scholarly journals Factors influencing development of atrial fibrillation after implantation of cardiac pacemaker for sinus node dysfunction

Medicina ◽  
2009 ◽  
Vol 45 (3) ◽  
pp. 169
Author(s):  
Audrius Aidietis ◽  
Jūratė Barysienė ◽  
Germanas Marinskis ◽  
Sigita Aidietienė ◽  
Diana Kairevičiūtė ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Mitral Regurgitation ◽  
Sick Sinus Syndrome ◽  
Sinus Node ◽  
Interventricular Septum ◽  
Pacemaker Implantation ◽  
Cardiac Pacemaker ◽  
Factors Influencing ◽  
Grade Ii ◽  
The Right

Objective. The aim of this study was to evaluate factors influencing the success of atrial fibrillation treatment associated with the sick sinus syndrome after pacemaker implantation. Methods and results. In 163 patients with sick sinus syndrome followed up after pacemaker implantation, statistical analysis showed that the recurrence of atrial fibrillation increased 2.8 times and 2.5 times when the left atrium or the right atrium, respectively, were increased by 1 cm (P=0.001). In addition, the recurrence of atrial fibrillation increased 2.5 times when the interventricular septum was thickened (P=0.007). Probability of atrial fibrillation recurrence was 2.73 times higher in the presence of grade II mitral regurgitation as compared to absent or grade I mitral regurgitation (P=0.029). The results of atrial fibrillation treatment did not significantly depend on age, gender, duration of atrial fibrillation symptoms, other cardiac structural changes, and concomitant noncardiac diseases. Conclusions. In patients with sick sinus syndrome, the effectiveness of atrial fibrillation treatment after pacemaker implantation is influenced by enlargement of the left and the right atria, increased interventricular septum thickness, and grade II mitral regurgitation. Evaluation of echocardiographic data before pacemaker implantation has prognostic value for determining the probability of maintenance of sinus rhythm.

scholarly journals GATA6 is a regulator of sinus node development and heart rhythm

2020 ◽  
Vol 118 (1) ◽  
pp. e2007322118
Author(s):  
Lara Gharibeh ◽  
Abir Yamak ◽  
Jamieson Whitcomb ◽  
Aizhu Lu ◽  
Mathieu Joyal ◽  
...  
Keyword(s):  
Molecular Basis ◽  
Human Heart ◽  
Sick Sinus Syndrome ◽  
Sinus Node ◽  
Pacemaker Implantation ◽  
Cardiac Pacemaker ◽  
Heart Rhythm ◽  
Important Regulator ◽  
Node Development ◽  
Specific Deletion

The sinus node (SAN) is the primary pacemaker of the human heart, and abnormalities in its structure or function cause sick sinus syndrome, the most common reason for electronic pacemaker implantation. Here we report that transcription factor GATA6, whose mutations in humans are linked to arrhythmia, is highly expressed in the SAN and its haploinsufficiency in mice results in hypoplastic SANs and rhythm abnormalities. Cell-specific deletion reveals a requirement for GATA6 in various SAN lineages. Mechanistically, GATA6 directly activates key regulators of the SAN genetic program in conduction and nonconduction cells, such as TBX3 and EDN1, respectively. The data identify GATA6 as an important regulator of the SAN and provide a molecular basis for understanding the conduction abnormalities associated with GATA6 mutations in humans. They also suggest that GATA6 may be a potential modifier of the cardiac pacemaker.

scholarly journals Risk of sick sinus syndrome in patients diagnosed with atrial fibrillation: a population-based cohort

2021 ◽  
Author(s):  
Pil-Sung Yang ◽  
Daehoon Kim ◽  
Eunsun Jang ◽  
Hee Tae Yu ◽  
Tae-Hoon Kim ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Elderly Population ◽  
Sick Sinus Syndrome ◽  
Sinus Node ◽  
Pacemaker Implantation ◽  
Population Based ◽  
Av Block ◽  
Increased Risk ◽  
Observation Period

Background: Sinoatrial node dysfunction and atrial fibrillation (AF) frequently coexist and interact with each other, often to initiate and perpetuate each other. Objective: To determine the effect of AF on the incidence and risk of sick sinus syndrome (SSS). Methods: The association of incident AF with the development of incident SSS was assessed from 2004 to 2013 in 302,229 SSS- and pacemaker-free participants aged ≥60 years in the Korea National Health Insurance Service-Senior cohort. Results: During an observation period of 1,854,800 person-years, incident AF was observed in a total of 12,797 participants (0.69%/year). The incidence of SSS was 0.2 and 3.4 per 1000 person-years in the incident AF and the propensity score matched no-AF groups, respectively. After adjustment, the risk of SSS caused by incident AF was significantly increased, with a hazard ratio (HR) of 13.4 (95% confidence interval [CI]: 8.4–21.4). This finding was consistently observed after censoring for heart failure (HR, 16.0; 95% CI: 9.2–28.0) or heart failure/myocardial infarction (HR, 16.6; 95% CI: 9.3-29.7). Incident AF also was associated with an increased risk of pacemaker implantation related with both SSS (HR, 21.8; 95% CI: 8.7–18.4) and atrioventricular (AV) block (HR, 9.5; 95% CI: 4.9–18.4). These results were consistent regardless of sex and comorbidities. Conclusion: Incident AF was associated with more than ten times increased risk of SSS in an elderly population regardless of comorbidities. Risk of pacemaker implantations related with both sinus node dysfunction and AV block were increased in elderly population with incident AF.

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.

scholarly journals Prolonged Sinus Pauses upon Termination of Paroxysmal Atrial Fibrillation: Abnormal Right Atrial Electrophysiologic and Electroanatomic Findings

2017 ◽  
Vol 44 (2) ◽  
pp. 107-114 ◽  
Author(s):  
Zhengyu Bao ◽  
Hongwu Chen ◽  
Bing Yang ◽  
Michael Shehata ◽  
Weizhu Ju ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Node ◽  
P Wave ◽  
Right Atrial ◽  
Control Group ◽  
Paroxysmal Supraventricular Tachycardia ◽  
Group A ◽  
Group B ◽  
Activation Times ◽  
The Right

The efficacy of pulmonary vein antral isolation for patients with prolonged sinus pauses (PSP) on termination of atrial fibrillation has been reported. We studied the right atrial (RA) electrophysiologic and electroanatomic characteristics in such patients. Forty patients underwent electroanatomic mapping of the RA: 13 had PSP (group A), 13 had no PSP (group B), and 14 had paroxysmal supraventricular tachycardia (control group C). Group A had longer P-wave durations in lead II than did groups B and C (115.5 ± 15.4 vs 99.5 ± 10.9 vs 96.5 ± 10.4 ms; P=0.001), and RA activation times (106.8 ± 13.8 vs 99 ± 8.7 vs 94.5 ± 9.1 s; P=0.02). Group A's PP intervals were longer during adenosine triphosphate testing before ablation (4.6 ± 2.3 vs 1.7 ± 0.6 vs 1.5 ± 1 s; P <0.001) and after ablation (4.7 ± 2.5 vs 2.2 ± 1.4 vs 1.6 ± 0.8 s; P <0.001), and group A had more complex electrograms (11.4% ± 5.4% vs 9.3% ± 1.6% vs 5.8% ± 1.6%; P <0.001). Compared with group C, group A had significantly longer corrected sinus node recovery times at a 400-ms pacing cycle length after ablation, larger RA volumes (100.1 ± 23.1 vs 83 ± 22.1 mL; P=0.04), and lower conduction velocities in the high posterior (0.87 ± 0.13 vs 1.02 ± 0.21 mm/ms; P=0.02) and high lateral RA (0.89 ± 0.2 vs 1.1 ± 0.35 mm/ms; P=0.04). We found that patients with PSP upon termination of atrial fibrillation have RA electrophysiologic and electroanatomic abnormalities that warrant post-ablation monitoring.

P1259Right atrial low voltage zone as a novel predictor of sinus node dysfunction in patients with non-paroxysmal atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Kondo ◽  
M Kimura ◽  
M Nakayama ◽  
O Matsuda
Keyword(s):  
Atrial Fibrillation ◽  
Low Voltage ◽  
Sinus Node ◽  
Pacemaker Implantation ◽  
Left Ventricular ◽  
Sinus Node Dysfunction ◽  
Right Atrial ◽  
Left Ventricular Ejection ◽  
Ablation Procedure ◽  
Ventricular Ejection Fraction

Abstract Background Although sinus node dysfunction (SND) coexists with atrial fibrillation (AF) in some cases, SND in patients with Non-paroxysmal AF (Non-PAF) could not be estimated in conventional electrophysiological study. Atrial low voltage zone (LVZ), which may be surrogate for atrial fibrosis, is although reported to present in patients with Non-PAF, the association between SND and right atrial LVZ (RA-LVZ) has not been fully evaluated. The aim of the present study was to assess the relationship between SND and RA-LVZ in patients with Non-PAF. Method Eighty-six Non-PAF patients underwent high density voltage mapping of right atrium (RA) during AF before ablation procedure. We defined LVZ as that with electrogram amplitude <0.1 mV in order to delineate strongly damaged area in RA. We evaluated the surface are of the RA-LVZ in Non-PAF patients with and without SND. Results Twenty-seven of 86 patients (31.4%) presented with SND after AF termination. There were no significant differences between patients with and without SND in variables such as age, sex, AF duration, left atrial diameter, and left ventricular ejection fraction. The mean value of RA-LVZ of all the patients was 12.1±11.4%, and RA-LVZ was significantly larger in patients with SND than in those without SND (22.8±14.6 vs 7.2±4.2%; P<0.001). In multivariate logistic regression analysis for the incidence of subsequent pacemaker implantation (PMI), only RA-LVZ was a significant predictor of subsequent PMI (odd ratio 1.306; 95% confidence interval 1.159 - 1.473; P<0.001). Receiving-operating characteristic curve for PMI following ablation procedure indicated cut-off value 10.5% for RA-LVZ with 85.2% sensitivity and 88.1% specificity (area under curve = 0.924, P<0.001). Kaplan-Meier analysis of the incidence of PMI after AF termination showed that freedom from pacemaker implantation was significantly better in patients with RA-LVA <10.5% than in those with RA-LVZ ≥10.5% (log-rank test; P<0.001). Conclusions Broad RA-LVZ measured during AF was strongly associated with SND and PMI after AF termination in patients with Non-PAF. Evaluation of RA-LVZ during AF could be a potential target in predicting SND requiring PMI in patients with Non-PAF.

scholarly journals Bradycardia-dependent rise in the atrial capture threshold early after cardiac pacemaker implantation in patients with sick sinus syndrome

2016 ◽  
Vol 2 (1) ◽  
pp. 27-31 ◽  
Author(s):  
Akira Kimata ◽  
Kentaro Yoshida ◽  
Noriyuki Takeyasu ◽  
Rieko Nakagami ◽  
Jun Osada ◽  
...  
Keyword(s):  
Sick Sinus Syndrome ◽  
Pacemaker Implantation ◽  
Cardiac Pacemaker ◽  
Atrial Capture

scholarly journals Electrical characteristics of deep septal vs. left bundle branch (area) pacing

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L.I.B Heckman ◽  
J Luermans ◽  
B Weijs ◽  
A.M.W Van Stipdonk ◽  
M Mafi-Rad ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Statistical Significance ◽  
Interventricular Septum ◽  
Pacemaker Implantation ◽  
Transverse Plane ◽  
Right Atrial ◽  
Routine Practice ◽  
Septal Pacing ◽  
Qrs Duration ◽  
The Right

Abstract Background/Introduction Recent studies have described transvenous left bundle branch (LBB) pacing as a new conduction system pacing strategy. However, information on effect of pacing depth within the septum and the additional effect of LBB capture is unknown. Purpose To investigate the relation of electrocardographic characteristics with transseptal LV lead implantation depth and LBB capture. Methods 20 consecutive patients referred for pacemaker implantation were enrolled. The right atrial (RA) lead was positioned according to routine practice. The LV septal pacing lead (Medtronic 3830) was transvenously positioned against the right side of the interventricular septum and advanced in small steps of 1–2mm towards the left side of the septum. At each depth in the septum 12-lead ECG's were recorded during pacing, from which vectorcardiograms (VCG) were calculated. QRS duration and QRS area were measured, the latter being the integral of the QRSarea in X, Y and Z directions. Successful LBB capture was defined as paced right bundle branch block (RBBB) morphology, stable and short stimulus to LV activation time (LVAT; R in V5) and recorded LBB potential. Differences were compared among pacing conditions using repeated measures ANOVA with Bonferroni multiple comparisons procedure applied to pairwise comparisons. Statistical significance was assumed at p&lt;0.05. Results LV septal lead implantation was successful in all patients. Left bundle branch capture was achieved in 10/20 patients (50%). Post-procedural LV pacing threshold, impedance and sensing was 0.7±0.1 V at 0.5 ms pulse width, 658±5 Ω and 13±10 mV, respectively. Compared to intrinsic rhythm, QRS duration was significantly increased by both RV septum (RVS; 124±5 vs. 161±3 ms) and LV septum pacing (LVS; 142±3 ms). QRS area increased significantly during RVS pacing as compared to intrinsic rhythm but decreased when moving from RVS to LVS to values close to intrinsic rhythm (panel A & B). LVS-pacing derived QRS area was significantly lower in patients with LBB capture (36±6 mV*ms) compared to patients without LBB capture (deep septal pacing; 46±12 mV*ms). The reduction in QRS area between RVS and LVS pacing coincided with normalization of the QRS vector in the transverse plane (panel C), which is characterized electrocardiographically by predominantly negative-to-positive inversion of the QRS complex in the precordial leads (V1-V3). Conclusions Compared to RV septal pacing, LV septal pacing restores ventricular electrical synchrony, as determined by QRS area, and normalizes the activation vector in the transverse plane to a level comparable to intrinsic rhythm. Differences in resynchronization between left bundle branch pacing and deep septal pacing are small. LBBAP restores ventricular synchrony Funding Acknowledgement Type of funding source: None

P1096Cardioneuroablation changes the type of vaso-vagal response in patients with asystolic reflex syncope

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
R Piotrowski ◽  
A Zuk ◽  
J Baran ◽  
A Sikorska ◽  
T Krynski ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Postgraduate Medical Education ◽  
Sinus Node ◽  
Pacemaker Implantation ◽  
Heart Rate Variability Parameter ◽  
History Of ◽  
The Right ◽  
The Impact

Abstract Funding Acknowledgements Centre of Postgraduate Medical Education No. 501-1-10-14-19 Background. Cardioneuroablation (CNA) - ablation of ganglionated plexi (GP) to eliminate or reduce parasympathetic overactivity, has been recently proposed as a new therapeutic method in patients with vaso-vagal syncope (VVS) due to cardioinhibitory or mixed mechanism. Purpose. To assess the impact of CNA on the type of VV response during tilt testing (TT). Methods. The study group consisted of the first 20 patients (7 males, mean age 38 ± 9 – year – old) enrolled in the ongoing prospective Roman study (NCT 03903744). All patients had a history of ECG documented syncope due to asystole and confirmed asystolic form of VVS at baseline TT. CNA was performed using electroanatomical system Carto 3 and radiofrequency applications delivered in the right and left atrium at the right anterior GP and right inferior GP sites. The second TT was performed three months later. Resting heart rate (HR) and heart rate variability parameter (SDDN) were also assessed. Results. At baseline TT, nineteen patients had cardioinhibitory syncope (asystole ranging from 3 to 60 s)  (sinus node arrest – 17 patients, A-V block – 2 patients) and 1 had mixed form of VVS (asystole lasting 3 s preceded by hypotension). During three-month follow-up no syncopal episodes were noted. At the 3-month TT, 6 (30 %) patients had no syncope whereas the remaining 13 (65 %)  had syncope – twelve (60 %) due to vasodepressor mechanism and only one (5 %) due to asystole - as before CNA. One patient did not have TT because of pregnancy. Mean resting HR after CNA was significantly faster and SDNN significantly lower than before the procedure (82 ± 9 vs 69 ± 11 beats/min, p = 0.0004 and 74 ± 22 vs 143 ± 40 ms, p = 0.00003, respectively) and these changes were was similar in those who fainted during second TT and those who did not (82 ± 11 vs 81 ± 4 beats/min, p = NS and (75 ± 2 vs 77 ± 18 ms, p = NS, respectively). Conclusions. CNA profoundly affects the type of VV reaction causing normalization of the response to tilting or changing cardiodepression to vasodepression. These effects are also depicted by changes in HR and heart rate variability. Elimination of TT-induced reflex asystole may prevent clinical recurrences of syncope during short-term follow-up. These findings encourage to conduct further studies involving CNA since this method appears to be effective and obviates the need for pacemaker implantation in young people with reflex asystolic syncope.

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