Successful leadless pacemaker implantation in a patient with dextroversion of the heart:A case report

BACKGROUND Dextroversion is defined as the presence of dextrocardia with situs solitus,dextroloop ventricles,and normally related great arteries.Dextrocardia can pose technical challenges when interventional treatments are required.However,the challenges posed by dextroversion can be amplified due to the disruption of typical anatomical relationships,the unpredictable positioning and boundaries of cardiac structures resulting from the shift,and the pathological processes influencing rotation.CASE SUMMARY A 73-year-old woman with cardiac dextroversion suffered from a recurrence of atrial fibrillation after her radiofrequency catheter ablation and Despite the cessation of antiarrhythmic medications,there were episodes of sinus pauses and symptomatic bradycardia,with heart rates dropping as low as 28 beats per minute.CONCLUSION Dextroversion makes the implantation of leadless pacemakers more challenging,and appropriate adjustments in fluoroscope angles may be crucial for intracardiac operations.Additionally,when advancing delivery systems,attention should be paid to rotational direction during valve-crossing procedures;changes in the perspective of posture angle between normal cardiac position and dextroversion can serve as references.

A Meta-analysis of Major Complications between Traditional Pacemakers and Leadless Pacemakers

Objectives:We aim to compare the major complications between leadless pacemakers and traditional pacemakers.Background:Leadless pacemakers,which are increasingly used in clinical practice,have several advantages compared with traditional pacemakers in avoiding pocket-and lead-related complications.However,the clinical effect of leadless pacemakers remains controversial.Methods:PubMed,Embase,the Cochrane Central Register of Controlled Trials(CENTRAL),the CNKI database,and the Wanfang database were searched from July 2013 to December 2019.Studies comparing leadless pacemakers and traditional pacemakers were included.The primary end point was major complications.The secondary end points were cardiac perforation/pericardial effusion,device revision or extraction,loss of device function,and death.Results:Six studies fulfi lled the inclusion criteria.Only four of the six studies reported data on major complications.Leadless pacemakers were associated with a lower incidence of major complications(risk ratio 0.33,95%confi dence interval 0.25–0.44,P<0.00001,I²=49%).We extracted data on cardiac perforation/pericardial effusion,device revision or extraction,loss of device function,and death from six studies.Our meta-analysis showed that leadless pacemakers have a higher risk of cardiac perforation or pericardial effusion(risk ratio 4.28,95%confi dence interval 1.66–11.08,P=0.003,I²=0%).No statistically signifi cant differences were found for mortality,device revision or extraction,and loss of device function.Conclusion:Compared with traditional pacemakers,leadless pacemakers have a signifi cantly decreased risk of major complications,but have a higher risk of cardiac perforation or pericardial effusion.

Emergent Technologies for Cardiovascular Surgery

The optimal vascular blood supply throughout the body guarantees the support of normal functions to tissues and organs.Implants are now becoming a seamless extension of the body and shall accompany a higher level of fidelity between the device and the patient.As regenerative medicine is still in its infancy,the ongoing search for new and effective prosthetic alternatives continues to be essential and highly rewarding.Thanks in part to the progress of imaging and the benefits of 3D printing,previously unimagined emergent technologies are at hand.The emerging technologies of the last few decades and the near future will continue to greatly improve both the quality and quantity of patients' lives.They focus on minimally invasive technologies(keyhole surgery) and approaches for deployment of valves,stent-grafts,leadless pacemakers and adaptation of medical devices for destination therapy(assist devices and artificial hearts).In addition,specific blood conduits for the aortic valves together with the aortic arch and the pulmonary valves are considered.These breakthroughs are currently at various stages of development and acceptability.Innovative biomaterials were essential in the development of cardiovascular devices.They were and they still are the essential support for conduction prosthesis,but their place in signal prosthesis is being revisited.Any new development in medical devices has been frequently driven by surgeons and industry.The emergent technologies are introduced by pioneers.The risks and benefits of devices must be continuously reassessed during the lifetime of the implants based upon sound scientific principles of investigation,clinical experience of the users and retrieval programs.