Purpose: Regadenoson (REG) is currently becoming the stress agent of choice in patients undergoing pharmacologic single photon emission computed tomography (SPECT). However, in patients with left bundle branch block (...Purpose: Regadenoson (REG) is currently becoming the stress agent of choice in patients undergoing pharmacologic single photon emission computed tomography (SPECT). However, in patients with left bundle branch block (LBBB) and ventricular paced rhythm (VPR), hesitation exists amongst clinicians to use REG-SPECT due to the concern that the increased heart rate could cause false positive SPECT results. We sought to evaluate the comparability of A-SPECT and REG-SPECT in patients with LBBB and VPR. Methods: Retrospective study of 30 patients who served as their own controls. All 30 patients who underwent REG-SPECT (Grp 1) were compared to their prior A-SPECT (Grp 2) done within two years prior to REG-SPECT. Heart rate (HR) and blood pressure (BP) parameters, ECG, stress perfusion and gated variables, SPECT ischemia, and side-effects were evaluated. Statistical significance was set at P < 0.05. Results: Grp 1 and Grp 2 were comparable in hemodynamic parameters with increase in HR and decrease in systolic and diastolic BP with administration of adenosine and REG stress agents. However, there were no significant differences found in hemodynamic parameters and II degree AV block between the groups. All normal A-SPECT were found to be normal with REG-SPECT. No differences could be found between the two groups among SPECT parameters. Muscle pain was significantly higher in REG (10.0% vs. 0.0%, P = 0.083) and so was the use of aminophylline (16.7% vs. 0.0%, P = 0.025) to relieve the side-effect. Conclusion: REG-SPECT can be administered in patients with LBBB and VPR patients based on favorable and comparable hemodynamic responses and arrhythmia occurrences to A-SPECT. REG-SPECT can also be used for adequate interpretation of presence or absence of SPECT ischemia particularly in the LAD territory without any concern for false positive perfusion defects.展开更多
The PQRST segment which include the major information in a heart beatis detected and used as the input pattern to cluster by ART2 model. The parametersof pacemaker which consist of pulse, QRS characteristics, clusteri...The PQRST segment which include the major information in a heart beatis detected and used as the input pattern to cluster by ART2 model. The parametersof pacemaker which consist of pulse, QRS characteristics, clustering results andprogrammed parameters are combined in analyzing paced ECG (PECG) synthetically.展开更多
Depression/anxiety is commonly present in paced patients and is associated with increased cardiovascular morbidity and mortality. The high prevalence of depression/anxiety in paced patients supports a strategy of incr...Depression/anxiety is commonly present in paced patients and is associated with increased cardiovascular morbidity and mortality. The high prevalence of depression/anxiety in paced patients supports a strategy of increased awareness and treatment for depression/anxiety in paced patients. Health-related quality of life （HRQoL） is being increasingly considered as an expected out-come of therapeutic interventions and rehabilitation programs in clinical cardi- ology including patients before and after pacemaker（PM） implantation. This multispeciahy consensus document reviews the evidence linking depression/anxiety with arrhythmia and cardiac pacing; HRQoL and cardiac pacing, at the same time, provides recommendations for healthcare providers for the treatment of depression/anxiety. （S Chin J Cardiol 2009; 10（4） ： 190 -195）展开更多
Purpose The purpose of the study was to investigate the acute effect of a beginner martial art class and aerobic exercise on executive function(EF)in college-aged young adults.There is overwhelming evidence that demon...Purpose The purpose of the study was to investigate the acute effect of a beginner martial art class and aerobic exercise on executive function(EF)in college-aged young adults.There is overwhelming evidence that demonstrates acute as well as long-term aerobic exercise improves EF.Nevertheless,there is limited research comparing externally paced exercise(EPE)to self-paced exercise(SPE)such as walking on improving EF.EPE requires greater cortical demand than SPE to execute a motor plan.Methods Eight men and eight women,aged 24.2±2.8 years,participated in a Repeated Measures Crossover Design.Pre-and post-testing of EF with the Stroop and Tower of London(ToL)and stress level were measured after each of the two 1-h conditions:the SPE consisted of a walk(aerobic exercise)and the EPE was a beginner martial art class.Results There were significant main effects for the martial art class for the Stroop’s mean reaction time for congruent trials(P=0.01)with a large-effect size.The mean reaction time for incongruent trials was significant(P=0.05)with a medium-effect size.The ToL’s mean solution time(P=0.003)and mean execution time(P=0.002)were also significant with large-effect sizes.Stress levels were not significantly improved following either condition.Conclusion The martial art class significantly improved all the major domains of EF,while aerobic exercise of a similar intensity did not demonstrate any measured significant changes.The physiological benefits of physical exercise are well documented;however,the cognitive enhancing capability of EPE should also be appreciated given the results of this study.展开更多
Solar flare prediction is an important subject in the field of space weather.Deep learning technology has greatly promoted the development of this subject.In this study,we propose a novel solar flare forecasting model...Solar flare prediction is an important subject in the field of space weather.Deep learning technology has greatly promoted the development of this subject.In this study,we propose a novel solar flare forecasting model integrating Deep Residual Network(ResNet)and Support Vector Machine(SVM)for both≥C-class(C,M,and X classes)and≥M-class(M and X classes)flares.We collected samples of magnetograms from May 1,2010 to September 13,2018 from Space-weather Helioseismic and Magnetic Imager(HMI)Active Region Patches and then used a cross-validation method to obtain seven independent data sets.We then utilized five metrics to evaluate our fusion model,based on intermediate-output extracted by ResNet and SVM using the Gaussian kernel function.Our results show that the primary metric true skill statistics(TSS)achieves a value of 0.708±0.027 for≥C-class prediction,and of 0.758±0.042 for≥M-class prediction;these values indicate that our approach performs significantly better than those of previous studies.The metrics of our fusion model’s performance on the seven datasets indicate that the model is quite stable and robust,suggesting that fusion models that integrate an excellent baseline network with SVM can achieve improved performance in solar flare prediction.Besides,we also discuss the performance impact of architectural innovation in our fusion model.展开更多
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
As humanity advances at a rapid pace,both material wealth and spiritual fulfillment continue to grow and enrich our lives.“The remarkable year of 2025 marks a pinnacle in AI advancement,a quantum leap in robotics app...As humanity advances at a rapid pace,both material wealth and spiritual fulfillment continue to grow and enrich our lives.“The remarkable year of 2025 marks a pinnacle in AI advancement,a quantum leap in robotics applications,and groundbreaking progress in cosmic exploration.Even Nezha II(a Chinese animated blockbuster) brilliantly integrates technology,space,culture,and AI into its narrative.Yet,none of these developments can escape humanity's enduring obsession with facial aesthetics.As civilizations flourish across all dimensions,the beauty economy emerges as a formidable industrial force,driving mankind's relentless pursuit of a better life and a more beautiful future.”展开更多
Background:The perception of effort is a key determinant of endurance performance and a barrier to physical activity in inactive populations.From a neurophysiological viewpoint,effort perception is thought to arise fr...Background:The perception of effort is a key determinant of endurance performance and a barrier to physical activity in inactive populations.From a neurophysiological viewpoint,effort perception is thought to arise from the brain processing of an efference copy of the motor command in sensory areas.However,recent research suggests that feedback from muscle spindles plays a significant role in this perception.In this study,tendon vibration protocols were employed to attenuate sensory feedback during subsequent cycling exercises.The aim was to assess whether vibration would increase cycling power output,muscle activation,and heart rate at fixed perceived effort intensities.Methods:Fifteen healthy young participants completed 2 experimental visits(vibration and sham).In each visit,participants performed two 3-min cycling bouts,1 at a moderate perceived effort intensity and 1 at a strong perceived effort intensity,before(pre)and after(post)an actual or a sham vibration protocol.Vibration was applied bilaterally on the patellar and Achilles tendons for 10 min.Power output,heart rate,and vastus lateralis electromyography(VL EMG)were recorded and averaged for each bout.Absolute values as well as relative change(%)between pre and post conditions were compared across sham and vibration conditions.Results:At moderate perceived effort,power output,heart rate,and VL EMG increased post-vibration compared to pre-vibration(p<0.05),while no difference was observed in the sham condition.At strong perceived effort,power output and VL EMG decreased post-sham(p<0.05)but remained unchanged post-vibration.Moreover,the relative change between pre and post conditions was significantly higher in the vibration conditions compared to the sham condition for all variables.Conclusion:This study shows that tendon vibration reduces effort perception during subsequent cycling bouts.This effect is likely a consequence of vibration-induced reduction in muscle spindle reafferent signaling to the brain,but this mechanism remains to be further elucidated.From an applied perspective,these findings highlight tendon vibration as a promising tool for enhancing physical activity engagement.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
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 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 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
文摘Purpose: Regadenoson (REG) is currently becoming the stress agent of choice in patients undergoing pharmacologic single photon emission computed tomography (SPECT). However, in patients with left bundle branch block (LBBB) and ventricular paced rhythm (VPR), hesitation exists amongst clinicians to use REG-SPECT due to the concern that the increased heart rate could cause false positive SPECT results. We sought to evaluate the comparability of A-SPECT and REG-SPECT in patients with LBBB and VPR. Methods: Retrospective study of 30 patients who served as their own controls. All 30 patients who underwent REG-SPECT (Grp 1) were compared to their prior A-SPECT (Grp 2) done within two years prior to REG-SPECT. Heart rate (HR) and blood pressure (BP) parameters, ECG, stress perfusion and gated variables, SPECT ischemia, and side-effects were evaluated. Statistical significance was set at P < 0.05. Results: Grp 1 and Grp 2 were comparable in hemodynamic parameters with increase in HR and decrease in systolic and diastolic BP with administration of adenosine and REG stress agents. However, there were no significant differences found in hemodynamic parameters and II degree AV block between the groups. All normal A-SPECT were found to be normal with REG-SPECT. No differences could be found between the two groups among SPECT parameters. Muscle pain was significantly higher in REG (10.0% vs. 0.0%, P = 0.083) and so was the use of aminophylline (16.7% vs. 0.0%, P = 0.025) to relieve the side-effect. Conclusion: REG-SPECT can be administered in patients with LBBB and VPR patients based on favorable and comparable hemodynamic responses and arrhythmia occurrences to A-SPECT. REG-SPECT can also be used for adequate interpretation of presence or absence of SPECT ischemia particularly in the LAD territory without any concern for false positive perfusion defects.
文摘The PQRST segment which include the major information in a heart beatis detected and used as the input pattern to cluster by ART2 model. The parametersof pacemaker which consist of pulse, QRS characteristics, clustering results andprogrammed parameters are combined in analyzing paced ECG (PECG) synthetically.
文摘Depression/anxiety is commonly present in paced patients and is associated with increased cardiovascular morbidity and mortality. The high prevalence of depression/anxiety in paced patients supports a strategy of increased awareness and treatment for depression/anxiety in paced patients. Health-related quality of life （HRQoL） is being increasingly considered as an expected out-come of therapeutic interventions and rehabilitation programs in clinical cardi- ology including patients before and after pacemaker（PM） implantation. This multispeciahy consensus document reviews the evidence linking depression/anxiety with arrhythmia and cardiac pacing; HRQoL and cardiac pacing, at the same time, provides recommendations for healthcare providers for the treatment of depression/anxiety. （S Chin J Cardiol 2009; 10（4） ： 190 -195）
文摘Purpose The purpose of the study was to investigate the acute effect of a beginner martial art class and aerobic exercise on executive function(EF)in college-aged young adults.There is overwhelming evidence that demonstrates acute as well as long-term aerobic exercise improves EF.Nevertheless,there is limited research comparing externally paced exercise(EPE)to self-paced exercise(SPE)such as walking on improving EF.EPE requires greater cortical demand than SPE to execute a motor plan.Methods Eight men and eight women,aged 24.2±2.8 years,participated in a Repeated Measures Crossover Design.Pre-and post-testing of EF with the Stroop and Tower of London(ToL)and stress level were measured after each of the two 1-h conditions:the SPE consisted of a walk(aerobic exercise)and the EPE was a beginner martial art class.Results There were significant main effects for the martial art class for the Stroop’s mean reaction time for congruent trials(P=0.01)with a large-effect size.The mean reaction time for incongruent trials was significant(P=0.05)with a medium-effect size.The ToL’s mean solution time(P=0.003)and mean execution time(P=0.002)were also significant with large-effect sizes.Stress levels were not significantly improved following either condition.Conclusion The martial art class significantly improved all the major domains of EF,while aerobic exercise of a similar intensity did not demonstrate any measured significant changes.The physiological benefits of physical exercise are well documented;however,the cognitive enhancing capability of EPE should also be appreciated given the results of this study.
基金supported by the National Key R&D Program of China (Grant No.2022YFF0503700)the National Natural Science Foundation of China (42074196, 41925018)
文摘Solar flare prediction is an important subject in the field of space weather.Deep learning technology has greatly promoted the development of this subject.In this study,we propose a novel solar flare forecasting model integrating Deep Residual Network(ResNet)and Support Vector Machine(SVM)for both≥C-class(C,M,and X classes)and≥M-class(M and X classes)flares.We collected samples of magnetograms from May 1,2010 to September 13,2018 from Space-weather Helioseismic and Magnetic Imager(HMI)Active Region Patches and then used a cross-validation method to obtain seven independent data sets.We then utilized five metrics to evaluate our fusion model,based on intermediate-output extracted by ResNet and SVM using the Gaussian kernel function.Our results show that the primary metric true skill statistics(TSS)achieves a value of 0.708±0.027 for≥C-class prediction,and of 0.758±0.042 for≥M-class prediction;these values indicate that our approach performs significantly better than those of previous studies.The metrics of our fusion model’s performance on the seven datasets indicate that the model is quite stable and robust,suggesting that fusion models that integrate an excellent baseline network with SVM can achieve improved performance in solar flare prediction.Besides,we also discuss the performance impact of architectural innovation in our fusion model.
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As humanity advances at a rapid pace,both material wealth and spiritual fulfillment continue to grow and enrich our lives.“The remarkable year of 2025 marks a pinnacle in AI advancement,a quantum leap in robotics applications,and groundbreaking progress in cosmic exploration.Even Nezha II(a Chinese animated blockbuster) brilliantly integrates technology,space,culture,and AI into its narrative.Yet,none of these developments can escape humanity's enduring obsession with facial aesthetics.As civilizations flourish across all dimensions,the beauty economy emerges as a formidable industrial force,driving mankind's relentless pursuit of a better life and a more beautiful future.”
基金supported by the French National Research Agency(Agence Nationale de la Recherche,ANR,Grant No.ANR-23-CE37-0014)for the Effort_(LESS)Project.
文摘Background:The perception of effort is a key determinant of endurance performance and a barrier to physical activity in inactive populations.From a neurophysiological viewpoint,effort perception is thought to arise from the brain processing of an efference copy of the motor command in sensory areas.However,recent research suggests that feedback from muscle spindles plays a significant role in this perception.In this study,tendon vibration protocols were employed to attenuate sensory feedback during subsequent cycling exercises.The aim was to assess whether vibration would increase cycling power output,muscle activation,and heart rate at fixed perceived effort intensities.Methods:Fifteen healthy young participants completed 2 experimental visits(vibration and sham).In each visit,participants performed two 3-min cycling bouts,1 at a moderate perceived effort intensity and 1 at a strong perceived effort intensity,before(pre)and after(post)an actual or a sham vibration protocol.Vibration was applied bilaterally on the patellar and Achilles tendons for 10 min.Power output,heart rate,and vastus lateralis electromyography(VL EMG)were recorded and averaged for each bout.Absolute values as well as relative change(%)between pre and post conditions were compared across sham and vibration conditions.Results:At moderate perceived effort,power output,heart rate,and VL EMG increased post-vibration compared to pre-vibration(p<0.05),while no difference was observed in the sham condition.At strong perceived effort,power output and VL EMG decreased post-sham(p<0.05)but remained unchanged post-vibration.Moreover,the relative change between pre and post conditions was significantly higher in the vibration conditions compared to the sham condition for all variables.Conclusion:This study shows that tendon vibration reduces effort perception during subsequent cycling bouts.This effect is likely a consequence of vibration-induced reduction in muscle spindle reafferent signaling to the brain,but this mechanism remains to be further elucidated.From an applied perspective,these findings highlight tendon vibration as a promising tool for enhancing physical activity engagement.
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 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 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).
