Souhrn: Stimulace oblasti levého Tawarova raménka (LBBAP) je nový způsob stimulace u nemocných s bradykardií či indikací k resynchronizační terapii (CRT). Údajů o peroperačních a pooperačních výsledcích této metody je nedostatek. Metody: Do registru byli zařazeni všichni nemocní s bradykardií nebo indikací k CRT, u kterých byla v období 11/2018-5/2021 v průběhu operačního zákroku prováděna LBBAP v Kardiocentru FNKV a 3. LF UK. Většina pacientů byla do registru zařazena prospektivně a vybrané ukazatele byly doplňovány retrospektivně. Ke shromáždění základních klinických, peroperačních a pooperačních ukazatelů byly použity údaje z elektronického nemocničního infomačního systému a elektrofyziologického zařízení používaného v průběhu operačních zákroků. Výsledky: LBBAP byla prováděna u 329 pacientů, z toho se jednalo o 237 nemocných s bradykardií a 92 nemocných se CRT indikací. Stimulační prahy k dosažení LBBAP byly průměrně 0,6 ± 0,5V na 0,5 ms a při průměrné délce sledování 5 ± 5 měsíců byly stabilní (0,7 ± 0,3V na 0,4 ms). Komplikace byly pozorovány u 26 pacientů (8 %), z toho se u 15 z nich jednalo o komplikace specifické pro LBBAP (12× peroperační penetrace elektrody do dutiny LKS, 1× bolest na hrudi a 1× bolest na hrudi s elevacemi ST úseků po fixaci elektrody), které však odezněly bez následků ještě v průběhu zákroku. Celková úspěšnost LBBAP byla 89 % a byla signifikantně vyšší u pacientů s bradykardií, než u pacientů se CRT indikací (92 % vs. 83 %, p = 0,02). Byl pozorován významný vliv počtu provedených zákroků na úspěšnost LBBAP a výskyt některých komplikací. Závěr: LBBAP je možnou alternativou trvalé kardiostimulace u pacientů s bradykardií a indikací k CRT. Vyskytují se u ní některé specifické komplikace, jejichž význam je potřeba posoudit v kontextu benefitu metody v randomizovaných studiích.
Summary: Left bundle branch area pacing (LBBAP) is a new method of pacing in patients who have bradycardia or are indicated to receive cardiac resynchronization therapy (CRT). Data on intraoperative and postoperative outcomes of this method are lacking. Methods: All patients with bradycardia or an indication for CRT, who underwent LBBAP during a surgical procedure at the Heart Centre of the Kralovske Vinohrady University Hospital and the Third Faculty of Medicine of Charles University in the period from 11/2018 to 05/2021, were included in the registry. Most patients were included in the registry in a prospective manner, and selected parameters were added retrospectively. To obtain basic clinical, intraoperative, and postoperative parameters, data from the electronic hospital information system and the electrophysiological device employed during the course of surgical procedures were used. Results: LBBAP was performed in 329 patients, of which 237 had bradycardia and 92 were indicated to receive CRT. The pacing thresholds for achieving LBBAP were 0.6 ± 0.5 V per 0.5 ms on average, and were stable with a mean follow-up duration of 5 ± 5 months (0.7 ± 0.3 V per 0.4 ms). Complications were seen in 26 patients (8%), of which 15 were specific complications related to LBBAP (12 cases of intraoperative lead penetration into the right ventricle, 1 case of chest pain, and 1 case of chest pain with ST segment elevation after lead placement) which, however, resolved without sequelae during the course of the procedure. The overall success rate of LBBAP was 89% and was significantly higher in patients with bradycardia than in those indicated to receive CRT (92% vs 83%, p = 0.02). A significant effect of the number of procedures performed on the success rate of LBBAP and the rate of some complications was observed. Conclusion: LBBAP is a possible alternative to permanent cardiac pacing in patients who have bradycardia or are indicated to receive CRT. It is associated with certain specific complications, whose significance requires evaluation in terms of the method's benefit in randomized trials.
Background: Three different ventricular capture types are observed during left bundle branch pacing (LBBp). They are selective LBB pacing (sLBBp), non-selective LBB pacing (nsLBBp), and myocardial left septal pacing transiting from nsLBBp while decreasing the pacing output (LVSP). Study aimed to compare differences in ventricular depolarization between these captures using ultra-high-frequency electrocardiography (UHF-ECG). Methods: Using decremental pacing voltage output, we identified and studied nsLBBp, sLBBp, and LVSP in patients with bradycardia. Timing of ventricular activations in precordial leads was displayed using UHF-ECGs, and electrical dyssynchrony (e-DYS) was calculated as the difference between the first and last activation. The durations of local depolarizations (Vd) were determined as the width of the UHF-QRS complex at 50% of its amplitude. Results: In 57 consecutive patients, data were collected during nsLBBp (n = 57), LVSP (n = 34), and sLBBp (n = 23). Interventricular dyssynchrony (e-DYS) was significantly lower during LVSP -16 ms (-21; -11), than nsLBBp -24 ms (-28; -20) and sLBBp -31 ms (-36; -25). LVSP had the same V1d-V8d as nsLBBp and sLBBp except for V3d, which during LVSP was shorter than sLBBp; the mean difference -9 ms (-16; -1), p = 0.01. LVSP caused less interventricular dyssynchrony and the same or better local depolarization durations than nsLBBp and sLBBp irrespective of QRS morphology during spontaneous rhythm or paced QRS axis. Conclusions: In patients with bradycardia, LVSP in close proximity to LBB resulted in better interventricular synchrony than nsLBBp and sLBBp and did not significantly prolong depolarization of the left ventricular lateral wall.
- Publikační typ
- časopisecké články MeSH
OBJECTIVES: This study sought to comprehensively determine the procedural safety and midterm efficacy of hybrid ablations. BACKGROUND: Hybrid ablation of atrial fibrillation (AF) (thoracoscopic ablation followed by catheter ablation) has been used for patients with nonparoxysmal AF; however, accurate data regarding efficacy and safety are still limited. METHODS: Patients with nonparoxysmal AF underwent thoracoscopic, off-pump ablation using the COBRA Fusion radiofrequency system (Estech) followed by a catheter ablation 3 months afterward. The safety of the procedure was assessed using sequential brain magnetic resonance and neuropsychological examinations at baseline (1 day before), postoperatively (2-4 days for brain magnetic resonance imaging or 1 month for neuropsychological examination), and at 9 months after the surgical procedure. Implantable loop recorders were used to detect arrhythmia recurrence. Arrhythmia-free survival (the primary efficacy endpoint) was defined as no episodes of AF or atrial tachycardia while off antiarrhythmic drugs, redo ablations or cardioversions. RESULTS: Fifty-nine patients (age: 62.5 ± 10.5 years) were enrolled, 37 (62.7%) were men, and the mean follow-up was 30.3 ± 10.8 months. Thoracoscopic ablation was successfully performed in 55 (93.2%) patients. On baseline magnetic resonance imaging, chronic ischemic brain lesions were present in 60.0% of patients. New ischemic lesions on postoperative magnetic resonance imaging were present in 44.4%. Major postoperative cognitive dysfunction was present in 27.0% and 17.6% at 1 and 9 months postoperatively, respectively. The probability of arrhythmia-free survival was 54.0% (95% CI: 41.3-66.8) at 1 year and 43.8% (95% CI: 30.7-57.0) at 2 years. CONCLUSIONS: The thoracoscopic ablation is associated with a high risk of silent cerebral ischemia. The midterm efficacy of hybrid ablations is moderate.
- MeSH
- antiarytmika terapeutické užití MeSH
- fibrilace síní * farmakoterapie chirurgie MeSH
- katetrizační ablace * škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- supraventrikulární tachykardie * chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
BACKGROUND: Nonselective His-bundle pacing (nsHBp), nonselective left bundle branch pacing (nsLBBp), and left ventricular septal myocardial pacing (LVSP) are recognized as physiological pacing techniques. OBJECTIVE: The purpose of this study was to compare differences in ventricular depolarization between these techniques using ultra-high-frequency electrocardiography (UHF-ECG). METHODS: In patients with bradycardia, nsHBp, nsLBBp (confirmed concomitant left bundle branch [LBB] and myocardial capture), and LVSP (pacing in left ventricular [LV] septal position without proven LBB capture) were performed. Timings of ventricular activations in precordial leads were displayed using UHF-ECG, and electrical dyssynchrony (e-DYS) was calculated as the difference between the first and last activation. Duration of local depolarization (Vd) was determined as width of the UHF-QRS complex at 50% of its amplitude. RESULTS: In 68 patients, data were collected during nsLBBp (35), LVSP (96), and nsHBp (55). nsLBBp resulted in larger e-DYS than did LVSP and nsHBp [- 24 ms (-28;-19) vs -12 ms (-16;-9) vs 10 ms (7;14), respectively; P <.001]. nsLBBp produced similar values of Vd in leads V5-V8 (36-43 ms vs 38-43 ms; P = NS in all leads) but longer Vd in leads V1-V4 (47-59 ms vs 41-44 ms; P <.05) as nsHBp. LVSP caused prolonged Vd in leads V1-V8 compared to nsHBp and longer Vd in leads V5-V8 compared to nsLBBp (44-51 ms vs 36-43 ms; P <.05) regardless of R-wave peak time in lead V5 or QRS morphology in lead V1 present during LVSP. CONCLUSION: nslbbp preserves physiological LV depolarization but increases interventricular electrical dyssynchrony. LV lateral wall depolarization during LVSP is prolonged, but interventricular synchrony is preserved.
- MeSH
- blokáda Tawarova raménka patofyziologie terapie MeSH
- elektrokardiografie metody MeSH
- funkce levé komory srdeční fyziologie MeSH
- Hisův svazek patofyziologie MeSH
- kardiostimulace umělá metody MeSH
- lidé MeSH
- mezikomorová přepážka patofyziologie MeSH
- následné studie MeSH
- prospektivní studie MeSH
- senioři MeSH
- srdeční komory patofyziologie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- srovnávací studie MeSH
BACKGROUND: Right ventricular (RV) pacing causes delayed activation of remote ventricular segments. We used the ultra-high-frequency ECG (UHF-ECG) to describe ventricular depolarization when pacing different RV locations. METHODS: In 51 patients, temporary pacing was performed at the RV septum (mSp); further subclassified as right ventricular inflow tract (RVIT) and right ventricular outflow tract (RVOT) for septal inflow and outflow positions (below or above the plane of His bundle in right anterior oblique), apex, anterior lateral wall, and at the basal RV septum with nonselective His bundle or RBB capture (nsHBorRBBp). The timings of UHF-ECG electrical activations were quantified as left ventricular lateral wall delay (LVLWd; V8 activation delay) and RV lateral wall delay (RVLWd; V1 activation delay). RESULTS: The LVLWd was shortest for nsHBorRBBp (11 ms [95% confidence interval = 5-17]), followed by the RVIT (19 ms [11-26]) and the RVOT (33 ms [27-40]; p < .01 between all of them), although the QRSd for the latter two were the same (153 ms (148-158) vs. 153 ms (148-158); p = .99). RV apical capture not only had a longer LVLWd (34 ms (26-43) compared to mSp (27 ms (20-34), p < .05), but its RVLWd (17 ms (9-25) was also the longest compared to other RV pacing sites (mean values for nsHBorRBBp, mSp, anterior and lateral wall captures being below 6 ms), p < .001 compared to each of them. CONCLUSION: RVIT pacing produces better ventricular synchrony compared to other RV pacing locations with myocardial capture. However, UHF-ECG ventricular dysynchrony seen during RVIT pacing is increased compared to concomitant capture of basal septal myocytes and His bundle or proximal right bundle branch.
