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
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
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
BACKGROUND Balloon aortic valvuloplasty(BAV)is a well-established treatment modality for congenital aortic valve stenosis.AIM To evaluate the role of rapid right ventricular pacing(RRVP)in balloon stabilization during...BACKGROUND Balloon aortic valvuloplasty(BAV)is a well-established treatment modality for congenital aortic valve stenosis.AIM To evaluate the role of rapid right ventricular pacing(RRVP)in balloon stabilization during BAV on aortic regurgitation(AR)in pediatric patients.METHODS A systematic review of the MEDLINE,Cochrane Library,and Scopus databases was conducted according to the PRISMA guidelines(end-of-search date:July 8,2020).The National Heart,Lung,and Blood Institute and Newcastle-Ottawa scales was utilized for quality assessment.RESULTS Five studies reporting on 72 patients were included.The studies investigated the use of RRVP-assisted BAV in infants(>1 mo)and older children,but not in neonates.Ten(13.9%)patients had a history of some type of aortic valve surgical or catheterization procedure.Before BAV,58(84.0%),7(10.1%),4(5.9%)patients had AR grade 0(none),1(trivial),2(mild),respectively.After BAV,34(49.3%),6(8.7%),26(37.7%),3(4.3%),patients had AR grade 0,1,2,and 3(moderate),respectively.No patient developed severe AR after RRVP.One(1.4%)developed ventricular fibrillation and was defibrillated successfully.No additional arrhythmias or complications occurred during RRVP.CONCLUSION RRVP can be safely used to achieve balloon stability during pediatric BAV,which could potentially decrease AR rates.展开更多
Permanent pacemaker implant is a commonly performed cardiac procedure for treatment of bradycardia or conduction system abnormality.With conventional right ventricular(RV)pacing a lead is implanted at the RV apex or o...Permanent pacemaker implant is a commonly performed cardiac procedure for treatment of bradycardia or conduction system abnormality.With conventional right ventricular(RV)pacing a lead is implanted at the RV apex or on the RV septum.However,RV apical or RV septal pacing causes iatrogenic left bundle-branch block and ventricular dyssynchrony and can lead to adverse cardiac remodeling,a pacing-mediated cardiomyopathy,and congestive heart failure.Alternatively,permanent His-bundle pacing uses the intrinsic rapidly-conducting His-Purkinje system to activate the ventricle,thereby maintaining(or sometimes even restoring)ventricular synchrony.Many patients may derive benefit from permanent His-bundle pacing.展开更多
Implantable cardioverter defibrillator(ICD) programminginvolves several parameters. In recent years antitachycardia pacing(ATP) has gained an increasing importance in the treatment of ventricular arrhythmias, whether ...Implantable cardioverter defibrillator(ICD) programminginvolves several parameters. In recent years antitachycardia pacing(ATP) has gained an increasing importance in the treatment of ventricular arrhythmias, whether slow or fast. It reduces the number of unnecessary and inappropriate shocks and improves both patient's quality of life and device longevity. There is no clear indication regarding the type of ATP to be used, except for the treatment of fast ventricular tachycardias(188 bpm-250 bpm) where it has been shown a greater efficacy and safety of burst compared to ramp; 8 impulses in each sequence of ATP appears to be the best programming option in this setting. Beyond ATP use, excellent clinical results were obtained with programming standardization following these principles: extended detection time in ventricular fibrillation(VF) zone; supraventricular discrimination criteria up to 200 bpm; first shock in VF zone at the maximum energy in order to reduce the risk of multiple shocks. The MADIT-RIT trial and some observational registries have also recently demonstrated that programming with a widespread use of ATP, higher cut-off rates or delayed intervention reduces the number of inappropriate and unnecessary therapies and improves the survival of patients during mid-term follow-up.展开更多
We present the case of a young woman corrected with a Mustard procedure undergoing successful transvenous double chamber pacemaker implantation with the atrial lead placed in the systemic venous channel. The case pres...We present the case of a young woman corrected with a Mustard procedure undergoing successful transvenous double chamber pacemaker implantation with the atrial lead placed in the systemic venous channel. The case presented demonstrates that, when the systemic venous atrium is separate from the left atrial appendage, the lead can be easily and safely placed in the systemic venous left atrium gaining satisfactory sensing and pacing thresholds despite consisting partially of pericardial tissue.展开更多
Background:Right ventricular pacing disrupts atrioventricular synchrony and increases the risk of atrial fi brillation(AF).However,whether algorithms for minimizing ventricular pacing reduce the incidence of AF remain...Background:Right ventricular pacing disrupts atrioventricular synchrony and increases the risk of atrial fi brillation(AF).However,whether algorithms for minimizing ventricular pacing reduce the incidence of AF remains controversial.Therefore,we conducted a systematic review and meta-analysis to compare the incidence of AF between minimizing ventricular pacing and conventional pacing protocols in patients with pacemakers implanted.Methods:The PubMed,Embase,and Cochrane Library databases were searched up to August 1,2017,for randomized controlled trials that reported the incidence of AF in patients with and without the use of algorithms for minimizing ventricular pacing.Results:Eleven studies comprising 5705 participants(61%males,mean age 71 years[standard deviation 11 years])were fi nally included in the analysis.The mean follow-up duration was 24 months.Use of algorithms for minimizing ventricular pacing signifi cantly reduced the incidence of AF,with an odds ratio of 0.74(95%confi dence interval 0.55–1.00;P<0.05).There was moderate heterogeneity among studies(I 2=63%).Conclusions:The incidence of AF was reduced by 26%with use of algorithms for minimizing ventricular pacing.The incorporation of such algorithms in routine clinical practice should in theory lead to a decrease in AF-related morbidity and mortality.展开更多
Objectives:People living with myalgic encephalomyelitis/chronic fatigue syndrome(ME/CFS)may face unique barriers to physical activity.Active video games may overcome these barriers and increase physical activity.The p...Objectives:People living with myalgic encephalomyelitis/chronic fatigue syndrome(ME/CFS)may face unique barriers to physical activity.Active video games may overcome these barriers and increase physical activity.The primary aim of this pilot study was to determine the feasibility and acceptability of active video games to increase physical activity levels of people with ME/CFS.Methods:A mixed method design was employed.Adults living with ME/CFS were randomised to a six-month intervention of(1)pacing,(2)pacing and conventional physical activity,or(3)pacing and active video gaming.Feasibility and acceptability were determined through semi-structured interviews.Health-related outcomes(e.g.,physical activity,blood samples,quality of life,and functioning)were also collected.Results:Fifteen people were assigned an intervention group with 12 completing.Three themes were identified from post-intervention interviews(1)positivity led to overall acceptability,(2)flexibility enabled participant autonomy,and(3)knowledge was gained about the self.No changes were seen in physical activity levels.An active video gaming intervention is acceptable but not feasible for people living with ME/CFS.Conclusions:Taken together,results suggest that physical activity can be managed safely by some people living with ME/CFS.Trial registration ACTRN12616000285459.展开更多
Congenitally corrected transposition of the great arteries(CCTGA)is a rare congenital heart disease characterized by atrioventricular,ventriculoarterial,and conduction system discordance,commonly accompanied by atriov...Congenitally corrected transposition of the great arteries(CCTGA)is a rare congenital heart disease characterized by atrioventricular,ventriculoarterial,and conduction system discordance,commonly accompanied by atrioventricular block(AVB).Pacing in patients with CCTGA and AVB(both pediatric and adult)poses challenges in strategy selection,procedural complexity,and clinical decision-making due to limited evidence.Conventional morphological left ventricular pacing is widely adopted but may induce ventricular dyssynchrony,heart failure,and tricuspid valve dysfunction.While cardiac resynchronization therapy serves as an upgrade for pacing-induced cardiomyopathy and heart failure,its application may be limited by coronary sinus anatomical variations and uncertain clinical outcomes.His bundle pacing is rarely reported due to the variation of the His bundle and high pacing threshold.The superficial,wide,multi-branched left bundle branch favors left bundle branch pacing,though delayed systemic right ventricle(sRV)activation may cause ventricular dyssynchrony and impair sRV function.Right bundle branch pacing offers a novel alternative for pacing therapy.Conduction system pacing-optimized cardiac resynchronization therapy is preferred in those with evidence of intrinsic ventricular conduction dysfunction.This narrative review synthesizes current evidence on pacing strategies for CCTGA with AVB,integrating anatomical and pathophysiological insights to evaluate physiological pacing strategies,while highlighting critical knowledge gaps to guide future research.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
本文围绕贵州“富矿精开”需求,针对贵州大学专业型研究生培养存在的模式同质化、实践资源短缺、成果转化率低等问题,通过整合矿山水文地质领域的特色课程资源、深化校企协同实践平台、推进多学科交叉创新,构建了以“课程引导-工程实践...本文围绕贵州“富矿精开”需求,针对贵州大学专业型研究生培养存在的模式同质化、实践资源短缺、成果转化率低等问题,通过整合矿山水文地质领域的特色课程资源、深化校企协同实践平台、推进多学科交叉创新,构建了以“课程引导-工程实践-创新提升-论文凝练”为核心的专业-应用-创新型精英人才(Professional Applied and Creative-skilled Elite,PACE)培养模式。该模式显著提升了研究生的实践创新能力,为区域产业升级提供了高层次应用型人才支撑。研究表明,PACE模式通过贯通“专业能力-实践能力-创新能力”培养链条,实现了专业型研究生“精英化”成才目标,为地方高校服务区域战略需求提供了可复制的教育范式。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
Background Super-responders （SRs） are defined as patients who show crucial cardiac function improvement after cardiac resynchro- nization therapy （CRT）. The purpose of this study is to identify and validate predic...Background Super-responders （SRs） are defined as patients who show crucial cardiac function improvement after cardiac resynchro- nization therapy （CRT）. The purpose of this study is to identify and validate predictors of SRs after CRT. Methods This study enrolled 201 patients who underwent CRT during the period from 2010 to 2014. Clinical and echocardiographic evaluations were conducted before CRT and 6 months after. Patients with a decrease in New York Heart Association （NYHA） fimctional class 〉 1, a decrease in left ventricular end-systolic volume （LVESV） ≥ 15%, and a final left ventricular ejection fraction （LVEF） ≥ 45% were classified as SRs. Results 29% of the 201 patients who underwent CRT were identified as SRs. At baseline, SRs had significantly smaller left atrial diameter （LAD）, LVESV, left ventricular end-diastolic volume （LVEDV） and higher LVEF than the non-super-responders （non-SRs）. The percentage of patients using angiotensin-converting enzyme inhibitors or angiotensin receptor blockers （ACEI/ARB） was higher in SRs than non-SRs. Most SRs had Biventricular （BiV） pacing percentage greater than 98% six months after CRT. In the multivariate logistic regression analysis, the independ- ent predictors of SRs were lower LVEDV [odd ratios （OR）： 0.93; confidence intervals （CI）： 0.90-0.97], use of ACEI/ARB （OR： 0.33; CI： 0.13~3.82） and BiV pacing percentage greater than 98% （OR： 0.29; CI： 0.16~.87）. Conclusion Patients with a better compliance of ACEI/ARB and a less ectatic ventricular geometry before CRT tends to have a greater probability of becoming SRs. Higher percentage of BiV pacing is essential for becoming SRs.展开更多
Objective To evaluate left univentricular （LUV） pacing for cardiac resynchronization therapy （CRT） using a rate-adaptive atrioven- tricular delay （RAAVD） algorithm to track physiological atrioventricular delay ...Objective To evaluate left univentricular （LUV） pacing for cardiac resynchronization therapy （CRT） using a rate-adaptive atrioven- tricular delay （RAAVD） algorithm to track physiological atrioventricular delay （AVD）. Methods A total of 72 patients with congestive heart failure （CHF） were randomized to RAAVD LUV pacing versus standard biventricular （BiV） pacing in a 1 ： 1 ratio. Echocardiography was used to optimize AVD for both groups. The effects of sequential BiV pacing and LUV pacing with optimized A-V （right atrio-LV） delay using an RAAVD algorithm were compared. The standard deviation （SD） of the S/R ratio in lead VI at five heart rate （HR） segments （Rs/R-SD5）, defined as the ＂tracking index,＂ was used to evaluate the accuracy of the RAAVD algorithm for tracking physiological AVD. Results TheQRS complex duration （132 ± 9.8 vs. 138± 10ms, P 〈 0.05）, the time required for optimization （21 ±5 vs. 50±8min, P〈 0.001）, the mitral regurgitant area （1.9 ± 1.1 vs. 2.5 ± 1.3 em2, P 〈 0.05）, the interventricular mechanical delay time （60.7 ± 13.3 ms vs. 68.3 ± 14.2 ms, P 〈 0.05）, and the average annual cost （13,200 ± 1000 vs. 21,600 ± 2000 RMB, P 〈 0.001） in the RAAVD LUV pacing group were significantly less than those in the standard BiV pacing group. The aortic valve velocity-time integral in the RAAVD LUV pacing group was greater than that in the standard BiV pacing group （22.7 ± 2.2 vs. 21.4 ± 2.1 cm, P 〈 0.05）. The Rs/R-SD5 was 4.08 ± 1.91 in the RAAVD LUV pacing group, and was significantly negatively correlated with improved left ventricular ejection fraction （LVEF） （ALVEF, Pearson＇s r = -0.427, P = 0.009）, and positively correlated with New York Heart Association class （Spearman＇s r - 0.348, P 0.037）. Conclusions RAAVD LUV pacing is as effective as standard BiV pacing, can be more physiological than standard BiV pacing, and can de- crease the average annual cost of CRT.展开更多
Summary： Lead placement for ventricular pacing variably impacts the physiological benefit of the pa- tient. This study evaluated the ventricular lead performance and safety of right ventricular outflow tract septal p...Summary： Lead placement for ventricular pacing variably impacts the physiological benefit of the pa- tient. This study evaluated the ventricular lead performance and safety of right ventricular outflow tract septal pacing in patients with bradyarrhythmia in South China over 60-month follow-up. Totally, 192 patients （108 males, and 84 females, 63-4-21 years old） with bradyarrhythmia were randomly divided into two groups. The right ventricular outflow tract septum （RVOTs） group had lead placement near the sep- tum （n=97）, while the right ventricular apex （RVA） group had a traditional apical placement （n=95）. RV septal lead positioning was achieved with a specialized stylet and confirmed using fluoroscopic projec- tion. All patients were followed up for 60 months. Follow-up assessment included stimulation threshold, R-wave sensing, lead impedance and lead complications. The time of electrode implantation in both the ROVTs and RVA groups were significantly different （4.29±0.61 vs. 2.16±0.22 min; P=0.009）. No dif- ferences were identified in threshold, impedance or R-wave sensing between the two groups at 1 st, 12th, 36th and 60th month during the follow-up period. No occurrence of electrode displacement, increased pacing threshold or inadequate sensing was found. The long-term active fixation ventricular electrode performance in RVOTs group was similar to that in RVA group. RVOTs pacing near the septum using active fixation electrodes may provide stability during long-term follow-up period.展开更多
AIM: To evaluate the current state-of-the-art of gastric electrical stimulation to treat obesity. METHODS: Systematic reviews of all studies have been conducted to evaluate the effect of different types of gastric ele...AIM: To evaluate the current state-of-the-art of gastric electrical stimulation to treat obesity. METHODS: Systematic reviews of all studies have been conducted to evaluate the effect of different types of gastric electrical stimulation(GES) on obesity.RESULTS: Thirty-one studies consisting of a total of 33 different trials were included in the systematic review for data analysis. Weight loss was achieved in most studies, especially during the first 12 mo, but only very few studies had a follow-up period longer than 1 year. Among those that had a longer follow-up period, many were from the Transcend(Implantable Gastric Stimulation) device group and maintained significant weight loss. Other significant results included changes in appetite/satiety, gastric emptying rate, blood pressure and neurohormone levels or biochemical markers such as ghrelin or HbA1 c respectively. CONCLUSION: GES holds great promises to be an effective obesity treatment. However, stronger evidence is required through more studies with a standardized way of carrying out trials and reporting outcomes, to determine the long-term effect of GES on obesity.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BACKGROUND Balloon aortic valvuloplasty(BAV)is a well-established treatment modality for congenital aortic valve stenosis.AIM To evaluate the role of rapid right ventricular pacing(RRVP)in balloon stabilization during BAV on aortic regurgitation(AR)in pediatric patients.METHODS A systematic review of the MEDLINE,Cochrane Library,and Scopus databases was conducted according to the PRISMA guidelines(end-of-search date:July 8,2020).The National Heart,Lung,and Blood Institute and Newcastle-Ottawa scales was utilized for quality assessment.RESULTS Five studies reporting on 72 patients were included.The studies investigated the use of RRVP-assisted BAV in infants(>1 mo)and older children,but not in neonates.Ten(13.9%)patients had a history of some type of aortic valve surgical or catheterization procedure.Before BAV,58(84.0%),7(10.1%),4(5.9%)patients had AR grade 0(none),1(trivial),2(mild),respectively.After BAV,34(49.3%),6(8.7%),26(37.7%),3(4.3%),patients had AR grade 0,1,2,and 3(moderate),respectively.No patient developed severe AR after RRVP.One(1.4%)developed ventricular fibrillation and was defibrillated successfully.No additional arrhythmias or complications occurred during RRVP.CONCLUSION RRVP can be safely used to achieve balloon stability during pediatric BAV,which could potentially decrease AR rates.
文摘Permanent pacemaker implant is a commonly performed cardiac procedure for treatment of bradycardia or conduction system abnormality.With conventional right ventricular(RV)pacing a lead is implanted at the RV apex or on the RV septum.However,RV apical or RV septal pacing causes iatrogenic left bundle-branch block and ventricular dyssynchrony and can lead to adverse cardiac remodeling,a pacing-mediated cardiomyopathy,and congestive heart failure.Alternatively,permanent His-bundle pacing uses the intrinsic rapidly-conducting His-Purkinje system to activate the ventricle,thereby maintaining(or sometimes even restoring)ventricular synchrony.Many patients may derive benefit from permanent His-bundle pacing.
文摘Implantable cardioverter defibrillator(ICD) programminginvolves several parameters. In recent years antitachycardia pacing(ATP) has gained an increasing importance in the treatment of ventricular arrhythmias, whether slow or fast. It reduces the number of unnecessary and inappropriate shocks and improves both patient's quality of life and device longevity. There is no clear indication regarding the type of ATP to be used, except for the treatment of fast ventricular tachycardias(188 bpm-250 bpm) where it has been shown a greater efficacy and safety of burst compared to ramp; 8 impulses in each sequence of ATP appears to be the best programming option in this setting. Beyond ATP use, excellent clinical results were obtained with programming standardization following these principles: extended detection time in ventricular fibrillation(VF) zone; supraventricular discrimination criteria up to 200 bpm; first shock in VF zone at the maximum energy in order to reduce the risk of multiple shocks. The MADIT-RIT trial and some observational registries have also recently demonstrated that programming with a widespread use of ATP, higher cut-off rates or delayed intervention reduces the number of inappropriate and unnecessary therapies and improves the survival of patients during mid-term follow-up.
文摘We present the case of a young woman corrected with a Mustard procedure undergoing successful transvenous double chamber pacemaker implantation with the atrial lead placed in the systemic venous channel. The case presented demonstrates that, when the systemic venous atrium is separate from the left atrial appendage, the lead can be easily and safely placed in the systemic venous left atrium gaining satisfactory sensing and pacing thresholds despite consisting partially of pericardial tissue.
文摘Background:Right ventricular pacing disrupts atrioventricular synchrony and increases the risk of atrial fi brillation(AF).However,whether algorithms for minimizing ventricular pacing reduce the incidence of AF remains controversial.Therefore,we conducted a systematic review and meta-analysis to compare the incidence of AF between minimizing ventricular pacing and conventional pacing protocols in patients with pacemakers implanted.Methods:The PubMed,Embase,and Cochrane Library databases were searched up to August 1,2017,for randomized controlled trials that reported the incidence of AF in patients with and without the use of algorithms for minimizing ventricular pacing.Results:Eleven studies comprising 5705 participants(61%males,mean age 71 years[standard deviation 11 years])were fi nally included in the analysis.The mean follow-up duration was 24 months.Use of algorithms for minimizing ventricular pacing signifi cantly reduced the incidence of AF,with an odds ratio of 0.74(95%confi dence interval 0.55–1.00;P<0.05).There was moderate heterogeneity among studies(I 2=63%).Conclusions:The incidence of AF was reduced by 26%with use of algorithms for minimizing ventricular pacing.The incorporation of such algorithms in routine clinical practice should in theory lead to a decrease in AF-related morbidity and mortality.
基金funded by the Mason Foundation National Medical Program(MAS2015F053).
文摘Objectives:People living with myalgic encephalomyelitis/chronic fatigue syndrome(ME/CFS)may face unique barriers to physical activity.Active video games may overcome these barriers and increase physical activity.The primary aim of this pilot study was to determine the feasibility and acceptability of active video games to increase physical activity levels of people with ME/CFS.Methods:A mixed method design was employed.Adults living with ME/CFS were randomised to a six-month intervention of(1)pacing,(2)pacing and conventional physical activity,or(3)pacing and active video gaming.Feasibility and acceptability were determined through semi-structured interviews.Health-related outcomes(e.g.,physical activity,blood samples,quality of life,and functioning)were also collected.Results:Fifteen people were assigned an intervention group with 12 completing.Three themes were identified from post-intervention interviews(1)positivity led to overall acceptability,(2)flexibility enabled participant autonomy,and(3)knowledge was gained about the self.No changes were seen in physical activity levels.An active video gaming intervention is acceptable but not feasible for people living with ME/CFS.Conclusions:Taken together,results suggest that physical activity can be managed safely by some people living with ME/CFS.Trial registration ACTRN12616000285459.
文摘Congenitally corrected transposition of the great arteries(CCTGA)is a rare congenital heart disease characterized by atrioventricular,ventriculoarterial,and conduction system discordance,commonly accompanied by atrioventricular block(AVB).Pacing in patients with CCTGA and AVB(both pediatric and adult)poses challenges in strategy selection,procedural complexity,and clinical decision-making due to limited evidence.Conventional morphological left ventricular pacing is widely adopted but may induce ventricular dyssynchrony,heart failure,and tricuspid valve dysfunction.While cardiac resynchronization therapy serves as an upgrade for pacing-induced cardiomyopathy and heart failure,its application may be limited by coronary sinus anatomical variations and uncertain clinical outcomes.His bundle pacing is rarely reported due to the variation of the His bundle and high pacing threshold.The superficial,wide,multi-branched left bundle branch favors left bundle branch pacing,though delayed systemic right ventricle(sRV)activation may cause ventricular dyssynchrony and impair sRV function.Right bundle branch pacing offers a novel alternative for pacing therapy.Conduction system pacing-optimized cardiac resynchronization therapy is preferred in those with evidence of intrinsic ventricular conduction dysfunction.This narrative review synthesizes current evidence on pacing strategies for CCTGA with AVB,integrating anatomical and pathophysiological insights to evaluate physiological pacing strategies,while highlighting critical knowledge gaps to guide future research.
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.
文摘本文围绕贵州“富矿精开”需求,针对贵州大学专业型研究生培养存在的模式同质化、实践资源短缺、成果转化率低等问题,通过整合矿山水文地质领域的特色课程资源、深化校企协同实践平台、推进多学科交叉创新,构建了以“课程引导-工程实践-创新提升-论文凝练”为核心的专业-应用-创新型精英人才(Professional Applied and Creative-skilled Elite,PACE)培养模式。该模式显著提升了研究生的实践创新能力,为区域产业升级提供了高层次应用型人才支撑。研究表明,PACE模式通过贯通“专业能力-实践能力-创新能力”培养链条,实现了专业型研究生“精英化”成才目标,为地方高校服务区域战略需求提供了可复制的教育范式。
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.
文摘Background Super-responders （SRs） are defined as patients who show crucial cardiac function improvement after cardiac resynchro- nization therapy （CRT）. The purpose of this study is to identify and validate predictors of SRs after CRT. Methods This study enrolled 201 patients who underwent CRT during the period from 2010 to 2014. Clinical and echocardiographic evaluations were conducted before CRT and 6 months after. Patients with a decrease in New York Heart Association （NYHA） fimctional class 〉 1, a decrease in left ventricular end-systolic volume （LVESV） ≥ 15%, and a final left ventricular ejection fraction （LVEF） ≥ 45% were classified as SRs. Results 29% of the 201 patients who underwent CRT were identified as SRs. At baseline, SRs had significantly smaller left atrial diameter （LAD）, LVESV, left ventricular end-diastolic volume （LVEDV） and higher LVEF than the non-super-responders （non-SRs）. The percentage of patients using angiotensin-converting enzyme inhibitors or angiotensin receptor blockers （ACEI/ARB） was higher in SRs than non-SRs. Most SRs had Biventricular （BiV） pacing percentage greater than 98% six months after CRT. In the multivariate logistic regression analysis, the independ- ent predictors of SRs were lower LVEDV [odd ratios （OR）： 0.93; confidence intervals （CI）： 0.90-0.97], use of ACEI/ARB （OR： 0.33; CI： 0.13~3.82） and BiV pacing percentage greater than 98% （OR： 0.29; CI： 0.16~.87）. Conclusion Patients with a better compliance of ACEI/ARB and a less ectatic ventricular geometry before CRT tends to have a greater probability of becoming SRs. Higher percentage of BiV pacing is essential for becoming SRs.
文摘Objective To evaluate left univentricular （LUV） pacing for cardiac resynchronization therapy （CRT） using a rate-adaptive atrioven- tricular delay （RAAVD） algorithm to track physiological atrioventricular delay （AVD）. Methods A total of 72 patients with congestive heart failure （CHF） were randomized to RAAVD LUV pacing versus standard biventricular （BiV） pacing in a 1 ： 1 ratio. Echocardiography was used to optimize AVD for both groups. The effects of sequential BiV pacing and LUV pacing with optimized A-V （right atrio-LV） delay using an RAAVD algorithm were compared. The standard deviation （SD） of the S/R ratio in lead VI at five heart rate （HR） segments （Rs/R-SD5）, defined as the ＂tracking index,＂ was used to evaluate the accuracy of the RAAVD algorithm for tracking physiological AVD. Results TheQRS complex duration （132 ± 9.8 vs. 138± 10ms, P 〈 0.05）, the time required for optimization （21 ±5 vs. 50±8min, P〈 0.001）, the mitral regurgitant area （1.9 ± 1.1 vs. 2.5 ± 1.3 em2, P 〈 0.05）, the interventricular mechanical delay time （60.7 ± 13.3 ms vs. 68.3 ± 14.2 ms, P 〈 0.05）, and the average annual cost （13,200 ± 1000 vs. 21,600 ± 2000 RMB, P 〈 0.001） in the RAAVD LUV pacing group were significantly less than those in the standard BiV pacing group. The aortic valve velocity-time integral in the RAAVD LUV pacing group was greater than that in the standard BiV pacing group （22.7 ± 2.2 vs. 21.4 ± 2.1 cm, P 〈 0.05）. The Rs/R-SD5 was 4.08 ± 1.91 in the RAAVD LUV pacing group, and was significantly negatively correlated with improved left ventricular ejection fraction （LVEF） （ALVEF, Pearson＇s r = -0.427, P = 0.009）, and positively correlated with New York Heart Association class （Spearman＇s r - 0.348, P 0.037）. Conclusions RAAVD LUV pacing is as effective as standard BiV pacing, can be more physiological than standard BiV pacing, and can de- crease the average annual cost of CRT.
基金supported in part by grants from the Science and Technology Key Foundation of Guangdong Province(No.2010B031600166)the Science and Technology Foundation of Guangdong Province(No.2011B061300072)
文摘Summary： Lead placement for ventricular pacing variably impacts the physiological benefit of the pa- tient. This study evaluated the ventricular lead performance and safety of right ventricular outflow tract septal pacing in patients with bradyarrhythmia in South China over 60-month follow-up. Totally, 192 patients （108 males, and 84 females, 63-4-21 years old） with bradyarrhythmia were randomly divided into two groups. The right ventricular outflow tract septum （RVOTs） group had lead placement near the sep- tum （n=97）, while the right ventricular apex （RVA） group had a traditional apical placement （n=95）. RV septal lead positioning was achieved with a specialized stylet and confirmed using fluoroscopic projec- tion. All patients were followed up for 60 months. Follow-up assessment included stimulation threshold, R-wave sensing, lead impedance and lead complications. The time of electrode implantation in both the ROVTs and RVA groups were significantly different （4.29±0.61 vs. 2.16±0.22 min; P=0.009）. No dif- ferences were identified in threshold, impedance or R-wave sensing between the two groups at 1 st, 12th, 36th and 60th month during the follow-up period. No occurrence of electrode displacement, increased pacing threshold or inadequate sensing was found. The long-term active fixation ventricular electrode performance in RVOTs group was similar to that in RVA group. RVOTs pacing near the septum using active fixation electrodes may provide stability during long-term follow-up period.
文摘AIM: To evaluate the current state-of-the-art of gastric electrical stimulation to treat obesity. METHODS: Systematic reviews of all studies have been conducted to evaluate the effect of different types of gastric electrical stimulation(GES) on obesity.RESULTS: Thirty-one studies consisting of a total of 33 different trials were included in the systematic review for data analysis. Weight loss was achieved in most studies, especially during the first 12 mo, but only very few studies had a follow-up period longer than 1 year. Among those that had a longer follow-up period, many were from the Transcend(Implantable Gastric Stimulation) device group and maintained significant weight loss. Other significant results included changes in appetite/satiety, gastric emptying rate, blood pressure and neurohormone levels or biochemical markers such as ghrelin or HbA1 c respectively. CONCLUSION: GES holds great promises to be an effective obesity treatment. However, stronger evidence is required through more studies with a standardized way of carrying out trials and reporting outcomes, to determine the long-term effect of GES on obesity.
