A single-centre experience of His bundle pacing without electrophysiological mapping system: implant success rate, safety, pacing characteristics and one-year follow up

INTRODUCTION@#Despite the challenges related to His bundle pacing (HBP), recent data suggest an improved success rate with experience. As a non-university, non-electrophysiology specialised centre in Singapore, we report our experiences in HBP using pacing system analyser alone.@*METHODS@#Data of 28 consecutive patients who underwent HBP from August 2018 to February 2019 was retrospectively obtained. The clinical and technical outcomes of these patients were compared between two timeframes of three months each. Patients were followed up for 12 months.@*RESULTS@#Immediate technical success was achieved in 21 (75.0%) patients (mean age 73.3 ± 10.7 years, 47.6% female). The mean left ventricular ejection fraction was 53.9% ± 12.1%. The indications for HBP were atrioventricular block (n = 13, 61.9%), sinus node dysfunction (n = 7, 33.3%) and upgrade from implantable cardioverter-defibrillator to His-cardiac resynchronisation therapy (n = 1, 4.8%). No significant difference was observed in baseline characteristics between Timeframe 1 and Timeframe 2. Improvements pertaining to mean fluoroscopy time were achieved between the two timeframes. There was one HBP-related complication of lead displacement during Timeframe 1. All patients with successful HBP achieved non-selective His bundle (NSHB) capture, whereas only eight patients had selective His bundle (SHB) capture. NSHB and SHB capture thresholds remained stable at the 12-month follow-up.@*CONCLUSION@#Permanent HBP is feasible and safe, even without the use of an electrophysiology recording system. This was successfully achieved in 75% of patients, with no adverse clinical outcomes during the follow-up period.

Chinese emergency expert consensus on bedside temporary cardiac pacing (2023) / 中华危重病急救医学

Temporary cardiac pacing is an essential technique in the diagnosis and treatment of arrhythmias. Due to its urgency, complexity, and uncertainty, it is necessary to develop an evidence-based emergency operation norms. Currently, there is no specific consensus guidelines at home or abroad. The Emergency Branch of Chinese Medical Association organized relevant experts to draft the Chinese emergency expert consensus on bedside temporary cardiac pacing (2023) to guide the operation and application of bedside cardiac pacing. The formulation of the consensus adopts the consensus meeting method and the evidentiary basis and recommendation grading of the Oxford Center for Evidence-based Medicine in the United States. A total of 13 recommendations were extracted from the discussion on the methods of bedside temporary cardiac pacing, the puncture site of transvenous temporary cardiac pacing, the selection of leads, the placement and placement of leads, pacemaker parameter settings, indications, complications and postoperative management. The recommended consensus includes the choice between transcutaneous and transvenous pacing, preferred venous access for temporary transvenous pacing, the target and best guidance method for implantation of bedside pacing electrodes, recommended default pacemaker settings, recommended indications for sinoatrial node dysfunction, atrioventricular block, acute myocardial infarction, cardiac arrest, ventricular and supraventricular arrhythmias. They also recommended ultrasound guidance and a shortened temporary pacing support time to reduce complications of temporary transvenous cardiac pacing, recommended bedrest, and anticoagulation after temporary transvenous pacing. Bedside temporary cardiac pacing is generally safe and effective. Accurate assessment, correct selection of the pacing mode, and timely performance of bedside temporary cardiac pacing can further improve the survival rate and prognosis of related emergency patients.

Estimulación cardíaca temporal de larga duración con cable activo y marcapaso permanente externo / Long-term temporary cardiac pacing with active lead and external permanent pacemaker

INTRODUCCIÓN. La estimulación cardíaca temporal de larga duración con cable activo y marcapaso permanente externo es una técnica recientemente incluida en las guías de manejo de bradicardias sintomáticas. CASOS CLÍNICOS. Se describen 4 casos de pacientes sometidos a estimulación cardíaca temporal de larga duración con cable activo y marcapaso permanente externo de la unidad de Hemodinámica del Hospital de Especialidades Carlos Andrade Marín, con indicaciones diversas. DISCUSIÓN. El tiempo medio de permanencia con el cable activo y el marcapaso externalizado fue 23 días. No hubo complicaciones del procedimiento. Un paciente falleció por causas no relacionadas con la estimulación y 2 se recuperaron en sus domicilios. CONCLUSIÓN. La técnica de estimulación temporal utilizando marcapasos permanentes recuperados se muestra extremadamente útil para mantener un marcapaso cardíaco seguro, incluso ambulatorio y por largo tiempo, hasta el implante de dispositivos definitivos. Su limitación es la factibilidad de hacerlo solo en centros de tercer nivel.

INTRODUCTION. Long-duration temporary cardiac pacing with active lead and permanent external pacemaker is a technique recently included in the guidelines for the management of symptomatic bradycardias. CLINICAL CASES. We describe 4 cases of patients who underwent long-duration temporary cardiac pacing with active lead and external permanent pacemaker at the Hemodynamics Unit of the Hospital de Especialidades Carlos Andrade Marín, with different indications. DISCUSSION. The mean length of stay with the active lead and externalized pacemaker was 23 days. There were no procedural complications. One patient died of causes unrelated to pacing and 2 recovered at home. CONCLUSIONS. The technique of temporary pacing using retrieved permanent pacemakers is extremely useful for maintaining safe cardiac pacing, even on an outpatient basis and for a long period of time, until implantation of definitive devices. Its limitation is the feasibility of doing it only in third level centers.

Study on Impedance of Implantable Cardiac Pacemaker in Unipolar/Bipolar Pacing Mode by in Vitro Experiment / 中国医疗器械杂志

The unipolar/bipolar pacing mode of pacemaker is related to its circuit impedance, which affects the battery life. In this study, the in vitro experiment scheme of pacemaker circuit impedance test was constructed. The human blood environment was simulated by NaCl solution, and the experimental environment temperature was controlled by water bath. The results of in vitro experiments showed that under the experimental conditions similar to clinical human parameters, the difference between the circuit impedance of bipolar mode and unipolar mode is 120~200 Ω. The results of the in vitro experiment confirmed that the circuit impedance of bipolar circuit was larger than that of unipolar mode, which was found in clinical practice. The results of this study have reference value to the optimization of pacing mode and the reduction of pacemaker power consumption.

Predictive value of impedance of leadless pacemaker during implantation on trend changes of pacing threshold / 中华心血管病杂志

Objective: To explore the predictive value of the impedance measured during leadless pacemaker Micra implantation on the trend of changes of pacing threshold post implantation. Methods: This is a retrospective cross-sectional study. Patients who received implantation of leadless pacemaker Micra at the Second Xiangya Hospital of Central South University from December 2019 to August 2020 were enrolled. The clinical data and the intraoperative electrical parameters during leadless pacemaker implantation were collected. The impedance and pacing threshold data were analyzed at three time points: immediate release, 5-10 min after release, and after traction test. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were used to analyze the value of the impedance at immediate release on predicting the trend of changes of pacing threshold post implantation. Results: A total of 21 patients (mean age: (72.2±12.5) years, 12 males) were included. The impedance of 21 patients was (798.1±35.3) Ω immediately after implantation, (800.9±35.6) Ω after 5-10 minutes of release, and (883.6±31.7) Ω after traction test. Impedance was similar between the three time points (P>0.05). The threshold was (0.97±0.11) V/0.24 ms immediately after implantation, (0.95±0.12) V/0.24 ms at 5-10 min after the release, and (0.59±0.06) V/0.24 ms after the traction test. The threshold was significantly lower after the traction test than that immediately after release (P=0.003) and than that at 5-10 minutes after release (P=0.008), suggesting a decreased tendency of the threshold over time. According to the analysis of the ROC curve, the immediate impedance after the release ≥680 Ω could predict the ideal pacing threshold after the traction test (AUC=0.989, 95%CI 0.702-0.964, P<0.001), the prediction sensitivity was 87%, and the specificity was 100%. The pacing threshold would be not ideal with the immediate impedance ≤ 520 Ω (95%CI 0.893-1.000, P<0.001), the sensitivity was 100%, and the specificity was 80%. Conclusions: The impedance immediately after the release has predictive value for the changing trend of threshold post leadless pacemaker Micra implantation. Impedance ≥680 Ω immediately after release is often related with ideal pacing threshold after the traction test. In contrast, the impedance ≤ 520 Ω pacing is often related with unsatisfactory threshold after the traction test, therefore, it is recommended to find a new pacing site to achieve the impedance ≥680 Ω immediately after release during leadless pacemaker Micra implantation.

Initial clinical experience of left bundle branch pacing after transcatheter aortic valve implantation / 中华心血管病杂志

Objective: To investigate the efficacy and safety of left bundle branch pacing(LBBP) in patients after transcatheter aortic valve implantation (TAVI). Methods: This is a retrospective study. A total of 35 patients underwent TAVI and received pacemaker implantation from January 2018 to December 2020 in Beijing Fuwai Hospital were enrolled. Patients were divided into LBBP group (n=12) and right ventricular apex pacing (RVAP) group (n=23) according to the pacing position. The success rate of operation in LBBP group was calculated, and the occurrence of complications were observed, and the parameters of pacemaker were measured on the 3rd day and 1, 3 and 6 months after operation. The N-terminal pro-B-type natriuretic peptide (NT-proBNP), echocardiographic and ECG indexes were compared between the two groups on the 3rd day and 1, 3, and 6 months after pacemaker implantation. Result: A total of 35 patients were included, The age was (76.4±7.7) years, including 19 males (54.3%). The procedure time ((86.58±17.10)min vs. (68.74±9.18)min, P<0.001) and fluoroscopy duration ((20.08±4.44)min vs. (17.00±2.26)min, P<0.001) were significantly longer in LBBP group compared with RVAP group. The operation success rate of LBBP group was 11/12. There was no serious operation related complications such as pneumothorax, hemothorax, electrode dislocation, infection, and lower limb bleeding. The patients were followed up for 7.43 (5.21, 9.84) months. The programmed parameters of pacemaker were in the ideal range and stable during follow-up. At 3 and 6 months after operation, the left ventricular ejection fraction in LBBP group was higher than that in RVAP Group (at 3 months: (60.75±2.89)% vs. (57.35±3.33)%, P=0.004; at 6 months: (63.17±3.33)% vs. (56.17±3.97)%, P<0.001), NT-proBNP values was lower in LBBP group than that in RVAP Group (at 3 months: 822 (607, 1 150)ng/L vs. 1 052 (902, 1 536)ng/L, P=0.006; at 6 months: 440 (330,679)ng/L vs. 783 (588, 1 023)ng/L, P=0.001). At 1, 3 and 6 months after operation, the QRS duration was shorter in LBBP group than that in RVAP group (1 month: 99 (97, 107)ms vs. 126(124, 130)ms, P<0.001; 3 months: 98(96, 105)ms vs. 129(128, 133)ms, P<0.001; 6 months: 96(94, 104)ms vs. 130(128, 132)ms, P<0.001). Conclusions: For patients with permanent pacemaker indications after TAVI, LBBP is feasible, safe and reliable. It could improve the cardiac function in the short term, the long-term effect of LBBP needs to be further observed.

The success rate of His-Purkinje system pacing in patients with various sites of atrioventricular block / 中华心血管病杂志

Objective: To evaluate the success rate of His-Purkinje system pacing (HPSP) in patients with various sites of atrioventricular block (AVB) and provide clinical evidence for the selection of HPSP in patients with AVB. Methods: This is a retrospective case analysis. 637 patients with AVB who underwent permanent cardiac pacemaker implantation and requiring high proportion of ventricular pacing from March 2016 to September 2021 in the Department of Cardiology, General Hospital of Northern Theater Command were enrolled. The site of AVB was determined by electrophysiological examination. His bundle pacing (HBP) was performed in the first 130 patients (20.4%) who were classified as the HBP group and HPSP included HBP and/or left bundle branch pacing (LBBP) was performed in later 507 patients (79.6%) and these patients were classified as the HPSP group. The basic clinical information such as age and sex of the two groups was compared, and the success rates of HBP or HPSP in patients with different sites of AVB and QRS intervals were analyzed. Results: The age of HBP group was (66.4±15.9) years with 75 males (57.7%). The age of HPSP group was (66.8±13.6) years with 288 (56.8%) males. Among 637 patients, 63.0% (401/637) had atrioventricular node block; 22.9% (146/637) had intra-His block; 14.1% (90/637) had distal or inferior His bundle block. Totally, the success rate of HPSP was higher than that of HBP [93.9% (476/507) vs. 86.9% (113/130), P<0.05]. In each group of patients with various AVB sites, the success rate of HPSP was higher than that of HBP respectively and both success rates of HBP and HPSP showed a declining trend with the distant AVB site. The success rate of HBP in patients with atrioventricular node block and intra-His block was higher than that in patients with distal or inferior His bundle block [95.2% (79/83) vs. 47.1% (8/17), P<0.001; 86.7% (26/30) vs. 47.1% (8/17), P=0.010]. The success rate of HPSP was higher than that of HBP in patients with distal or inferior His bundle block [87.7% (64/73) vs 47.1% (8/17), P=0.001]. In patients with QRS<120 ms, 94.9% (520/548) of AVB sites were in atrioventricular node or intra-His, and HBP had a similar high success rate with HPSP [95.6% (109/114) vs. 96.3% (418/434), P=0.943] in these patients. In patients with QRS ≥ 120 ms, 69.7% (62/89) of AVB sites were at distal or inferior His bundle, and the success rate of HBP was only 25.0% (4/16), while the success rate of HPSP was as high as 79.5% (58/73), P<0.001. Conclusions: In patients with QRS<120 ms and atrioventricular node block or intra-His block, success rates of HBP and HPSP are similarly high and HBP might be considered as the first choice. In patients with QRS ≥ 120 ms and AVB site at distal or inferior His bundle, the success rate of HPSP is higher than that of HBP, suggesting LBBP should be considered as the first-line treatment option.

Estimulação do Ramo Esquerdo do Sistema His-Purkinje: Experiência Inicial / Left Bundle Branch Pacing of His-Purkinje Conduction System: Initial Experience

Resumo Fundamento A estimulação ventricular direita convencional aumenta o risco de fibrilação atrial e insuficiência cardíaca em portadores de marca-passo. A estimulação do ramo esquerdo (RE) do sistema His-Purkinje pode evitar os desfechos indesejados da estimulação ventricular direita. Objetivo Analisar retrospectivamente os desfechos intraoperatórios, eletrocardiográficos e os dados clínicos do seguimento inicial de pacientes submetidos à estimulação do RE. Métodos Foram avaliados os parâmetros eletrônicos do implante e eventuais complicações precoces de 52 pacientes consecutivos submetidos à estimulação do sistema de condução. O nível de significância alfa adotado foi igual a 0,05. Resultados 52 pacientes foram submetidos a estimulação do RE do sistema His-Purkinje, obtendo sucesso em 50 procedimentos. 69,2% dos pacientes eram do sexo masculino e a mediana e intervalo interquatil da idade no momento do implante foi de 73,5 (65,0-80,0) anos. A duração do QRS pré-implante foi de 146 (104-175) ms e de 120 (112-130) ms após o procedimento. O tempo de ativação do ventrículo esquerdo foi de 78 (70-84) ms. A amplitude da onda R foi de 12,00 (7,95-15,30) mV, com limiar de estimulação de 0,5 (0,4-0,7) V × 0,4 ms e impedância de 676 (534-780) ohms. O tempo de procedimento foi de 116 (90-130) min e o tempo de fluoroscopia foi de 14,2 (10,0-21,6) min. Conclusão A estimulação cardíaca do sistema de condução His-Purkinje por meio da estimulação do ramo esquerdo é uma técnica segura e factível. Nesta casuística, apresentou alta taxa de sucesso, foi realizada com tempo de procedimento e fluoroscopia baixos e obteve medidas eletrônicas adequadas.

Abstract Background Conventional right ventricular pacing increases the risk of atrial fibrillation and heart failure in pacemaker patients. Stimulation of the left bundle branch (LBB) of the His-Purkinje system can prevent the unwanted outcomes of right ventricular pacing. Objective To retrospectively analyze the intraoperative outcomes, electrocardiographic and clinical data from the initial follow-up of patients submitted to stimulation of the LBB. Methods The electronic parameters of the implant and of possible early complications of 52 consecutive patients submitted to stimulation of the conduction system were evaluated. The adopted significance level was 0.05. Results Fifty-two patients underwent left bundle branch stimulation, with 50 successful procedures; 69.2% of the patients were male, and the median and interquartile range of age at the time of implantation was 73.5 (65.0-80.0) years. The pre-implant QRS duration was 146 (104-175) ms and 120 (112-130) ms after the procedure. The left ventricle activation time was 78 (70-84) ms. The R-wave amplitude was 12.00 (7.95-15.30) mV, with a stimulation threshold of 0.5 (0.4-0.7) V x 0.4 ms and impedance of 676 (534-780) ohms. The procedure duration was 116 (90-130) min, and the fluoroscopy time was 14.2 (10.0-21.6) min. Conclusion Cardiac stimulation of the His-Purkinje conduction system through the stimulation of the left bundle branch is a safe and feasible technique. In this study, it showed a high success rate, with low procedure and fluoroscopy periods, achieving adequate electronic measurements.

Sincronia Ventricular na Estimulação Cardíaca Parahissiana: Alternativa por Ativação Cardíaca Fisiológica (Estimulação Indireta do Feixe de His)? / Ventricular Synchrony in Para-Hisian Cardiac Pacing as an Alternative for Physiological Cardiac Activation (Indirect Recruitment of the His Bundle?)

Resumo Fundamento A estimulação cardíaca artificial (ECA) por captura direta ou indireta do feixe de His resulta em contração ventricular sincrônica (ECA fisiológica). Objetivos Comparar sincronia cardíaca, características técnicas e resultados de parâmetros eletrônicos entre duas técnicas de ECA indireta do feixe de His: a não seletiva e a parahissiana. Métodos Intervenção experimental (novembro de 2019 a abril de 2020) com implante de marca-passo definitivo (MPd) DDD em pacientes com fração de ejeção ventricular esquerda > 35%. Foram comparadas a sincronia cardíaca resultante mediante algoritmo de análise eletrocardiográfica da variância espacial do QRS e as características técnicas associadas a cada método entre ECA hissiana não seletiva (DDD-His) e parahissiana (DDD-Var). Resultados De 51 pacientes (28 homens), 34 (66,7%) foram alocados no grupo DDD-Var e 17 (33,3%), no grupo DDD-His, com idade média de 74 e 79 anos, respectivamente. No grupo DDD-Var, a análise da variância espacial do QRS (índice de sincronia ventricular) mostrou melhora após o implante de MPd (p < 0,001). Ao ECG pós-implante, 91,2% dos pacientes do grupo DDD-Var mostraram padrão fisiológico de ECA, comprovando ativação similar à do DDD-His (88,2%; p = 0,999). O eixo do QRS estimulado também foi similar (fisiológico) para ambos os grupos. A mediana do tempo de fluoroscopia do implante foi de 7 minutos no grupo DDD-Var e de 21 minutos no DDD-His (p < 0,001), favorecendo a técnica parahissiana. A duração média do QRS aumentou nos pacientes do DDD-Var (114,7 ms pré-MPd e 128,2 ms pós-implante, p = 0,044). A detecção da onda R foi de 11,2 mV no grupo DDD-Var e de 6,0 mV no DDD-His (p = 0,001). Conclusão A ECA parahissiana comprova recrutamento indireto do feixe de His, mostrando-se uma estratégia eficaz e comparável à ECA fisiológica ao resultar em contração ventricular sincrônica similar à obtida por captura hissiana não seletiva.

Abstract Background Artificial cardiac pacing by direct or indirect His bundle capture results in synchronous ventricular contraction (physiological pacing). Objectives To compare cardiac synchronization, technical characteristics, and electronic parameters between two techniques of indirect His-bundle pacing: non-selective (NS-HBP) vs para-Hisian pacing (PHP). Methods The experimental intervention (between November 2019 and April 2020) consisted of implanting a DDD pacemaker in patients who had left ventricular ejection fraction (LVEF) > 35%. The resulting cardiac synchronization was compared using an electrocardiographic algorithm that analyzed QRS variation and the technical characteristics of non-selective Hisian pacing (DDD-His) and para-Hisian pacing (DDD-Var). Results Of 51 total patients (men: 28), 66.7% (34) were allocated to the DDD-Var group and 33.3% (17) to the DDD-His group. The mean ages in each group were 74 and 79 years, respectively. In the DDD-Var group, QRS variation (ventricular synchrony) improved after implantation (p < 0.001). In post-implantation ECG, 91.2% of the DDD-Var group presented a physiological pacing pattern, which was similar to the DDD-His group (88.2%; p = 0.999). The paced QRS axis was also similar (physiological) for both groups. Intraoperative fluoroscopy time (XRay) during implantation was lower for the para-Hisian technique (median 7 min in the DDD-Var group vs 21 min in the DDD-His group, p < 0.001). The mean QRS duration increased in the DDD-Var group (114.7 ms pre-implantation vs 128.2 ms post-implantation, p = 0.044). The mean post-implantation R-wave amplitude was 11.2 mV in the DDD-Var group vs 6.0 mV in the DDD-His group, p = 0.001. Conclusion Para-Hisian pacing appears to indirectly recruit the His bundle, which would make this an effective and comparable strategy for physiological pacing, resulting in synchronous ventricular contraction similar to that of non-selective Hisian pacing.

Patient with an implantable cardiac electrical stimulation device. What should the anesthesiologist know? / Paciente con dispositivo de estimulación eléctrica cardiaca implantable. ¿Qué debe saber el anestesiólogo?

Abstract Patients with implantable electric stimulation devices are challenging to the anesthesiologist since these cases demand a comprehensive knowledge about how the device operates, the indications for the implant and the implications that must be addressed during the perioperative period. This article is intended to provide the reader with clear and structured information so that the anesthesiologist will be able to safely deal with the situation of a patient with an implantable cardiac stimulation device, who has been programmed for emergent surgery. A search for the scientific evidence available was conducted in Pubmed / Medline, ScienceDirect, OVID, SciELO), for a non-systematic review. The incidence of the use of cardiac electric stimulation devices has been growing. Their operation is increasingly complex, and demands being constantly updated on the knowledge in the area.

Resumen El paciente portador de un dispositivo de estimulación eléctrica cardiaca implantable se convierte en un reto para el anestesiólogo debido a que implica un conocimiento integral que abarca su funcionamiento, las indicaciones que llevaron a su implante y las implicaciones que se deben abordar en el perioperatorio. Este artículo busca proporcionar al lector información clara y estructurada que le permita al anestesiólogo enfrentarse de forma segura al escenario de un paciente con un dispositivo de estimulación eléctrica cardiaca implantable programado para cirugía emergente. Se realizó una búsqueda de la evidencia científica disponible en bases de datos (Pubmed / Medline, ScienceDirect, OVID, SciELO), para una revisión no sistemática. La incidencia en el uso de dispositivos de estimulación eléctrica cardiaca viene en aumento. Su funcionamiento es cada vez más complejo lo cual implica una actualización permanente del conocimiento en esta área.

Association between fragmented QRS and postprocedural rhythm disturbances in patients who underwent transcatheter aortic valve implantation

SUMMARY INTRODUCTION: According to recent studies, the rate of atrioventricular block requiring permanent pacing in patients following transcatheter aortic valve implantation varied between 5.7% and 42.5%. Fragmented QRS is a useful marker of myocardial scar and can predict adverse cardiac events. In this study, we examined association between f ragmented QRS and postprocedural rhythm disturbances and the need for permanent pacing in patients who underwent transcatheter aortic valve implantation. OBJECTIVE: In this study, we examined association between fragmented QRS and postprocedural rhythm disturbances and the need for permanent pacing in patients who underwent transcatheter aortic valve implantation' sentence is enough for it. METHODS: We retrospectively analyzed standard 12-lead electrocardiographic recordings of 124 consecutive patients in whom a CoreValve prosthesis was implanted. We examined 12-lead electrocardiogram before and after procedure along with one- and six-month follow-up. We documented QRS fragmentation and postprocedural rhythm disturbances. RESULTS: There was a significant increase in the frequency of left bundle branch block, (21.1 versus 0%, p<0.05) and the incidence of atrioventricular blocks requiring permanent pacing (21.1 versus 0%, p<0.05) following transcatheter aortic valve implantation in patients whose preprocedural electrocardiogram recordings revealed fragmented QRS compared to those without fragmented QRS. Based our collected data, the presence of QRS fragmentation in anterior derivations was the only independent factor associated with postprocedural rhythm disturbances (B-value 0.217; OR 0.805; 95%CI 0.136-4.78; p=0.004). CONCLUSION: Our data showed an increased risk for the development of new-onset left bundle branch block and atrioventricular blocks following transcatheter aortic valve implantation in patients whose baseline electrocardiogram recordings demonstrated QRS fragmentation.

Left ventricular systolic function between left bundle branch pacing and right ventricular septum pacing in patients with pacemaker dependence by three-dimensional speckle tracking imaging / 中南大学学报(医学版)

OBJECTIVES@#To compare the left ventricular systolic function between the 1eft bundle branch pacing (LBBP) and right ventricular septum pacing (RVSP) in patients with pacemaker dependence by three-dimensional speckle tracking imaging (3D-STI).@*METHODS@#A total of 65 patients with atrioventricular block (AVB) (Mobitz type II second-degree AVB, high-degree AVB, or third-degree AVB), who underwent permanent cardiac pacing implantation including 32 patients receiving LBBP (LBBP group) and 33 patients receiving RVSP (RVSP group) from June 2018 to June 2019,were enrolled in this study. These patients met the following inclusion criterion: pre-operative left ventricular ejection fraction (LVEF)>50% and ventricular pacing rate>40% at 6-month programming follow-up; and the patients underwent echocardiography at pre-operation and 6 months after operation. The 3D-STI was used to obtain global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and global area strain (GAS).@*RESULTS@#All the patients in the LBBP group and the RVSP group had normal LVEF, there was no significant difference between the 2 group (@*CONCLUSIONS@#For patients with pacemaker dependence and normal LVEF at pre-operation, the cardiac function in the LBBP group is not significantly better than that in the RVSP group in short term follow-up. But in terms of physiologic pacing and long-term cardiac function protection, the 1eft bundle branch pacing is an optimal pacing mode.

La asincronía ventricular izquierda como resultado de la estimulación apical permanente por dispositivos en el ventrículo derecho / Left ventricular dyssynchrony as result of right ventricular permanent apical pacing

Resumen La estimulación apical permanente del ventrículo derecho (VD) puede producir asincronía del ventrículo izquierdo (VI) desde los puntos de vista eléctrico y mecánico. Este fenómeno es efecto de una alteración de la activación normal del VI que lleva al deterioro de la función sistólica y la aparición de insuficiencia cardíaca y sus efectos deletéreos relacionados. Para el estudio de la asincronía eléctrica del VI se ha propuesto en fecha reciente el nuevo sistema electrocardiográfico no invasivo Synchromax, que puede cuantificar el grado de asincronía eléctrica que causa una subsecuente asincronía mecánica. Esta última se ha estudiado casi siempre mediante la ecocardiografía transtorácica bidimensional (ETT2D) a través del Doppler tisular y la deformación miocárdica y ahora con la ecocardiografía tridimensional transtorácica en tiempo real (E3DTR). La relación entre estos fenómenos ha sido motivo de estudio a fin de identificar a los pacientes que se benefician de la transición a un tratamiento de resincronización cardíaca. Conclusiones: La estimulación artificial permanente del VD produce asincronía eléctrica del VI que puede cuantificarse mediante el nuevo sistema electrocardiográfico Synchromax y desencadenar asincronía mecánica estudiada mediante la ecocardiografía transtorácica para reconocer a los pacientes que pueden beneficiarse de un tratamiento de resincronización cardíaca.

Abstract Permanent apical pacing of right ventricle (RV) can produce dyssynchrony of the left ventricle (LV) from an electrical and mechanical point of view. This phenomenon is caused by an alteration in the normal activation of LV leading to a deterioration of systolic function and the appearance of heart failure and its associated deleterious effects. For the study of the electrical asynchrony of the LV, a new noninvasive electrocardiographic system Synchromax has recently been proposed, being able to quantify the degree of electrical asynchrony that leads to a subsequent mechanical dyssynchrony. The latter has been traditionally studied by two-dimensional transthoracic echocardiography (2DTTE) through tissue Doppler and myocardial deformation and lately by real-time 3-dimensional echocardiography (RT3DE). The relationship between these phenomena has been the subject of study to predict those patients who benefit from an “upgrade” to cardiac resynchronization therapy. Conclusions: Permanent apical pacing of the RV produces electrical dyssynchrony of the LV that can be quantified using a new electrocardiographic system Synchromax and trigger mechanical asynchrony studied through transthoracic echocardiography allowing to predict those patients who benefit from cardiac resynchronization therapy.

Unusual ventricular activation produced by temporary transvenous cardiac pacing: electrovectorcardiographic findings / Activación ventricular inusual producida por estimulación cardíaca transvenosa temporal: hallazgos electrovectorcardiográficos

Abstract Complete heart block (CHB) results from dysfunction of the cardiac conduction system, which results in complete electrical dissociation. The ventricular escape rhythm can have its origin anywhere from the atrioventricular node to the bundle branch-Purkinje system. CHB typically results in bradycardia, hypotension, fatigue, hemodynamic instability, syncope, or even Stokes-Adams syndrome. Escape rhythm originating above the bifurcation of the His bundle (HB) produces narrow QRSs with relatively rapid heart rate (HR) (except in cases of His system disease). We present a middle-aged man with an HR of 34 bpm, progressive fatigue, in whom a temporary pacemaker was implanted in the subtricuspid region. The post-intervention electrocardiogram had unusual features.

Resumen El bloqueo cardíaco completo (BCC) resulta de la disfunción del sistema de conducción cardíaco, lo que ocasiona una disociación eléctrica completa entre aurículas y ventrículos. El ritmo de escape resultante puede tener su origen en cualquier lugar desde el nodo auriculoventricular hasta el sistema His Purkinje. El BCC generalmente produce bradicardia, hipotensión, fatiga, inestabilidad hemodinámica, síncope o incluso el síndrome de Stokes-Adams. El ritmo de escape que se origina por encima de la bifurcación del haz de His produce intervalos QRS estrechos con frecuencia cardíaca no muy lenta (excepto en casos de enfermedad del sistema Hisiano). Presentamos a un hombre de mediana edad con una frecuencia cardíaca de 34 lpm, fatiga progresiva, en el que se implantó un marcapasos temporario en la región subtricuspídea. El electrocardiograma resultante a la intervención presentó características inusuales.

Feasibility and safety of new simplified left bundle branch area pacing via nine-partition method / 中华心血管病杂志

Objective: To investigate the efficacy and safety of left bundle branch area pacing (LBBaP) with the new simplified approach (nine-partition method). Methods: A total of 118 patients with clinical indications and received pacemaker implantation from December 1, 2018 to December 31, 2019 in Beijing Anzhen Hospital were enrolled. LBBaP was performed with the nine-partition method (in the right anterior oblique 30° position, the ventriculogram was divided into nine partitions and the initial implant sites were located in the lower base 1/3 partitions). In X-ray image, the 3830 lead is located in the left bundle branch area, the unipolar pacing QRS wave is in the form of right bundle branch block, and the peak time from stimulation to left ventricular activation<90 ms is defined as successful operation. The clinical characters, such as the methods of venipuncture, electrode parameters, operation duration, fluoroscopy duration, the peak time from stimulation to left ventricular, pacemaker types, surgical success rate, complications, and immediate postoperative ECG parameters were collected. The patients were followed up after the operation, and the electrode parameters and postoperative complications were recorded. Results: This study is a retrospective study. There were 62 (52.5%) male patients in this cohort, the average age was (65.9±13.4) years old,and there were 49(41.5%) sick sinus syndrome, 6(5.1%) abnormal sinus node and atrioventricular node simultaneously, 63(53.4%) atrioventricular block, 26(22.0%) atrial fibrillation, 20(16.9%) cardiomyopathy; the baseline duration of QRS was (109.21±39.03) ms. Successful LBBaP was achieved in 109 patients with"nine-partition method"and the success rate was 92.4%; 104 patients (95.5%) were axillary vein puncture, 5 (4.6%) were subclavian vein puncture; the operation duration was (80.3±23.0) min, the fluoroscopy duration was (12.29±5.13) min; the QRS duration after LBBaP was (116.36±18.11) ms. The threshold of the left bundle branch (LBB) lead was (0.92±0.63) V, the R wave amplitude was (10.60±5.04) mV and the impedance was (798.71±194.90) Ω. In 1 V pacing, the peak time from stimulation to left ventricular activation was (67.91±12.15) ms, and in 5 V pacing was (67.52±12.45) ms; 1 case (0.9%) with a single-chamber pacemaker implanted, 106 cases (97.3%) with dual-chamber pacemaker and 2 cases (1.8%) with three-chamber pacemakers. There were no hematomas, pneumothorax, hemothorax, electrode dislocation, infection, and capsular hemorrhage and other serious surgery-related complications during the operation. A total of 97 patients (89.0%) were followed up for (6.21±2.90) months. The electrode parameters of all patients were stable and no complications observed. Conclusions: The LBBaP with nine-partition method is a simple, safe and effective physiological pacing approach. However, its long-term effect still needs to be further verified.

Qualidade de vida de indivíduos portadores de dispositivo cardíaco eletrônico implantável / Quality of life of individuals with implantable electronic cardiac device / Calidad de vida de las personas con dispositivo cardiaco electrónico implantable

Objetivo: avaliar a qualidade de vida de indivíduos portadores de dispositivo cardíaco eletrônico implantável. Método: estudo descritivo e transversal realizado com 50 indivíduos em 2018. Utilizou-se o SF-36 e AQUAREL. Resultados: a comorbidade mais frequente foi a hipertensão arterial sistêmica ­ 39 (78%), a cardiopatia de base a bradicardia ­ 18 (36%) e queixas de palpitação e pré-síncope. Predominaram indivíduos com tempo do dispositivo cardíaco eletrônico de até 5 anos ­ 24 (48%), sem troca de gerador ­ 31 (62%). A maioria negou o consumo de bebida alcóolica ­ 47 (94%), de cigarros ­ 44 (88%) e não realiza atividade física regular ­ 34 (68%). No SF-36, o menor escore foi no domínio aspectos físicos (15) e o maior em dor (88,8). No AQUAREL o menor escore foi no domínio dispneia (78,98) e o maior em desconforto (86,54). Conclusão: constatou-se sintomatologia reduzida. Houve associação significativa entre sexo masculino e atividade física. Os indivíduos apresentam melhora da qualidade de vida após a implantação do dispositivo cardíaco.

Objective: to evaluate the quality of life of individuals with implantable electronic cardiac devices. Method: descriptive and cross-sectional study conducted with 50 individuals in 2018. SF-36 and AQUAREL were used. Results: the most frequent comorbidity was systemic arterial hypertension ­ 39 (78%), baseline heart disease bradycardia ­ 18 (36%) and complaints of palpitation and pre-syncope. Individuals with electronic cardiac device time of up to 5 years 24 (48%) predominated, without changing the generator ­ 31 (62%). The majority denied alcohol consumption ­ 47 (94%), cigarettes ­ 44 (88%) and regular physical activity ­ 34 (68%). In the SF-36 the lowest score was in the physical aspects domain (15) and the highest in pain (88.8). In AQUAREL the lowest score was in the domain dyspnea (78.98) and the highest in discomfort (86.54). Conclusion: reduced symptomatology was observed. There was a significant association between males and physical activity. Individuals have improved quality of life after implantation of the cardiac device.

Objetivo: evaluar la calidad de vida de las personas con dispositivos cardíacos electrónicos implantables. Método: estudio descriptivo y transversal realizado con 50 individuos, en 2018. SF-36 y AQUAREL se utilizaron. Resultados: la comorbilidad más frecuente fue la hipertensión arterial sistémica ­ 39 (78%), las cardiopatías subyacentes, bradicardia ­ 18 (36%) y quejas de palpitación y presíncope. Predominan los individuos con tiempo de dispositivo cardíaco electrónico de hasta 5 años ­ 24 (48%) sin cambiar el generador ­ 31 (62%). La mayoría negó el consumo de alcohol ­ 47 (94%), cigarrillos ­ 44 (88%) y actividad física regular 34 (68%). En el SF-36, la puntuación más baja estaba en el dominio de aspectos físicos (15) y la más alta en dolor (88.8). En AQUAREL, la puntuación más baja estaba en el dominio disnea (78,98) y la más alta en malestar (86,54). Conclusión: se observó una sintomatología reducida. Hubo una asociación significativa entre los varones y la actividad física. Los individuos han mejorado la calidad de vida después de la implantación del dispositivo cardíaco.