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  2. Keyword: Artificial Cardiac Pacing
Prognostic Evaluation of Chagasic and Non-Chagasic Patients Undergoing Pacemaker Implantation and Cardiac Resynchronization in a Tertiary Center
ABC
Original Article

Prognostic Evaluation of Chagasic and Non-Chagasic Patients Undergoing Pacemaker Implantation and Cardiac Resynchronization in a Tertiary Center

Laís Toledo de Vasconcelos et al. Larissa Natany Almeida Martins Anna Terra França Fábio Morato de Castilho Antônio Luiz Pinho Ribeiro

Abstract

Background:

Chagas cardiomyopathy (ChCC) is one of the causes of the implantation of pacemakers (PM) in many patients and has been associated with an adverse prognosis.

Objectives:

To compare the prognosis of the chagasic and non-chagasic populations undergoing PM and cardiac resynchronizer implantation.

Methods:

Observational, retrospective study, which analyzed a cohort of patients who underwent implantation of these devices, in a tertiary center, from October 2007 to December 2017, comparing the chagasic group with non-chagasic patients. The non-parametric Kaplan-Meier method was used to calculate patient survival. The significance level adopted in the statistical analysis was 5%. The primary outcome was mortality from any cause, while the secondary outcomes were the occurrence of hospitalization and the combination of hospitalization and death.

Results:

A total of 911 patients were included, of which 23.4% had ChCC. In a Cox analysis adjusted for sex and age, Chagas disease (ChD) was not associated with an increased risk of death (HR: 1.14, CI:95%, 0.86-1.51, p=0.365), hospitalization (HR: 0.79, CI:95%, 0.61-1.04, p=0.09) or combined outcome of death and hospitalization (HR: 0.90, CI:95%, 0.72-1 .12, p=0.49).

Conclusions:

ChD was not associated with an increased risk of death, hospitalization, or combined outcome of death and hospitalization, even after adjustment for sex and age. These results contrast with those of previous studies and suggest changes in the quality of care of patients with cardiomyopathy.

  • Artificial Cardiac Pacing
  • Artificial Pacemaker
  • Chagas Cardiomyopathy
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Creative Commons Attribution (CC BY) Creative Commons license
18/10/2024 DOI: 10.36660/abc.20230875i Views 1
ABC
Original Article

Ventricular Synchrony in Para-Hisian Cardiac Pacing as an Alternative for Physiological Cardiac Activation (Indirect Recruitment of the His Bundle?)

Andres Di Leoni Ferrari et al. Guilherme Ferreira Gazzoni Luis Manuel Ley Domingues Jessica Caroline Feltrin Willes … Gustavo Chiari Cabral Flavio Vinicius Costa Ferreira Laura Orlandini Lodi Gustavo Reis

Abstract

Background

Artificial cardiac pacing by direct or indirect His bundle capture results in synchronous ventricular contraction (physiological pacing).

Objectives

To compare cardiac synchronization, technical characteristics, and electronic parameters between two techniques of indirect His-bundle pacing: non-selective (NS-HBP) vs para-Hisian pacing (PHP).

Methods

The experimental intervention (between November 2019 and April 2020) consisted of implanting a DDD pacemaker in patients who had left ventricular ejection fraction (LVEF) > 35%. The resulting cardiac synchronization was compared using an electrocardiographic algorithm that analyzed QRS variation and the technical characteristics of non-selective Hisian pacing (DDD-His) and para-Hisian pacing (DDD-Var).

Results

Of 51 total patients (men: 28), 66.7% (34) were allocated to the DDD-Var group and 33.3% (17) to the DDD-His group. The mean ages in each group were 74 and 79 years, respectively. In the DDD-Var group, QRS variation (ventricular synchrony) improved after implantation (p < 0.001). In post-implantation ECG, 91.2% of the DDD-Var group presented a physiological pacing pattern, which was similar to the DDD-His group (88.2%; p = 0.999). The paced QRS axis was also similar (physiological) for both groups. Intraoperative fluoroscopy time (XRay) during implantation was lower for the para-Hisian technique (median 7 min in the DDD-Var group vs 21 min in the DDD-His group, p < 0.001). The mean QRS duration increased in the DDD-Var group (114.7 ms pre-implantation vs 128.2 ms post-implantation, p = 0.044). The mean post-implantation R-wave amplitude was 11.2 mV in the DDD-Var group vs 6.0 mV in the DDD-His group, p = 0.001.

Conclusion

Para-Hisian pacing appears to indirectly recruit the His bundle, which would make this an effective and comparable strategy for physiological pacing, resulting in synchronous ventricular contraction similar to that of non-selective Hisian pacing.

  • Artificial Cardiac Pacing
  • Artificial Pacemaker
  • Electric Stimulation Therapy
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Creative Commons Attribution (CC BY) Creative Commons license
07/03/2022 DOI: 10.36660/abc.20201233 Views 1
ABC
Original Article

Left Bundle Branch Pacing of His-Purkinje Conduction System: Initial Experience

Alexander Romeno Janner Dal Forno et al. Caique M. P. Ternes João Vítor Ternes Rech Helcio Garcia Nascimento … Andrei Lewandowski Grazyelle Damasceno Andre d’Avila

Abstract

Background

Conventional right ventricular pacing increases the risk of atrial fibrillation and heart failure in pacemaker patients. Stimulation of the left bundle branch (LBB) of the His-Purkinje system can prevent the unwanted outcomes of right ventricular pacing.

Objective

To retrospectively analyze the intraoperative outcomes, electrocardiographic and clinical data from the initial follow-up of patients submitted to stimulation of the LBB.

Methods

The electronic parameters of the implant and of possible early complications of 52 consecutive patients submitted to stimulation of the conduction system were evaluated. The adopted significance level was 0.05.

Results

Fifty-two patients underwent left bundle branch stimulation, with 50 successful procedures; 69.2% of the patients were male, and the median and interquartile range of age at the time of implantation was 73.5 (65.0-80.0) years. The pre-implant QRS duration was 146 (104-175) ms and 120 (112-130) ms after the procedure. The left ventricle activation time was 78 (70-84) ms. The R-wave amplitude was 12.00 (7.95-15.30) mV, with a stimulation threshold of 0.5 (0.4-0.7) V x 0.4 ms and impedance of 676 (534-780) ohms. The procedure duration was 116 (90-130) min, and the fluoroscopy time was 14.2 (10.0-21.6) min.

Conclusion

Cardiac stimulation of the His-Purkinje conduction system through the stimulation of the left bundle branch is a safe and feasible technique. In this study, it showed a high success rate, with low procedure and fluoroscopy periods, achieving adequate electronic measurements.

  • Artificial Cardiac Pacing
  • Artificial Pacemaker
  • Electric Stimulation Therapy
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Creative Commons Attribution (CC BY) Creative Commons license
07/03/2022 DOI: 10.36660/abc.20201085 Views 1

How to cite this article

EndNote RIS

Electronic Document Format (Vancouver)

Vasconcelos LT, Martins LNA, França AT, Castilho FM, Ribeiro ALP. Prognostic Evaluation of Chagasic and Non-Chagasic Patients Undergoing Pacemaker Implantation and Cardiac Resynchronization in a Tertiary Center. Arquivos Brasileiros de Cardiologia 2024;121(9):e20230875.

Electronic Document Format (ABNT)

Vasconcelos, Laís Toledo de; Martins, Larissa Natany Almeida; França, Anna Terra; Castilho, Fábio Morato de; Ribeiro, Antônio Luiz Pinho. Prognostic Evaluation of Chagasic and Non-Chagasic Patients Undergoing Pacemaker Implantation and Cardiac Resynchronization in a Tertiary Center. Arquivos Brasileiros de Cardiologia, v. 121, n. 9, e20230875, Oct. 2024.

Electronic Document Format (APA)

Vasconcelos, L. T. , Martins, L. N. A., França, A. T., Castilho, F. M. , & Ribeiro, A. L. P. (2024). Prognostic Evaluation of Chagasic and Non-Chagasic Patients Undergoing Pacemaker Implantation and Cardiac Resynchronization in a Tertiary Center. Arquivos Brasileiros de Cardiologia, 121(9), e20230875.

Electronic Document Format (ISO)

Vasconcelos, Laís Toledo de and Martins, Larissa Natany Almeida and França, Anna Terra and Castilho, Fábio Morato de and Ribeiro, Antônio Luiz Pinho. Prognostic Evaluation of Chagasic and Non-Chagasic Patients Undergoing Pacemaker Implantation and Cardiac Resynchronization in a Tertiary Center. Arquivos Brasileiros de Cardiologia [online]. 2024, vol. 121, n. 9, [cited 2026-10-14], e20230875. Available from: <https://journals.cardiol.br/en/article/prognostic-evaluation-of-chagasic-and-non-chagasic-patients-undergoing-pacemaker-implantation-and-cardiac-resynchronization-in-a-tertiary-center/>. ISSN 0066-782X

EndNote RIS

Electronic Document Format (Vancouver)

Ferrari ADL, Gazzoni GF, Domingues LML, Willes JCF, Cabral GC, Ferreira FVC, Lodi LO, et al. Ventricular Synchrony in Para-Hisian Cardiac Pacing as an Alternative for Physiological Cardiac Activation (Indirect Recruitment of the His Bundle?). Arquivos Brasileiros de Cardiologia 2022;118(2):488-502.

Electronic Document Format (ABNT)

Ferrari, Andres Di Leoni; Gazzoni, Guilherme Ferreira; Domingues, Luis Manuel Ley; Willes, Jessica Caroline Feltrin; Cabral, Gustavo Chiari; Ferreira, Flavio Vinicius Costa; Lodi, Laura Orlandini; Reis, Gustavo. Ventricular Synchrony in Para-Hisian Cardiac Pacing as an Alternative for Physiological Cardiac Activation (Indirect Recruitment of the His Bundle?). Arquivos Brasileiros de Cardiologia, v. 118, n. 2, p. 488-502, Mar. 2022.

Electronic Document Format (APA)

Ferrari, A. D. L., Gazzoni, G. F., Domingues, L. M. L., Willes, J. C. F., Cabral, G. C., Ferreira, F. V. C., Lodi, L. O., & Reis, G. (2022). Ventricular Synchrony in Para-Hisian Cardiac Pacing as an Alternative for Physiological Cardiac Activation (Indirect Recruitment of the His Bundle?). Arquivos Brasileiros de Cardiologia, 118(2), 488-502.

Electronic Document Format (ISO)

Ferrari, Andres Di Leoni and Gazzoni, Guilherme Ferreira and Domingues, Luis Manuel Ley and Willes, Jessica Caroline Feltrin and Cabral, Gustavo Chiari and Ferreira, Flavio Vinicius Costa and Lodi, Laura Orlandini and Reis, Gustavo. Ventricular Synchrony in Para-Hisian Cardiac Pacing as an Alternative for Physiological Cardiac Activation (Indirect Recruitment of the His Bundle?). Arquivos Brasileiros de Cardiologia [online]. 2022, vol. 118, n. 2, [cited 2026-10-14], pp. 488-502. Available from: <https://journals.cardiol.br/en/article/ventricular-synchrony-in-para-hisian-cardiac-pacing-as-an-alternative-for-physiological-cardiac-activation-indirect-recruitment-of-the-his-bundle/>. ISSN 0066-782X

EndNote RIS

Electronic Document Format (Vancouver)

Forno ARJD, Ternes CMP, Rech JVT, Nascimento HG, Lewandowski A, Damasceno G, d’Avila A, et al. Left Bundle Branch Pacing of His-Purkinje Conduction System: Initial Experience. Arquivos Brasileiros de Cardiologia 2022;118(2):505-16.

Electronic Document Format (ABNT)

Forno, Alexander Romeno Janner Dal; Ternes, Caique M. P.; Rech, João Vítor Ternes; Nascimento, Helcio Garcia; Lewandowski, Andrei; Damasceno, Grazyelle; d’Avila, Andre. Left Bundle Branch Pacing of His-Purkinje Conduction System: Initial Experience. Arquivos Brasileiros de Cardiologia, v. 118, n. 2, p. 505-516, Mar. 2022.

Electronic Document Format (APA)

Forno, A. R. J. D., Ternes, C. M. P., Rech, J. V. T., Nascimento, H. G., Lewandowski, A., Damasceno, G., & d’Avila, A. (2022). Left Bundle Branch Pacing of His-Purkinje Conduction System: Initial Experience. Arquivos Brasileiros de Cardiologia, 118(2), 505-516.

Electronic Document Format (ISO)

Forno, Alexander Romeno Janner Dal and Ternes, Caique M. P. and Rech, João Vítor Ternes and Nascimento, Helcio Garcia and Lewandowski, Andrei and Damasceno, Grazyelle and d’Avila, Andre. Left Bundle Branch Pacing of His-Purkinje Conduction System: Initial Experience. Arquivos Brasileiros de Cardiologia [online]. 2022, vol. 118, n. 2, [cited 2026-10-14], pp. 505-516. Available from: <https://journals.cardiol.br/en/article/left-bundle-branch-pacing-of-his-purkinje-conduction-system-initial-experience/>. ISSN 0066-782X

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