scholarly journals Non-invasive electrical synchrony method to guide para-hisian stimulation implant technique

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Logarzo ◽  
D Ortega ◽  
L Barja ◽  
A Paolucci ◽  
N Mangani ◽  
...  
Keyword(s):  
Pacemaker Implantation ◽  
Conventional Technique ◽  
Fluoroscopy Time ◽  
Implantation Technique ◽  
Bundle Branch Block ◽  
Novel Device ◽  
Non Invasive ◽  
Device Implantation ◽  
Implant Technique

Abstract Introduction Right ventricular apex stimulation solves electrical disorder but electrical disynchrony can be generated. Left bundle branch block results in heart failure and device upgrade is needed in some cases. Para-hisian stimulation generates a physiological cardiac activation through normal conduction system. Sheaths and special leads are used with current techniques. We developed an implantation technique guided by non-invasive electric synchrony using conventional screw-in leads. Synchromax is a novel device used to evaluate non-invasive cardiac electrical synchrony. It is easy to understand, fast to obtain, non-invasive and reproducible. Synchromax was analyzed in previous studies and correlated with other methods. Objective Usefulness and safety of non-invasive cardiac electrical synchrony method using conventional screw-in leads to guide para-hisian device implantation. Materials and methods 421 patients were evaluated. All patients had indication of ventricular stimulation (pacemaker and ICD). Non-invasive electrical synchrony was performed with Synchromax study during the device implantations in all patients. Synchrony index and curves were analyzed. Type 2 curve and index between 0,1 and 0,4 were considered synchronous. Type 8 curve and index more than 0.7 were considered dyssynchronous. Attempt numbers, thresholds, fluoroscopy time and dislodgments were analyzed. Results Mean age 69 years (±8 years). 67,9% males. 421 devices were implanted (334 pacemakes and 87 ICDs). Sick sinus syndrome was the main pacemaker aetiology and dilated cardiomyopathy was in patients with ICD. Conventional screw-in leads were used in all cases. An implant technique was designed. A J-shaped curve with a small perpendicular curve at the tip is performed in the stylet. On average 1,9 attempts were made. Thresholds average 1,2 mV. High thresholds in 4 patients with selective parahisian stimulation. 7 dislodgments was evidenced (1,6%). Fluoroscopy time average 8,4 min. Type 2 curve and index under 0,4 was obtained in 94,5% of cases. Conclusions Para-hisian pacemaker implantation guided by Synchromax method using conventional screw-in leads is safe and useful achieving a physiological stimulation. Few attempts were needed with this new technique. Thresholds were similar to those used in conventional technique. Funding Acknowledgement Type of funding source: None

Non-selective para-hisian stimulation used for QRS normalization guided by non-invasive electrical synchrony method in patients with electrical conduction disorders

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Logarzo ◽  
D Ortega ◽  
L Barja ◽  
A Paolucci ◽  
G Revollo ◽  
...  
Keyword(s):  
Electrical Conduction ◽  
Conduction System ◽  
Funding Source ◽  
Av Block ◽  
Bundle Branch Block ◽  
Novel Device ◽  
Non Invasive ◽  
Conduction Disorders ◽  
Implant Technique

Abstract Introduction Para-hisian stimulation produces a physiological cardiac activation through normal conduction system. Frequently it is used in patients with no electrical conduction disorders. We developed an implant technique guided by non-invasive electrical synchrony using conventional screw-in leads. Non-selective para-hisian stimulation can normalize electrical conduction disorders. Synchromax is a novel device used to evaluate non-invasive cardiac electrical synchrony. It is easy to understand, fast to obtain, non-invasive and reproducible. Synchromax was analyzed in previous studies and correlated with other methods. Objective Evaluate usefulness and safety of non-selective para-hisian stimulation guided by non-invasive cardiac electrical synchrony method using conventional screw-in leads to normalize electrical conduction disorders. Materials and methods 421 patients with para-hisian stimulation were analyzed retrospectively. 139 patients had different intraventricular and auriculo-ventricular electrical disorders. Non-selective para-hisian stimulation guided by no-invasive electrical synchrony method (Synchromax) was performed in all cases. Synchrony index and curves were analyzed according curves chart. Type 2 curve and index between 0,1 and 0,4 were considered synchronous. Type 8 curve and index more than 0.7 were considered dyssynchronous. Results Mean age 71 years (±7 years). 65,4% males. 30,9% had 2° and 3° grade AV block associated. Patients were divided in 5 groups: 1-Right bundle branch block (RBBB): 43 patients 2-Left bundle branch block (LBBB): 33 patients 3-Brugada Syndrome: 8 patients 4-Left anterior hemi-block (LAHB) 30 patients. 5-RBBB associated with LAHB: 25 patients. QRS normalization was achieved in 87% of the cases using non-selective para-hisian stimulation guided by Synchromax with conventional screw in leads. A ventricular approach was performed during implantation. Electrical synchrony was not solved in 13% of patients mostly in LBBB and RBBB associated with LAHB. Two dislodgments were evidenced. Conclusions Non-selective para-hisian stimulation guided by Synchromax method using conventional screw in leads solved most of intraventricular electrical disorders. It is also safe to use in patients with auriculo-ventricular electrical disorder. Funding Acknowledgement Type of funding source: None

scholarly journals Serum Anti-Collagen IV IgM and IgG Antibodies as Indicators of Low Vascular Turnover of Collagen IV in Patients with Long-Term Complications of Type 2 Diabetes

Diagnostics ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 900
Author(s):  
Krasimir Kostov ◽  
Alexander Blazhev
Keyword(s):  
Type 2 Diabetes ◽  
Serum Levels ◽  
Vascular Wall ◽  
Collagen Iv ◽  
Collagen Type Iv ◽  
Non Invasive ◽  
Type Iv ◽  
Antibody Levels

Thickening of the vascular basement membrane (BM) is a fundamental structural change in the small blood vessels in diabetes. Collagen type IV (CIV) is a major component of the BMs, and monitoring the turnover of this protein in type 2 diabetes (T2D) can provide important information about the mechanisms of vascular damage. The aim of the study was through the use of non-invasive biomarkers of CIV (autoantibodies, derivative peptides, and immune complexes) to investigate vascular turnover of CIV in patients with long-term complications of T2D. We measured serum levels of these biomarkers in 59 T2D patients with micro- and/or macrovascular complications and 20 healthy controls using an ELISA. Matrix metalloproteinases-2 and -9 (MMP-2 and MMP-9) were also tested. In the T2D group, significantly lower levels of CIV markers and significantly higher levels of MMP-2 and MMP-9 were found compared to controls. A significant positive correlation was found between IgM antibody levels against CIV and MMP-2. These findings suggest that vascular metabolism of CIV is decreased in T2D with long-term complications and show that a positive linear relationship exists between MMP-2 levels and CIV turnover in the vascular wall.

scholarly journals Non‐invasive assessment of temporal changes in myocardial microvascular function in persons with type 2 diabetes and healthy controls

2021 ◽  
Author(s):  
Ida K. B. Rasmussen ◽  
Philip Hasbak ◽  
Bernt J. Scholten ◽  
Jens C. Laursen ◽  
Emilie H. Zobel ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Temporal Changes ◽  
Microvascular Function ◽  
Healthy Controls ◽  
Non Invasive

scholarly journals Worsening of gas exchange parameters at high FiO2 in COVID-19: misleading or informative?

2021 ◽  
Vol 16 ◽  
Author(s):  
Federico Raimondi ◽  
Luca Novelli ◽  
Gianmariano Marchesi ◽  
Fabrizio Fabretti ◽  
Lorenzo Grazioli ◽  
...  
Keyword(s):  
Diabetes Type 2 ◽  
Lung Mechanics ◽  
Systemic Hypertension ◽  
Gas Exchange Parameters ◽  
Respiratory Impairment ◽  
Non Invasive ◽  
High Fio2 ◽  
Myocardial Infraction ◽  
Chest X Ray

Background: In COVID-19, higher than expected level of intrapulmonary shunt has been described, in association with a discrepancy between the initial relatively preserved lung mechanics and the hypoxia severity. This study aim was to measure the shunt fraction and variations of PaO2/FiO2 ratio and oxygen alveolar-arterial gradient (A-a O2) at different FiO2.Methods: Shunt was measured by a non-invasive system during spontaneous breathing in 12 patients hospitalized at COVID-19 Semi-Intensive Care Unit of Papa Giovanni XXIII Hospital, Bergamo, Italy, between October 22 and November 23, 2020.Results: Nine patients were men, mean age (±SD) 62±15 years, mean BMI 27.5±4.8 Kg/m2. Systemic hypertension, diabetes type 2 and previous myocardial infraction were referred in 33%, 17%, and 7%, respectively. Mean PaO2/FiO2 ratio was 234±66 and 11 patients presented a bilateral chest X-ray involvement. Mean shunt was 21±6%. Mainly in patients with a more severe respiratory failure, we found a progressive decrease of PaO2/FiO2 ratio with higher FiO2. Considering (A-a O2), we found a uniform tendency to increase with FiO2 increasing. Even in this case, the more severe were the patients, the higher was the slope, suggesting FiO2 insensitiveness due to a shunt effect, as strengthened by our measurements.Conclusion: Relying on a single evaluation of PaO2/FiO2 ratio, especially at high FiO2, could be misleading in COVID-19. We propose a two steps evaluation, the first at low SpO2 value (e.g., 92-94%) and the second one at high FiO2 (i.e., >0.7), allowing to characterize both the amendable (ventilation/perfusion mismatch), and the fixed (shunt) contribution quote of respiratory impairment, respectively.

scholarly journals Diagnosis of experimental stetohepatosis using ultrasound shear wave elastography

2015 ◽  
Vol 26 (1) ◽  
pp. 109-113
Keyword(s):  
Insulin Resistance ◽  
Shear Wave ◽  
Shear Wave Elastography ◽  
Mixed Diet ◽  
Sweetened Condensed Milk ◽  
Non Invasive ◽  
Condensed Milk ◽  
First Time ◽  
Diagnosis Technique

According to available literature data, NAFLD may play crucial role in the pathogenesis of type 2 diabetes and other conditions connected with insulin resistance. In order to study the essence of the NAFLD, we have created an experimental model of the steatohepatosis. The mixed diet for 8 weeks consisting of standard food (47%), sweetened condensed milk (44%), vegetable oil (8%) and vegetable starch (1%) develops non-alcoholic steatohepatosis in the animals undergoing the experiment. The morphological signs of the non-alcoholic steatohepatosis comprised as follows in the hepatocytes of the rats undergoing the experiment: presence of fine-drop fattiness (fine-drop steatosis) and accumulation of fat vacuoles shifting the nucleus towards the cell peripheral. Substantial increase in the liver pulp of the animals undergoing the experiment defined using the ultrasound shear wave elastography technique is indicative of the presence of the non-alcoholic steatohepatosis. The ultrasound shear wave elastography technique can be used as a non-invasive diagnosis marker of the non-alcoholic steatohepatosis. The said diagnosis technique has been recommended for the first time.

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