vercelli, Italy
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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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5
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Boczar K, Ząbek A, Golińska-Grzybała K, Sławuta A, Dębski M, Gajek J, Holcman K, Gackowski A, Lelakowski J, Małecka B. The usefulness of echo-based hemodynamic parameters in cardiac resynchronization therapy with conduction system pacing for optimal device programing. Echocardiography 2023; 40:1068-1078. [PMID: 37632153 DOI: 10.1111/echo.15679] [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: 03/03/2023] [Revised: 05/25/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND His bundle pacing (HBP) has proved to be a valuable alternative enabling the physiological activation of cardiac contraction in cardiac resynchronization therapy (CRT). At present, however, little is known about the optimal method of programming of the His bundle-paced CRT systems in terms of achieving the best cardiac output. AIM The aim of this study was to evaluate the impact of cardiac resynchronization therapy with conduction system pacing (CRT+CSP) on echo-based hemodynamic parameters in the early post-operative measurements. METHODS The study enrollment criteria included: permanent atrial fibrillation, heart failure and bundle branch block. All patients underwent implantation of CRT + HBP. During the post-operative phase, we aimed to optimize HOT-CRT settings in order to achieve the greatest cardiac output assessed by complex echocardiographic measurements. RESULTS The study included 21 patients, mean age 71.2 (6.3) years, predominantly men (71.4%) with non-ischemic cardiomyopathy 62%. All patients had heart failure with NYHA functional class III and IV (81%). Mean left ventricular ejection fraction was 27.5 (9.7%). The mean duration of the QRS complex was 148.8 ms. The effects of resynchronization pacing: HBP alone, HBP with left ventricular pacing, HBP with biventricular pacing (BiV) and BiV without HBP were analyzed consecutively. HBP combined with left ventricular pacing demonstrated the best hemodynamic response. CONCLUSION His bundle pacing coupled with LV pacing proved to be the most advantageous pacing program setting with regard to cardiac output. Moreover, it performed better than biventricular pacing and significantly better than RV pacing.
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Affiliation(s)
- Krzysztof Boczar
- Department of Electrocardiology, The John Paul II Hospital, Kraków, Poland
| | - Andrzej Ząbek
- Department of Electrocardiology, The John Paul II Hospital, Kraków, Poland
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | | | - Agnieszka Sławuta
- Department of Internal and Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wrocław, Poland
| | - Maciej Dębski
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Jacek Gajek
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
| | - Katarzyna Holcman
- Department of Cardiac and Vascular Diseases Krakow, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Andrzej Gackowski
- Jagiellonian University, Medical College, Institute of Cardiology, Department of Coronary Disease and Heart Failure, John Paul II Hospital, Kraków, Poland
| | - Jacek Lelakowski
- Department of Electrocardiology, The John Paul II Hospital, Kraków, Poland
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Barbara Małecka
- Department of Electrocardiology, The John Paul II Hospital, Kraków, Poland
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
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6
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Minczykowski A, Guzik P, Sajkowska A, Pałasz-Borkowska A, Wykrętowicz A. Interrelationships between Peak Strain Dispersion, Myocardial Work Indices, Isovolumetric Relaxation and Systolic-Diastolic Coupling in Middle-Aged Healthy Subjects. J Clin Med 2023; 12:5623. [PMID: 37685690 PMCID: PMC10488442 DOI: 10.3390/jcm12175623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/11/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
In echocardiography, peak strain dispersion (PSD) is the standard deviation of the time to peak longitudinal strain for each left ventricular (LV) segment during systole. It assesses the coordination and synchrony of LV segment contractility. Global work efficiency (GWE) and global wasted work (GWW) quantify LV myocardial work and, if impaired, the coupling between LV systolic contraction and early relaxation. Isovolumetric relaxation (IVRT) measures the duration of initial LV relaxation, while the ratio of early diastolic recoil to systolic excursion (E'VTI/S'VTI) describes systolic-diastolic coupling. We evaluated these parameters in 69 healthy subjects and found that PSD correlated negatively with GWE (r = -0.49, p < 0.0001) and E'VTI/S'VTI (r = -0.44, p = 0.0002), but positively with GWW (r = 0.4, p = 0.0007) and IVRT (r = 0.53, p < 0.0001). GWE correlated negatively with GWW (r = -0.94, p < 0.0001) and IVRT (r = -0.30, p = 0.0127), but positively with E'VTI/S'VTI (r = 0.3, p = 0.0132). In addition, E'VTI/S'VTI was negatively correlated with GWW (r = -0.35, p = 0.0032) and IVRT (r = -0.36, p = 0.0024). These associations remained significant after adjustment for sex, age and LV mass index of the subjects. In conclusion, there is an interaction between measures of LV asynchrony, myocardial work, diastolic function and its systolic-diastolic coupling in middle-aged healthy subjects. The clinical value of these interactions requires further investigation.
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Affiliation(s)
- Andrzej Minczykowski
- Department of Cardiology-Intensive Therapy, Poznań University of Medical Sciences, 49 Przybyszewskiego, 60-355 Poznań, Poland; (P.G.); (A.S.); (A.P.-B.); (A.W.)
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7
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Michalik J, Kozielski J, Węclewicz M, Moroz R, Sterliński M, Szołkiewicz M. Leadless AV Pacemaker in Patient with Complete Heart Block and Bilaterally Implanted Two Deep Brain Stimulators Can Be Safe Therapeutic Option. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:388. [PMID: 36612708 PMCID: PMC9819868 DOI: 10.3390/ijerph20010388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/11/2022] [Accepted: 12/23/2022] [Indexed: 06/17/2023]
Abstract
There are reports documenting that electromagnetic waves generated by deep brain stimulation devices can interfere with cardiac pacemakers. This might be even a life-threatening problem in cardiac pacemaker-dependent patients. Herein, we present a case report on a patient with bilaterally implanted deep brain stimulation devices, who concomitantly had the indications for permanent cardiac pacing. The report shows that a leadless AV pacemaker may be a safe and reasonable option in these cases.
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Affiliation(s)
- Jędrzej Michalik
- Department of Cardiology and Interventional Angiology, Kashubian Center for Heart and Vascular Diseases, Pomeranian Hospitals, 84-200 Wejherowo, Poland
| | - Jonasz Kozielski
- Department of Cardiology and Interventional Angiology, Kashubian Center for Heart and Vascular Diseases, Pomeranian Hospitals, 84-200 Wejherowo, Poland
| | - Mateusz Węclewicz
- Department of Neurosurgery, Copernicus Hospital, 80-803 Gdańsk, Poland
| | - Roman Moroz
- Department of Cardiology and Interventional Angiology, Kashubian Center for Heart and Vascular Diseases, Pomeranian Hospitals, 84-200 Wejherowo, Poland
| | - Maciej Sterliński
- 1st Department of Heart Arrhythmia, National Institute of Cardiology, 04-628 Warsaw, Poland
| | - Marek Szołkiewicz
- Department of Cardiology and Interventional Angiology, Kashubian Center for Heart and Vascular Diseases, Pomeranian Hospitals, 84-200 Wejherowo, Poland
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Physiologic Pacing Targeting the His Bundle and Left Bundle Branch: a Review of the Literature. Curr Cardiol Rep 2022; 24:959-978. [PMID: 35678938 DOI: 10.1007/s11886-022-01723-3] [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: 05/18/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Conduction system pacing (CSP) has emerged as a means to preserve or restore physiological ventricular activation via pacing at the His bundle or at more distal targets in the conduction system, including the left bundle branch area. This review examines strengths, weaknesses, and clinical applications of CSP performed via these approaches. RECENT FINDINGS His bundle pacing (HBP) has been successfully utilized for standard bradyarrhythmia indications and for QRS correction among patients receiving devices for cardiac resynchronization therapy (CRT). Limitations of HBP pacing have included implant complexity and rising pacing thresholds over time. Left bundle branch area pacing (LBBAP) appears to deliver similar physiological benefits with shorter implant times and more stable thresholds. More recently, hybrid systems utilizing HBP or LBBAP in combination with left ventricular leads have been used to treat heart failure (HF) patients, and may be useful in multilevel or mixed conduction blocks. There is growing interest in CSP for bradycardia and HF indications, although high quality data with randomized controlled trials are needed to help guide future treatment paradigms.
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9
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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] [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
- *Correspondence: Jing Yao,
| | - 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
- Dalin Tang,
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