Left bundle branch pacing vs biventricular pacing in heart failure patients with left bundle branch block:A systematic review and meta-analysis

BACKGROUND Left bundle branch pacing(LBBP)is a novel pacing modality of cardiac resynchronization therapy(CRT)that achieves more physiologic native ventricular activation than biventricular pacing(BiVP).AIM To explore the validity of electromechanical resynchronization,clinical and echocardiographic response of LBBP-CRT.METHODS Systematic review and Meta-analysis were conducted in accordance with the standard guidelines as mentioned in detail in the methodology section.RESULTS In our analysis,the success rate of LBBP-CRT was determined to be 91.1%.LBBP CRT significantly shortened QRS duration,with significant improvement in echocardiographic parameters,including left ventricular ejection fraction,left ventricular end-diastolic diameter and left ventricular end-systolic diameter in comparison with BiVP-CRT.CONCLUSION A significant reduction in New York Heart Association class and B-type natriuretic peptide levels was also observed in the LBBP-CRT group vs BiVP-CRT group.Lastly,the LBBP-CRT cohort had a reduced pacing threshold at follow-up as compared to BiVP-CRT.

Left bundle branch pacing set to outshine biventricular pacing for cardiac resynchronization therapy?

The deleterious effects of long-term right ventricular pacing necessitated the search for alternative pacing sites which could prevent or alleviate pacinginduced cardiomyopathy.Until recently,biventricular pacing(BiVP)was the only modality which could mitigate or prevent pacing induced dysfunction.Further,BiVP could resynchronize the baseline electromechanical dssynchrony in heart failure and improve outcomes.However,the high non-response rate of around 20%-30%remains a major limitation.This non-response has been largely attributable to the direct non-physiological stimulation of the left ventricular myocardium bypassing the conduction system.To overcome this limitation,the concept of conduction system pacing(CSP)came up.Despite initial success of the first CSP via His bundle pacing(HBP),certain drawbacks including lead instability and dislodgements,steep learning curve and rapid battery depletion on many occasions prevented its widespread use for cardiac resynchronization therapy(CRT).Subsequently,CSP via left bundle branch-area pacing(LBBP)was developed in 2018,which over the last few years has shown efficacy comparable to BiVP-CRT in small observational studies.Further,its safety has also been well established and is largely free of the pitfalls of the HBP-CRT.In the recent metanalysis by Yasmin et al,comprising of 6 studies with 389 participants,LBBPCRT was superior to BiVP-CRT in terms of QRS duration,left ventricular ejection fraction,cardiac chamber dimensions,lead thresholds,and functional status amongst heart failure patients with left bundle branch block.However,there are important limitations of the study including the small overall numbers,inclusion of only a single small randomized controlled trial(RCT)and a small follow-up duration.Further,the entire study population analyzed was from China which makes generalizability a concern.Despite the concerns,the meta-analysis adds to the growing body of evidence demonstrating the efficacy of LBBP-CRT.At this stage,one must acknowledge that the fact that still our opinions on this technique are largely based on observational data and there is a dire need for larger RCTs to ascertain the position of LBBPCRT in management of heart failure patients with left bundle branch block.

Comparison of electrocardiogram characteristics between left bundle branch pacing and right ventricular septal pacing in patients receiving pacemaker therapy

Background and Objective Cardiac pacing is an effective therapy in patients with bradycardia.Conventional right ventricular(RV)pacing is the source of ventricular dyssynchrony,leading to unfavorable clinical outcome.This study compared the electrocardiogram(ECG)characteristics during left bundle branch pacing(LBBP)with that during RV septal pacing(RVSP)which has been thought to be better than RV apical pacing.

Late rising right ventricular pacing lead threshold four yearsafter implantation of a dual chamber pacemaker

Late rising in pacing threshold is an uncommon complication of permanent pacing. Treatment with high dose systemic steroid could spare the patient another procedure. We report a case of late rising pacing threshold that responded to high dose sys-temic steroid which lowered the pacing threshold to one volt, then rose again to around 2 volts.

Selective his bundle pacing eliminates crochetage sign:A case report

BACKGROUND Crochetage sign is a specific electrocardiographic manifestation of ostium secundum atrial septal defects(ASDs),which is associated with the severity of the left-to-right shunt.Herein,we reported a case of selective his bundle pacing(SHBP)that eliminated crochetage sign in a patient with ostium secundum ASD.CASE SUMMARY A 77-year-old man was admitted with a 2-year history of chest tightness and shortness of breath.Transthoracic echocardiography revealed an ostium secundum ASD.Twelve-lead electrocardiogram revealed atrial fibrillation with a prolonged relative risk interval,incomplete right bundle branch block,and crochetage sign.The patient was diagnosed with an ostium secundum ASD,atrial fibrillation with a second-degree atrioventricular block,and heart failure.The patient was treated with selective his bundle pacemaker implantation.After the procedure,crochetage sign disappeared during his bundle pacing on the electrocardiogram.CONCLUSION S-HBP eliminated crochetage sign on electrocardiogram.Crochetage sign may be a manifestation of a conduction system disorder.

Left bundle branch area pacing combined with implantable cardioverter-defibrillator treatment for heart failure after myocardial infarction

Left bundle branch area pacing(LBBAP)has emerged as a new physiological pacing mode.Previous studies have confirmed the feasibility and efficacy of LBBAP for cardiac resynchronization therapy(CRT)in heart failure(HF)patients with left bundle branch block(LBBB)and a narrower QRS duration(QRSd)to have a higher percentage of super responders,and lower pacing thresholds than biventricular pacing(BiVP).

Left bundle branch area pacing:A new era of cardiac resynchronization therapy?

The recent systematic review and meta-analysis provided a comprehensive focus on the current state of cardiac resynchronization therapy(CRT).The authors determined the feasibility of physiological left bundle branch area pacing(LBBAP)in patients indicated for CRT through a careful analysis of trials.They found that LBBAP was associated with significant reductions in QRS duration,New York Heart Association functional class,B-type natriuretic peptide levels,and pacing thresholds as well as improvements in echocardiographic parameters compared to biventricular pacing.

Management of a patient with an unusual trajectory of a temporary trans-venous pacing lead

Perforation of the right ventricle during placement of pacing wires is a welldocumented complication and can be potentially fatal.Use of temporary pacemaker,helical screw leads and steroids use prior to implant are recognised as risk factors for development of post-permanent pacemaker effusion.We reported an unusual case of pacing wire perforating interventricular septum into the left ventricle that occurred during the implant procedure performed in another institution.After the preoperative work-up and transfer to our tertiary cardiothoracic centre,the patient underwent successful surgical management.In conclusion,early recognition and timely diagnosis using advanced multimodality imaging can guide surgical intervention and prevent unfavourable consequences of device-related complications.

Dual-chamber pacing confers better myocardial performance and improves clinical outcomes compared to single-chamber pacing

The deleterious effects of long term right ventricular pacing are increasingly being recognized today.Current clinical practice favors the implantation of dual-chamber permanent pacemaker which maintains atrioventricular synchrony and is associated with better quality of life.However,despite the popular belief and common sense surrounding the superiority of dual-chamber pacing over single chamber pacing,the same has never been conclusively verified in clinical trials.Some observational evidence however,does exists which supports the improved cardiac hemodynamics,lower the rate of atrial fibrillation,heart failure and stroke in dual-chamber pacing compared to single-chamber pacing.In the index study by Haque et al,right ventricular pacing,particularly in ventricular paced,ven-tricular sensed,inhibited response and rate responsive pacemaker adversely im-pacted the left ventricular functions over 9-months compared to dual pacing,dual sensing,dual responsive and rate responsive pacemaker.Although there are key limitations of this study,these findings does support a growing body of evidence reinstating the superiority of dual chamber pacing compared to single chamber pacing.

The Impact of Cardiac Pacing Site on Patient's Cardiac Function and Psychological State

With the widespread application of artificial permanent pacemakers in clinical practice,there have been new changes in the indications for pacemaker implantation.The current clinical indications include high atrioventricular block,sick sinus syndrome,cardiac resynchronization therapy for heart failure,and implantation of cardioverter defibrillators for ventricular arrhythmias.The implantation of a pacemaker can improve the quality of life and prognosis of patients with arrhythmia.In the past,permanent pacemaker implantation was performed in clinical practice,and the right ventricular pacing electrode was often fixed at the apex of the right ventricle,which belongs to non physiological pacing.Through long-term clinical follow-up,it was found that apex pacing can easily cause abnormal depolarization of the left ventricle,asynchronous contraction of the myocardium,and ultimately lead to myocardial fibrosis,which has adverse effects on the patient's cardiac function and psychological state.In recent years,Scholars have found that pacing in the right ventricular outflow tract septum is closer to the atrioventricular node and closer to the His bundle Purkinje fibers.The pacing impulse almost simultaneously expands towards both ventricles,closer to the physiological pacing state,thereby reducing the occurrence of cardiovascular events in patients.This article explores the impact of pacing in different parts of the heart on the cardiac function and psychological state of patients based on clinical data from the past three years.

Analysis of the Effect of Extracorporeal Diaphragmatic Pacing Combined with Noninvasive Ventilator on the Respiratory Function and Prognosis of COPD Patients

Objective: To investigate the effect of extracorporeal diaphragmatic pacing combined with noninvasive ventilators on the respiratory function and prognosis of chronic obstructive pulmonary disease (COPD) patients. Methods: A total of 50 COPD patients were selected between January 2023 to December 2023 and randomly grouped into an observation group and a control group, with 25 cases. The observation group was given extracorporeal diaphragm pacing combined with a noninvasive ventilator, while the control group was given a conventional treatment mode. After the treatment, the results of each index in the two groups were compared. Results: Compared with the diaphragm function indexes of the two groups, the data of the observation group were more dominant (P < 0.05). The rehospitalization rate of the observation group was lower than that of the control group (P < 0.05). The COPD assessment test (CAT) and mMRC (Modified Medical Research Council) Dyspnoea scale scores after treatment between the two groups were significantly different (P < 0.05). Compared with the control group, the lung function indexes of the observation group were more dominant (P < 0.05). Conclusion: Extracorporeal diaphragmatic pacing combined with a noninvasive ventilator promoted the improvement of the patient’s prognosis and improved their respiratory function.

PACE模式在现在分词作状语教学中的应用

语法教学是英语教学中必不可少的部分。PACE 模式较传统语法教学更加注重依托语境进行语法知识的输入加工、注重师生互动,更加强调学生的语言输出能力。本文以“现在分词作状语的用法”为例,探讨 PACE 模式“呈现 - 注意 - 共建 - 扩展”四个阶段在英语语法教学中的应用,总结其对语法教学的启发,旨在为语法教学提供思路,在课堂上提高语法教学的效率,促进学生语法能力的培养。

2019年捷豹I-PACE动力电池报警

故障现象 一辆2019年捷豹路虎生产的捷豹I-PACE纯电动SUV,VIN码为SADHA2B16K1F21^(****),行驶里程为44471km,车主反映该车无法挂挡行驶,且仪表台上显示“检测到电池故障”的提醒信息。

PACE教学模式在中职英语口语情境教学中的应用研究

中等职业英语教学目的是提升学生的交际能力,为其未来职业发展打基础。本文从教学实践出发,以高等教育出版社的《中职英语基础模块 3》U7 Natural Disasters 的口语课为实际案例,阐述将 PACE 教学模式应用于单元口语教学,探讨中职英语教师的口语教学新思路。基于教材中的口语内容,本文分析了教师如何呈现语言材料、引导学生注意语言形式、与学生共同建构对话框架、创设贴近学生生活和职业场景的任务来拓展对话学习,培养学生语言实际应用能力,提升英语学科核心素养。

捷豹路虎(中国)投资有限公司召回部分进口捷豹I-PACE系列纯电汽车

日前,捷豹路虎(中国)投资有限公司根据《缺陷汽车产品召回管理条例》和《缺陷汽车产品召回管理条例实施办法》的要求,向国家市场监督管理总局备案了召回计划。决定自即日起,召回2018年6月21日至10月2日期间生产的部分进口2019款捷豹I-PACE系列纯电汽车,共计113辆。

PACE——新型而高效的老年人医疗服务模式

PAcE是一种起源于美国华人社区的医疗服务模式,向脆弱的老年人提供包括基础医疗、急性病治疗以及慢性病长期照顾等全套的医疗服务。这种模式在节约成本的同时还能够高效地服务,更能体现医疗的延续性,有值得我们借鉴之处。本文介绍了这种模式的启动背景、发展状况及系统运作情况等,希望能给相关人士提供一些参考。

一种适用于机载SAR的改进PACE自聚焦算法

PACE算法是一种新的非模型的高性能SAR图像自聚焦算法,可以有效提取SAR图像中高频相位误差。由于PACE算法直接以图像相位误差校正值系列为待估计参量,计算量巨大,该文从提高PACE算法的执行效率的角度出发,提出了一种插值PACE算法(IPACE)。IPACE算法以图像对比度函数为目标函数,以待估计的相位校正矢量中的若干个相位校正值为自变量,通过拟牛顿算法迭代获得它们的最优估计,然后通过插值获得整个相位误差校正矢量的最优估计值。IPACE算法可以有效地减少待估计变量的个数,提高算法的执行效率,同时几乎不降低算法的聚焦性能。实际相位误差未知的超宽带SAR回波数据的聚焦结果表明了该算法能显著改善图像的质量,是一种鲁棒性良好的图像自聚焦算法。

美国PACE整合型照护模式的特征及借鉴

介绍了美国整合型照护的典型模式——PACE的特征及优势,提出对我国医养结合社区养老服务的建议:对我国老年人群进行分类评估,集中优势资源用于低收入失能和半失能老人,科学设置社区养老服务对象的准入标准;通过整合资金和信息技术等手段,完善医养结合社区养老服务模式,实现政府主导的多元合作治理格局。

PACE技术在流利型失语症中的应用(附2例报告)

采用A-B-A个例设计方法对1例底节性失语,具有传导性失语特征的患者进行了提高失语症患者的交际效果技术(Promoting Aphasic's Communicative Effectiveness,PACE)治疗。对1例感觉性失语进行了刺激法与PACE技术的对照治疗。治疗前后经改良波士顿诊断性失语症检查听理解分测验与呼名分测验检查。结果表明,PACE技术可以改善某些流利型失语症的听理解、呼名能力,对复杂概念的听理解改善较刺激法大。尤其是可以使那些尚未能应用非语言方式进行交际的患者逐步学会运用非语言的交际技能。

PACE模式在军队老干部医疗保健网络服务平台中的应用初探

随着军队老干部医疗保障体制改革的深入开展,传统医疗模式很难有效地解决老干部预防、保健、医疗、康复等医疗保障问题。因此,需要一个能提供全面服务的医疗模式和医疗保健网络服务平台。美国全面的老人服务项目（PACE）模式是一种新型而高效的老年人医疗服务模式,它与网络服务平台的结合在军队老干部医疗保健应用中正处于摸索阶段。