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Yang C, Qi J, Alam M, Zou D. Transvenous endocardial pacing with SelectSecure ™ 3830 lead in pediatric patients: case series of two infants and a literature review. BMC Cardiovasc Disord 2024; 24:145. [PMID: 38443792 PMCID: PMC10913624 DOI: 10.1186/s12872-024-03820-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 02/28/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND The SelectSecure™ 3830 lead is an innovative, lumenless, and thin active fixed lead with a nonretractable screw-in tip and a diameter of 4.1 Fr, making it the thinnest pacing lead available. Its high anti-extrusion properties and durability have shown favorable outcomes in cardiac pacing, especially in pediatric patients. The superfine design and easy implantation of the lead have rendered it a preferred choice in children, particularly in cases of congenital heart disease. CASE PRESENTATION This case series presents two infant patients who underwent transvenous endocardial pacing using the SelectSecure™ 3830 lead, along with a comprehensive literature review on the topic. The study followed the patients for 5 years and 3 years, respectively, and observed stable pacing parameters, indicating a positive therapeutic outcome and safety. This article discusses the optimal age and body shape for transvenous lead implantation in infants and highlights the advantages and disadvantages of endocardial and epicardial pacing approaches. Although endocardial pacing offers several benefits such as minimal trauma, short hospital stay, and longer battery life, it may not be suitable for intracardiac shunts, and venous occlusion remains a concern. On the other hand, epicardial pacing may be considered for children with challenging endocardial access but comes with higher risk of lead failure and coronary artery compression. This study emphasizes the importance of careful follow-up in pediatric patients with pacing, as lead failure can occur in young patients owing to growth and development, leading to syncope and battery depletion. The article also underscores the significance of selecting the appropriate pacing location to minimize the impact of cardiac function, with right ventricular septal pacing emerging as a preferable option. CONCLUSIONS The SelectSecure™ 3830 lead presents a promising solution for transvenous endocardial pacing in pediatric patients with high degree atrioventricular block and bradycardia, ensuring safe and effective pacing as they grow and develop.
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Affiliation(s)
- Chuan Yang
- Department of Cardiology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, China
| | - Jing Qi
- Department of Cardiology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, China
| | - Mahmood Alam
- Department of Cardiology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, China
| | - Deling Zou
- Department of Cardiology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, China.
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Li M, Li C, Li J, Yu H, Xu G, Gao Y, Xu B, Sun M, Wang Z, Han Y, Liang Y. An individualized criterion for left bundle branch capture in patients with a narrow QRS complex. Heart Rhythm 2024; 21:294-300. [PMID: 37952864 DOI: 10.1016/j.hrthm.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/25/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Left bundle branch (LBB) pacing (LBBP) is a physiological pacing; however, the accuracy of current electrocardiographic criteria for LBBP remains inadequate. OBJECTIVE The purpose of this study was to establish a novel individualized criterion to improve the accuracy of LBBP determination in patients with a narrow QRS complex. METHODS Patients in whom both LBBP and left ventricular septal pacing (LVSP) were acquired during operation were enrolled. LBB conduction time (LBBCT) was measured from LBB potential (LBBpo) to intrinsic QRS onset. LBBpo-V6RWPT, Native-V6RWPT, and Paced-V6RWPT were respectively measured from LBBpo, intrinsic QRS onset, and stimulus to R-wave peak in V6. ΔV6RWPT was the difference value between Paced-V6RWPT and Native-V6RWPT. The accuracy of ΔV6RWPT criterion for determining LBBP was evaluated. RESULTS In all 71 enrolled patients, ΔV6RWPT was <30 ms during LBBP (21.3 ± 4.6 ms; range 9.3-28.3 ms) but was >30 ms during LVSP (38.5 ± 4.6 ms; range 31.1-47.0 ms). The probability distribution of ΔV6RWPT was well separated between LBBP and LVSP. Sensitivity and specificity of the novel criterion of "ΔV6RWPT <30 ms" for determining LBBP both were 100%. However, the optimal cutoff value of Paced-V6RWPT for validation of LBBP was 64.2 ms, and sensitivity and specificity were 84.5% and 97.2%, respectively. Paced-V6RWPT during LBBP was equivalent to LBBpo-V6RWPT in all patients. There was a strong linear correlation between Native-V6RWPT and LBBpo-V6RWPT (r = 0.796; P <.001). CONCLUSION ΔV6RWPT could be an accurate individualized criterion for determining LBB capture with high sensitivity and specificity and was superior over the fixed Paced-V6RWPT criterion.
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Affiliation(s)
- Miaomiao Li
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Shenyang, China
| | - Changqing Li
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Shenyang, China
| | - Jialin Li
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Shenyang, China
| | - Haibo Yu
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Shenyang, China
| | - Guoqing Xu
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Shenyang, China
| | - Yang Gao
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Shenyang, China
| | - Baige Xu
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Shenyang, China
| | - Mingyu Sun
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Shenyang, China
| | - Zulu Wang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Shenyang, China
| | - Yaling Han
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Shenyang, China
| | - Yanchun Liang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Shenyang, China.
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Vajapey R, Amuthan R, Chung M, Tchou P, Rickard J, Chung R, Varma N, Niebauer M. High predictive value of paced QRS frequency in verification of left bundle branch pacing. J Interv Card Electrophysiol 2023; 66:2041-2046. [PMID: 37014480 PMCID: PMC10548354 DOI: 10.1007/s10840-023-01541-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Left bundle branch area pacing (LBBAP) is a newer technique to deliver more synchronous left ventricular activation. Several criteria have been proposed, but not fully validated, to confirm LBBAP during implantation of the pacing lead. Spectral analysis has been used to characterize the frequency components of the clinical QRS utilizing the Fourier transform algorithm. We hypothesized that higher frequency content of the paced QRS complex may show predictive value of successful LBBAP. METHODS We evaluated 84 patients with ejection fraction > 50%, who underwent LBB lead placement (n = 42) using ≥ 1 current criteria and right ventricular midseptal (RVsp) lead placement (n = 42) from 2000 to 2022. Time frequency analysis (Matlab) was used to determine the frequency content of the paced QRS complex. The centroid frequency (CF), which is the weighted average QRS frequency, was calculated. RESULTS Patients in RVsp group had a longer paced QRS duration (155.6 ± 28.0 vs 127.1 ± 17.2, p < 0.002) compared to the LBBAP group. Of all standard ECG leads, the paced QRS in V2 gave the greatest difference of the CF of the LBBAP group at 8.8 ± 1.6 Hz versus 5.7 ± 0.7 Hz of the RVsp group. This difference was significant by both univariate (p < 0.003) and multivariate (p < 0.010) analysis. Predictive value of the CF for successful LBB pacing in lead V2 was highest with an AUC of 0.98. The sensitivity and specificity were 88.1% and 97.6%, respectively. CONCLUSION Spectral analysis predicts successful LBBAP with higher frequency content when compared to RVsp pacing. Given the limitations to the current criteria to confirm LBBAP, intraprocedural use of frequency content analysis of the paced QRS complex in patients may prove useful at verifying LBB capture if verified by prospective clinical trials.
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Affiliation(s)
- Ramya Vajapey
- Cleveland Clinic Foundation, Cleveland, OH, 44195, USA.
| | - Ram Amuthan
- Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Mina Chung
- Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Patrick Tchou
- Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - John Rickard
- Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Roy Chung
- Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Niraj Varma
- Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Mark Niebauer
- Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
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Chung WH, Wu HP, Wu MY, Lin YN, Chen JY, Lin KH, Chang KC. Correlations between myocardial injury current and lead performance in His bundle pacing compared with left bundle branch area pacing and right ventricular septum pacing. J Interv Card Electrophysiol 2023; 66:1349-1358. [PMID: 36198845 DOI: 10.1007/s10840-022-01385-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 09/25/2022] [Indexed: 10/10/2022]
Abstract
BACKGROUND Conduction system pacing by implanting the lead in the His bundle (HBP) region or in the left bundle branch area (LBBAP) has gained popularity. Myocardial injury current (IC) is useful for predicting adequate lead fixation in right ventricular septal pacing (RVSP). OBJECTIVES AND METHODS We compared the correlations between IC and lead performance among patients receiving HBP (n = 41), LBBAP (n = 53), and historical RVSP (n = 88). LBBAP was an alternative if optimal HBP was not achieved. A positive IC (STpost-screw-in - STpre-screw-in) was defined as > 0.2 mV or a > 25% ST elevation and prolongation of the ventricular electrograms > 10 ms from baseline. RESULTS HBP patients with a positive IC (48%, 0.84 ± 0.4 V/0.4 ms) exhibited a similar pacing threshold to their LBBAP counterparts (76%, 0.75 ± 0.3 V/0.4 ms, p = 0.329), but a higher pacing threshold than their RVSP counterparts (67%, 0.50 ± 0.1 V/0.4 ms, p < 0.001) at implantation. The R-wave (5.70 ± 3.4 mV) and impedance (660.91 ± 140.8 Ω) were both lower than those of LBBAP (10.35 ± 6.0 mV, p = 0.002; 822.36 ± 235.8 Ω, p = 0.005) and RVSP (11.24 ± 4.9 mV, p < 0.001; 754.27 ± 126.4 Ω, p = 0.006) patients respectively at implantation. The trend of electrical parameter comparisons remained unchanged during follow-up (3.56 ± 1.4 months). Notably, HBP patients without ICs had a higher pacing threshold (1.24 ± 0.6 V/0.4 ms) compared to their LBBAP (0.73 ± 0.3 V/0.4 ms, p = 0.009) and RVSP (0.53 ± 0.1 V/0.4 ms, p < 0.001) counterparts at implantation and during follow-up. CONCLUSIONS The detection of positive changes of myocardial ICs during HBP was associated with a better capture threshold equivalent to the LBBAP counterpart both at implantation and during short-term follow-up. Further large-scale studies with longer follow-up are necessary to confirm these findings.
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Affiliation(s)
- Wei-Hsin Chung
- Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, 2, Yude Road, Taichung, 40447, Taiwan
| | - Hung-Pin Wu
- Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, 2, Yude Road, Taichung, 40447, Taiwan
| | - Mei-Yao Wu
- School of Post-Baccalaureate Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yen-Nien Lin
- Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, 2, Yude Road, Taichung, 40447, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
- Cardiovascular Research Laboratory, China Medical University Hospital, Taichung, Taiwan
| | - Jan-Yow Chen
- Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, 2, Yude Road, Taichung, 40447, Taiwan
| | - Kuo-Hung Lin
- Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, 2, Yude Road, Taichung, 40447, Taiwan
| | - Kuan-Cheng Chang
- Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, 2, Yude Road, Taichung, 40447, Taiwan.
- School of Medicine, China Medical University, Taichung, Taiwan.
- Cardiovascular Research Laboratory, China Medical University Hospital, Taichung, Taiwan.
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Naruse Y, Sano M, Kurebayashi N, Morikawa S, Tsurumi N, Shiozawa T, Takano S, Ogano M, Kimura K, Miyajima K, Sugiura R, Henmi R, Muto M, Hosoya N, Hasebe H, Mizukami A, Iguchi K, Atsumi A, Odagiri K, Kiyama Y, Maekawa Y, Hideki S, Daichi I, Kazuki I, Ayako O, Yasuyo T, Tomoyuki W, Yoshitaka K, Yasushi W, Yohei T, Kohei S, Jun T, Soushi M, Go I, Daigo T, Ryota N, Kentaro Y, Taketo S, Shoichiro Y, Jun S, Hideki W, Manabu O, Satoru S, Yumiko J, Takashi O, Tomotaka S, Tomoya I, Naoya I, Tuyoshi U, Masao S, Hayato O, Kenichiro S, Satoshi M, Taro N, Tomoaki S, Yutaro K. Usefulness of delivery catheter on accurate right ventricular septal pacing: Mt FUJI trial. Europace 2023; 25:1451-1457. [PMID: 36794652 PMCID: PMC10105868 DOI: 10.1093/europace/euad027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/06/2023] [Indexed: 02/17/2023] Open
Abstract
AIMS Although the delivery catheter system for pacemaker-lead implantation is a new alternative to the stylet system, no randomized controlled trial has addressed the difference in right ventricular (RV) lead placement accuracy to the septum between the stylet and the delivery catheter systems. This multicentre prospective randomized controlled trial aimed to prove the efficacy of the delivery catheter system for accurate delivery of RV lead to the septum. METHODS AND RESULTS In this trial, 70 patients (mean age 78 ± 11 years; 30 men) with pacemaker indications of atrioventricular block were randomized to the delivery catheter or the stylet groups. Right ventricular lead tip positions were assessed using cardiac computed tomography within 4 weeks of pacemaker implantation. Lead tip positions were classified into RV septum, anterior/posterior edge of the RV septal wall, and RV free wall. The primary endpoint was the success rate of RV lead tip placement to the RV septum. RESULTS Right ventricular leads were implanted as per allocation in all patients. The delivery catheter group had higher success rate of RV lead deployment to the septum (78 vs. 50%; P = 0.024) and narrower paced QRS width (130 ± 19 vs. 142 ± 15 ms P = 0.004) than those in the stylet group. However, there was no significant difference in procedure time [91 (IQR 68-119) vs. 85 (59-118) min; P = 0.488] or the incidence of RV lead dislodgment (0 vs. 3%; P = 0.486). CONCLUSION The delivery catheter system can achieve a higher success rate of RV lead placement to the RV septum and narrower paced QRS width than the stylet system. TRIAL REGISTRATION NUMBER jRCTs042200014 (https://jrct.niph.go.jp/en-latest-detail/jRCTs042200014).
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Affiliation(s)
- Yoshihisa Naruse
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu 431-3192, Japan
| | - Makoto Sano
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu 431-3192, Japan
| | - Nobutake Kurebayashi
- Department of Cardiology, Chutoen General Medical Center, 1-1 Shobugaike, Kakegawa, 436-0040, Japan
| | - Shuji Morikawa
- Department of Cardiology, Chutoen General Medical Center, 1-1 Shobugaike, Kakegawa, 436-0040, Japan
| | - Naoki Tsurumi
- Department of Cardiology, Chutoen General Medical Center, 1-1 Shobugaike, Kakegawa, 436-0040, Japan
| | - Tomoyuki Shiozawa
- Department of Cardiology, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, 410-2211, Japan
| | - Shintaro Takano
- Department of Cardiology, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, 410-2211, Japan
| | - Michio Ogano
- Department of Cardiovascular Medicine, Shizuoka Medical Center, 762-1 Nagasawa, Sunto-gun, 411-8611, Japan
| | - Kei Kimura
- Department of Cardiovascular Medicine, Shizuoka Medical Center, 762-1 Nagasawa, Sunto-gun, 411-8611, Japan
| | - Keisuke Miyajima
- Department of Cardiology, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ward, Hamamatsu, 433-8558, Japan
| | - Ryo Sugiura
- Department of Cardiology, Seirei Hamamatsu General Hospital, 2-12-1 Sumiyoshi, Naka-ward, Hamamatsu, 430-0906, Japan
| | - Ryuta Henmi
- Department of Cardiology, Seirei Hamamatsu General Hospital, 2-12-1 Sumiyoshi, Naka-ward, Hamamatsu, 430-0906, Japan
| | - Masahiro Muto
- Department of Cardiology, Hamamatsu Medical Center, 328 Tomitsuka-cho, Naka-ward, Hamamatsu, 432-8580, Japan
| | - Natsuko Hosoya
- Department of Cardiology, Hamamatsu Medical Center, 328 Tomitsuka-cho, Naka-ward, Hamamatsu, 432-8580, Japan
| | - Hideyuki Hasebe
- Division of Arrhythmology, Shizuoka Saiseikai General Hospital, 1-1-1 Kojika, Suruga-ward, Shizuoka, 422-8021, Japan
| | - Akira Mizukami
- Department of Cardiology, Kameda Medical Center, 929 Higashi-cho, Kamogawa, 296-8602, Japan
| | - Keisuke Iguchi
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu 431-3192, Japan
| | - Akiko Atsumi
- Department of Cardiology, Shintoshi Hospital, 703 Nakaizumi, Iwata, 438-0078, Japan
| | - Keiichi Odagiri
- Center for Clinical Research, Hamamatsu University Hospital, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3125, Japan
| | - Yumi Kiyama
- Center for Clinical Research, Hamamatsu University Hospital, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3125, Japan
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu 431-3192, Japan
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Qian Z, Xue S, Zou F, Qin C, Wang Y, Zhang X, Qiu Y, Wu H, Hou X, Zou J. New criterion to determine left bundle branch capture on the basis of individualized His bundle or right ventricular septal pacing. Heart Rhythm 2022; 19:1984-1992. [PMID: 35932987 DOI: 10.1016/j.hrthm.2022.07.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/17/2022] [Accepted: 07/21/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Left bundle branch pacing (LBBP) is an emerging physiological pacing modality. How to differentiate LBBP from left ventricular septal pacing (LVSP) remains challenging. OBJECTIVE We aimed to develop a new personalized intraoperative criterion to confirm left bundle branch (LBB) capture in patients with or without heart failure (HF). METHODS Patients were enrolled if 12-lead surface electrocardiograms of LBBP, LVSP, temporary His bundle pacing (HBP), and right ventricular septal pacing (RVSP) were recorded during the procedure, with the leads placed in the basal midseptal region. Left ventricular activation time (LVAT) was measured during different pacing modalities. ΔLVAT1 was defined as the difference in LVAT between HBP and LBBP/LVSP. ΔLVAT2 was estimated by the difference in LVAT between RVSP and LBBP/LVSP. ΔLVAT1% and ΔLVAT2% were calculated as the percent reduction of ΔLVAT1 and ΔLVAT2, respectively. RESULTS A total of 105 consecutive patients were included, of whom 80 (76.2%) had normal cardiac function (65 LBBP and 15 LVSP) and 25 had HF. Patients with LBBP showed significantly shorter LVAT than did those with LVSP. In patients with normal cardiac function, a cutoff value of ΔLVAT1 > 12.5 ms showed 73.9% sensitivity and 93.3% specificity to confirm LBB capture. In patients with HF, a cutoff value of ΔLVAT1% > 9.8% exhibited great accuracy for LBB capture (sensitivity 92.0%; specificity 92.3%). The optimal value of ΔLVAT2% for differentiating LBBP from LVSP was 21.2%. CONCLUSION Temporary HBP and RVSP can serve as references to confirm LBB capture in an individualized fashion in patients with or without HF.
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Affiliation(s)
- Zhiyong Qian
- Department of Cardiology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Siyuan Xue
- Department of Cardiology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Fengwei Zou
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Bronx, New York
| | - Chaotong Qin
- Department of Cardiology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Yao Wang
- Department of Cardiology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Xinwei Zhang
- Department of Cardiology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Yuanhao Qiu
- Department of Cardiology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Hongping Wu
- Department of Cardiology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaofeng Hou
- Department of Cardiology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Jiangang Zou
- Department of Cardiology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China.
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Li W, Ding Y, Gong C, Zhou G, Lu X, Wei Y, Peng S, Cai L, Yuan T, Li F, Liu S, Chen S. Comparisons of electrophysiological characteristics, pacing parameters and mid- to long-term effects in right ventricular septal pacing, right ventricular apical pacing and left bundle branch area pacing. BMC Cardiovasc Disord 2022; 22:417. [PMID: 36123615 PMCID: PMC9484219 DOI: 10.1186/s12872-022-02855-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 09/09/2022] [Indexed: 11/29/2022] Open
Abstract
Background As a near-physiological pacing innovation, left bundle branch area pacing (LBBAP) has drawn much attention recently. This study was aimed to investigate the electrophysiological characteristics, unipolar/bipolar pacing parameters and mid- to long-term effects and safety of three different pacing methods and identify possible predictors of adverse left ventricular remodeling.
Methods Ninety-two patients were divided into the LBBAP group, right ventricular septal pacing (RVSP) group and right ventricular apical pacing (RVAP) group. Baseline information, electrophysiological, pacing and echocardiographic parameters were collected. Results The three pacing methods were performed with a similar high success rate. The paced QRSd was significantly different among the LBBAP, RVSP and RVAP groups (105.93 ± 15.85 ms vs. 143.63 ± 14.71 ms vs. 155.39 ± 14.17 ms, p < 0.01). The stimulus to left ventricular activation time (Sti-LVAT) was the shortest in the LBBAP group, followed by the RVSP and RVAP groups (72.80 ± 12.07 ms vs. 86.29 ± 8.71 ms vs. 94.14 ± 10.14 ms, p < 0.001). LBBAP had a significantly lower tip impedance during the procedure and 3-month follow up as compared to RVSP and RVAP (p < 0.001). Higher bipolar captured thresholds were observed in LBBAP during the procedure (p < 0.001). Compared to the baseline values, there was a greater reduction in left ventricular end-diastolic dimension (LVEDD) in the LBBAP group (p = 0.046) and a significant enlargement in LVEDD in the RVAP group (p = 0.008). Multiple regression analysis revealed that the Sti-LVAT was a significant predictor of LVEDD at 12 months post-procedure. At the 24-h post-procedure, significant elevations were observed in the cTnI levels in LBBAP (p < 0.001) and RVSP (p < 0.05). More transient RBB injury was observed in LBBAP. But no significant difference was found in cardiac composite endpoints among three groups (p > 0.05). Conclusions LBBAP demonstrated a stable captured threshold, a low tip impedance and a high R-wave amplitude during the 12-month follow-up. Left ventricular remodeling was improved at 12 months post-procedure through LBBAP. The Sti-LVAT was a significant predictor of left ventricular remodeling. LBBAP demonstrated its feasibility, effectiveness, safety and some beneficial electrophysiological characteristics during this mid- to long-term follow-up, which should be confirmed by further studies.
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Affiliation(s)
- Wenhua Li
- Department of Cardiology, Shanghai General Hospital of Nanjing Medical University, No. 100 Haining Road, Hongkou District, Shanghai, 200080, China.,Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou City, Jiangsu Province, China
| | - Yu Ding
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Gong
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Genqing Zhou
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaofeng Lu
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Wei
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shi Peng
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lidong Cai
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianyou Yuan
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fangfang Li
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shaowen Liu
- Department of Cardiology, Shanghai General Hospital of Nanjing Medical University, No. 100 Haining Road, Hongkou District, Shanghai, 200080, China. .,Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Songwen Chen
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Miyajima K, Urushida T, Naruse Y, Ito K, Kin F, Okazaki A, Takashima Y, Watanabe T, Kawaguchi Y, Wakabayashi Y, Maekawa Y. The usefulness of a delivery catheter system for right ventricular "true" septal pacing. Heart Vessels 2021; 36:1056-1063. [PMID: 33507356 DOI: 10.1007/s00380-021-01780-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/08/2021] [Indexed: 01/19/2023]
Abstract
Right ventricular (RV) septum is an alternate site for the placement of RV lead tip instead of RV apex. Recent studies have demonstrated that less than half of the RV leads targeted for septal implantation are placed on the RV septum using a conventional stylet system; new guiding catheter systems have become available for RV lead placement. This study aimed to investigate the usefulness of the delivery catheter system in lead placement on the RV septum when compared with the stylet system. We retrospectively evaluated 198 patients who underwent fluoroscopically guided pacemaker implantation with RV leads targeted to be placed in the RV septum and in whom computed tomography was incidentally and subsequently performed. A delivery catheter was used in 16 patients, and a stylet in 182 patients. The primary endpoint of this study was the success rate of RV lead placement on the RV septum. The proportion of RV lead placement on the RV septum was higher in the delivery catheter group than in the stylet group (100% vs. 44%; p < 0.001). In the stylet group, the lead tips were placed at the hinge in 92 cases (51%) and on the free wall in 9 cases (5%). Paced QRS duration was narrower in the delivery catheter group than in the stylet group (128 ± 16 vs. 150 ± 21 ms, p < 0.01). The delivery catheter system designated for pacing leads may aid in selecting RV septal sites and achieve good physiologic ventricular activation.
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Affiliation(s)
- Keisuke Miyajima
- Department of Cardiology, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Tsuyoshi Urushida
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan
| | - Yoshihisa Naruse
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan.
| | - Kazuki Ito
- Department of Cardiology, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Fumihiko Kin
- Department of Cardiology, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Ayako Okazaki
- Department of Cardiology, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Yasuyo Takashima
- Department of Cardiology, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Tomoyuki Watanabe
- Department of Cardiology, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Yoshitaka Kawaguchi
- Department of Cardiology, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Yasushi Wakabayashi
- Department of Cardiology, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan
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Algazzar AS, Elbably MM, Katta AA, Elmeligy N, Elrabbat K, Qutub MA. Merits of Different Ventricular Lead Locations on Left Ventricular Myocardial Strain and Dyssynchrony in Patients with Cardiac Resynchronization Therapy. Cardiology 2019; 145:13-20. [PMID: 31778999 DOI: 10.1159/000503953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 10/07/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The idea behind cardiac resynchronization therapy (CRT) is to pace both ventricles resulting in a synchronized electro-mechanical coupling of the left ventricle (LV), meaning every effort should be made to improve the percentage of CRT responders. OBJECTIVES This study aimed at demonstrating the short-term effect of right ventricular apical (RVA) and mid-septal (RVS) lead locations combined with different LV lead positions on LV myocardial strain, dyssynchrony, and clinical outcomes. METHODS We examined 60 patients with indication for CRT before and after 6 months of implantation for clinical outcome and CRT response (6-min walk test [6MWT], NYHA class, decrease in left ventricular end systolic volume [LVESV] by >15%), dyssynchrony, and myocardial strain. RESULTS After 6 months of follow-up, the two RV lead locations represented a significant improvement in 6MWT, left ventricular ejection fraction, and LVESV in comparison to baseline values, but no significant difference was found between both groups. With regards to NYHA class improvement, p values were insignificant between the groups (0.44 and 0.88) at baseline and 6 months after implantation, respectively. The mean 6MWT was 273.8 m in the RVA group compared to 279.0 m in the RVS group (p = 0.84) at baseline. After 6 months of CRT implantation, the 6MWT mean was 326.5 m in the RVA group compared to 316.2 m in the RVS group (p = 0.74). The posterolateral cardiac vein site showed a significant improvement when combined with RVS location in interventricular and intraventricular dyssynchrony, global longitudinal strain, global circumferential strain, and apical circumferential strain (p = 0.01 0.032, 0.02, 0.005, and 0.049), respectively. CONCLUSION RVS is not inferior and provides a good alternative to RVA pacing in short-term follow-up. However, the QRS duration, myocardial strain, and dyssynchrony varies depending on RV and LV stimulation sites. Long-term morbidity and mortality outcomes according to LV lead location in coronary sinus need more assessment.
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Affiliation(s)
- Alaa S Algazzar
- Division of Cardiology, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,
| | | | | | | | | | - Mohammed A Qutub
- Division of Cardiology, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Hattori M, Naruse Y, Oginosawa Y, Matsue Y, Hanaki Y, Kowase S, Kurosaki K, Mizukami A, Kohno R, Abe H, Aonuma K, Nogami A. Prognostic impact of lead tip position confirmed via computed tomography in patients with right ventricular septal pacing. Heart Rhythm 2019; 16:921-927. [PMID: 30633981 DOI: 10.1016/j.hrthm.2019.01.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Although fluoroscopy-guided right ventricular (RV) lead placement in the ventricular septum is a widely performed procedure, variation in true RV lead tip position confirmed via computed tomography (CT) and its prognostic implications in patients with atrioventricular block (AVB) are not well understood. OBJECTIVE The purpose of this study was to evaluate the prognostic impact of CT-confirmed RV lead tip position. METHODS We retrospectively enrolled 228 consecutive patients (age 77 ± 10 years; 125 men) with AVB who underwent fluoroscopy-guided RV septal lead implantation and thoracic CT after pacemaker implantation. Patients were classified into septal and free-wall groups according to RV lead tip position. The primary endpoint was the composite outcome of cardiac death and heart failure hospitalization. RESULTS The RV lead tip was located at the free wall in 18 patients (8%). The primary endpoint occurred in 37 patients (16%) over median follow-up of 41 months. Electrocardiographic analysis found that R amplitude >0.53 mV in lead I was significantly predictive of free-wall pacing, with sensitivity of 70% and specificity of 77%. Multivariate Cox regression analysis demonstrated that the lead tip in the free wall (hazard ratio 2.93; 95% confidence interval 1.21-7.11; P = .018) was an independent predictor of the primary endpoint. CONCLUSION Fluoroscopy-guided RV lead placement carries potential risk of unexpected RV free-wall pacing and may increase the risk of cardiac death and heart failure-related hospitalization in patients undergoing RV septal pacing due to AVB and receiving thoracic CT for medical reasons.
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Affiliation(s)
- Masayuki Hattori
- Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan
| | - Yoshihisa Naruse
- Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan.
| | - Yasushi Oginosawa
- Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yuya Matsue
- Department of Cardiology, Kameda Medical Center, Kamogawa, Japan
| | - Yuichi Hanaki
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shinya Kowase
- Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan
| | - Kenji Kurosaki
- Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan
| | - Akira Mizukami
- Department of Cardiology, Kameda Medical Center, Kamogawa, Japan
| | - Ritsuko Kohno
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kazutaka Aonuma
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akihiko Nogami
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Occhetta E, Quirino G, Baduena L, Nappo R, Cavallino C, Facchini E, Pistelli P, Magnani A, Bortnik M, Francalacci G, Dell’Era G, Plebani L, Marino P. Right ventricular septal pacing: Safety and efficacy in a long term follow up. World J Cardiol 2015; 7:490-498. [PMID: 26322189 PMCID: PMC4549783 DOI: 10.4330/wjc.v7.i8.490] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 03/24/2015] [Accepted: 06/19/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the safety and efficacy of the permanent high interventricular septal pacing in a long term follow up, as alternative to right ventricular apical pacing.
METHODS: We retrospectively evaluated: (1) 244 patients (74 ± 8 years; 169 men, 75 women) implanted with a single (132 pts) or dual chamber (112 pts) pacemaker (PM) with ventricular screw-in lead placed at the right ventricular high septal parahisian site (SEPTAL pacing); (2) 22 patients with permanent pacemaker and low percentage of pacing (< 20%) (NO pacing); (3) 33 patients with high percentage (> 80%) right ventricular apical pacing (RVA). All patients had a narrow spontaneous QRS (101 ± 14 ms). We evaluated New York Heart Association (NYHA) class, quality of life (QoL), 6 min walking test (6MWT) and left ventricular function (end-diastolic volume, LV-EDV; end-systolic volume, LV-ESV; ejection fraction, LV-EF) with 2D-echocardiography.
RESULTS: Pacing parameters were stable during follow up (21 mo/patient). In SEPTAL pacing group we observed an improvement in NYHA class, QoL score and 6MWT. While LV-EDV didn’t significantly increase (104 ± 40 mL vs 100 ± 37 mL; P = 0.35), LV-ESV slightly increased (55 ± 31 mL vs 49 ± 27 mL; P = 0.05) and LV-EF slightly decreased (49% ± 11% vs 53% ± 11%; P = 0.001) but never falling < 45%. In the RVA pacing control group we observed a worsening of NYHA class and an important reduction of LV-EF (from 56% ± 6% to 43% ± 9%, P < 0.0001).
CONCLUSION: Right ventricular permanent high septal pacing is safe and effective in a long term follow up evaluation; it could be a good alternative to the conventional RVA pacing in order to avoid its deleterious effects.
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Chan NY, Yuen HC, Choy CC, Mok NS, Tsui PT, Lau CL, Lo YK, Chu PS, Chow HF. Left ventricular volumes and systolic function after long-term right ventricular pacing may be predicted by paced QRS duration, but not pacing site. Heart Lung Circ 2014; 23:43-8. [PMID: 23806197 DOI: 10.1016/j.hlc.2013.04.122] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 04/23/2013] [Accepted: 04/27/2013] [Indexed: 01/20/2023]
Abstract
BACKGROUND Long-term right ventricular apical (RVA) pacing causes adverse left ventricular (LV) remodelling and clinical outcomes. METHODS Forty-one patients (19 men, mean age 70.9±14.2, 23 right ventricular septal and 18 RVA pacing) underwent pacemaker implantation for atrioventricular block. LV volumes and left ventricular ejection fraction (LVEF) were assessed by echocardiography 39.3±17.2 months after implantation. Predictors of left ventricular systolic volume (LVESV), left ventricular diastolic volume (LVEDV) and LVEF were analysed. RESULTS No difference was found between RVA pacing and right ventricular septal pacing groups in LVESV (40.6±22.6 vs 33±14.4ml; p=0.199), LVEDV (88.2±31.2 vs 73.7±23.9ml; p=0.102) and LVEF (56.1±8.6 vs 56±6.6%; p=0.996). With multivariate stepwise regression, only pQRSd and renal impairment independently predicted LVESV (β=0.522, 95% CI: 0.242-0.802; p=0.001 and β=40.3, 95% CI: 17.6-62.9; p=0.001 respectively), LVEDV (β=0.786, 95% CI: 0.338-1.235; p=0.001 and β=42.8, 95% CI: 6.6-79; p=0.022 respectively) and LVEF (β=-0.161, 95% CI: -0.283 to -0.04; p=0.011 and β=-14.8, 95% CI: -24.6 to -5.0; p=0.004 respectively). CONCLUSIONS pQRSd and renal impairment, but not pacing site or baseline LVEF, may be predictors for LV volumes and systolic function after long-term RV pacing. pQRSd may be target for pacing site optimisation.
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