Permanent Cardiac Pacing of the Right Ventricular Outflow Tract Guided by Real-time Assessment of Electromechanical Synchrony.

Permanent right ventricular apical pacing deteriorates cardiac systolic function in some patients. We investigated an alternative site for permanent pacemaker (PPM) lead positioning with the goal of achieving more physiological pacing. A total of 132 patients with bradyarrhythmias underwent PPM implantation at the right ventricular outflow tract (RVOT) with conventional active-fixation leads.

Breaching septal veins while attempting left bundle branch area pacing. If necessary, septography contrast should be injected in a stepwise approach.

Permanent transseptal left bundle branch area pacing (LBBAP) is a promising technique developed to avoid the detrimental effects of pacing-induced dyssynchrony with right ventricular (RV) pacing, by offering more physiologic activation of the heart. Lesions to tributary veins of the coronary sinus have been increasingly reported, mostly associated with venous fistula or venous septal system infringement. Despite being mostly benign, venous complications may be related to the maneuver of contrast injection through the sheath and failure to follow simple but essential steps.

Coronary artery complications after left bundle branch area pacing: An increasingly reported issue in the era of physiologic pacing.

Coronary artery lesions related to pacemaker implantation are rare complications. With the increasing adoption of the technique of permanent transseptal pacing of the left bundle branch area pacing (LBBAP), an increase in the incidence of these complications may be expected. We report two cases of coronary lesions after permanent transeptal pacing of the LBBAP: the first with a small coronary artery fistula, and the second with an extrinsic coronary compression.

Cardiomyopathy Induced by Artificial Cardiac Pacing: To Whom, When, Why, and How? Insights on Heart Failure Development.

Coordinated and harmonic (synchronous) ventricular electrical activation is essential for better left ventricular systolic function. Intraventricular conduction abnormalities, such as left bundle branch block due to artificial cardiac pacing, lead to electromechanical "dyssynchronopathy" with deleterious structural and clinical consequences. The aim of this review was to describe and improve the understanding of all the processes connecting the several mechanisms involved in the development of artificially induced ventricular dyssynchrony by cardiac pacing, most known as pacing-induced cardiomyopathy (PiCM).

Ventricular Synchrony in Para-Hisian Cardiac Pacing as an Alternative for Physiological Cardiac Activation (Indirect Recruitment of the His Bundle?).

Background: Artificial cardiac pacing by direct or indirect His bundle capture results in synchronous ventricular contraction (physiological pacing).

Objectives: To compare cardiac synchronization, technical characteristics, and electronic parameters between two techniques of indirect His-bundle pacing: non-selective (NS-HBP) vs para-Hisian pacing (PHP).

Methods: The experimental intervention (between November 2019 and April 2020) consisted of implanting a DDD pacemaker in patients who had left ventricular ejection fraction (LVEF) > 35%.

Brugada pattern as part of the electrocardiographic abnormalities in hyperkalemia.

A 78-year-old man presented to the emergency department with a 10-day history of diarrhea and presyncope. His electrocardiogram showed a type-1 Brugada pattern but also a first-degree atrioventricular block, right bundle branch block, and peaked and symmetrical hyperacute T waves. A blood test revealed a potassium level of 9.

Ultrasound-guided Axillary Vein Puncture in Cardiac Lead Implantation: Time to Move to a New Standard Access?

Cardiac stimulation therapy has evolved significantly over the past 30 years. Currently, cardiac implantable electronic devices (CIED) are the mainstream therapy for many potentially lethal heart conditions, such as advanced atrioventricular block or sustained ventricular tachycardia or fibrillation. Despite sometimes being lifesaving, the implant is surgical and therefore carries all the inevitable intrinsic risks.

Axillary vein puncture guided by ultrasound vs cephalic vein dissection in pacemaker and defibrillator implant: A multicenter randomized clinical trial.

Background: Axillary vein puncture guided by ultrasound (US-Ax) has emerged as a valid alternative access route to pacemaker and defibrillator lead insertion.

Objective: The purpose of this study was to evaluate whether US-Ax compared to cephalic vein dissection (CV) improves success and early complications in pacemaker or defibrillator implant.

Methods: This prospective, multicenter clinical trial included 88 adult patients randomized 1:1 to US-Ax (n = 44) or CV (n = 44).

Predictors of Total Mortality and Echocardiographic Response for Cardiac Resynchronization Therapy: A Cohort Study.

Background: Clinical studies demonstrate that up to 40% of patients do not respond to cardiac resynchronization therapy (CRT), thus, appropriate patient selection is critical to the success of CRT in heart failure.

Objective: Evaluation of mortality predictors and response to CRT in the Brazilian scenario.

Methods: Retrospective cohort study including patients submitted to CRT in a tertiary hospital in southern Brazil from 2008 to 2014.

Permanent Pacing After Transcatheter Aortic Valve Implantation: Incidence, Predictors and Evolution of Left Ventricular Function.

Background: Transcatheter aortic valve implantation (TAVI) is a well-established procedure; however, atrioventricular block requiring permanent pacemaker implantation (PPI) is a common complication.

Objectives: To determine the incidence, predictors and clinical outcomes of PPI after TAVI, focusing on how PPI affects left ventricular ejection fraction (LVEF) after TAVI.

Methods: The Brazilian Multicenter TAVI Registry included 819 patients submitted to TAVI due to severe aortic stenosis from 22 centers from January/2008 to January/2015.

Atrioventricular block in coronary artery bypass surgery: perioperative predictors and impact on mortality.

Introduction: Disturbances of the cardiac conduction system are frequent in the postoperative period of coronary artery bypass surgery. They are mostly reversible and associated with some injury of the conduction tissue, caused by the ischemic heart disease itself or by perioperative factors.

Objective: Primary: investigate the association between perioperative factors and the emergence of atrioventricular block in the postoperative period of coronary artery bypass surgery.

Cardiomyopathy induced by artificial cardiac pacing: myth or reality sustained by evidence?

Implantable cardiac pacing systems are a safe and effective treatment for symptomatic irreversible bradycardia. Under the proper indications, cardiac pacing might bring significant clinical benefit. Evidences from literature state that the action of the artificial pacing system, mainly when the ventricular lead is located at the apex of the right ventricle, produces negative effects to cardiac structure (remodeling, dilatation) and function (dissinchrony).

Atrioventricular block in the postoperative period of heart valve surgery: incidence, risk factors and hospital evolution.

Introduction: Disturbances of the cardiac conduction system are potential complications after cardiac valve surgery.

Objectives: This study was designed to investigate the association between perioperative factors and atrio-ventricular block, the need for temporary cardiac artificial pacing and, if necessary, permanent pacemaker implantation after cardiac valve surgery.

Methods: Retrospective analysis of the Cardiac Surgery Database - Hospital São Lucas/PUCRS.