Conduction System Pacing Following Septal Myectomy: Insights into Site of Conduction Block

2022 ◽  
Author(s):  
Rujie Zheng ◽  
Yingxue Dong ◽  
Shengjie Wu ◽  
Lan Su ◽  
Dongdong Zhao ◽  
...  
Keyword(s):  
Conduction Block ◽  
Conduction System ◽  
Septal Myectomy

His-Purkinje Conduction System Pacing in Atrioventricular Block: New Insights into Site of Conduction Block

2021 ◽  
Author(s):  
Pugazhendhi Vijayaraman ◽  
Neil Patel ◽  
Shaun Colburn ◽  
Dominik Beer ◽  
Angela Naperkowski ◽  
...  
Keyword(s):  
Atrioventricular Block ◽  
Conduction Block ◽  
Conduction System

scholarly journals Defining Left Bundle Branch Block Patterns in Cardiac Resynchronisation Therapy: A Return to His Bundle Recordings

2020 ◽  
Vol 9 (1) ◽  
pp. 28-33 ◽  
Author(s):  
Roderick Tung ◽  
Gaurav A Upadhyay
Keyword(s):  
Left Bundle Branch Block ◽  
Conduction Block ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Conduction System ◽  
Bundle Branch Block ◽  
His Bundle ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy ◽  
The Impact

Left bundle branch block (LBBB) is associated with improved outcome after cardiac resynchronisation therapy (CRT). One historical presumption of LBBB has been that the underlying pathophysiology involved diffuse disease throughout the distal conduction system. The ability to normalize wide QRS patterns with His bundle pacing (HBP) has called this notion into question. The determination of LBBB pattern is conventionally made by assessment of surface 12-lead ECGs and can include patients with and without conduction block, as assessed by invasive electrophysiology study (EPS). During a novel extension of the classical EPS to involve left-sided recordings, we found that conduction block associated with the LBBB pattern is most often proximal, usually within the left-sided His fibres, and these patients are the most likely to demonstrate QRS correction with HBP for resynchronisation. Patients with intact Purkinje activation and intraventricular conduction delay are less likely to benefit from HBP. Future EPS are required to determine the impact of newer approaches to conduction system pacing, including intraseptal or left ventricular septal pacing. Left-sided EPS has the potential to refine patient selection in CRT trials and may be used to physiologically phenotype distinct conduction patterns beyond LBBB pattern.

scholarly journals B-AB04-04 SITE OF CONDUCTION BLOCK IN AV BLOCK: NEW INSIGHTS FROM HIS-PURKINJE CONDUCTION SYSTEM PACING

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S7
Author(s):  
Pugazhendhi Vijayaraman ◽  
Shaun Colburn ◽  
Neil R. Patel ◽  
Angela Naperkowski ◽  
Faiz A. Subzposh
Keyword(s):  
Conduction Block ◽  
Conduction System ◽  
Av Block

Entrapment Neuropathies: Electrodiagnostic Criteria

2019 ◽  
Vol 24 (6) ◽  
pp. 12-15
Author(s):  
Jay Blaisdell ◽  
James B. Talmage
Keyword(s):  
Nerve Conduction ◽  
Task Force ◽  
Conduction Block ◽  
Cubital Tunnel Syndrome ◽  
Conduction Delay ◽  
Test Results ◽  
Sixth Edition ◽  
Entrapment Neuropathies ◽  
Axon Loss ◽  
Tunnel Syndrome

Abstract Like the diagnosis-based impairment (DBI) method and the range-of-motion (ROM) method for rating permanent impairment, the approach for rating compression or entrapment neuropathy in the upper extremity (eg, carpal tunnel syndrome [CTS]) is a separate and distinct methodology in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition. Rating entrapment neuropathies is similar to the DBI method because the evaluator uses three grade modifiers (ie, test findings, functional history, and physical evaluation findings), but the way these modifiers are applied is different from that in the DBI method. Notably, the evaluator must have valid nerve conduction test results and cannot diagnose or rate nerve entrapment or compression without them; postoperative nerve conduction studies are not necessary for impairment rating purposes. The AMA Guides, Sixth Edition, uses criteria that match those established by the Normative Data Task Force and endorsed by the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM); evaluators should be aware of updated definitions of normal from AANEM. It is possible that some patients may be diagnosed with carpal or cubital tunnel syndrome for treatment but will not qualify for that diagnosis for impairment rating; evaluating physicians must be familiar with electrodiagnostic test results to interpret them and determine if they confirm to the criteria for conduction delay, conduction block, or axon loss; if this is not the case, the evaluator may use the DBI method with the diagnosis of nonspecific pain.

Development of an Atrioventricular (AV) conduction block in the rat- investigation tool for effects of heart failure

2013 ◽  
Vol 61 (S 01) ◽  
Author(s):  
S Pecha ◽  
F Weinberger ◽  
Y Yildirim ◽  
B Sill ◽  
L Conradi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Conduction Block ◽  
Av Conduction ◽  
Av Conduction Block

Modified Septal Myectomy Using a Curved Knife for Left Ventricular Septal Hypertrophy

2014 ◽  
Vol 17 (5) ◽  
pp. 269
Author(s):  
Shinya Takahashi ◽  
Taiichi Takasaki ◽  
Futoshi Tadehara ◽  
Takahiro Taguchi ◽  
Keijiro Katayama ◽  
...  
Keyword(s):  
Blood Flow ◽  
Chest Pain ◽  
Aortic Valve ◽  
Cross Section ◽  
Left Ventricular ◽  
Chest Discomfort ◽  
Septal Myectomy ◽  
Asymmetric Septal Hypertrophy ◽  
Septal Hypertrophy ◽  
Septal Myocardium

An 86-year-old woman presented with chest pain and discomfort. Echocardiography revealed severe aortic valve stenosis and asymmetric septal hypertrophy. Aortic valve replacement and myectomy were performed using a curved knife. The blade was U-shaped in cross-section, and was curved upward along the long axis. Hypertrophic septal myocardium was removed along the long axis of the left ventricle (LV), and a groove for blood flow was constructed. The patient was discharged uneventfully without recurrence of her chest discomfort. Our result suggested that a curved knife is a reasonable option for transaortic septal myectomy in patients with obstructive LV hypertrophy.

Extended Myectomy for Hypertrophic Obstructive Cardiomyopathy

2012 ◽  
Vol 15 (5) ◽  
pp. 251
Author(s):  
Changqing Gao ◽  
Chonglei Ren ◽  
Cangsong Xiao ◽  
Yang Wu ◽  
Gang Wang ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Surgical Procedures ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Systolic Anterior Motion ◽  
Anterior Leaflet ◽  
Septal Myectomy ◽  
The Mean

<p><b>Background:</b> The purpose of this study was to summarize our experience of extended ventricular septal myectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM).</p><p><b>Methods:</b> Thirty-eight patients (26 men, 12 women) with HOCM underwent extended ventricular septal myectomy. The mean age was 36.3 years (range, 18-64 years). Diagnosis was made by echocardiography. The mean (mean � SE) systolic gradient between the left ventricle (LV) and the aorta was 89.3 � 31.1 mm Hg (range, 50-184 mm Hg) according to echocardiographic assessments before the operations. Moderate or severe systolic anterior motion (SAM) of the anterior leaflet of the mitral valve was found in 38 cases, and mitral regurgitation was present in 29 cases. Extended ventricular septal myectomy was performed in all 38 cases. The results of the surgical procedures were evaluated intraoperatively with transesophageal echocardiography (TEE) and with transthoracic echocardiography (TTE) at 1 to 2 weeks after the operation. All patients were followed up with TTE after their operation.</p><p><b>Results:</b> All patients were discharged without complications. The TEE evaluations showed that the mean systolic gradient between the LV and the aorta decreased from 94.8 � 35.6 mm Hg preoperatively to 13.6 � 10.8 mm Hg postoperatively (<i>P</i> = .0000) and that the mean thickness of the ventricular septum decreased from 28.3 � 7.9 mm to 11.8 � 3.2 mm (<i>P</i> = .0000). Mitral regurgitation and SAM were significantly reduced or eliminated. During the follow-up, all patients promptly became completely asymptomatic or complained of mild effort dyspnea only, and syncope was abolished. TTE examinations showed that the postoperative pressure gradient either remained the same or diminished.</p><p><b>Conclusions:</b> Extended ventricular septal myectomy is mostly an effective method for patients with HOCM, and good surgical exposure and thorough excision of the hypertrophic septum are of paramount importance for a successful surgery.</p>

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