Pacing and Clinical Electrophysiology : PACE

To understand the seemingly complex behavior of a pacemaker, it is important to carefully read the ECG and understand the manufacturer-specific behavior. This report focuses on the interesting ECG acquired from a patient with a pacemaker operating in DDD mode during a routine outpatient clinic examination. This article is protected by copyright. All rights reserved.

OBJECTIVE: In this study, the efficacy and safety of salvianolate were compared with enoxaparin in the prevention of perioperative deep vein thrombosis in gastrointestinal surgery. METHODS: From October 2017 to September 2019, 563 patients who underwent gastrointestinal surgery were collected. Based on the inclusion and exclusion criteria, 119 patients were divided into two groups: enoxaparin group (n = 65) and salvianolate group (n = 54). Comparisons were made regarding the outcomes: prothrombin time (PT), prothrombin activity (PTA), international normalized ratio (INR), activated partial thromboplastin time (APTT), fibrinogen (FIB), thrombin time (TT), D-dimer level (D-D), platelet count (PLT), hematokrit (HCT), and incidence of deep vein thrombosis (DVT)...

During catheter ablation of tachycardia, conventional point-by-point mapping may be hindered due to hemodynamic instability. We performed open-window mapping (CARTO, Biosense Webster, USA) in a patient who developed hemodynamic instability during orthodromic atrioventricular reciprocating tachycardia (AVRT) and unwarranted induction of AVRT during attempts to map accessory pathway (AP) with ventricular pacing. With over 11,000 points acquired rapidly, the system accurately identified AP at the mitral valve annulus where application of single radiofrequency lesion promptly eliminated AP's conduction...

BACKGROUND: Outcomes of transvenous lead extraction (TLE) are well reported in the general population, However, data on safety, efficacy of TLE in octogenarians with a long lead dwell time, using powered extraction tools are limited.The aim of this multicenter study was to evaluate the safety, effectiveness of TLE in octogenarians using the bidirectional rotational mechanical sheaths and mid-term outcome after TLE. METHODS: The study population comprised 83 patients [78% male; mean age 85±3 years; (range 80-94 years)] with 181 target leads...

BACKGROUND: Heart failure (HF) and atrial arrhythmias (AAs) are two clinical conditions that characterize the daily clinical practice of cardiologists. In this perspective review, we analyze the shared etiopathogenetic pathways of atrial arrhythmias, which are the most common cause of atrial arrhythmias-induced cardiomyopathy (AACM) and HF. HYPOTHESIS: The aim is to explore the pathophysiology of these two conditions considering them as a "unicum", allowing the definition of a cardiovascular continuum where it is possible to predict the factors and to identify the patient phenotype most at risk to develop HF due to atrial arrhythmias...

BACKGROUND: Patients with cardiac implantable electronic devices (CIEDs) need specific education to successfully adapt to life with new devices in their bodies. This requires specifically-tailored training processes. To determine the educational requirements, robust measurement tools are essential; however, a literature review revealed that no reliable and valid knowledge scale currently exists for patients with CIEDs. OBJECTIVE: The study was conducted to develop and test the psychometric properties of the scale for measuring the knowledge of patients with CIEDs...

BACKGROUND: The ablation of arrhythmias arising near the His-bundle region in the non-coronary aortic cusp (NCAC) is challenging. Among the aortic sinuses of Valsalva, the NCAC is located between the right atrium and the left atrium. For this reason, pacing from the NCAC should result in atrial capture while pacing from the right and left coronary cusps (LCC) may result in ventricular capture. The objective of this study is to prove that atrial capture during pacing from the sinuses of Valsalva may be used to confirm a correct position in the non-coronary cusp...

BACKGROUNDS: Two technologies, cardiac contractility modulation (CCM) and subcutaneous implantable cardioverter-defibrillator (S-ICD), can be successfully combined and applied to patients with advanced heart failure (HF) with reduced left ventricular ejection fraction (LVEF). CASE REPORT: We reported a case of a 51-year-old man with reduced ejection fraction (LVEF = 33%) and a narrow QRS complex who firstly underwent simultaneous implantation of CCM and S-ICD...

BACKGROUND: The implications of LBBB in heart failure with preserved ejection fraction (HFpEF) is unclear. Our study assesses clinical outcomes among patients with LBBB and HFpEF who were admitted with acute decompensated heart failure. METHODS: This is a cross-sectional study was conducted using the National Inpatient Sample (NIS) database from 2016-2019. RESULTS: We found 74,365 hospitalizations with HFpEF and LBBB and 3,892,354 hospitalizations with HFpEF without LBBB...

BACKGROUND: Recent evidence indicates that abnormal P-wave parameters (PWPs)-ECG markers of atrial myopathy-are associated with incident dementia, independent of atrial fibrillation (AF) and clinical ischemic stroke. However, the mechanisms remain unclear and may include subclinical vascular brain injury. Hence, we evaluated the association of abnormal PWPs with brain MRI correlates of vascular brain injury in the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS). METHODS: ARIC-NCS participants who underwent 3T brain MRI scans in 2011-2013 were included...

BACKGROUND: An enlarged right atrium (RA) is a challenging anatomy that can limit the successful use of His bundle pacing (HBP). It is unknown whether new implantation tools could help overcome these challenges. METHODS: Consecutive patients with RA volume index >25 mL/m2 in men and >21 mL/m2 in women underwent permanent HBP. We used a stylet-driven lead (SDL) with an extendable helix delivered via a dedicated delivery sheath (Selectra 3D, Biotronik) as a first attempt...

Deep septal ventricular pacing is a recently developed physiological pacing modality with good efficacy; however, it has a potential risk of unusual complications. Here, we report a patient with pacing failure and spontaneous, complete lead dislodgement after >2 years of deep septal pacing, possibly caused by systemic bacterial infection and specific lead behavior in the septal myocardium. This case report may implicate a hidden risk of unusual complications in deep septal pacing. This article is protected by copyright...

BACKGROUND: The implantation procedure of left ventricular (LV) leads and the management of cardiac resynchronization therapy (CRT) patients can be challenging. The IS-4 standard for CRT offers additional pacing vectors compared to bipolar leads (IS-1). IS-4 leads improve procedural outcome and may also result in lower adverse events during follow-up (FU) and improve clinical outcome in CRT patients. Further long-term FU data comparing the two lead designs are necessary. METHODS: In this retrospective, single-center study we included adult patients implanted with a CRT-Defibrillator (CRT-D) or CRT-Pacemaker (CRT-P) with a quadripolar (IS-4 group) or bipolar (IS-1 group) LV lead and with available ≥3 years clinical FU...

OBJECTIVES: Evidence indicates left atrial (LA) involvement in vasovagal syncope (VVS). The LA regulates left ventricular filling during the cardiac cycle. We aimed to assess LA function in patients with VVS by 2D speckle-tracking echocardiography. METHODS: Sixty-nine consecutive patients with VVS were recruited. Based on the head-up tilt test (HUTT) results, the study population was divided into 2 groups: HUTT+ (n = 45) and HUTT- (n = 24). Fifty-one consecutive subjects were enrolled as the control group...

BACKGROUND: We present a case of epicardial pacemaker implantation in a low birth weight newborn using a lumenless active fixation lead. RESULTS: We found that superior pacing parameters can be obtained by implanting a lumenless active fixation lead into the epicardium, but more evidence is needed to support this hypothesis. This article is protected by copyright. All rights reserved.

Automatic pacing threshold adjustment algorithms and remote monitoring are widely used to improve the utility of pacemakers and ensure patient safety. However, healthcare providers involved in the management of permanent pacemakers should know the potential pitfalls of these functions. In this report, we present a case of atrial pacing failure induced by the automatic pacing threshold adjustment algorithm that went unnoticed even under remote monitoring. This article is protected by copyright. All rights reserved...

BACKGROUND: 51-year-old female with extensive prior atrial surgery involving myxoma resection and patch septum repair and prior typical atrial flutter as well as peripatch reentry underwent redo radiofrequency ablation of typical atrial flutter. METHODS: After high density mapping was performed, and gap in the prior typical flutter line was ablated. RESULT: During the ablation transient atrioventricular (AV) block was noted. Subsequent remapping of the right atrium revealed that there was a narrow strip of tissue between the cavotricuspid isthmus (CTI) and the coronary sinus os on which activation of the AV node was now depending...

INTRODUCTION: We describe 2 patients with right supero-paraseptal accessory pathway (SPAP) who developed left ventricular dysfunction associated with increased degree of ventricular pre-excitation and frequent orthodromic reciprocating tachycardia (ORT) due to worsening AV node conduction. METHODS AND RESULTS: Case 1: 48-year-old female with a history of normally functioning mechanical mitral valve, CABG, and ventricular pre-excitation that worsened after her open heart surgery...

The recently published "electrophysiologically guided low-voltage bridge (LVB) strategy" is effective in the ablation of AVNRT (atrioventricular reentry tachycardia) in children. This study aimed to evaluate its efficacy and safety in children <26Kgs. Fourteen children [64% males, median age 6.5 years (IQR 6-8 years), median weight 25.5kg (IQR 24-26kg) with AVNRT were treated. In all patients, we detected a LVB associated to a typical slow pathway potential. The acute success rate was 100% with a mean of 5...

INTRODUCTION: left ventricular (LV) summit premature ventricular contractions (PVCs) are often unresponsive to radiofrequency (RF) ablation. Retrograde venous ethanol infusion (RVEI) can be a valuable alternative in this scenario. METHODS: a 43-year-old woman without structural heart disease presented with LV summit PVCs unresponsive to RF ablation because of their deep-seated origin. RESULTS: Unipolar pace mapping performed through a wire inserted into a branch of the distal great cardiac vein (GCV) demonstrated 12/12 concordance with the clinical PVCs thus indicating close proximity to PVCs' origin...