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Sanchez-Nadales A, Sarkar A, Sleiman J, Sanchez-Nadales A, Alonso M, Bibawy J, Helguera M, Pinski S, Baez-Escudero J. Safety and performance of the Medtronic 3830 lead in His-bundle and Left bundle branch area pacing: A single-center experience. J Interv Card Electrophysiol 2025:10.1007/s10840-025-02070-3. [PMID: 40515957 DOI: 10.1007/s10840-025-02070-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2025] [Accepted: 05/12/2025] [Indexed: 06/16/2025]
Abstract
BACKGROUND Conduction system pacing (CSP) using His Bundle Pacing (HBP) and Left Bundle Branch Area Pacing (LBAP) is an evolving alternative to traditional right ventricular pacing (RVP), promising better physiological outcomes. This study evaluates the safety, feasibility, and performance of HBP and LBAP with Medtronic SelectSecure 3830 leads. METHODS We conducted a single-center retrospective analysis of 490 patients undergoing HBP or LBAP. The study assessed implant success rates, pacing thresholds, device longevity, and complication rates over an average follow-up of 28 months for HBP and 14 months for LBAP. RESULTS The implantation success rate was 85% for HBP and 97.4% for LBAP. LBAP demonstrated lower and more stable pacing thresholds, with initial values of 0.8V at 0.5 ms rising slightly to 0.9V at 0.5 ms, and fewer device revisions compared to HBP, whose initial pacing threshold of 1.3V at 0.8ms increased to 1.68 V at 0.7ms. Complications were minimal and similar across both groups. The need for fewer device revisions and potential for prolonged device life highlighted LBAP as potentially more cost-effective. Cardiac function measured by LVEF remained stable across both groups. CONCLUSIONS Both HBP and LBAP are safe and feasible with comparable safety profiles. LBAP may offer advantages in terms of stability, fewer revisions, and extended device longevity. The study underscores the need for further research into optimal lead positioning and long-term outcomes of CSP, particularly for LBAP.
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Affiliation(s)
- Alejandro Sanchez-Nadales
- Robert and Suzanne Tomsich Department of Cardiology, Department of Cardiovascular Disease, Cleveland Clinic Florida, Weston Campus, Weston, FL, 33324, USA.
| | - Abdullah Sarkar
- Robert and Suzanne Tomsich Department of Cardiology, Department of Cardiovascular Disease, Cleveland Clinic Florida, Weston Campus, Weston, FL, 33324, USA
| | - Jose Sleiman
- Robert and Suzanne Tomsich Department of Cardiology, Department of Cardiovascular Disease, Cleveland Clinic Florida, Weston Campus, Weston, FL, 33324, USA
| | - Andres Sanchez-Nadales
- Robert and Suzanne Tomsich Department of Cardiology, Department of Cardiovascular Disease, Cleveland Clinic Florida, Weston Campus, Weston, FL, 33324, USA
| | - Mileydis Alonso
- Robert and Suzanne Tomsich Department of Cardiology, Department of Cardiovascular Disease, Cleveland Clinic Florida, Weston Campus, Weston, FL, 33324, USA
| | - John Bibawy
- Robert and Suzanne Tomsich Department of Cardiology, Department of Cardiovascular Disease, Cleveland Clinic Florida, Weston Campus, Weston, FL, 33324, USA
| | - Marcelo Helguera
- Robert and Suzanne Tomsich Department of Cardiology, Department of Cardiovascular Disease, Cleveland Clinic Florida, Weston Campus, Weston, FL, 33324, USA
| | - Sergio Pinski
- Robert and Suzanne Tomsich Department of Cardiology, Department of Cardiovascular Disease, Cleveland Clinic Florida, Weston Campus, Weston, FL, 33324, USA
| | - Jose Baez-Escudero
- Robert and Suzanne Tomsich Department of Cardiology, Department of Cardiovascular Disease, Cleveland Clinic Florida, Weston Campus, Weston, FL, 33324, USA
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Ren J, Zhao J, Yang S, An S, Cai C, Wang J, Gu M, Niu H, Li S, Hua W, Gao B. Transcoronary study of biomarkers in patients with heart failure: Insights into intracardiac production. ESC Heart Fail 2025; 12:1640-1651. [PMID: 39728840 PMCID: PMC12055380 DOI: 10.1002/ehf2.15175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 09/01/2024] [Accepted: 11/08/2024] [Indexed: 12/28/2024] Open
Abstract
AIMS Biomarkers are pivotal in the management of heart failure (HF); however, their lack of cardiac specificity could limit clinical utility. This study aimed to investigate the transcoronary changes and intracardiac production of these biomarkers. METHODS Transcoronary gradients for B-type natriuretic peptide (BNP) and five novel biomarkers-galectin-3 (Gal-3), soluble suppression of tumourigenicity 2 (sST2), tissue inhibitor of metalloproteinase 1 (TIMP-1), growth differentiation factor 15 (GDF-15) and myeloperoxidase (MPO)-were determined using femoral artery (FA) and coronary sinus (CS) samples from 30 HF patients and 10 non-HF controls. Intracardiac biomarker production was assessed in an HF canine model using real-time quantitative PCR (qPCR) and western blot (WB) analysis. RESULTS Compared with the control group, levels of all detected biomarkers were significantly elevated in the HF group, while transcoronary gradients were only observed for BNP, Gal-3 and TIMP-1 levels in the HF group (BNP: FA: 841.5 ± 727.2 ng/mL vs. CS: 1132.0 ± 959.1 ng/mL, P = 0.005; Gal-3: FA: 9.5 ± 3.0 ng/mL vs. CS: 19.7 ± 16.4 ng/mL, P = 0.002; and TIMP-1: FA: 286.7 ± 68.9 ng/mL vs. CS: 377.3 ± 108.9 ng/mL, P = 0.001). Real-time qPCR and WB analysis revealed significant elevation of BNP, Gal-3 and TIMP-1 in the cardiac tissues of the HF group relative to other groups. CONCLUSIONS This study provided evidence of transcoronary changes in BNP, Gal-3 and TIMP-1 levels in HF patients, offering insights into their intracardiac production. These findings enhance the understanding of the biology of these biomarkers and may inform their clinical application.
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Affiliation(s)
- Jie Ren
- Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Junhan Zhao
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Shengwen Yang
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina
| | - Shuoyan An
- Department of CardiologyChina‐Japan Friendship HospitalBeijingChina
| | - Chi Cai
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jing Wang
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Min Gu
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Hongxia Niu
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Shurong Li
- Department of Anesthesiology, Beijing Institute of Heart Lung and Blood Vessel DiseasesBeijing Anzhen Hospital, Capital Medical UniversityBeijingChina
| | - Wei Hua
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Beiyao Gao
- Department of Rehabilitation MedicineChina‐Japan Friendship HospitalBeijingChina
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Miyazaki Y, Ishibashi K, Ueda N, Nakamura T, Oka S, Wakamiya A, Nakajima K, Kamakura T, Wada M, Inoue Y, Miyamoto K, Nagase S, Aiba T, Kusano K. Mid-Range Paced-QRS as an Independent Negative Predictor of Cardiac Events - Right Ventricular Pacing Implications. Circ J 2025; 89:803-808. [PMID: 40024802 DOI: 10.1253/circj.cj-24-0611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2025]
Abstract
BACKGROUND The effect of paced-QRS (p-QRS) duration on long-term outcomes is unclear, so we assessed the association between p-QRS duration and cardiac events. METHODS AND RESULTS We enrolled 187 patients (103 males, mean age: 77±12 years) who underwent pacemaker implantation between 2018 and 2021. During the median follow-up period of 972 days (761-1,292 days), 18 patients experienced cardiac events (1 cardiac death, 17 heart failure hospitalizations). The p-QRS duration was longer in the cardiac event group than in the noncardiac event group (162±17 vs. 148±17 ms, P=0.005). Receiver operating characteristic curve analysis identified 149 ms as the optimal cutoff value for predicting cardiac events (area under the curve, 0.72). Kaplan-Meier analysis showed better outcomes for mid-range p-QRS duration (≤149 ms, n=89) compared with long p-QRS duration (>149 ms, n=98) (P=0.005). Multivariate Cox hazard analysis indicated a good outcome with mid-range p-QRS duration (hazard ratio: 0.28, 95% confidence interval: 0.06-0.88, P=0.029). CONCLUSIONS A p-QRS duration of ≤149 ms was associated with a reduction in cardiac events. Therefore, it may serve as a target index of success in right ventricular pacing.
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Affiliation(s)
- Yuichiro Miyazaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Kohei Ishibashi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Nobuhiko Ueda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Toshihiro Nakamura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Satoshi Oka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Akinori Wakamiya
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kenzaburo Nakajima
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Tsukasa Kamakura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Mitsuru Wada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Yuko Inoue
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koji Miyamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Department of General Internal Medicine 3, Kawasaki Medical School General Medical Center
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
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Yeh SE, Chen JY, Liu CY, Li CY, Yu CH, Sung JM. Right ventricular pacing burden and progression of renal failure in chronic kidney disease patients with permanent pacemakers. J Formos Med Assoc 2025:S0929-6646(25)00228-1. [PMID: 40404489 DOI: 10.1016/j.jfma.2025.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2025] [Revised: 04/03/2025] [Accepted: 05/12/2025] [Indexed: 05/24/2025] Open
Abstract
BACKGROUND In patients with permanent pacemaker (PPM) implantation, chronic kidney disease (CKD) milieu increases the risk of pacing-induced cardiomyopathy and worse long-term survival. Conversely, whether high right ventricular (RV) pacing burden in these patients could potentially accelerate renal failure progression and lead to poor outcomes remains unexplored yet. METHOD We analyzed the renal outcomes of advanced CKD (stage 3b-4) patients who received PPM implantation, identified from a multidisciplinary CKD longitudinal management program. RV pacing burden was defined as the average RV pacing percentage (RVP %) from pacemaker insertion to the event or censoring, logarithmically transformed into LogRVP %. RVP % ≥20 % was categorized as a high RV pacing burden group. The primary outcome was a composite of a ≥50 % decline in eGFR from baseline, a sustained eGFR ≤10 mL/min/1.73 m2, initiation of dialysis, and death from renal causes. RESULTS A total of 90 patients with mean baseline eGFR 37.8 ± 15.3 mL/min/1.73 m2 and mean averaged RVP % 30.8 % were analyzed over a median follow-up of 3.9 years. Twenty-six patients reached the composite outcome. Higher LogRVP % was significantly associated with the primary composite outcome (hazard ratio [HR]: 1.771, 95 % confidence interval [CI]: 1.096-2.860, p = 0.02), especially those with baseline eGFR <30 mL/min/1.73 m2. Patients with RVP% ≥ 20 % faced a higher risk of primary composite outcome (HR: 2.907, 95 % CI: 1.263-6.687, p = 0.01). CONCLUSION Among advanced CKD patients who underwent PPM implantation, a higher RV pacing burden was significantly associated with an increased risk of poor renal outcomes.
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Affiliation(s)
- Shang-En Yeh
- Division of Nephrology and Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ju-Yi Chen
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chieh-Yen Liu
- Division of Nephrology and Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Yi Li
- Department of Public Health, Basic Medical Science, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Hen Yu
- Division of Nephrology and Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Clinical Medicine and Basic Medical Science, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Basic Medical Science, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Junne-Ming Sung
- Division of Nephrology and Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Clinical Medicine and Basic Medical Science, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Badertscher P, Arnet R, Isenegger C, Subin B, Knecht S, Trussardi J, Krisai P, Mahfoud F, Sticherling C, Schär B, Kühne M. Long-term follow up of single-chamber atrial pacing-system upgrade and Wenckebach block point behavior: potential implications for leadless AAI pacing? J Interv Card Electrophysiol 2025:10.1007/s10840-025-02061-4. [PMID: 40380037 DOI: 10.1007/s10840-025-02061-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2025] [Accepted: 04/29/2025] [Indexed: 05/19/2025]
Abstract
BACKGROUND Single chamber atrial pacing (AAI) provides a disease-specific treatment for sick sinus syndrome (SSS) but has largely been replaced by DDD pacing. With the advent of leadless atrial pacemakers (PM), there is growing interest in long-term follow-up data in patients with SSS and an AAI pacemaker. PURPOSE To assess the incidence of system upgrade in patients treated with AAI-PM for SSS during long-term follow-up. METHODS This is an analysis of prospectively enrolled patients undergoing implantation of an AAI-PM. Wenckebach block point (WBP) was measured at implantation and serially during follow up. RESULTS We included 178 patients (58% female, median age at implantation 77 [71-83] years). The median follow-up duration was 6.5 [2.0-9.7] years. Twenty-three patients (13%) received a system upgrade to a DDD system, corresponding to a yearly upgrade rate of 2.0%. Median time to system upgrade was 5.2 [1.6-8.7] years. Reasons for system upgrade were higher-degree AVB (39%), atrial arrhythmias (35%), low WBP (17%), and syncope (9%). Median WBP at implantation was 130 [120-140] bpm, showing a significant decline over time in the upgrade-group compared to the rest of the cohort with 103 [91-130] bpm vs. 130 [120-130] bpm (p = 0.011). CONCLUSION In this cohort of patients undergoing AAI-PM implantation for SSS, upgrade to a DDD system was low during long-term follow-up. Therefore, AAI pacing for the treatment of SSS may be considered a patient-tailored treatment option, especially in light of novel leadless pacing therapies.
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Affiliation(s)
- Patrick Badertscher
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.
| | - Rebecca Arnet
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Corinne Isenegger
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Behnam Subin
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Jessica Trussardi
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Philipp Krisai
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Felix Mahfoud
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Beat Schär
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
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Sales-Belles C, Mincholé A, Melero-Polo J, Cabrera-Ramos M, Vadillo-Martín P, Montilla-Padilla I, Sorinas-Villanueva L, Julián-García I, Mayo-Carlos GV, Ruiz-Arroyo JR, Pueyo E, Ramos-Maqueda J. ECG-based evaluation of ventricular synchrony in left bundle branch area pacing through characterization of the activation sequence. Sci Rep 2025; 15:15584. [PMID: 40320473 PMCID: PMC12050288 DOI: 10.1038/s41598-025-98608-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2025] [Accepted: 04/14/2025] [Indexed: 05/08/2025] Open
Abstract
Left bundle branch area pacing (LBBAP) overcomes ventricular dyssynchrony induced by conventional right ventricular pacing (RVP). Despite QRS duration (QRSd) being the standard ECG marker for biventricular synchrony, it lacks insights into the ventricular activation sequence. Our aim is to assess biventricular synchrony by characterizing the ventricular activation sequence and introducing robust markers using the 12-lead ECG. A prospective single-center study was conducted, involving patients with pacemaker indication due to bradycardia. Patients were divided into LBBAP and RVP, and classified by baseline-QRS morphology. To assess biventricular synchrony, low frequency-based QRS analysis was performed to compute the ventricular activation sequence and precordial activation delay (pAD). Additional QRS markers including QRSd, QRS60, and QRS area (QRSa) were calculated. A total of 176 patients (107 LBBAP, 69 RVP) were included. The paced ventricular activation sequence indicated a more physiological pattern after LBBAP than RVP, with lower pAD values in narrow QRS, RBBB, and LBBB subgroups [ - 10( - 20,14) vs. 26(5, 39) ms; - 18( - 30, - 8) vs. 34(26, 55) ms; 10( - 14, 25) vs. 32(12, 48) ms] (p < 0.01). In all subgroups, QRS60 showed lower values after LBBAP than RVP [52(41, 62) vs.73(65, 80) ms; 60(55, 66) vs. 77(67, 83) ms; 59(53, 64) vs. 77(74, 82) ms] (p < 0.01) and QRSa were also lower [53(38, 66) vs. 121(92, 143) μVs; 60(50, 89) vs. 124(97, 159) μVs; 62(52, 80) vs. 133(99, 148) μVs] (p < 0.01). pAD provides valuable insights into ventricular activation beyond paced-QRSd. Together with QRS60 and QRSa, pAD could be a promising tool to assess biventricular synchrony.
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Affiliation(s)
- Clara Sales-Belles
- BSICoS Group, Aragon Institute of Engineering Research, IIS Aragón, University of Zaragoza, Zaragoza, Spain
| | - Ana Mincholé
- BSICoS Group, Aragon Institute of Engineering Research, IIS Aragón, University of Zaragoza, Zaragoza, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Madrid, Spain
| | - Jorge Melero-Polo
- Arrhythmias Unit, Cardiology Department, Lozano Blesa Clinical University Hospital, Calle San Juan Bosco 15, 50009, Zaragoza, Spain
- Aragon Health Research Institute, Zaragoza, Spain
| | - Mercedes Cabrera-Ramos
- Arrhythmias Unit, Cardiology Department, Lozano Blesa Clinical University Hospital, Calle San Juan Bosco 15, 50009, Zaragoza, Spain
- Aragon Health Research Institute, Zaragoza, Spain
| | - Pablo Vadillo-Martín
- Arrhythmias Unit, Cardiology Department, Lozano Blesa Clinical University Hospital, Calle San Juan Bosco 15, 50009, Zaragoza, Spain
| | - Isabel Montilla-Padilla
- Arrhythmias Unit, Cardiology Department, Lozano Blesa Clinical University Hospital, Calle San Juan Bosco 15, 50009, Zaragoza, Spain
- Aragon Health Research Institute, Zaragoza, Spain
| | - Laura Sorinas-Villanueva
- Arrhythmias Unit, Cardiology Department, Lozano Blesa Clinical University Hospital, Calle San Juan Bosco 15, 50009, Zaragoza, Spain
| | - Inés Julián-García
- Arrhythmias Unit, Cardiology Department, Lozano Blesa Clinical University Hospital, Calle San Juan Bosco 15, 50009, Zaragoza, Spain
| | - Gualber Vitto Mayo-Carlos
- Arrhythmias Unit, Cardiology Department, Lozano Blesa Clinical University Hospital, Calle San Juan Bosco 15, 50009, Zaragoza, Spain
| | - José Ramón Ruiz-Arroyo
- Arrhythmias Unit, Cardiology Department, Lozano Blesa Clinical University Hospital, Calle San Juan Bosco 15, 50009, Zaragoza, Spain
| | - Esther Pueyo
- BSICoS Group, Aragon Institute of Engineering Research, IIS Aragón, University of Zaragoza, Zaragoza, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Ramos-Maqueda
- Arrhythmias Unit, Cardiology Department, Lozano Blesa Clinical University Hospital, Calle San Juan Bosco 15, 50009, Zaragoza, Spain.
- Aragon Health Research Institute, Zaragoza, Spain.
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Yao Y, Sun M, Sheng Y, Xu C, Ren C, Song A, Gu J, Li K. Long-Term Follow-Up of Left Bundle Branch Area Pacing in Pacing-Dependent Patients and Normal Cardiac Function. Pacing Clin Electrophysiol 2025; 48:480-487. [PMID: 40254922 DOI: 10.1111/pace.15188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Revised: 02/26/2025] [Accepted: 03/24/2025] [Indexed: 04/22/2025]
Abstract
INTRODUCTION Left bundle branch area pacing (LBBAP) has emerged as a novel physiological pacing strategy. The purpose of this study was to evaluate the long-term effect of LBBAP in ventricular pacing-dependent patients and baseline normal cardiac function. METHODS This retrospective observational study included patients who underwent LBBAP or RVP for bradycardia indications between January 2018 and July 2021. Baseline characteristics and electrophysiological, pacing and echocardiographic data were collected. RESULTS Sixty patients with VP% ≥ 40% were enrolled, including 30 patients in the LBBAP group and 30 patients in the RVP group. The mean follow-up time was 53.03 ± 8.10 months in the LBBAP group and 51.87 ± 11.68 months in the RVP group. No ventricular septum perforation was observed during the procedure or follow-up. The R-wave amplitudes did not differ between the two groups at implantation, but the R-wave amplitude in the LBBAP group at last follow-up was higher than that in the RVP group (17.67 ± 7.50 mV vs. 12.38 ± 5.36 mV, p = 0.003). Paced QRS duration in the LBBAP group was significantly shorter than that in the RVP group (138.93 ± 15.36 ms vs. 164.30 ± 19.48 ms, p < 0.0001). The LBBAP group had a higher LVEF (64.81 ± 5.49 vs. 60.44 ± 9.28, p = 0.041) and lower LVESD (29.70 ± 4.59 mm vs. 32.03 ± 3.97 mm, p = 0.039) than the RVP group at last follow-up. CONCLUSION This study found LBBAP electrodes had a stable anatomic position, better pacing parameters, and better maintaining cardiac performances than RVP in patients with normal cardiac function and bradyarrhythmia indications.
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Affiliation(s)
- Yunjie Yao
- Department of Cardiology, The Affiliated Zhangjiagang Hospital of Soochow University, Zhangjiagang, Jiangsu, China
| | - Minmin Sun
- Department of Cardiology, The Affiliated Zhangjiagang Hospital of Soochow University, Zhangjiagang, Jiangsu, China
| | - Yufeng Sheng
- Department of Cardiology, The Affiliated Zhangjiagang Hospital of Soochow University, Zhangjiagang, Jiangsu, China
| | - Chunming Xu
- Department of Cardiology, The Affiliated Zhangjiagang Hospital of Soochow University, Zhangjiagang, Jiangsu, China
| | - Chen Ren
- Department of Cardiology, The Affiliated Zhangjiagang Hospital of Soochow University, Zhangjiagang, Jiangsu, China
| | - Aiping Song
- Department of Cardiology, The Affiliated Zhangjiagang Hospital of Soochow University, Zhangjiagang, Jiangsu, China
| | - Jiaqun Gu
- Department of Cardiology, The Affiliated Zhangjiagang Hospital of Soochow University, Zhangjiagang, Jiangsu, China
| | - Kebei Li
- Department of Cardiology, The Affiliated Zhangjiagang Hospital of Soochow University, Zhangjiagang, Jiangsu, China
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van Nuland PJA, Halim J, van Ginkel DJ, Overduin DC, Brouwer J, Nijenhuis VJ, Van't Hof AWJ, Tonino PAL, Ten Berg JM, Vriesendorp PA. The Impact of Permanent Pacemaker Implantation After TAVI on Mortality and Quality of Life: A POPular TAVI Substudy. Catheter Cardiovasc Interv 2025; 105:1098-1107. [PMID: 39878245 DOI: 10.1002/ccd.31431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Revised: 01/03/2025] [Accepted: 01/19/2025] [Indexed: 01/31/2025]
Abstract
BACKGROUND Conduction disturbances are common after transcatheter aortic valve implantation (TAVI) and frequently require permanent pacemaker implantation (PPI). Data regarding its impact on mortality and morbidity are conflicting. This study aims to assess the impact of PPI before or within 30 days after TAVI on mortality and health-related Quality of Life (QoL) during the first year after TAVI. METHODS In this POPular TAVI substudy, 978 patients were included and categorized into three groups: Neither PPI before or within 30 days after TAVI (no PPI, n = 779), PPI before TAVI (PPI pre-TAVI, n = 102), PPI within 30 days after TAVI (PPI post-TAVI, n = 97). All-cause death and cardiac death were evaluated at 1 year. QoL was assessed using the SF-12 and EQ-5D-5L questionnaires at baseline and 3, 6, and 12 months. RESULTS At 1-year, all-cause death was seen in 6.9% (PPI pre-TAVI, p = 0.53) and 10.3% (PPI post-TAVI, p = 0.66) of the patients compared to 8.7% of the patients (no PPI). Cardiac death was observed in 4.9% (PPI pre-TAVI, p = 0.58) and 6.2% (PPI post-TAVI, p = 0.94) of the patients compared to 6.2% of patients (no PPI). Regarding QoL, the PPI pre-TAVI group showed lower PCS-12 over time compared to the no PPI group (p = 0.04), while MCS-12, EQ-5D Index and EQ-5D VAS scores were equal. No significant differences in QoL were seen between the PPI post-TAVI group and the no PPI group. CONCLUSION PPI before or within 30 days after TAVI was not associated with increased mortality within 1 year. PPI pre-TAVI was associated with lower physical QoL.
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Affiliation(s)
- P J A van Nuland
- Faculty of Health, Medicine and Life Sciences (FHML), University Maastricht, Maastricht, The Netherlands
| | - J Halim
- Department of Cardiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - D J van Ginkel
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - D C Overduin
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - J Brouwer
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - V J Nijenhuis
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - A W J Van't Hof
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - P A L Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - J M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - P A Vriesendorp
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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9
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Fathallah I, Qatza A, Al-Talep A, Yousef R, Hasn RA. A rare case of myocardial bridging as a cause of complete heart block: A diagnostic challenge. Radiol Case Rep 2025; 20:1882-1887. [PMID: 39897757 PMCID: PMC11786798 DOI: 10.1016/j.radcr.2025.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Accepted: 01/01/2025] [Indexed: 02/04/2025] Open
Abstract
Complete heart block (CHB) is a disruption in electrical impulses to travel from atria to ventricles and can rarely be caused by myocardial bridging (MB), where cardiac tissue compresses a coronary artery during systole. The incidence of MB ranges from 0.5 % to 16 % in coronary angiography patients. This case report presents a 30-year-old female presented with dizziness, shortness of breath, and chest pain, diagnosed with third-degree AV block. Echocardiography revealed interventricular septal thickening and mild mitral regurgitation. Coronary angiography identified myocardial bridging in the mid LAD artery causing significant systolic stenosis. After ruling out reversible causes, a dual-chamber permanent pacemaker was implanted due to persistent heart block. The patient remained stable postprocedure, with decreasing cardiac biomarkers, and was discharged symptom-free with a follow-up appointment scheduled. MB can lead to serious cardiovascular events, including myocardial infarction and CHB. Clinicians must recognize the risks associated with MB and maintain a high suspicion for CHB to ensure timely management. Further studies are needed to clarify the CHB-MB relationship and improve patient outcomes.
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Affiliation(s)
| | - Ayham Qatza
- Faculty of Medicine, Hama University, Hama, Syria
| | | | - Reham Yousef
- Faculty of Pharmacy, Damascus University, Damascus, Syria
| | - Rami Asef Hasn
- Department of Cardiology, Albasel Hospital, Tartous University, Tartous, Syria
- Faculty of Medicine, Tishreen University, Latakia, Syria
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10
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Serbetci YA, Jaryal S, Bhasin I, Elhassan M, Muslim A, Aquilini P, Reddy A L, Tavera D, Caicco AP, Rai M. Pacemakers in Modern Cardiology and Their Transition From Traditional to Leadless Models. Cureus 2025; 17:e82182. [PMID: 40364882 PMCID: PMC12074492 DOI: 10.7759/cureus.82182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2025] [Indexed: 05/15/2025] Open
Abstract
Cardiac rhythm disorders are a major subset of cardiovascular diseases and continue to pose significant global health challenges. Pacemakers remain central to their management, with evolving technologies offering improved therapeutic outcomes. This narrative review traces the progression of pacemaker technology from traditional cardiac pacemakers (TCPs) to leadless cardiac pacemakers (LCPs), emphasizing key differentiators such as implantation techniques, complication profiles, and long-term clinical performance. While TCPs have proven effective, they are associated with issues like lead-related complications, infections, and mechanical failures. In contrast, LCPs, which are implanted via minimally invasive transcatheter approaches and lack transvenous leads, significantly reduce these risks, resulting in improved patient satisfaction and fewer hospitalizations. Although limited to single-chamber pacing and higher initial costs, LCPs may prove cost-effective over time due to lower complication-related expenses. This review synthesizes current evidence on safety, efficacy, and patient outcomes and explores recent advancements, including multicomponent systems, energy-harvesting mechanisms, and biocompatible materials. Many of these innovations are in preclinical or early clinical stages but hold promise for broader applicability and long-term sustainability. Despite challenges, the trajectory of pacemaker technology underscores its potential to revolutionize cardiac care, driven by increasing clinical adoption of leadless systems, evolving regulatory approvals, and a growing emphasis on equitable access and personalized management.
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Affiliation(s)
| | - Shelly Jaryal
- Medicine, Medical University of the Americas (MUA), Charlestown, KNA
| | - Ira Bhasin
- Internal Medicine, Kasturba Medical College, Manipal, IND
| | | | - Amna Muslim
- Internal Medicine, Karachi Medical and Dental College, Karachi, PAK
| | - Parisa Aquilini
- Internal Medicine, The Royal College of Surgeons of Ireland, Dublin, IRL
| | | | - David Tavera
- Surgery, Jose Felix Patino's School of Medicine, Bogotá, COL
| | | | - Manju Rai
- Biotechnology, Shri Venkateshwara University, Gajraula, IND
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11
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Hummel JP, Lan Z, Jones PW, Khera R, Stein K, Curtis JP, Akar JG. Predictors of Right Ventricular Pacing in Patients Undergoing Implantable Defibrillator Placement. J Cardiovasc Electrophysiol 2025; 36:807-812. [PMID: 39930894 DOI: 10.1111/jce.16570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2024] [Revised: 11/27/2024] [Accepted: 01/01/2025] [Indexed: 04/11/2025]
Abstract
INTRODUCTION Identifying patients who will develop a need for right ventricular (RV) pacing after defibrillator (ICD) placement would help inform appropriate device selection, specifically to identify patients who might be more suitable for dual chamber or biventricular transvenous defibrillators versus single-chamber or subcutaneous devices which do not provide pacing. We sought to determine predictors of RV pacing in patients who did not have a pacing indication at the time of initial ICD implant. METHODS This observational study assessed single-chamber ICD recipients implanted from 2006 to 2016 from Boston Scientific's ALTITUDE database and linked to the NCDR® ICD Registry. The study population (n = 11 044) of ICDs (programmed VVI mode at 40 bpm), and without a clinical indication for pacing. was randomly divided into training and validation cohorts (70/30) and characteristics associated with RV pacing were identified using logistic regression. The outcome was defined as the development of > 20% RV pacing averaged over any continuous 90-day period within 24 months after the ICD implant. RESULTS Patients who developed > 20% RV pacing (n = 148, 1.3%) had a higher likelihood of being older, male, and with a history of syncope, ventricular tachycardia or cardiac arrest, hypertension, previous or ongoing AF, and longer PR, QRS duration and BUN level (p < 0.01). After adjustment, PR > 230 ms, history of AF, ongoing AF at time of implant, history of VT or cardiac arrest, and age > 70 were independently associated with RV pacing. CONCLUSIONS This study provides insight into predictors of RV pacing in ICD recipients without pacing needs at baseline.
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Affiliation(s)
- James P Hummel
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Zhou Lan
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Rohan Khera
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Jeptha P Curtis
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Joseph G Akar
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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12
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Gao T, Li Z, Li W, Wang X, Xie X. The Risk of New-Onset Atrial Fibrillation in Patients With Conduction System Pacing Versus Right Ventricular Pacing: A Meta-Analysis. Rev Cardiovasc Med 2025; 26:27921. [PMID: 40351701 PMCID: PMC12059758 DOI: 10.31083/rcm27921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2024] [Revised: 01/14/2025] [Accepted: 01/24/2025] [Indexed: 05/14/2025] Open
Abstract
Background Prior studies have established the safety and efficacy of conduction system pacing (CSP) in improving echocardiographic parameters and clinical outcomes. This meta-analysis aimed to investigate whether CSP could reduce the occurrence of new-onset atrial fibrillation (AF) in comparison to traditional right ventricular pacing (RVP) therapy. Methods A literature search was performed in PubMed, Embase, and the Cochrane Library to identify relevant clinical studies comparing CSP with RVP from January 2000 to June 2024. The study outcome was new-onset AF after pacemaker implantation. Estimated risk ratios (RR), odds ratio (OR) with 95% confidence intervals (CI) were evaluated. Results Our analysis included 8 observational studies comprising a total of 2033 patients. The results indicated that 20% (406/2033) of study patients experienced new-onset AF, and CSP was associated with a significantly lower risk of new-onset AF when compared with RVP (RR: 0.44, 95% CI: 0.36-0.54, p < 0.00001, I2 = 11%; OR: 0.34, 95% CI: 0.27-0.44, p < 0.0001, I2 = 0). In the subgroup analysis, patients with atrioventricular block (AVB) tended to benefit more from CSP than those with sinus node dysfunction (SND) or AVB (p = 0.06 for RR; p = 0.12 for OR). Publication bias was observed and confirmed by the Egger's test (p = 0.0125 for RR and 0.0345 for OR). Trim and fill analysis was performed, and the overall summary effect size (RR: 0.51, 95% CI: 0.40-0.64; OR: 0.40, 95% CI: 0.31-0.52) remained significant after adjusting for publication bias. Conclusion CSP could reduce the occurrence of new-onset AF compared with RVP, and this benefit appeared to be more pronounced in patients with AVB than those with SND or AVB. However, large scale randomized controlled trials are needed to validate our findings. The PROSPERO Registration Registration number: CRD42024569052; registration date: July 25, 2024; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024569052.
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Affiliation(s)
- Tingwen Gao
- Department of Cardiology, Rizhao Heart Hospital Qingdao University, 276800 Rizhao, Shandong, China
| | - Zhaofeng Li
- Department of Cardiology, Rizhao Heart Hospital Qingdao University, 276800 Rizhao, Shandong, China
| | - Wei Li
- Department of Cardiology, Rizhao Heart Hospital Qingdao University, 276800 Rizhao, Shandong, China
| | - Xue Wang
- Department of Cardiology, Rizhao Heart Hospital Qingdao University, 276800 Rizhao, Shandong, China
| | - Xinxing Xie
- Department of Cardiology, Rizhao Heart Hospital Qingdao University, 276800 Rizhao, Shandong, China
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13
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Zhang CY, Fan C, Li SH, Wu J, Peng YZ, Sung HW, Liu S, Li RK. A conductive polymer restores connexin43 expression through the suppression of mitogen-activated protein kinases to improve intercellular communication and alleviate atrial fibrillation. Acta Biomater 2025; 196:123-135. [PMID: 40023467 DOI: 10.1016/j.actbio.2025.02.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2024] [Revised: 01/29/2025] [Accepted: 02/26/2025] [Indexed: 03/04/2025]
Abstract
Conductive biomaterials have shown promising results for correcting pathological cardiac electrical signaling. However, their mechanisms of operation are still largely unclear. One reason behind disrupted cardiac intercellular communication, though, is lowered expression of the gap junction protein connexin43 (Cx43), which may be alleviated by conductive biomaterials. In this study, we aimed to test this hypothesis, using the self-doping conductive biomaterial poly-3-amino-4-methoxybenzoic acid-gelatin (PAMB-G). An in vitro model was established, in which cardiomyocytes (CMs) were treated with anisomycin, while the in vivo model involved anisomycin-treated mice subjected to electrical pacing to induce atrial fibrillation (AF). Cx43 expression, Ca2+ transient propagation, and CM electrical conduction in vitro, as well as the in vivo effects of PAMB-G on AF, were evaluated; additionally, the underlying molecular mechanisms were identified. We found that anisomycin, at different concentrations, down-regulated Cx43; this was counteracted by PAMB-G, which restored proper Cx43 expression, coupled with improved Ca2+ signal and electrical conduction. Cx43 restoration was due to PAMB-G suppressing anisomycin-induced activation of MAPKs P38 and JNK, which are involved in phosphorylating Cx43 for degradation. Similar observations were also found in vivo, where a PAMB-G patch acted against anisomycin-induced Cx43 downregulation and impaired atrial cell communication, subsequently alleviating pacing-induced AF. Therefore, PAMB-G suppresses MAPKs, in turn upregulating Cx43, leading to improved electrical signal transduction. As a result, modulating the MAPK-Cx43 pathway, such as with PAMB-G, could serve as a potential therapeutic strategy for cardiac arrhythmia. STATEMENT OF SIGNIFICANCE: Disruption of atrial intercellular gap junction channels, comprised of connexins, leads to atrial fibrillation (AF), the most prevalent arrhythmia, with poor clinical outcomes. Current AF treatments are associated with adverse effects, and only focus on managing symptoms, thereby necessitating innovative treatment strategies. One such strategy is conductive biomaterials, which show promising results for correcting pathological cardiac electrical signaling. We synthesized a self-doping conductive biomaterial, poly-3-amino-4-methoxybenzoic acid-gelatin (PAMB-G), and found that it counteracts against anisomycin-induced connexin43 (Cx43) downregulation, subsequently improving cardiac electrical conduction and alleviating pacing-induced AF. This is owed to PAMB-G suppressing anisomycin-associated activation of mitogen-activated kinases P38 and JNK, which are involved in phosphorylating Cx43 for degradation. Therefore, PAMB-G modulation of MAPK-Cx43 pathway could aid in cardiac arrhythmia treatment.
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Affiliation(s)
- Chong-Yu Zhang
- Guangzhou Institute of Cardiovascular Disease, Guangdong Key Laboratory of Vascular Diseases, State Key Laboratory of Respiratory Disease, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Toronto General Hospital Research Institute, Division of Cardiovascular Surgery, University Health Network, Toronto, Canada
| | - Cheng Fan
- Toronto General Hospital Research Institute, Division of Cardiovascular Surgery, University Health Network, Toronto, Canada; Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Shu-Hong Li
- Toronto General Hospital Research Institute, Division of Cardiovascular Surgery, University Health Network, Toronto, Canada
| | - Jun Wu
- Toronto General Hospital Research Institute, Division of Cardiovascular Surgery, University Health Network, Toronto, Canada
| | - Yvonne Ziyi Peng
- Toronto General Hospital Research Institute, Division of Cardiovascular Surgery, University Health Network, Toronto, Canada
| | - Hsing-Wen Sung
- Department of Chemical Engineering, National Tsing Hua University, Hsinchu, Taiwan
| | - Shiming Liu
- Guangzhou Institute of Cardiovascular Disease, Guangdong Key Laboratory of Vascular Diseases, State Key Laboratory of Respiratory Disease, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Ren-Ke Li
- Toronto General Hospital Research Institute, Division of Cardiovascular Surgery, University Health Network, Toronto, Canada; Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Canada.
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14
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Glikson M, Burri H, Abdin A, Cano O, Curila K, De Pooter J, Diaz JC, Drossart I, Huang W, Israel CW, Jastrzębski M, Joza J, Karvonen J, Keene D, Leclercq C, Mullens W, Pujol-Lopez M, Rao A, Vernooy K, Vijayaraman P, Zanon F, Michowitz Y. European Society of Cardiology (ESC) clinical consensus statement on indications for conduction system pacing, with special contribution of the European Heart Rhythm Association of the ESC and endorsed by the Asia Pacific Heart Rhythm Society, the Canadian Heart Rhythm Society, the Heart Rhythm Society, and the Latin American Heart Rhythm Society. Europace 2025; 27:euaf050. [PMID: 40159278 PMCID: PMC11957271 DOI: 10.1093/europace/euaf050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2025] [Revised: 03/09/2025] [Accepted: 03/10/2025] [Indexed: 04/02/2025] Open
Abstract
Conduction system pacing (CSP) is being increasingly adopted as a more physiological alternative to right ventricular and biventricular pacing. Since the 2021 European Society of Cardiology pacing guidelines, there has been growing evidence that this therapy is safe and effective. Furthermore, left bundle branch area pacing was not covered in these guidelines due to limited evidence at that time. This Clinical Consensus Statement provides advice on indications for CSP, taking into account the significant evolution in this domain.
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Affiliation(s)
- Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, 12 Shmuel Beit Street, 9103102, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Haran Burri
- Cardiac Pacing Unit, Cardiology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Amr Abdin
- Internal Medicine Clinic III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital, Homburg/Saar, Germany
| | - Oscar Cano
- Unidad de Arritmias, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Karol Curila
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Jan De Pooter
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Juan C Diaz
- Clínica Las Vegas, Universidad CES, Medellín, Colombia
| | - Inga Drossart
- ESC Patient Forum, Sophia Antipolis, France
- European Society of Cardiology, Sophia Antipolis, France
| | - Weijian Huang
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Carsten W Israel
- Department of Medicine-Cardiology, Diabetology and Nephrology, Bethel-Clinic, Bielefeld, Germany
| | - Marek Jastrzębski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
| | - Jacqueline Joza
- Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Jarkko Karvonen
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Daniel Keene
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Christophe Leclercq
- Service de Cardiologie et Maladies Vasculaires, Université de Rennes, CHU Rennes, INSERM, LTSI—UMR 1099, F-35000 Rennes, France
| | | | - Margarida Pujol-Lopez
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Archana Rao
- Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | - Yoav Michowitz
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, 12 Shmuel Beit Street, 9103102, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
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15
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Russo AM, Desai MY, Do MM, Butler J, Chung MK, Epstein AE, Guglin ME, Levy WC, Piccini JP, Bhave NM, Russo AM, Desai MY, Do MM, Ambardekar AV, Berg NC, Bilchick KC, Dec GW, Gopinathannair R, Han JK, Klein L, Lampert RJ, Panjrath GS, Reeves RR, Yoerger Sanborn DM, Stevenson LW, Truong QA, Varosy PD, Villines TC, Volgman AS, Zareba KM. ACC/AHA/ASE/HFSA/HRS/SCAI/SCCT/SCMR 2025 Appropriate Use Criteria for Implantable Cardioverter-Defibrillators, Cardiac Resynchronization Therapy, and Pacing. J Am Coll Cardiol 2025; 85:1213-1285. [PMID: 39808105 PMCID: PMC11998028 DOI: 10.1016/j.jacc.2024.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2025]
Abstract
This appropriate use criteria (AUC) document is developed by the American College of Cardiology along with key specialty and subspecialty societies. It provides a comprehensive review of common clinical scenarios where implantable cardioverter-defibrillator (ICD), cardiac resynchronization therapy (CRT), cardiac contractility modulation, leadless pacing, and conduction system pacing therapies are frequently considered. The 335 clinical scenarios covered in this document address ICD indications including those related to secondary prevention, primary prevention, comorbidities, generator replacement at elective replacement indicator, dual-chamber, and totally subcutaneous ICDs, as well as device indications related to CRT, conduction system pacing, leadless pacing, cardiac contractility modulation, and ICD therapy in the setting of left ventricular assist devices (LVADs). The indications (clinical scenarios) were derived from common applications or anticipated uses, as well as from current clinical practice guidelines and results of studies examining device implantation. The indications in this document were developed by a multidisciplinary writing group and scored by a separate independent rating panel on a scale of 1 to 9 to designate care that is considered “Appropriate” (median 7 to 9), “May Be Appropriate” (median 4 to 6), and “Rarely Appropriate” (median 1 to 3). The final ratings reflect the median score of the 17 rating panel members. In general, Appropriate designations were assigned to scenarios for which clinical trial evidence and/or clinical experience was available that supported device implantation. In contrast, scenarios for which clinical trial evidence was limited or device implantation seemed reasonable for extenuating or practical reasons were categorized as May Be Appropriate. Scenarios for which there were data showing harm, or no data were available, and medical judgment deemed device therapy was illadvised were categorized as Rarely Appropriate. For example, comorbidities including reduced life expectancy related to noncardiac conditions or severe cognitive dysfunction would negatively impact appropriateness ratings. The appropriate use criteria for ICD, CRT, and pacing have the potential to enhance clinician decision making, healthcare delivery, and payment policy. Furthermore, recognition of clinical scenarios rated as May Be Appropriate facilitates the identification of areas where there may be gaps in evidence that would benefit from future research. The American College of Cardiology (ACC) has a long history of developing documents (eg, expert consensus decision pathways, health policy statements, AUC documents) to provide members with guidance on both clinical and nonclinical topics relevant to cardiovascular care. In most circumstances, these documents have been created to complement clinical practice guidelines and to inform clinicians about areas where evidence is new and evolving or where sufficient data are more limited. Despite this, numerous gaps persist, highlighting the need for more streamlined and efficient processes to implement best practices in patient care. Central to the ACC’s strategic plan is the generation of actionable knowledge —a concept that places emphasis on making clinical information easier to consume, share, integrate, and update. To this end, the ACC has shifted from developing isolated documents to creating integrated “solution sets.” These are groups of closely related activities, policy, mobile applications, decision-support tools, and other resources necessary to transform care and/or improve heart health. Solution sets address key questions facing care teams and attempt to provide practical guidance to be applied at the point of care. They use both established and emerging methods to disseminate information for cardiovascular conditions and their related management. The success of solution sets rests firmly on their ability to have a measurable impact on the delivery of care. Because solution sets reflect current evidence and ongoing gaps in care, the associated tools will be refined across time to match changing evidence and member needs. AUC represent a key component of solution sets. They consist of common clinical scenarios associated with given disease states and ratings that define when it is reasonable to perform testing or provide therapies and, importantly, when it is not. AUC methodology relies on content development work groups, which create patient scenarios, and independent rating panels that employ a modified Delphi process to rate the relevant options for testing and intervention as Appropriate, May Be Appropriate, or Rarely Appropriate. AUC should not replace clinician judgment and practice experience but should function as tools to improve patient care and health outcomes in a cost-effective manner. I extend sincere gratitude to the writing group for their invaluable contributions to the development of this document’s structure and clinical scenarios; to the rating panelists—a distinguished group of professionals with diverse expertise—for their thoughtful deliberation of the merits of device implantation across various clinical contexts; and to the reviewers for their thoughtful evaluation of the clinical scenarios and evidence mapping. Additionally, I am grateful to the members of the Solution Set Oversight Committee, which provided insight and guidance, and to ACC staff members María Velásquez and Lara Gold, for their support in bringing this document to fruition.
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16
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Zhang D, Zhao Q, Hou S, Qu C, Zhang R, Gao Y, Yang O, Xian H. Clinical outcomes of His bundle pacing vs. right ventricular pacing in patients with conduction disturbances following transcatheter aortic valve replacement. BMC Cardiovasc Disord 2025; 25:202. [PMID: 40114092 PMCID: PMC11924759 DOI: 10.1186/s12872-025-04643-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2025] [Accepted: 03/07/2025] [Indexed: 03/22/2025] Open
Abstract
OBJECTIVE To assess and compare the clinical outcomes of His bundle pacing (HBP) versus right ventricular pacing (RVP) in patients who develop conduction disturbances following transcatheter aortic valve replacement (TAVR). METHODS In this retrospective study, 120 patients who developed CD following TAVR were enrolled, and were implanted with HBP or RVP between January 2015 and December 2024. To adjust for variations in initial risk factors and baseline characteristics between patients who underwent HBP or RVP, we employed the propensity score matching. Each patient was matched in a 1:1 ratio with replacement. Patients who either received HBP or RVP, but could not be adequately matched, were excluded from the study population. Procedural and clinical outcomes were compared among different modalities at pacing implantation and12-month follow-up. RESULTS Paced QRS duration, R-wave amplitude at implantation and at follow-up, impedance at follow-up were lower in HBP group compared to RVP group. At12-month follow-up, the decrease in pacing burden was significantly greater in the HBP group than in the RVP group. Pacing threshold at implantation and at follow-up and capture threshold at implantation and at follow-up were higher in HBP group compared to RVP group. During follow-up, the left ventricular ejection fraction (LVEF) and tricuspid regurgitation (TR) area in the HBP group showed a significant improvement compared to preoperative values, while no significant increase in LVEF was observed in the RVP group, with a clear statistical difference between the two groups. At 12-month follow-up, NT-proBNP levels in the HBP group were significantly lower than those in the RVP group. The rates of NYHA functional class II were higher, while the rates of NYHA functional class III and MACE were lower in the HBP group compared to the RVP group during follow-up. CONCLUSIONS HBP was feasible and safe in patients after TAVR, demonstrating a reduction in the composite outcome of MACE and better cardiac function compared to RVP.
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Affiliation(s)
- Donghui Zhang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, 150007, China
| | - Qi Zhao
- Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin, 150086, China
| | - Shenglong Hou
- Department of Cardiology, Heilongjiang Provincial Hospital, Harbin, 163000, China
| | - Chao Qu
- Department of Cardiology, Heilongjiang Provincial Hospital, Harbin, 163000, China
| | - Ruoxi Zhang
- Department of Cardiology, Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou, 215028, China.
| | - Yanhui Gao
- Department of Cardiology, Forth Affiliated Hospital of Harbin Medical University, Harbin, 150023, China
| | - Ou Yang
- Department of Cadre Ward, The First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Huimin Xian
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, 150007, China.
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Ungureanu AI, Târtea G, Docea AO, Negroiu CE, Marginean CM, Mitruț R, Deutsch MC, Țieranu E, Vătășescu RG, Mitruț P. New-Onset Atrial Fibrillation in Patients with Pacemakers and the Implications of Hepatic Impairment. Life (Basel) 2025; 15:450. [PMID: 40141794 PMCID: PMC11944125 DOI: 10.3390/life15030450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2025] [Revised: 03/06/2025] [Accepted: 03/12/2025] [Indexed: 03/28/2025] Open
Abstract
(1) Background: Atrial fibrillation (A Fib) is a common arrhythmia that affects millions of people worldwide and is characterized by irregular and often rapid heartbeats that can cause stroke. The aim of our study was to assess the importance of predictors for the occurrence of atrial fibrillation in patients with cardiac pacemakers and to analyze their impact on these patients, especially the impact of hepatic impairment. (2) Methods: This study is an observational, retrospective study, including 182 patients who were implanted with a dual-chamber pacemaker (DDD), with no known history of A Fib. (3) Results: We identified as predictors for the occurrence of atrial fibrillation in patients with cardiac pacemakers, DDD with rate response mode, NYHA class III of heart failure, as well as the presence of hepatic impairment (HI). Analysis of echocardiographic parameters of the left atrium revealed a larger left atrial volume as well as a larger left atrial area compared to patients who had a much smaller area at baseline and who did not experience any atrial fibrillation at follow-up. The fact that there were no statistically significant differences between the two groups of patients in terms of left atrial ejection fraction at baseline was very interesting. Patients in the A Fib group had a higher percentage of atrial pacing at the 9-month follow-up (86.23 ± 22.19%) compared to patients in the group without A Fib (44.92 ± 29.99%, p < 0.0001) and had a 9-month follow-up rate of A Fib of 25.806% vs. 2.247% in those with a low percentage of atrial pacing (p < 0.0001). The percentage of ventricular pacing at the 9-month follow-up, the observations were almost similar. (4) Conclusions: The importance of pacemakers in detecting subclinical episodes of atrial fibrillation remains crucial for the prevention of embolic events in these patients. Hepatic impairment may be a risk factor for the occurrence of atrial fibrillation in patients with pacemakers, but it can also create significant problems in stroke prevention.
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Affiliation(s)
- Adrian-Ionuț Ungureanu
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
- Department of Cardiology, Emergency County Hospital of Craiova, 200642 Craiova, Romania;
| | - Georgică Târtea
- Department of Cardiology, Emergency County Hospital of Craiova, 200642 Craiova, Romania;
- Department of Physiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Anca Oana Docea
- Department of Toxicology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Cristina Elena Negroiu
- Department of Pathophysiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Cristina Maria Marginean
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (C.M.M.); (P.M.)
| | - Radu Mitruț
- Department of Cardiology, University and Emergency Hospital, 050098 Bucharest, Romania;
| | | | - Eugen Țieranu
- Department of Cardiology, Emergency County Hospital of Craiova, 200642 Craiova, Romania;
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Radu-Gabriel Vătășescu
- Department of Cardiology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Paul Mitruț
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (C.M.M.); (P.M.)
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18
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Wu H, Jiang L, Shen J, Zhang L. Comparison of electrophysiological left bundle branch pacing characteristics in different bilateral electrode pacing vector configurations. Front Cardiovasc Med 2025; 12:1500196. [PMID: 40144932 PMCID: PMC11936911 DOI: 10.3389/fcvm.2025.1500196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2024] [Accepted: 02/19/2025] [Indexed: 03/28/2025] Open
Abstract
Introduction Left bundle branch pacing (LBBP) in bipolar pacing with anodal capture produces a more balanced ventricular activation than conventional unipolar pacing but need high pacing output. The present study aimed to compare the electrophysiological characteristics of LBBP in different bilateral electrode pacing vector configurations. Methods A total of 57 patients who met the criteria for left bundle branch (LBB) capture and underwent three bilateral electrode pacing vector configuration test were enrolled. The electrocardiogram (ECG) and electrogram (EGM) parameters were evaluated and other electrophysiological characteristics were analyzed using a three-electrode configuration test. Results Seven capture modes [right ventricular septal (RVS) + left ventricular septal (LVS) + LBB, RVS + LBB, LVS + LBB, RVS + LVS, RVS, LVS, and LBB] were utilized in the study. The thresholds of full fusion mode (RVS + LVS + LB) in Bilateral Cathodes and Ring Bipolar were all lower than that in Tip Bipolar (1.2 ± 0.5 V vs. 2.7 ± 1.0 V, P < 0.001; 1.6 ± 0.6 V vs. 2.7 ± 1.0 V, P < 0.001). Full fusion mode had the shortest P-QRS (116.9 ± 12.8 ms) and V1 RWPT (94.5 ± 12.3 ms), V6 RWPT remain the shortest (64.9 ± 9.7 ms). Conclusion Changing the bilateral electrode pacing vector configuration to Bilateral Cathodes and Ring Bipolar can reduce the full fusion mode capture threshold compared to conventional bipolar pacing.
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Affiliation(s)
- Hao Wu
- Department of Cardiovascular Medicine, Ningbo No. 2 Hospital, Ningbo, Zhejiang, China
| | - Longfu Jiang
- Department of Cardiovascular Medicine, Ningbo No. 2 Hospital, Ningbo, Zhejiang, China
- Cardiovascular Disease Clinical Medical Research Center of Ningbo, Ningbo, Zhejiang, China
| | - Jiabo Shen
- Department of Cardiovascular Medicine, Ningbo No. 2 Hospital, Ningbo, Zhejiang, China
| | - Lu Zhang
- Department of Cardiovascular Medicine, Ningbo No. 2 Hospital, Ningbo, Zhejiang, China
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19
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Funck RC, Müller HH, Lunati M, De Roy L, Klein N, Meisel E, Milasinovic G, Carlson MD, Wittenberg M, Hindricks G, Blanc JJ. Biventricular vs. right ventricular pacing devices in patients anticipated to require frequent ventricular pacing (BioPace). Europace 2025; 27:euaf029. [PMID: 40105785 PMCID: PMC11921422 DOI: 10.1093/europace/euaf029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Accepted: 11/25/2024] [Indexed: 03/20/2025] Open
Abstract
AIMS Right ventricular (RV) pacing may promote left ventricular (LV) dysfunction. Particularly in patients with preserved LV ejection fraction (LVEF), narrow QRS, and anticipated high ventricular pacing burden (HVPB), evidence is missing that biventricular (BiV) pacing can improve clinical outcome. We therefore evaluated whether implantation of a BiV pacing device (BiVPD) compared with a RV pacing device (RVPD) may improve clinical outcome in predominantly this kind of patients. METHODS AND RESULTS In the Biventricular Pacing for atrioventricular Block to Prevent Cardiac Desynchronization (BioPace) trial [multicentre, single-blinded (patients), randomized, parallel group], patients were equally allocated to either receive a BiVPD or a RVPD. Co-primary endpoints were (i) the composite of time to death or first heart failure hospitalization and (ii) survival time. We analysed 1810 randomized patients (median age: 73.5 years; female sex: 31.7%; mean LVEF 55.4%; mean QRS 118.4 ms), 902 to BiV and 908 to RV pacing. During mean follow-up of 68.8 months, the difference in the primary composite endpoint between both groups [346 vs. 363 events, hazard ratio (HR) 0.878; 95% confidence interval (CI) 0.756-1.020; P = 0.0882) or in mortality (305 vs. 307 deaths, HR 0.926; 95% CI 0.789-1.088; P = 0.3492) was smaller than 20%. CONCLUSION In patients, predominantly with preserved LVEF, narrow QRS, and HVPB, superiority of implanting BiVPDs compared with RVPDs could not be proven. Right ventricular pacing may be less harmful for this kind of patients than often suggested and primary BiV pacing does not clearly improve their clinical outcome. CLINICAL TRIAL REGISTRATION Registered in ClinicalTrials.gov, number NCT00187278 (https://clinicaltrials.gov/ct2/show/study/NCT00187278).
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Affiliation(s)
- Reinhard C Funck
- Klinik für Innere Medizin - Kardiologie, Philipps-Universität Marburg, Baldingerstr, Marburg 35033, Germany
| | - Hans-Helge Müller
- Institut für Medizinische Bioinformatik und Biostatistik, Philipps-Universität Marburg, Hans-Meerwein-Str. 6, Marburg 35043, Germany
| | - Maurizio Lunati
- Cardiologia 3 – Elettrofisiologia, Ospedale Niguarda, Piazza Ospedale Maggiore 3, Milano 20162, Italy
| | - Luc De Roy
- Cardiology Department, CHU Namur, Ave G. Therasse 1-8, Yvoir 5530, Belgium
| | - Norbert Klein
- Department of Cardiology, Klinikum St. Georg gGmbH, Delitzscher Str. 141, Leipzig 04129, Germany
| | - Eckhard Meisel
- Praxisklinik HerzKreislauf am WASA-Platz, August-Bebel-Str. 33, Dresden 01219, Germany
| | | | - Mark D Carlson
- Abbott Cardiac Arrhythmias and Heart Failure, 15900 Valley View Court, Sylmar, CA, USA
| | - Michael Wittenberg
- Coordinating Center for Clinical Trials, Philipps-University Marburg, Karl-von-Frisch-Str. 4, Marburg 35043, Germany
| | - Gerhard Hindricks
- Department of Cardiology, Angiology and Intensive Care Medicine, Campus Charité Mitte, Charitéplatz 1, Berlin 10117, Germany
| | - Jean-Jacques Blanc
- Department of Cardiology, Brest University Hospital, Boulevard Tanguy Prigent, Brest 29609, France
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20
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Vlachakis PK, Theofilis P, Apostolos A, Kordalis A, Sideris S, Leventopoulos G, Mountantonakis SE, Kollias G, Leontsinis I, Drakopoulou M, Karakasis P, Tousoulis D, Toutouzas K, Tsiachris D, Gatzoulis K, Tsioufis C. Conduction system pacing in heart failure: Time for a paradigm shift? Heart Fail Rev 2025; 30:365-380. [PMID: 39579301 DOI: 10.1007/s10741-024-10469-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2024] [Indexed: 11/25/2024]
Abstract
Heart failure (HF) is a major clinical challenge characterized by significant morbidity and mortality. Electrical conduction abnormalities play a critical role in HF pathophysiology and progression, often leading to suboptimal outcomes with conventional pacing techniques. Con-duction system pacing (CSP), encompassing His bundle pacing and left bundle branch area pacing, has emerged as a novel approach. Despite data come from observational studies, recent guidelines recommend that a specific population may benefit from CSP. However, significant practical considerations and challenges need to be clarified before CSP can be routinely implemented in clinical practice. The reliance on observational studies means that long-term clinical outcomes for HF patients remain uncertain until data from randomized controlled trials (RCTs) become available. Current CSP practices face challenges with lead implantation, mechanical stress on leads, and the need for more advanced tools and artificial intelligence integration to improve procedure efficacy and safety. Future large-scale RCTs are essential to identify optimal candidates and address these technical challenges, potentially leading to a paradigm shift in HF management.
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Affiliation(s)
- Panayotis K Vlachakis
- First Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine "Hippokration" General Hospital, 114 Vasilissis Sofias avenue, Athens, 11527, Greece.
| | - Panagiotis Theofilis
- First Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine "Hippokration" General Hospital, 114 Vasilissis Sofias avenue, Athens, 11527, Greece
| | - Anastasios Apostolos
- First Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine "Hippokration" General Hospital, 114 Vasilissis Sofias avenue, Athens, 11527, Greece
| | - Athanasios Kordalis
- First Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine "Hippokration" General Hospital, 114 Vasilissis Sofias avenue, Athens, 11527, Greece
| | - Skevos Sideris
- State Department of Cardiology, "Hippokration" General Hospital of Athens, Athens, Greece
| | | | | | - Georgios Kollias
- Ordensklinikum Linz Elisabethinen, Fadingerstraße 1, Linz, 4020, Austria
| | - Ioannis Leontsinis
- First Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine "Hippokration" General Hospital, 114 Vasilissis Sofias avenue, Athens, 11527, Greece
| | - Maria Drakopoulou
- First Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine "Hippokration" General Hospital, 114 Vasilissis Sofias avenue, Athens, 11527, Greece
| | - Paschalis Karakasis
- Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine "Hippokration" General Hospital, 114 Vasilissis Sofias avenue, Athens, 11527, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine "Hippokration" General Hospital, 114 Vasilissis Sofias avenue, Athens, 11527, Greece
| | - Dimitrios Tsiachris
- First Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine "Hippokration" General Hospital, 114 Vasilissis Sofias avenue, Athens, 11527, Greece
| | - Konstantinos Gatzoulis
- First Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine "Hippokration" General Hospital, 114 Vasilissis Sofias avenue, Athens, 11527, Greece
| | - Costas Tsioufis
- First Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine "Hippokration" General Hospital, 114 Vasilissis Sofias avenue, Athens, 11527, Greece
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21
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Vijayaraman P, Longacre C, Kron J, Subzposh F, Zimmerman P, Butler K, Crossley GH, Ellenbogen KA. Conduction system pacing associated with reduced heart failure hospitalizations and all-cause mortality compared with traditional right ventricular pacing in the Medicare population. Heart Rhythm 2025; 22:735-743. [PMID: 39226948 DOI: 10.1016/j.hrthm.2024.08.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Revised: 08/23/2024] [Accepted: 08/23/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND Conduction system pacing (CSP) has emerged as an alternative therapy to traditional right ventricular (RV) pacing. However, most CSP studies reflect small cohorts or single-center experience. OBJECTIVE This analysis compared CSP with dual-chamber (DC) RV pacing in a large, population-based cohort using data from the Micra Coverage with Evidence Development study. METHODS Medicare administrative claims data were used to identify patients implanted with a DC RV pacemaker. Lead placement data from Medtronic's device registration system identified patients treated with CSP (n = 6197) using a 3830 catheter-delivered lead or DC RV (non-3830 lead, non-CSP placement; n = 16,989) at the same centers. CSP patients were stratified into left bundle branch area pacing (LBBAP; n = 4738) and His bundle pacing (HBP; n = 1459). Incident heart failure hospitalizations, all-cause mortality, complication rates, and reinterventions at 6 months were analyzed. RESULTS CSP patients with a 3830 catheter-delivered lead experienced significantly lower rates of incident heart failure hospitalization (hazard ratio [HR], 0.70; P = .02) and all-cause mortality at 6 months compared with DC RV patients (HR, 0.66; P < .0001). There was no difference in chronic complications (HR, 0.97; P = .62) or need for reintervention (HR, 0.95; P = .63) with CSP compared with DC RV, although LBBAP patients experienced significantly lower rates of complications (HR, 0.71; P = .001) compared with HBP. CONCLUSION DC pacemaker patients treated with CSP using a 3830 catheter-delivered lead experienced significant all-cause mortality and heart failure hospitalization benefits compared with DC RV pacing. LBBAP had lower complications compared with HBP. These real-world results align with findings in small clinical studies demonstrating the benefits of CSP.
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Affiliation(s)
| | | | - Jordana Kron
- Virginia Commonwealth University, Richmond, Virginia
| | - Faiz Subzposh
- Geisinger Heart Institute, Wilkes-Barre, Pennsylvania
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22
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Michalik J, Sterliński M, Świerżyńska-Wodarska E, Klaus A, Szołkiewicz M. Conduction system optimized cardiac resynchronization therapy- exceptional modality of cardiac pacing in patients with severe heart failure. A hope for non-responders? Adv Med Sci 2025; 70:197-202. [PMID: 40023372 DOI: 10.1016/j.advms.2025.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2024] [Revised: 12/05/2024] [Accepted: 02/26/2025] [Indexed: 03/04/2025]
Abstract
For many years, the apex of the right ventricle (RV) seemed to be a sufficiently good site for ventricular pacing, effectively protecting both the health and life of patients with atrioventricular conduction disorders. However, the studies have demonstrated that this is not an optimal site, since it leads to electrical and mechanical interventricular asynchrony, which in some cases (15-20 %) results in the development of pacing-induced cardiomyopathy (PICM). The introduction of biventricular cardiac resynchronization therapy (BiV-CRT) into clinical practice was a real breakthrough in the development of modern electrotherapy, and conduction system pacing (CSP) has heralded even greater hopes. The CSP-optimized CRT is the most complex modality of CRT, involving the simultaneous pacing of His bundle or its left branch, and additionally, epicardial pacing of the left ventricle. This modality of pacing may represent the most optimal method for spreading the ventricle depolarization wave in severely damaged cardiac muscle and may represent a real hope for patients who do not adequately respond to other forms of CRT.
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Affiliation(s)
- Jędrzej Michalik
- Department of Cardiology and Interventional Angiology, Kashubian Center for Heart and Vascular Diseases, Pomeranian Hospitals, Wejherowo, Poland
| | - Maciej Sterliński
- 1st Department of Arrhythmia, The Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Ewa Świerżyńska-Wodarska
- 1st Department of Arrhythmia, The Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland; Doctoral School, Medical University of Warsaw, Warsaw, Poland.
| | - Aleksandra Klaus
- Department of Cardiology and Interventional Angiology, Kashubian Center for Heart and Vascular Diseases, Pomeranian Hospitals, Wejherowo, Poland
| | - Marek Szołkiewicz
- Department of Cardiology and Interventional Angiology, Kashubian Center for Heart and Vascular Diseases, Pomeranian Hospitals, Wejherowo, Poland
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23
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Kamsani SH, Fitzgerald JL, Thiyagarajah A, Evans S, Jayakumar M, Ariyaratnam JP, Malik V, O’Shea C, Pitman BM, Wong CX, Emami M, Young GD, Lau DH. Adoption of left bundle branch area pacing using stylet-driven lead in a tertiary academic training center: Learning curve and acute procedural outcomes. Heart Rhythm O2 2025; 6:253-258. [PMID: 40201670 PMCID: PMC11973689 DOI: 10.1016/j.hroo.2024.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2025] Open
Abstract
Background Left bundle branch area pacing (LBBAP) has recently emerged as a strategy for conduction system pacing. Objective The purpose of this study was to evaluate the initial learning experience and acute procedural success in adopting this procedure in an academic training center. Methods A retrospective review of LBBAP procedures using the Biotronik Solia stylet-driven lead from June 2022 to December 2023 was performed. Procedural and fluoroscopy times with electrocardiographic and pacing parameters were evaluated to determine safety and acute procedural outcomes. Results A total of 69 patients (mean age 75 ± 12 years; 60.9% male) underwent LBBAP implantation over 18 months for standard pacing indications by 10 implanters (including 7 fellows-in-training) without previous experience in LBBAP technique. Mean total procedural time was 74.1 ± 23.5 minutes, and mean fluoroscopy time for LBBAP lead insertion was 9.3 ± 5.4 minutes. Mean paced QRS duration was 115.2 ± 15.5 ms, and mean left ventricular activation time was 79.4 ± 14.5 ms. An rsR' pattern was achieved in 76.8%. LBBAP was successful in 78.3% (overall 43.5% single deployment; median 2 [interquartile range 1-3]) with excellent LBBAP lead parameters: threshold 0.8 ± 0.4 V at 0.4 ms; sensing 9.4 ± 4.2 mV; impedance 627 ± 131 Ω. Acute procedural complications included damaged lead helix requiring a second lead (4.3%), pneumothorax (2.9%), and acute LBBAP lead dislodgment (1.4%). Septal perforation occurred in 10.1% of cases with no acute sequelae. When analyzed in tertiles, the number of lead deployment attempts was significantly reduced with no changes to procedural success rates with increasing experience. Conclusion Adoption of LBBAP with stylet-driven lead in an academic training center is feasible and safe, with satisfactory success rates and no overly steep learning curve.
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Affiliation(s)
- Suraya Hani Kamsani
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Department of Cardiology, National Heart Institute, Kuala Lumpur, Malaysia
| | - John L. Fitzgerald
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Anand Thiyagarajah
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Shaun Evans
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Mohanaraj Jayakumar
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jonathan P. Ariyaratnam
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Australian Dysautonomia and Arrhythmia Research Collaborative, The University of Adelaide, Adelaide, South Australia, Australia
| | - Varun Malik
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Catherine O’Shea
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Bradley M. Pitman
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christopher X. Wong
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Australian Dysautonomia and Arrhythmia Research Collaborative, The University of Adelaide, Adelaide, South Australia, Australia
| | - Mehrdad Emami
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Glenn D. Young
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Dennis H. Lau
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Australian Dysautonomia and Arrhythmia Research Collaborative, The University of Adelaide, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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24
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Crea P, Cocuzza F, Bonanno S, Ferrara N, Teresi L, La Maestra D, Bellocchi P, Micari A, Moncada A, Micari A, Di Bella G, Dattilo G. New Diseases Related to Cardiac Implantable Electronic Devices (CIEDs): An Overview. J Clin Med 2025; 14:1322. [PMID: 40004852 PMCID: PMC11856071 DOI: 10.3390/jcm14041322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2025] [Revised: 02/11/2025] [Accepted: 02/12/2025] [Indexed: 02/27/2025] Open
Abstract
The widespread use of Cardiac Implantable Electronic Devices (CIEDs) has transformed the management of cardiac arrhythmias, improving survival and quality of life for millions. However, this progress has introduced a range of device-related complications, which can significantly impact patient outcomes. This review examines "new diseases" linked to CIEDs, categorizing them into physical (e.g., infections, venous obstruction, lead failure, and device recalls) and functional complications (e.g., arrhythmias, pacemaker syndrome, and left ventricular dysfunction). Prevention and management strategies are emphasized. Emerging technologies, such as leadless devices, quadripolar leads, and remote monitoring systems, hold promise in reducing risks and enhancing patient care. Future directions include integrating artificial intelligence for real-time monitoring, improving device durability, and exploring novel materials to minimize infections and mechanical failures. Understanding CIED-related complications is essential for healthcare providers to balance the benefits and risks of these life-saving technologies.
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Affiliation(s)
- Pasquale Crea
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 98124 Messina, Italy; (F.C.); (S.B.); (N.F.); (L.T.); (D.L.M.); (P.B.); (A.M.); (A.M.); (A.M.); (G.D.B.); (G.D.)
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25
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Iwasaki YK, Noda T, Akao M, Fujino T, Hirano T, Inoue K, Kusano K, Nagai T, Satomi K, Shinohara T, Soejima K, Sotomi Y, Suzuki S, Yamane T, Kamakura T, Kato H, Katsume A, Kondo Y, Kuroki K, Makimoto H, Murata H, Oka T, Tanaka N, Ueda N, Yamasaki H, Yamashita S, Yasuoka R, Yodogawa K, Aonuma K, Ikeda T, Minamino T, Mitamura H, Nogami A, Okumura K, Tada H, Kurita T, Shimizu W. JCS/JHRS 2024 Guideline Focused Update on Management of Cardiac Arrhythmias. Circ J 2025:CJ-24-0073. [PMID: 39956587 DOI: 10.1253/circj.cj-24-0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2025]
Affiliation(s)
- Yu-Ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Takashi Noda
- Department of Cardiology, Tohoku University Hospital
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | - Tadashi Fujino
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | - Teruyuki Hirano
- Department of Stroke Medicine, Kyorin University School of Medicine
| | - Koichi Inoue
- Department of Cardiology, National Hospital Organization Osaka National Hospital
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | | | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Kyoko Soejima
- Department of Cardiovascular Medicine, Kyorin University School of Medicine
| | - Yohei Sotomi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Shinya Suzuki
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Teiichi Yamane
- Department of Cardiology, The Jikei University School of Medicine
| | - Tsukasa Kamakura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiroyuki Kato
- Department of Cardiology, Japan Community Healthcare Organization Chukyo Hospital
| | - Arimi Katsume
- Department of Cardiovascular Medicine, Kyorin University School of Medicine
| | - Yusuke Kondo
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| | - Kenji Kuroki
- Department of Cardiology, Faculty of Medicine, University of Yamanashi
| | - Hisaki Makimoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Data Science Center, Jichi Medical University
| | | | - Takafumi Oka
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Nobuaki Tanaka
- Department of Cardiology, Cardiovascular Center, Sakurabashi Watanabe Hospital
| | - Nobuhiko Ueda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiro Yamasaki
- Department of Cardiology, Institute of Medicine, University of Tsukuba
| | - Seigo Yamashita
- Department of Cardiology, The Jikei University School of Medicine
| | - Ryobun Yasuoka
- Department of Cardiology, Kindai University School of Medicine
| | - Kenji Yodogawa
- Department of Cardiology, Nippon Medical School Hospital
| | | | - Takanori Ikeda
- Department of Cardiology, Toho University Medical Center Omori Hospital
| | - Toru Minamino
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Hideo Mitamura
- National Public Service Mutual Aid Federation Tachikawa Hospital
| | | | - Ken Okumura
- Department of Cardiology, Cardiovascular Center, Saiseikai Kumamoto Hospital
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | - Takashi Kurita
- Division of Cardiovascular Center, Kindai University School of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
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26
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Wedin JO, Näslund V, Rodin S, Simonson OE, Flachskampf FA, James SK, Ståhle E, Grinnemo KH. Conduction Disturbances and Outcome After Surgical Aortic Valve Replacement in Patients With Bicuspid and Tricuspid Aortic Stenosis. Circulation 2025; 151:288-298. [PMID: 39440421 PMCID: PMC11789612 DOI: 10.1161/circulationaha.124.070753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 10/01/2024] [Indexed: 10/25/2024]
Abstract
BACKGROUND This study aimed to compare the incidence and prognostic implications of new-onset conduction disturbances after surgical aortic valve replacement (SAVR) in patients with bicuspid aortic valve (BAV) aortic stenosis (AS) versus patients with tricuspid aortic valve (TAV) AS (ie, BAV-AS and TAV-AS, respectively). Additionally, the study included stratification of BAV patients according to subtype. METHODS In this cohort study, the incidence of postoperative third-degree atrioventricular (AV) block with subsequent permanent pacemaker requirement and new-onset left bundle-branch block (LBBB) was investigated in 1147 consecutive patients without preoperative conduction disorder who underwent isolated SAVR (with or without ascending aortic surgery) between January 1, 2005, and December 31, 2022. The groups were stratified by aortic valve morphology (BAV, n=589; TAV, n=558). The outcomes of interests were new-onset third-degree AV block or new-onset LBBB during the index hospitalization. The impact of new-onset postoperative conduction disturbances on survival was investigated in BAV-AS and TAV-AS patients during a median follow-up of 8.2 years. BAV morphology was further categorized according to the Sievers and Schmidtke classification system (possible in 307 BAV-AS patients) to explore association between BAV subtypes and new-onset conduction disturbances after SAVR. RESULTS The overall incidence of third-degree AV block and new-onset LBBB after SAVR was 4.5% and 7.8%, respectively. BAV-AS patients had a higher incidence of both new-onset third-degree AV block (6.5% versus 2.5%; P=0.001) and new-onset LBBB (9.7% versus 5.7%; P=0.013) compared with TAV-AS patients. New-onset LBBB was associated with an increased all-cause mortality during follow-up (adjusted hazard ratio, 1.60 [95% CI, 1.12-2.30]; P=0.011), whereas new-onset third-degree AV block was not associated with worse prognosis. Subgroup analysis of the BAV cohort revealed that BAV-AS patients with fusion of the right- and non-coronary cusps had the highest risk of new-onset third-degree AV block (adjusted odds ratio [aOR], 8.33 [95% CI, 3.31-20.97]; P<0.001, with TAV as reference group) and new-onset LBBB (aOR, 4.03 [95% CI, 1.84-8.82]; P<0.001, with TAV as reference group), whereas no significant association was observed for the other BAV subtypes. CONCLUSIONS New-onset LBBB after SAVR is associated with increased all-cause mortality during follow-up, and is more frequent complication in BAV AS patients compared with TAV-AS patients. BAV-AS patients with fusion of the right- and non-coronary cusps have an increased risk for conduction disturbances after SAVR. This should be taken into consideration when managing these patients.
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Affiliation(s)
- Johan O. Wedin
- Cardio-Thoracic Translational Medicine Lab (J.O.W., S.R., O.E.S., E.S., K-H.G.), Uppsala University, Sweden
- Departments of Surgical Sciences (J.O.W., S.R., O.E.S., E.S., K-H.G.), Uppsala University, Sweden
- Departments of Cardiothoracic Surgery and Anesthesiology (J.O.W., V.N. S.R., O.E.S., E.S., K-H.G.), Uppsala University Hospital, Sweden
| | - Viktor Näslund
- Departments of Cardiothoracic Surgery and Anesthesiology (J.O.W., V.N. S.R., O.E.S., E.S., K-H.G.), Uppsala University Hospital, Sweden
| | - Sergey Rodin
- Cardio-Thoracic Translational Medicine Lab (J.O.W., S.R., O.E.S., E.S., K-H.G.), Uppsala University, Sweden
- Departments of Surgical Sciences (J.O.W., S.R., O.E.S., E.S., K-H.G.), Uppsala University, Sweden
- Departments of Cardiothoracic Surgery and Anesthesiology (J.O.W., V.N. S.R., O.E.S., E.S., K-H.G.), Uppsala University Hospital, Sweden
| | - Oscar E. Simonson
- Cardio-Thoracic Translational Medicine Lab (J.O.W., S.R., O.E.S., E.S., K-H.G.), Uppsala University, Sweden
- Departments of Surgical Sciences (J.O.W., S.R., O.E.S., E.S., K-H.G.), Uppsala University, Sweden
- Departments of Cardiothoracic Surgery and Anesthesiology (J.O.W., V.N. S.R., O.E.S., E.S., K-H.G.), Uppsala University Hospital, Sweden
| | - Frank A. Flachskampf
- Medical Sciences (F.A.F., S.K.J.), Uppsala University, Sweden
- Clinical Physiology and Cardiology (F.A.F., S.K.J.), Uppsala University Hospital, Sweden
| | - Stefan K. James
- Medical Sciences (F.A.F., S.K.J.), Uppsala University, Sweden
- Clinical Physiology and Cardiology (F.A.F., S.K.J.), Uppsala University Hospital, Sweden
- Uppsala Clinical Research Center, Sweden. (S.K.J.)
| | - Elisabeth Ståhle
- Cardio-Thoracic Translational Medicine Lab (J.O.W., S.R., O.E.S., E.S., K-H.G.), Uppsala University, Sweden
- Departments of Surgical Sciences (J.O.W., S.R., O.E.S., E.S., K-H.G.), Uppsala University, Sweden
- Departments of Cardiothoracic Surgery and Anesthesiology (J.O.W., V.N. S.R., O.E.S., E.S., K-H.G.), Uppsala University Hospital, Sweden
| | - Karl-Henrik Grinnemo
- Cardio-Thoracic Translational Medicine Lab (J.O.W., S.R., O.E.S., E.S., K-H.G.), Uppsala University, Sweden
- Departments of Surgical Sciences (J.O.W., S.R., O.E.S., E.S., K-H.G.), Uppsala University, Sweden
- Departments of Cardiothoracic Surgery and Anesthesiology (J.O.W., V.N. S.R., O.E.S., E.S., K-H.G.), Uppsala University Hospital, Sweden
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27
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Biffi M, Bagatin A, Spadotto A, Lazzeri M, Carecci A, Bartoli L, Martignani C, Angeletti A, Diemberger I, Massaro G, Bertelli M, Ziacchi M. Atrioventricular Block Treatment: Pacing Site, AV Synchrony, or Both? J Clin Med 2025; 14:980. [PMID: 39941650 PMCID: PMC11818370 DOI: 10.3390/jcm14030980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2024] [Revised: 01/21/2025] [Accepted: 01/30/2025] [Indexed: 02/16/2025] Open
Abstract
Background/Objectives: Right ventricular pacing (RVP), leadless pacing (LL), and conduction system pacing (CSP) are treatment options for atrioventricular block (AVB), each with distinct characteristics. However, the long-term outcomes of these pacing strategies remain insufficiently compared. This study evaluates clinical and echocardiographic outcomes of patients with AVB treated with dual chamber RVP, His bundle pacing (HBP), or LL. Methods: This single-center observational registry study included 22 consecutive patients receiving LL with atrioventricular resynchronization functionality (October 2020 to October 2022), matched with 66 control patients receiving either RVP (33 patients) or HBP (33 patients) using propensity score matching (2:3:3 ratio). Primary and secondary endpoints included all-cause mortality, cardiovascular mortality, heart failure, and echocardiographic outcomes. Atrioventricular synchrony in the LL group was assessed. Results: At two years, all-cause mortality was significantly higher in the LL group compared to RVP (36.4% vs. 6.1%, p = 0.002) and HBP (36.4% vs. 12.1%, p = 0.03), but LL had a more severe clinical profile. Cardiovascular mortality and heart failure incidence showed no significant differences. Patients receiving RVP showed a significant decrease in left ventricular ejection fraction and an increase in ventricular volumes. In contrast, HBP patients exhibited favorable cardiac remodeling. Stratification based on atrial sensing showed that LL patients with >66% AV synchrony had a lower mortality (p = 0.02). Conclusions: CSP offers superior results compared to other pacing methods in terms of ventricular function owing to a physiological ventricular activation and maintenance of AV synchrony. However, LL may be a viable alternative for frail and high-risk patients, as the suboptimal AV synchrony is traded off with lesser ventricular dyssynchrony.
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Affiliation(s)
- Mauro Biffi
- Institute of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Annalisa Bagatin
- Department of Medical and Surgical Sciences, Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Alberto Spadotto
- Department of Medical and Surgical Sciences, Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Mirco Lazzeri
- Department of Medical and Surgical Sciences, Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Alessandro Carecci
- Department of Medical and Surgical Sciences, Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Lorenzo Bartoli
- Department of Medical and Surgical Sciences, Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Cristian Martignani
- Institute of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Andrea Angeletti
- Institute of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Igor Diemberger
- Department of Medical and Surgical Sciences, Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Giulia Massaro
- Department of Medical and Surgical Sciences, Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Michele Bertelli
- Department of Medical and Surgical Sciences, Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Matteo Ziacchi
- Institute of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138 Bologna, Italy
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28
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Nohno Y, Kozu R, Ito K, Chikazawa Y, Maruyama S, Hasegawa T, Tsuchiya H, Tachibana T, Kimura H, Yazaki Y. Comparative analysis of left bundle branch area pacing in patients with and without a history of open-heart surgery. J Arrhythm 2025; 41:e70010. [PMID: 39886037 PMCID: PMC11780717 DOI: 10.1002/joa3.70010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Revised: 01/07/2025] [Accepted: 01/19/2025] [Indexed: 02/01/2025] Open
Abstract
Background Left bundle branch area pacing (LBBAP) is widely performed in routine clinical practice. Achieving LBBAP requires deep insertion of the lead into the interventricular septum. LBBAP may be challenging in patients with a history of open-heart surgery (OHS) because of myocardial fibrosis associated with surgical trauma. This study aimed to report the feasibility and safety of performing LBBAP in patients with a history of OHS. Methods This retrospective analysis included patients who underwent successful LBBAP between November 2020 and September 2024, with approval from our institutional review board. LBBAP was performed using a 3830 SelectSecure lead, and pacing parameters were assessed before and after implantation. Results One hundred patients were analyzed, including 26 in the OHS group and 74 in the non-OHS group. The success rates of LBBAP were 84.6% in the OHS group and 90.5% in the non-OHS group (p = 0.375). Notably, the number of LBBAP lead placements was higher in the OHS group (3.0 ± 2.1 vs. 2.0 ± 1.4, p = 0.017). The left ventricular activation time in lead V6 was comparable between the groups at implantation (73.6 ± 13.3 ms vs. 75.6 ± 12.1 ms, p = 0.522). The QRS duration was significantly wider in the OHS group at implantation (131.3 ± 14.6 vs. 121.1 ± 12.3 ms, p = 0.002), but parameters remained stable at 1 year. Conclusions LBBAP in patients with a history of OHS may present a slightly higher level of technical difficulty, but it is both feasible and safe.
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Affiliation(s)
- Yasumasa Nohno
- Department of CardiologySaku Central Hospital Advanced Care CenterSakuJapan
| | - Ryosuke Kozu
- Department of CardiologyAsama Nanroku Komoro Medical CenterKomoroJapan
| | - Kii Ito
- Department of CardiologySaku Central Hospital Advanced Care CenterSakuJapan
| | - Yuta Chikazawa
- Department of CardiologySaku Central Hospital Advanced Care CenterSakuJapan
| | - Shusaku Maruyama
- Department of CardiologySaku Central Hospital Advanced Care CenterSakuJapan
| | - Tomoya Hasegawa
- Department of CardiologySaku Central Hospital Advanced Care CenterSakuJapan
| | - Hiromi Tsuchiya
- Department of CardiologySaku Central Hospital Advanced Care CenterSakuJapan
| | - Takahiro Tachibana
- Department of CardiologySaku Central Hospital Advanced Care CenterSakuJapan
| | - Hikaru Kimura
- Department of CardiologySaku Central Hospital Advanced Care CenterSakuJapan
| | - Yoshikazu Yazaki
- Department of CardiologySaku Central Hospital Advanced Care CenterSakuJapan
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29
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Goergen JA, Peigh G, Varberg N, Ziegler PD, Roberts AI, Stanelle E, Soderlund D, Khan SS, Passman RS. Racial Differences in Device-Detected Incident Atrial Fibrillation. JACC Clin Electrophysiol 2025; 11:298-308. [PMID: 39708033 DOI: 10.1016/j.jacep.2024.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 08/27/2024] [Accepted: 10/04/2024] [Indexed: 12/23/2024]
Abstract
BACKGROUND Prior research suggests Black individuals have a lower risk of atrial fibrillation (AF) than White individuals, but this may be related to the underdetection of AF. Whether this trend persists using highly sensitive methods of AF diagnosis has not been well-studied. OBJECTIVES The objective of this study was to use cardiac implantable electronic devices (CIEDs) capable of AF diagnosis to compare AF incidence between Black and White individuals. METHODS This was a retrospective observational study involving Black and White patients who had a CIED implanted between January 1, 2007, and June 1, 2019. Patients with insertable cardiac monitors, insufficient monitoring, or prior AF were excluded. The primary endpoint was the overall adjusted incidence of device-detected AF between Black and White individuals. RESULTS Of 441,047 patients with a CIED implanted during the study period, 88,427 patients (mean age, 69 ± 13 years; 80,382 White [91%]; 55,840 male [63%]) were included in analysis. The mean follow-up duration was 2.2 ± 1.7 years, and 35,143 patients (40%) had device-detected AF. The crude incidence of AF was greater among White, compared with Black, individuals (27.95 vs 24.86 cases per 100 person-years, P < 0.001). After adjusting for age, sex, and medical comorbidities, the hazard of AF was similar between Black and White individuals (HR: 1.02; 95% CI: 0.98-1.06). In subgroup analysis by type of CIED, White individuals had a greater hazard of AF in the pacemaker cohort, whereas Black individuals had a greater hazard of AF in the implantable cardioverter defibrillator cohort. CONCLUSIONS The adjusted hazard of AF was similar between Black and White individuals with CIEDs.
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Affiliation(s)
- Jack A Goergen
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Graham Peigh
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | | | | | - Anthony I Roberts
- Medtronic Inc, Minneapolis, Minnesota, USA; Brown University School of Public Health, Providence, Rhode Island, USA
| | | | | | - Sadiya S Khan
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rod S Passman
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
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30
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Pestrea C, Cicala E, Enache R, Rusu M, Gavrilescu R, Vaduva A, Risca S, Clapon D, Ortan F. Mid-term comparison of new-onset AHRE between His bundle and left bundle branch area pacing in patients with AV block. J Arrhythm 2025; 41:e70009. [PMID: 39906094 PMCID: PMC11792577 DOI: 10.1002/joa3.70009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2024] [Revised: 01/06/2025] [Accepted: 01/19/2025] [Indexed: 02/06/2025] Open
Abstract
Background Atrial high-rate episodes (AHRE) detected by cardiac implanted electronic devices are known markers for adverse cardiac events. Previous studies have shown that the incidence of new-onset AHREs in patients with right ventricular pacing reaches 50%. At the same time, His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) were associated with significantly fewer AHRE. This study aimed to compare the incidence of new-onset AHRE between HBP and LBBAP in patients with atrioventricular block and no history of atrial fibrillation. Methods One hundred and forty-two patients, fifty-nine with HBP and eighty-three with LBBAP for advanced atrioventricular block, were prospectively followed for new-onset AHRE. Results The mean follow-up period was 624 ± 148.6 days for the HBP patients and 663.4 ± 157.4 days for the LBBAP patients. New-onset AHRE was encountered in 8 of 59 patients (13.5%) with HBP and 14 of 83 (16.8%) with LBBAP (hazard ratio-0.91, log rank p = .84). In the multivariate Cox regression model, HBP and LBBAP had similar predictive values, while only age and diabetes mellitus were significantly associated with new-onset AHRE occurrence. Conclusion HBP and LBBAP were associated with a similar incidence of device-detected new-onset AHRE during a medium-term follow-up period in patients with atrioventricular block and no history of atrial fibrillation.
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Affiliation(s)
- Catalin Pestrea
- Department of Interventional CardiologyBrasov County Clinical Emergency HospitalBrasovRomania
| | - Ecaterina Cicala
- Department of Interventional CardiologyBrasov County Clinical Emergency HospitalBrasovRomania
| | - Roxana Enache
- Department of Interventional CardiologyBrasov County Clinical Emergency HospitalBrasovRomania
| | - Marcela Rusu
- Department of Interventional CardiologyBrasov County Clinical Emergency HospitalBrasovRomania
| | - Radu Gavrilescu
- Department of Interventional CardiologyBrasov County Clinical Emergency HospitalBrasovRomania
| | - Adrian Vaduva
- Department of Interventional CardiologyBrasov County Clinical Emergency HospitalBrasovRomania
| | - Sever Risca
- Department of Interventional CardiologyBrasov County Clinical Emergency HospitalBrasovRomania
| | - Dana Clapon
- Department of Interventional CardiologyBrasov County Clinical Emergency HospitalBrasovRomania
| | - Florin Ortan
- Department of Interventional CardiologyBrasov County Clinical Emergency HospitalBrasovRomania
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31
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Chung HG, Yang PS, Jang E, Kim J, Kim M, Kim D, Yu HT, Kim TH, Uhm JS, Sung JH, Pak HN, Lee MH, Joung B. Associations of accelerometer-derived moderate-to-vigorous physical activity and atrioventricular block in a healthy elderly population. Heart Rhythm 2025:S1547-5271(25)00012-8. [PMID: 39798681 DOI: 10.1016/j.hrthm.2025.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2024] [Revised: 12/16/2024] [Accepted: 01/03/2025] [Indexed: 01/15/2025]
Abstract
BACKGROUND There is limited information on protective factors related to atrioventricular (AV) block. OBJECTIVE This study examines the association between accelerometer-derived moderate-to-vigorous physical activity (MVPA) and AV block in healthy elderly individuals. METHODS A total of 23,590 UK Biobank participants ≥60 years of age involved in a wrist-worn accelerometer study with no history of hypertension, diabetes mellitus, dyslipidemia, and coronary heart disease were analyzed. The associations of MVPA with primary (second- or third-degree AV block) and secondary outcome (third-degree AV block, pacemaker implantation) were evaluated by Cox regression analysis. The associations of MVPA with electrocardiogram parameters were evaluated by linear regression analysis. RESULTS The mean age was 63.8 ± 2.8 years, and 57.4% were women. During the median follow-up period of 6.1 years, 115 primary outcome events occurred. Compared with quintile 1 (< 89 min/week), those in quintile 4 (280-449 min/week) had a 63% lower incidence of primary outcome (hazard ratio [HR] 0.37, 95% confidence interval [CI] 0.19-0.73, P = .004); however, the result was attenuated in quintile 5. This pattern was consistently observed in the relationship between MVPA and third-degree AV block (quintile 4 vs quintile 1: HR 0.29, 95% CI 0.11-0.74, P = .010) and pacemaker implantation. MVPA per 150 minutes per week increase was independently negatively associated with normalized PQ interval (msec) (β: -2.13, 95% CI 0-3.03 to ‒1.24, P < .001). CONCLUSION In the healthy elderly population, MVPA was associated with a lower risk of second- or third-degree AV block, which correlates with the reduction of normalized PQ interval. However, excessive MVPA attenuated the results.
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Affiliation(s)
- Ho-Gi Chung
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Pil-Sung Yang
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Eunsun Jang
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Juntae Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Min Kim
- Chungbuk National University Hospital, Cheongju, South Korea
| | - Daehoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jung-Hoon Sung
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.
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Xu N, Cheng X, Ren L, Yuan Q. Application prospect of speckle tracking echocardiography in pacemaker implantation. Front Cardiovasc Med 2025; 11:1484520. [PMID: 39830006 PMCID: PMC11739361 DOI: 10.3389/fcvm.2024.1484520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Accepted: 12/10/2024] [Indexed: 01/22/2025] Open
Abstract
More than 1 million permanent pacemakers are implanted worldwide each year, half of which are in patients with high-grade atrioventricular block. Pacemakers provide adequate frequency support in the initial stage, but traditional right ventricular (RV) pacing may lead to or aggravate left ventricular dysfunction and arrhythmia. Several potential risk factors for heart failure and arrhythmias after pacemaker surgery have been identified, but their occurrence remains difficult to predict clinically. Compared with RV pacing, His bundle pacing (HBP) and left bundle branch pacing (LBBP) activate the intrinsic His-Purkinje conduction system and provide physiological activation, but whether HBP and LBBP also cause ventricular mechanical dyssynchrony remains uncertain. The implantation of cardiac resynchronization therapy and implantable cardioverter defibrillator depends on left ventricular ejection fraction (LVEF). LVEF This depends on volume changes and is less reproducible. Speckle tracking echocardiography (STE) is a technique that can accurately quantify the degree and duration of systolic deformation. STE detects changes in myocardial function more sensitively than traditional measures of diastolic and systolic function, including LVEF. Clinicians can evaluate myocardial strain and synchrony based on strain (percent change in segmental length from baseline) and strain rate (strain per unit time). This review and case series investigate the clinical use of speckle tracking echocardiography in pacemaker implantation.
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Affiliation(s)
- Nan Xu
- Department of Cardiology, The First People’s Hospital of Neijiang, Neijiang, China
| | - Xiaoping Cheng
- Department of Ultrasonic Medicine, The First People’s Hospital of Neijiang, Neijiang, China
| | - Lei Ren
- Department of Cardiology, The First People’s Hospital of Neijiang, Neijiang, China
| | - Quan Yuan
- Department of Cardiology, The First People’s Hospital of Neijiang, Neijiang, China
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Tang JE, Guirguis F, Holloway JO, Wernke C, Reeves J, Kumar NA, Savona SJ, Essandoh MK, Iyer MH. Two Is Better than One: Aveir DR Leadless Pacemaker System with Dual-Chamber Pacing. J Cardiothorac Vasc Anesth 2025; 39:286-291. [PMID: 39547867 DOI: 10.1053/j.jvca.2024.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Revised: 09/26/2024] [Accepted: 10/07/2024] [Indexed: 11/17/2024]
Abstract
The Aveir DR dual-chamber Leadless Pacemaker system (Abbott Laboratories) was recently approved by the US Food and Drug Administration and is heralded to be the next generation of leadless pacemakers. Earlier generations of leadless pacemakers could only provide single-chamber right ventricular pacing, limiting their application to a small subset of patients in whom pacemaker therapy is indicated. With the expansion of pacing therapy, the Aveir DR system expands availability of leadless pacing to more patients. Although there have been prior documented experiences with the earlier generation of leadless pacemakers, the addition of a second leadless pacemaker to provide dual-chamber pacing adds new complexities. It is essential to understand what makes the Aveir DR system unique if an anesthesiologist were to come across one perioperatively.
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Affiliation(s)
- Jonathan E Tang
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH.
| | - Fady Guirguis
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Jordan O Holloway
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Cassidy Wernke
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Jeremy Reeves
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Nicolas A Kumar
- Department of Anesthesia, Pain Medicine, and Critical Care Medicine, Massachusetts General Hospital, Boston, MA
| | - Salvatore J Savona
- Division of Cardiovascular Medicine, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH
| | - Michael K Essandoh
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Manoj H Iyer
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
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Kim SS, Park HW, Jeong HK. Post-Implant Global Longitudinal Strain as a Predictor of Pacing-Induced Cardiomyopathy in Patients with Preserved Ejection Fraction Undergoing Pacemaker Placement. Rev Cardiovasc Med 2025; 26:26173. [PMID: 39867201 PMCID: PMC11760551 DOI: 10.31083/rcm26173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2024] [Revised: 09/24/2024] [Accepted: 09/27/2024] [Indexed: 01/28/2025] Open
Abstract
Background Right ventricular (RV) pacing exacerbates heart failure and increases cardiac mortality in patients with reduced ejection fraction (EF). However, its impact on left ventricular dysfunction in patients with preserved EF remains inconclusive. This study investigates the relationship between RV pacing, global longitudinal strain (GLS), and EF in patients with preserved EF. Methods This prospective registry study included patients with preserved EF (≥50%) undergoing de novo permanent pacemaker (PPM) implantation for atrioventricular block at Chosun University Hospital, South Korea, from 2018 to 2022. Echocardiographic evaluations were performed pre-implant, post-implant, and at 12 months, with follow-up visits every 3-6 months. Composite outcomes included cardiac death, heart failure hospitalization, pacing-induced cardiomyopathy (PICM), and biventricular pacing (BVP) upgrade. Results A total of 71 patients (28 males, mean age 73.1 years) were included. Following PPM implantation, significant declines in both EF and GLS were noted, especially in those with PICM. Over three years, 2 patients died, 6 were hospitalized, 7 developed PICM, and 3 underwent a BVP upgrade. Reduced post-implant GLS was an independent predictor of PICM (hazard ratios (HR) 1.715, 95% CI 1.174-2.504; p = 0.005). Receiver operating characteristic (ROC) analysis showed an area under curve (AUC) of 0.92 for GLS, with a GLS <-15.0 having 100% sensitivity and 80.9% specificity for predicting PICM. Conclusions Post-implant GLS is a reliable predictor of PICM in patients with preserved EF. Regular GLS monitoring can guide timely interventions, including guideline-directed medical therapy or BVP upgrades, to prevent deterioration and improve outcomes.
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Affiliation(s)
- Sung Soo Kim
- Department of Cardiovascular Medicine, Chosun University Medical School, 61469 Gwangju, Republic of Korea
| | - Hyung Wook Park
- Department of Cardiovascular Medicine, Chonnam National University Medical School, 61469 Gwangju, Republic of Korea
| | - Hyung Ki Jeong
- Department of Cardiovascular Medicine, Wonkwang University Medical School, 54536 Iksan, Republic of Korea
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Tang J, Kong NW, Beaser A, Aziz Z, Yeshwant S, Ozcan C, Tung R, Upadhyay GA. Clinical outcomes of conduction system pacing compared to biventricular pacing in patients with mid-range ejection fraction. J Interv Card Electrophysiol 2025; 68:111-116. [PMID: 39153133 DOI: 10.1007/s10840-024-01882-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/15/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND There is a paucity of data comparing conduction system pacing (CSP) to biventricular pacing (BiVP) in patients with heart failure (HF) with mid-range left ventricular ejection fraction (LVEF). OBJECTIVE Compare the clinical outcomes of patients with mid-range LVEF undergoing CSP versus BiVP. METHODS Patients with mid-range LVEF (> 35 to 50%) undergoing CSP or BiVP were retrospectively identified. Lead performance, LVEF, HF hospitalization, and clinical composite outcome including upgrade to cardiac resynchronization therapy and mortality were compared. RESULTS A total of 36 patients (20 BiVP, 16 CSP--14 His bundle pacing, 4 left bundle branch area pacing) were analyzed. The mean age was 73 ± 15, 44% were female, and the mean LVEF was 42 ± 5%. Procedural and fluoroscopy time was comparable between the two groups. QRS duration was significantly shorter for the CSP group compared to the BiVP group (P < 0.001). During a mean follow-up of 47 ± 36 months, no significant differences were found in thresholds or need for generator change due to early battery depletion. LVEF improved in both groups (41.5 ± 4.5% to 53.9 ± 10.9% BiVP, P < 0.001; 41.6 ± 5.3% to 52.5 ± 8.3% CSP, P < 0.001). There were no significant differences in HF hospitalizations (P = 0.71) or clinical composite outcomes (P = 0.07). CONCLUSION Among patients with HF with moderately reduced ejection fraction, CSP appears associated with similar improvements in LVEF and had similar clinical outcomes as BiVP in mid-term follow-up.
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Affiliation(s)
- Jiaojiao Tang
- Center for Arrhythmia Care, Heart and Vascular Institute, The University of Chicago Pritzker School of Medicine, 5841 S. Maryland Avenue, MC 9024, Chicago, IL, 60637, USA
- The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Nathan W Kong
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Andrew Beaser
- Center for Arrhythmia Care, Heart and Vascular Institute, The University of Chicago Pritzker School of Medicine, 5841 S. Maryland Avenue, MC 9024, Chicago, IL, 60637, USA
| | - Zaid Aziz
- Center for Arrhythmia Care, Heart and Vascular Institute, The University of Chicago Pritzker School of Medicine, 5841 S. Maryland Avenue, MC 9024, Chicago, IL, 60637, USA
| | - Srinath Yeshwant
- Center for Arrhythmia Care, Heart and Vascular Institute, The University of Chicago Pritzker School of Medicine, 5841 S. Maryland Avenue, MC 9024, Chicago, IL, 60637, USA
| | - Cevher Ozcan
- Center for Arrhythmia Care, Heart and Vascular Institute, The University of Chicago Pritzker School of Medicine, 5841 S. Maryland Avenue, MC 9024, Chicago, IL, 60637, USA
| | - Roderick Tung
- Center for Arrhythmia Care, Heart and Vascular Institute, The University of Chicago Pritzker School of Medicine, 5841 S. Maryland Avenue, MC 9024, Chicago, IL, 60637, USA
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
- Banner-University Medical Center Phoenix, Phoenix, AZ, USA
| | - Gaurav A Upadhyay
- Center for Arrhythmia Care, Heart and Vascular Institute, The University of Chicago Pritzker School of Medicine, 5841 S. Maryland Avenue, MC 9024, Chicago, IL, 60637, USA.
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Raad M, Kramer DB, Stabenau HF, Anyanwu E, Frankel DS, Waks JW. Spatial ventricular gradient is associated with pacing-induced cardiomyopathy. Heart Rhythm 2024:S1547-5271(24)03710-X. [PMID: 39736431 DOI: 10.1016/j.hrthm.2024.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Revised: 12/08/2024] [Accepted: 12/25/2024] [Indexed: 01/01/2025]
Abstract
BACKGROUND Pacing-induced cardiomyopathy (PICM) is a frequent complication of right ventricular pacing that often requires reoperation for biventricular or conduction system pacing. Better methods for predicting PICM may inform initial pacing strategy and follow-up monitoring. OBJECTIVE The purpose of this study was to determine whether the spatial ventricular gradient (SVG), a vectorcardiographic marker of ventricular electrical and mechanical heterogeneity, is associated with the subsequent development of PICM. METHODS This was a retrospective study of patients with pacemakers implanted between 2003 and 2012 at the Hospital of the University of Pennsylvania. Baseline demographic, echocardiographic, and electrocardiographic parameters, including SVG magnitude, elevation, and azimuth, were measured from standard 12-lead electrocardiograms. Adjusted Cox proportional hazards modeling was used to assess the associations between the SVG and the risk of PICM over follow-up. RESULTS Of the 203 patients with a median age of 74 years (p25-p75 64-79), 110 (54%) male, and median baseline left ventricular ejection fraction 65% (p25-p75 57-70), 44 (22%) developed PICM during follow-up. In unadjusted Cox regression, male sex, native QRS duration in patients without bundle branch block, and both native and paced mean adjusted SVG azimuth predicted future PICM. After multivariable adjustment, higher tertile (tertile 3 vs tertiles 1-2) of the mean adjusted SVG azimuth before (adjusted hazard ratio 1.95; P = .047) and immediately after (adjusted hazard ratio 2.55; P=.003) pacemaker implantation remained significant predictors of PICM. CONCLUSION Assessment of the SVG both before and immediately after pacemaker implantation can help identify patients at elevated risk of PICM and may identify a cohort of patients who would be better served with initial biventricular or conduction system pacing.
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Affiliation(s)
- Mohamad Raad
- Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel B Kramer
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Hans F Stabenau
- Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Emeka Anyanwu
- Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Cardiovascular Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David S Frankel
- Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jonathan W Waks
- Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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Chen Y, Ma ZL, Liu F, Wang N, Ma YY, Guan ZA, Zhe ZC, Xia YL, Dong YX. Is conduction system pacing more effective than right ventricular pacing in reducing atrial high-rate episodes in patients with heart failure and preserved ejection fraction? Front Physiol 2024; 15:1500159. [PMID: 39687519 PMCID: PMC11647302 DOI: 10.3389/fphys.2024.1500159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2024] [Accepted: 11/19/2024] [Indexed: 12/18/2024] Open
Abstract
Background The relationship between conduction system pacing (CSP) and the incidence of atrial fibrillation (AF) in patients with heart failure and preserved ejection fraction (HFpEF) remains uncertain. This study aims to investigate the occurrence of atrial high-rate episodes (AHREs) following CSP in patients with HFpEF, in comparison to right ventricular pacing (RVP). Methods Patients with HFpEF who received dual-chamber pacemakers for atrioventricular block were retrospectively enrolled from January 2018 to January 2023. Both new-onset and progressive AHREs were recorded, along with other clinical data, including cardiac performance and lead outcomes. Results A total of 498 patients were enrolled, comprising 387 patients with RVP and 111 patients with CSP, with a follow-up duration of 44.42 ± 10.41 months. In patients without a prior history of AF, CSP was associated with a significantly lower incidence of new-onset AHREs when the percentage of ventricular pacing was ≥20% (9.52% vs. 29.70%, P = 0.001). After adjusting for confounding factors, CSP exhibited a lower hazard ratio for new-onset AHREs compared to RVP (HR 0.336; [95% CI: 0.142-0.795]; P = 0.013), alongside left atrial diameter (LAD) (HR 1.109; [95% CI: 1.048-1.173]; P < 0.001). In patients with a history of AF, the progression of AHREs in CSP and RVP did not differ significantly (32.35% vs. 34.75%, P = 0.791). Cardiac performance metrics, including left ventricular end-diastolic diameter (LVEDD) (49.09 ± 4.28 mm vs. 48.08 ± 4.72 mm; P = 0.015), LAD (40.68 ± 5.49 mm vs. 39.47 ± 5.24 mm; P = 0.001), and NYHA class (2.31 ± 0.46 vs. 1.59 ± 0.73; P < 0.001), improved obviously following CSP, while LVEDD (48.37 ± 4.57 mm vs. 49.30 ± 5.32 mm; P < 0.001), LAD (39.77 ± 4.58 mm vs. 40.83 ± 4.80 mm; P < 0.001), NYHA class (2.24 ± 0.43 vs. 2.35 ± 0.83; P = 0.018), and left ventricular ejection fraction (LVEF) (57.41 ± 2.42 vs. 54.24 ± 6.65; P < 0.001) deteriorated after RVP. Conclusion Our findings suggest that CSP may be associated with improvements in cardiac performance and a reduction in new-onset AHREs compared to RVP in patients with HFpEF. However, prospective randomized trials are anticipated to confirm these potential benefits.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ying-Xue Dong
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
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Yoshioka G, Yamaguchi T, Tanaka A, Sakai H, Koyamatsu J, Umeki T, Kaneta K, Sakamoto Y, Kawaguchi A, Node K. Impact of left atrial strain on clinical outcomes in patients with permanent pacemaker implantation. ESC Heart Fail 2024; 11:3982-3992. [PMID: 39075809 PMCID: PMC11631268 DOI: 10.1002/ehf2.14973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 06/10/2024] [Accepted: 07/01/2024] [Indexed: 07/31/2024] Open
Abstract
AIMS This study aimed to investigate the clinical impact of pre-procedural left atrial strain (LAS) in patients undergoing permanent pacemaker implantation (PPI). METHODS AND RESULTS This single-centre retrospective study enrolled 434 patients who were admitted for transvenous PPI between 2010 and 2020. After excluding patients with persistent atrial fibrillation, PPI for complete atrioventricular block, severe valvular disease, history of open-heart surgery and those without LAS data, 172 patients were analysed. The LAS was measured using commercially available software to calculate the average strain value of the apical four- and two-chamber views before PPI. The primary composite endpoint was hospitalization due to heart failure or cardiovascular death. Cox proportional hazard models were used to evaluate risk factors for the primary composite endpoint. The mean patient age was 78 ± 8 years, and 42% of the patients were men. PPI was performed for sick sinus syndrome in 64% and second-degree atrioventricular block in 36% of the patients. The pre-procedure left atrial reservoir strain (LASr) was 28 ± 11%. The median follow-up period was 4.7 years, and the primary endpoint was observed in 23 (13%) patients. In multivariate Cox proportional risk analysis, LASr was independently associated with the primary composite endpoint (hazard ratio, 1.08 per 1% decrease; 95% confidence interval, 1.02-1.15; P = 0.007). The receiver operating characteristic curve of the LASr for the primary composite endpoint showed a cutoff value of 21% (area under the curve 0.657, P = 0.004). The prognostic impact of LASr was consistent with that of sick sinus syndrome and atrioventricular block. CONCLUSIONS A decreased pre-procedure LASr was associated with long-term adverse outcomes after PPI use.
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Affiliation(s)
- Goro Yoshioka
- Department of Cardiovascular MedicineSaga UniversitySagaJapan
| | | | - Atsushi Tanaka
- Department of Cardiovascular MedicineSaga UniversitySagaJapan
| | - Hikari Sakai
- Department of Cardiovascular MedicineSaga UniversitySagaJapan
| | - Junji Koyamatsu
- Department of Clinical Laboratory Medicine, Faculty of MedicineSaga UniversitySagaJapan
| | - Toshiharu Umeki
- Department of Clinical Laboratory Medicine, Faculty of MedicineSaga UniversitySagaJapan
| | - Kohei Kaneta
- Department of Cardiovascular MedicineSaga UniversitySagaJapan
| | | | - Atsushi Kawaguchi
- Education and Research Center for Community Medicine, Faculty of MedicineSaga UniversitySagaJapan
| | - Koichi Node
- Department of Cardiovascular MedicineSaga UniversitySagaJapan
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Ramos-Maqueda J, Cabrera-Ramos M, Melero-Polo J, Montilla-Padilla I, Riaño-Ondiviela A, Ruiz-Arroyo JR. Left Bundle Branch Area Pacing Compared to Right Ventricular Outflow Tract Septal Pacing: Mid-term Results and Learning Curve. J Innov Card Rhythm Manag 2024; 15:6113-6121. [PMID: 39802075 PMCID: PMC11717158 DOI: 10.19102/icrm.2024.15123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/03/2024] [Indexed: 01/16/2025] Open
Abstract
Our study evaluated the efficacy and feasibility of left bundle branch area pacing (LBBAP) compared to right ventricular outflow tract septal pacing (RVOSP). We conducted a prospective, single-center, observational study involving 200 consecutive patients who required pacemaker implantation. The patients were divided into two groups (LBBAP and RVOSP), with 100 patients in each group. We aimed to compare the safety and efficacy, as well as the procedure and fluoroscopy times, between the two groups. Additionally, we aimed to describe the learning curve for the LBBAP group. The success and acute complication rates were similar (P = .56 vs. P = .65). The procedure time was longer in the LBBAP group compared to the RVOSP group (18 [13-28] vs. 11 [7-17] min; P < .001), while the fluoroscopy time was shorter in the LBBAP group compared to the RVOSP group (2.8 [1.3-3.7] vs. 3.1 [2-5.9] min; P = .02). The paced QRS interval was narrower in the LBBAP group (123.77 ± 10.25 vs. 159.79 ± 17.0 ms; P = .001). There were no significant differences in pacing parameters like R-wave sensing (9.6 ± 5.2 vs. 9.1 ± 4.7 mV; P = .91), bipolar impedance (685.9 ± 151.8 vs. 686.5 ± 158.6 Ω; P = .98), or pacing threshold (0.70 ± 0.29 vs. 0.64 ± 0.26 V @ 0.4 ms; P = .63). In the LBBAP group, both the procedure time (12 [10.5-15] vs. 32 [28.5-38.5] min; P < .001) and the fluoroscopy time (2 [1-4.6] vs. 5.1 [3.4-12] min; P < .01) were shorter in the last quartile (Q4) compared to the first quartile (Q1). The procedure time was similar between LBBAP Q4 and RVOSP (12 [10.5-15] vs. 11 [7-17] min; P = .33). LBBAP is as safe as RVOSP and achieves a narrower paced QRS compared to RVOSP. After a rapid learning curve, a shorter fluoroscopy time and a similar procedure time can be achieved.
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Affiliation(s)
- Javier Ramos-Maqueda
- Arrhythmia Unit, Department of Cardiology, University Hospital Clinico Lozano Blesa, Zaragoza, Spain
- Health Investigation Institute Aragon, Zaragoza, Spain
| | - Mercedes Cabrera-Ramos
- Arrhythmia Unit, Department of Cardiology, University Hospital Clinico Lozano Blesa, Zaragoza, Spain
- Health Investigation Institute Aragon, Zaragoza, Spain
| | - Jorge Melero-Polo
- Arrhythmia Unit, Department of Cardiology, University Hospital Clinico Lozano Blesa, Zaragoza, Spain
- Health Investigation Institute Aragon, Zaragoza, Spain
| | - Isabel Montilla-Padilla
- Arrhythmia Unit, Department of Cardiology, University Hospital Clinico Lozano Blesa, Zaragoza, Spain
- Health Investigation Institute Aragon, Zaragoza, Spain
| | - Adrián Riaño-Ondiviela
- Arrhythmia Unit, Department of Cardiology, University Hospital Clinico Lozano Blesa, Zaragoza, Spain
| | - José Ramón Ruiz-Arroyo
- Arrhythmia Unit, Department of Cardiology, University Hospital Clinico Lozano Blesa, Zaragoza, Spain
- Health Investigation Institute Aragon, Zaragoza, Spain
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Hayashi K, Abe H, Olshansky B, Sharma AD, Jones PW, Wold N, Perschbacher D, Kohno R, Lip GYH, Varma N, Wilkoff BL. High initial heart rate score is an independent predictor of new atrial high-rate episodes in pacemaker patients with sinus node dysfunction. Heart Rhythm 2024; 21:2543-2551. [PMID: 38936446 DOI: 10.1016/j.hrthm.2024.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/20/2024] [Accepted: 06/22/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Heart rate score (HRSc), the percentage of atrial depolarizations in the largest paced and sensed 10-beats/min histogram bin recorded in cardiac devices, is associated with several adverse outcomes, but it remains uncertain whether HRSc independently predicts atrial high-rate episodes (AHREs) in patients with sinus node dysfunction (SND) undergoing pacemaker (PM) implantation. OBJECTIVE This study aimed to determine whether initial HRSc after PM implantation predicts new-onset AHREs in patients with SND. METHODS Patients had Boston Scientific PMs implanted for SND from 2012 to 2021 at Cleveland Clinic, University of Occupational and Environmental Health, Japan, Kyushu Rosai Hospital, and JCHO Kyushu Hospital. Patients were excluded if they had atrial fibrillation before PM implantation or AHREs within 3 months after implantation. Subsequent AHREs after implantation were evaluated and correlated with HRSc. RESULTS During 48.9 (interquartile range, 25.7-50.4) months, 130 consecutive PM patients (76 ± 10 years; 40% male) had a median initial HRSc of 74% (57%-86%). AHREs defined by >1%, >6 h/d burden, and atrial tachycardia response events >24 hours developed in 27 of 130 (21%), 15 of 130 (12%), and 9 of 130 (7%), respectively. For each definition, patients with HRSc ≥80% had higher occurrence of AHREs than those with HRSc <80% (both P = .008, log-rank test). After adjustment for age, race, comorbidities, left ventricular ejection fraction, left atrial diameter, and cumulative percentage of right atrial and right ventricular pacing, initial HRSc ≥80% (hazard ratio, 3.33; 95% CI, 1.35-8.18; P = .009) and male sex (hazard ratio, 2.59; 95% CI, 1.06-6.33; P = .04) independently predicted AHREs. CONCLUSION HRSc ≥80% is associated with new-onset, device-determined AHREs for patients undergoing PM implantation for SND. HRSc may have prognostic and therapeutic implications.
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Affiliation(s)
- Katsuhide Hayashi
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
| | - Haruhiko Abe
- Department of Heart Rhythm, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Brian Olshansky
- Department of Internal Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | | | | | | | | | - Ritsuko Kohno
- Department of Heart Rhythm, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Gregory Y H Lip
- Department of Cardiovascular Medicine, Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Niraj Varma
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Bruce L Wilkoff
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
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Mohan B, Batta A. Dual-chamber pacing confers better myocardial performance and improves clinical outcomes compared to single-chamber pacing. World J Cardiol 2024; 16:626-631. [PMID: 39600992 PMCID: PMC11586728 DOI: 10.4330/wjc.v16.i11.626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2024] [Revised: 09/29/2024] [Accepted: 10/15/2024] [Indexed: 10/30/2024] Open
Abstract
The deleterious effects of long term right ventricular pacing are increasingly being recognized today. Current clinical practice favors the implantation of dual-chamber permanent pacemaker which maintains atrioventricular synchrony and is associated with better quality of life. However, despite the popular belief and common sense surrounding the superiority of dual-chamber pacing over single chamber pacing, the same has never been conclusively verified in clinical trials. Some observational evidence however, does exists which supports the improved cardiac hemodynamics, lower the rate of atrial fibrillation, heart failure and stroke in dual-chamber pacing compared to single-chamber pacing. In the index study by Haque et al, right ventricular pacing, particularly in ventricular paced, ventricular sensed, inhibited response and rate responsive pacemaker adversely impacted the left ventricular functions over 9-months compared to dual pacing, dual sensing, dual responsive and rate responsive pacemaker. Although there are key limitations of this study, these findings does support a growing body of evidence reinstating the superiority of dual chamber pacing compared to single chamber pacing.
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Affiliation(s)
- Bishav Mohan
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India
| | - Akash Batta
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India.
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Khan S, Abdo DBFK, Mushtaq V, Ahmed N, Bai K, Neelam F, Malik M, Malik J. Cardiac Implantable Electronic Devices in Cardiac Transplant Patients: A Comprehensive Review. Cardiol Rev 2024:00045415-990000000-00368. [PMID: 39707617 DOI: 10.1097/crd.0000000000000817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2024]
Abstract
A fraction of patients (approximately 10%) undergoing heart transplantation require permanent pacemaker (PPM) implantation due to sinus node dysfunction or atrioventricular block, occurring either shortly after surgery or later. The incidence of PPM implantation has declined to less than 5% with the introduction of bicaval anastomosis transplantation surgery. Pacing dependency during follow-up varies among recipients. A smaller subset (1.5-3.4%) receives implantable cardioverter-defibrillators (ICDs), but data on their use in transplant recipients are limited, primarily from cohort studies and case series. Sudden cardiac death affects around 10% of transplant recipients, attributed to various nonarrhythmic factors such as acute rejection, late graft failure, and cardiac allograft vasculopathy-induced ischemia. This review offers a comprehensive analysis of the existing data concerning the role of PPMs and ICDs in this population, encompassing leadless PPMs, subcutaneous ICDs, unique considerations, and future directions.
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Affiliation(s)
- Shayan Khan
- From the Department of Cardiology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | | | - Varda Mushtaq
- Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Najeeb Ahmed
- Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Kajal Bai
- Department of Medicine, Chandka Medical College, Larkana, Pakistan
| | - Fnu Neelam
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Maria Malik
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Islamabad, Pakistan
| | - Jahanzeb Malik
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Islamabad, Pakistan
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Sudo Y. Transient pacing pulse on the T-wave: What is the mechanism? Indian Pacing Electrophysiol J 2024; 24:358-360. [PMID: 39270780 DOI: 10.1016/j.ipej.2024.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Revised: 08/12/2024] [Accepted: 09/10/2024] [Indexed: 09/15/2024] Open
Abstract
A patient with a dual-chamber pacemaker for sick sinus syndrome was hospitalized for heart failure. The electrocardiography (ECG) during hospitalization displayed seemingly abnormal pacing artifacts. This report focuses on the problem-solving of an abnormal-looking paced ECG and identifies the pacemaker's operational behavior as the underlying reason.
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Affiliation(s)
- Yuta Sudo
- Department of Cardiology, Soka Municipal Hospital, Saitama, Japan.
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Notaristefano F, Barengo A, Spighi L, Piraccini S, Freschini M, Sforna S, Pesce F, Giuffrè G, Bagnacani A, D'Ammando M, Zingarini G, Notaristefano S, Cavallini C, Verdecchia P, Sclafani R, Angeli F. Left ventricular volumes and function in successful and failed His-BundLe Pacing. A comparative prospective study. J Cardiovasc Electrophysiol 2024; 35:2153-2160. [PMID: 39252444 DOI: 10.1111/jce.16426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 08/18/2024] [Accepted: 08/27/2024] [Indexed: 09/11/2024]
Abstract
INTRODUCTION Initial data suggest that His Bundle Pacing (HBP) could preserve long-term cardiac structure and function better than Right Ventricular Pacing (RVP), but evidence is limited. METHODS We studied consecutive patients with baseline ejection fraction (EF) ≥ 50% who underwent HBP attempt, either successful (HBP group) or failed (RVP group). Two-dimensional (2D) and three-dimensional (3D) echocardiography were carried out at baseline and after 6 months of ventricular pacing burden > 20%. RESULTS Among 68 patients, 40 underwent successful HBP, and 28 RVP. The HBP and RVP groups did not differ for age, sex and pacing indication. At baseline, the HBP and RVP groups did not differ for 2D EF (62% vs. 62%), 3D EF (60% vs. 63%), 2D (-19% vs. -19%) and 3D global longitudinal strain (GLS) (-15% vs. -16%). After 6 months, 2D EF (-3.86%) and 3D EF (-5.71%) significantly decreased in the RVP group and did not change in the HBP group (p for interaction .006 and <.001, respectively). 2D GLS (3.08%) and 3D GLS (2.22%) significantly increased in the RVP group, but did not change in the HBP group (p for interaction .013 and <.016, respectively). Pacing induced cardiomyopathy (PICM) (EF drop ≥ 10% and EF < 50%) occurred in 14% (RVP) versus 0% (HBP) of patients (p = .025). CONCLUSIONS Successful HBP was superior to RVP in preserving LV systolic function despite a high ventricular pacing burden, and was less frequently associated with PICM.
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Affiliation(s)
| | | | - Lorenzo Spighi
- Department of Cardiology, Hospital degli Infermi, Rimini, Italy
| | - Silvia Piraccini
- Department of Cardiology, Hospital S. Maria della Misericordia, Urbino, Italy
| | - Manuel Freschini
- Cardiology and Cardiovascular Pathophysiology, University of Perugia and Hospital S. Maria della Misericordia, Perugia, Italy
| | - Stefano Sforna
- Cardiology and Cardiovascular Pathophysiology, University of Perugia and Hospital S. Maria della Misericordia, Perugia, Italy
| | - Federica Pesce
- Cardiology and Cardiovascular Pathophysiology, University of Perugia and Hospital S. Maria della Misericordia, Perugia, Italy
| | - Giuseppe Giuffrè
- Department of Cardiology, Hospital "S. Scolastica", Cassino, Italy
| | | | - Matteo D'Ammando
- Department of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
| | - Gianluca Zingarini
- Department of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
| | | | - Claudio Cavallini
- Department of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
| | - Paolo Verdecchia
- Department of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
- Fondazione Umbra Cuore e Ipertensione-ONLUS, Perugia, Italy
| | - Rocco Sclafani
- Department of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
| | - Fabio Angeli
- Department of Medicine and Surgery, Varese and Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, University of Insubria, Varese, Italy
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Feroze R, Kang P, Dallan LAP, Akula N, Galo J, Yoon SH, Ukaigwe A, Filby SJ, Baeza C, Pelletier M, Rushing G, Rajagopalan S, Al-Kindi S, Rashid I, Attizzani GF. Elevated myocardial extracellular volume fraction is associated with the development of conduction pathway defects following transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2024; 104:1119-1128. [PMID: 38952304 DOI: 10.1002/ccd.31136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 05/27/2024] [Accepted: 06/16/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has become an established method of aortic stenosis treatment but suffers from the risk of heart block and pacemaker requirement. Risk stratification for patients who may develop heart block remains imperfect. Simultaneously, myocardial fibrosis as measured by cardiac magnetic resonance imaging (CMR) has been demonstrated as a prognostic indicator of ventricular recovery and mortality following TAVR. However, the association of CMR-based measures of myocardial fibrosis with post-TAVR conduction disturbances has not yet been explored. AIMS We evaluated whether myocardial fibrosis, as measured by late gadolinium enhancement and extracellular volume (ECV) from CMR would be associated with new conduction abnormalities following TAVR. METHODS One hundred seventy patients who underwent CMR within 2 months before TAVR were retrospectively reviewed. Septal late gadolinium enhancement (LGE) and ECV measurements were made as surrogates for replacement and interstitial fibrosis respectively. New conduction abnormalities were defined by the presence of transient or permanent atrioventricular block, new bundle branch blocks, and need for permanent pacemaker. Association of myocardial fibrosis and new conduction derangements were tested using receiver operator curve (ROC) and regression analysis in patients with and without pre-existing conduction issues. RESULTS Forty-six (27.1%) patients developed post-TAVR conduction deficits. ECV was significantly higher among patients who experienced new conduction defects (26.2 ± 3.45% vs. 24.7% ± 4.15%, p value: 0.020). A greater fraction of patients that had new conduction defects had an elevated ECV of ≥26% (54.3% vs. 36.3%, p value: 0.026). ECV ≥ 26% was independently associated with the development of new conduction defects (odds ratio [OR]: 2.364, p value: 0.030). ROC analysis revealed a significant association of ECV with new conduction defects with an area under the receiver operating characteristic curve (AUC) of 0.632 (95% confidence interval: 0.555-0.705, p value: 0.005). The combination of prior right bundle branch block (RBBB) and ECV revealed a greater AUC of 0.779 (0.709-0.839, p value: <0.001) than RBBB alone (Delong p value: 0.049). No association of LGE/ECV with new conduction defects was observed among patients with pre-existing conduction disease. Among patients without baseline conduction disease, ECV was independently associated with the development of new conduction deficits (OR: 3.685, p value: 0.008). CONCLUSION The present study explored the association of myocardial fibrosis, as measured by LGE and ECV with conduction deficits post-TAVR. Our results demonstrate an association of ECV, and thereby interstitial myocardial fibrosis, with new conduction derangement post-TAVR and introduce ECV as a potentially new risk stratification tool to identify patients at higher risk for needing post-TAVR surveillance and/or permanent pacemaker.
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Affiliation(s)
- Rafey Feroze
- Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Puneet Kang
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Luis Augusto Palma Dallan
- Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Navya Akula
- Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jason Galo
- Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Sung-Han Yoon
- Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Anene Ukaigwe
- Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Steven J Filby
- Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Cristian Baeza
- Division of Cardiovascular Surgery, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Marc Pelletier
- Division of Cardiovascular Surgery, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Gregory Rushing
- Division of Cardiovascular Surgery, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Sanjay Rajagopalan
- Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Sadeer Al-Kindi
- Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Imran Rashid
- Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Guilherme F Attizzani
- Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Yamazaki D. Measurement of Tip Load With a Pacemaker Lead Stylet and Guiding Catheter Using a Silicone Heart Model. Cureus 2024; 16:e74655. [PMID: 39735111 PMCID: PMC11682690 DOI: 10.7759/cureus.74655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2024] [Indexed: 12/31/2024] Open
Abstract
Background Ventricular septal pacing has long been performed using a stylet during pacemaker implantation, but with the availability of guiding catheters, His bundle pacing and left bundle branch area pacing have also been performed. However, it is not known to what extent the tip load of the ventricular lead differs when a guiding catheter is used compared with a stylet alone. In this study, the tip load was measured for different stylet stiffness and guiding catheter geometries at sites where His bundle pacing and left bundle branch area pacing were assumed. Method A small weighing instrument was placed in the right ventricular septal portion of the silicone heart model to measure the apical load of the ventricular lead when using two types of guiding catheters and three different types of stylets according to stiffness at the site where His bundle pacing and left bundle branch area pacing were assumed. Results The guiding catheter group had by far the highest tip load compared to the stylet group (Site Selective Pacing Catheter (SSPC) multipurpose group 17.9 ± 1.6 g, SSPC extended hook group 3.6 ± 0.8 g). There was no significant difference in tip load between His bundle pacing site and the left bundle branch area pacing site for the normally used stiffness stylet. Conclusions Guiding catheters are used for conduction system pacing but must be used with great care as they apply a much greater tip load than conventional lead placement with a stylet alone.
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Affiliation(s)
- Daisuke Yamazaki
- Cardiology, Akita Cerebrospinal and Cardiovascular Center, Akita, JPN
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Aggarwal AK, Nanthakumar A, Daba B, Veluppillai A, Nanthakumar K, Burg MR. Paced QRS Interval Duration and Pacing-Induced Cardiomyopathy - Time to Display. CJC Open 2024; 6:1320-1323. [PMID: 39582708 PMCID: PMC11583853 DOI: 10.1016/j.cjco.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Accepted: 08/05/2024] [Indexed: 11/26/2024] Open
Affiliation(s)
- Arjun K. Aggarwal
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Ayana Nanthakumar
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Bonnie Daba
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Arulalan Veluppillai
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Kumaraswamy Nanthakumar
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Melanie R. Burg
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
- Department of Cardiology, Mater Dei Hospital, Triq id-Donaturi tad-Demm, Msida, Malta
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Paton MF, Gierula J, Jamil HA, Straw S, Lowry JE, Byrom R, Slater TA, Fellows AM, Gillott RG, Chumun H, Smith P, Cubbon RM, Stocken DD, Kearney MT, Witte KK. Echocardiographic screening for heart failure and optimization of the care pathway for individuals with pacemakers: a randomized controlled trial. Nat Med 2024; 30:3303-3309. [PMID: 39300290 PMCID: PMC11564098 DOI: 10.1038/s41591-024-03265-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 08/22/2024] [Indexed: 09/22/2024]
Abstract
Individuals with pacemakers are at increased risk of left ventricular systolic dysfunction (LVSD). Whether screening for and optimizing the medical management of LVSD in these individuals can improve clinical outcomes is unknown. In the present study, in a multicenter controlled trial (OPT-PACE), we randomized 1,201 patients (717 men) with a pacemaker to echocardiography screening or usual care. In the screening arm, LVSD was detected in 201 of 600 (34%) patients, who then received management in either primary care or a specialist heart failure (HF) and devices clinic. The primary outcome of the trial was the difference in a composite of time to first HF hospitalization or death. Over 31 months (interquartile range = 30-40 months), the primary outcome occurred in 106 of 600 (18%) patients receiving echocardiography screening, which was not significantly different compared with the occurrence of the primary outcome in 115 of 601 (19%) patients receiving the usual care (hazard ratio = 0.89; 95% confidence interval = 0.69, 1.17). In a prespecified, nonrandomized, exploratory analysis, patients with LVSD managed by the specialist clinic experienced the primary outcome event less frequently than those managed in primary care. The results of this trial indicate that echocardiography screening commonly identifies LVSD in individuals with pacemakers but alone does not alter outcomes. ClinicalTrials.gov registration: NCT01819662 .
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Affiliation(s)
- Maria F Paton
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Department of Cardiology, Leeds, UK
| | - John Gierula
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Haqeel A Jamil
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sam Straw
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Judith E Lowry
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Rowena Byrom
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Thomas A Slater
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Alasdair M Fellows
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Richard G Gillott
- Leeds Teaching Hospitals NHS Trust, Department of Cardiology, Leeds, UK
| | - Hemant Chumun
- Leeds Teaching Hospitals NHS Trust, Department of Cardiology, Leeds, UK
| | - Paul Smith
- Department of Cardiology, Bradford Teaching Hospitals NHS Trust, Bradford, UK
| | - Richard M Cubbon
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Deborah D Stocken
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Mark T Kearney
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Klaus K Witte
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
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Yang W, Wu T, Wu Y, Xu J, Jiang Z, Zhou X, Shan Q. Left Bundle Branch Pacing for Bradycardia in Non-obstructive Hypertrophic Cardiomyopathy Patients: Feasibility, Safety, and Effect. Cardiovasc Drugs Ther 2024; 38:927-935. [PMID: 36847900 DOI: 10.1007/s10557-023-07440-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Left bundle branch pacing (LBBP) is as an innovative physiological pacing approach. The research on LBBP in non-obstructive hypertrophic cardiomyopathy (NOHCM) patients is scarce. This study aimed to assess the feasibility, safety, and effect of LBBP in bradycardia NOHCM patients with permanent pacemaker (PPM) implantation indication. METHODS Thirteen consecutive patients with NOHCM who received LBBP were retrospectively enrolled as a hypertrophic cardiomyopathy (HCM) group. Following 1:3 matching, 39 patients without HCM were randomly matched as a control group. Echocardiographic index and pacing parameters were collected. RESULTS The successful LBBP was achieved in 96.2% of all cases (50/52), and the success rate of the HCM group was 92.3% (12/13). In the HCM group, the paced QRS duration (from the pacing stimulus to QRS end) was 145.6±20.8 ms. The stimulus to left ventricular activation time (s-LVAT) was 87.4±15.2 ms. In the control group, the paced QRS duration was 139.4±17.2 ms, and the s-LVAT was 79.9±14.1 ms. During the implantation, R-wave sensing and the pacing threshold of the HCM group were significantly higher than the control group (20.2±10.5 vs 12.5±5.9 mV, P < 0.05; 0.8±0.3 vs 0.6±0.2V/0.4 ms, P < 0.05). In addition, the fluoroscopic duration and procedural duration were longer in the HCM group (14.8±8.3 vs 10.3±6.6min, P = 0.07; 131.8±50.5 vs 101.4±41.6 min, P < 0.05). The lead insertion depth was 15±2 mm in the HCM group, and no procedure-related complications occurred. During the 12-month follow-up, pacing parameters remained stable and were of no significance in the two groups. The cardiac function did not deteriorate, and the left ventricular outflow tract gradient (LVOTG) did not increase in the follow-up. CONCLUSION LBBP might be feasible and safe for NOHCM patients with conventional bradycardia pacing indication, and there is no deterioration in cardiac function and LVOTG of patients with NOHCM.
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Affiliation(s)
- Wen Yang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), 300, Guangzhou Road, Nanjing, 210029, China
| | - Tian Wu
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), 300, Guangzhou Road, Nanjing, 210029, China
| | - Yixian Wu
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), 300, Guangzhou Road, Nanjing, 210029, China
| | - Jiayi Xu
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), 300, Guangzhou Road, Nanjing, 210029, China
| | - Zhixin Jiang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), 300, Guangzhou Road, Nanjing, 210029, China
| | - Xiujuan Zhou
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), 300, Guangzhou Road, Nanjing, 210029, China.
| | - Qijun Shan
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), 300, Guangzhou Road, Nanjing, 210029, China.
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50
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Wang Q, He C, Fan X, Zhu H, Li X, Liu Z, Yao Y. Comparison of clinical and echocardiographic outcomes between left bundle branch area pacing and right ventricular pacing in older patients. Pacing Clin Electrophysiol 2024; 47:1346-1357. [PMID: 39210616 DOI: 10.1111/pace.15056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 06/02/2024] [Accepted: 08/02/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Left bundle branch area pacing (LBBAP) is safe and effective, but studies in older patients are lacking. This study compared the clinical and echocardiographic outcomes of LBBAP and right ventricular pacing (RVP) in patients aged ≥75 years. METHODS This prospective observational study included older patients with symptomatic bradycardia who underwent LBBAP or RVP between 2019 and 2022. Clinical data, including pacing and electrophysiological characteristics, echocardiographic measurements, and device-related complications were collected. The primary endpoint was a composite of all-cause mortality, heart failure hospitalization, and upgrade to biventricular pacing. Secondary outcomes included changes in left ventricular ejection fraction (LVEF). RESULTS Of 267 included patients, 110 underwent LBBAP and 157 underwent RVP. LBBAP was successful in 109 patients (success rate: 99.1%), with one patient eventually undergoing RVP. The pacing parameters of LBBAP were similar to those of RVP, except for a significantly narrower paced QRS duration (112.8 ± 11.6 vs. 138.3 ± 23.9 ms, p < .001). Ventricular lead implanting procedural duration was longer for LBBAP than RVP (14.0 vs. 6.0 min, p < .001), as was the fluoroscopy time (4.0 vs. 2.0 min, p < .001). During a mean follow-up period of 31.0 ± 16.8 months, the primary outcome incidence was significantly lower following LBBAP than RVP (15.1% vs. 21.1%; hazard ratio, 0.471; 95% confidence interval, 0.215-1.032; p = .036) in 149 patients (55.8%) with ventricular pacing burden > 20%. RVP reduced LVEF from 62.7 ± 4.1% at baseline to 59.8 ± 7.8% at the final follow-up (p = .001), whereas LBBAP preserved LVEF (61.4 ± 6.3% vs. 60.1 ± 7.4%, p = .429). CONCLUSION LBBAP demonstrated improved clinical outcomes compared with RVP and maintained LVEF in older patients with high ventricular pacing burdens.
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Affiliation(s)
- Qian Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Chen He
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xiaohan Fan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Haojie Zhu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xiaofei Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zhimin Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yan Yao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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