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We present an unusual case of alternating left anterior and left posterior fascicular block. Given the known risk for progression to complete atrioventricular block with alternating right bundle and left bundle branch block, we performed an electrophysiological study. Findings were consistent with infra-Hisian disease, and the patient underwent pacemaker implantation.

Advancements in optoelectronic biointerfaces have revolutionized healthcare by enabling targeted stimulation and monitoring of cells, tissues, and organs. Photostimulation, a key application, offers precise control over biological processes, surpassing traditional modulation methods with increased spatial resolution and reduced invasiveness. This perspective highlights three approaches in non-genetic optoelectronic photostimulation: nanostructured phototransducers for cellular stimulation, micropatterned photoelectrode arrays for tissue stimulation, and thin-film flexible photoelectrodes for multiscale stimulation. Nanostructured phototransducers provide localized stimulation at the cellular or subcellular level, facilitating cellular therapy and regenerative medicine. Micropatterned photoelectrode arrays offer precise tissue stimulation, critical for targeted therapeutic interventions. Thin-film flexible photoelectrodes combine flexibility and biocompatibility for scalable medical applications. Beyond neuromodulation, optoelectronic biointerfaces hold promise in cardiology, oncology, wound healing, and endocrine and respiratory therapies. Future directions include integrating these devices with advanced imaging and feedback systems, developing wireless and biocompatible devices for long-term use, and creating multifunctional devices that combine photostimulation with other therapies. The integration of light and electronics through these biointerfaces paves the way for innovative, less invasive, and more accurate medical treatments, promising a transformative impact on patient care across various medical fields. Highlights: • Non-genetic optoelectronic biointerfaces revolutionize healthcare by enabling precise biological stimulation and monitoring. • Key methods include nanostructured phototransducers, micropatterned arrays, and thin-film flexible electrodes. • Future advancements will integrate imaging, develop wireless devices, and create multifunctional therapies, transforming patient care. [ABSTRACT FROM AUTHOR]

BACKGROUND: Bradycardia is more common among well-trained athletes than in the general population, but the association with pacemaker implantations is less known. We investigated associations of endurance training with incidence of bradycardia and pacemaker implantations, including sex differences and long-term outcome, in a cohort of endurance trained individuals. METHODS: All Swedish skiers who completed >1 race in the cross-country skiing event Vasaloppet between 1989 and 2011 (n=209 108) and a sample of 532 290 nonskiers were followed until first event of bradycardia, pacemaker implantation, or death, depending on end point. The Swedish National Patient Register was used to obtain diagnoses. Cox regression was used to investigate associations of number of completed races and finishing time in Vasaloppet with incidence of bradycardia and pacemaker implantations. In addition, Cox regression was used to investigate associations of pacemaker implantations with death in skiers and nonskiers. RESULTS: Male skiers had a higher incidence of bradycardia (adjusted hazard ratio [aHR], 1.19 [95% CI, 1.05-1.34]) and pacemaker implantations (aHR, 1.17 [95% CI, 1.04-1.31]) compared with male nonskiers. Those who completed the most races and had the best performances exhibited the highest incidence. For female skiers in Vasaloppet, the incidence of bradycardia (aHR, 0.98 [95% CI, 0.75-1.30]) and pacemaker implantations (aHR, 0.98 [95% CI, 0.75-1.29]) was not different from that of female nonskiers. The indication for pacemaker differed between skiers and nonskiers, with sick sinus syndrome more common in the former and third-degree atrioventricular block in the latter. Skiers had lower overall mortality rates than nonskiers (aHR, 0.16 [95% CI, 0.15-0.17]). There were no differences in mortality rates by pacemaker status among skiers. CONCLUSIONS: In this study, male endurance skiers had a higher incidence of bradycardia and pacemaker implantations compared with nonskiers, a pattern not seen in women. Among male skiers, those who completed the most races and had the fastest finishing times had the highest incidence of bradycardia and pacemaker implantations. Within each group, mortality rates did not differ in relation to pacemaker status. These findings suggest that bradycardia associated with training leads to a higher risk for pacemaker implantation without a detrimental effect on mortality risk. [ABSTRACT FROM AUTHOR]

Background This case report details the application of left bundle branch pacing in a patient with congenitally corrected transposition of the great arteries (cc-TGA), a rare congenital heart defect characterized by anatomical complexities that pose unique challenges in the management of device-related complications and heart failure. The patient's history is notable for complex anatomical considerations, cardiovascular implantable electronic device (CIED) infection, and heart failure. Case summary The patient underwent a series of interventions, including treatment for pocket-site infections, abandonment of epicardial leads, and an unsuccessful attempt at trans-catheter leadless pacemaker implantation. Given the patient's complex anatomy and prior CIED infection, traditional pacing methods were deemed unsuitable, leading to the selection of left bundle branch pacing. The lead implantation was guided using 3D electro-anatomical mapping to ensure synchronous physiologic pacing in a patient with heart failure. Discussion The case underscores the heightened risks faced by cc-TGA patients, with a focus on systemic right ventricular dysfunction and pacing-induced ventricular dysfunction. In these patients, ventricular synchrony is critical and can be achieved with biventricular pacing. Physiologic pacing emerges as a promising alternative to cardiac resynchronization therapy (CRT), especially in cases where endovascular CRT is unfeasible. This case demonstrates the utilization of 3D electro-anatomical mapping for achieving successful physiologic pacing in complex congenital heart lesions. At the 12-month follow-up, the patient presented with stable clinical status and a narrow QRS complex. Echocardiography indicated improvement in the right systemic ventricular function. [ABSTRACT FROM AUTHOR]

Tumor Treating Fields (TTFields) therapy is an anti-cancer treatment modality that is delivered noninvasively to the tumor site via skin-placed arrays. The therapy is US Food and Drug Administration (FDA) approved and Conformite' Europe'enne (CE) marked for adults with newly diagnosed and recurrent glioblastoma (GBM) (grade 4 glioma in the European Union). To date, there are limited data on the safety and efficacy of TTFields therapy in patients with implanted cardiac pacemakers. Herein, we report a case of a 79-year-old male patient with GBM receiving TTFields therapy with a prior medical history of cardiac events necessitating a cardiac pacemaker. The patient presented to the emergency department in May 2021 with newly onset left-sided weakness along with seizures. Based on an initial evaluation and results of the initial computed tomography (CT) scans (May 2021), the patient was clinically diagnosed with a high-grade glioma which was later confirmed as IDH wildtype following a biopsy. He was treated with radiotherapy (40 Gy in 15 fractions), followed by adjuvant temozolomide (TMZ) (75 mg/m²). TTFields therapy was initiated alongside maintenance TMZ (150 mg/m²). Average TTFields therapy usage was 67% throughout the duration of treatment. Follow-up CT scans (February and May of 2022) indicated stable disease. CT scans in August 2022 showed an increase in size of a mass with heterogeneous contrast enhancement and the patient subsequently passed away in October 2022. The patient's last cardiac tests demonstrated that the pacemaker was operational with adequate cardiac function. This report suggests that TTFields therapy concomitant with an implanted electronic device may be safe in patients with GBM. [ABSTRACT FROM AUTHOR]

Study Design. Modified Delphi consensus study. Objective. To develop consensus-based best practices for the care of pediatric patients who have implanted programmable devices (IPDs) and require spinal deformity surgery. Summary of Background Data. Implanted programmable devices (IPDs) are often present in patients with neuromuscular or syndromic scoliosis who require spine surgery. Guidelines for monitoring and interrogating these devices during the perioperative period are not available. Methods. A panel was assembled consisting of 25 experts (i.e., spinal deformity surgeons, neurosurgeons, neuroelectrophysiologists, cardiologists, and otolaryngologists). Initial postulates were based on a literature review and results from a prior survey. Postulates addressed the following IPDs: vagal nerve stimulators (VNS), programmable ventriculoperitoneal shunts (VPS), intrathecal baclofen pumps (ITBP), cardiac pacemakers and implantable cardioverter-defibrillators (ICD), deep brain stimulators (DBS), and cochlear implants. Cardiologist and otolaryngologist participants responded only to postulates on cardiac pacemakers or cochlear implants, respectively. Consensus was defined as ≥ 80% agreement, items that did not reach consensus were revised and included in subsequent rounds. A total of 3 survey rounds and 1 virtual meeting were conducted. Results. Consensus was reached on 39 total postulates across 6 IPD types. Postulates addressed general spine surgery considerations, the use of intraoperative monitoring and cautery, the use of magnetically controlled growing rods (MCGRs), and the use of an external remote controller to lengthen MCGRs. Across IPD types, consensus for the final postulates ranged from 94.4% to 100%. Overall, experts agreed that MCGRs can be surgically inserted and lengthened in patients with a variety of IPDs and provided guidance for the use of intraoperative monitoring and cautery, which varied between IPD types. Conclusion. Spinal deformity correction surgery often benefits from the use of intraoperative monitoring, monopolar and bipolar cautery, and MCGRs. The final postulates from this study can inform the perioperative and postoperative practices of spinal deformity surgeons who treat patients with both scoliosis and IPDs. Level of Evidence. V-Expert opinion. [ABSTRACT FROM AUTHOR]

Copyright of Psychotherapie im Alter is the property of Psychosozial-Verlag and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article presents the case of a 27-year-old female patient with idiopathic congenital complete heart block who does not consent to the implantation of a cardiac pacemaker but was referred by her primary care physician for cardiological evaluation. The conduction disturbance was recognized at the age of 6 and was asymptomatic. The professional disqualification from pacemaker implantation included a detailed history of a patient's symptoms, an echocardiographic assessment of the heart, exercise testing and ECG Holter monitoring. The aid of salbutamol administered orally was also useful. [ABSTRACT FROM AUTHOR]

Summary: In order to reduce the implantation volume and improve the transmission efficiency of the magnetically coupled resonant wireless power transfer system for cardiac pacemakers, a dual‐coupled wireless power transfer system for cardiac pacemakers that integrates a compensation coil into the main coil was designed. First, the mutual inductance equivalent model of the dual‐coupled wireless power transfer system was established and the impedance matching parameters were solved. The double‐sided inductor–capacitor–inductor (DS‐LCL) circuit simulation model considering the equivalent series resistance was established with MATLAB. The influence of different inductance ratios on the output power and transfer efficiency of the system was analyzed in the range of 200–300 kHz, and the system parameters for optimal transfer efficiency were determined. Second, the compensation coil on the same side was naturally decoupled by changing the aspect ratio of the compensation coil. The magnetic field distribution between the internally integrated dual‐coupled structure proposed in this paper and the conventional integrated structure was compared using COMSOL, and the safety assessment of the system was conducted, considering parameters such as temperature rise and specific absorption rate. Finally, an experimental platform was established to verify the system's output performance and safety. The results showed that compared with conventional integrated structures, the proposed integrated structure increased the output power by 0.229 W and transmission efficiency by 10.08% at a transmission distance of 8 mm. The maximum temperature rise is 1.9°C. [ABSTRACT FROM AUTHOR]

To solve the low power transfer efficiency and magnetic field leakage problems of cardiac pacemaker wireless powering, we proposed a wireless power supply system suitable for implanted cardiac pacemaker based on mu-negative (MNG) and mu-near-zero (MNZ) metamaterials. First, a hybrid metamaterial consisted of central MNG unit for magnetic field concentration and surrounding MNZ units for magnetic leakage shielding was established by theoretical calculation. Afterwards, the magnetic field distribution of wireless power supply system with MNG-MNZ metamaterial slab was acquired via finite element simulation and verified to be better than the distribution with conventional MNG slab deployed. Finally, an experimental platform of wireless power supply system was established with which power transfer experiment and system temperature rise experiment were conducted. Simulation and experimental results showed that the power transfer efficiency was improved from 44.44%, 19.42%, 8.63% and 6.19% to 55.77%, 62.39%, 20.81% and 14.52% at 9.6 mm, 20 mm, 30 mm and 50 mm, respectively. The maximum SAR acquired by SAR simulation under human body environment was -7.14 dbm and maximum reduction of the magnetic field strength around the receiving coil was 2.82 A/m. The maximum temperature rise during 30min charging test was 3.85°C, and the safety requirements of human bodies were met.

For real-time patient heart rate management, most widely used biomedical implantable devices in the cardiovascular system is the cardiac pacemaker (CP). A key factor in keeping the patient alive is the development of novel heart pacing techniques which can reduce the risk of cardiac arrhythmia. The present work is inspired to achieve this goal. To achieve an accurate, controlled, and regulated heart rate, a pacemaker with an intelligent proportional integral derivative (PID) controller is considered. The proposed PID controller is an integration of the traditional PID controller with appropriate tuning, that uses a swarm intelligence-based artificial bee colony (ABC) algorithm for handling the bio-electrical signals. To ensure the efficacy of the proposed controller experiments are conducted. MATLAB/Simulink software is used to test and simulate the suggested model and to adjust the controller gains. The simulation is performed in the time and frequency domain. The resulting pulse rate from the ABC-PID controller has a rise time (0.0985 s), settling time (0.3293 s), maximum overshoot (0.111367%), and MSE (0.0040565). External disturbances of various duty cycles are also introduced in the proposed CP control system. The proposed ABC-PID controller for implanted pacemakers reduces the risk of heart rate over-run.

Mobitz type II second-degree atrioventricular block (AVB) is an electrocardiographic pattern that describes what appears to be an all-or-none conduction without visible changes in the AV conduction time or PR intervals before and after a single non-conducted P wave. An unchanged PR interval after the block is a sine qua non of Mobitz type II block. A 2:1 AVB cannot be classified in terms of type I or type II AVB. The diagnosis of Mobitz type II block AVB requires a stable sinus rate, which is an important criterion because a vagal surge (generally benign) can cause simultaneous sinus slowing and AV nodal block, which can resemble Mobitz type II AVB. Atypical forms of Wenckebach AVB may be misinterpreted as Mobitz type II AVB when a series of PR intervals are constant before the block. Concealed His bundle or ventricular extrasystoles may mimic both Wenckebach and/or type II AVB (pseudo-AVB). Correctly identified Mobitz type II AVB is invariably at the level of the His–Purkinje system and is an indication for a pacemaker.

Tumor Treating Fields (TTFields) therapy is an anti-cancer treatment modality that is delivered noninvasively to the tumor site via skin-placed arrays. The therapy is US Food and Drug Administration (FDA) approved and Conformité Européenne (CE) marked for adults with newly diagnosed and recurrent glioblastoma (GBM) (grade 4 glioma in the European Union). To date, there are limited data on the safety and efficacy of TTFields therapy in patients with implanted cardiac pacemakers. Herein, we report a case of a 79-year-old male patient with GBM receiving TTFields therapy with a prior medical history of cardiac events necessitating a cardiac pacemaker. The patient presented to the emergency department in May 2021 with newly onset left-sided weakness along with seizures. Based on an initial evaluation and results of the initial computed tomography (CT) scans (May 2021), the patient was clinically diagnosed with a high-grade glioma which was later confirmed as IDH wildtype following a biopsy. He was treated with radiotherapy (40 Gy in 15 fractions), followed by adjuvant temozolomide (TMZ) (75 mg/m2). TTFields therapy was initiated alongside maintenance TMZ (150 mg/m2). Average TTFields therapy usage was 67% throughout the duration of treatment. Follow-up CT scans (February and May of 2022) indicated stable disease. CT scans in August 2022 showed an increase in size of a mass with heterogeneous contrast enhancement and the patient subsequently passed away in October 2022. The patient’s last cardiac tests demonstrated that the pacemaker was operational with adequate cardiac function. This report suggests that TTFields therapy concomitant with an implanted electronic device may be safe in patients with GBM.

Dear Editor, Temporary cardiac pacing is an artificial method of electrical cardiac stimulation to treat a bradyarrhythmia (BA) or tachyarrhythmia until resolution or initiation of long-term treatment. The goal of this temporary stimulation is to restore circulation and normal hemodynamics that has been significantly compromised by abnormal heart rate (1). Temporary artificial pacing is recommended in a variety of circumstances, most notably in individuals with severe BA such as second- or third-degree atrioventricular block (AVB), or severe symptomatic bradycardia irrespective of the cause. Furthermore, temporary pacing can be used as an overpass while awaiting placement of permanent pacemaker (PPM) in patients (2). Temporary pacemakers (TPM) are used to treat emergencies in individuals with severe symptomatic BA and for elderly patients who are hemodynamically unstable and refractory to medical treatment. TPM is a critical emergency tool for saving lives in such situations, which is why it is highly concerning that the people of Khyber Pakhtunkhwa (KPK) can avail this vital therapy only at the province's four tertiary care hospitals (TCH). For people residing in peripheral areas, it takes more than 4-5 hours on average to reach TCH, which is dreadful in face of an emergency. This discrepancy in availability of TPM often causes thromboembolism, stroke and in many cases culminating in the patient's death before reaching the hospital. According to the American Heart Association (AHA), if left untreated, severe or prolonged bradycardia can lead to a variety of problems, including heart failure, hypotension, and hypertension. For certain situations, bradycardia can be followed by a rapid heartbeat, known as tachycardia. When these two conditions occur simultaneously, they are referred to as Bradycardia-Tachycardia or Tachy-Brady syndrome. This is a form of sick sinus syndrome that can be linked with the heart rhythm disease atrial fibrillation, increasing the risk of consequences such as stroke and sudden death, or cardiac arrest (3). As of 2019, almost 15 million Pakistanis were over the age of 60 years, accounting for 7% of the country's total population (4). This is concerning since research shows that conduction abnormalities increased with age. According to a study done in Pakistan, the incidence of conduction defects rose with age, with the highest frequency (28%) seen between the ages of 61 to 70. Third-degree heart block was common (75%) among conduction abnormalities in the investigated group. It was also determined that the rate of pacemaker placement increased with age (5). Therefore, the need for an unprecedented demand for TPM is crucial. It is high time to take steps towards widespread availability of TPM all over KPK at the District Head Quarters (DHQs) level. It is also critical to appoint appropriate allied health professionals for TPM placement, who could deal with the situation without immediate supervision by the cardiologist. With this letter, we call for action to the concerned health care sector authorities in KPK and in Pakistan to supply the requisite quantity of TPM in all KPK health care institutions including smaller set-ups such as DHQs. This would safeguard the preservation of valuable lives while also help reduce mortality and morbidity owing to the scarcity of TPM. To conclude, there is an urgent need for TPM to be made available in all the province's hospitals to prevent the vulnerable population from the life-threatening consequences of BA.

We present an unusual case of alternating left anterior and left posterior fascicular block. Given the known risk for progression to complete atrioventricular block with alternating right bundle and left bundle branch block, we performed an electrophysiological study. Findings were consistent with infra-Hisian disease, and the patient underwent pacemaker implantation.

Patients undergoing subcutaneous implantable cardioverter-defibrillator (S-ICD) placement can experience significant perioperative pain. General anesthesia is traditionally used for S-ICD placement and is associated with increased risk. Truncal plane blocks (TPBs) and sedation offer an alternative for adequate analgesia while avoiding hemodynamic compromise related to general anesthesia. A comprehensive evidence search utilized PubMed, CINAHL, Google Scholar, EBSCOhost, US National Library of Medicine Clinical Trials, and Medline Complete databases and the evidence examined the efficacy of TPBs in S-ICD placement. The quality of evidence was assessed using the guidelines described in the Johns Hopkins Nursing Evidence-Based Practice Model. Three randomized-controlled trials, four nonrandomized experimental studies, two nonexperimental studies, and three case studies totaling 379 patients were reviewed. Ultrasound-guided TPBs with sedation demonstrated superior analgesic efficacy for S-ICD procedures. Hemodynamics marginally deviated from baseline values and were well tolerated by patients. The evidence suggests that TPBs provide adequate analgesia during intraoperative and postoperative periods. TPBs are effective in reducing pain scores and opioid consumption postoperatively. Although there were no significant changes in hemodynamic values, more research should be conducted to evaluate the effects on intraoperative hemodynamics. [ABSTRACT FROM AUTHOR]

Objective To observe the clinical efficacy and safety of left bundle branch pacing ( LBBP) in patients with persistent atrial fibrillation ( PAF) complicating slow ventricular rate. Methods Fifty-six patients who had undergone pacing treatment due to PAF complicating slow ventricular rate were selected. The patients were divided into right ventricular septal pacing (RVSP) group (29 cases) and LBBP group (27 cases) based on the implantation site of ventricular pacing electrode. Each group was further divided into heart failure (HF) and non-HF subgroups according to clinical symptoms and related examination results. The changes of pacing parameters (such as threshold, perception and impedance ), ECG, echocardiography, and plasma pro-brain natriuretic peptide (NT-proBNP) were observed during operation and 12 months after operation. Other conditions including pacing related complications, re-hospitalization due to HF, newly emerging cerebral infarction and all-cause death were also observed. Results (ⅰ) There is no statistically significant difference in pacing parameters between the two groups (P>0. 05). The NT-proBNP level of HF patients in both subgroups decreases 12 months after surgery compared with that before, however its reduction in the HF subgroup of the RVSP group is not significant (P> 0. 05). (ⅱ) In the RVSP group, there is no significant difference in LVEF or LVDd 12 months after surgery compared with that before ( P > 0. 05); LAD significantly increases ( P < 0. 05) while mitral regurgitation is obviously worsened (P<0. 05). In the LBBP group, there is no significant change in LAD or mitral regurgitation 12 months after surgery compared with that before (P>0. 05); LVEF increases while LVDd decreases in those with HF 12 months after surgery (P < 0. 05). (ⅲ) Compared with that before operation, QRS complex duration is prolonged in both groups (P<0. 05), and its value in the RVSP group is significantly greater than that in the LBBP group (P<0. 05). (ⅳ) There is no significant difference in pacing related complications or cardiovascular and cerebrovascular events between the two groups (P>0. 05); the re-hospitalization rate in the RVSP group is higher than that in the LBBP group (P<0. 05).Conclusion Among patients with PAF complicated by slow ventricular rate, LBBP helps to delay or reverse left ventricular remodeling of those with HF, improve cardiac function, and reduce readmission rate due to HF. LBBP should be recommended as the preferred pacing treatment method for atrial fibrillation patients with slow ventricular rate. [ABSTRACT FROM AUTHOR]

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Norepinephrine (NE), which is released by sympathetic nerve endings, causes an increase in the frequency of spontaneous action potentials in the pacemaker cardiomyocytes of the sinoatrial node (SAN) of the heart. This results in an increase in heart rate (HR). Two types of postsynaptic adrenoreceptors (ARs), α1-AR and β-AR, mediate the effects of NE. The role of α1-AR in the sympathetic control of heart rate and SAN automaticity, as well as the membrane mechanisms involved in α1-AR-mediated pacemaker control, have not yet been elucidated. In this study, we utilized immunofluorescence confocal microscopy to examine the distribution of α1A-AR in the SAN of rats. Additionally, we assessed the expression of α1A-AR mRNA in the SAN tissue using RT-PCR. Furthermore, we investigated the impact of α1-AR stimulation on key functional parameters of the pacemaker, including the corrected sinus node recovery time (SNRT/cSNRT) and the SAN accommodation, using the Langendorff perfused heart technique. We also used optical mapping of the electrical activity of perfused, isolated tissue preparations to study the effect of α1-AR stimulation on the spatiotemporal characteristics of SAN excitation. We tested the effects of chloride transmembrane conductance blockade on alteration of functional parameters and pattern of SAN excitation caused by α1-AR. Fluorescent signals corresponding to α1A-AR have been identified in SAN cardiomyocytes, indicating the presence of α1A-AR at protein level. The expression of α1A-AR in SAN has been also confirmed at the mRNA level. The stimulation of α1-AR affects SAN functioning. Phenylephrine (PHE) utilized as α1A-AR agonist caused a decrease in SNRT/cSNRT, as well as an acceleration of SAN accommodation. These effects were rate dependent and were observed in a high frequency range of pacemaker tissue stimulation. PHE induces changes in the excitation pattern of the SAN. The effects of PHE on functional parameters and SAN excitation pattern are attenuated by Ca2+-dependent chloride channel blocker NPPB but remains unaffected by the protein kinase C inhibitor BIM. Our results suggest that cardiac α1-ARs are important for maintaining function of SAN pacemaker at high heart rates and that α1-AR signalling cascades in the SAN by targeting Ca2+-dependent chloride channels are involved in the α1-adrenergic modulation of the electrophysiological properties of the heart pacemaker. [ABSTRACT FROM AUTHOR]

Copyright of Die Kardiologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Cardiac implantable electronic devices (CIEDs) are an established treatment option for arrhythmias, sudden cardiac death prevention, and heart failure. Approximately 1000 devices are implanted per million inhabitants in European countries each year. However, the main concern in patients with an indication for CIED implantation is frequently associated with comorbidities requiring antithrombotic medications. The invasive device implantation procedure represents a bleeding risk ranging from pocket hematoma to cardiac tamponade. On the other hand, temporary interruption of antithrombotic therapy increases the risk for thromboembolic events. Implanting CIEDs in patients on antithrombotic medications incites several clinical dilemmas of balancing thromboembolic risk against bleeding risk, as complications are associated with higher mortality rates in both aspects. The most common bleeding complication is pocket haematoma formation, which is associated with a prolonged hospital stay, higher cost, higher risk of pocket infection, and thus higher morbidity and mortality. Studies have shown that the heparin bridging strategy in patients on oral anticoagulants imposes a greater risk for pocket haematoma formation and no benefit in reducing thromboembolic events. Most procedures of CIED implantation can be performed safely with uninterrupted oral anticoagulants. Dual antiplatelet therapy increases the risk of pocket haematoma and should be avoided whenever possible.

Background: This study examined the intent to be COVID-19 vaccinated and its correlates among patients with a pacemaker. Methods: This observational study was carried out between July 1, 2021, and May 17, 2022 in Beijing, China. Patients with a pacemaker were consecutively invited by a research physician to participate in the study. Intent to be COVID-19 vaccinated, depression, anxiety, insomnia, pain and smoking were measured with standard scales or questions. Results: Of the 206 participating patients, 72.82% (N = 150; 95% confidence interval [CI]: 66.74%–78.89%) expressed an intention to be COVID-19 vaccinated. Intent to be COVID-19 vaccinated was not significantly associated with severity of depression, anxiety, and insomnia. Multiple logistic regression analysis revealed that patients believing that COVID-19 vaccines provided protection and smokers were more likely to express an intention to receive COVID-19 vaccines. In contrast, older patients and those with higher level of physical pain were less likely to express an intention to be vaccinated against COVID-19. Conclusions: Specific vaccination promotion strategies should be implemented targeting this vulnerable segment of the population.

Objectives: To evaluate at 1.5 and 3 T MRI the safety and performance of trademarked ENO®, TEO®, or OTO® pacing systems with automated MRI Mode and the image quality of non-enhanced MR examinations. Methods: A total of 267 implanted patients underwent MRI examination (brain, cardiac, shoulder, cervical spine) at 1.5 (n = 126) or 3 T (n = 141). MRI-related device complications, lead electrical performances stability at 1-month post-MRI, proper functioning of the automated MRI mode and image quality were evaluated. Results: Freedom from MRI-related complications at 1 month post-MRI was 100% in both 1.5 and 3 T arms (both p < 0.0001). The stability of pacing capture threshold was respectively at 1.5 and 3 T (atrial:: 98.9% (p = 0.001) and 100% (p < 0.0001); ventricular: both 100% (p < 0001)). The stability of sensing was respectively at 1.5 and 3 T (atrial: 100% (p = 0.0001) and 96.9% (p = 0.01); ventricular: 100% (p < 0.0001) and 99.1% (p = 0.0001)). All devices switched automatically to the programmed asynchronous mode in the MRI environment and to initially programmed mode after the MRI exam. While all MR examinations were assessed as interpretable, artifacts deteriorated a subset of examinations including mostly cardiac and shoulder ones. Conclusion: This study demonstrates the safety and electrical stability of ENO®, TEO®, or OTO® pacing systems at 1 month post-MRI at 1.5 and 3 T. Even if artifacts were noticed in a subset of examinations, overall interpretability was preserved. Clinical relevance statement: ENO®, TEO®, and OTO® pacing systems switch to MR-mode when detecting magnetic field and switch back on conventional mode after MRI. Their safety and electrical stability at 1 month post MRI were shown at 1.5 and 3 T. Overall interpretability was preserved. Key Points: • Patients implanted with an MRI conditional cardiac pacemaker can be safely scanned under 1.5 or 3 Tesla MRI with preserved interpretability. • Electrical parameters of the MRI conditional pacing system remain stable after a 1.5 or 3 Tesla MRI scan. • The automated MRI mode enabled the automatic switch to asynchronous mode in the MRI environment and to initial settings after the MRI scan in all patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: The clinical utilization of leadless pacemakers (LPs) as an alternative to traditional transvenous pacemakers is likely to increase with the advent of dual-chamber LP systems. Since device retrieval to allow LP upgrade or replacement will become an important capability, the first such dual-chamber, helix-fixation LP system (Aveir DR; Abbott, Abbott Park, IL) was specifically designed to allow catheter-based retrieval. In this study, the preclinical performance and safety of retrieving chronically implanted dual-chamber LPs was evaluated. METHODS: Atrial and ventricular LPs were implanted in the right atrial appendage and right ventricular apex of 9 healthy ovine subjects. After ?2 years, the LPs were retrieved using a dedicated transvenous retrieval catheter (Aveir Retrieval Catheter; Abbott) by snaring, docking, and unscrewing from the myocardium. Comprehensive necropsy/histopathology studies were conducted to evaluate device- and procedure-related outcomes. RESULTS: At a median of 1.9 years postimplant (range, 1.8-2.6), all 18 of 18 (100%) LPs were retrieved from 9 ovine subjects without complications. The median retrieval procedure duration for both LPs, from first-catheter-in to last-catheterout, was 13.3 minutes (range, 2.5-36.4). Postretrieval, all right atrial, and right ventricular implant sites demonstrated minimal tissue disruption, with intact fibrous tissue limited to the distal device body. No significant device-related trauma, perforation, pericardial effusion, right heart or tricuspid valve injury, or chronic pulmonary thromboembolism were observed at necropsy. CONCLUSIONS: This preclinical study demonstrated the safe and effective retrieval of chronically implanted, helix-fixation, dualchamber LP systems, paving the way for clinical studies of LP retrieval. [ABSTRACT FROM AUTHOR]

Takotsubo cardiomyopathy (TTC), also known as 'broken heart syndrome,' is a transient cardiovascular condition characterized by acute and reversible dysfunction of the left ventricle. This syndrome can mimic acute coronary syndrome, with coronary angiography typically not showing significant stenosis of the coronary arteries. TTC is more common in postmenopausal women and is often associated with intense emotional or physical stress. Although the etiology of TTC is not fully understood, it is hypothesized that excessive catecholamine production may play a key role. Diagnosis is established based on clinical, echocardiograpic, electrocardiographic, and biochemical findings, and treatment is mostly symptomatic and supportive. The prognosis for TTC is generally favourable. Research suggests that the pathophysiological basis of Takotsubo syndrome may be linked to microvascular dysfunction and myocardial edema, which can lead to transient myocardial impairment. This review article addresses TTC that occurred in a 59-year-old patient with no prior cardiovascular morbidity shortly after the implantation of a dual-chamber pacemaker. [ABSTRACT FROM AUTHOR]

Background: Carotid sinus syndrome (CSS) is a condition caused by sudden autonomic nervous system imbalance with vagal overactivity. It may lead to sinus bradycardia, sinus arrest, and AV block with severe symptoms and syncope, which may be treated with a pacemaker (PM). Cardioneuroablation (CNA) is an atrial endocardial catheter radiofrequency (RF) ablation aiming vagal denervation that could be used to remove the cardioinhibitory response in the CSS as suggested in the original study. Objective: To study the outcome of CNA controlled by extracardiac vagal stimulation (ECVS) in patients with CSS without significant cardiopathy. Methods: Prospective, controlled study of eight patients with symptomatic CSS, positive carotid sinus massage (CSM), and normal atropine response. Bi-atrial RF-ablation of the neuro endo-myocardial interface was guided by filtered endocardial electrograms, fractionation, and 3D anatomical mapping, identifying AF-Nests (AFN) related to the four main ganglionic plexuses (GP) with bi-atrial RF ablation (irrigated catheter 30W/42°C/20-60s). ECVS (5s) at the left jugular foramen and CSM was performed before, during, and at the end of the ablation to guide the level of denervation, defining the higher CNA effect and end of the procedure, analyzing pauses and AVB, induced by ECVS and CSM. Results: The mean age of patients was 58.6 (± 11.8). Pre-CNA, CSM, and ECVS responses were asystole and transient AVB in all patients. Post-CNA, ECVS, and Atropine responses were completely abolished in seven out of eight patients. In a 31 ± 16.1 months follow up, one case with incomplete CNA experienced syncope recurrence due to AVB and was submitted to a new CNA for AVB becoming asymptomatic. Another case had a positive CSM six months after CNA and had a pacemaker (PM) implanted even though asymptomatic, as per his physician's discretion. There was immediate sustained HR (58.9 ± 12,7/81,8 ± 4.9 bpm) and Wenckebach's point increase (133.5 ± 39.2 / 164.7 ± 10.8ppm), p: < 0,01. Conclusion: Complete bi-atrial CNA vagal denervation, based on AFN/GP ablation guided by vagal effect abolishment confirmed by ECVS and CSM responses, was effective in eliminating syncope recurrence in all patients with CSS. [ABSTRACT FROM AUTHOR]

We present here a rare case of an elderly male who presented with the complaints of progressively worsening gait imbalance, associated with acute onset giddiness. On evaluation, the patient had bradycardia with exaggerated upper and lower limb deep tendon reflexes and pain on neck movements. A Magnetic Resonance Imaging (MRI) showed posterior disc herniations at C6-C7 level with neural foraminal narrowing, and 12 lead Electrocardiogram showed Complete Heart Block (CHB). Decompressive surgery with temporary pacing was done, following which, the patient recovered well. Although Permanent Pacemaker (PPM) was initially planned, it was not required due to reversion to normal sinus rhythm on ECG, post-surgery. Hence, rare reversible causes of CHB should be ruled out, before opting for a long term permanent invasive treatment modality.

This paper summarized the treatment and nursing measures for an octogenarian patient with acute inferior myocardial infarction combined with sick sinus syndrome. Patient had the Adams-Stokes syndrome after percutaneous coronary intervention, and was implanted with a permanent pacemaker after emergency PCI with temporary pacemaker. Key issues of nursing included continuous ECG monitoring to enable timely detection and management of the condition, postoperative renal function monitoring, defecation care, observation of the condition after temporary pacemaker implantation and permanent pacemaker implantation, health education on pacemaker implantation, management of postoperative complications and psychological care. (本文总结1例急性下壁心肌梗死合并病态窦房结综合征高龄患者的治疗措施和护理经验。患者行急诊经皮冠状动脉介入治疗术后发生阿-斯综合征, 行临时起搏器后植入永久心脏起搏器。护理要点包括: 给予患者持续心电监护, 及时发现和处理病情; 术后加强肾功能监测, 做好排便护理; 临时起搏器植入和永久起搏器植入后的病情观察; 起搏器植入健康教育, 术后并发症的管理和心理护理。)

This is a report of one of the most serious complications of the cardiac pacemaker implantation ‐ infection of the implanted system. We present the case, which was misdiagnosed at the beginning and after cardiological consultation it was decided to immediately remove the peacemaker and transfer the patient to the Cardiological Department. [ABSTRACT FROM AUTHOR]

This paper presents the implementation of a sense amplifier for a low-power cardiac pacemaker using the Differential Voltage Current Conveyor (DVCC). Two significant aspects of the pacemaker are sensing and pacing. The pulse generator, which is the heart of the pacemaker, consists of a sense amplifier, a logic unit and a timing control unit. The sense amplifier comprises an instrumentation amplifier, a bandpass filter and a comparator that are used to detect the QRS complex wave from the cardiac signal. Based on the output of a sense amplifier, the logic unit and the timing control unit decide whether to pace the heart or not, which achieves the requirement of the demand pacing. In this paper, a novel design of the sense amplifier using a DVCC is proposed, and the simulations are performed using 130-nm TSMC technology. Furthermore, the modes of the pacemaker VVI, DDD and rate-responsive algorithms have been implemented using the structural approach in VHDL by taking into consideration the timing cycles of a pacemaker. The design analysis shows that the proposed model of pacemaker is highly efficient and consumes significantly less energy. [ABSTRACT FROM AUTHOR]

Backround: Currently, permanent pacemakers and internal defibrillators are widely used as a result of technological developments. Infection and dysfunction are the most important reasons for removing these devices from patients. Transvenous removal of these devices is the first recommended method. Failure of transvenous methods, presence of endocarditis, large vegetation or thrombus requires the use of surgical methods to remove these devices. In this study, our purpose is to present our management in surgical removal of cardiac implantable electronic devices (CIED). Methods: Between June 2017 and October 2019, 667 CIED were implanted and 10 patients underwent surgical removal of CIED in our hospital. The demographic data of the patients were obtained from the polyclinic files and the hospital registration system. Results: Eight (80%) patients were male and the mean age was 55.3±16.4 years (22.0-77.0). Complete pacemaker system removal was decided by the heart team in all cases. In 4 patients, permanent pacemaker reimplantation was required intraoperatively. Conclusion: CIED infection is a serious disease associated with high mortality. For this reason, we believe that it should be beneficial to consider the long-term results in determining permanent pacemaker and internal defibrillator indications. [ABSTRACT FROM AUTHOR]

Background Anti-mitochondrial antibody (AMA)-associated myopathy is known to be concomitant with primary biliary cirrhosis and to cause both skeletal muscle disorders and arrhythmias, myocardium disorders, and respiratory muscle disorders. We report a case of AMA-associated myopathy in which the bradycardia-related symptoms preceded the skeletal muscle symptoms. Case summary A 59-year-old woman visited the emergency room in our hospital following a syncopal event. The patient was bradycardiac (45 b.p.m.) with a junctional rhythm resulting from sick sinus syndrome (SSS) and was suffering from heart failure. Blood tests revealed elevated creatine kinase (CK) and hepatic enzymes. She underwent permanent pacemaker implantation. However, it proved difficult to detect the electrical potential in the right atrium. Although successful atrial pacing was achieved at the lower right atrial septum, the atrial threshold was markedly high and she depended on ventricular pacing. One year later, neurological examination and muscle biopsy confirmed the diagnosis of AMA-associated myopathy. Following this diagnosis, steroid pulse therapy was initiated. Steroid administration relieved her symptoms and lowered the CK levels but the atrial standstill persisted. The patient takes low-dose prednisolone and has had an uneventful course for 3 years. Discussion To the best of our knowledge, this is the first case of AMA-associated myopathy diagnosed by the first symptom related to bradycardia due to SSS. Patients with AMA-associated myopathy can experience a variety of cardiac symptoms, including arrhythmias, and initially complain of cardiac symptoms without symptoms of skeletal myopathy. This disease should be considered when diagnosing patients with arrhythmia and elevated CK. [ABSTRACT FROM AUTHOR]

Background: Cardiac implantable electronic devices (CIEDs) may enable early identification of COVID-19 to facilitate timelier intervention. Objective: To characterize early physiologic changes associated with the onset of acute COVID-19 infection, as well as during and after acute infection, among patients with CIEDs. Methods: CIED sensor data from March 2020 to February 2021 from 286 patients with a CIED were linked to clinical data from electronic health records. Three cohorts were created: known COVID-positive (n = 20), known COVID-negative (n = 166), and a COVID-untested control group (n = 100) included to account for testing bias. Associations between changes in CIED sensors from baseline (including HeartLogic index, a composite index predicting worsening heart failure) and COVID-19 status were evaluated using logistic regression models, Wilcoxon signed rank tests, and Mann-Whitney U tests. Results: Significant differences existed between the cohorts by race, ethnicity, CIED device type, and medical admissions. Several sensors changed earlier for COVID-positive vs COVID-negative patients: HeartLogic index (mean 16.4 vs 9.2 days [P = .08]), respiratory rate (mean 8.5 vs 3.9 days [P = .01], and activity (mean 8.2 vs 3.5 days [P = .008]). Respiratory rate during the 7 days before testing significantly predicted a positive vs negative COVID-19 test, adjusting for age, sex, race, and device type (odds ratio 2.31 [95% confidence interval 1.33–5.13]). Conclusion: Physiologic data from CIEDs could signal early signs of infection that precede clinical symptoms, which may be used to support early detection of infection to prevent decompensation in this at-risk population.

There is increasing evidence that Takotsubo cardiomyopathy behaves more like a highly variable and dangerous syndrome than an isolated cardiomyopathy. In this case report, we describe a case of Takotsubo cardiomyopathy complicated by complete heart block. We discuss the potential mechanisms for its etiology and examine the need for pacemaker placement. [ABSTRACT FROM AUTHOR]

In recent years, the number of implanted pacemakers has been increasing. The number of patients with cardiac pacemakers reporting to physiotherapy departments and referred for further treatment at spa hospitals has been increasing. There is an urgent need for popularising knowledge about this issue among physicians and physiotherapists. The paper presents examples of individual pacing modes and describes possible use of physiotherapy in the patients. Most physical therapy procedures may be performed in patients with a pacemaker, but on condition that appropriate safety principles are followed. [ABSTRACT FROM AUTHOR]

Abstract This is a report of one of the most serious complications of the cardiac pacemaker implantation ‐ infection of the implanted system. We present the case, which was misdiagnosed at the beginning and after cardiological consultation it was decided to immediately remove the peacemaker and transfer the patient to the Cardiological Department.

Abstract Background Symptomatic sick sinus syndrome is one of the indications for pacemaker implantation, and we have to consider to program the pacemaker to an asynchronous pacing mode during an operation. Case presentation We reported two cases with a pacemaker implanted for sick sinus syndrome undergoing cardiac operation. We changed programming of the pacemaker to an asynchronous pacing mode (DOO) and modulated the programmed atrioventricular delay to avoid ventricular pacing, resulting in better hemodynamic condition. Although we observed premature ventricular contraction, no lethal arrhythmias induced by the R-on-T phenomenon were noted. Conclusion Programming of the pacemaker to an asynchronous pacing mode and modulation of the programmed atrioventricular delay to avoid ventricular pacing may be an option for pacemaker management during an operation.

We present a case of a young man with complete atrioventricular block and aneurysm of the right sinus of Valsalva penetrating the interventricular septum and causing severe aortic regurgitation. Chest trauma and inflammatory or infectious diseases are potential causes. Bentall–de Bono surgical repair was performed. Anatomopathologic analysis demonstrated fibrosis, hyalinization, and extensive myxoid material. (Level of Difficulty: Beginner.)

Association between alcohol intake and atrioventricular block is rare. This case describes a previously healthy 27-year-old man experiencing syncopes preceded by moderate alcohol intake. An implantable loop recorder demonstrated episodes of total atrioventricular block coinciding with an additional syncope after alcohol intake, resulting in pacemaker implantation. (Level of Difficulty: Intermediate.)

Biomedical implants (BMIs) and biomedical sensors (BMSs) help to improve quality of life, detect diseases, provide monitoring of vital signs, and take over the role of malfunctioning organs. These implants and sensors require continuous battery power to work effectively, but the batteries used are restricted by their limited capacity and lifetime. This research reported here involved the design and implementation of a wireless charging system based on a series–parallel spider‐web coil (WPT‐SP‐SWC), specifically for cardiac pacemakers. The experimental design investigated several important parameters, including air gap, applied source voltage, coil size, and operating frequency. Performance metrics were evaluated in terms of output DC voltage, delivered output power, and power transfer efficiency. The target voltage was 5 V, which is adequate to charge a BMI such as a pacemaker, and three source voltages (5, 15, and 25 V) were tested. The design was examined at six operating frequencies, ranging from 1.78 MHz to 6.78 MHz. The most favorable results were achieved at 1.78 MHz. Power transfer efficiencies at a 10 mm air gap were 95.75% and 92.08% for applied voltages of 5 V and 15 V, respectively. The effectiveness of the proposed system was also validated by comparing the findings with previous articles. [ABSTRACT FROM AUTHOR]

Lipomatous hypertrophy of the interatrial septum is a rare benign condition characterized by adipocyte hyperplasia with fat infiltration between the myocardial fibers in the interatrial septum. Although lipomatous hypertrophy does not occur only in the interatrial septum, its location in the interventricular septum is extremely rare. A 45-year-old woman with no medical or family history of cardiac disease presented with an episode of syncope. Transthoracic echocardiography revealed an echogenic mass in the interventricular septum and no outflow obstruction. The mass-like area showed fat tissue-specific features on computed tomography and magnetic resonance imaging, and furthermore, it showed late gadolinium enhancement. We diagnosed it as lipomatous hypertrophy of the interventricular septum. An implantable loop recorder documented paroxysmal complete atrioventricular block with presyncope. A permanent dual-chamber pacemaker was implanted. This is the first reported case of lipomatous hypertrophy of the interventricular septum treated with a pacemaker for complete atrioventricular block with syncope. We have described the case and the treatment strategy in detail. To understand lipomatous hypertrophy, a rare disorder, and its characteristics and differences between lipomatous hypertrophy and cardiac adipose tumors on computed tomography and magnetic resonance imaging. To learn about the appropriate treatment and clinical management of this benign condition and treat symptomatic patients. [ABSTRACT FROM AUTHOR]

Background: Pacemaker implantation is an effective life-long treatment in patients with atrioventricular block to generate a reliable heartbeat. Choosing between epicardial and endocardial (trans-venous) techniques in children is based on the cardiac center experience and each technique has some benefits and risks. Methods: In this observational cross-sectional study, we reviewed file-records of 186 under 18- year-old patients who underwent cardiac pacemaker implantation due to atrioventricular block. All of endocardial implantations had been performed by experienced pediatric cardiologists and all epicardial pacemakers by experienced cardiac surgeon from 2006 to 2018 in Namazi and Faghihi hospitals in Shiraz, Iran. Results: One hundred and five patients had epicardial pacemaker and 81 patients had endocardial pacemaker. One hundred and seventy-eight patients had postoperative complete heart block after correction of congenital cardiac abnormality due to the destruction of conductive pathway. Eight patients were born with complete heart block. Four (2.15%) patients in the endocardial group developed pacemaker related infection. Two (1%) patients had sudden cardiac death after pacemaker insertion in the follow-up; Medtronic single chamber pacemaker was inserted for one patient who had complete heart block after surgical ventricular septal defect closure. However, a month later she expired due to sudden cardiac arrest during exercise and one patient after correction of complete atrio-ventricular septal defect had pacemaker insertion and sudden death, 3 months after pace insertion (1.12%); none of them had history of palpitation, syncope, arrhythmia in their post-operation electrocardiography, or tachycardia in their pacemaker analysis. Conclusion: In Conclusion, epicardial pacemaker has a noticeable battery longevity in comparison to endocardial pacemakers and fewer valvular complications and endocarditis cases. Also, it appears that increasing size and vessel stiffness followed by aging can prime better vascular access and less lead malfunction in older pediatrics in endocardial approach; however, the site of ventricular pacing is still a puzzle because of the effect of pacing site on left ventricle synchrony and ejection fraction.

Cystic tumors of the atrioventricular node are rare primary cardiac neoplasms, frequently reported as a postmortem diagnosis during autopsy. Despite their small size, they can present with complete heart block or sudden cardiac death. Herein, we present a case of rapidly progressing high-grade atrioventricular block that improved after surgery. (Level of Difficulty: Intermediate.)

In the mid-twentieth century, cardiac surgery emerged thanks to John Gibbon & IBM Company heart-lung machine incorporation in Philadelphia, USA, allowing open heart surgery to be carry out, which was soon possible in most developing countries. However, a few years before, some surgeons tried to cure their patients with ingenious closed-heart surgical techniques. During World War II, several military surgeons landed a decisive role in the development of this surgery by incorporating some surgical techniques that saved the life of numerous soldiers on the battlefront, among them Dwight E. Harken and C. Walton Lillehei, worldwide considered «fathers of cardiac surgery». Several important achievements emerged later, from these pioneers, regardless of their military activity, such as the intensive care units, the first mitral valvuloplasties and mechanical artificial heart valves, the implantable cardiac pacemakers, or the use of moderate hypothermia in open heart surgery. The important contributions of these admirable surgeons constituted the building blocks on which modern cardiac surgery was built. [ABSTRACT FROM AUTHOR]