Difference in Cardiac Electrical Vulnerability Between Passive Silicone Steroid Eluting Lead vs. Active Screw-in Lead

2019 ◽  
Vol 56 (4) ◽  
pp. 968-972
Author(s):  
Adrian Apostol ◽  
Nicolae Albulescu ◽  
Stela Iurciuc ◽  
Mircea Iurciuc ◽  
Carina Bogdan ◽  
...  
Keyword(s):  
Atrioventricular Block ◽  
Cardiac Pacing ◽  
Ventricular Myocardium ◽  
Surrounding Tissue ◽  
Late Potentials ◽  
Prognosis Factor ◽  
Mechanical Coupling ◽  
Different Types ◽  
Fixation Type ◽  
Total Atrioventricular Block

Patients with total atrioventricular block are of particular interest and prone to severe prognosis unless treated with emergency cardiac pacing. We evaluated different types of leads and their impact on the myocardium, according to the fixation type and pacing method.. A pacemaker patient has a different depolarization pattern and a single chamber pacemaker, has by definition, an intracardiac desynchronization and a different electro-mechanical coupling activity. The presence of late potentials is an independent prognosis factor for cardiac death and electrical vulnerability, especially after myocardial infarction(MI). Late potentials recorded as magnitude vector are the expresion of late depolarization of the surrounding tissue and represent the morfological substrate for reentry. Thus, the incidence of late potentials after pacemaker implant, represents the expresion of electrical vulnerability of the stimulated right ventricular myocardium. In order to deeply study the parameters of magnitude vectors, we noticed the appearance of late potentials during the transitory stimulation in acute atrioventricular block and a restoration of vector normal parameters, after conduction recovery and sinus rhythm conversion.

Abstract P437: Deep Learning-based Models For Complete Atrioventricular Block Heart Rhythm Analysis

2021 ◽  
Vol 129 (Suppl_1) ◽  
Author(s):  
Dahim Choi ◽  
Nam Kyun Kim ◽  
Young H Son ◽  
Yuming Gao ◽  
Christina Sheng ◽  
...  
Keyword(s):  
Neural Networks ◽  
Deep Learning ◽  
Atrioventricular Block ◽  
Prediction Models ◽  
Pacemaker Implantation ◽  
Heart Rhythm ◽  
High Sensitivity ◽  
Ventricular Myocardium ◽  
True Positive Rate ◽  
Starting Point

Atrioventricular block (AVB), caused by impairment in the heart conduction system, presents extreme diversity and is associated with other complications. Only half of AVB patients require a permanent pacemaker, and the process determining the pacemaker implantation is associated with an increase in cost and patient morbidity and mortality. Thus, there is a need for models capable of accurately identifying transient or reversible causes for conduction disturbances and predicting the patient risks and the necessity of a pacemaker. Deep learning (DL) is brought to the forefront due to its prediction accuracy, and the DL-based electrocardiogram (ECG) analysis can be a breakthrough to analyze a massive amount of data. However, the current DL models are unsuitable for AVB-ECG, where the P waves are decoupled from the QRS/T waves, and a black-box nature of the DL-based model lowers the credibility of prediction models to physicians. Here, we present a real-time-capable DL-based algorithm that can identify AVB-ECG waves and automate AVB phenotyping for arrhythmogenic risk assessment. Our algorithm can analyze unformatted ECG records with abnormal patterns by integrating the two representative DL algorithms: convolutional neural networks (CNN) and recurrent neural networks (RNN). This hybrid CNN/RNN network can memorize local patterns, spatial hierarchies, and long-range temporal dependencies of ECG signals. Furthermore, by integrating parameters derived from dimension reduction analysis and heart rate variability into the hybrid layers, the algorithm can capture the P/QRS/T-specific morphological and temporal features in ECG waveforms. We evaluated the algorithm using the six AVB porcine models, where TBX18, a pacemaker transcription factor, was transduced into the ventricular myocardium to form a biological pacemaker, and an additional electronic pacemaker was transplanted as a backup pacemaker. We achieved high sensitivity (95% true positive rate) and quantified the potential risks of various pathological ECG patterns. This study may be a starting point in conducting both retrospective and prospective patient studies and will help physicians understand its decision-making workflow and find the incorrect recommendations for AVB patients.

Bradycardias and blocks

2020 ◽  
pp. 241-270
Keyword(s):  
Adverse Effects ◽  
Clinical Significance ◽  
Atrioventricular Block ◽  
Early Identification ◽  
Sinus Bradycardia ◽  
Cardiac Pacing

This chapter covers bradycardia, heart blocks, and cardiac pacing. Bradyarrhythmias that require pacing can be caused by a range of aetiologies and early identification of possible reversible causes is the first stage of treatment. Although a degree of bradycardia and heart blocks might not have any clinical significance, it is always important to assess the patient for signs of adverse effects. Generally, pacing is only indicated for symptomatic sinus bradycardia. In contrast, patients with asymptomatic atrioventricular block may require pacing for prognostic purposes.

scholarly journals Case Report: III° atrioventricular block due to fulminant myocarditis managed with non-invasive transcutaneous pacing

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 239
Author(s):  
Kiran Devkota ◽  
Ya Hong Wang ◽  
Meng Yi Liu ◽  
Yan Li ◽  
You Wei Zhang
Keyword(s):  
Heart Failure ◽  
Case Report ◽  
Atrioventricular Block ◽  
Cardiac Arrhythmias ◽  
Cardiac Pacing ◽  
Active Management ◽  
Fulminant Myocarditis ◽  
Non Invasive ◽  
Transcutaneous Pacing ◽  
Life Threatening

Fulminant myocarditis is a life-threatening clinical condition. It is the inflammation of myocardium leading to acute heart failure, cardiogenic shock and cardiac arrhythmias. Incidence of fulminant myocarditis is low and mortality is high. Most grievous complications of fulminant myocarditis is mainly cardiac arrhythmias; if there is delay on active management of the patient, it may be fatal. Here, we describe a case of III° atrioventricular block due to fulminant myocarditis that was managed with non-invasive transcutaneous cardiac pacing in the absence of ECMO. The non-invasive transcutaneous pacemaker is a safe, effective and convenient device to revert arrhythmias.

Temporary pacing

Curationis ◽  
1983 ◽  
Vol 6 (2) ◽  
Author(s):  
L.J. Workman
Keyword(s):  
Quality Of Life ◽  
Heart Rate ◽  
Heart Block ◽  
Cardiac Pacing ◽  
Pacemaker Therapy ◽  
Temporary Pacing ◽  
Different Types ◽  
The Many ◽  
Electrical Stimuli

Artificial cardiac pacing, the use of electrical stimuli to cause contraction of heart muscle, is a sophisticated therapeutic and diagnostic tool. Its rapid technologic improvement since first developed in the late 1930’s by Hyman, has made it possible not only to avoid certain cases of death due to heart block, but also to extend and improve the quality of life. Pacemaker therapy is generally used to treat heart rate or rhythm disturbances, being either tachy- or bradyarrhythmias that produce a detrimental drop in cardiac output. Of the many different types of pacemakers and electrodes currently available, ventricular demand pacing is the most commonly used.

scholarly journals Murine Electrophysiological Models of Cardiac Arrhythmogenesis

2017 ◽  
Vol 97 (1) ◽  
pp. 283-409 ◽  
Author(s):  
Christopher L.-H. Huang
Keyword(s):  
Structural Change ◽  
Surface Membrane ◽  
Experimental Studies ◽  
Cardiac Activity ◽  
Cardiac Pacing ◽  
Ventricular Myocardium ◽  
Cellular Tissue ◽  
Cardiac Arrhythmogenesis ◽  
Voltage Dependent ◽  
Intracellular Ca

Cardiac arrhythmias can follow disruption of the normal cellular electrophysiological processes underlying excitable activity and their tissue propagation as coherent wavefronts from the primary sinoatrial node pacemaker, through the atria, conducting structures and ventricular myocardium. These physiological events are driven by interacting, voltage-dependent, processes of activation, inactivation, and recovery in the ion channels present in cardiomyocyte membranes. Generation and conduction of these events are further modulated by intracellular Ca2+ homeostasis, and metabolic and structural change. This review describes experimental studies on murine models for known clinical arrhythmic conditions in which these mechanisms were modified by genetic, physiological, or pharmacological manipulation. These exemplars yielded molecular, physiological, and structural phenotypes often directly translatable to their corresponding clinical conditions, which could be investigated at the molecular, cellular, tissue, organ, and whole animal levels. Arrhythmogenesis could be explored during normal pacing activity, regular stimulation, following imposed extra-stimuli, or during progressively incremented steady pacing frequencies. Arrhythmic substrate was identified with temporal and spatial functional heterogeneities predisposing to reentrant excitation phenomena. These could arise from abnormalities in cardiac pacing function, tissue electrical connectivity, and cellular excitation and recovery. Triggering events during or following recovery from action potential excitation could thereby lead to sustained arrhythmia. These surface membrane processes were modified by alterations in cellular Ca2+ homeostasis and energetics, as well as cellular and tissue structural change. Study of murine systems thus offers major insights into both our understanding of normal cardiac activity and its propagation, and their relationship to mechanisms generating clinical arrhythmias.

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