The Cutting Edge of Cardiac Pacing, Electrophysiology and Diagnostic Techniques

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Point-of-Care Diagnostics and Devices".

Deadline for manuscript submissions: 31 May 2025 | Viewed by 2475

Special Issue Editors


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Guest Editor
De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, 20126 Milan, Italy
Interests: cardiac electrophysiology; cardiac devices; ventricular tachycardia; atrial fibrillation; left atrial appendage closure
Special Issues, Collections and Topics in MDPI journals

E-Mail Website
Guest Editor
De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, 20126 Milan, Italy
Interests: ventricular arrhythmias; sudden death; genetics; electrophysiology study; ablation of ventricular arrhythmias
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

From the first implantable pacemaker developed in the 1950s by Dr. Wilson Greatbatch, technologies and therapies have evolved rapidly in the field of electrophysiology and cardiac pacing, particularly with the aim of improving quality of life and life expectancy by using even more minimally invasive techniques. Implantable cardioverter defibrillators (ICDs) have clearly established a proven benefit in reducing the risk of sudden cardiac death in patients affected by advanced heart failure or genetic diseases. Novel extravascular ICDs ensure the same benefits as transvenous ones but at the cost of a significantly reduced rate of complications, with subsequent fewer negative implications, especially in young patients. Resynchronization therapy is the cornerstone of the heart failure armamentarium, with even more well-tested technologies and possible fields of employment, in particular regarding conduction system pacing. Leadless pacemakers represent the most significant innovation in cardiac pacing technology, avoiding leads, surgical wounds, infections and battery replacement. On the other hand, catheter ablation is currently capable of treating 100% of cardiac arrhythmias, although with variable results. The advent of three-dimensional (3D) mapping systems has completely overturned electrophysiological techniques by providing detailed anatomical and electrical information of the heart, allowing for precise localization of arrhythmogenic substrates and targeted ablation. Innovations in catheter design, such as the development of irrigated-tip catheters and contact force-sensing catheters, have improved procedural efficacy and safety. The integration of advanced imaging modalities, such as magnetic resonance imaging (MRI), computed tomography (CT) and intracardiac echocardiography (ICE), with mapping systems has improved procedural planning and visualization. New developments will undoubtedly become available that will eliminate human error through the increasing use of automation and robotics in such procedures. Cardiac electrophysiology is one of the fields that has seen the strongest scientific and technical developments over recent decades, capable of effectively treating patients who were deemed impossible cases a few years ago. The need for more complex therapies is further increased by the ageing population.

Dr. Fabrizio Guarracini
Dr. Patrizio Mazzone
Guest Editors

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Keywords

  • cardiac pacing
  • electrophysiology
  • abnormal heart rhythms
  • rhythm abnormalities
  • ablation
  • atrial fibrillation
  • cardioverter defibrillator (ICD) devices
  • diagnostic devices

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Published Papers (2 papers)

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9 pages, 532 KiB  
Article
Transesophageal Echocardiography-Guided Transseptal Puncture Reduces Pericardial Tamponade in Electrophysiological Procedures
by Yannick Teumer, Daniel Eckart, Lyuboslav Katov, Dominik Felbel, Carlo Bothner, Wolfgang Rottbauer and Karolina Weinmann-Emhardt
Diagnostics 2024, 14(22), 2495; https://doi.org/10.3390/diagnostics14222495 - 8 Nov 2024
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Abstract
Background: Transseptal puncture (TSP) is a critical step in electrophysiological (EP) procedures, as a misdirected TSP can result in life-threatening complications. Although TSP is predominantly performed under fluoroscopic guidance in EP procedures, transesophageal echocardiography (TEE) offers more precision and certainty in the [...] Read more.
Background: Transseptal puncture (TSP) is a critical step in electrophysiological (EP) procedures, as a misdirected TSP can result in life-threatening complications. Although TSP is predominantly performed under fluoroscopic guidance in EP procedures, transesophageal echocardiography (TEE) offers more precision and certainty in the localization of the transseptal needle at the interatrial septum. Despite the widespread use of TSP, evidence supporting the added value of TEE-guided TSP in EP procedures remains limited. This study evaluates the impact of additional TEE guidance on TSP-associated complications during EP procedures. Methods: This study enrolled patients who underwent left atrial or left ventricular procedures with TSP, performed either without (fluoroscopy group) or with additional TEE guidance (TEE group), at the University Heart Center Ulm, Germany. Results: A total of 932 patients were included: 443 in the TEE group (mean age 68.1 ± 11.8 years, 40.6% female) and 489 in the fluoroscopy group (mean age 68.8 ± 11.0 years, 38.2% female). The mean number of transseptal accesses per patient was 1.18 ± 0.38 in the TEE group and 1.14 ± 0.34 in the fluoroscopy group (p = 0.101). Pericardial tamponade occurred significantly less in the TEE group (0.5%) than in the fluoroscopy group (1.8%; p = 0.046). Logistic regression revealed a 91.8% lower risk of pericardial tamponade with TEE-guided TSP compared to fluoroscopy guidance alone. The overall TEE complication rate was low (0.9%). Conclusions: TEE guidance during TSP significantly reduces the risk of pericardial tamponade in EP procedures, indicating that TSP should be performed with additional sonographic guidance to increase patient safety. Full article
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5 pages, 3097 KiB  
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Dual Chamber Pacemaker Implant in Coronary Sinus Leading to Several Complications
by Nancy Wassef, Mina Ibrahim, Christine Botrous, Amr Anos, Kai Hogrefe and Janaka Pathiraja
Diagnostics 2024, 14(22), 2465; https://doi.org/10.3390/diagnostics14222465 - 5 Nov 2024
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Abstract
Permanent pacemaker implantation is a low-risk procedure. However, complications may occur at a rate of around 4–8%. We present a case where initial implantation resulted in complications that could have been avoided by meticulous assessment of lead position in different projections and early [...] Read more.
Permanent pacemaker implantation is a low-risk procedure. However, complications may occur at a rate of around 4–8%. We present a case where initial implantation resulted in complications that could have been avoided by meticulous assessment of lead position in different projections and early post-procedure X-ray that would have delineated other serious complications. We present a case where the right ventricular lead was placed in the coronary sinus, which resulted in the loss of pacing capture with further syncope after the pacemaker implant. This was apparent in the post-procedure electrocardiogram (ECG) with right bundle branch pacing and the lead was repositioned in the right ventricular apex the following day. Furthermore, the patient was discharged home without a chest X-ray (CXR), and she represented a week later with a haemo-pneumothorax and pericardial effusion. A chest drain was placed and was discharged after a slow recovery following several complications that could have been avoidable. Full article
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