Pacing-induced cardiomyopathy (PICM) resultsf rom the detrimental effect of frequent right ventricular pacing.^([1]) The diagnosis relies on a combination of pacing-associated ventricular dyschrony manifested with ECG...Pacing-induced cardiomyopathy (PICM) resultsf rom the detrimental effect of frequent right ventricular pacing.^([1]) The diagnosis relies on a combination of pacing-associated ventricular dyschrony manifested with ECG wide LBBB-pattern QRS duration and clinical assessment, imaging studies. Conduction system pacing (CSP), such as His bundle pacing (HBP)and left bundle branch pacing (LBBP), may help to prevent PICM,^([2]) but the criteria for optimal patient selection remain inadequately defined.展开更多
Cardiac resynchronization therapy(CRT)reduces heart failure(HF)hospitaliz-ations and all-cause mortality in patients with HF with reduced ejection fraction with left bundle branch(LBB)block.Biventricular pacing(BVP)is...Cardiac resynchronization therapy(CRT)reduces heart failure(HF)hospitaliz-ations and all-cause mortality in patients with HF with reduced ejection fraction with left bundle branch(LBB)block.Biventricular pacing(BVP)is considered the gold standard for achieving CRT;however,approximately 30%–40%of patients do not respond to BVP-CRT.Recent studies have demonstrated that LBB pacing(LBBP)produces remarkable results in CRT.In this meta-analysis,LBBP-CRT showed better outcomes than conventional BVP-CRT,including greater QRS duration reduction and left ventricular ejection fraction improvement,along with consistently lower pacing thresholds on follow-up.Additionally,there was a grea-ter reduction in New York Heart Association class and brain natriuretic peptide levels.This study contributes to the growing body of encouraging data on LBBP-CRT from recent years.With ongoing technological advancements and increasing operator expertise,the day may not be far when LBBP-CRT becomes the standard of care rather than the exception.展开更多
The deleterious effects of long-term right ventricular pacing necessitated the search for alternative pacing sites which could prevent or alleviate pacinginduced cardiomyopathy.Until recently,biventricular pacing(BiVP...The deleterious effects of long-term right ventricular pacing necessitated the search for alternative pacing sites which could prevent or alleviate pacinginduced cardiomyopathy.Until recently,biventricular pacing(BiVP)was the only modality which could mitigate or prevent pacing induced dysfunction.Further,BiVP could resynchronize the baseline electromechanical dssynchrony in heart failure and improve outcomes.However,the high non-response rate of around 20%-30%remains a major limitation.This non-response has been largely attributable to the direct non-physiological stimulation of the left ventricular myocardium bypassing the conduction system.To overcome this limitation,the concept of conduction system pacing(CSP)came up.Despite initial success of the first CSP via His bundle pacing(HBP),certain drawbacks including lead instability and dislodgements,steep learning curve and rapid battery depletion on many occasions prevented its widespread use for cardiac resynchronization therapy(CRT).Subsequently,CSP via left bundle branch-area pacing(LBBP)was developed in 2018,which over the last few years has shown efficacy comparable to BiVP-CRT in small observational studies.Further,its safety has also been well established and is largely free of the pitfalls of the HBP-CRT.In the recent metanalysis by Yasmin et al,comprising of 6 studies with 389 participants,LBBPCRT was superior to BiVP-CRT in terms of QRS duration,left ventricular ejection fraction,cardiac chamber dimensions,lead thresholds,and functional status amongst heart failure patients with left bundle branch block.However,there are important limitations of the study including the small overall numbers,inclusion of only a single small randomized controlled trial(RCT)and a small follow-up duration.Further,the entire study population analyzed was from China which makes generalizability a concern.Despite the concerns,the meta-analysis adds to the growing body of evidence demonstrating the efficacy of LBBP-CRT.At this stage,one must acknowledge that the fact that still our opinions on this technique are largely based on observational data and there is a dire need for larger RCTs to ascertain the position of LBBPCRT in management of heart failure patients with left bundle branch block.展开更多
BACKGROUND Left bundle branch pacing(LBBP)is a novel pacing modality of cardiac resynchronization therapy(CRT)that achieves more physiologic native ventricular activation than biventricular pacing(BiVP).AIM To explore...BACKGROUND Left bundle branch pacing(LBBP)is a novel pacing modality of cardiac resynchronization therapy(CRT)that achieves more physiologic native ventricular activation than biventricular pacing(BiVP).AIM To explore the validity of electromechanical resynchronization,clinical and echocardiographic response of LBBP-CRT.METHODS Systematic review and Meta-analysis were conducted in accordance with the standard guidelines as mentioned in detail in the methodology section.RESULTS In our analysis,the success rate of LBBP-CRT was determined to be 91.1%.LBBP CRT significantly shortened QRS duration,with significant improvement in echocardiographic parameters,including left ventricular ejection fraction,left ventricular end-diastolic diameter and left ventricular end-systolic diameter in comparison with BiVP-CRT.CONCLUSION A significant reduction in New York Heart Association class and B-type natriuretic peptide levels was also observed in the LBBP-CRT group vs BiVP-CRT group.Lastly,the LBBP-CRT cohort had a reduced pacing threshold at follow-up as compared to BiVP-CRT.展开更多
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 atrioventricu...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,ven-tricular sensed,inhibited response and rate responsive pacemaker adversely im-pacted 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.展开更多
The recent systematic review and meta-analysis provided a comprehensive focus on the current state of cardiac resynchronization therapy(CRT).The authors determined the feasibility of physiological left bundle branch a...The recent systematic review and meta-analysis provided a comprehensive focus on the current state of cardiac resynchronization therapy(CRT).The authors determined the feasibility of physiological left bundle branch area pacing(LBBAP)in patients indicated for CRT through a careful analysis of trials.They found that LBBAP was associated with significant reductions in QRS duration,New York Heart Association functional class,B-type natriuretic peptide levels,and pacing thresholds as well as improvements in echocardiographic parameters compared to biventricular pacing.展开更多
BACKGROUND Crochetage sign is a specific electrocardiographic manifestation of ostium secundum atrial septal defects(ASDs),which is associated with the severity of the left-to-right shunt.Herein,we reported a case of ...BACKGROUND Crochetage sign is a specific electrocardiographic manifestation of ostium secundum atrial septal defects(ASDs),which is associated with the severity of the left-to-right shunt.Herein,we reported a case of selective his bundle pacing(SHBP)that eliminated crochetage sign in a patient with ostium secundum ASD.CASE SUMMARY A 77-year-old man was admitted with a 2-year history of chest tightness and shortness of breath.Transthoracic echocardiography revealed an ostium secundum ASD.Twelve-lead electrocardiogram revealed atrial fibrillation with a prolonged relative risk interval,incomplete right bundle branch block,and crochetage sign.The patient was diagnosed with an ostium secundum ASD,atrial fibrillation with a second-degree atrioventricular block,and heart failure.The patient was treated with selective his bundle pacemaker implantation.After the procedure,crochetage sign disappeared during his bundle pacing on the electrocardiogram.CONCLUSION S-HBP eliminated crochetage sign on electrocardiogram.Crochetage sign may be a manifestation of a conduction system disorder.展开更多
Left bundle branch area pacing(LBBAP)has emerged as a new physiological pacing mode.Previous studies have confirmed the feasibility and efficacy of LBBAP for cardiac resynchronization therapy(CRT)in heart failure(HF)p...Left bundle branch area pacing(LBBAP)has emerged as a new physiological pacing mode.Previous studies have confirmed the feasibility and efficacy of LBBAP for cardiac resynchronization therapy(CRT)in heart failure(HF)patients with left bundle branch block(LBBB)and a narrower QRS duration(QRSd)to have a higher percentage of super responders,and lower pacing thresholds than biventricular pacing(BiVP).展开更多
Perforation of the right ventricle during placement of pacing wires is a welldocumented complication and can be potentially fatal.Use of temporary pacemaker,helical screw leads and steroids use prior to implant are re...Perforation of the right ventricle during placement of pacing wires is a welldocumented complication and can be potentially fatal.Use of temporary pacemaker,helical screw leads and steroids use prior to implant are recognised as risk factors for development of post-permanent pacemaker effusion.We reported an unusual case of pacing wire perforating interventricular septum into the left ventricle that occurred during the implant procedure performed in another institution.After the preoperative work-up and transfer to our tertiary cardiothoracic centre,the patient underwent successful surgical management.In conclusion,early recognition and timely diagnosis using advanced multimodality imaging can guide surgical intervention and prevent unfavourable consequences of device-related complications.展开更多
Objective: To investigate the effect of extracorporeal diaphragmatic pacing combined with noninvasive ventilators on the respiratory function and prognosis of chronic obstructive pulmonary disease (COPD) patients. Met...Objective: To investigate the effect of extracorporeal diaphragmatic pacing combined with noninvasive ventilators on the respiratory function and prognosis of chronic obstructive pulmonary disease (COPD) patients. Methods: A total of 50 COPD patients were selected between January 2023 to December 2023 and randomly grouped into an observation group and a control group, with 25 cases. The observation group was given extracorporeal diaphragm pacing combined with a noninvasive ventilator, while the control group was given a conventional treatment mode. After the treatment, the results of each index in the two groups were compared. Results: Compared with the diaphragm function indexes of the two groups, the data of the observation group were more dominant (P < 0.05). The rehospitalization rate of the observation group was lower than that of the control group (P < 0.05). The COPD assessment test (CAT) and mMRC (Modified Medical Research Council) Dyspnoea scale scores after treatment between the two groups were significantly different (P < 0.05). Compared with the control group, the lung function indexes of the observation group were more dominant (P < 0.05). Conclusion: Extracorporeal diaphragmatic pacing combined with a noninvasive ventilator promoted the improvement of the patient’s prognosis and improved their respiratory function.展开更多
With the widespread application of artificial permanent pacemakers in clinical practice,there have been new changes in the indications for pacemaker implantation.The current clinical indications include high atriovent...With the widespread application of artificial permanent pacemakers in clinical practice,there have been new changes in the indications for pacemaker implantation.The current clinical indications include high atrioventricular block,sick sinus syndrome,cardiac resynchronization therapy for heart failure,and implantation of cardioverter defibrillators for ventricular arrhythmias.The implantation of a pacemaker can improve the quality of life and prognosis of patients with arrhythmia.In the past,permanent pacemaker implantation was performed in clinical practice,and the right ventricular pacing electrode was often fixed at the apex of the right ventricle,which belongs to non physiological pacing.Through long-term clinical follow-up,it was found that apex pacing can easily cause abnormal depolarization of the left ventricle,asynchronous contraction of the myocardium,and ultimately lead to myocardial fibrosis,which has adverse effects on the patient's cardiac function and psychological state.In recent years,Scholars have found that pacing in the right ventricular outflow tract septum is closer to the atrioventricular node and closer to the His bundle Purkinje fibers.The pacing impulse almost simultaneously expands towards both ventricles,closer to the physiological pacing state,thereby reducing the occurrence of cardiovascular events in patients.This article explores the impact of pacing in different parts of the heart on the cardiac function and psychological state of patients based on clinical data from the past three years.展开更多
Percutaneous retrieval of retained epicardial pacing wires is largely reported to be safe and effective. We have described a case report of delayed presentation of retained epicardial pacing wire, which migrated to th...Percutaneous retrieval of retained epicardial pacing wires is largely reported to be safe and effective. We have described a case report of delayed presentation of retained epicardial pacing wire, which migrated to the pulmonary trunk, in a patient 1 year post coronary artery bypass graft surgery. The retained wire was safely removed percutaneously. There are an increasing number of cases reporting migration of epicardial pacing wires to important structures, with a combination of unknown and documented serious outcomes. The aim of this case report is to emphasise the importance of highlighting the risk of retention of these wires to surgeons and their patients. Furthermore, the reasons and implications of this happening should be explored.展开更多
BACKGROUND Left bundle branch pacing(LBBP)is a physiological pacing method that has emerged in recent years.It is an ideal choice for patients with complete left bundle branch block who are in need of cardiac resynchr...BACKGROUND Left bundle branch pacing(LBBP)is a physiological pacing method that has emerged in recent years.It is an ideal choice for patients with complete left bundle branch block who are in need of cardiac resynchronization therapy(CRT).Moreover,LBBP is superior in maintaining physiological ventricular activation and can effectively improve heart function and quality of life in patients with pacemaker-induced cardiomyopathy.However,LBBP in pacing-dependent patients who already have cardiac dysfunction has not been well assessed.CASE SUMMARY A 69-year-old male patient presented with symptoms of chest tightness,palpitation and systolic heart failure with New York Heart Association class III for 1 mo.The 12-lead electrocardiogram showed atrial fibrillation with third-degree atrioventricular block and ventricular premature beat.Holter revealed a right bundle branch block,atrial fibrillation with third-degree atrioventricular block,frequent multifocal ventricular premature beats,Ron-T and ventricular tachycardia.The echocardiogram documented an enlarged left atrium and left ventricle and a low left ventricular ejection fraction.Coronary angiography indicated a stenosis of 30%in the middle left anterior descending artery.Apparently,a CRT-D pacemaker was the best choice for this patient according to previous findings.However,the patient was worried about the financial burden.A single-chamber pacemaker with LBBP was selected,with the plan to take amiodarone and upgrade with dual-chamber implantable cardioverter-defibrillator or CRT-D at an appropriate time.During the follow-up at 3 mo after LBBP,the patient showed an improvement in cardiac function with slight improvement in echocardiography parameters,and the New York Heart Association functional class was maintained at I.Moreover,the patient no longer suffered from chest tightness and palpitation.Holter showed decreased ventricular arrhythmia of less than 5%.CONCLUSION LBBP might be used in patients with heart failure and a high-degree atrioventricular block as an alternative to conventional CRT.展开更多
Objective： We are aimed to investigate whether right ventricular mid-septal pacing （RVMSP） is superior to conventional right ventricular apical pacing （RVAP） in improving clinical functional capacity and left ven...Objective： We are aimed to investigate whether right ventricular mid-septal pacing （RVMSP） is superior to conventional right ventricular apical pacing （RVAP） in improving clinical functional capacity and left ventricular ejection fraction （LVEF） for patients with high-degree atrio-ventricular block and moderately depressed left ventricle （LV） function. Methods： Ninety-two patients with high-degree atrio-ventricular block and moderately reduced LVEF （ranging from 35% to 50%） were randomly allocated to RVMSP （n=45） and RVAP （n=47）. New York Heart Association （NYHA） functional class, echocardiographic LVEF, and distance during a 6-min walk test （6MWT） were determined at 18 months after pacemaker implantation. Serum levels of N-terminal pro-brain natriuretic peptide （NT-proBNP） were measured using an enzyme-linked immunosorbent assay （ELISA） kit. Results： Compared with baseline, NYHA functional class remained unchanged at 18 months, distance during 6MVVT （485 m vs. 517 m） and LVEF （36.7% vs. 41.8%） were increased, but BNP levels were reduced （2352 pg/ml vs. 710 pg/ml） in the RVMSP group compared with those in the RVAP group, especially in patients with LVEF 35%-40% （for all comparisons, P〈0.05）. However, clinical function capacity and LV function measurements were not significantly changed in patients with RVAP, despite the pacing measurements being similar in both groups, such as R-wave amplitude and capture threshold. Conclusions： RVMSP provides a better clinical utility, compared with RVAP, in patients with high-degree atrioventricular block and moderately depressed LV function whose LVEF levels ranged from 35% to 40%.展开更多
Background The study was to access the feasibility and effectiveness of permanent left bundle branch pacing(LBBP)in patients with bradycardia after cardiac surgery,in comparison with conventional right ventricular out...Background The study was to access the feasibility and effectiveness of permanent left bundle branch pacing(LBBP)in patients with bradycardia after cardiac surgery,in comparison with conventional right ventricular outflow tract septal pacing(RVOSP).Methods A total of 50 patients with cardiac surgery who underwent permanent pacemaker implantation(PPI)were enrolled,21 patients underwent LBBP(LBBP group)and 29 patients underwent RVOSP(RVOSP group).Pacing electrical parameters,QRS duration(QRSd),echocardiographic measurements,lead and device related complications were obtained at procedure and during follow-ups.Results There were no statistically significant differences between the LBBP group and the RVOSP group at procedure and at the twelfth month’s follow-up in pacing thresholds(0.64±0.16 V vs.0.63±0.22 V)and(0.91±0.28 V vs.0.85±0.20 V),R-wave amplitude(16.68±4.52 mV vs.15.09±4.53 mV)and(14.41±8.65 mV vs.12.65±6.17 mV),pacing impedances(719.24±152.65Ωvs.639.13±177.04Ω)and(534.01±96.92Ωvs.499.18±77.87Ω).But the average ventricular pacing percentage(VP%)at the first month’s follow-up(81.96±32.06%vs.58.37±42.96%)and at the twelfth month’s follow-up(84.65±35.84%vs.53.57±38.47%)showed significant difference between two groups(P<0.05);The LBBP group produced narrower QRSd(121.13±23.91 ms)than the RVOSP group(158.00±9.69 ms)(P=0.011).There were no significant differences between the LBBP group and the RVOSP group at pre-procedure and at the twelfth month’s follow-up in echocardiographic parameters,which included left ventricular end-diastolic dimension(LVEDD)(48.76±7.08 mm vs.47.34±6.91 mm)and(50.58±10.33 mm vs.45.97±7.11 mm),left ventricular ejection fraction(LVEF)(58.33±12.64%vs.61.50±8.40%)and(55.85±16.35%vs.61.50±10.52%),and area of tricuspid regurgitation(TR)(2.79±3.65 cm2 vs.2.85±2.26 cm2)and(3.09±2.34 cm2 vs.2.95±1.92 cm2).No lead and device related complication was observed during follow-ups.Conclusions LBBP is feasible and effective in patients with bradycardia after cardiac surgery.LBBP produces narrow QRSd,which may be a preferred pacing strategy for patients after cardiac surgery.[S Chin J Cardiol 2021;22(1):13-20]展开更多
Left bundle branch pacing(LBBP)emerged as a new physiological pacing strategy during the past several years.Recent observational studies have demonstrated the advantages of LBBP,including a high success rate,stable pa...Left bundle branch pacing(LBBP)emerged as a new physiological pacing strategy during the past several years.Recent observational studies have demonstrated the advantages of LBBP,including a high success rate,stable pacing parameters,and excellent clinical benefits.Widespread adoption of LBBP will depend on improvements in device/lead technology and further verification of its efficacy in large randomized clinical trials.In this review,we summarize re-cent advancements in LBBP,including the definition and evaluation of left bundle branch capture,LBBP applications,and future directions in this growing field.展开更多
Background:Cross-country skiing(XCS)racing,a popular international winter sport,is complex and challenging from physical,technical,and tactical perspectives.Despite the vast amount of research focusing on this sport,n...Background:Cross-country skiing(XCS)racing,a popular international winter sport,is complex and challenging from physical,technical,and tactical perspectives.Despite the vast amount of research focusing on this sport,no review has yet addressed the pacing strategies of elite XCS racers or the factors that influence their performance.The aim was to review the scientific literature in an attempt to determine the effects of pacing strategy on the performance of elite XCS racers.Methods:Four electronic databases were searched using relevant subject headings and keywords.Only original research articles published in peerreviewed journals and the English language and addressing performance,biomechanics,physiology,and anthropometry of XCS racers were reviewed.Results:All 27 included articles applied correlative designs to study the effectiveness of different pacing strategies.None of the articles involved the use of an experimental design.Furthermore,potential changes in external conditions(e.g.,weather,ski properties)were not taken into consideration.A comparable number of studies focused on the skating or classical technique.In most cases,positive pacing was observed,with certain indications that higher-level athletes and those with more endurance and strength utilized a more even pacing strategy.The ability to achieve and maintain a long cycle length on all types of terrain was an important determinant of performance in all of the included studies,which was not the case for cycle rate.In general,uphill performance was closely related to overall race performance,with uphill performance being most closely correlated to the success of female skiers and performance on flat terrain being more important for male skiers.Moreover,pacing was coupled to the selection and distribution of technique during a race,with faster skiers employing more double poling and kick double poling,less diagonal stride,and more V2(double dance)than V1(single dance)skating across a race.Conclusion:We propose that skiers at all levels can improve their performance with more specific training in techniques(i.e.,maintaining long cycles without compromising cycle rate and selecting appropriate techniques)in combination with training for endurance and more strength.Furthermore,we would advise less experienced skiers and/or those with lower levels of performance to apply a more even pacing strategy rather than a positive one(i.e.,starting the race too fast).2018 Published by Elsevier B.V.on behalf of Shanghai University of Sport.This is an open access article under the CC BY-NC-ND license.(http://creativecommons.org/licenses/by-nc-nd/4.0/).展开更多
AIM: To evaluate the safety and efficacy of the permanent high interventricular septal pacing in a long term follow up, as alternative to right ventricular apical pacing. METHODS: We retrospectively evaluated:(1) 244 ...AIM: To evaluate the safety and efficacy of the permanent high interventricular septal pacing in a long term follow up, as alternative to right ventricular apical pacing. METHODS: We retrospectively evaluated:(1) 244 patients(74 ± 8 years; 169 men, 75 women) implanted with a single(132 pts) or dual chamber(112 pts) pacemaker(PM) with ventricular screw-in lead placed at the right ventricular high septal parahisian site(SEPTAL pacing);(2) 22 patients with permanent pacemaker and low percentage of pacing(< 20%)(NO pacing);(3) 33 patients with high percentage(> 80%) right ventricular apical pacing(RVA). All patients had a narrow spontaneous QRS(101 ± 14 ms). We evaluated New York Heart Association(NYHA) class, quality of life(Qo L), 6 min walking test(6MWT) and left ventricular function(end-diastolic volume, LV-EDV; end-systolic volume, LVESV; ejection fraction, LV-EF) with 2D-echocardiography. RESULTS: Pacing parameters were stable duringfollow up(21 mo/patient). In SEPTAL pacing group we observed an improvement in NYHA class, Qo L score and 6MWT. While LV-EDV didn't significantly increase(104 ± 40 m L vs 100 ± 37 m L; P = 0.35), LV-ESV slightly increased(55 ± 31 m L vs 49 ± 27 m L; P = 0.05) and LV-EF slightly decreased(49% ± 11% vs 53% ± 11%; P = 0.001) but never falling < 45%. In the RVA pacing control group we observed a worsening of NYHA class and an important reduction of LV-EF(from 56% ± 6% to 43% ± 9%, P < 0.0001).CONCLUSION: Right ventricular permanent high septal pacing is safe and effective in a long term follow up evaluation; it could be a good alternative to the conventional RVA pacing in order to avoid its deleterious effects.展开更多
The right atrial appendage (RAA) and right ventricular apex (RVA) have been widely considered as conventional sites for typical dual-chamber atrio-ventricular cardiac (DDD) pacing. Unfortunately conventional RAA pacin...The right atrial appendage (RAA) and right ventricular apex (RVA) have been widely considered as conventional sites for typical dual-chamber atrio-ventricular cardiac (DDD) pacing. Unfortunately conventional RAA pacing seems not to be able to prevent atrial fibrillation in DDD pacing for tachycardia-bradycardia syndrome, and the presence of a left bundle branch type of activation induced by RVA pacing can have negative effects. A new technology with active screw-in leads permits a more physiological atrial and right ventricular pacing. In this review, we highlight the positive effects of pacing of these new and easily selected sites. The septal atrial lead permits a shorter and more homogeneous atrial activation, allowing better prevention of paroxysmal atrial fibrillation. The para-Hisian pacing can be achieved in a simpler and more reliable way with respect to biventricular pacing and direct Hisian pacing. We await larger trials to consider this "easy and physiological pacing" as a first approach in patients who need a high frequency of pacing.展开更多
Symptomatic bradycardia is effectively treated with the implantation of a cardiac pacemaker. Although a highly successful therapy, during recent years there has been a focus on the negative effects associated with lon...Symptomatic bradycardia is effectively treated with the implantation of a cardiac pacemaker. Although a highly successful therapy, during recent years there has been a focus on the negative effects associated with longterm pacing of the apex of the right ventricle(RV). It has been shown in both experimental and clinical studies that RV pacing leads to ventricular dyssynchrony, similar to that of left bundle branch block, with subsequent detrimental effects on cardiac structure and function, and in some cases adverse clinical outcomes such as atrial fibrillation, heart failure and death. There is substantial evidence that patients with reduced left ventricular function(LVEF) are at particular high risk of suffering the detrimental clinical effects of long-term RV pacing. The evidence is, however, incomplete, coming largely from subanalyses of pacemaker and implantable cardiac defibrillator studies. In this group of patients with reduced LVEF and an expected high amount of RV pacing, biventricular pacing(cardiac resynchronization therapy) devices can prevent the negative effects of RV pacing and reduce ventricular dyssynchrony. Therefore, cardiac resynchronization therapy has emerged as an attractive option with promising results and more clinical studies are underway. Furthermore, specific pacemaker algorithms, which minimize RV pacing, can also reduce the negative effects of RV stimulation on cardiac function and may prevent clinical deterioration.展开更多
文摘Pacing-induced cardiomyopathy (PICM) resultsf rom the detrimental effect of frequent right ventricular pacing.^([1]) The diagnosis relies on a combination of pacing-associated ventricular dyschrony manifested with ECG wide LBBB-pattern QRS duration and clinical assessment, imaging studies. Conduction system pacing (CSP), such as His bundle pacing (HBP)and left bundle branch pacing (LBBP), may help to prevent PICM,^([2]) but the criteria for optimal patient selection remain inadequately defined.
文摘Cardiac resynchronization therapy(CRT)reduces heart failure(HF)hospitaliz-ations and all-cause mortality in patients with HF with reduced ejection fraction with left bundle branch(LBB)block.Biventricular pacing(BVP)is considered the gold standard for achieving CRT;however,approximately 30%–40%of patients do not respond to BVP-CRT.Recent studies have demonstrated that LBB pacing(LBBP)produces remarkable results in CRT.In this meta-analysis,LBBP-CRT showed better outcomes than conventional BVP-CRT,including greater QRS duration reduction and left ventricular ejection fraction improvement,along with consistently lower pacing thresholds on follow-up.Additionally,there was a grea-ter reduction in New York Heart Association class and brain natriuretic peptide levels.This study contributes to the growing body of encouraging data on LBBP-CRT from recent years.With ongoing technological advancements and increasing operator expertise,the day may not be far when LBBP-CRT becomes the standard of care rather than the exception.
文摘The deleterious effects of long-term right ventricular pacing necessitated the search for alternative pacing sites which could prevent or alleviate pacinginduced cardiomyopathy.Until recently,biventricular pacing(BiVP)was the only modality which could mitigate or prevent pacing induced dysfunction.Further,BiVP could resynchronize the baseline electromechanical dssynchrony in heart failure and improve outcomes.However,the high non-response rate of around 20%-30%remains a major limitation.This non-response has been largely attributable to the direct non-physiological stimulation of the left ventricular myocardium bypassing the conduction system.To overcome this limitation,the concept of conduction system pacing(CSP)came up.Despite initial success of the first CSP via His bundle pacing(HBP),certain drawbacks including lead instability and dislodgements,steep learning curve and rapid battery depletion on many occasions prevented its widespread use for cardiac resynchronization therapy(CRT).Subsequently,CSP via left bundle branch-area pacing(LBBP)was developed in 2018,which over the last few years has shown efficacy comparable to BiVP-CRT in small observational studies.Further,its safety has also been well established and is largely free of the pitfalls of the HBP-CRT.In the recent metanalysis by Yasmin et al,comprising of 6 studies with 389 participants,LBBPCRT was superior to BiVP-CRT in terms of QRS duration,left ventricular ejection fraction,cardiac chamber dimensions,lead thresholds,and functional status amongst heart failure patients with left bundle branch block.However,there are important limitations of the study including the small overall numbers,inclusion of only a single small randomized controlled trial(RCT)and a small follow-up duration.Further,the entire study population analyzed was from China which makes generalizability a concern.Despite the concerns,the meta-analysis adds to the growing body of evidence demonstrating the efficacy of LBBP-CRT.At this stage,one must acknowledge that the fact that still our opinions on this technique are largely based on observational data and there is a dire need for larger RCTs to ascertain the position of LBBPCRT in management of heart failure patients with left bundle branch block.
文摘BACKGROUND Left bundle branch pacing(LBBP)is a novel pacing modality of cardiac resynchronization therapy(CRT)that achieves more physiologic native ventricular activation than biventricular pacing(BiVP).AIM To explore the validity of electromechanical resynchronization,clinical and echocardiographic response of LBBP-CRT.METHODS Systematic review and Meta-analysis were conducted in accordance with the standard guidelines as mentioned in detail in the methodology section.RESULTS In our analysis,the success rate of LBBP-CRT was determined to be 91.1%.LBBP CRT significantly shortened QRS duration,with significant improvement in echocardiographic parameters,including left ventricular ejection fraction,left ventricular end-diastolic diameter and left ventricular end-systolic diameter in comparison with BiVP-CRT.CONCLUSION A significant reduction in New York Heart Association class and B-type natriuretic peptide levels was also observed in the LBBP-CRT group vs BiVP-CRT group.Lastly,the LBBP-CRT cohort had a reduced pacing threshold at follow-up as compared to BiVP-CRT.
文摘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,ven-tricular sensed,inhibited response and rate responsive pacemaker adversely im-pacted 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.
文摘The recent systematic review and meta-analysis provided a comprehensive focus on the current state of cardiac resynchronization therapy(CRT).The authors determined the feasibility of physiological left bundle branch area pacing(LBBAP)in patients indicated for CRT through a careful analysis of trials.They found that LBBAP was associated with significant reductions in QRS duration,New York Heart Association functional class,B-type natriuretic peptide levels,and pacing thresholds as well as improvements in echocardiographic parameters compared to biventricular pacing.
文摘BACKGROUND Crochetage sign is a specific electrocardiographic manifestation of ostium secundum atrial septal defects(ASDs),which is associated with the severity of the left-to-right shunt.Herein,we reported a case of selective his bundle pacing(SHBP)that eliminated crochetage sign in a patient with ostium secundum ASD.CASE SUMMARY A 77-year-old man was admitted with a 2-year history of chest tightness and shortness of breath.Transthoracic echocardiography revealed an ostium secundum ASD.Twelve-lead electrocardiogram revealed atrial fibrillation with a prolonged relative risk interval,incomplete right bundle branch block,and crochetage sign.The patient was diagnosed with an ostium secundum ASD,atrial fibrillation with a second-degree atrioventricular block,and heart failure.The patient was treated with selective his bundle pacemaker implantation.After the procedure,crochetage sign disappeared during his bundle pacing on the electrocardiogram.CONCLUSION S-HBP eliminated crochetage sign on electrocardiogram.Crochetage sign may be a manifestation of a conduction system disorder.
文摘Left bundle branch area pacing(LBBAP)has emerged as a new physiological pacing mode.Previous studies have confirmed the feasibility and efficacy of LBBAP for cardiac resynchronization therapy(CRT)in heart failure(HF)patients with left bundle branch block(LBBB)and a narrower QRS duration(QRSd)to have a higher percentage of super responders,and lower pacing thresholds than biventricular pacing(BiVP).
文摘Perforation of the right ventricle during placement of pacing wires is a welldocumented complication and can be potentially fatal.Use of temporary pacemaker,helical screw leads and steroids use prior to implant are recognised as risk factors for development of post-permanent pacemaker effusion.We reported an unusual case of pacing wire perforating interventricular septum into the left ventricle that occurred during the implant procedure performed in another institution.After the preoperative work-up and transfer to our tertiary cardiothoracic centre,the patient underwent successful surgical management.In conclusion,early recognition and timely diagnosis using advanced multimodality imaging can guide surgical intervention and prevent unfavourable consequences of device-related complications.
文摘Objective: To investigate the effect of extracorporeal diaphragmatic pacing combined with noninvasive ventilators on the respiratory function and prognosis of chronic obstructive pulmonary disease (COPD) patients. Methods: A total of 50 COPD patients were selected between January 2023 to December 2023 and randomly grouped into an observation group and a control group, with 25 cases. The observation group was given extracorporeal diaphragm pacing combined with a noninvasive ventilator, while the control group was given a conventional treatment mode. After the treatment, the results of each index in the two groups were compared. Results: Compared with the diaphragm function indexes of the two groups, the data of the observation group were more dominant (P < 0.05). The rehospitalization rate of the observation group was lower than that of the control group (P < 0.05). The COPD assessment test (CAT) and mMRC (Modified Medical Research Council) Dyspnoea scale scores after treatment between the two groups were significantly different (P < 0.05). Compared with the control group, the lung function indexes of the observation group were more dominant (P < 0.05). Conclusion: Extracorporeal diaphragmatic pacing combined with a noninvasive ventilator promoted the improvement of the patient’s prognosis and improved their respiratory function.
文摘With the widespread application of artificial permanent pacemakers in clinical practice,there have been new changes in the indications for pacemaker implantation.The current clinical indications include high atrioventricular block,sick sinus syndrome,cardiac resynchronization therapy for heart failure,and implantation of cardioverter defibrillators for ventricular arrhythmias.The implantation of a pacemaker can improve the quality of life and prognosis of patients with arrhythmia.In the past,permanent pacemaker implantation was performed in clinical practice,and the right ventricular pacing electrode was often fixed at the apex of the right ventricle,which belongs to non physiological pacing.Through long-term clinical follow-up,it was found that apex pacing can easily cause abnormal depolarization of the left ventricle,asynchronous contraction of the myocardium,and ultimately lead to myocardial fibrosis,which has adverse effects on the patient's cardiac function and psychological state.In recent years,Scholars have found that pacing in the right ventricular outflow tract septum is closer to the atrioventricular node and closer to the His bundle Purkinje fibers.The pacing impulse almost simultaneously expands towards both ventricles,closer to the physiological pacing state,thereby reducing the occurrence of cardiovascular events in patients.This article explores the impact of pacing in different parts of the heart on the cardiac function and psychological state of patients based on clinical data from the past three years.
文摘Percutaneous retrieval of retained epicardial pacing wires is largely reported to be safe and effective. We have described a case report of delayed presentation of retained epicardial pacing wire, which migrated to the pulmonary trunk, in a patient 1 year post coronary artery bypass graft surgery. The retained wire was safely removed percutaneously. There are an increasing number of cases reporting migration of epicardial pacing wires to important structures, with a combination of unknown and documented serious outcomes. The aim of this case report is to emphasise the importance of highlighting the risk of retention of these wires to surgeons and their patients. Furthermore, the reasons and implications of this happening should be explored.
文摘BACKGROUND Left bundle branch pacing(LBBP)is a physiological pacing method that has emerged in recent years.It is an ideal choice for patients with complete left bundle branch block who are in need of cardiac resynchronization therapy(CRT).Moreover,LBBP is superior in maintaining physiological ventricular activation and can effectively improve heart function and quality of life in patients with pacemaker-induced cardiomyopathy.However,LBBP in pacing-dependent patients who already have cardiac dysfunction has not been well assessed.CASE SUMMARY A 69-year-old male patient presented with symptoms of chest tightness,palpitation and systolic heart failure with New York Heart Association class III for 1 mo.The 12-lead electrocardiogram showed atrial fibrillation with third-degree atrioventricular block and ventricular premature beat.Holter revealed a right bundle branch block,atrial fibrillation with third-degree atrioventricular block,frequent multifocal ventricular premature beats,Ron-T and ventricular tachycardia.The echocardiogram documented an enlarged left atrium and left ventricle and a low left ventricular ejection fraction.Coronary angiography indicated a stenosis of 30%in the middle left anterior descending artery.Apparently,a CRT-D pacemaker was the best choice for this patient according to previous findings.However,the patient was worried about the financial burden.A single-chamber pacemaker with LBBP was selected,with the plan to take amiodarone and upgrade with dual-chamber implantable cardioverter-defibrillator or CRT-D at an appropriate time.During the follow-up at 3 mo after LBBP,the patient showed an improvement in cardiac function with slight improvement in echocardiography parameters,and the New York Heart Association functional class was maintained at I.Moreover,the patient no longer suffered from chest tightness and palpitation.Holter showed decreased ventricular arrhythmia of less than 5%.CONCLUSION LBBP might be used in patients with heart failure and a high-degree atrioventricular block as an alternative to conventional CRT.
基金Project supported by the National Natural Science Foundation of China(Nos.30900604 and 81270004)the Shanghai Natural Science Foundation(No.11ZR1422800)+1 种基金the Medical Key Project of Shanghai Science and Technology Commission(No.12411952100)the New Outstanding Youth Program of Shanghai Municipal Commission of Health and Family Planning(No.XYQ2013105),China
文摘Objective： We are aimed to investigate whether right ventricular mid-septal pacing （RVMSP） is superior to conventional right ventricular apical pacing （RVAP） in improving clinical functional capacity and left ventricular ejection fraction （LVEF） for patients with high-degree atrio-ventricular block and moderately depressed left ventricle （LV） function. Methods： Ninety-two patients with high-degree atrio-ventricular block and moderately reduced LVEF （ranging from 35% to 50%） were randomly allocated to RVMSP （n=45） and RVAP （n=47）. New York Heart Association （NYHA） functional class, echocardiographic LVEF, and distance during a 6-min walk test （6MWT） were determined at 18 months after pacemaker implantation. Serum levels of N-terminal pro-brain natriuretic peptide （NT-proBNP） were measured using an enzyme-linked immunosorbent assay （ELISA） kit. Results： Compared with baseline, NYHA functional class remained unchanged at 18 months, distance during 6MVVT （485 m vs. 517 m） and LVEF （36.7% vs. 41.8%） were increased, but BNP levels were reduced （2352 pg/ml vs. 710 pg/ml） in the RVMSP group compared with those in the RVAP group, especially in patients with LVEF 35%-40% （for all comparisons, P〈0.05）. However, clinical function capacity and LV function measurements were not significantly changed in patients with RVAP, despite the pacing measurements being similar in both groups, such as R-wave amplitude and capture threshold. Conclusions： RVMSP provides a better clinical utility, compared with RVAP, in patients with high-degree atrioventricular block and moderately depressed LV function whose LVEF levels ranged from 35% to 40%.
文摘Background The study was to access the feasibility and effectiveness of permanent left bundle branch pacing(LBBP)in patients with bradycardia after cardiac surgery,in comparison with conventional right ventricular outflow tract septal pacing(RVOSP).Methods A total of 50 patients with cardiac surgery who underwent permanent pacemaker implantation(PPI)were enrolled,21 patients underwent LBBP(LBBP group)and 29 patients underwent RVOSP(RVOSP group).Pacing electrical parameters,QRS duration(QRSd),echocardiographic measurements,lead and device related complications were obtained at procedure and during follow-ups.Results There were no statistically significant differences between the LBBP group and the RVOSP group at procedure and at the twelfth month’s follow-up in pacing thresholds(0.64±0.16 V vs.0.63±0.22 V)and(0.91±0.28 V vs.0.85±0.20 V),R-wave amplitude(16.68±4.52 mV vs.15.09±4.53 mV)and(14.41±8.65 mV vs.12.65±6.17 mV),pacing impedances(719.24±152.65Ωvs.639.13±177.04Ω)and(534.01±96.92Ωvs.499.18±77.87Ω).But the average ventricular pacing percentage(VP%)at the first month’s follow-up(81.96±32.06%vs.58.37±42.96%)and at the twelfth month’s follow-up(84.65±35.84%vs.53.57±38.47%)showed significant difference between two groups(P<0.05);The LBBP group produced narrower QRSd(121.13±23.91 ms)than the RVOSP group(158.00±9.69 ms)(P=0.011).There were no significant differences between the LBBP group and the RVOSP group at pre-procedure and at the twelfth month’s follow-up in echocardiographic parameters,which included left ventricular end-diastolic dimension(LVEDD)(48.76±7.08 mm vs.47.34±6.91 mm)and(50.58±10.33 mm vs.45.97±7.11 mm),left ventricular ejection fraction(LVEF)(58.33±12.64%vs.61.50±8.40%)and(55.85±16.35%vs.61.50±10.52%),and area of tricuspid regurgitation(TR)(2.79±3.65 cm2 vs.2.85±2.26 cm2)and(3.09±2.34 cm2 vs.2.95±1.92 cm2).No lead and device related complication was observed during follow-ups.Conclusions LBBP is feasible and effective in patients with bradycardia after cardiac surgery.LBBP produces narrow QRSd,which may be a preferred pacing strategy for patients after cardiac surgery.[S Chin J Cardiol 2021;22(1):13-20]
基金This work was supported by the National Natural Science Foundation of China(82070521)Clinical Competence Improvement Project of Jiangsu Province Hospital(JSPH-MA-2020-3)Project on New Technology of Jiangsu Province(JX233C202103).
文摘Left bundle branch pacing(LBBP)emerged as a new physiological pacing strategy during the past several years.Recent observational studies have demonstrated the advantages of LBBP,including a high success rate,stable pacing parameters,and excellent clinical benefits.Widespread adoption of LBBP will depend on improvements in device/lead technology and further verification of its efficacy in large randomized clinical trials.In this review,we summarize re-cent advancements in LBBP,including the definition and evaluation of left bundle branch capture,LBBP applications,and future directions in this growing field.
文摘Background:Cross-country skiing(XCS)racing,a popular international winter sport,is complex and challenging from physical,technical,and tactical perspectives.Despite the vast amount of research focusing on this sport,no review has yet addressed the pacing strategies of elite XCS racers or the factors that influence their performance.The aim was to review the scientific literature in an attempt to determine the effects of pacing strategy on the performance of elite XCS racers.Methods:Four electronic databases were searched using relevant subject headings and keywords.Only original research articles published in peerreviewed journals and the English language and addressing performance,biomechanics,physiology,and anthropometry of XCS racers were reviewed.Results:All 27 included articles applied correlative designs to study the effectiveness of different pacing strategies.None of the articles involved the use of an experimental design.Furthermore,potential changes in external conditions(e.g.,weather,ski properties)were not taken into consideration.A comparable number of studies focused on the skating or classical technique.In most cases,positive pacing was observed,with certain indications that higher-level athletes and those with more endurance and strength utilized a more even pacing strategy.The ability to achieve and maintain a long cycle length on all types of terrain was an important determinant of performance in all of the included studies,which was not the case for cycle rate.In general,uphill performance was closely related to overall race performance,with uphill performance being most closely correlated to the success of female skiers and performance on flat terrain being more important for male skiers.Moreover,pacing was coupled to the selection and distribution of technique during a race,with faster skiers employing more double poling and kick double poling,less diagonal stride,and more V2(double dance)than V1(single dance)skating across a race.Conclusion:We propose that skiers at all levels can improve their performance with more specific training in techniques(i.e.,maintaining long cycles without compromising cycle rate and selecting appropriate techniques)in combination with training for endurance and more strength.Furthermore,we would advise less experienced skiers and/or those with lower levels of performance to apply a more even pacing strategy rather than a positive one(i.e.,starting the race too fast).2018 Published by Elsevier B.V.on behalf of Shanghai University of Sport.This is an open access article under the CC BY-NC-ND license.(http://creativecommons.org/licenses/by-nc-nd/4.0/).
文摘AIM: To evaluate the safety and efficacy of the permanent high interventricular septal pacing in a long term follow up, as alternative to right ventricular apical pacing. METHODS: We retrospectively evaluated:(1) 244 patients(74 ± 8 years; 169 men, 75 women) implanted with a single(132 pts) or dual chamber(112 pts) pacemaker(PM) with ventricular screw-in lead placed at the right ventricular high septal parahisian site(SEPTAL pacing);(2) 22 patients with permanent pacemaker and low percentage of pacing(< 20%)(NO pacing);(3) 33 patients with high percentage(> 80%) right ventricular apical pacing(RVA). All patients had a narrow spontaneous QRS(101 ± 14 ms). We evaluated New York Heart Association(NYHA) class, quality of life(Qo L), 6 min walking test(6MWT) and left ventricular function(end-diastolic volume, LV-EDV; end-systolic volume, LVESV; ejection fraction, LV-EF) with 2D-echocardiography. RESULTS: Pacing parameters were stable duringfollow up(21 mo/patient). In SEPTAL pacing group we observed an improvement in NYHA class, Qo L score and 6MWT. While LV-EDV didn't significantly increase(104 ± 40 m L vs 100 ± 37 m L; P = 0.35), LV-ESV slightly increased(55 ± 31 m L vs 49 ± 27 m L; P = 0.05) and LV-EF slightly decreased(49% ± 11% vs 53% ± 11%; P = 0.001) but never falling < 45%. In the RVA pacing control group we observed a worsening of NYHA class and an important reduction of LV-EF(from 56% ± 6% to 43% ± 9%, P < 0.0001).CONCLUSION: Right ventricular permanent high septal pacing is safe and effective in a long term follow up evaluation; it could be a good alternative to the conventional RVA pacing in order to avoid its deleterious effects.
文摘The right atrial appendage (RAA) and right ventricular apex (RVA) have been widely considered as conventional sites for typical dual-chamber atrio-ventricular cardiac (DDD) pacing. Unfortunately conventional RAA pacing seems not to be able to prevent atrial fibrillation in DDD pacing for tachycardia-bradycardia syndrome, and the presence of a left bundle branch type of activation induced by RVA pacing can have negative effects. A new technology with active screw-in leads permits a more physiological atrial and right ventricular pacing. In this review, we highlight the positive effects of pacing of these new and easily selected sites. The septal atrial lead permits a shorter and more homogeneous atrial activation, allowing better prevention of paroxysmal atrial fibrillation. The para-Hisian pacing can be achieved in a simpler and more reliable way with respect to biventricular pacing and direct Hisian pacing. We await larger trials to consider this "easy and physiological pacing" as a first approach in patients who need a high frequency of pacing.
文摘Symptomatic bradycardia is effectively treated with the implantation of a cardiac pacemaker. Although a highly successful therapy, during recent years there has been a focus on the negative effects associated with longterm pacing of the apex of the right ventricle(RV). It has been shown in both experimental and clinical studies that RV pacing leads to ventricular dyssynchrony, similar to that of left bundle branch block, with subsequent detrimental effects on cardiac structure and function, and in some cases adverse clinical outcomes such as atrial fibrillation, heart failure and death. There is substantial evidence that patients with reduced left ventricular function(LVEF) are at particular high risk of suffering the detrimental clinical effects of long-term RV pacing. The evidence is, however, incomplete, coming largely from subanalyses of pacemaker and implantable cardiac defibrillator studies. In this group of patients with reduced LVEF and an expected high amount of RV pacing, biventricular pacing(cardiac resynchronization therapy) devices can prevent the negative effects of RV pacing and reduce ventricular dyssynchrony. Therefore, cardiac resynchronization therapy has emerged as an attractive option with promising results and more clinical studies are underway. Furthermore, specific pacemaker algorithms, which minimize RV pacing, can also reduce the negative effects of RV stimulation on cardiac function and may prevent clinical deterioration.
