Objective: To determine the feasibility of using temporary permanent pacemaker (TPPM) in patients with high-degree atrioventricular block (AVB) after transcatheter aortic valve replacement (TAVR) as bridging strategy to reduce avoidable permanent pacemaker implantation. Methods: This is a prospective observational study. Consecutive patients undergoing TAVR at Beijing Anzhen Hospital and the First Affiliated Hospital of Zhengzhou University from August 2021 to February 2022 were screened. Patients with high-degree AVB and TPPM were included. Patients were followed up for 4 weeks with pacemaker interrogation at every week. The endpoint was the success rate of TPPM removal and free from permanent pacemaker at 1 month after TPPM. The criteria of removing TPPM was no indication of permanent pacing and no pacing signal in 12 lead electrocardiogram (EGG) and 24 hours dynamic EGG, meanwhile the last pacemaker interrogation indicated that ventricular pacing rate was 0. Routinely follow-up ECG was extended to 6 months after removal of TPPM. Results: Ten patients met the inclusion criteria for TPPM, aged (77.0±11.1) years, wirh 7 females. There were 7 patients with third-degree AVB, 1 patient with second-degree AVB, 2 patients with first degree AVB with PR interval>240 ms and LBBB with QRS duration>150 ms. TPPM were applied on the 10 patients for (35±7) days. Among 8 patients with high-degree AVB, 3 recovered to sinus rhythm, and 3 recovered to sinus rhythm with bundle branch block. The other 2 patients with persistent third-degree AVB received permanent pacemaker implantation. For the 2 patients with first-degree AVB and LBBB, PR interval shortened to within 200 ms. TPPM was successfully removed in 8 patients (8/10) at 1 month without permanent pacemaker implantation, of which 2 patients recovered within 24 hours after TAVR and 6 patients recovered 24 hours later after TAVR. No aggravation of conduction block or permanent pacemaker indication were observed in 8 patients during follow-up at 6 months. No procedure-related adverse events occurred in all patients. Conclusion: TPPM is reliable and safe to provide certain buffer time to distinguish whether a permanent pacemaker is necessary in patients with high-degree conduction block after TAVR.
Female ; Humans ; Atrioventricular Block/therapy* ; Feasibility Studies ; Transcatheter Aortic Valve Replacement ; Pacemaker, Artificial ; Bundle-Branch Block

Bundle-Branch Block/therapy* ; Cardiac Pacing, Artificial ; Cardiac Resynchronization Therapy ; Electrocardiography ; Humans ; Treatment Outcome

Bundle of His ; Bundle-Branch Block/therapy* ; Cardiac Pacing, Artificial ; Electrocardiography ; Heart Conduction System ; Heart Failure/therapy* ; Humans

Objective: To investigate the efficacy and safety of left bundle branch area pacing (LBBaP) with the new simplified approach (nine-partition method). Methods: A total of 118 patients with clinical indications and received pacemaker implantation from December 1, 2018 to December 31, 2019 in Beijing Anzhen Hospital were enrolled. LBBaP was performed with the nine-partition method (in the right anterior oblique 30° position, the ventriculogram was divided into nine partitions and the initial implant sites were located in the lower base 1/3 partitions). In X-ray image, the 3830 lead is located in the left bundle branch area, the unipolar pacing QRS wave is in the form of right bundle branch block, and the peak time from stimulation to left ventricular activation<90 ms is defined as successful operation. The clinical characters, such as the methods of venipuncture, electrode parameters, operation duration, fluoroscopy duration, the peak time from stimulation to left ventricular, pacemaker types, surgical success rate, complications, and immediate postoperative ECG parameters were collected. The patients were followed up after the operation, and the electrode parameters and postoperative complications were recorded. Results: This study is a retrospective study. There were 62 (52.5%) male patients in this cohort, the average age was (65.9±13.4) years old,and there were 49(41.5%) sick sinus syndrome, 6(5.1%) abnormal sinus node and atrioventricular node simultaneously, 63(53.4%) atrioventricular block, 26(22.0%) atrial fibrillation, 20(16.9%) cardiomyopathy; the baseline duration of QRS was (109.21±39.03) ms. Successful LBBaP was achieved in 109 patients with"nine-partition method"and the success rate was 92.4%; 104 patients (95.5%) were axillary vein puncture, 5 (4.6%) were subclavian vein puncture; the operation duration was (80.3±23.0) min, the fluoroscopy duration was (12.29±5.13) min; the QRS duration after LBBaP was (116.36±18.11) ms. The threshold of the left bundle branch (LBB) lead was (0.92±0.63) V, the R wave amplitude was (10.60±5.04) mV and the impedance was (798.71±194.90) Ω. In 1 V pacing, the peak time from stimulation to left ventricular activation was (67.91±12.15) ms, and in 5 V pacing was (67.52±12.45) ms; 1 case (0.9%) with a single-chamber pacemaker implanted, 106 cases (97.3%) with dual-chamber pacemaker and 2 cases (1.8%) with three-chamber pacemakers. There were no hematomas, pneumothorax, hemothorax, electrode dislocation, infection, and capsular hemorrhage and other serious surgery-related complications during the operation. A total of 97 patients (89.0%) were followed up for (6.21±2.90) months. The electrode parameters of all patients were stable and no complications observed. Conclusions: The LBBaP with nine-partition method is a simple, safe and effective physiological pacing approach. However, its long-term effect still needs to be further verified.
Aged ; Atrioventricular Block ; Bundle-Branch Block/therapy* ; Cardiac Pacing, Artificial ; Feasibility Studies ; Humans ; Male ; Middle Aged ; Retrospective Studies

BACKGROUND: Although device-based optimization has been developed to overcome the limitations of conventional optimization methods in cardiac resynchronization therapy (CRT), few real-world data supports the results of clinical trials that showed the efficacy of automatic optimization algorithms. We investigated whether CRT using the adaptive CRT algorithm is comparable to non-adaptive biventricular (BiV) pacing optimized with electrocardiogram or echocardiography-based methods. METHODS: Consecutive 155 CRT patients were categorized into 3 groups according to the optimization methods: non-adaptive BiV (n = 129), adaptive BiV (n = 11), and adaptive left ventricular (LV) pacing (n = 15) groups. Additionally, a subgroup of patients (n = 59) with normal PR interval and left bundle branch block (LBBB) was selected from the non-adaptive BiV group. The primary outcomes included cardiac death, heart transplantation, LV assist device implantation, and heart failure admission. Secondary outcomes were electromechanical reverse remodeling and responder rates at 6 months after CRT. RESULTS: During a median 27.5-month follow-up, there was no significant difference in primary outcomes among the 3 groups. However, there was a trend toward better outcomes in the adaptive LV group compared to the other groups. In a more rigorous comparisons among the patients with normal PR interval and LBBB, similar patterns were still observed. CONCLUSION: In our first Asian-Pacific real-world data, automated dynamic CRT optimization showed comparable efficacy to conventional methods regarding clinical outcomes and electromechanical remodeling.
Bundle-Branch Block ; Cardiac Resynchronization Therapy ; Death ; Electrocardiography ; Follow-Up Studies ; Heart Failure ; Heart Transplantation ; Humans ; Immunodeficiency Virus, Bovine

Brugada syndrome is an arrhythmic syndrome characterized by right bundle branch block, ST segment elevation in the precordial lead (V1-V3), and sudden death caused by ventricular fibrillation, which is not effectively prevented by anti-arrhythmic drug therapy. We are reporting a 30-year-old male patient with Brugada syndrome who got an exploratory laparotomy and a tenorrhaphy due to stab wound which was managed with general anesthesia and brachial plexus block without any complications.
Adult ; Anesthesia, General ; Brachial Plexus Block* ; Brachial Plexus* ; Brugada Syndrome* ; Bundle-Branch Block ; Death, Sudden ; Drug Therapy ; Humans ; Laparotomy ; Male ; Ventricular Fibrillation ; Wounds, Stab

BACKGROUNDPatients with heart failure were candidates for cardiac resynchronization therapy (CRT) regardless of underlying aetiology. This study observed the effect of CRT in patients with ischaemic or nonischaemic cardiomyopathy.

METHODSOne hundred and forty-two patients with refractory chronic heart failure and left bundle branch block received cardiac resynchronization therapy, 91 men and 51 women, average age 60 years. Left ventricular ejection fraction (LVEF) was severely depressed (mean 29%), left ventricular end diastolic diameter (LVEDD) enlarged (mean 72 mm) and QRS width was lengthened (mean 147 ms). Ninety-eight had nonischaemic cardiomyopathy and 44 had ischaemic cardiomyopathy.

RESULTSAfter cardiac resynchronization therapy, the heart function was significantly improved. The mean LVEF increased from 29% to 36% after pacing. In patients with nonischaemic cardiomyopathy, the LVEF was improved from 28% to 37%, and in patients with ischaemic cardiomyopathy, the LVEF was improved from 30% to 36%. No significant difference of the improvement was found between the two groups (P > 0.05).

CONCLUSIONSCardiac resynchronization therapy could significantly improve cardiac function in patients with chronic heart failure regardless of the underlying heart disease.

Bundle-Branch Block ; physiopathology ; therapy ; Cardiac Pacing, Artificial ; methods ; Electrocardiography ; Female ; Heart Failure ; physiopathology ; therapy ; Humans ; Male ; Middle Aged ; Time Factors ; Treatment Outcome ; Ventricular Function, Left ; physiology

Although the estimates from limited studies vary on the proportion of patients with heart failure who also have ventricular dyssynchrony as reflected by a prolonged QRS complex, often in the form of left bundle branch block, the number of such patients is large (27% to 53%) and it is certainly in excess of the rate for the general population. Among these patients, 10% to 15% are candidates for cardiac resynchronization therapy (CRT) via biventricular pacing. Accumulated evidence from randomized controlled studies over the last few years has indicated that significant hemodynamic and clinical improvement is conferred by CRT to the class III or IV heart failure patients with idiopathic or ischemic dilated cardiomyopathy and who also have a low left ventricular ejection fraction (< or =35%) and a wide QRS complex (> or =120-150 ms). Newer data suggest a significant reduction in mortality and heart failure hospitalization, particularly when CRT is combined with an automatic defibrillator backup. This technique has transformed the traditional concepts associated with stimulation of the heart, and it is now being applied not only to restore an appropriate heart rate, but also to change the process of cardiac mechanical activation. Since this treatment must be integrated within a comprehensive and multidisciplinary CHF management program, CRT has altered the medical practice of heart experts in the field of cardiac pacing. Technical advances with percutaneous methods that access the tributaries of the cardiac veins have raised the success rate of implanting left ventricular leads to >90%. Further confirmation from ongoing trials is eagerly awaited, and more data from the studies on this procedure's cost effectiveness are needed before CRT is considered as a prime therapy in the heart failure population.
Bundle-Branch Block ; Cardiac Resynchronization Therapy* ; Cardiomyopathy, Dilated ; Cost-Benefit Analysis ; Defibrillators ; Heart ; Heart Failure ; Heart Rate ; Hemodynamics ; Hospitalization ; Humans ; Mortality ; Stroke Volume ; Veins

The occurrence of ventricular fibrillation in the absence of any structural heart disease is classified as "primary electrical disorder". The paradigm of primary electrical disease is the long-QT syndrome. In 1992, Brugada and Brugada first reported a unique electrocardiographic syndrome in which ventricular fibrillation could occur without obvious structural heart disease. Their report drew attention to this condition as another form of primary electrical disorder and Brugada syndrome has subsequently been recognized in virtually all parts of the world. Brugada syndrome is electrocardiographically characterized by ST-segment elevation in the right precordial leads, either with or without right bundle branch block. Although its incidence and distribution have not been confirmed, it may be considerably more common in Southeast Asia. Sudden death is common, may be the first manifestation of disease during its clinical course, and is not effectively prevented by anti-arrhythmic drug therapy. This has led to the recommendation for the placement of an implantable cardioverter-defibrillator in symptomatic patients. The purpose of this paper is to describe the current understanding of Brugada syndrome.
Asia, Southeastern ; Brugada Syndrome* ; Bundle-Branch Block ; Death, Sudden ; Death, Sudden, Cardiac ; Defibrillators, Implantable ; Drug Therapy ; Electrocardiography ; Heart Diseases ; Humans ; Incidence ; Ventricular Fibrillation

65-year-old woman was admitted to our hospital with acute decompensated heart failure with reduced left ventricular ejection fraction and severe mitral regurgitation. Electrocardiography revealed a typical left bundle branch block and atrial fibrillation. Her condition deteriorated despite administering high-doses of inotropes and vasopressors. Pending a decision to therapy, venoarterial extracorporeal membrane oxygenation (ECMO) was performed when the patient underwent a cardiogenic shock. Although the hemodynamic status stabilized with ECMO support, weaning the patient from ECMO was not possible. Thus, we decided to perform cardiac resynchronization with defibrillator implantation as a “rescue” therapy. Five days post-implantation, the patient was successfully weaned from ECMO.
Aged ; Atrial Fibrillation ; Bundle-Branch Block ; Cardiac Resynchronization Therapy* ; Defibrillators ; Electrocardiography ; Extracorporeal Membrane Oxygenation ; Female ; Heart Failure ; Hemodynamics ; Humans ; Mitral Valve Insufficiency ; Shock, Cardiogenic* ; Stroke Volume ; Weaning