scholarly journals Cardiac Stimulation in the Third Millennium: Where Do We Head from Here?

Hearts ◽  
2021 ◽  
Vol 2 (1) ◽  
pp. 15-35
Author(s):  
Mauro Biffi ◽  
Alberto Spadotto ◽  
Giuseppe Pio Piemontese ◽  
Sebastiano Toniolo ◽  
Lorenzo Bartoli ◽  
...  
Keyword(s):  
Heart Diseases ◽  
Heart Rhythm ◽  
Cardiac Pacing ◽  
Right Atrial ◽  
Cardiac Stimulation ◽  
Life Saving ◽  
Heart Rhythm Disorders ◽  
Structural Heart Diseases ◽  
Right Atrial Appendage ◽  
The Right

Over the years, pacemakers have evolved from a life-saving tool to prevent asystole to a device to treat heart rhythm disorders and heart failure, aiming at improving both cardiac function and clinical outcomes. Cardiac stimulation nowadays aims to correct the electrophysiologic roots of mechanical inefficiency in different structural heart diseases. This has led to awareness of the concealed risks of customary cardiac pacing that can inadvertently cause atrioventricular and inter-/intra-ventricular dyssynchrony, and has promoted the development of new pacing modalities and the use of stimulation sites different from the right atrial appendage and the right ventricular apex. The perspective of truly physiologic pacing is the leading concept of the continued research in the past 30 years, which has made cardiac stimulation procedure more sophisticated and challenging. In this article, we analyze the emerging evidence in favor of the available strategies to achieve an individualized physiologic setting in bradycardia pacing.

Spontaneously Resolved Ventricular Fibrillation and Ventricular Tachycardia in Arrhythmic Variant of Acute Myocardial Infarction (Clinical Case)

2019 ◽  
Vol 2 (3) ◽  
pp. 74-82
Author(s):  
E. Skorodumova ◽  
V. Kostenko ◽  
E. Skorodumova ◽  
Y. Shulenina ◽  
K. Shulenin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Blood Circulation ◽  
Heart Diseases ◽  
Heart Rhythm ◽  
Paroxysmal Tachycardia ◽  
Electrical Instability ◽  
Heart Rhythm Disorders ◽  
Structural Heart Diseases ◽  
Almost All ◽  
Cerebral Blood Circulation

Abstract Different heart rhythm disorders occur in almost all patients with myocardial infarction (MI). Arrhythmias in setting of MI are caused by electrical instability of myocardium as a result of metabolic and microcirculatory disorders. However, the presence of even severe heart rhythms disorders does not provide a basis for diagnosis of arrhythmic MI. In arrhythmic variant of infarction heart rhythm disorders and associated symptoms should prevail in clinical presentation. Supra ventricular or ventricular paroxysmal tachycardia, less often atrial fibrillation or flutter, and high degree AV block are registered most commonly. Pain may be absent or slight. Loss of consciousness is possible, due to cerebral blood circulation disorder. Arrhythmic variant may be accompanied by acute heart failure or significant arterial hypotension, up to arrhythmogenic shock. This variant of MI often occurs in older people who have anamnesis of structural heart diseases. In MI patients, reduction of cerebral blood circulation due to tachyarrhythmia and hypotension can cause ischemic stroke.

scholarly journals Clinical Case: Condition of the patient after repeated acute cerebrovascular disruption by ischemic type in the basin of the right middle cerebral artery with left-sided hemiparesis

2018 ◽  
pp. 32-37
Author(s):  
N. Svyrydova ◽  
N. Ingula ◽  
І. Bieliakova ◽  
N. Ruda ◽  
K. Pidgirna ◽  
...  
Keyword(s):  
Death Rate ◽  
Clinical Case ◽  
Heart Diseases ◽  
Significant Risk ◽  
Heart Rhythm ◽  
Heart Rhythm Disorders ◽  
Artery Disease ◽  
Ischemic Attack ◽  
The Right ◽  
Basic Treatment

Cardiovascular diseases (CVD) – represent between 30 percent to 50 percent of all cardiovascular system’s diseases, and account 110 thousands of new stroke cases every year in Ukraine, death rate during first 30 days is 30-40 % and 50 % during 1st year. Primary stroke morbidity is higher in 1.5-2 times than world’s average. The most significant risk factors of stroke are hypertension, heart diseases (coronary artery disease, heart rhythm disorders), transient ischemic attack in anamnesis, diabetes, atherosclerosis (dyslipidemia). According conducted researches it is proven, that level of systolic blood pressure correlates with decreased risk of stroke in patients with hypertension. This article describes a case from clinical practice – management of patient with acute ischemic stroke. The attention is focused on the methods of examination, basic treatment strategy and rehabilitation of patient with this pathology.

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 Feasibility of remote support for electrophysiological ablation procedures during CoVid-19 pandemics

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Muessigbrodt ◽  
F Demoniere ◽  
S Finoly ◽  
M Mommarche ◽  
J Inamo
Keyword(s):  
Atrial Flutter ◽  
Medical Training ◽  
Human Life ◽  
Heart Rhythm ◽  
Left Ventricular ◽  
Technical Support ◽  
Right Atrial ◽  
Global Challenge ◽  
Heart Rhythm Disorders ◽  
Technical Support Staff

Abstract   The COVID-19 pandemics is a global challenge with a huge impact on medicine, politics, economy, education, travel and many other aspects of human life. The treatment of heart rhythm disorders has also been affected by the disease itself and by restrictions in order to constrain the spread of the virus. Catheter ablations of cardiac arrhythmias are nowadays frequently guided by electro-anatomic mapping systems. Technical staff with medical training, or medical staff with technical training, is needed to assist the operator. Travel restrictions due to current COVID-19 pandemics have limited the in person availability for technical support staff. To overcome these limitations we explored the feasibility of remote support with an internet based communication platform. A total of 9 patients (87,5% male, mean age 66,6 years) with different arrhythmias (atrial fibrillation, left atrial flutter, typical right atrial flutter, left ventricular tachycardia), having undergone ablation procedures between October 2020 and February 2021, were included. Acute procedural success was obtained in 9 out of 9 procedures. No complications occurred. Our experience with remote support for electro-anatomic mapping for complex electrophysiological ablation procedures, show the feasibility and safety of this approach. It increases the availability of technical support at reduced costs and a reduced CO2 footprint. Remote support for electro-anatomic mapping may therefore facilitate continuous care for patients with arrhythmias during the COVID-19 pandemics. Due to its advantages beyond COVID-19 pandemics related problems, it will likely play a greater role in the future. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Temporary transvenous endocardial pacing: method of endocardial electrode reposition in the right ventricular cavity of the heart

2016 ◽  
Vol 97 (3) ◽  
pp. 453-457
Author(s):  
A N Osmolovsky
Keyword(s):  
Myocardial Infarction ◽  
Right Ventricular ◽  
Heart Rhythm ◽  
Ventricular Cavity ◽  
Cardiac Stimulation ◽  
Artificial Pacemaker ◽  
Temporary Pacing ◽  
The Right ◽  
Electrical Impulses ◽  
Endocardial Electrode

Aim. To justify and develop method of endocardial electrode reposition in the right ventricular cavity of the heart in the spontaneous termination of temporary pacing in patients with recurrent myocardial infarction.Methods. A method of endocardial electrode reposition was used in 23 patients with myocardial infarction complicated by acute bradyarrhythmias. Written informed consent was obtained from all patients, and in the absence of contact with the patient, decision to insert temporary artificial pacemaker was made by medical consultation.Results. A method of endocardial electrode reposition that provides threading the electrode from the venous bed to the right ventricular cavity of the heart, cardiac stimulation by electrical impulses and creation the new contacts between electrode and right ventricular endocardium of the heart using the same electrode, both in the presence and in absence of the heart conduction and excitation function, was developed. At the same time, it excludes the electrode dislocation from the right ventricular cavity of the heart, provides the electrode fixation with endocardium, and at the same time allows to impose a stable artificial heart rhythm in the shortest time. During the spontaneous termination of the effective artificial pacemaker, endocardial electrodes reposition enabled to promptly regain the heart rhythm control in all 23 patients with acute bradyarrhythmia of infarction genesis.Conclusion. Effective and safe method of endocardial electrode reposition in the right ventricular cavity of the heart in the spontaneous termination of temporary pacing in patients with recurrent myocardial infarction was developed and introduced into clinical practice.

Atrial tachycardias: macroreentrant atrial tachycardias, CTI-dependent atrial flutter (clockwise, anticlockwise), and non-CTI-dependent macroreentrant atrial tachycardia

ESC CardioMed ◽  
2018 ◽  
pp. 2075-2082
Author(s):  
Jose L. Merino
Keyword(s):  
Atrial Flutter ◽  
Atrial Tachycardia ◽  
Heart Diseases ◽  
Vena Cava ◽  
Common Type ◽  
Tricuspid Annulus ◽  
Significant Morbidity ◽  
Structural Heart Diseases ◽  
The Right ◽  
Invasive Evaluation

Macroreentrant atrial tachycardia is, after atrial fibrillation, the most common sustained form of supraventricular tachycardia. It is often associated with significant morbidity and mortality. Originally, atrial flutter was the most used term but has been discouraged in favour of the most generally applied macroreentrant atrial tachycardia and the definition and diagnosis changed from an electrocardiogram-based to an electrophysiological one after invasive evaluation. The most common type of macroreentrant atrial tachycardia is cavotricuspid isthmus (CTI)-dependent atrial flutter. The reentrant circuit of CTI-atrial flutter revolves around the tricuspid annulus in the counterclockwise or the less common clockwise direction. The treatment of choice for most presentations of CTI-dependent flutter is catheter ablation by linear radiofrequency application of the isthmus between the tricuspid annulus and the inferior vena cava. Different reentrant circuits of non-CTI-dependent macroreentrant atrial tachycardia have been reported in both the right and the left atrium. They are often associated with different structural heart diseases.

scholarly journals Transthoracic Right Atrial Cannulation for Total Parenteral Nutrition — Case Report

1981 ◽  
Vol 9 (1) ◽  
pp. 53-57 ◽  
Author(s):  
L. Hayden ◽  
G. Ramsey Stewart ◽  
D. C. Johnson ◽  
M. McD. Fisher
Keyword(s):  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Right Atrium ◽  
Venous Catheter ◽  
Right Atrial ◽  
X Ray ◽  
Right Thoracotomy ◽  
Right Atrial Appendage ◽  
The Right ◽  
Nutrition Programme

A man with severe peripheral vascular disease and requiring total parenteral nutrition because of short bowel syndrome was referred because a central venous catheter could not be inserted by conventional techniques. A right thoracotomy was performed and a Hickman catheter inserted via the right atrial appendage into the right atrium. This catheter was used for a total of seven months for total parenteral nutrition. For the last two months of this time, the patient was maintained at home on a Home Parenteral Nutrition Programme. After four months of total parenteral nutrition the patient developed recurrent fevers and the catheter was found to have migrated from the right atrium into the pulmonary artery. The catheter was resited under x-ray control and used for a further three months until the recurrence of fever and dyspnoea heralded the onset of septic pulmonary emboli resulting in his death.

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