Abstract 16795: Fate of Dislodged Micra Transcatheter Pacing System in Coronary Sinus

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sangeeta Prabhakar Bhat ◽  
Vijay Pratap Singh ◽  
Wilson Young
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Sinus ◽  
Persistent Atrial Fibrillation ◽  
Case Presentation ◽  
Leadless Pacemaker ◽  
Device Implantation ◽  
Ventricular Response ◽  
Chest X Ray ◽  
Symptomatic Bradycardia ◽  
The Right

Background: Micra Transcatheter Pacing System is a leadless pacemaker for treatment of symptomatic high-grade atrioventricular block and persistent atrial fibrillation. We present a case report of dislodgement of a Micra device into the coronary sinus. Case presentation: An 87 year old man with permanent atrial fibrillation presented to the hospital with dizziness and fall. His medications included Lasix and Metoprolol. Electrocardiogram revealed atrial fibrillation with slow ventricular response. Metoprolol was held. During the hospital stay, telemetry monitoring revealed heart rates of 30-40 bpm. Micra device implantation was indicated for symptomatic bradycardia. After deployment, the Micra dislodged into the right atrium. Efforts to retrieve the device led to its embolism into mid-coronary sinus and dissection of the coronary sinus. Given comorbidities, the Micra was deactivated and a single chamber pacemaker was implanted with serial radiographic monitoring of Micra. Post procedure Chest X-ray (Fig. 1) and Computed Tomography Angiography of the chest (Fig. 2) confirmed location of Micra in the coronary sinus. Discussion: This is the first described case of dislodged Micra device in the coronary sinus. Device retrieval attempts resulted in dissection of the coronary sinus and there was no myocardial capture when pacing from the device. Serial CXR showed stable Micra position over the next two years. Conclusion: Embolization and dislodgement of Micra leadless pacemaker into the coronary sinus is possible and chronic management with serial imaging after abandoning the device is feasible.

scholarly journals Injection of contrast medium through a delivery sheath reveals interventricular septal vascular injury in a case of left bundle branch pacing

2020 ◽  
Vol 48 (8) ◽  
pp. 030006052094788
Author(s):  
Peng Qi ◽  
Xue-Xun Li ◽  
Ying Tian ◽  
Liang Shi ◽  
Yan-Jiang Wang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Contrast Medium ◽  
Interventricular Septum ◽  
Pacemaker Implantation ◽  
Persistent Atrial Fibrillation ◽  
Potential Method ◽  
Alternative Technique ◽  
Symptomatic Bradycardia ◽  
The Right ◽  
Delivery Sheath

A 70-year-old woman with symptomatic bradycardia caused by persistent atrial fibrillation and atrioventricular block was referred to our institution for pacemaker implantation. After we failed to obtain adequate His bundle capture thresholds (>2.5 V at 1.0 ms) at three pacing sites, left bundle branch pacing was attempted as an alternative technique. The tip of the 3830 lead was screwed towards the left side of the interventricular septum. Contrast medium was injected through the C315 sheath, which was placed close to the right side of the interventricular septum to determine the exact depth of the 3830 lead inside the septum. Unexpectedly, the vessels in the interventricular septum were revealed by the contrast, which showed that the lead had penetrated one of the septal vessels. To the best of our knowledge, this is the first reported case of a patient in whom injection of a contrast agent through a delivery sheath showed damage to the interventricular septal vessels. Findings from this case suggest that injection of contrast medium through a C315 sheath that is placed close to the interventricular septum is a potential method for excluding damage to interventricular septal vessels.

Abstract 15570: Direct Evidence of Endo-Epicardial Dissociation of the Atrial Wall in Patients With Longstanding Persistent Atrial Fibrillation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Natasja de Groot ◽  
Lisette vd Does ◽  
Ameeta Yaksh ◽  
Paul Knops ◽  
Pieter Woestijne ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Direct Evidence ◽  
Persistent Atrial Fibrillation ◽  
Right Atrial ◽  
Electrode Arrays ◽  
Atrial Wall ◽  
Ablative Therapies ◽  
Epicardial Layer ◽  
Right Atrial Appendage ◽  
The Right

Introduction: Transition of paroxysmal to longstanding persistent atrial fibrillation (LsPAF) is associated with progressive longitudinal dissociation in conduction and a higher incidence of focal fibrillation waves. The aim of this study was to provide direct evidence that the substrate of LsPAF consists of an electrical double-layer of dissociated waves, and that focal fibrillation waves are caused by endo-epicardial breakthrough. Hypothesis: LsPAF in humans is caused by electrical dissociation of the endo- and epicardial layer. Methods: Intra-operative mapping of the endo- and epicardial right atrial wall was performed in 9 patients with induced (N=4), paroxysmal (N=1), persistent (N=2) or longstanding-persistent AF (N=2). A clamp of two rectangular electrode-arrays (128 electrodes; inter-electrode distance 2mm) was introduced through an incision in the right atrial appendage. Series of 10 seconds of AF were analyzed and the incidence of endo-epicardial dissociation (≥15ms) was determined for all 128 endo-epicardial recording sites. Results: In patients with LsPAF the averaged degree of endo-epicardial dissociation was highest (24.9% vs. 5.9%). Using strict criteria for breakthrough (presence of an opposite wave within 4mm and <15ms before the origin of the focal wave), the far majority (77%) of all focal fibrillation waves could be attributed to endo-epicardial excitation. Conclusions: During LsPAF considerable differences in activation of the right endo- and epicardial wall exist. Endo-epicardial fibrillation waves that are out of phase, may conduct transmurally and create breakthrough waves in the opposite layer. This may explain the high persistence of AF and the low succes rate of ablative therapies in patients with LsPAF.

scholarly journals LV remodeling caused by persistent atrial fibrillation was associated with high cardiac hyaluronan in coronary sinus vein

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P5609-P5609
Author(s):  
A. Okada ◽  
T. Tomita ◽  
Y. Kashima ◽  
K. Yoshie ◽  
T. Takeuchi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Sinus ◽  
Persistent Atrial Fibrillation ◽  
Lv Remodeling

scholarly journals ELECTRICAL ISOLATION VERSUS FOCAL ABLATION OF THE CORONARY SINUS IN PATIENTS WITH PERSISTENT ATRIAL FIBRILLATION

2020 ◽  
Vol 75 (11) ◽  
pp. 281
Author(s):  
Domenico Giovanni Della Rocca ◽  
Luigi Di Biase ◽  
Sanghamitra Mohanty ◽  
Chintan Trivedi ◽  
Nicola Tarantino ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Sinus ◽  
Persistent Atrial Fibrillation ◽  
Electrical Isolation ◽  
Focal Ablation

P6552Is it possible to recognize free-wall implantation of leadless pacemakers from an ECG?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Kajiyama ◽  
Y Kondo ◽  
M A Nakano ◽  
M I Nakano ◽  
T Hayashi ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Transitional Zone ◽  
Free Wall ◽  
Ventricular Pacing ◽  
Right Ventricular Free Wall ◽  
Leadless Pacemaker ◽  
Device Implantation ◽  
The Difference ◽  
The Right ◽  
Wall Group

Abstract Background Leadless pacemaker (Micra, Medtronic, US) is a effective treatment for bradycardia and eliminates any malfunctions related to intravenous leads. However, some cases exhibit pericardial effusion, presumably associated to device implantation to right ventricular free-wall. Objectives The present study was carried out to find ECG features during ventricular pacing by Micra, which enabled to distinguish free-wall implantation from septal implantation without imaging modalities. Methods Consecutive 21 patients who received implantation of Micra in our facility were enrolled. Location of device in the right ventricle was evaluated using echocardiography or computed tomography in order to determine whether the device was implanted on the septum or the freewall. The difference of 12-lead ECG during ventricular pacing from Micra were analyzed between the septum group and the free wall group. Results According to the imaging investigation, body of Micra was clearly identifiable in 17 patients. The locations of device were classified into septum in 11 patients, free-wall in 4 patients, and indeterminate but apex in 2 patients. Further analysis regarding ECG was performed exclusively between the septum group and the free-wall group. In lead V1, peak deflection index (PDI) was significantly larger in free-wall group than septum group (0.64±0.06 vs. 0.45±0.10, P=0.005), whereas there was no difference of QRS duration, transitional zone and QRS pattern. PDI of V1 and Location of LPM Conclusion PDI of V1 could be useful to predict implantation of Micra to free-wall and may potentially stratify the risk of postprocedural pericardial effusion.

Electrophysiological and Electroanatomical Mapping of the Right Atrium in Persistent Atrial Fibrillation: Relation to Collagen Turnover

2015 ◽  
Vol 38 (9) ◽  
pp. 1039-1048 ◽  
Author(s):  
CHRISTOS A. GOUDIS ◽  
ELEFTHERIOS M. KALLERGIS ◽  
EMMANUEL M. KANOUPAKIS ◽  
HERCULES E. MAVRAKIS ◽  
NIKI E. MALLIARAKI ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Right Atrium ◽  
Persistent Atrial Fibrillation ◽  
Electroanatomical Mapping ◽  
Collagen Turnover ◽  
The Right

scholarly journals Neurohumoral Markers of Cardiac Autonomic Denervation After Surgical Ablation of Long- Standing Persistent Atrial Fibrillation

2021 ◽  
Author(s):  
Alexey Evtushenko ◽  
Vladimir Evtushenko ◽  
Anna Gusakova ◽  
Tatiana Suslova ◽  
Yulia Varlamova ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Coronary Sinus ◽  
Cardiac Electrophysiology ◽  
Persistent Atrial Fibrillation ◽  
Practical Significance ◽  
Main Stage ◽  
Mibg Uptake ◽  
Efficacy Evaluation ◽  
Surgical Ablation

Abstract Background. The autonomic nervous system (ANS) plays an important role in modulation of cardiac electrophysiology and arrhythmogenesis. Disorders of the ANS components can be a prognostic factor of an unfavorable course of cardiovascular diseases. The aim of the study was to evaluate the association between efficacy of radiofrequency (RF) surgical ablation of long-standing persistent atrial fibrillation (AF) and neurohumoral transmitter levels as well as correlation between these data with myocardial iodine-123-metaiodobenzylguanidine (123I-MIBG) uptake.Methods. Two groups of patients with acquired valvular heart disease were compared: patients with surgical AF ablation and patients with sinus rhythm.Results. The decrease of norepinephrine (NE) level in coronary sinus has a direct association with the heart-to-mediastinum ratio (p=0.02) and negative correlation with 123I-MIBG uptake defect (p=0.01). NE level decreased significantly after the main stage of surgery, both in patients with AF (p=0.0098) and sinus rhythm (p=0.0039). Furthermore, the significance (p=0.001) of the aortic root and coronary sinus gradient of NE level 0.405 pg/mL was determined as a cut-off value for efficacy evaluation of the RF denervation.Conclusion. The practical significance of the obtained results lies in the possibility of using the technique to predict the efficacy of the ‘Maze-IV’ procedure, which will allow assessing the risk of AF recurrence after ablation.

scholarly journals An off-pump biatrial mini-maze procedure for treatment of long-standing persistent atrial fibrillation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
T Yan ◽  
S.J Zhu ◽  
M Zhu ◽  
C.F Guo
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Vena Cava ◽  
Persistent Atrial Fibrillation ◽  
Maze Procedure ◽  
Purse String ◽  
Off Pump ◽  
Bipolar Radiofrequency ◽  
The Right

Abstract Background Surgical treatment has assumed a more prominent role in the therapy of atrial fibrillation (AF) with favorable efficiency and acceptable safety during the last decades. The traditional Cox-Maze procedure and Wolf Mini-Maze procedure focused on left atrial ablation. However, it is ubiquitous that patients with long-standing persistent atrial fibrillation (LSPAF) typically suffer from biatrial electrical and structural remodeling. The left atrial procedures are still not enough in patients with LSPAF. Purpose Herein, we aimed to introduce a modified biatrial off-pump ablation procedure based on the Wolf Mini-Maze procedure and to detect the safety and efficacy of the surgery for patients with LSPAF. Methods Between January 2016 and September 2020, 102 patients of LSPAF underwent our modified Mini-Maze procedure using bipolar radiofrequency ablation. Those patients firstly underwent a Mini-Maze procedure using Dallas lesion set, including video-assisted bilateral mini-thoracotomy, left atrial appendage excision, bilateral pulmonary vein isolation, ganglionic plexi evaluation and destruction, left atrial roof connecting lesion, and a linear lesion connecting this roofline to the root of the aorta at the junction of the left coronary and the non-coronary cusp. Secondly, a purse-string suture was performed on the right atrium, and then four ablation lesions were made to the superior vena cava, to the inferior vena cava, to the appendix of the right atrium, and to the tricuspid valve annulus from the purse-string suture point by the bipolar radiofrequency clamp. After the operation, the patients were followed up at an interval of 3, 6, 12 months, and every 1 year after that. Results No mortality No surgical re-exploration for bleeding. No permanent pacemaker implantation. 99 patients were free from LSPAF upon discharge. A follow-up at interval of 3, 6, 12, 24, 36, and 48 months showed a success rate free from LSPAF was 95.1% (97/102), 94.4% (85/90), 94.8% (73/77), 91.5% (54/59), 90.3% (28/31) and 100% (9/9), respectively Conclusions The modified biatrial Mini-Maze suggested a safe and feasible procedure. Early follow-up demonstrated an acceptable success rate free from AF. It might have the potential to become another option for clinical treatment of LSPAF. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): General Program of the National Natural Science Foundation of China Schematic of the procedure

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