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Monge Barrios B, Lapetina Arroyo R, Franqui Rivera H. Unearthing an artifact: Managed ventricular pacing pseudo-malfunction in an 81-year-old puerto rican female. Indian Pacing Electrophysiol J 2024:S0972-6292(24)00071-8. [PMID: 38866105 DOI: 10.1016/j.ipej.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/29/2024] [Accepted: 06/10/2024] [Indexed: 06/14/2024] Open
Affiliation(s)
- Brian Monge Barrios
- Institutions: University of Puerto Rico School of Medicine, Department of Medicine, Cardiovascular Disease Division, San Juan, USA.
| | - Roberto Lapetina Arroyo
- Institutions: University of Puerto Rico School of Medicine, Department of Medicine, Cardiovascular Disease Division, San Juan, USA
| | - Hilton Franqui Rivera
- Institutions: University of Puerto Rico School of Medicine, Department of Medicine, Cardiovascular Disease Division, San Juan, USA
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Ragnarsson S, Taha A, Nielsen SJ, Amabile A, Geirsson A, Krane M, Mörtsell D, Sjögren J, Jeppsson A, Martinsson A. Pacemaker implantation following tricuspid valve annuloplasty. JTCVS OPEN 2023; 16:276-289. [PMID: 38204629 PMCID: PMC10775064 DOI: 10.1016/j.xjon.2023.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/02/2023] [Accepted: 08/21/2023] [Indexed: 01/12/2024]
Abstract
Objective Tricuspid annuloplasty is associated with increased risk of atrioventricular block and subsequent implantation of a permanent pacemaker. However, the exact incidence of permanent pacemaker, associated risk factors, and outcomes in this frame remain debated. The aim of the study was to report permanent pacemaker incidence, risk factors, and outcomes after tricuspid annuloplasty from nationwide databases. Methods By using data from multiple Swedish mandatory national registries, all patients (n = 1502) who underwent tricuspid annuloplasty in Sweden from 2006 to 2020 were identified. Patients who needed permanent pacemaker within 30 days from surgery were compared with those who did not. The cumulative incidence of permanent pacemaker implantation was estimated. A multivariable logistic regression model was fit to identify risk factors of 30-day permanent pacemaker implantation. The association between permanent pacemaker implantation and long-term survival was evaluated with multivariable Cox regression. Results The 30-day permanent pacemaker rate was 14.2% (214/1502). Patients with permanent pacemakers were older (69.8 ± 10.3 years vs 67.5 ± 12.4 years, P = .012). Independent risk factors of permanent pacemaker implantation were concomitant mitral valve surgery (odds ratio, 2.07; 95% CI, 1.34-3.27), ablation surgery (odds ratio, 1.59; 95% CI, 1.12-2.23), and surgery performed in a low-volume center (odds ratio, 1.85; 95% CI, 1.17-2.83). Permanent pacemaker implantation was not associated with increased long-term mortality risk (adjusted hazard ratio, 0.74; 95% CI, 0.53-1.03). Conclusions This nationwide study demonstrated a high risk of permanent pacemaker implantation within 30 days of tricuspid annuloplasty. However, patients who needed a permanent pacemaker did not have worse long-term survival, and the cumulative incidence of heart failure and major adverse cardiovascular events was similar to patients who did not receive a permanent pacemaker.
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Affiliation(s)
- Sigurdur Ragnarsson
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Cardiothoracic and Vascular Surgery, Skane University Hospital, Lund, Sweden
| | - Amar Taha
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Susanne J. Nielsen
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andrea Amabile
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
| | - Arnar Geirsson
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
| | - Markus Krane
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
- Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - David Mörtsell
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Cardiology, Skane University Hospital, Lund, Sweden
| | - Johan Sjögren
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Cardiothoracic and Vascular Surgery, Skane University Hospital, Lund, Sweden
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andreas Martinsson
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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3
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Shan Y, Lin M, Sheng X, Zhang J, Sun Y, Fu G, Wang M. Feasibility and safety of left bundle branch area pacing for patients with stable coronary artery disease. Front Cardiovasc Med 2023; 10:1246846. [PMID: 38099227 PMCID: PMC10720039 DOI: 10.3389/fcvm.2023.1246846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 11/20/2023] [Indexed: 12/17/2023] Open
Abstract
Aims Stable coronary artery disease (CAD) is a prevalent comorbidity among patients requiring pacemaker implantation. This comorbidity may have an impact on the safety and prognosis of traditional right ventricular pacing (RVP). Left bundle branch area pacing (LBBaP) is a new physiological pacing modality. Our aim was to investigate the feasibility and safety of LBBaP in patients with the stable CAD. Methods This study included 309 patients with symptomatic bradycardia who underwent LBBaP from September 2017 to October 2021. We included 104 patients with stable CAD (CAD group) and 205 patients without CAD (non-CAD group). Additionally, 153 stable CAD patients underwent RVP, and 64 stable CAD patients underwent His-bundle pacing (HBP) were also enrolled in this study. The safety and prognosis of LBBaP was assessed by comparing pacing parameters, procedure-related complications, and clinical events. Results During a follow-up period of 17.4 ± 5.3 months, the safety assessment revealed that the overall rates of procedure-related complications were similar between the stable CAD group and the non-CAD group (7.7% vs. 3.9%). Likewise, similar rates of heart failure hospitalization (HFH) (4.8% vs. 3.4%, stable CAD vs. non-CAD) and the primary composite outcome including death due to cardiovascular disease, HFH, or the necessity for upgrading to biventricular pacing (6.7% vs. 3.9%, stable CAD vs. non-CAD), were observed. In stable CAD patients, LBBaP demonstrated lower pacing thresholds and higher R wave amplitudes when compared to HBP. Additionally, LBBaP also had significantly lower occurrences of the primary composite outcome (6.7% vs. 19.6%, P = 0.003) and HFH (4.8% vs. 13.1%, P = 0.031) than RVP in stable CAD patients, particularly among patients with the higher ventricular pacing (VP) burden (>20% and >40%). Conclusion Compared with non-CAD patients, LBBaP was found to be attainable in stable CAD patients and exhibited comparable mid-term safety and prognosis. Furthermore, in the stable CAD population, LBBaP has demonstrated more stable pacing parameters than HBP, and better prognostic outcomes compared to RVP.
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Affiliation(s)
- Yu Shan
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Maoning Lin
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Xia Sheng
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Jiefang Zhang
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Yaxun Sun
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Guosheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Min Wang
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
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4
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Abhilash SP, Raja DC, Stolcman S, Yi DS, Rahman M, Tan R, Mahajan A, Lau DH, Abhayaratna WP, Sanders P, Pathak RK. Computerized tomography image correlation of His bundle/deep septal pacing location and outcomes: an analysis from the Canberra HIs bundle/deep septal Pacing Study (CHIPS). J Interv Card Electrophysiol 2022; 64:137-148. [PMID: 35084617 PMCID: PMC9236978 DOI: 10.1007/s10840-022-01133-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 01/17/2022] [Indexed: 12/03/2022]
Abstract
Background Localisation of the conduction system under fluoroscopy is not easy and the ideal location of the pacing leads in physiological pacing is still being debated. Objective The primary aim was to assess the lead locations using cardiac CT scan. Secondary aims were clinical outcomes including success and safety of the procedure and lead performance. Methods Of the 100 consecutive patients who received physiological pacing, 34 patients underwent follow-up cardiac CT scan. The four different types of pacing were identified as His bundle (HBP), para-Hisian, left bundle branch (LBBP), and deep septal pacing. Results Most patients had successful HBP via the right atrium (RA) (87.5%) as compared to the right ventricle (RV) (12.5%). Lower thresholds were observed when leads were placed within 2 mm of the junction of the membranous and muscular ventricular septum. Unlike HBP, LBBP was possible at a wide region of the septum and selective capture of individual fascicles was feasible. LBBP showed deeper penetration of leads into the septum, as compared to deep septal pacing (70% vs. 45%). Approximately, 80% of patients did not have an intra-ventricular portion of the membranous septum. Conclusions The anterior part of the atrio-ventricular (AV) septum at the junction between the membranous and muscular septum via RA appeared to be the best target to successfully pace His bundle. LBBP was possible at a wide region of the septum and selective capture of individual fascicle was feasible. Adequate depth of penetration of lead was very important to capture the left bundle. Supplementary Information The online version contains supplementary material available at 10.1007/s10840-022-01133-z.
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Affiliation(s)
- Sreevilasam P Abhilash
- Canberra Heart Rhythm, Australian National University, Canberra, ACT, Australia.,Cardiac Electrophysiology Unit, Department of Cardiology, Canberra Hospital, Yamba Drive, Garran, ACT, 2605, Australia
| | - Deep Chandh Raja
- Canberra Heart Rhythm, Australian National University, Canberra, ACT, Australia.,Cardiac Electrophysiology Unit, Department of Cardiology, Canberra Hospital, Yamba Drive, Garran, ACT, 2605, Australia
| | - Simon Stolcman
- Canberra Heart Rhythm, Australian National University, Canberra, ACT, Australia
| | - Dong Seok Yi
- Canberra Heart Rhythm, Australian National University, Canberra, ACT, Australia.,Cardiac Electrophysiology Unit, Department of Cardiology, Canberra Hospital, Yamba Drive, Garran, ACT, 2605, Australia
| | - Moyazur Rahman
- Cardiac Electrophysiology Unit, Department of Cardiology, Canberra Hospital, Yamba Drive, Garran, ACT, 2605, Australia
| | - Ren Tan
- Cardiac Electrophysiology Unit, Department of Cardiology, Canberra Hospital, Yamba Drive, Garran, ACT, 2605, Australia
| | - Aakash Mahajan
- Canberra Heart Rhythm, Australian National University, Canberra, ACT, Australia.,Cardiac Electrophysiology Unit, Department of Cardiology, Canberra Hospital, Yamba Drive, Garran, ACT, 2605, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Walter P Abhayaratna
- Cardiac Electrophysiology Unit, Department of Cardiology, Canberra Hospital, Yamba Drive, Garran, ACT, 2605, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Rajeev Kumar Pathak
- Canberra Heart Rhythm, Australian National University, Canberra, ACT, Australia. .,Cardiac Electrophysiology Unit, Department of Cardiology, Canberra Hospital, Yamba Drive, Garran, ACT, 2605, Australia.
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5
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Li X, Zhang J, Qiu C, Wang Z, Li H, Pang K, Yao Y, Liu Z, Xie R, Chen Y, Wu Y, Fan X. Clinical Outcomes in Patients With Left Bundle Branch Area Pacing vs. Right Ventricular Pacing for Atrioventricular Block. Front Cardiovasc Med 2021; 8:685253. [PMID: 34307499 PMCID: PMC8297826 DOI: 10.3389/fcvm.2021.685253] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/31/2021] [Indexed: 12/21/2022] Open
Abstract
Background: Left bundle branch area pacing (LBBAP) is a novel pacing modality with stable pacing parameters and a narrow-paced QRS duration. We compared heart failure (HF) hospitalization events and echocardiographic measures between LBBAP and right ventricular pacing (RVP) in patients with atrioventricular block (AVB). Methods and Results: This multicenter observational study prospectively recruited consecutive AVB patients requiring ventricular pacing in five centers if they received LBBAP or RVP and had left ventricular ejection fraction (LVEF) >50%. Data on electrocardiogram, pacing parameters, echocardiographic measurements, device complications, and clinical outcomes were collected at baseline and during follow-up. The primary outcome was first episode hospitalization for HF or upgrade to biventricular pacing. LBBAP was successful in 235 of 246 patients (95.5%), while 120 patients received RVP. During a mean of 11.4 ± 2.7 months of follow-up, the ventricular pacing burden was comparable (83.9 ± 35.1 vs. 85.7 ± 30.0%), while the mean LVEF differed significantly (62.6 ± 4.6 vs. 57.8 ± 11.4%) between the LBBAP and RVP groups. Patients with LBBAP had significantly lower occurrences of HF hospitalization and upgrading to biventricular pacing than patients with RVP (2.6 vs. 10.8%, P <0.001), and differences in primary outcome between LBBAP and RVP were mainly observed in patients with ventricular pacing >40% or with baseline LVEF <60%. The primary outcome was independently associated with LBBAP (adjusted HR 0.14, 95% CI: 0.04–0.55), previous myocardial infarction (adjusted HR 6.82, 95% CI: 1.23–37.5), and baseline LVEF (adjusted HR 0.91, 95% CI: 0.86–0.96). Conclusion: Permanent LBBAP might reduce the risk of HF hospitalization or upgrade to biventricular pacing compared with RVP in AVB patients requiring a high burden of ventricular pacing. Clinical Trial Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03851315; URL: http://www.chictr.org.cn; Unique Identifier: ChiCTR2100043296.
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Affiliation(s)
- Xiaofei Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junmeng Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chunguang Qiu
- Department of Cardiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhao Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Li
- Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kunjing Pang
- Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Yao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhimin Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruiqin Xie
- Department of Cardiology, The Second Hospital of Hebei Medical University, Hebei Institute of Cardiovascular Research, Shijiazhuang, China
| | - Yangxin Chen
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yongquan Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaohan Fan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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6
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The electrocardiogram characteristics and pacing parameters of permanent left bundle branch pacing: a systematic review and meta-analysis. J Interv Card Electrophysiol 2021; 63:215-224. [PMID: 34173915 DOI: 10.1007/s10840-021-01000-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Recent advances in conduction system pacing have led to the use of left bundle branch pacing (LBBP), which has potential advantages over His bundle pacing (HBP). For example, LBBP engages the electrical activation through the left bundle branch, produces ventricular electrical synchrony, and avoids the weakness of HBP such as lead instability, higher threshold, and early battery depletion. This pacing modality has been considered an attractive mode to achieve normal physiological pacing. However, as a new technology, LBBP is still in the stage of clinical exploration and lacks adequate evaluation. This study aims to investigate the electrocardiogram characteristics, pacing parameters, the safety, and the effectiveness of LBBP. METHODS A computerized search of PubMed, Embase, and The Cochrane Library for the effects of LBBP was done. The baseline characteristics of patients, successful rate of implantation, capture threshold, R-wave amplitude, pacing impedance, QRS duration, and follow-up date were extracted and summarized. RESULTS Thirteen studies including 712 patients were included in this analysis. The overall successful rate for implantation was 92.9%. The main indications for LBBP were atrioventricular block (AVB), sinus node dysfunction (SND), atrial fibrillation (AF) with slow ventricular rate, and cardiac resynchronization therapy (CRT) candidates. For patients with QRS duration>120 ms, permanent LBBP resulted in narrower QRS duration compared to that before implantation (P = 0.05). QRS duration and capture threshold of LBBP remained stable during follow-up. Moreover, there was higher R-wave amplitude and lower pacing impedance at follow-up compared to those at implantation (P = 0.01 and P < 0.00001, respectively). CONCLUSIONS Permanent LBBP has shown promising results for pacemaker-indicated patients in small observational studies. Good electrical synchronization, high success rates, and stable pacemaker lead parameters suggested significant advantages of LBBP in physiological pacing. Randomized controlled trials are needed to assess the efficacy of LBBP in patients.
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7
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Garweg C, Khelae SK, Chan JYS, Chinitz L, Ritter P, Johansen JB, Sagi V, Epstein LM, Piccini JP, Pascual M, Mont L, Willems R, Splett V, Stromberg K, Sheldon T, Kristiansen N, Steinwender C. Behavior of AV synchrony pacing mode in a leadless pacemaker during variable AV conduction and arrhythmias. J Cardiovasc Electrophysiol 2021; 32:1947-1957. [PMID: 33928713 PMCID: PMC8360010 DOI: 10.1111/jce.15061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/03/2021] [Accepted: 03/16/2021] [Indexed: 11/28/2022]
Abstract
Introduction MARVEL 2 assessed the efficacy of mechanical atrial sensing by a ventricular leadless pacemaker, enabling a VDD pacing mode. The behavior of the enhanced MARVEL 2 algorithm during variable atrio‐ventricular conduction (AVC) and/or arrhythmias has not been characterized and is the focus of this study. Methods Of the 75 patients enrolled in the MARVEL 2 study, 73 had a rhythm assessment and were included in the analysis. The enhanced MARVEL 2 algorithm included a mode‐switching algorithm that automatically switches between VDD and ventricular only antibradycardia pacing (VVI)‐40 depending upon AVC status. Results Forty‐two patients (58%) had persistent third degree AV block (AVB), 18 (25%) had 1:1 AVC, 5 (7%) had variable AVC status, and 8 (11%) had atrial arrhythmias. Among the 42 patients with persistent third degree AVB, the median ventricular pacing (VP) percentage was 99.9% compared to 0.2% among those with 1:1 AVC. As AVC status changed, the algorithm switched to VDD when the ventricular rate dropped less than 40 bpm. During atrial fibrillation (AF) with ventricular response greater than 40 bpm, VVI‐40 mode was maintained. No pauses longer than 1500 ms were observed. Frequent ventricular premature beats reduced the percentage of AV synchrony. During AF, the atrial signal was of low amplitude and there was infrequent sensing. Conclusion The mode switching algorithm reduced VP in patients with 1:1 AVC and appropriately switched to VDD during AV block. No pacing safety issues were observed during arrhythmias.
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Affiliation(s)
- Christophe Garweg
- Department of Cardiovascular Sciences, University Hospitals Leuven, University of Leuven, Leuven, Belgium
| | - Surinder Kaur Khelae
- Department of Electrophysiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Joseph Yat Sun Chan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Larry Chinitz
- Leon H. Charney Division of Cardiology, NYU Langone Medical Center, New York, New York, USA
| | - Philippe Ritter
- Department of Electrophysiology and Cardiac Stimulation, Hôpital Haut- Lévêque-CHU de Bordeaux, Pessac, France
| | | | - Venkata Sagi
- Baptist Heart Specialists, Baptist Medical Center, Jacksonville, Florida, USA
| | - Laurence M Epstein
- Department of Electrophysiology, North Shore University Hospital, Manhasset, New York, USA
| | - Jonathan P Piccini
- Division of Cardiology, Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Mario Pascual
- Miami Cardiac & Vascular Institute, Baptist Hospital, Miami, Florida, USA
| | - Lluis Mont
- Institut Clinic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Rik Willems
- Department of Cardiovascular Sciences, University Hospitals Leuven, University of Leuven, Leuven, Belgium
| | | | | | | | | | - Clemens Steinwender
- Department of Cardiology, Kepler University Hospital, Medical Faculty, Johannes Kepler University, Linz, Austria.,Department of Cardiology, Paracelsus Medical University Salzburg, Salzburg, Austria
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Abstract
Cardiac implantable electronic devices (CIEDs) are essential for the management of a variety of cardiac conditions, including tachyarrhythmias, bradyarrhythmias, and medically refractory heart failure (HF). Recent advancements in CIED technology have led to innovative solutions that overcome shortcomings associated with traditional devices or address unmet needs. Leadless pacemakers, subcutaneous implantable cardioverter defibrillators (ICDs), and extravascular ICDs eliminate lead-related complications common with conventional pacemakers or ICDs. Conduction system pacing (His bundle pacing and left bundle branch pacing) is a more physiologic method of pacing and avoids the deleterious consequences associated with long-term right ventricular pacing. For HF-related devices, cardiac contractility modulation is an emerging therapy that bridges a gap for many patients ineligible for cardiac resynchronization therapy and has been shown to improve HF symptoms and decrease hospitalizations and mortality in select patients. Implantable pulmonary artery pressure monitors help guide HF management and reduce hospitalizations. Lastly, new phrenic nerve stimulating devices are being utilized to treat central sleep apnea, a common comorbidity associated with HF. While further long-term studies are still underway for many of these new technologies, it is anticipated that these devices will become indispensable therapeutics in the expanding cardiovascular armamentarium.
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9
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Andersson C, Schou M, Gislason GH, Køber L, Torp-Pedersen C, Monahan KM. Long-term risk of heart failure and mortality following mitral valve surgery in patients with and without right ventricular pacemaker. J Card Surg 2020; 35:2598-2604. [PMID: 32652752 DOI: 10.1111/jocs.14847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Patients undergoing mitral valve surgery are at risk of developing postoperative conduction blocks and have a high incidence of heart failure (HF). Mitral valve surgery often results in reduced left ventricular systolic ejection fraction following surgery and the imposition of dyssynchrony with right ventricular (RV) pacing may further compromise stroke volume. Our aim was to investigate the risks of HF and mortality in patients with vs without RV pacemaker placement (PPM) after mitral valve surgery. METHODS Using Danish nationwide databases, we identified all patients undergoing mitral valve repair or replacement surgery between 1997 and 2017, who were free from HF at baseline. The association of PPM implanted within 30 days following surgery with long-term risks of HF and mortality was investigated by multivariable Cox regression models. RESULTS Of 4072 patients (33% female), 248 (6%) had a PPM implanted at 30-day postsurgery. Patients with PPM were older (68 vs 63 years), had a higher prevalence of concomitant aortic valve surgery (15% vs 11%), ischemic heart disease (13% vs 8%), and atrial fibrillation (19% vs 12%), compared with patients without PPM. Over a median follow-up of 5 years, 68 (27%) vs 825 (22%) patients with vs without PPM developed HF and 74 (30%) vs 1018 (27%) died. In multivariable-adjusted models, the hazard ratios associated with PPM were 1.00 (0.78-1.30), P = .93 for HF, and .96 (0.76-1.21), P = .72 for mortality. CONCLUSIONS Postoperative implantation of a permanent RV pacemaker does not alter the long-term risks of HF and mortality following mitral valve surgery.
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Affiliation(s)
- Charlotte Andersson
- Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.,Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University, Gentofte, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University, Gentofte, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University, Gentofte, Denmark.,The Danish Heart Foundation, Copenhagen, Denmark
| | - Lars Køber
- The Heart Center, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Clinical Investigation and Cardiology, Nordsjaellands Hospital, Hillerød, Denmark
| | - Kevin M Monahan
- Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
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10
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Sundaram S, Vijayaraman P. Left bundle branch pacing. Herzschrittmacherther Elektrophysiol 2020; 31:124-134. [PMID: 32458056 DOI: 10.1007/s00399-020-00694-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 04/01/2020] [Indexed: 10/24/2022]
Abstract
Chronic right ventricular (RV) pacing has been associated with significant electrical and mechanical dyssynchrony leading to increased risk for recurrent heart failure hospitalizations and atrial arrhythmias. His bundle pacing (HBP) is an effective alternative to RV pacing as it is physiological and provides synchronized contraction of both ventricles. But there are limitations to HBP, which include lead stability, rise in threshold, early battery depletion and longer learning curve. Huang et al. recently reported a novel technique to directly capture the left bundle branch (LBB) by deep septal pacing. Subsequently, many studies have demonstrated the feasibility, safety and efficacy of left bundle branch pacing (LBBP). This has the potential to overcome the limitations of HBP and provide a safe technique to capture the conduction system in patients with distal His bundle and proximal bundle branch disease. The criteria for LBB capture and the methodology to perform LBBP are discussed in detail in this review. The Medtronic SelectSecure®3830 pacing lead is used along with a fixed-curve C315His® or a deflectable C304His® sheath. LBBP provides safe and low threshold compared to HBP. Left bundle potential should be demonstrable in all patients except in those with infrahisian complete heart block (CHB) and complete left bundle branch block (LBBB), wherein antegrade activation of the left bundle will not occur. LBBP has the potential to be an effective alternative to biventricular pacing or HBP in patients with left ventricular dysfunction, LBBB and recurrent heart failure. Long-term safety and clinical outcomes compared to traditional pacing need to be carefully studied in randomized clinical trials.
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Affiliation(s)
| | - Pugazhendhi Vijayaraman
- Cardiac Electrophysiology, Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, MC 36-10, 1000 E Mountain Blvd, 18711, Wilkes-Barre, PA, USA.
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Li X, Li H, Ma W, Ning X, Liang E, Pang K, Yao Y, Hua W, Zhang S, Fan X. Permanent left bundle branch area pacing for atrioventricular block: Feasibility, safety, and acute effect. Heart Rhythm 2019; 16:1766-1773. [DOI: 10.1016/j.hrthm.2019.04.043] [Citation(s) in RCA: 130] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Indexed: 02/07/2023]
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12
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Kaye G. The desire for physiological pacing: Are we there yet? J Cardiovasc Electrophysiol 2019; 30:3025-3038. [DOI: 10.1111/jce.14248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/11/2019] [Accepted: 10/16/2019] [Indexed: 01/23/2023]
Affiliation(s)
- Gerry Kaye
- University of Queensland Medical School, Herston Brisbane Queensland Australia
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Lee WC, Fang HY, Chen HC, Chen YL, Tsai TH, Pan KL, Lin YS, Chen MC. Post-pacemaker implant QRS duration and heart failure admission in patients with sick sinus syndrome and complete atrioventricular block. ESC Heart Fail 2019; 6:686-693. [PMID: 31111655 PMCID: PMC6676452 DOI: 10.1002/ehf2.12445] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 04/09/2019] [Indexed: 12/19/2022] Open
Abstract
AIMS High demand right ventricular pacing may elicit left ventricular systolic dysfunction known as pacing-induced cardiomyopathy, increasing the risks of heart failure (HF) hospitalization. Percentage of demand ventricular pacing is different between patients with sick sinus syndrome (SSS) and those with complete atrioventricular block (CAVB). This study aims to compare the incidence of HF admission and pacing-induced cardiomyopathy between patients with SSS and CAVB. METHODS AND RESULTS A total of 824 patients who received single ventricular or dual-chamber pacemaker implantation at our hospital between January 2003 and December 2012 were recruited for the study. Patients with HF, those without complete cardiac echocardiography, and those with significant coronary artery disease were excluded. Finally, 315 patients with SSS and 289 patients with CAVB were enrolled in this study. The CAVB group had a higher pacing percentage (39.37 ± 9.17% vs. 83.82 ± 33.06%; P < 0.001), longer pacing QRS duration (142.56 ± 33.02 ms vs. 156.63 ± 25.18 ms; P < 0.001), and higher prevalence of follow-up left ventricular ejection fraction ≤40% (1.3% vs. 4.2%; P = 0.040). However, the incidence of HF admission was similar between the two groups (log-rank P = 0.647). Age [hazard ratio (HR), 95% confidence interval (CI): 1.121, 1.054-1.193], diabetes mellitus (HR, 95% CI: 2.667, 1.159-6.136), pacing QRS duration ≥163 ms (HR, 95% CI: 3.506, 1.491-8.247), and left atrial size (HR, 95% CI: 1.070, 1.012-1.131) were independent predictors of HF admission. The Kaplan-Meier curve showed a significant difference in HF admission over a 3.5 year follow-up period (3.5 years: P value = 0.004; 5 years: P value = 0.002) between patients with pacing QRS duration ≥163 and <163 ms. CONCLUSIONS There was no difference in HF admission between patients with SSS and CAVB, although the CAVB group had a higher pacing percentage. Post-pacemaker implant pacing QRS duration ≥163 ms was the most important predictor of HF admission.
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Affiliation(s)
- Wei-Chieh Lee
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Huang-Chung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yung-Lung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tzu-Hsien Tsai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuo-Li Pan
- Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yu-Sheng Lin
- Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Mien-Cheng Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Midrange ejection fraction as a risk factor for deterioration of cardiofunction after permanent pacemaker implantation. J Interv Card Electrophysiol 2019; 55:213-224. [PMID: 30739257 DOI: 10.1007/s10840-019-00513-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 01/15/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE To determine whether the midrange ejection fraction (mrEF) is associated with increased risk of deterioration of cardiac function (DCF) after dual chamber permanent pacemaker (PPM) implantation. METHODS We performed a prospective cohort study of relevance in patients with EF ≥ 40% and indications for PPMs. Patient characteristics were recorded at baseline and 1 day, 1 month, 3 months, and 6 months after PPM implantation with leads placed in the right ventricular apex. These included clinical symptoms, signs, biochemical parameters, BNP, echocardiography and ECG parameters, and pacing-related parameter changes. The patients were followed-up for 6 months. Univariate and multivariable Cox regression analyses were performed. RESULTS A total of 879 patients were included, aged 35 to 88 years (mean age 67.2 ± 9.6); a total of 81 patients (9.2%) developed DCF after PPM implantation, including LVEF < 40% (57 cases) and increased NYHA class (24 cases). Cox models demonstrated that age ≥ 75 years (HR 2.273 [95% CI, 1.541-3.626]), OMI (HR 2.078 [95% CI, 1.275-3.604]), mrEF (HR 2.762 [95% CI, 1.558-4.769]), moderate mitral regurgitation (HR 2.819 [95% CI, 1.604-4.153]), and right ventricular pacing ≥ 50% (HR 2.311 [95% CI, 1.478-3.937]) were strong predictors for DCF, and NT-proBNP > 1000 ng/L and paced QRS duration ≥ 180 ms were also the independent predictors of DCF. CONCLUSIONS MrEF was associated with increased risk of deterioration of cardiac function after PPM implantation. Moderate mitral regurgitation and increased NT-proBNP levels are also potential independent predictors for deterioration of cardiac function after PPM implantation.
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Paton MF, Witte KK. Heart failure and right ventricular pacing - how to avoid the need for cardiac resynchronization therapy. Expert Rev Med Devices 2018; 16:35-43. [PMID: 30477355 DOI: 10.1080/17434440.2019.1552133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Heart failure (HF) is a common finding in patients with pacemakers implanted for bradycardia, with cross-sectional and longitudinal studies contributing to the growing consensus that right ventricular pacing can cause adverse cardiac remodeling and left ventricular systolic dysfunction increasing the risk of hospitalization and death. An unselected approach using cardiac resynchronization therapy from the time of first implant in patients with heart block has produced equivocal results. Contemporary research has therefore begun to focus on the stratification of patients' risk of pacemaker-associated impairment to permit focused, personalized management. AREAS COVERED The present review will describe the incidence and relevance of HF in the pacemaker population and discuss current management options for such patients. EXPERT COMMENTARY At present there are few contemporary data to guide the identification of patients with and at risk of pacemaker-associated cardiac remodeling and dysfunction. Emphasis must be placed on precise and personalized treatment approaches which currently remain under-investigated due to a number of challenges, for example, small sample sizes, limited clarity on programmed settings, and short follow-up periods.
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Affiliation(s)
- Maria F Paton
- a Leeds Institute of Cardiovascular and Metabolic Medicine , University of Leeds , Leeds , UK
| | - Klaus K Witte
- a Leeds Institute of Cardiovascular and Metabolic Medicine , University of Leeds , Leeds , UK
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Kim JH, Kang KW, Chin JY, Kim TS, Park JH, Choi YJ. Major determinant of the occurrence of pacing-induced cardiomyopathy in complete atrioventricular block: a multicentre, retrospective analysis over a 15-year period in South Korea. BMJ Open 2018; 8:e019048. [PMID: 29439074 PMCID: PMC5829811 DOI: 10.1136/bmjopen-2017-019048] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES The predictors of pacing-induced cardiomyopathy (PICM) for complete atrioventricular block (CAVB) have not yet been defined. The aim of this study was to investigate the major determinant of the occurrence of PICM. SETTING This is a multicentre, retrospective analysis of CAVB from tertiary referral centres in Daejeon, South Korea. PARTICIPANTS A cohort of 900 consecutive patients with an implanted pacemaker was collected from December 2001 to August 2015. Of these, a total of 130 patients with CAVB with pacing-dependent rhythm who underwent ECG and echocardiogram before and after implantation were analysed for the occurrence of PICM. OUTCOME MEASURES Cox proportional hazards models evaluated the determinant of PICM by ECG, device parameters and echocardiogram over a mean of 4.5 years. RESULTS PICM was observed in 16.1% (n=21) of all patients with CAVB (age, 64±11 years; male, 36.2%). The preimplant left ventricular (LV) ejection fraction (66%±9% vs 66%±8%) and non-apical pacing (40.4% vs 33.3%) were similar; however, the native QRS duration (124±34 ms vs 149±32 ms) and the paced QRS duration (pQRSd) (139±29 ms vs 167±28 ms) were significantly different between the two groups. The postimplant LV ejection fraction (61%±7% vs 31%±8%) was also significantly different at the end of follow-up. A pQRSd significantly correlated with PICM (HR 1.05, 95% CI 1.02 to 1.09, P=0.001). A pQRSd with a cut-off value of above 140 ms had a sensitivity of 95% while a pQRSd with a cut-off value of above 167 ms had a specificity of 90% for PICM. CONCLUSION In patients with CAVB with pacing-dependent rhythm, regardless of the pacing site, the pQRSd is a major determinant of the occurrence of PICM.
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Affiliation(s)
- Jun Hyung Kim
- Division of Cardiology, Chungnam National University Hospital, Daejeon, Korea
| | - Ki-Woon Kang
- Division of Cardiology, Eulji University Hospital, Daejeon, Korea
| | - Jung Yeon Chin
- Division of Cardiology, Eulji University Hospital, Daejeon, Korea
| | - Tae-Seok Kim
- Division of Cardiology, Catholic Saint Hospital, Daejeon, Korea
| | - Jae-Hyeong Park
- Division of Cardiology, Chungnam National University Hospital, Daejeon, Korea
| | - Yu Jeong Choi
- Division of Cardiology, Eulji University Hospital, Daejeon, Korea
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Early Right Ventricular Apical Pacing-Induced Gene Expression Alterations Are Associated with Deterioration of Left Ventricular Systolic Function. DISEASE MARKERS 2017; 2017:8405196. [PMID: 28928601 PMCID: PMC5591927 DOI: 10.1155/2017/8405196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 07/04/2017] [Indexed: 01/05/2023]
Abstract
The chronic high-dose right ventricular apical (RVA) pacing may have deleterious effects on left ventricular (LV) systolic function. We hypothesized that the expression changes of genes regulating cardiomyocyte energy metabolism and contractility were associated with deterioration of LV function in patients who underwent chronic RVA pacing. Sixty patients with complete atrioventricular block and preserved ejection fraction (EF) who underwent pacemaker implantation were randomly assigned to either RVA pacing (n = 30) group or right ventricular outflow tract (RVOT) pacing (n = 30) group. The mRNA levels of OPA1 and SERCA2a were significantly lower in the RVA pacing group at 1 month's follow-up (both p < 0.001). Early changes in the expression of selected genes OPA1 and SERCA2a were associated with deterioration in global longitudinal strain (GLS) that became apparent months later (p = 0.002 and p = 0.026, resp.) The altered expressions of genes that regulate cardiomyocyte energy metabolism and contractility measured in the peripheral blood at one month following pacemaker implantation were associated with subsequent deterioration in LV dyssynchrony and function in patients with preserved LVEF, who underwent RVA pacing.
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Chen S, Wang Z, Kiuchi MG, Andrea BR, Krucoff MW, Liu S, Pürerfellner H. Cardiac pacing strategies and post-implantation risk of atrial fibrillation and heart failure events in sinus node dysfunction patients: a collaborative analysis of over 6000 patients. Clin Res Cardiol 2016; 105:687-698. [DOI: 10.1007/s00392-016-0973-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 02/12/2016] [Indexed: 10/22/2022]
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Kawakami H, Nagai T, Matsuyama TA, Nishimura K, Higaki J, Ogimoto A. Benefit of magnetic resonance-conditional cardiac resynchronization therapy defibrillator: A case of cardiac sarcoidosis-involved cervical extradural lesion. HeartRhythm Case Rep 2016; 2:88-91. [PMID: 28491641 PMCID: PMC5412658 DOI: 10.1016/j.hrcr.2015.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hiroshi Kawakami
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Takayuki Nagai
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Taka-aki Matsuyama
- Department of Pathology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazuhisa Nishimura
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Jitsuo Higaki
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Akiyoshi Ogimoto
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
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Paced QT interval as a risk factor for new-onset left ventricular systolic dysfunction and cardiac death after permanent pacemaker implantation. Int J Cardiol 2016; 203:158-63. [DOI: 10.1016/j.ijcard.2015.10.128] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/28/2015] [Accepted: 10/18/2015] [Indexed: 11/30/2022]
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