Current knowledge for the risk factors of early permanent pacemaker implantation following transcatheter aortic valve replacement and what is next for the primary prevention?

In this editorial,we comprehensively summarized the preoperative risk factors of early permanent pacemaker implantation after transcatheter aortic valve replacement(TAVR)among patients with severe aortic stenosis from several renowned clinical studies and focused on the primary prevention of managing the modifiable factors,e.g.,paroxysmal atrial fibrillation before the TAVR.

Prediction of permanent pacemaker implantation after transcatheter aortic valve replacement:The role of machine learning

BACKGROUND Atrioventricular block requiring permanent pacemaker(PPM)implantation is an important complication of transcatheter aortic valve replacement(TAVR).Application of machine learning could potentially be used to predict preprocedural risk for PPM.AIM To apply machine learning to be used to predict pre-procedural risk for PPM.METHODS A retrospective study of 1200 patients who underwent TAVR(January 2014-December 2017)was performed.964 patients without prior PPM were included for a 30-d analysis and 657 patients without PPM requirement through 30 d were included for a 1-year analysis.After the exclusion of variables with near-zero variance or≥50%missing data,167 variables were included in the random forest gradient boosting algorithm(GBM)optimized using 5-fold cross-validations repeated 10 times.The receiver operator curve(ROC)for the GBM model and PPM risk score models were calculated to predict the risk of PPM at 30 d and 1 year.RESULTS Of 964 patients included in the 30-d analysis without prior PPM,19.6%required PPM post-TAVR.The mean age of patients was 80.9±8.7 years.42.1%were female.Of 657 patients included in the 1-year analysis,the mean age of the patients was 80.7±8.2.Of those,42.6%of patients were female and 26.7%required PPM at 1-year post-TAVR.The area under ROC to predict 30-d and 1-year risk of PPM for the GBM model(0.66 and 0.72)was superior to that of the PPM risk score(0.55 and 0.54)with a P value<0.001.CONCLUSION The GBM model has good discrimination and calibration in identifying patients at high risk of PPM post-TAVR.

Successful transcatheter arterial embolization treatment for chest wall haematoma following permanent pacemaker implantation: A case report

BACKGROUND Haematoma is one of the main complications associated with pacemaker implantation.Pseudoaneurysm is a rare condition that is not easy to identify and is often overlooked.CASE SUMMARY A female patient diagnosed with high-grade atrioventricular block underwent permanent pacemaker implantation.During the operation,puncturing a small branch of the right subclavian artery developed into a pseudoaneurysm and resulted in further haematoma formation.Conventional treatment of compression haemostasis and haemostatic drugs was not effective.A series of timely transcatheter arterial embolizations avoided serious complications.CONCLUSION More possible conditions should be taken into consideration as haematoma is discovered,and timely treatment might prevent severe adverse events.

Subclavian Arterial Bleeding during Permanent Pacemaker Implantation: Clinical Case Report and Literature Review

Research objective: To study a clinical case that had a complication of subclavian artery bleeding during permanent pacemaker implantation process. Subject and Method: Clinical case report and literature review. Study of a patient had an indication for permanent pacemaker implantation who had complication of subclavian artery bleeding during the procedure. Result: An 84-year-old female patient was admitted to the hospital because of fainting spells with chest pain, on the background of dangerous complex arrhythmias and ischemic heart disease, and was prescribed a pacemaker for this patient. The patient had complication occurred during the procedure, which left subclavian artery bleeding was detected and treated promptly, a cardiac pacemaker was implanted on the right side of the chest, and the patient had a successful endovascular stent cover in the left subclavian artery. Conclude: Subclavian artery bleeding is a rare complication in the procedure of permanent pacemaker implantation, but it can still occur and requires quick detection and timely treatment, needs to be successful in cardiac pacemaker placement and subclavian artery drug-eluting stent cover placement intervention. Individualized patient risk assessment is needed;appropriate and standardized intervention techniques and experience can reduce the occurrence of this variable.

Radioactive ^125I seed implantation for locally advanced pancreatic cancer:A retrospective analysis of 50 cases

BACKGROUND Pancreatic cancer is one of the common malignant tumors of the digestive system,and radical resection is the first choice of treatment for pancreatic cancer.If patients with locally advanced pancreatic cancer cannot be treated in time and effectively,their disease often develops rapidly and their survival period is very short.AIM To evaluate the therapeutic effect of ^125I seed implantation in patients with locally advanced pancreatic cancer.METHODS The demographics and perioperative outcomes of a consecutive series of patients who underwent ^125I seed implantation to treat locally advanced pancreatic cancer between January 1,2017 and June 30,2019 were retrospectively analyzed.According to the results of preoperative computed tomography or magnetic resonance imaging,the treatment planning system was used to determine the area and number of ^125I seeds implanted.During the operation,^125I seeds were implanted into the tumor under the guidance of intraoperative ultrasound,with a spacing of 1.5 cm and a row spacing of 1.5 cm.For patients with obstructive jaundice and digestive tract obstruction,choledochojejunostomy and gastroenterostomy were performed simultaneously.After operation,the patients were divided into a non-chemotherapy group and a chemotherapy group that received gemcitabine combined with albumin-bound paclitaxel treatment.RESULTS Among the 50 patients,there were 29 males and 21 females,with a mean age of 56.9±9.8 years.The main reason for the failure of radical resection was superior mesenteric artery invasion(37,74%),followed by superior mesenteric vein invasion(33,66%).Twenty-one(62%)patients underwent palliative surgery and postoperative pain relief occurred in 40(80%)patients.The estimated blood loss in operation was 107.4±115.3 mL and none of the patient received blood transfusion.The postoperative hospital stay was 7.5±4.2 d;one patient had biliary fistula and three had pancreatic fistula,all of whom recovered after conservative treatment.After operation,26 patients received chemotherapy and 24 did not.The 1-year survival rate was significantly higher in patients who received chemotherapy than in those who did not(60.7%vs 35.9%,P=0.034).The mean overall survival of patients of the chemotherapy group and nonchemotherapy group was 14 and 11 mo,respectively(χ^2=3.970,P=0.046).CONCLUSION Radioactive ^125I seed implantation combined with postoperative chemotherapy can prolong the survival time,relieve pain,and improve the quality of life of patients with locally advanced pancreatic cancer.

Small balloon strategy associated with low pacemaker implantation rate after self-expanding transcatheter valve implantation

BACKGROUND: This study aims to investigate whether small balloon aortic valvuloplasty(BAV) reduces the need for permanent pacemaker implantation (PPMI) after transcatheter aortic valveimplantation (TAVI).METHODS: This was a retrospective analysis using data from our local TAVI database. SmallBAV was defined as a small balloon size (=18 mm) pre-dilatation. Normal BAV was defined as aballoon size >18 mm. The primary endpoint was the incidence of new PPMI.RESULTS: Of 99 consecutive TAVI patients, five patients were excluded due to pre-existingpermanent pacemaker. Patients in the small BAV group (n=57) had a signifi cantly lower PPMI ratecompared with the normal BAV group (n=37) (3.5% vs. 18.9%, P=0.026). Moderate or severe aorticvalve regurgitation post-procedure was similar between the small BAV and normal BAV groups (5.3%vs. 8.1%, P=0.480);likewise, the mean aortic gradient post-procedure did not differ significantly(11.5±5.2 mmHg vs. 12.2±7.3 mmHg, 1 mmHg=0.133 kPa, P=0.580) between the groups. Devicesuccess rates were also similar (94.7% vs. 91.8%, P=0.680). In multivariable analysis, small BAV(P=0.027), the ratio of prosthesis diameter to annulus diameter (P=0.048), and mean aortic gradientby echo in the basement (P=0.021) were independent predictors of PPMI.CONCLUSIONS: The small BAV strategy is associated with a low rate of permanentpacemaker implantation after transcatheter self-expanding valve implantation in this single-centerobservational study.

Radioactive 125I seed implantation for pancreatic cancer with unexpected liver metastasis:A preliminary experience with 26 patients

BACKGROUND Preoperative diagnosis rate of pancreatic cancer has increased year by year.The prognosis of pancreatic cancer patients with unexpected liver metastasis found by intraoperative exploration is very poor,and there is no effective and unified treatment strategy.AIM To evaluate the therapeutic effect of radioactive 125I seed implantation for pancreatic cancer patients with unexpected liver metastasis.METHODS The demographics and perioperative outcomes of patients who underwent 125I seed implantation to treat pancreatic cancer with unexpected liver metastasis between January 1,2017 and June 1,2019 were retrospectively analyzed.During the operation,125I seeds were implanted into the pancreatic tumor under the guidance of intraoperative ultrasound,with a spacing of 1.5 cm and a row spacing of 1.5 cm.For patients with obstructive jaundice and digestive tract obstruction,choledochojejunostomy and gastroenterostomy were performed simultaneously.After operation,the patients were divided into a non-chemotherapy group and a chemotherapy group that received gemcitabine combined with albumin-bound paclitaxel treatment.RESULTS Preoperative imaging evaluation of all patients in this study showed that the tumor was resectable without liver metastasis.There were 26 patients in this study,including 18 males and 8 females,aged 60.5±9.7 years.The most common tumor site was the pancreatic head(17,65.4%),followed by the pancreatic neck and body(6,23.2%)and pancreatic tail(3,11.4%).Fourteen patients(53.8%)underwent palliative surgery and postoperative pain relief occurred in 22 patients(84.6%).The estimated blood loss in operation was 148.3±282.1 mL and one patient received blood transfusion.The postoperative hospital stay was 7.6±2.8 d.One patient had biliary fistula,one had pancreatic fistula,and all recovered after conservative treatment.After operation,7 patients received chemotherapy and 19 did not.The 1-year survival rate was significantly higher in patients who received chemotherapy than in those who did not(68.6%vs 15.8%,P=0.012).The mean overall survival of patients in the chemotherapy group and non-chemotherapy group was 16.3 mo and 10 mo,respectively(χ2=7.083,P=0.008).CONCLUSION Radioactive 125I seed implantation combined with postoperative chemotherapy can prolong the survival time and relieve pain of pancreatic cancer patients with unexpected liver metastasis.

Impact of central venous port implantation method and access choice on outcomes

BACKGROUND Although the number of patients who need central venous ports for permanent vascular access is increasing,there is still no“gold standard”for the implantation technique.AIM To identify the implantation technique that should be favored.METHODS Two hundred central venous port-implanted patients in a tertiary hospital were retrospectively evaluated.Patients were assigned into two groups according to the access method.The first group comprised patients whose jugular veins were used,and the second group comprised patients whose subclavian veins were used.Groups were evaluated regarding age,sex,application side,primary diagnosis,active follow-up period in the hospital,chemotherapy agents administered,number of complications,and the Clavien-Dindo severity score.The distribution of the variables was tested with the Kolmogorov-Smirnov test and the Mann-Whitney U test.Theχ^(2) test was used to analyze the variables.RESULTS There was no statistically significant difference between the groups regarding age,sex,side,number of chemotherapy drugs,and duration of port usage(P>0.05).Only 2 patients in group 1 had complications,whereas in group 2 we observed 19 patients with complications(P<0.05).No port occlusion was found in group 1,but the catheters of 4 patients were occluded in group 2.One port was infected in group 1 compared to three infected ports in group 2.Two port ruptures,two pneumothorax,one revision due to a mechanical problem,one tachyarrhythmia during implantation,and four suture line problems were also recorded in group 2 patients.We also showed that it would be sufficient to evaluate and wash ports once every 2 mo.CONCLUSION Our results robustly confirm that the jugular vein route is safer than the subclavian vein approach for central venous port implantation.

Prevention of self-harm through early detection of depression among the elderly with permanent pacemaker:a case report

There is consensus regarding the efficacy and safety of permanent pacemakers(PPM) and other cardiac implantable electronic devices. These devices improve the quality of life by reliving symptoms of bradycardia including dizziness, fatigue and exercise intolerance. The decision to implant a PPM is often made at the time of the initial encounter with the patient, such as when symptomatic bradyarrhythmia is first diagnosed.

ANALYSIS OF THE POSTOPERATIVE OMPLICATIONS IN 415 CASES WITH PACIMAkER IMPLANTATION

415 cases of permanent pacemaker implantation had be per-formed from 1980 to 1997 among them 86 cases of poatopertivecomplications occured(20.7%),which predominated by lnfetion(3.9%)and electrode diaplacement(3.9%).The maincause of electrode displacement was hypoperis.No infectionoccured among the 35 cases with the catheters and pacemakersimplanted at the identical incision after 1992.Complete AVBoccured in 2 cases while Radiaofrequency catheter ablationwere performed for postoperative atrial fibrillation accom-partied by cardiac failure,but their cardiac function recoveredafter repeating.No undesirable impact on pacemakers and ca-theters caused by Radiofrequency catheter ablation was found.The results remind that Radiofrequency catheter ablation is asafe and effective method in high-speed arrhythmia treatmentwith pacemake implantation.

Effects of medically generated electromagnetic interference from medical devices on cardiac implantable electronic devices: A review

As cardiac implantable electronic devices(CIED)become more prevalent,it is important to acknowledge potential electromagnetic interference(EMI)from other sources,such as internal and external electronic devices and procedures and its effect on these devices.EMI from other sources can potentially inhibit pacing and trigger shocks in permanent pacemakers(PPM)and implantable cardioverter defibrillators(ICD),respectively.This review analyzes potential EMI amongst CIED and left ventricular assist device,deep brain stimulators,spinal cord stimulators,transcutaneous electrical nerve stimulators,and throughout an array of procedures,such as endoscopy,bronchoscopy,and procedures involving electrocautery.Although there is evidence to support EMI from internal and external devices and during procedures,there is a lack of large multicenter studies,and,as a result,current management guidelines are based primarily on expert opinion and anecdotal experience.We aim to provide a general overview of PPM/ICD function,review documented EMI effect on these devices,and acknowledge current management of CIED interference.

Electrochemotherapy and heart function:Treatment in a patient with implantable cardioverter defibrillator/pacemaker

Electrochemotherapy(ECT) is a recently described therapy that relies on the permeation of cancer cell membranes by electrical pulses to enhance cytotoxic drug penetration. It has been successfully used in the treatment of primary and metastatic skin cancer. Systemic chemotherapy is the most commonly used therapeutic strategy, and the prevailing orientation calls for the administration of the maximum tolerated dose; however, considerable limitations exist including toxicities to healthy tissues and low achievable drug concentrations at tumor sites. We reported a case of an 83-years-old patient with a laterocervical metastasis of a squamous epidermoidal lip cancer. The patient had a complex medical history and an implantable cardioverter defibrillator(ICD)/pace-maker. The lesion was localized in the supraclavicular right side with a distance from the pace-maker/ICD about 5 cm, but the nodule was not deeply located. The ECT was performed un-der general anesthesia and particular attention we put on the interference with the functioning of the heart. The synchronization algorithm currently implemented in Clinoporator Vitae device coupled with the external triggering device Accu Sync proved to be effective in preventing external stimulation of the heart during the so-called vulnerable period of the ventricles. As a result all electroporation pulses in our study were delivered outside the vulnerable period and no heart arrhythmias or any other pathological morphological changes were observed. The safety of treatment was demonstrated also by absence of side effects during and after ECT.

永久性心脏起搏器植入术后患者运动恐惧的潜在剖面分析

目的探索永久性心脏起搏器植入术后患者运动恐惧的特征差异及影响因素。方法于2023年1月至2024年4月采用回顾性研究方法,选取河南省南阳市中心医院369例初次行永久性心脏起搏器植入的患者为研究对象,采用一般资料调查表、心脏病患者运动恐惧量表、运动自我效能量表调查,运用潜在剖面分析识别患者运动恐惧的潜在类别,通过有序logistic回归模型分析其影响因素。结果永久性心脏起搏器植入术后患者运动恐惧可分3个潜在类别:低水平运动恐惧组(16.0%)、中水平运动恐惧组(56.4%)、高水平运动恐惧组(27.6%)。单因素分析显示,性别、文化程度、居住地、家庭月收入、心功能分级、疼痛程度、运动自我效能在不同类别中比较,差异有统计学意义(P<0.05)。回归分析结果显示,女性(OR=2.218,P=0.039)、小学及以下(OR=4.170,P=0.002)是运动恐惧潜在类别的危险因素;城镇(OR=0.423,P=0.032)、运动自我效能高(OR=0.046,P<0.001)是运动恐惧潜在类别的保护因素。结论永久性心脏起搏器植入术后患者运动恐惧水平存在显著异质性,医护人员可根据不同潜在类别和影响因素,实施精准干预,降低患者术后运动恐惧水平。

经导管主动脉瓣置换术后永久起搏器植入的研究进展

随着经导管主动脉瓣置换术(TAVR)的适应证逐渐向中低危患者扩展,高度房室阻滞是TAVR术后的常见并发症之一,永久起搏器(PPM)植入越来越受重视。本文从TAVR术后高度房室阻滞发生的解剖学基础、PPM植入指征、预测因素以及该类患者的预后等方面的研究进展进行综述。

Pacemaker post transcatheter aortic valve replacement:A multifactorial risk?

Pacemaker post-transcatheter aortic valve replacement is related to multifactorial risk.Nwaedozie et al brought to the body of evidence electrocardiogram and clinical findings.However,procedural characteristics have at least as much impact on the final need for a permanent pacemaker and potentially on the pacing rate.In this regard,long-term follow-up and understanding of the impact of long-term stimulation is of utmost importance.

永久心脏起搏器植入术后患者自我管理能力影响因素分析与干预模型的构建

目的了解永久心脏起搏器植入术后患者的自我管理能力现状,分析相关影响因素,通过影响因素权重构建干预模型。方法选择2020年1月—2023年1月在新疆医科大学第一附属医院心脏内科行永久起搏器植入术的210例患者作为研究对象,采用问卷调查法收集患者术后6个月的自我管理能力情况,应用单因素和Logistic回归分析探讨患者术后自我管理能力的影响因素。根据分析结果构建干预模型,采用ROC曲线对模型条目的可行性进行验证。结果患者自我管理能力普遍较差(得分率为60.23%);单因素分析结果显示,年龄、患病病程、文化程度等9项因素是患者术后自我管理能力的影响因素;Logistic回归分析结果表明,有并发症、文化程度为小学及以下的、无慢性病等6项因素是自我管理能力较低的独立因素;通过对Logistic回归中危险系数(权重)及ROC曲线结果分析,初步建立以提高“有并发症、小学及以下文化程度、慢性病史及病程≤5年”的患者术后自我管理能力的干预模型。结论基于循证理念构建心脏起搏器植入术后患者自我管理干预模型,对术后患者自我管理能力的提升具有良好的理论和实践价值。

高龄心房颤动伴功能性三尖瓣反流的危险因素分析

目的:分析高龄心房颤动伴功能性三尖瓣反流的危险因素。方法:选取242例高龄心房颤动伴三尖瓣反流患者作为研究对象,跟踪随访1年,分析入组和随访1年后相关指标的差异性。采用Logistic回归分析、ROC曲线分析高龄心房颤动伴三尖瓣反流的影响因素及预测因子。结果:与入组时相比,随访1年后数据显示三尖瓣反流量明显增加,平均值为(7.1±0.5)m L,范围波动在0~40mL,且肌酐、尿酸、同型半胱氨酸(homocysteine,HCY)、三尖瓣反流、左心房左右径、左心房前后径、左心房上下径、右心房左右径、右心房上下径、LVEDD、LVESD、右心室内径及永久心脏起搏器置入术,差异有统计学意义(P<0.05)。三尖瓣反流组和非反流组在肌酐、尿素氮、胱抑素C、HCY、NT-proBNP、左心房左右径、左心房前后径、左心房上下径、右心房左右径、右心房上下径、右心室内径、LVEF、冠心病、高血压、慢性心力衰竭、慢性肾功能不全、永久心脏起搏器置入术,两组间差异有统计学意义(P<0.05)。其中,高龄心房颤动伴三尖瓣反流可能受右心房左右径(P=0.028)、永久心脏起搏器置入术(P=0.001)等因素影响;ROC曲线分析发现,右心房左右径(曲线下面积=0.753)、永久心脏起搏器置入术(曲线下面积=0.682)是高龄心房颤动患者发生三尖瓣反流的危险因素。结论:右心房左右径、永久心脏起搏器置入术不仅与高龄心房颤动伴三尖瓣反流存在关联性,也可作为高龄心房颤动伴功能性三尖瓣反流的预测因子。

右心室间隔部起搏对永久心脏起搏器植入患者心肌损伤情况、心功能和左心室收缩功能的影响

目的:探讨右心室间隔部起搏对永久心脏起搏器植入患者心肌损伤情况、心功能和左心室收缩功能的影响。方法:选择2019年1月—2021年1月清远市人民医院收治的80例行永久心脏起搏器植入术的患者,按照计算机分组法将其分为心尖组(起搏部位为心尖部)和间隔组(起搏部位为右心室间隔部),各80例。观察两组心肌损伤情况、心功能、左心室收缩功能及同步性、并发症。结果:术后,两组氨基末端脑钠肽前体(NT-proBNP)、肌酸激酶同工酶(CK-MB)水平均低于术前,间隔组NT-proBNP、CK-MB水平低于心尖组,差异有统计学意义(P<0.05)。术后,两组心输出量(CO)、左心室射血分数(LVEF)、左室舒张末期内径(LVEDD)均低于术前,间隔组CO、LVEF、LVEDD高于心尖组,差异有统计学意义(P<0.05)。术后,两组收缩末期左心室容积(LVESV)、舒张末期左心室容积(LVEDV)、左心室18节段达峰时间标准差(Tp-SD)、QRS均高于术前,间隔组LVESV、LVEDV高于心尖组,Tp-SD、QRS低于心尖组,差异有统计学意义(P<0.05)。间隔组并发症总发生率为7.50%,与心尖组的12.50%比较,差异无统计学意义(P>0.05)。结论:与心尖部起搏相比,右心室间隔部起搏能减轻植入永久心脏起搏器患者心肌损伤和对心功能的影响,提高左心室收缩功能及同步性,且不增加并发症的发生。

经导管主动脉瓣置换术后传导阻滞及起搏器植入的预测因子研究进展

主动脉瓣狭窄(aortic stenosis,AS)是由先天或后天因素引起的瓣膜结构改变,发病率随年龄增长而升高。经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)是一种安全可行的重度AS微创治疗方法。自2011年被FDA首次批准应用于无法进行外科手术治疗的重度AS患者以来,其适应证不断扩展至中低手术风险AS人群。人工瓣膜植入后可压迫位于主动脉根部的房室传导系统,导致术后心脏传导异常的发生,永久起搏器植入(permanent pacemaker implantation,PPMI)是其治疗手段。TAVR术后PPMI与患者预后密切相关。因此,本文对TAVR术后传导功能障碍发生及PPMI的预测因素进行综述。

^(125)I粒子组织间永久植入治疗恶性肿瘤(附113例分析)

为观察12 5I放射粒子组织间永久性植入治疗恶性肿瘤的临床效果 ,选择 113例的治疗病例 ,其中口腔、颌面部肿瘤 4 9例 ,头、肺、乳腺、肝、胰、结肠、直肠及前列腺等各种肿瘤共 6 4例 ,病理诊断明确。经CT定位术植入 5 7例 ,CT、B超引导下经皮穿刺植入 5 2例 ,模板插植 3例 ,立体定向支架术插植 1例 ,均为组织间永久植入。随访 4 10个月 ,结果显示有 2例患者肿瘤完全消失 ,4例晚期肿瘤患者 6个月后转移衰竭死亡 ,2例因心脑疾病死亡 ,其余患者肿瘤均有不同程度缩小 ,症状改善 ,生存时间延长。在治疗中 ,全组无白细胞下降 ,无因植入12 5I粒子而导致的严重并发症。临床实践证明12 5I放射粒子组织间永久植入治疗恶性肿瘤安全有效 。