We compared the response of endocardial lead systems to radiofrequency (RF) current delivered during atrio-ventricular junction ablation (AVJA) for atrial fibrillation with uncontrolled ventricular rate in 107 patients. The mean age was 67 +/- 11 years and the mean ejection fraction 42 +/- 15%. Patients were divided into 3 groups based on the type of ventricular lead present at the time of ablation: a previously implanted defibrillator lead (group 3, n = 13), a previously implanted pacemaker lead (group 2, n = 46) or a temporary lead (group 1, n = 48), which was subsequently followed by a permanent lead implantation. During AVJA, a median of 5 RF applications (44 +/- 8 W) were given via 4-5-mm electrodes. All but 1 patient had right-sided lesions, while 6 patients also had left sided lesions. Ventricular pacing thresholds were evaluated immediately pre- and post-ablation at 24 hours and at 1 to 3 months. Increases in ventricular pacing voltage thresholds were noted in all 3 groups over time, with the greatest mean increase in group 3 patients: [table: see text]. A greater than 2-fold increase in pacing thresholds was observed only with previously implanted leads, usually within the first 48 hours. It occurred significantly more often in patients with group 3 (6/13 [46%]) compared to group 2 (6/46 [13%], odds ratio 7.6, P = 0.006). A progressive rise in pacing threshold required lead revision in 2/13 group 3 patients (15%) and 2/46 group 2 patients (4%). While RF current has only minor effects on pacing threshold in most patients with previously implanted ventricular lead systems, clinically important alterations requiring device reprogramming or lead revision may occur. Group 3 are significantly more vulnerable to RF current, though the mechanisms are unclear. Group 1 during AVJA, followed by permanent lead implantation appears advisable. Pts with a previously implanted group 3 who require AVJA should be monitored closely.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1054/jelc.2001.28854 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Left atrial appendage velocity, association with inflammatory indices in non-valvular atrial fibrillation patients.
Future Cardiol
January 2025
Echocardiography research Center, Rajaie cardiovascular medical and research Center, Iran University of Medical Science, Tehran, Iran.
Introduction: Decreased left atrial appendage emptying velocity (LAAV) is a marker for thrombus formation. This study evaluates the association between LAAV and inflammatory indices in non-valvular atrial fibrillation (AF) patients.
Methods: The study population was 1428 patients with AF, 875 of whom enrolled.
The crucial role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in diagnosing pulmonary valve endocarditis in patients after transcatheter pulmonary valve implantation: a case report.
Eur Heart J Case Rep
January 2025
Department of Cardiology, Azorg, Merestraat 80, 9300 Aalst, Belgium.
Background: Patients after transcatheter pulmonary valve implantation (TPVI) are at increased risk for infective prosthetic valve endocarditis. Diagnosis of infective endocarditis (IE) following TPVI is particularly difficult due to impaired visualization of the transcatheter pulmonary valve (TPV) with echocardiography [Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, et al. 2023 ESC guidelines for the management of endocarditis.
View Article and Find Full Text PDFFeasibility of anchoring active fixation quadripolar lead to the main body of the dilated coronary sinus in a patient with persistent left superior vena cava: a case report.
Eur Heart J Case Rep
January 2025
Department of Cardiology, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-Ku, Yokohama city, Kanagawa 236-0004, Japan.
Background: Coronary sinus (CS) lead placement in persistent left superior vena cava (PLSVC) cases is challenging because of the poor backup force of the guiding catheter within the enlarged CS. Active fixation Quadripolar leads (Attain Stability™ Quad 4798, Medtronic) can expand choice to CS branches with limited access; however, no cases of anchoring to the main body of the CS have been published to date.
Case Summary: We describe a case of cardiac resynchronization therapy pacemaker upgrade in a 79-year-old female who developed pacing-induced cardiomyopathy after pacemaker implantation via the right superior vena cava (SVC) for atrioventricular block eight years ago wherein PLSVC was revealed during the procedure.
Determining the QRS axis: visual estimation is equal to calculation.
Herzschrittmacherther Elektrophysiol
January 2025
Hannover Heart Rhythm Center, Department of Cardiology & Angiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany.
Background: The QRS axis of the electrocardiogram (ECG) is often considered in clinical practice, but its determination is frequently limited to a rough estimation, such as "normal", with left or right deviation, and superior or inferior in the case of premature ventricular complexes (PVCs). However, a more exact determination of the QRS axis may be warranted in certain scenarios, such as to determine the origin of PVCs more precisely, and is attainable by visual estimation using the hexaxial reference system.
Objectives: The aim of this study was to determine how well such an estimation of the QRS axis would correlate with the axis calculated by formulas.
Leadless Pacemaker Implantation Following Lead Extraction in a Patient With Recent Percutaneous Tricuspid Valve Repair.
Pacing Clin Electrophysiol
January 2025
Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
This case details the successful implantation of a leadless pacemaker following the extraction of transvenous leads in a 72-year-old female patient with a complex cardiovascular history. The patient had undergone a series of cardiac interventions, including a recent percutaneous tricuspid valve repair with a metal clip implant due to severe regurgitation. After presenting with an infection at the pacemaker site, methicillin-resistant Staphylococcus hominis was identified, necessitating the removal of the entire pacing system.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!