ABSTRACT
BACKGROUND: Congenitally corrected transposition of the great arteries (ccTGA) is a rare cardiac anomaly and can lead to abnormal electrical activity of the heart. The implant of a pacemaker in such patients is more complicated than conventional operations. This case report of an adult with ccTGA who had a leadless pacemaker implant will provide a reference for diagnosing and treating such patients. CASE PRESENTATION: A 50-year-old male patient was admitted to hospital having experienced intermittent vision loss for a month. An electrocardiogram and Holter monitoring showed intermittent third-degree atrioventricular block, and echocardiography, cardiac computed tomography and cardiac magnetic resonance imaging confirmed a diagnosis of ccTGA. A leadless pacemaker was successfully implanted into the patient's anatomical left ventricle, and the postoperative parameters were stable. CONCLUSION: Implanting a leadless pacemaker into a patient with a rare anatomical and electrophysiological abnormality, such as ccTGA, is feasible and efficacious, but preoperative imaging evaluation is of considerable importance.
Subject(s)
Pacemaker, Artificial , Transposition of Great Vessels , Male , Adult , Humans , Middle Aged , Congenitally Corrected Transposition of the Great Arteries/complications , Transposition of Great Vessels/surgery , Echocardiography , ElectrocardiographyABSTRACT
The recent two decades have witnessed a greater interest in L2 writing research to explore how individual learners engage with and participate in peer feedback. However, not much attention has been directed to peer feedback in the collaborative format, despite the fact that peer collaboration can enable learners to draw on their respective strengths and pool their knowledge. In this qualitative study, we adopted an educational psychological perspective to discover the intricate nature of learners working together to give anonymous feedback to their peers. In addition to learners' cognitive engagement with the correction and revision process, we also investigated learners' affective, behavioral, and social engagement in collaborative peer feedback. The findings show that, although learners can cognitively engage with the task by identifying a number of language-related problems and providing feedback, their affective, behavioral, and social engagement differed considerably. While some participants' engagement was relatively extensive, especially in the affective and social aspect, others' engagement was at a relatively limited level, characterized by negative emotions and low mutuality in peer interaction. The unpleasant task experience affected their attitudes toward collaborative peer feedback activities and their willingness to participate in subsequent tasks.
ABSTRACT
OBJECTIVE: To explore short-term changes after left bundle branch pacing (LBBP) using echocardiography and computed tomography (CT), especially for postoperative ventricular septal perforation. METHODS: Between January and September 2019, 33 patients with atrioventricular block underwent LBBP at Beijing Anzhen Hospital. All the patients were evaluated using electrocardiography, pacing, parameters and echocardiographic measurements, including for major complications, during the 1, 3, 6, 12 and 24-month follow-up. Interval perforations were examined during a 1-month follow-up echocardiogram and CT. RESULTS: Left bundle branch pacing was successfully performed in 100% (33/33) of patients. The mean seizure threshold was stable and unchanged postoperatively at the 1, 3, 6, 12 and 24-month follow-up. The paced QRS duration of the LBBP was 119.72 ± 2.53 ms and <130 ms in all patients. Unipolar impedance during the procedure was higher than 500 Ω (662.00 ± 181.50 Ω). No ventricular septal perforation occurred at the end of the procedure. At the 1-month follow-up, two patients reported transthoracic echocardiography, with CT revealing septal lead perforation. Through CT, two other patients were found to have septal lead perforation, and echocardiography indicated that the pacing lead had penetrated the interventricular septum and entered the left subendocardium. At the 1, 3, 6, 12 and 24-month follow-up, these four patients exhibited no significant increase in pacing threshold or impedance (p > .05). No ventricular thrombus or stroke was detected. CONCLUSION: Permanent LBBP is safe and feasible in patients with bradycardia. Echocardiography and/or CT can more accurately evaluate changes in cardiac structure and function after LBBP.
