BACKGROUND: Adoption and outcomes for conduction system pacing (CSP), which includes His bundle pacing (HBP) or left bundle branch area pacing (LBBAP), in real-world settings are incompletely understood. We sought to describe real-world adoption of CSP lead implantation and subsequent outcomes. METHODS: We performed an online cross-sectional survey on the implantation and outcomes associated with CSP, between November 15, 2020, and February 15, 2021. We described survey responses and reported HBP and LBBAP outcomes for bradycardia pacing and cardiac resynchronization CRT indications, separately. RESULTS: The analysis cohort included 140 institutions, located on 5 continents, who contributed data to the worldwide survey on CSP. Of these, 127 institutions (90.7%) reported experience implanting CSP leads. CSP and overall device implantation volumes were reported by 84 institutions. In 2019, the median proportion of device implants with CSP, HBP, and/or LBBAP leads attempted were 4.4% (interquartile range [IQR], 1.9-12.5%; range, 0.4-100%), 3.3% (IQR, 1.3-7.1%; range, 0.2-87.0%), and 2.5% (IQR, 0.5-24.0%; range, 0.1-55.6%), respectively. For bradycardia pacing indications, HBP leads, as compared to LBBAP leads, had higher reported implant threshold (median [IQR]: 1.5 V [1.3-2.0 V] vs 0.8 V [0.6-1.0 V], p = 0.0008) and lower ventricular sensing (median [IQR]: 4.0 mV [3.0-5.0 mV] vs. 10.0 mV [7.0-12.0 mV], p < 0.0001). CONCLUSION: In conclusion, CSP lead implantation has been broadly adopted but has yet to become the default approach at most surveyed institutions. As the indications and data for CSP continue to evolve, strategies to educate and promote CSP lead implantation at institutions without CSP lead implantation experience would be necessary.

• Klíčová slova
• Conduction system pacing, His bundle pacing, Left bundle branch area pacing,
• MeSH
• bradykardie * terapie   MeSH
• elektrokardiografie MeSH
• Hisův svazek * MeSH
• kardiostimulace umělá MeSH
• lidé MeSH
• nemoci převodního systému srdečního MeSH
• převodní systém srdeční MeSH
• průřezové studie MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF REVIEW: To review and prioritize data on pediatric cardiac pacing published during the period of the last 18 months. RECENT FINDINGS: New approaches to preservation of ventricular function in pediatric pacing are based on recent publications confirming major influence of the ventricular pacing site on left ventricular (LV) function and synchrony. Current studies on epicardial vs. transvenous pacing continue to show survival superiority of endocardial leads. Long-term outcome of epicardial pacing may, however, be positively influenced by technical refinements. Recent amendments of the guidelines for cardiac resynchronization therapy (CRT) in adult idiopathic and ischemic cardiomyopathy are likely to influence CRT indications in children. Novel data give interesting insights into implantable cardioverter-defibrillator (ICD) lead survival as well as the use of ICDs in young patients with hypertrophic cardiomyopathy. SUMMARY: Pediatric cardiac pacing and ICD therapy is still a developing field likely to improve with technical refinements, proper lead placement and more specific therapy indications. The current review will give the reader information about recent developments and directions for the future.

• MeSH
• defibrilátory implantabilní MeSH
• dítě MeSH
• funkce levé komory srdeční MeSH
• kardiomyopatie komplikace   MeSH
• kardiostimulace umělá metody   MeSH
• kardiostimulátor * MeSH
• lidé MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• srdeční arytmie etiologie   terapie   MeSH
• srdeční resynchronizační terapie metody   MeSH
• srdeční selhání etiologie   terapie   MeSH
• vrozené srdeční vady komplikace   MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

BACKGROUND: Bifocal pacing (BFP) has been proposed as a feasible alternative to cardiac resynchronization therapy. AIM: To evaluate BFP in patients with severe heart failure and significant intraventricular conduction delay and to compare it with biventricular pacing (BVP). METHODS: Echocardiographic examination including TDI and invasive measurement of haemodynamics was performed under basal conditions, during BFP and during BVP. RESULTS: Fifty patients were included: 29 with ischaemic heart disease (IHD), 21 with idiopathic dilated cardiomyopathy (IDCM). LV dp/dt(max) increased during BFP compared to the basal state (13.4%, 95% CI 9.2-17.6%, p<0.0001) and a further increase was achieved during BVP (29.5%, 95% CI 23.7-35.4%, p<0.0001). A significant correlation was found between the distance of the right ventricular apical and outflow tract leads and percentage of dp/dt(max) increase in IDCM patients (r=0.72), but not in IHD patients. Interventricular mechanical delay (IVMD) decreased in BFP (43+/-22 ms vs. 53+/-31 ms, p=0.006), but BVP produced even shorter IVMD (22+/-19 ms, p<0.0001). In all patients, regional systolic contraction times were significantly shortened, corresponding with prolongation of the respective regional diastolic filling times during both BFP (p<0.05 for all segments) and BVP (p<0.001 for all segments). CONCLUSIONS: BFP improves LV haemodynamics by decreasing the inter- and intraventricular conduction delays. The leads in the right ventricle should be placed at the longest achievable distance. BVP is superior to BFP.

• MeSH
• časové faktory MeSH
• dilatační kardiomyopatie patofyziologie   terapie   MeSH
• dopplerovská echokardiografie metody   MeSH
• ischemická choroba srdeční patofyziologie   terapie   MeSH
• kardiostimulace umělá škodlivé účinky   metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• reprodukovatelnost výsledků MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• hodnotící studie MeSH
• srovnávací studie MeSH

BACKGROUND: In patients with biventricular pacing (BIV), triple-site pacing (TSP), i.e. standard biventricular cathodal pacing of the right and the left ventricle plus additional anodal capture of the right ventricle, is sometimes present. AIMS: To evaluate the incidence of TSP phenomenon, to examine TSP-related QRS changes, and to assess the effect of TSP on intraventricular resynchronization by means of tissue Doppler imaging (TDI). METHODS AND RESULTS: 23 patients with a first generation biventricular device (Medtronic 8040) and 16 patients with a new generation device (Medtronic 8042) were evaluated to look for the presence of TSP. TSP was found in 6 patients (26%) with the Medtronic 8040 (group I) and in 13 patients (81%) with the Medtronic 8042 device (group II). QRS duration decreased by 10 to 20 ms and QRS amplitude of leads I and aVL increased in almost all patients in group I during TSP modality. In group II, QRS morphology, duration and amplitude did not change as obviously. TDI analysis of the left ventricular (LV) basal segments showed significant shortening of the systole, together with a corresponding prolongation of the diastole, at the inferior wall of the LV, during TSP compared to standard BIV in all patients ( p < 0.01). Other LV segments did not show any change. Qualitative TDI electro-mechanical activation pattern of all LV segments improved in 22%, while it remained unchanged in 72%. CONCLUSIONS: TSP phenomenon can be identified in approximately a quarter of patients with the first-generation biventricular devices on the basis of the QRS morphology changes. In the second-generation biventricular pacemakers it can be demonstrated in the vast majority of patients. TSP may increase the effectiveness of cardiac resynchronization therapy by counteracting the regional activation delay located at the inferior wall of the LV.

• MeSH
• dopplerovská echokardiografie MeSH
• elektrokardiografie MeSH
• funkce levé komory srdeční MeSH
• kardiostimulace umělá metody   MeSH
• kardiostimulátor MeSH
• kontrakce myokardu MeSH
• lidé MeSH
• senioři MeSH
• srdeční selhání terapie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Dual-chamber leadless pacemakers (LPs) require robust communication between distinct right atrial (RA) and right ventricular (RV) LPs to achieve atrioventricular (AV) synchrony. OBJECTIVE: The purpose of this preclinical study was to evaluate a novel, continuous implant-to-implant (i2i™) communication methodology for maintaining AV-synchronous, dual-chamber DDD(R) pacing by the 2 LPs. METHODS: RA and RV LPs were implanted and paired in 7 ovine subjects (4 with induced complete heart block). AV synchrony (% AV intervals <300 ms) and i2i communication success (% successful i2i transmissions between LPs) were evaluated acutely and chronically. During acute testing, 12-lead electrocardiographic and LP diagnostic data were collected from 5-minute recordings, in 4 postures and 2 rhythms (AP-VP and AS-VP, or AP-VS and AS-VS) per subject. Chronic i2i performance was evaluated through 23 weeks postimplant (final i2i evaluation period: week 16-23). RESULTS: Acute AV synchrony and i2i communication success across multiple postures and rhythms were median [interquartile range] 100.0% [100.0%-100.0%] and 99.9% [99.9%-99.9%], respectively. AV synchrony and i2i success rates did not differ across postures (P = .59, P = .11) or rhythms (P = 1, P = .82). During the final i2i evaluation period, the overall i2i success was 98.9% [98.1%-99.0%]. CONCLUSION: Successful AV-synchronous, dual-chamber DDD(R) leadless pacing using a novel, continuous, wireless communication modality was demonstrated across variations in posture and rhythm in a preclinical model.

• Klíčová slova
• Atrioventricular synchrony, Aveir, Cardiac implantable electronic device, Conduction block, DDDR, Dual-chamber, Leadless pacemaker, Wireless communication, i2i,
• MeSH
• atrioventrikulární blokáda * terapie   MeSH
• kardiostimulace umělá metody   MeSH
• kardiostimulátor * MeSH
• lidé MeSH
• lipopolysacharidy MeSH
• ovce MeSH
• srdeční frekvence MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• lipopolysacharidy MeSH

AIMS: To evaluate the results of permanent epicardial pacing in children. METHODS AND RESULTS: All consecutive patients from one country (n = 119, period 1977-2009) undergoing permanent epicardial pacemaker implantation at <18 years of age (median 1.8 years, inter-quartile range 0.3-6.4 years) were studied retrospectively. Median patient follow up was 6.4 years (inter-quartile range 2.9-11.1 years); 207 generators, 89 atrial and 153 ventricular pacing leads were implanted. The probability of absence of any pacing system dysfunction was 70.1 and 47.2% at 5 and 10 years after implantation, respectively. Overall probability of continued epicardial pacing was 92.8 and 76.1% at 5 and 10 years, respectively, and increased in the recent implantation era (post-2000, P = 0.04). The use of steroid-eluting leads decreased the risk of exit block with a hazard ratio (HR) of 0.20 [95% confidence interval (CI) 0.09-0.44, P < 0.001)]. The use of bipolar Medtronic 4968 leads reduced the risk of surgical reintervention because of fracture, insulation break, outgrowth or exit block in comparison to the unipolar 4965 lead design (HR 0.12, 95% CI 0.04-0.40, P < 0.001). The AutoCapture™ feature (HR 0.08, 95% CI 0.02-0.36, P < 0.001) and steroid-eluting leads (HR 0.30, 95% CI 0.11-0.84, P = 0.021) decreased the risk of battery depletion. CONCLUSION: The probability of continued epicardial pacing in children was 76% at 10 years after implantation, increased for implantation in recent years, and allowed transvenous pacing to be deferred to a significantly greater age. The use of bipolar steroid-eluting leads and of a beat-to-beat capture tracking feature significantly increased pacing system longevity and decreased the need for surgical reinterventions.

• MeSH
• dítě MeSH
• hodnocení rizik MeSH
• kardiostimulace umělá statistika a číselné údaje   MeSH
• kojenec MeSH
• lidé MeSH
• longitudinální studie MeSH
• perikard * MeSH
• předškolní dítě MeSH
• rizikové faktory MeSH
• srdeční arytmie epidemiologie   prevence a kontrola   MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

OBJECTIVE: Pharmacotherapy for epilepsy is limited with 30% of patients refractory to this approach of suppressing seizures. Current surgical options are invasive and carry significant morbidities including infection, bleeding, and the potential for deleterious neurocognitive effects. As a result, there is a burgeoning need for innovation to develop safer and efficacious interventions. METHODS: Four distinct catheters (2 existing: Cardima catheter, Standard EPT Blazer catheter; 2 new prototypes: balloon catheter, basket catheters) were tested in 12 baboons (21-30 kg, 100% male). For each, we assessed whether or not the catheter was able to be maneuvered safely in various locations of the cerebral venous system, provide adequate cortical tissue contact to record signals, detect these signals as normal or abnormal, successfully stimulate the cortex, and capture the cortical tissue. Locations trialed included the petrosal sinus, straight sinus, vein of Galen, and occipital vein. Pacing cycle length and pacing thresholds varied among experiments. RESULTS: Successful mapping was conducted in all 12 baboons. The pacing cycle length varied from 75 ms to 650 ms depending on location of the cortex. Pacing threshold was recorded in 4/12 (33%) of the experiments; data is not available for the remaining 8/12 experiments. The threshold values ranged from 0.3 - 20 mAmps. Capture of cortical electrical activity was observed in 11/12 (91.7 %) experiments though the number of successful capture and stimulation attempts varied among experiments. The most reliable and consistent capture occurred with the use of our novel prototyped over-the-wire balloon catheter (9/12; 75%) and basket catheter (3/3; 100%). Necropsy and histology were performed post-experimentation, and only minimal complications were noted (Table 1). CONCLUSION: New electrode design can be maneuvered safely in the venous system, provide adequate cortical tissue contact to record signals, detect these signals as normal or abnormal, successfully stimulate the cortex, and capture cortical tissue. These novel devices merit further study in chronic baboons to establish long-term efficacy of continuous seizure recording.

• Klíčová slova
• Epilepsy, cerebral cortex, primates, venous pacing,
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: To evaluate systolic dyssynchrony index (SDI) measured by real time three-dimensional echocardiography (RT3DE) and Doppler tissue imaging (DTI) dyssynchrony parameters in predicting the hemodynamic response to biventricular (BIV) pacing in the early postoperative period after cardiac surgery. To compare right ventricular (RV) and BIV pacing using invasively measured hemodynamic values. METHODS: A prospective randomized clinical study enrolling 11 patients with ischemic heart disease, concomitant valvular heart disease, and left ventricular ejection fraction (LVEF) ≤ 35% comparing preoperative SDI by RT3DE and DTI LV dyssynchrony parameters to hemodynamic values obtained during RV or BIV sequential (DDD) epicardial pacing in the first 72 hours after cardiac surgery. RESULTS: BIV pacing produced a statistically significant higher cardiac output (CO) (6.27 ± 1.55 L/min) and cardiac index (CI) (3.44 ± 0.93 L/min per m(2) ) than RV pacing (CO 5.44 ± 0.97 L/min, CI 3.03 ± 0.83 L/min per m(2) , P < 0.05). We found a statistically moderate correlation between preoperative SDI by RT3DE and CO (r = 0.596, P < 0.05) and a nonsignificant correlation to CI (r = 0.535, P < 0.10) during BIV pacing. No correlation was observed between DTI dyssynchrony parameters and measured hemodynamic values. BIV pacing reduced the ICU stay and inotropic support requirements of patients after heart surgery. CONCLUSIONS: SDI measured preoperatively using RT3DE can predict CO during BIV pacing in the early postoperative period after cardiac surgery. BIV pacing is more hemodynamically effective than RV pacing in patients with LV dysfunction after coronary artery bypass grafting with or without a valve procedure.

• MeSH
• dopplerovská echokardiografie metody   MeSH
• dysfunkce levé srdeční komory diagnostické zobrazování   prevence a kontrola   MeSH
• echokardiografie trojrozměrná metody   MeSH
• kardiochirurgické výkony MeSH
• lidé MeSH
• pilotní projekty MeSH
• počítačové systémy MeSH
• pooperační péče MeSH
• reprodukovatelnost výsledků MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• srdeční resynchronizační terapie * MeSH
• stupeň závažnosti nemoci MeSH
• systolické srdeční selhání diagnostické zobrazování   prevence a kontrola   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH

The aim of this study was to determine the neurocognitive and neuropsychiatric effects of continuous positive airway pressure treatment on patients with obstructive sleep apnea. This cross-sectional, prospective, observational study included 126 patients with sleep apnea. The following tests were performed: the Montreal Cognitive Assessment for the evaluation of cognitive impairment, the Beck Depression Inventory, and the State-Trait Anxiety Inventory, together with the Epworth Sleepiness Scale for the evaluation of neuropsychiatric symptoms and a person's general level of daytime sleepiness. The first measurement did not show neurocognitive impairment or a higher level of depressive and anxiety symptoms in 126 patients with obstructive sleep apnea in comparison to normative standards. After the 3-month treatment indicated for 43 patients with obstructive sleep apnea, we did not find any significant improvement in cognitive performance (p = .213). However, patients with sleep apnea with continuous positive airway pressure treatment did show significantly less daytime sleepiness, anxiety and depressive symptoms (all p < .001). In conclusion, short-term (3 months) treatment of patients with obstructive sleep apnea can substantially alleviate their daytime sleepiness, as well as depressive and anxiety symptoms.

• Klíčová slova
• affective disorders, anxiety, cognition, depression, sleep disorders,
• MeSH
• lidé středního věku MeSH
• lidé MeSH
• neurokognitivní poruchy etiologie   patologie   MeSH
• neuropsychologické testy normy   MeSH
• obstrukční spánková apnoe patofyziologie   MeSH
• prospektivní studie MeSH
• průřezové studie MeSH
• trvalý přetlak v dýchacích cestách metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Continuous deep septal pacing and signal recording during implantation of left bundle branch pacing (LBBP) lead enables to monitor beat-to-beat changes of electrocardiogram (ECG) and myocardial current of injury (COI) as the lead crosses the septum. OBJECTIVES: This study aimed to characterize patterns of continuous QRS, ST-T, and COI change for monitoring of the lead depth and instantaneous determination of the obtained capture type (LBBP vs left ventricular septal pacing [LVSP]). METHODS: The ECG and COI during lead implantation were scrutinized for sudden changes of V6 R-wave peak time, V1 initial and terminal R-wave amplitude, V3-V6 R-wave amplitude, repolarization pattern and S-wave amplitude in I, V5-V6, and COI drop. The sudden and gradual transition patterns were diagnosed depending on the presence or absence of the above beat-to-beat ECG phenomena, respectively. RESULTS: A total of 212 pacemaker recipients were analyzed; LBBP and LVSP were obtained in 77.4% and 22.6%, respectively. There were 4.7 ± 2.1 and 0.2 ± 0.6 beat-to-beat phenomena in LBBP and LVSP patients, respectively. The sudden transition pattern, recognized in 80.7%, had sensitivity and specificity for LBBP diagnosis of 98.8% and 81.2%, respectively. A sudden drop of COI (29.4 ± 8.5 mV to 12.8 ± 4.9 mV) was observed in 53.9% patients (LBBP was simultaneously obtained in 92.7%). CONCLUSIONS: Capture of left bundle branch during lead penetration is a beat-to-beat phenomenon. Two transseptal transition patterns were identified: 1) sudden, which is typical for obtaining LBBP; and 2) gradual, which is typical for obtaining LVSP. A sudden COI drop, a very observable phenomenon, also identified reaching the left subendocardial area.

• Klíčová slova
• continuous pacing, current of injury, left bundle branch pacing, left ventricular septal pacing, transseptal patterns,
• MeSH
• blokáda Tawarova raménka patofyziologie   terapie   MeSH
• elektrokardiografie * MeSH
• Hisův svazek patofyziologie   MeSH
• kardiostimulace umělá metody   MeSH
• kardiostimulátor MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• srdeční septum patofyziologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH