Implantation of the Micra transcatheter pacing system: A single center North India experience

BackgroundThe leadless pacemaking transcatheter system, Micra, is a miniaturized, single-chamber pacemaker system. We report herein our experience with implantation of the Micra TPS system.ObjectiveThe current study was conducted to evaluate the safety and efficacy of the leadless Micra Transcatheter Pacemaker System (Medtronic).Research design and methodsThis was a prospective single centre nonrandomized study without controls. A transcatheter pacemaker was implanted in patients who had guideline based indications for ventricular pacing. 28 subjects were screened based on the selection criteria. Mica TPS was implanted. Parameters assessed were: duration of procedure (from femoral vein puncture to venous access closure), fluoroscopy time, number of device repositions, periprocedural electrical measurements (sensing, threshold and impedance) and in-hospital, intermediate to long term adverse events related to procedure.Result and conclusions: The device was successfully implanted in 28 subjects. The mean intraoperative sensing value was 9.04 ± 1.5 mV and the impedance was 766.89 ± 213.9 Ω. At discharge from hospital, those values were 13.2 ± 15.83 mV and 855 ± 111.7, respectively. The recommended pacing threshold value as achieved in all subjects was 0.78 V, i.e. ≤ 1 V at 0.24 ms. There was no adverse event or complications reported for any of the subjects. Mean time from hospitalization to discharge was 1.5 days. Implantation of leadless pacemakers is feasible, safe and provides advantages over the conventional system.     

Cardiac Pacing and Defibrillation in Children and Young Adults

The population of children and young adults requiring a cardiac pacing device has been consistently increasing. The current generation of devices are small with a longer battery life, programming capabilities that can cater to the demands of the young patients and ability to treat brady and tachyarrhythmias as well as heart failure. This has increased the scope and clinical indications of using these devices. As patients with congenital heart disease (CHD) comprise majority of these patients requiring devices, the knowledge of indications, pacing leads and devices, anatomical variations and the technical skills required are different than that required in the adult population. In this review we attempt to discuss these specific points in detail to improve the understanding of cardiac pacing in children and young adults.     

肌浆网钙ATP酶过表达对心房颤动兔心房及L型钙通道alc蛋白表达的影响

目的探讨心肌肌浆网钙ATP酶2a（SERCA2a）基因过表达,对兔急性心房颤动（AF）的心房肌L型电压依赖钙通道蛋白alc亚单位（LVDCCalc）表达的影响。方法48只成年新西兰兔,随机分成为房颤组（AF组,n=12）、9一型腺相关病毒＋增强型绿色荧光蛋白组＋房颤组（rAAV9＋EGFP＋AF组,n=12）、9一型腺相关病毒＋肌浆网钙ATP酶2a＋增强型绿色荧光蛋白组＋房颤组（rAAV9＋SERCA2a＋EGFP＋AF组,n=12）,并设假手术组作为对照（Control组,,l=12）。rAAV9＋EGFP＋AF组和rAAV9＋SERCA2a4-EGFP4-AF组起搏前30d开胸心包腔内注射包含报告基因的rAAV9一EGFP和包含靶基因的rAAV9-SERCA2a—EGFP各500肛L（1×10”v．g／ptL）。转染30d后,AF组、rAAV9＋EGFP＋AF组和rAAV9＋SERCA2a＋EGFP＋AF组,以600BPM刺激频率,持续起搏兔右心房24h制作AF模型。处死各组动物,倒置荧光显微镜下观察右心房肌组织EGFP表达情况,行HE染色对右心房组织形态检查,应用免疫组化技述检测SERCA2a蛋白及LVDCCalc蛋白在心房肌中的表达情况。结果rAAV9＋EGFP＋SERCA2a4-AF组SERCA2a蛋白及LVDCCalc蛋白表达量显著高于AF组和rAAV9＋EGFP＋AF组（P〈0．05）,但与对照组比较差异无显著性。结论心房肌转SERCA2a基因,显著减少了急性房颤心房肌的LVDCCalc蛋白表达的降低,有逆转急性AF电重构的作用。     

Electrical stimulation of cardiomyocytes activates mitochondrial matrix metalloproteinase causing electrical remodeling

Cardiac arrhythmias, instigated by mechanical and electrical remodeling, are associated with activation of extracellular matrix metalloproteinases (MMPs). However, the connection between intracellular MMPs activation and arrhythmogenesis is not well established. Previously, we determined localization of MMP in the mitochondria using confocal microscopy. We tested the hypothesis that electrical pacing induces the activation of mitochondrial MMP (mtMMP) and is associated with myocyte mechanical dysfunction. Myocytes were isolated and field stimulated at 1 and 4 Hz. Myocyte mechanics and calcium transient was studied using Ion-Optix system. Mitochondrial MMP-9 activation was evaluated using zymography. There was a 25% increase in 1 Hz and 40% increase in 4 Hz stimulation. We observed an increase in mtMMP activation with increase in electrical pacing compared to 0 Hz with a significant increase (p < 0.05, n = 3). Field stimulation at 4 Hz decreased cell re-lengthening. The levels of calcium transient were reduced with increase in contraction frequency. We conclude that electrical stimulation activates mtMMP-9 that is associated with myocyte mechanical dysfunction.     

The downside of right ventricular apical pacing

The right ventricular (RV) apex has been the standard pacing site since the development of implantable pacemaker technology. Although RV pacing was initially only utilized for the treatment of severe bradyarrhythmias usually due to complete heart block, today the indications for and implantation of RV pacing devices is dramatically larger. Recently, the adverse effects of chronic RV apical pacing have been described including an increased risk of heart failure and death. This review details the detrimental effects of RV apical pacing and their shared hemodynamic pathophysiology. In particular, the role of RV apical pacing induced ventricular dyssynchrony is highlighted with a specific focus on differential outcome based upon QRS morphology at implant.     

Speed, pacing strategy and aerodynamic drafting in Thoroughbred horse racing

Choice of pacing strategy and the benefit of aerodynamic drafting are thought to be key determinants of racing performance. These effects have largely been analysed without reference to final outcome, in small datasets with low temporal resolution, and a focus on human swimming, cycling and running. Here, we determined the position and speed of 44,803 racehorses, once per second, in 3,357 races ranging in length from 1006 to 4225 m (50.9-292.9 seconds duration) using a validated radio tracking system. We find that aerodynamic drafting has a marked effect on horse performance, and hence racing outcome. Furthermore, we demonstrate that race length-dependent pacing strategies are correlated with the fastest racing times, with some horses reaching a maximum speed in excess of 19 m s(-1). The higher speeds seen with certain pacing strategies may arise due to the nature of pack racing itself, or may be a reflection of individual capabilities, that is, corresponding to horses that perform well in roles suited to their 'front-running' or 'chaser' personality traits.     

Environmental influences on stereotypy and the activity budget of Indian leopards (Panthera pardus) in four zoos in Southern India

To eliminate abnormal behaviors in leopards (Panthera pardus), such as stereotypic pacing, by utilizing environmental enrichment techniques, a proper understanding of their behavior in captive environments is required. Hence there is a need for animal welfare studies in Indian zoos. The activity budgets of 16 leopards were recorded across four southern Indian zoos: Thiruvananthapuram Zoo, Arignar Anna Zoological Park, Shri Chamarajendra Zoological Gardens, and the Guindy Children's Park. Of the 16 study animals, 14 were studied on‐exhibit on zoo holidays as well as on days with visitors present, and all 16 individuals were studied off‐exhibit on other days with visitors present. The 11 behaviors recorded were categorized into active, resting, and stereotypic behaviors. Leopards exhibited higher levels of activity in the on‐exhibit enclosures on days with no visitors. Feeding time influenced the behavioral repertoire of all 14 leopards studied on‐exhibit. Lower proportions of resting were exhibited during the hours before feeding. The proportion of active behaviors differed significantly across zoos. Stereotypic pacing levels were not influenced by the presence of visitors or by feeding time, but was significantly influenced by enclosure features. Higher levels of stereotypic pacing were exhibited in off‐exhibit than on‐exhibit enclosures. Our study shows that the behavior of captive leopards is influenced by enclosure type, feeding regime, and the presence of visitors. Zoo Biol 21:585–595, 2002. © 2002 Wiley‐Liss, Inc.     

Low pasture allowance until late gestation in ewes: behavioural and physiological changes in ewes and lambs from lambing to weaning

Low pasture allowance during gestation affects ewes’ BW at parturition, the bond with their lamb, lamb development, and thus also may affect their responses to weaning. The objectives were to determine if native pasture allowance from before conception until late pregnancy affects ewe–lamb behaviours at lambing, ewes’ milk yield, lambs’ BW, and the behavioural and physiological changes of ewes and lambs at weaning. From 23 days before conception until 122 days of pregnancy, 24 ewes grazed on two different native pasture allowances: high (10 to 12 kg of dry matter (DM)/100 kg of BW per day; HPA treatment; n=12) or low (5 to 8 kg of DM/100 kg of BW per day; LPA treatment; n=12). Thereafter, all ewes grazed on Festuca arundinacea and received rice bran and crude glycerine. Ewes’ body condition score (BCS) and BW were recorded during pregnancy and postpartum periods. Milk yield was determined on days 32, 41 and 54 after lambing. Lambs’ BW was recorded from birth until 72 days after lambing. Latency from parturition until the ewe licked her lamb, maternal behaviour score (a test that evaluates maternal attachment to the lamb) and latency for lamb to stand up and suckle were determined. The behaviour of the lambs and ewes was recorded before and after weaning (at 65 days). The ewes’ serum total protein, albumin and globulin concentrations were measured before and after weaning. The HPA ewes presented greater BW (P<0.005) and BCS (P<0.005) than the LPA ewes during pregnancy and postpartum (P<0.04), and had a greater milk yield than the LPA ewes (P<0.03). Treatments did not influence any behaviour at lambing, lambs’ BW, neither the ewes’ behavioural and physiological changes at weaning. HPA lambs paced and vocalized more than LPA lambs (P<0.0001). The variation of albumin concentration before and after weaning was greater in the HPA lambs than in the LPA lambs (P<0.0001). In conclusion, although ewes’ BW, BCS and milk production were affected by pasture allowance until late pregnancy, this did not affect the behaviours that lead to the establishment of the mother–young bond, nor the ewes’ behavioural responses at weaning. Lambs reared by ewes that grazed on low pasture allowance during pregnancy presented fewer behavioural changes and a lower decrease of albumin concentration after weaning. Lambs’ BW was not affected by the feeding received by their mothers.     

Cardiac resynchronization: insight from experimental and computational models

Cardiac resynchronization therapy (CRT) is a promising therapy for heart failure patients with a conduction disturbance, such as left bundle branch block. The aim of CRT is to resynchronize contraction between and within ventricles. However, about 30% of patients do not respond to this therapy. Therefore, a better understanding is needed for the relation between electrical and mechanical activation. In this paper, we focus on to what extent animal experiments and mathematical models can help in order to understand the pathophysiology of asynchrony to further improve CRT.     

Correlation between the sudden jump-like increases of the atrio-Hisian interval induced during burst atrial pacing and during programmed atrial stimulation in patients with atrioventricular nodal reentrant tachycardia

Purpose

To study the correlation between the sudden prolongations of the atrio-Hisian (AH) interval with ≥50 ms during burst and programmed atrial stimulation, and to define whether the AH jump during burst atrial pacing is a reliable diagnostic criterion for dual AV nodal physiology.