PACE - Pacing and Clinical Electrophysiology
0147-8389
1540-8159
Anh Quốc
Cơ quản chủ quản: WILEY , Wiley-Blackwell Publishing Ltd
Lĩnh vực:
Medicine (miscellaneous)Cardiology and Cardiovascular Medicine
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Thông tin về tạp chí
Pacing and Clinical Electrophysiology (PACE) is the foremost peer-reviewed journal in the field of pacing and implantable cardioversion defibrillation, publishing over 50% of all English language articles in its field, featuring original, review, and didactic papers, and case reports related to daily practice. Articles also include editorials, book reviews, Musings on humane topics relevant to medical practice, electrophysiology (EP) rounds, device rounds, and information concerning the quality of devices used in the practice of the specialty.
Các bài báo tiêu biểu
Is Local Myocardial Contractility Related to Endocardial Acceleration Signals Detected by a Transvenous Pacing Lead? The availability of sensors monitoring cardiac function parameters may offer many interesting new applications in cardiac pacing. A microaccelerometer sensor (BEST, Biomechanical Endocardial Sorin Transducer) located at the tip of a pacing lead (PL) has been developed by Sorin Biomedica. The signal detected by the accelerometer, peak Endocardial acceleration (PEA), was shown to reflect cardiac contractility and to be related to the dP/dt signal. Whether the PEA detected by the BEST sensor in different cardiac locations is the expression of local acceleration forces or reflects the whole heart contractility has not yet been demonstrated in humans. Endocardial acceleration and PEA were evaluated in five patients (4 males, 1 female, mean age 68 years) who underwent cardiac catheterization. Sinus rhythm was present in four patients and chronic atrial fibrillation was present in one. The BEST PL was introduced through the left subclavian vein and PEA signals were recorded: (1) at the apex of the right ventricle (RV), (2) within the coronary sinus (CS), (3) at the right atrial appendage (RAA), and (4) floating in the right atrium. The PEA signals were recorded simultaneously with surface ECG, intracardiac electrograins, and RV pressure. At each recording site, PEA signals with significant amplitude were always recorded during the preelection period, during the isovolumic contraction phase, independently of the recording site and cardiac rhythm. The PEA amplitude was higher in the RV (mean value 1.32 g) and it decreased in the RAA and CS (0.75 and 0.45 g, respectively). The same behavior of PEA was observed during sinus rhythm or atrial fibrillation. The amplitude and the timing of the PEA signals detected by the BEST accelerometer were independent of the recording site and atrial rhythm; they appeared to be strictly related to the global ventricular contractility. These results suggest that the BEST could be used either as an effective sensor in closed loop pacing systems, or primarily as a diagnostic hemodynamic sensor.
Tập 19 Số 11 - Trang 1682-1688 - 1996
Atrial Tachycardia Facilitating Initiation of Ventricular Tachycardia A 17‐year‐old male was studied because of clinically documented tachycardias showing narrow and wide QRS complexes. He was found to suffer from an atrial and a ventricular tachycardia. It was demonstrated that initiation of ventricular tachycardia occurred on reaching a critical ventricular rate during atrial tachycardia. Our study illustrates the value of electrophysiological studies in patients suspected of suffering from double or multiple tachycardias. It also shows that the occurrence of one type of tachycardia may be critically related to another type of tachycardia.
Tập 6 Số 1 - Trang 47-52 - 1983
Treatment of Thalamic Pain by Chronic Motor Cortex Stimulation All forms of therapy, including chronic stimulation of the thalamic relay nucleus, can provide satisfactory pain control in only 20%‐30% of cases of thalamic pain syndrome. In order to develop a more effective treatment for fhalamic pain syndrome, we investigated the effects of stimulation of various brain regions on the burst hyperactivity of thalamic neurons recorded in cats after deafferentiation of the spinothalamic pathway. Complete, long‐ term inhibition of the burst hyperactivity was induced by stimulation of the motor cortex, Based on this experimental finding, we treated seven cases of thalamic pain syndrome by chronic motor cortex stimulation employing epidural plate electrodes. Excellent or good pain control was obtained in all cases without any complications or side effects. During the stimulation, an increase in regional blood flow of the cerebral cortex and thalamus, a marked rise in temperature of the painful skin regions, and improved movements of the painful limbs were observed. These results suggest that thalamic pain syndrome can be most effectively treated by chronic motor cortex stimulation.
Tập 14 Số 1 - Trang 131-134 - 1991
Cardioverter Defibrillator Implantation in a Pregnant Woman Guided with Transesophageal Echocardiography This report describes a 28‐year‐old pregnant woman with mitral valve prolapse and sudden cardiac death due to a ventricular fibrillation who underwent an ICD implantation guided by tranesophageal echocardiography. (PACE 2003; 26:1913–1914)
Tập 26 Số 9 - Trang 1913-1914 - 2003
Implantable Cardioverter Defibrillator Implantation without Using Fluoroscopy in a Pregnant Patient Conventional lead implantation requires fluoroscopic guidance. This may be problematic in certain patient groups such as pregnant patients. We report a case of an implantable cardioverter defibrillator implantation without fluoroscopy in a pregnant patient. (PACE 2012; 35:e265–e266)
Tập 35 Số 9 - 2012
Implantable Cardioverter Defibrillator System with Floating Atrial Sensing Dipole: A Single‐Center Experience Background The concept of a single‐lead dual‐chamber implantable cardioverter defibrillator (ICD) with floating sensing atrial dipole has been proven safe and functional. We report a single‐center experience with this ICD system; the major focus of the work is on the recorded atrial activation and its stability on a medium term follow‐up. Methods Thirteen patients received a DX ICD (BIOTRONIK SE & Co, Berlin, Germany) with the Linox Smart S DXProMRI ICD lead; the implantation data were reported. Daily P‐ and R‐wave sensing amplitude was collected and followed up during 200 days; their coefficient of variance (CV) was calculated. In addition, all the atrial and ventricular high‐rate episodes were analyzed. Results The total x‐ray exposure time was 3.9 ± 1.8 minutes. The overall mean sensing was 4.2 ± 1.9 mV for P wave and 12.9 ± 4.5 mV for R wave. The CV was significantly higher for the P‐wave amplitude than for the R‐wave one (0.25 ± 0.11 vs 0.08 ± 0.06; P < 0.001). A total of 27 high ventricular rate episodes were recorded and correctly discriminated by the device. Fifty‐six high atrial rate episodes were recorded, 49 were true arrhythmic events. Conclusions The single‐lead ICD system with floating atrial dipole provides reliable atrial sensing amplitude over time. The physician, without the implantation of an additional lead, has the atrial information that may be used for the discrimination of supraventricular tachyarrhythmia/ventricular tachycardia, for the early detection of atrial fibrillation episodes and for the evaluation of changes in the patient's heart status.
Tập 37 Số 10 - Trang 1265-1273 - 2014
Accuracy of Swabs, Tissue Specimens, and Lead Samples in Diagnosis of Cardiac Rhythm Management Device Infections
Aims: Pacemaker and implantable‐cardioverter defibrillator lead infections widely increased with consequent need to accurately recognize responsible bacteria.
Methods: Between May 2003 and December 2007, we extracted 118 leads, 104 (87.3%) due to infections (sepsis, lead‐associated endocarditis, pocket infection) or chronic draining sinus (with negative local bacteriological analyses). Swabs and tissue specimens from pocket and fragments of pin and tip of each extracted lead were obtained during extraction and sent for bacteriological examination.
Results: Cultures from explanted lead pins returned positive results in 100% of the cases presenting with local infections and in 92.5% of those with chronic draining sinus. In cases of sepsis, positive results of blood samples are less common than lead samples (58.3 vs 86.7, P = 0.02), the latter being more sensitive for infection diagnosis. Concordance between bacterial isolates from pocket and lead is quite low, approaching 45%, seemingly due to contamination effect. Concordance between isolates within the lead (pin and tip) is quite high, close to 70%, reflecting a more accurate expression of the real infection. In cases of sepsis, concordance between lead and blood samples, and mainly from tip and blood, is very high, resembling 80–85%; consequently bacterial isolates from the lead, particularly from lead tip, are clearly associated with clinical infections.
Conclusions: Our results strongly support the hypothesis that chronic draining sinus is often sustained by infection. Moreover, diagnostic accuracy of lead samples is higher not only than swabs and tissue samples, but also than blood samples to confirm an infection and to guide effective therapy.
Tập 32 Số s1 - 2009
Factors predicting persistence of AV nodal block in post‐TAVR patients following permanent pacemaker implantation Abstract Introduction A common complication of transcatheter aortic valve repair (TAVR) is development of conduction defects requiring pacemaker (PPM) implantation. These defects are not universally permanent. Objective To determine the incidence and predictors of persistent device dependency in patients with PPM implantation following TAVR with a self‐expanding prosthesis. Methods Records of patients who underwent post‐TAVR PPM implantation were reviewed. Patients with persistent complete AV block (AVBIII) one month post‐TAVR were compared to those regaining conduction. Results Between September 2014 and March 2017, 485 patients underwent TAVR with a self‐expanding prosthesis; 77 (15.9%) underwent PPM implantation for AVBIII. Device interrogation at one month was available for 61 patients (79%): 22 (36.1%) had resolution of AVBIII while 39 (63.9%) remained pacemaker‐dependent. Pre‐TAVR right bundle branch block was more frequent in device‐dependent patients (19 of 38, 50% vs 4 of 22, 18%; RR 2.75; P = .01). Device‐dependence was associated with AVBIII as the first postprocedural rhythm (37 of 39, 95% vs 12 of 22, 55%; RR 1.74; P < .0001), earlier implantation (median 1d, IQR: 0‐1.5d vs 2d, IQR: 1.0‐4.0d, P = .0004), and a shorter duration of hospitalization (median 3d, IQR: 2‐3.5d vs 4d, IQR: 2‐5.75d, P = .03). Pacemaker dependence was also associated with a higher prosthesis‐to left ventricular outflow tract (LVOT) diameter (1.45 ± 0.11 vs 1.39 ± 0.07; P = .02) and the lack of prior aortic valvuloplasty (5 of 39, 13% vs 8 of 22, 36%; RR 0.35; P = .03). Conclusions In patients receiving a PPM following self‐expanding TAVR, a long‐term pacing requirement can be predicted from the timing of AV block, existing conduction‐system disease, larger prosthesis‐to‐LVOT diameter, and the lack of aortic valvuloplasty.
Tập 42 Số 10 - Trang 1347-1354 - 2019
Cardiac conduction abnormalities associated with pacemaker implantation after transcatheter aortic valve replacement Abstract Background Complete heart block is a known complication after transcatheter aortic valve replacement (TAVR), often requiring pacemaker implantation within 24 hours of the procedure. However, clinical markers for delayed progression to complete heart block after TAVR remain unclear. Objectives We examined electrocardiographic data that may correlate with delayed progression to complete heart block and need for pacemaker. Methods This is a single‐center retrospective study of 608 patients who underwent TAVR between April 2008 and June 2017. We excluded 164 (27.0%) patients due to having a pacemaker before the procedure or expiring within 24 hours of the procedure (8, 1.3%). We excluded an additional 50 (8.2%) patients who received a pacemaker within 24 hours of the procedure. Electrocardiograms (EKGs) obtained after the procedure were compared to the preprocedural EKG to detect new changes. Results Left bundle branch block, intraventricular conduction delay, left anterior fascicular block, and right bundle branch block were the most commonly seen conduction abnormalities after TAVR (25.1%, 10.9%, 7.5%, and 3.6%, respectively). Both left bundle branch block (odds ratio [OR] = 2.77 [95% confidence interval (CI): 1.24–6.22]) and right bundle branch block (OR = 13.2 [95% CI: 4.18–41.70]) carried an increased risk of pacemaker implantation after TAVR. Additionally, ΔPR greater than 40 ms from baseline also carried an increased risk of pacemaker implantation (OR = 3.53 [95% CI: 1.49–8.37]). Conclusion Left bundle branch block, right bundle branch block, and ΔPR greater than 40 ms were all associated with delayed progression to complete heart block and need for pacemaker implantation after TAVR.
Tập 42 Số 7 - Trang 846-852 - 2019