Pacing and Clinical Electrophysiology (PACE) is the foremost peer-reviewed journal in the field of pacing and implantable cardioversion defibrillation, publishing over 50% of all English language articles in its field, featuring original, review, and didactic papers, and case reports related to daily practice. Articles also include editorials, book reviews, Musings on humane topics relevant to medical practice, electrophysiology (EP) rounds, device rounds, and information concerning the quality of devices used in the practice of the specialty.

PACE - Pacing and Clinical Electrophysiology is the leading peer-reviewed journal in the field of pacing and implantable cardioversion defibrillation, publishing over 50% of all English language articles in this area. The journal features original research, reviews, didactic papers, and case reports relevant to daily practice. Additionally, it includes editorials, book reviews, reflections on humane topics related to medical practice, electrophysiology (EP) rounds, device rounds, and information regarding the quality of devices used in the specialty.

《PACE - Pacing and Clinical Electrophysiology》是心脏起搏和植入式心脏复律除颤领域的顶尖同行评审期刊，发表了该领域超过50%的英文文章。期刊内容包括原创研究、综述、教学论文和与日常实践相关的病例报告。此外，文章还包括社论、书评、与医学实践相关的人文主题思考、电生理（EP）讨论、设备讨论，以及有关该专业使用设备质量的信息。

PACE - Pacing and Clinical Electrophysiology

Abstract Background To investigate the impact of uncontrolled blood pressure (BP) on left atrial (LA) remodeling and clinical outcome after pulmonary vein isolation (PVI) in paroxysmal atrial fibrillation (AF). Methods One hundred and one symptomatic paroxysmal AF patients (85 males, 62.2 ± 8.4‐year‐old) who underwent successful PVI were classified as follows: group 1 (n = 46), no hypertension (HTN); group 2 (n = 36), HTN with controlled BP; and group 3 (n = 19), HTN with uncontrolled BP. Uncontrolled BP was defined as BP &gt; 140/90 mm Hg. LA dimension was measured by echocardiography before and 6 months after PVI. LA wall thickness along the ablation line was measured using computed tomography prior to PVI. Cox regression analysis was performed for the prediction of recurrence. Results LA wall thickness in groups 2 and 3 was greater than that of group 1, except for the anterior right superior pulmonary vein (PV) and posterior left inferior PV. Kaplan‐Meier analysis revealed a significantly higher recurrence in group 3 (52.6%). LA dimension only increased in group 3 (38.2 ± 5.6 mm to 41.3 ± 6.2 mm, P = 0.022). At the second procedure, all group 3 recurrent patients showed substrate degradation (low voltage area and/or dense scar formation) and required substrate modification. Uncontrolled BP was an independent risk factor for recurrence (hazard ratio: 2.350, P = 0.033). Conclusions HTN induced heterogeneous LA hypertrophy regardless of whether HTN was controlled. Uncontrolled BP promoted atrial remodeling, and is therefore a strong predictor for recurrence of AF after PVI.

Masashi Kamioka

Naoko Hijioka

Yoshiyuki Matsumoto

Minoru Nodera

Takashi Kaneshiro

Hitoshi Suzuki

Yasuchika Takeishi

Pacing and Clinical Electrophysiology

Uncontrolled blood pressure affects atrial remodeling and adverse clinical outcome in paroxysmal atrial fibrillation

In recent years, pacemaker lead failure due to compressive damage has been reported with increasing frequency. To document the mechanism of this failure, we evaluated explanted mechanically damaged leads with electrical testing, optical microscopy, and in some cases, scanning electron microscopy (SEM) In addition, we performed an autopsy study to measure the compressive loads on catheters placed percutaneously through the costoclavicular angle, as well as by cephalic cutdown. Of the 49 explanted compression damaged leads with enough clinical data for analysis, all had been placed by percutaneous subclavian puncture. Our autopsy data confirmed the significant increase in pressures generated in the costoclavicular angle for medial percutaneous subclavian catheterization (126 ± 26 mmHg) compared to a more lateral percutaneous subclavian puncture (63 ± 15 mmHg) or a cephalic cutdown (38 ± 13 mmHg) (P &lt; 0.01). In vivo coil compression testing documented loads up to 100 pounds per linear inch of coil and a compressive morphology by SEM identical to that seen in the clinical explants. Pacemaker leads appear to be susceptible to compression damage when placed by subclavian venipuncture. When possible, leads should be placed such that they avoid the tight costoclavicular angle.

DONALD M. JACOBS

ANDREW S. FINK

ROBERT P. MILLER

W. ROBERT ANDERSON

RICK D. MCVENES

JOSEPH F. LESSAR

KENNETH E. COBIAN

DALE B. STAFFANSON

JAMES E. UPTON

MELVIN P. BUBRICK

Anatomical and Morphological Evaluation of Pacemaker Lead Compression

起搏器导线压迫的解剖学与形态学评估

The extrathoracic approach to transvenous introducer insertion into the subclavian vein was initially described as an alternative approach in “Safe Introducer Technique for Pacemaker Lead Implantation.” Since this technique was so successful as an alternative approach, it was tried as the primary approach in 213 consecutive cases. The subclavian vein was cannulated in all cases. There were no introducer related complications. The extrathoracic approach cannulates the subclavian vein as it passes over the body of the first rib prior to entering the thoracic inlet. The technique includes maneuvering the introducer needle from the clavicle to the first rib by a series of partial withdrawals and reinsertions, visualized by fluoroscopy, The needle is advanced posteriorly along the rib until the vein is punctured. Orientation is maintained by touching the rib with each maneuver. The early results of the extrathoracic approach reinforces the belief that a complication‐free, transvenous introducer approach can he achieved.

CHARLES L. BYRD

Clinical Experience with the Extrathoracic Introducer Insertion Technique

经胸外导引插入技术的临床经验

Pacing and Clinical ElectrophysiologyVolume 26, Issue 1p1 p. 114-124 Lessons From the First Patient with an Implanted Pacemaker: 1958–2001 BERIT LARSSON, BERIT LARSSON St. Jude Medical AB, JärfällaSearch for more papers by this authorHÅKAN ELMQVIST, HÅKAN ELMQVIST Department of Medical Laboratory Sciences & Technology, Karolinska Institute, StockholmSearch for more papers by this authorLARS RYDÉN, LARS RYDÉN Department of Cardiology, Karolinska Hospital, StockholmSearch for more papers by this authorHANS SCHÜLLER, HANS SCHÜLLER Department of Cardiothoracic Surgery, University Hospital, Lund, SwedenSearch for more papers by this author BERIT LARSSON, BERIT LARSSON St. Jude Medical AB, JärfällaSearch for more papers by this authorHÅKAN ELMQVIST, HÅKAN ELMQVIST Department of Medical Laboratory Sciences & Technology, Karolinska Institute, StockholmSearch for more papers by this authorLARS RYDÉN, LARS RYDÉN Department of Cardiology, Karolinska Hospital, StockholmSearch for more papers by this authorHANS SCHÜLLER, HANS SCHÜLLER Department of Cardiothoracic Surgery, University Hospital, Lund, SwedenSearch for more papers by this author First published: 26 March 2003 https://doi.org/10.1046/j.1460-9592.2003.00162.xCitations: 66 Address for reprints: Lars Rydén, M.D., Dept. of Cardiology, Karolinska Hospital SE –171 76 Stockholm, Sweden. Fax: +46-8-311044. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume26, Issue1p1January 2003Pages 114-124 RelatedInformation

BERIT LARSSON

HÅKAN ELMQVIST

LARS RYDÉN

HANS SCHÜLLER

Lessons From the First Patient with an Implanted Pacemaker:

植入式心脏起搏器首位患者带来的启示

Background Spinal cord stimulation (SCS) reduces sympathetic activity in animal models of heart failure with reduced ejection fraction (HF) but limited data exist of SCS in patients with HF. The aim of the present study was to test the primary hypothesis that SCS reduces cardiac sympathetic nerve activity in HF patients. Secondary hypotheses were that SCS improves left ventricular function and dimension, exercise capacity, and clinical variables relevant to HF. Methods HF patients with a SCS device previously participating in the DEFEAT‐HF trial were included in this crossover study with 6‐week intervention periods (SCS‐ON and SCS‐OFF). SCS (50 Hz, 210‐μs pulse duration, aiming at T2–T4 segments) was delivered for 12 hours daily. Indices of myocardial sympathetic neuronal function (heart‐to‐mediastinum ratio, HMR) and activity (washout rate, WR) were assessed using 123 I‐metaiodobenzylguanidine (MIBG) scintigraphy. Echocardiography, exercise testing, and clinical data collection were also performed. Results We included 13 patients (65.3 ± 8.0 years, nine males) and MIBG scintigraphy data were available in 10. HMR was not different comparing SCS‐ON (1.37 ± 0.16) and SCS‐OFF (1.41 ± 0.21, P = 0.46). WR was also unchanged comparing SCS‐ON (41.5 ± 5.3) and SCS‐OFF (39.1 ± 5.8, P = 0.30). Similarly, average New York Heart Association class (2.4 ± 0.5 vs 2.3 ± 0.6, P = 0.34), quality of life score (24 ± 16 vs 24 ± 16, P = 0.94), and left ventricular dimension and function as well as exercise capacity were all unchanged comparing SCS‐ON and SCS‐OFF. Conclusion In patients with HF, SCS (12 hours daily, targeting the T2–T4 segments of the spinal cord) does not appear to influence cardiac sympathetic neuronal activity or function as assessed by MIBG scintigraphy.

JAN NAAR

DEBORAH JAYE

CECILIA LINDE

PETR NEUŽIL

PETR DOŠKÁŘ

FILIP MÁLEK

FRIEDER BRAUNSCHWEIG

LARS H. LUND

LARS MORTENSEN

BENGT LINDEROTH

GÖRAN LIND

DIANNA BONE

ARTHUR J. SCHOLTE

FRED KUEFFER

JODI KOEHLER

KAMBIZ SHAHGALDI

OTTO LANG

MARCUS STÅHLBERG

Effects of Spinal Cord Stimulation on Cardiac Sympathetic Nerve Activity in Patients with Heart Failure

脊髓电刺激对心力衰竭患者心脏交感神经活动的影响

ABSTRACT Children with indications of pacing often require epicardial pacemakers with generators implanted in the abdominal wall due to small body size or challenging anatomy because of congenital heart diseases. However, left ventricle (LV) systolic dyssynchrony induced by epicardial pacing may result in adverse remodeling and LV dysfunction. Recently, distal His bundle pacing (dHBP) has been shown to restore normal ventricular function in adult patients with pacemaker induced ventricular dysfunction. Nevertheless, the effects and relevance of HBP in pediatric patients are largely unresolved, with only limited data analyzing the feasibility and efficacy of HBP in the pediatric population. We report the case of a young girl with congenital atrioventricular (AV) block who developed LV dysfunction induced by prolonged epicardial stimulation. After upgrading to dHBP, she improved her LV ejection fraction from 40% to 60% and maintained stable pacing‐sensing parameters over‐time. We here provide a review of existing literature on the topic.

Giaccardi Marzia

Zampieri Mattia

Crudeli Elena

Cartei Stella

Chechi Tania

Cipani Simone

Passantino Silvia

Porcedda Giulio

Distal His Pacing Promotes Reverse Remodeling in a Child With Conventional Pacing‐Induced Ventricular Dysfunction

远端希氏束起搏促进常规起搏诱发心室功能障碍儿童的逆向重构

ABSTRACT Background The degree and time course of improvement in left ventricular (LV) function with treatment in patients with tachycardiomyopathy (TCMP) is highly variable. This study aims to clinically characterize the recovery of TCMP based on the extent and course of improvement in LV function and identify predictors of complete myocardial recovery. Methods In this prospective, single‐center, observational study, patients with suspected TCMP who underwent successful tachyarrhythmia termination/control were included. Clinical and echocardiographic assessment of LV function was done at baseline, within 1 h after tachyarrhythmia termination, 24 h later, and at 12 weeks follow‐up. Results Ninety‐nine patients were enrolled in the study. Six patients had immediate normalization of LV ejection fraction (LVEF) with reversion to sinus rhythm and were labeled as “pseudo‐TCMP”; the remaining 93 patients were included in the analysis. Based on complete versus partial normalization of LVEF at 12‐week follow‐up, 50 patients (53.8%) were labeled as completely recovered TCMP and 43 (46.2%) as partially recovered TCMP respectively. Causative arrhythmias included atrial fibrillation (38%), focal atrial tachycardia (28%), atrial flutter (22%), ventricular arrhythmias (11%), and orthodromic re‐entrant tachycardia (2%). The LVEF at presentation was 0.25 ± 0.05 which improved to 0.36 ± 0.11 within 1 h after tachycardia termination ( p &lt; 0.0001), 0.41 ± 0.14 24 h later ( p = 0.009) and to 0.52 ± 0.12 at 12 weeks follow‐up ( p &lt; 0.0001). Male gender was the only differentiating statistically significant variable between completely recovered and partially recovered TCMP, 24 (48%) versus 30 (69.7%) respectively ( p = 0.0339). Conclusion Nearly half of the TCMP patients have complete recovery of LV function at 12 weeks follow‐up, while the other half have a partial recovery only. There was no robust predictor of complete myocardial recovery.

Neeta Bachani

Harshad Shah

Raghav Bansal

Vijay Soorampally

Gopi Krishna Panicker

Yash Lokhandwala

Characterization of Myocardial Recovery in Patients With Tachycardiomyopathy

心动过速性心肌病患者心肌恢复的特征

ABSTRACT Introduction The VDD‐leadless pacemaker aims to maintain high atrioventricular (AV) synchrony, but proper sensing setup is crucial. Methods and Results This case was an elderly woman with an AV block who received a dual‐chamber pacemaker. Due to ventricular pacing failure, a Micra AV2 was implanted. However, postimplantation, high sinus rate, and frequent premature ventricular contractions were noted. Therefore, the auto + A3 threshold function was used in the atrial‐sensing setup. A few days later, the MAM test confirmed good AV synchrony. Conclusion The auto + A3 threshold function equipped in the Micra AV2 may offer to maintain high AV synchrony.

Ryo Ohinata

Naoya Inoue

Shuji Morikawa

Utility of the Novel Auto + A3 Threshold Function in Maintaining Atrioventricular Synchrony

新型Auto + A3阈值功能在维持房室同步中的应用价值

ABSTRACT Background Predicting premature ventricular contraction (PVC) origin pre‐ablation is a fundamental step, as right ventricular outflow tract (RVOT) PVC often leads to higher success rates. Objective To compare nine published ECG criteria to differentiate between RVOT and non‐RVOT origins of PVCs and develop a stepwise algorithm using those criteria to better determine PVC origin to predict ablation success. Methods Two centers were involved in this study, the derivation group and the validation group. The derivation group included 65 patients with PVC left bundle branch block (LBBB) pattern morphology (predominantly negative in lead V 1 ) and inferior axis (predominantly positive in leads II and III), who underwent ablation at Cipto Mangunkusumo Hospital (RSCM) (2017–2022). The validation group included 291 patients who underwent ablation at the Taipei Veteran General Hospital (2020–2023). We calculated and compared six diagnostic accuracy measures from nine previously published ECG morphology criteria to develop an algorithm to enhance the accuracy of predicting RVOT PVC origin for successful ablation. Results Our multistep algorithm using Criteria 5, 8, and 1 enhanced diagnostic performance compared to using each criterion alone. The accuracy, sensitivity, and specificity in the derivation group were 86.2%, 93.6%, and 66.7%, respectively; those in the validation group were 85.9%, 90.8%, and 64.7%, respectively. The ROC curve AUCs were 0.802 and 0.775, respectively. Conclusion In cases of inferior axis and LBBB pattern PVCs, a multistep algorithm using multiple criteria increases the accuracy of predicting RVOT PVC origin instead of using a single criterion.

Muhammad Rafdi Amadis

Li‐Wei Lo

Simon Salim

Muhammad Yamin

Yenn‐Jiang Lin

Shih‐Lin Chang

Yu‐Feng Hu

Fa‐Po Chung

Rubiana Sukardi

Chin‐Yu Lin

Ting‐Yung Chang

Ling Kuo

Angga Pramudita

Chih‐Min Liu

Shin‐Huei Liu

Cheng‐I Wu

Yu‐Shan Huang

Dinh Son Ngoc Nguyen

Dat Cao Tran

Shih‐Ann Chen

Multistep Algorithm to Predict RVOT PVC Site of Origin for Successful Ablation Using Available Criteria: A Two‐Center Cross‐Validation Study

多步算法预测RVOT PVC起源部位以实现成功消融的可用标准：一项两中心交叉验证研究

ABSTRACT Background Transseptal catheterization is critical for atrial fibrillation (AF) ablation but risks thromboembolism. Transseptal sheaths (TSS) were suggested for continuous heparinized saline solution flush. The safety and effectiveness of a simple TSS management to reduce sheath‐associated thrombus development risk was investigated. Methods AF patients who underwent radiofrequency ablation with the simple TSS management were studied under a retrospective multi‐center observation study and a prospective single‐center observation study. TSS and dilators were washed and perfused with high concentration heparinized saline (20 u/mL). Immediately after two successful transseptal punctures, activated clotting time ≥300 s was maintained by heparin infusion. TSS aspiration with negative suction and re‐perfusion with high concentration heparinized saline (20 u/mL) was performed for the remaining procedure before and after catheter withdrawal. Results A total of 4765 AF patients underwent 5367 ablation procedures were enrolled in the retrospective study, involving 156 (2.9% per procedure) complications. No acute stroke occurred during all the procedures. Perioperative thromboembolic complications occurred in 10 (0.21%) patients and in 10 (0.19%) procedures. Thromboembolic complications occurred within 24 h, between 24–48 h, and after 48 h post‐procedure in six, two, and two patients, respectively. In the prospective observation study, neither sheath‐ nor catheter‐associated thrombus were detected by the intracardiac echocardiography during all 127 procedures, without any perioperative thromboembolic complications. No hemorrhagic cerebrovascular complication was encountered in both observational studies. Conclusion For AF radiofrequency ablation, it was safe and effective for TSS high concentration heparinized saline infusion only. This approach could avoid sheath‐associated thrombus for interventional procedures.

Juan Xu

Shi Peng

Yuanjun Sun

Zhenning Nie

Ya Zhen

Xiaomeng Yin

Xiaofeng Lu

Yan Liu

Xiaoyu Zhang

Dayang Huang

Shuai Guo

Yong Wei

Genqing Zhou

Yunlong Xia

Jun Li

Shaowen Liu

Songwen Chen

Transseptal Sheath Perfused with High Concentration Heparinized Saline for Reducing Sheath‐associated Thrombus

高浓度肝素化盐水灌注的经间隔鞘管用于减少鞘管相关血栓

Abbreviation	Pacing Clinical Electrophis
Journal Impact	1.65
Quartiles(Global)	ENGINEERING, BIOMEDICAL(Q3)

ISSN	0147-8389, 1540-8159
h-index	110

Publication Information	Publisher: John Wiley and Sons Inc，Publishing cycle: Monthly，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 1978，Proportion of original research papers: 88.10%，Self Citation Rate:5.90%， Gold OA Rate: 18.67%
Average review cycle	网友分享经验：较快,2-4周
Average recruitment ratio	网友分享经验：容易

PACE - Pacing and Clinical Electrophysiology

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