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Kuschyk J, Sattler K, Fastenrath F, Rudic B, Akin I. [Treatment with cardiac electronic implantable devices]. Herz 2024; 49:233-246. [PMID: 38709278 DOI: 10.1007/s00059-024-05246-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 05/07/2024]
Abstract
Cardiac device therapy provides not only treatment options for bradyarrhythmia but also advanced treatment for heart failure and preventive measures against sudden cardiac death. In heart failure treatment it enables synergistic reverse remodelling and reduces pharmacological side effects. Cardiac resynchronization therapy (CRT) has revolutionized the treatment of reduced left ventricular ejection fraction (LVEF) and left bundle branch block by decreasing the mortality and morbidity with improvement of the quality of life and resilience. Conduction system pacing (CSP) as an alternative method of physiological stimulation can improve heart function and reduce the risk of pacemaker-induced cardiomyopathy. Leadless pacers and subcutaneous/extravascular defibrillators offer less invasive options with lower complication rates. The prevention of infections through preoperative and postoperative strategies enhances the safety of these therapies.
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Affiliation(s)
- Jürgen Kuschyk
- I. Medizinische Klinik, Kardiologie, Angiologie, Hämostaseologie und Internistische Intensivmedizin, Sektion für Invasive Kardiologie und Elektrophysiologie, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - Katherine Sattler
- I. Medizinische Klinik, Sektion für Invasive Kardiologie und Elektrophysiologie, Universitätsmedizin Mannheim, Mannheim, Deutschland
| | - Fabian Fastenrath
- I. Medizinische Klinik, Sektion für Invasive Kardiologie und Elektrophysiologie, Universitätsmedizin Mannheim, Mannheim, Deutschland
| | - Boris Rudic
- I. Medizinische Klinik, Sektion für Invasive Kardiologie und Elektrophysiologie, Universitätsmedizin Mannheim, Mannheim, Deutschland
| | - Ibrahim Akin
- I. Medizinische Klinik, Sektion für Invasive Kardiologie und Elektrophysiologie, Universitätsmedizin Mannheim, Mannheim, Deutschland
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Bazire B, Para M, Raffoul R, Nataf P, Cachier A, Extramiana F, Iung B, Algalarrondo V. Prophylactic epicardial pacemaker implantation in tricuspid valve replacement. Eur J Cardiothorac Surg 2023; 64:ezad344. [PMID: 37843446 DOI: 10.1093/ejcts/ezad344] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 09/25/2023] [Accepted: 10/15/2023] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVES Patients undergoing surgical tricuspid valve replacement (TVR) are at high risk of atrioventricular conduction disorders. Because implanting a lead through the tricuspid bioprosthesis is discouraged, the patients who undergo TVR in our centre are usually given a prophylactic epicardial pacemaker. Our aim was to assess the benefits and risks of this strategy. METHODS Among the patients who underwent TVR with prophylactic epicardial pacemaker implantation, clinical evaluations and pacemaker reports were analysed retrospectively after surgery. The need for cardiac pacing were assessed by characterizing the atrioventricular conduction, while the risks were evaluated by listing and adjudicating post-operative events. RESULTS A total of 80 patients were analysed (mean age was 57 ± 16 years old, 30% males). TVR was isolated in 28 (35%) patients, but most often associated with another valve surgery. In the postoperative period, heart rhythm was analysed in 59/80 patients during a median follow-up of 35 months. Cardiac pacing was needed in 46% patients: 14% had complete pacing dependency, 17% had high degree AV block, while 15% had a high ventricular pacing rate (>80%). No pre- or per-operative variables could predict cardiac pacing requirement. Post-operatively, a spontaneous heart rate >70 bpm (P = 0.02) and the presence of narrow QRS (P = 0.03) were significantly associated with a lower risk of cardiac pacing requirement. Complications related to epicardial pacemaker were documented in 2 (2.5%) patients. CONCLUSIONS After TVR, cardiac pacing was needed in 46% of patients for post-operative atrioventricular conduction disorders. This high incidence associated with an acceptable safety profile supports a prophylactic epicardial pacing strategy for the patients undergoing TVR.
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Affiliation(s)
- Baptiste Bazire
- Service de Cardiologie, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
- Université de Paris Cité, Paris, France
| | - Marylou Para
- Université de Paris Cité, Paris, France
- Service de Chirurgie Cardiaque, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| | - Richard Raffoul
- Service de Chirurgie Cardiaque, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| | - Patrick Nataf
- Université de Paris Cité, Paris, France
- Service de Chirurgie Cardiaque, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| | - Agnès Cachier
- Service de Cardiologie, Hôpital Beaujon, AP-HP, Clichy, France
| | - Fabrice Extramiana
- Service de Cardiologie, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
- Université de Paris Cité, Paris, France
| | - Bernard Iung
- Service de Cardiologie, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
- Université de Paris Cité, Paris, France
| | - Vincent Algalarrondo
- Service de Cardiologie, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
- Université de Paris Cité, Paris, France
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Wang X, Zhang X, Li J, Hu B, Zhang J, Zhang W, Weng W, Li Q. Analysis of prescription medication rules of traditional Chinese medicine for bradyarrhythmia treatment based on data mining. Medicine (Baltimore) 2022; 101:e31436. [PMID: 36343087 PMCID: PMC9646641 DOI: 10.1097/md.0000000000031436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Multiple studies have revealed that Traditional Chinese Medicine (TCM) prescriptions can provide protective effect on the cardiovascular system, increase the heart rate and relieve the symptoms of patients with bradyarrhythmia. In China, the TCM treatment of bradyarrhythmia is very common, which is also an effective complementary therapy. In order to further understand the application of Chinese medicines in bradyarrhythmia, we analyzed the medication rules of TCM prescriptions for bradyarrhythmia by data mining methods based on previous clinical studies. METHODS We searched studies reporting the clinical effect of TCM on bradyarrhythmia in the PubMed and Chinese databases China National Knowledge Infrastructure database, and estimated publication bias by risk of bias tools ROB 2. Descriptive analysis, hierarchical clustering analysis and association rule analysis based on Apriori algorithm were carried out by Microsoft Excel, SPSS Modeler, SPSS Statistics and Rstidio, respectively. Association rules, co-occurrence and clustering among Chinese medicines were found. RESULTS A total of 48 studies were included in our study. Among the total 99 kinds of Chinese medicines, 22 high-frequency herbs were included. Four new prescriptions were obtained by hierarchical cluster analysis. 81 association rules were found based on association rule analysis, and a core prescription was intuitively based on the grouping matrix of the top 15 association rules (based on confidence level), of which Guizhi, Zhigancao, Wuweizi, Chuanxiong, Danshen, Danggui, Huangqi, Maidong, Dangshen, Rougui were the most strongly correlated herbs and in the core position. CONCLUSION In this study, data mining strategy was applied to explore the TCM prescription for the treatment of bradyarrhythmia, and high-frequency herbs and core prescription were found. The core prescription was in line with the treatment ideas of TCM for bradyarrhythmia, which could intervene the disease from different aspects and adjust the patient's Qi, blood, Yin and Yang, so as to achieve the purpose of treatment.
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Affiliation(s)
- Xujie Wang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
| | - Xuexue Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiaxi Li
- Shanxi University of Chinese Medicine, Taiyuan, China
| | | | - Jiwei Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Wantong Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
| | - Weiliang Weng
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
| | - Qiuyan Li
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
- * Correspondence: Qiuyan Li, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China (e-mails: )
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Knops RE, Pepplinkhuizen S, Delnoy PPHM, Boersma LVA, Kuschyk J, El-Chami MF, Bonnemeier H, Behr ER, Brouwer TF, Kaab S, Mittal S, Quast AFBE, van der Stuijt W, Smeding L, de Veld JA, Tijssen JGP, Bijsterveld NR, Richter S, Brouwer MA, de Groot JR, Kooiman KM, Lambiase PD, Neuzil P, Vernooy K, Alings M, Betts TR, Bracke FALE, Burke MC, de Jong JSSG, Wright DJ, Jansen WPJ, Whinnett ZI, Nordbeck P, Knaut M, Philbert BT, van Opstal JM, Chicos AB, Allaart CP, Borger van der Burg AE, Dizon JM, Miller MA, Nemirovsky D, Surber R, Upadhyay GA, Weiss R, de Weger A, Wilde AAM, Olde Nordkamp LRA. Device-related complications in subcutaneous versus transvenous ICD: a secondary analysis of the PRAETORIAN trial. Eur Heart J 2022; 43:4872-4883. [PMID: 36030464 PMCID: PMC9748587 DOI: 10.1093/eurheartj/ehac496] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The subcutaneous implantable cardioverter-defibrillator (S-ICD) is developed to overcome lead-related complications and systemic infections, inherent to transvenous ICD (TV-ICD) therapy. The PRAETORIAN trial demonstrated that the S-ICD is non-inferior to the TV-ICD with regard to the combined primary endpoint of inappropriate shocks and complications. This prespecified secondary analysis evaluates all complications in the PRAETORIAN trial. METHODS AND RESULTS The PRAETORIAN trial is an international, multicentre, randomized trial in which 849 patients with an indication for ICD therapy were randomized to receive an S- ICD (N = 426) or TV-ICD (N = 423) and followed for a median of 49 months. Endpoints were device-related complications, lead-related complications, systemic infections, and the need for invasive interventions. Thirty-six device-related complications occurred in 31 patients in the S-ICD group of which bleedings were the most frequent. In the TV-ICD group, 49 complications occurred in 44 patients of which lead dysfunction was most frequent (HR: 0.69; P = 0.11). In both groups, half of all complications were within 30 days after implantation. Lead-related complications and systemic infections occurred significantly less in the S-ICD group compared with the TV-ICD group (P < 0.001, P = 0.03, respectively). Significantly more complications required invasive interventions in the TV-ICD group compared with the S-ICD group (8.3% vs. 4.3%, HR: 0.59; P = 0.047). CONCLUSION This secondary analysis shows that lead-related complications and systemic infections are more prevalent in the TV-ICD group compared with the S-ICD group. In addition, complications in the TV-ICD group were more severe as they required significantly more invasive interventions. This data contributes to shared decision-making in clinical practice.
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Affiliation(s)
| | | | | | - Lucas V A Boersma
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart failure & Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands,Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Juergen Kuschyk
- First Department of Medicine, University Medical Center Mannheim, Mannheim, Germany,German Center for Cardiovascular Research Partner Site Heidelberg, Mannheim, Germany
| | - Mikhael F El-Chami
- Division of Cardiology Section of Electrophysiology, Emory University, Atlanta, GA, United States
| | - Hendrik Bonnemeier
- Klinik für Innere Medizin III, Schwerpunkt Kardiologie und Angiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Elijah R Behr
- St George’s University of London, London, United Kingdom,St George’s University hospitals NHS Foundation Trust, London, United Kingdom
| | - Tom F Brouwer
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart failure & Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Stefan Kaab
- Department of Medicine I, Ludwig-Maximillians University Hospital, München, Germany,German Center for Cardiovascular Research, Munich Heart Alliance, Munich, Germany,European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart
| | - Suneet Mittal
- The Valley Health System, Ridgewood, NJ, United States
| | - Anne-Floor B E Quast
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart failure & Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Willeke van der Stuijt
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart failure & Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Lonneke Smeding
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart failure & Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Jolien A de Veld
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart failure & Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Jan G P Tijssen
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart failure & Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | | | - Sergio Richter
- Department of Electrophysiology, Heart Center at University of Leipzig, Leipzig, Germany,Heart Surgery, Heart Center Dresden, Carl Gustav Carus Medical Faculty, Dresden University of Technology, Dresden, Germany
| | - Marc A Brouwer
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joris R de Groot
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart failure & Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Kirsten M Kooiman
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart failure & Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Pier D Lambiase
- Office of the Director of Clinical Electrophysiology Research and Lead for Inherited Arrhythmia Specialist Services, University College London and Barts Heart Centre, London, United Kingdom
| | - Petr Neuzil
- Department of Cardiology, Homolka Hospital, Prague, Czech Republic
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Marco Alings
- Department of Cardiology, Amphia Hospital, Breda, the Netherlands,Werkgroep Cardiologische Centra Nederland, Utrecht, the Netherlands
| | - Timothy R Betts
- Oxford Biomedical Research Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Frank A L E Bracke
- Department of Electrophysiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | | | | | - David J Wright
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Ward P J Jansen
- Department of Cardiology, Tergooi MC, Blaricum, The Netherlands
| | - Zachary I Whinnett
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Peter Nordbeck
- University and University Hospital Würzburg, Würzburg, Germany
| | - Michael Knaut
- Heart Surgery, Heart Center Dresden, Carl Gustav Carus Medical Faculty, Dresden University of Technology, Dresden, Germany
| | - Berit T Philbert
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Alexandru B Chicos
- Division of Cardiology, Northwestern Memorial Hospital, Northwestern University, Chicago, IL, United States
| | - Cornelis P Allaart
- Department of Cardiology, and Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, Location VUMC, Amsterdam, The Netherlands
| | | | - Jose M Dizon
- Department of Medicine—Cardiology, Columbia University Irving Medical Center, New York, NY, United States
| | - Marc A Miller
- Icahn School of Medicine at Mount Sinai, Mount Sinaï Hospital, New York, NY, United States
| | - Dmitry Nemirovsky
- Cardiac Electrophysiology Division, Department of Medicine, Englewood Hospital and Medical Center, Englewood, NJ, United States
| | - Ralf Surber
- Department of Internal Medicine I, Jena University Hospital, Jena, Germany
| | - Gaurav A Upadhyay
- Center for Arrhythmia Care, Heart and Vascular Institute, University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - Raul Weiss
- Division of Cardiovascular Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Anouk de Weger
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart failure & Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
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Lo SW, Chen JY. Case report: A rare complication after the implantation of a cardiac implantable electronic device: Contralateral pneumothorax with pneumopericardium and pneumomediastinum. Front Cardiovasc Med 2022; 9:938735. [PMID: 36061532 PMCID: PMC9433779 DOI: 10.3389/fcvm.2022.938735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Cardiac implantable electronic devices (CIED) including pacemakers (PM), implantable cardioverter defibrillators (ICD), and cardiac resynchronized therapy (CRT) have become the mainstay of therapy for many cardiac conditions, consequently drawing attention to the risks and benefits of these procedures. Although CIED implantation is usually a safe procedure, pneumothorax remains an important complication and may contribute to increased morbidity, mortality, length of stay, and hospital costs. On the other hand, pneumopericardium and pneumomediastinum are rare but potentially fatal complications. Accordingly, a high degree of awareness about these complications is important. Pneumothorax almost always occurs on the ipsilateral side of implantation. The development of contralateral pneumothorax is uncommon and may be undetected on an initial chest radiograph. Contralateral pneumothorax with concurrent pneumopericardium and pneumomediastinum is much rarer. We describe a rare case of concurrent right-sided pneumothorax with pneumopericardium and pneumomediastinum after left-sided pacemaker implantation and highlight the risk factors, management, and possible ways to prevent the complications.
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Bannehr M, Reiners D, Lichtenauer M, Kopp K, Jirak P, Georgi C, Butter C, Edlinger C. Impact of socioeconomic aspects on cardiac implantable electronic device treatment and application of the EHRA guidelines : A European comparison. Wien Klin Wochenschr 2022; 134:646-653. [PMID: 35916927 DOI: 10.1007/s00508-022-02056-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/13/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cardiac implantable electronic devices (CIED) have become an indispensable part in everyday clinical practice in cardiology. The indications for CIED implantation are based on the guidelines of the European Heart Rhythm Association (EHRA). Nevertheless, numbers of CIED implantations in Europe are subject to considerable differences. We hypothesized that reimbursements linked to the respective health systems may influence implantation behavior. METHODS Based on the EHRA White Book 2017, CIED implantation data as well as socioeconomic key figures were collected, in particular gross domestic product (GDP) and share of gross domestic product spent on healthcare. Implantation numbers for pacemakers, implantable cardioverter defibrillators and cardiac resynchronization treatment as well as all in total were assessed, compared with the health care expenditures and visualized using heat maps. RESULTS Total implantation numbers per 100,000 inhabitants varied from 196.53 (Germany) to 2.81 (Kosovo). Higher implantation numbers correlated moderately with a higher GDP (r = 0.456, p 0.002) and higher health expenditure (r = 0.586, p < 0.001). The annual financial resources per inhabitant were also subject to fluctuations ranging from 9476 $ (Switzerland) to 140 $ (Ukraine); however, there were countries with high financial means, such as Switzerland or Scandinavian countries, which showed significantly lower implantation rates. CONCLUSION There were considerable differences in CIED implantations in Europe. These seem to be explained in part by socioeconomic disparities within Europe. Also, a potential influence by the respective remuneration system is likely.
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Affiliation(s)
- Marwin Bannehr
- Department of Cardiology, Heart Center Brandenburg, Ladeburger Str. 17, 16321, Bernau, Germany
- Brandenburg Medical School (MHB) "Theodor Fontane", Neuruppin, Germany
| | - David Reiners
- Department of Cardiology, Heart Center Brandenburg, Ladeburger Str. 17, 16321, Bernau, Germany
- Brandenburg Medical School (MHB) "Theodor Fontane", Neuruppin, Germany
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Kristen Kopp
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Peter Jirak
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Christian Georgi
- Department of Cardiology, Heart Center Brandenburg, Ladeburger Str. 17, 16321, Bernau, Germany
- Brandenburg Medical School (MHB) "Theodor Fontane", Neuruppin, Germany
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg, Ladeburger Str. 17, 16321, Bernau, Germany
- Brandenburg Medical School (MHB) "Theodor Fontane", Neuruppin, Germany
| | - Christoph Edlinger
- Department of Cardiology, Heart Center Brandenburg, Ladeburger Str. 17, 16321, Bernau, Germany.
- Brandenburg Medical School (MHB) "Theodor Fontane", Neuruppin, Germany.
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria.
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Frausing MHJP, Nielsen JC, Johansen JB, Jørgensen OD, Kristensen J, Olsen T, Gerdes C, Kronborg MB. Lead complications after cardiac surgery in patients with cardiac implantable electronic devices. Eur J Cardiothorac Surg 2022; 62:6593490. [PMID: 35639747 DOI: 10.1093/ejcts/ezac318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/20/2022] [Accepted: 05/20/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Manipulation of the heart during cardiac surgery in patients with cardiac implantable electronic devices may result in lead damage or -displacement, but whether cardiac surgery truly infers an excess risk of lead failure is not known. The objective of this study was to examine risk of lead complications after cardiac surgery in patients with cardiac implantable electronic devices. METHODS AND RESULTS We conducted a nationwide nested case-control study. The source population comprised all Danish patients ≥18 of age who underwent a de novo cardiac implantable electronic device implantation during 1998-2017. For inclusion, patients had to be alive and event-free 6 months after implantation. Cases were matched 1:30 to controls on time, age, sex and device type using risk set sampling. We used conditional logistic regression to estimate incidence rate ratios (IRRs) for the association between cardiac surgery and lead-related reoperation. RESULTS Our final population consisted of 67,621 patients. We identified 1437 (2.1%) incident cases of lead-related reoperations and 42,698 controls. Risk of lead complications was highest within six months of cardiac surgery (IRR 9.7, 95% CI 6.3-14.8, adjusted IRR 9.6, 95% CI 6.2-14.7), and at one year, the relative risk of lead-related reoperation was close to unity (adjusted IRR 1.2, 95% CI 0.8-1.7). CONCLUSION Cardiac surgery was associated with a considerable risk of lead complications in patients with de novo cardiac implantable electronic devices.
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Affiliation(s)
- Maria Hee Jung Park Frausing
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Bvld. 99, 8200, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Palle-Juul Jensens Bvld. 82, 8200, Aarhus N, Denmark
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Bvld. 99, 8200, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Palle-Juul Jensens Bvld. 82, 8200, Aarhus N, Denmark
| | - Jens Brock Johansen
- Department of Cardiology, Odense University Hospital, JB Winsløws Vej 4, 5000, Odense, Denmark.,The Danish Pacemaker and ICD Register, JB Winsløws Vej 4, 5000, Odense, Denmark
| | - Ole Dan Jørgensen
- The Danish Pacemaker and ICD Register, JB Winsløws Vej 4, 5000, Odense, Denmark.,Department of Cardiac-, Vascular- and Thoracic Surgery, Odense University Hospital, JB Winsløws Vej 4, 5000, Odense, Denmark
| | - Jens Kristensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Bvld. 99, 8200, Aarhus N, Denmark
| | - Thomas Olsen
- Department of Cardiology, Odense University Hospital, JB Winsløws Vej 4, 5000, Odense, Denmark
| | - Christian Gerdes
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Bvld. 99, 8200, Aarhus N, Denmark
| | - Mads Brix Kronborg
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Bvld. 99, 8200, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Palle-Juul Jensens Bvld. 82, 8200, Aarhus N, Denmark
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2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Translation of the document prepared by the Czech Society of Cardiology. COR ET VASA 2022. [DOI: 10.33678/cor.2022.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJ, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. Grupo de trabajo sobre estimulación cardiaca y terapia de resincronización cardiaca de la Sociedad Europea de Cardiología (ESC). Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM, Leyva F, Linde C, Abdelhamid M, Aboyans V, Arbelo E, Asteggiano R, Barón-Esquivias G, Bauersachs J, Biffi M, Birgersdotter-Green U, Bongiorni MG, Borger MA, Čelutkienė J, Cikes M, Daubert JC, Drossart I, Ellenbogen K, Elliott PM, Fabritz L, Falk V, Fauchier L, Fernández-Avilés F, Foldager D, Gadler F, De Vinuesa PGG, Gorenek B, Guerra JM, Hermann Haugaa K, Hendriks J, Kahan T, Katus HA, Konradi A, Koskinas KC, Law H, Lewis BS, Linker NJ, Løchen ML, Lumens J, Mascherbauer J, Mullens W, Nagy KV, Prescott E, Raatikainen P, Rakisheva A, Reichlin T, Ricci RP, Shlyakhto E, Sitges M, Sousa-Uva M, Sutton R, Suwalski P, Svendsen JH, Touyz RM, Van Gelder IC, Vernooy K, Waltenberger J, Whinnett Z, Witte KK. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Europace 2022; 24:71-164. [PMID: 34455427 DOI: 10.1093/europace/euab232] [Citation(s) in RCA: 111] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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12
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Yee R, Karim SS, Bashir J, Bennett MT, Exner DV, Guerra PG, Healey JS, Korkola S, Manlucu J, Parkash R, Philippon F, Rinne C. Canadian Heart Rhythm Society Task Force Report on Physician Training and Maintenance of Competency for Cardiovascular Implantable Electronic Device Therapies: Executive Summary. Can J Cardiol 2021; 37:1857-1860. [PMID: 34571165 DOI: 10.1016/j.cjca.2021.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022] Open
Abstract
Physicians engaged in cardiovascular implantable electronic device (CIED)-related practice come from diverse training backgrounds with variable degrees of CIED implant training. The objective of the Canadian Heart Rhythm Society Task Force on CIED Implant Training was to establish a common structure and content for training programs in CIED implantation, related activities and maintenance of competency. This executive summary presents the essence of the report with key recommendations included, with the complete version made available in a linked supplement. The goals are to ensure that future generations of CIED implanters are better prepared for continuously evolving CIED practice and quality care for all Canadians.
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Affiliation(s)
- Raymond Yee
- Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada.
| | - Shahzad S Karim
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jamil Bashir
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew T Bennett
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Derek V Exner
- Division of Cardiac Sciences, Cardiology Section, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Peter G Guerra
- Division de Cardiologie, Departement de Medicine, Universite de Montreal, Montreal, Quebec, Canada
| | - Jeff S Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Stephen Korkola
- Division of Cardiac Surgery, Department of Surgery, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Jaimie Manlucu
- Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| | - Ratika Parkash
- Division of Cardiology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Francois Philippon
- Division de Cardiologie, Departement de Medicine, Universite Laval, Ville de Quebec, Quebec, Canada
| | - Claus Rinne
- St. Mary's Regional Cardiac Care Centre, Kitchener, Ontario, Canada
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13
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J 2021; 42:3427-3520. [PMID: 34455430 DOI: 10.1093/eurheartj/ehab364] [Citation(s) in RCA: 783] [Impact Index Per Article: 261.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Single-Pass VDD Pacing Lead for Cardiac Resynchronization Therapy: A Reliable Alternative. MICROMACHINES 2021; 12:mi12080978. [PMID: 34442600 PMCID: PMC8401433 DOI: 10.3390/mi12080978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 11/17/2022]
Abstract
(1) Background: Cardiac resynchronization therapy (CRT) systems can be simplified by excluding the atrial lead and using a Ventricular-Dual-Dual (VDD) pacing lead. Possible disadvantages might include atrial undersensing and Ventricular-Ventricular-Inhibition (VVI) pacing. Because literature data concerning these systems are scarce, we analyzed their benefits and technical safety. (2) Methods: this retrospective study compared 50 patients implanted with VDD–CRT systems (group A), mainly because of unfavorable venous anatomy concerning the complication rate, with 103 subjects with Dual-Dual-Dual (DDD)–CRT systems (group B) implanted during 2000–2016 and 49 (group C) during 2016–2020. To analyze the functional parameters of the devices, we selected subgroups of 27 patients (subgroup A) and 47 (subgroup B) patients with VDD–CRT in 2000–2016, and 36 subjects (subgroup C) with DDD–CRT implanted were selected in 2017–2020. (3) Results: There was a trend of a lower complication rate with VDD–CRT systems, especially concerning infections during 2000–2016 (p = 0.0048), but similar results were obtained after rigorous selection of patients and employment of an upgraded design of devices/leads. With a proper device programing, CRT pacing had similar results, atrial undersensing being minimal (p = 0.65). For VDD-systems, VVI pacing was recorded only 1.7 ± 2.24% of the time. (4) Conclusions: In patients with a less favorable venous anatomy, VDD–CRT systems may represent a safe alternative regarding complications rates and functional parameters.
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Frausing MHJP, Kronborg MB, Johansen JB, Nielsen JC. Avoiding implant complications in cardiac implantable electronic devices: what works? Europace 2021; 23:163-173. [PMID: 33063088 DOI: 10.1093/europace/euaa221] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/08/2020] [Indexed: 01/14/2023] Open
Abstract
Nearly one in ten patients experience complications in relation to cardiac implantable electronic device (CIED) implantations. CIED complications have serious implications for the patients and for the healthcare system. In light of the rising rates of new implants and consistent rate of complications, primary prevention remains a major concern. To guide future efforts, we sought to review the evidence base underlying common preventive actions made during a primary CIED implantation.
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Affiliation(s)
| | - Mads Brix Kronborg
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Bvld. 99, DK-8200, Aarhus, Denmark
| | - Jens Brock Johansen
- Department of Cardiology, Odense University Hospital, J. B. Winsløvs Vej 4, DK-5000, Odense, Denmark
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Bvld. 99, DK-8200, Aarhus, Denmark
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16
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Ostrowska B, Gkiouzepas S, Kurland S, Blomström-Lundqvist C. Device infections related to cardiac resynchronization therapy in clinical practice-An analysis of its prevalence, risk factors and routine surveillance at a single center university hospital. Clin Cardiol 2021; 44:739-747. [PMID: 34032293 PMCID: PMC8207984 DOI: 10.1002/clc.23620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/13/2021] [Accepted: 04/27/2021] [Indexed: 01/22/2023] Open
Abstract
Background The implantation rates of cardiac implantable electronic devices have steadily increased, accompanied by a steeper rise of device related infections (DRI). Hypothesis The prevalence of DRI for cardiac resynchronization therapy (CRT) is higher in clinical practice than reported previously, even at a university hospital, and likely higher than reported to the national device registry. Methods Electronic medical records of consecutive patients undergoing a CRT procedure between January 2016 and December 2017 were analyzed. Clinical history, procedure related variables and complications were reviewed by specialists in cardiology and infectious diseases. Results A total of 171 patients, mean aged 74 years, 138 males (80.7%) were included. Twelve DRI occurred in 10 patients during mean 2.5 years follow‐up, giving a prevalence of 7% (incidence of 29/1000 person‐years). Reoperation, pocket haematoma, ≥3 procedures, previous device infection and indwelling central venous line were the strongest predictive factors according to univariate analysis. Out of 63/171 (36.8%) major complications, 31(49.2%) were lead‐related. There were 49/171 (28.7%) reoperations and 15/171 (8.8%) minor complications. The number major complications and DRI reported to the national device registry were 7/171 (4.1%) and 2/171 (0.6%), respectively, reflecting a 5‐fold underreporting. Conclusions The high rate of CRT device infections is in sharp contrast to those reported by others and to the national device registry. Although a center specific explanation cannot be excluded, the high rates highlight a major issue with registries, reinforcing the need for better surveillance and automatic reporting of device related complications.
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Affiliation(s)
- Bozena Ostrowska
- Department of Cardiology, Uppsala University, Uppsala, Sweden.,Department of Medical Sciences and Cardiology, Uppsala University, Uppsala, Sweden
| | - Spyridon Gkiouzepas
- Department of Medical Sciences and Cardiology, Uppsala University, Uppsala, Sweden.,Department of Internal Medicine, Uppsala University, Uppsala, Sweden
| | - Siri Kurland
- Department of Infectious Diseases, Uppsala University, Uppsala, Sweden
| | - Carina Blomström-Lundqvist
- Department of Cardiology, Uppsala University, Uppsala, Sweden.,Department of Medical Sciences and Cardiology, Uppsala University, Uppsala, Sweden
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Bjerre J, Rosenkranz SH, Schou M, Jøns C, Philbert BT, Larroudé C, Nielsen JC, Johansen JB, Riahi S, Melchior TM, Torp-Pedersen C, Hlatky M, Gislason G, Ruwald AC. Driving following defibrillator implantation: a nationwide register-linked survey study. Eur Heart J 2021; 42:3529-3537. [PMID: 33954626 DOI: 10.1093/eurheartj/ehab253] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/04/2021] [Accepted: 04/13/2021] [Indexed: 01/09/2023] Open
Abstract
AIMS Patients are restricted from driving following implantable cardioverter defibrillator (ICD) implantation or shock. We sought to investigate how many patients are aware of, and adhere to, the driving restrictions, and what proportion experience an ICD shock or other cardiac symptoms while driving. METHODS AND RESULTS We performed a nationwide survey of all living Danish residents 18 years or older who received a first-time ICD between 2013 and 2016 (n = 3913) and linked their responses with nationwide registers. Of 2741 respondents (47% primary prevention, 83% male, median age 67 years), 2513 (92%) held a valid driver's license at ICD implantation, 175 (7%) of whom had a license for professional driving. Many drivers were unaware of driving restrictions: primary prevention 58%; secondary prevention 36%; post-appropriate shock 28%; professional drivers 55%. Almost all (94%) resumed non-professional driving after ICD implantation, more than one-third during the restricted period; 35% resumed professional driving. During a median follow-up of 2.3 years, 5 (0.2%) reported receiving an ICD shock while driving, one of which resulted in a traffic accident. The estimated risk of harm was 0.0002% per person-year. CONCLUSION In this nationwide study, many ICD patients were unaware of driving restrictions, and more than one third resumed driving during a driving restriction period. However, the rate of reported ICD shocks while driving was very low.
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Affiliation(s)
- Jenny Bjerre
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 6, 3rd Floor, Hellerup 2900, Denmark.,Department of Cardiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Simone Hofman Rosenkranz
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 6, 3rd Floor, Hellerup 2900, Denmark
| | - Morten Schou
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 6, 3rd Floor, Hellerup 2900, Denmark
| | - Christian Jøns
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Berit Thornvig Philbert
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Charlotte Larroudé
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 6, 3rd Floor, Hellerup 2900, Denmark
| | - Jens Cosedis Nielsen
- Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Blvd. 82, 8200 Aarhus, Denmark
| | - Jens Brock Johansen
- Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9200 Aalborg, Denmark
| | - Thomas Maria Melchior
- Department of Cardiology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology and Clinical Research, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Mark Hlatky
- Department of Medicine, Stanford University School of Medicine, 615 Crothers Way Encina Commons, Stanford, CA 94305, USA
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 6, 3rd Floor, Hellerup 2900, Denmark.,Department of Cardiovascular Epidemiology and Research, The Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark
| | - Anne-Christine Ruwald
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 6, 3rd Floor, Hellerup 2900, Denmark.,Department of Cardiology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark
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18
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Cardiac Contractility Modulation in Patients with Heart Failure with Reduced Left Ventricular Ejection Fraction. HEARTS 2021. [DOI: 10.3390/hearts2010013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Cardiac contractility modulation is an innovative therapy conceived for the treatment of heart failure. It is a device-based therapy, employing multiple electrodes to deliver relatively high-voltage (~7.5 V) biphasic signals to the endocardium of the right ventricular septum, in order to improve heart failure symptoms, exercise capacity and quality of life. Multiple clinical and mechanistic studies have been conducted to investigate the potential usefulness of this technology and, as of now, they suggest that it could have a place in therapy and meet a relevant medical need for a specific sub-category of underserved heart failure patients with reduced left ventricular ejection fraction. More studies are needed to further investigate its effect on outcomes such as mortality and rate of hospitalizations.
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19
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Semmler G, Barbieri F, Thudt K, Vock P, Mörtl D, Mayr H, Wollmann CG, Adukauskaite A, Pfeifer B, Senoner T, Dichtl W. Long-Term Technical Performance of the Osypka QT-5 ® Ventricular Pacemaker Lead. J Clin Med 2021; 10:jcm10040639. [PMID: 33567486 PMCID: PMC7915016 DOI: 10.3390/jcm10040639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 01/25/2021] [Accepted: 02/04/2021] [Indexed: 12/01/2022] Open
Abstract
Background: Lead-associated complications and technical issues in patients with cardiac implantable electronic devices are common but underreported in the literature. Methods: All patients undergoing implantation of the Osypka QT-5® ventricular lead at the University Clinic St. Pölten between 1 January 2006 and 31 December 2012 were retrospectively analyzed (n = 211). Clinical data including pacemaker follow-up examinations and the need for lead revisions were assessed. Kaplan–Meier analysis to estimate the rate of lead dysfunction during long-term follow-up was conducted. Results: Patients were followed for a median of 5.2 years (interquartile range (IQR) 2.0–8.7). R-wave sensing properties at implantation, compared to last follow-up, remained basically unchanged: 9.9 mV (IQR 6.8–13.4) and 9.6 mV (IQR 5.6–12.0), respectively). Ventricular pacing threshold significantly increased between implantation (0.5 V at 0.4 ms; IQR 0.5–0.8) and the first follow-up visit (1.0 V at 0.4 ms; IQR 0.8–1.3; p < 0.001) and this increase persisted throughout to the last check-up (0.9 V at 0.4 ms; IQR 0.8–1.2). Impedance significantly declined from 1142 Ω (IQR 955–1285) at implantation to 814 Ω (IQR 701–949; p < 0.001) at the first check-up, followed by a further decrease to 450 Ω (IQR 289–652; p < 0.001) at the last check-up. Overall, the Osypka QT-5® ventricular lead was replaced in 36 patients (17.1%). Conclusions: This report shows an unexpected high rate of technical issues of the Osypka QT-5® ventricular lead during long-term follow-up.
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Affiliation(s)
- Georg Semmler
- Department of Internal Medicine III, University Clinic St. Pölten & Karl Landsteiner Private University, 3100 St. Pölten, Austria; (G.S.); (K.T.); (P.V.); (D.M.); (H.M.); (C.G.W.)
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University Vienna, 1090 Vienna, Austria
| | - Fabian Barbieri
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (F.B.); (A.A.); (T.S.)
| | - Karin Thudt
- Department of Internal Medicine III, University Clinic St. Pölten & Karl Landsteiner Private University, 3100 St. Pölten, Austria; (G.S.); (K.T.); (P.V.); (D.M.); (H.M.); (C.G.W.)
| | - Paul Vock
- Department of Internal Medicine III, University Clinic St. Pölten & Karl Landsteiner Private University, 3100 St. Pölten, Austria; (G.S.); (K.T.); (P.V.); (D.M.); (H.M.); (C.G.W.)
| | - Deddo Mörtl
- Department of Internal Medicine III, University Clinic St. Pölten & Karl Landsteiner Private University, 3100 St. Pölten, Austria; (G.S.); (K.T.); (P.V.); (D.M.); (H.M.); (C.G.W.)
| | - Harald Mayr
- Department of Internal Medicine III, University Clinic St. Pölten & Karl Landsteiner Private University, 3100 St. Pölten, Austria; (G.S.); (K.T.); (P.V.); (D.M.); (H.M.); (C.G.W.)
| | - Christian Georg Wollmann
- Department of Internal Medicine III, University Clinic St. Pölten & Karl Landsteiner Private University, 3100 St. Pölten, Austria; (G.S.); (K.T.); (P.V.); (D.M.); (H.M.); (C.G.W.)
| | - Agne Adukauskaite
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (F.B.); (A.A.); (T.S.)
| | - Bernhard Pfeifer
- Institute of Medical Informatics, UMIT TIROL, Eduard Wallnöfer Zentrum, 6600 Hall in Tirol, Austria;
- Landesinstitut für Integrierte Versorgung, LIV, Tirol Kliniken GmbH, 6020 Innsbruck, Austria
| | - Thomas Senoner
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (F.B.); (A.A.); (T.S.)
| | - Wolfgang Dichtl
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (F.B.); (A.A.); (T.S.)
- Correspondence: ; Tel.: +43-512-5048-1388
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Assessing safety of leadless pacemaker (MICRA) at various implantation sites and its impact on paced QRS in Indian population. Indian Heart J 2020; 72:376-382. [PMID: 33189197 PMCID: PMC7670279 DOI: 10.1016/j.ihj.2020.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/02/2020] [Accepted: 08/03/2020] [Indexed: 11/29/2022] Open
Abstract
Background In this study we report our experience in implanting MICRA TPS (transcatheter pacing system) at various RV sites; observing its safety, and impact on paced QRS in Indian population. Material & methods 35 patients with MICRA TPS deployed from March 2017 to December 2019 at Army Hospital Research and Referral, New Delhi, at RVOT, apical septum and mid septum of RV were enrolled in the study. These patents were followed up and impact of implantation site, procedure related complications, change in pacing parameters, left ventricular ejection fraction and duration of paced QRS were monitored. Results Sick sinus syndrome was the commonest indication of pacing in this study (51.5%), followed by high degree AV block (34.2%). Mean follow up of 1.4 years showed no change in left ventricular ejection fraction, electrical parameters or change in pacing thresholds after implantation. Mean pQRS was broadest (166.60 ms) in apically implanted MICRA TPS and narrowest in mid septum group 139.33 ms. Among 35 cases, in our study one patient developed pericardial effusion, and other had intermittent diaphragmatic pacing. Conclusion Among these three implantation sites mid septum deployment is associated with narrowest paced QRS in Indian population.
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Heckman L, Vijayaraman P, Luermans J, Stipdonk AMW, Salden F, Maass AH, Prinzen FW, Vernooy K. Novel bradycardia pacing strategies. Heart 2020; 106:1883-1889. [DOI: 10.1136/heartjnl-2020-316849] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/08/2020] [Accepted: 08/30/2020] [Indexed: 11/04/2022] Open
Abstract
The adverse effects of ventricular dyssynchrony induced by right ventricular (RV) pacing has led to alternative pacing strategies, such as biventricular, His bundle (HBP), LV septal (LVSP) and left bundle branch pacing (LBBP). Given the overlap, LVSP and LBBP are also collectively referred to as left bundle branch area pacing (LBBAP). Although among these alternative pacing sites HBP is theoretically the ideal strategy as it maintains a physiological ventricular activation, its application requires more skills and is associated with the most complications. LBBAP, where the ventricular pacing lead is advanced through the interventricular septum to its left side, creates ventricular activation that is only slightly more dyssynchronous. Preliminary studies have shown that LBBAP is feasible, safe and encounters less limitations than HBP. Further studies are needed to differentiate between LVSP and LBBP with regard to acute functional and long-term clinical outcome.
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Cardiac contractility modulation for the treatment of heart failure with reduced ejection fraction. Heart Fail Rev 2020; 26:217-226. [PMID: 32852661 DOI: 10.1007/s10741-020-10017-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2020] [Indexed: 12/11/2022]
Abstract
There has been a progressive evolution in the management of patients with chronic heart failure and reduced ejection fraction (HFrEF), including cardiac resynchronisation therapy (CRT) in those that fulfil pre-defined criteria. However, there exists a significant proportion with refractory symptoms in whom CRT devices are not clinically indicated or ineffective. Cardiac contractility modulation (CCM) is a novel therapy that incorporates administration of non-excitatory electrical impulses to the interventricular septum during the absolute refractory period. Implantation is analogous to a traditional transvenous pacemaker system, but with the use of two right ventricular leads. Mechanistic studies have shown augmentation of left ventricular contractility and beneficial global effects on reverse remodeling, primarily through alterations in calcium handling. This appears to occur without increasing myocardial oxygen consumption. Data from clinical trials have shown translational improvements in functional capacity and quality of life, though long-term outcome data are lacking. This review explores the rationale, evidence base and limitations of this nascent technology.
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Maldari M, Albatat M, Bergsland J, Haddab Y, Jabbour C, Desgreys P. Wide Frequency Characterization of Intra-Body Communication for Leadless Pacemakers. IEEE Trans Biomed Eng 2020; 67:3223-3233. [PMID: 32167883 DOI: 10.1109/tbme.2020.2980205] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Leadless Cardiac Pacemakers (LCP) have the potential to revolutionize Cardiac Rhythm Management (CRM). Current LCPs can only pace a single location of the heart limiting their use to patients requiring single-chamber stimulation. A Multi-node system of synchronized LCPs could be used in a significantly larger patient population. Synchronization using standard communication techniques involves high power consumption decreasing the longevity of the device. In this work, we investigate Galvanic Intra Body Communication (IBC) as a method to synchronize multi-node LCP systems. First, an accurate computational torso model was used for quasi-static simulations to estimate channel pathloss in the frequency range [40 kHz-20 MHz]. The model was then verified with in-vivo measurements using a novel experimental setup, where two LCP devices were placed in the right atrium, right ventricle and left ventricle. All channels involved in a potential multi-node LCP system were characterized. The orientation of the transducers relative to each other had a great impact on the results, with the attenuation level ranging between 55 dB and 70 dB between the best and worst orientations. The best results were achieved in the MHz range. Coupled with the fact that it does not require additional electrodes, this study suggests Galvanic IBC be superior to conventional communication methods for LCP devices. This analysis defines a methodology for galvanic IBC channel characterization for LCP systems, which is an important step for the design of efficient transceivers for IBC applications. More experiments with larger datasets are needed to bring this method to practice.
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Technological and Clinical Challenges in Lead Placement for Cardiac Rhythm Management Devices. Ann Biomed Eng 2019; 48:26-46. [DOI: 10.1007/s10439-019-02376-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/25/2019] [Indexed: 01/29/2023]
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Farkowski MM, Maciag A, Ciszewski J, Kowalik I, Syska P, Sterlinski M, Szwed H, Pytkowski M. The long term risk of lead failure in patients with cardiovascular implantable electronic devices undergoing catheter ablation. SCAND CARDIOVASC J 2019; 53:323-328. [DOI: 10.1080/14017431.2019.1653489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Michal M. Farkowski
- Heart Arrhythmia Ward, II Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
| | - Aleksander Maciag
- Heart Arrhythmia Ward, II Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
| | - Jan Ciszewski
- Heart Arrhythmia Ward, II Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
| | - Ilona Kowalik
- Heart Arrhythmia Ward, II Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
| | - Pawel Syska
- Heart Arrhythmia Ward, II Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
| | - Maciej Sterlinski
- Department of Heart Arrhythmia, Institute of Cardiology, Warsaw, Poland
| | - Hanna Szwed
- Heart Arrhythmia Ward, II Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
| | - Mariusz Pytkowski
- Heart Arrhythmia Ward, II Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
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Hai JJ, Fang J, Tam CC, Wong CK, Un KC, Siu CW, Lau CP, Tse HF. Safety and feasibility of a midseptal implantation technique of a leadless pacemaker. Heart Rhythm 2019; 16:896-902. [DOI: 10.1016/j.hrthm.2018.12.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Indexed: 10/27/2022]
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Ludwig S, Theis C, Wolff C, Nicolle E, Witthohn A, Götte A. Complications and associated healthcare costs of transvenous cardiac pacemakers in Germany. J Comp Eff Res 2019; 8:589-597. [PMID: 31099255 DOI: 10.2217/cer-2018-0114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This study evaluated the occurrence and associated costs of pacemaker complications in Germany from 2010 to 2013. Patients & methods: Patients with a de novo or replacement implantation of a single or dual chamber pacemaker between 2010 and 2013 were followed for 12 months post-implant using German health insurance claims data. A case-control analysis was performed using propensity score matching to estimate the costs of complications. Results: Out of 12,922 implanted patients, 12.0% had a complication in the year following the implant. Complications related to lead and pocket were found in 10.2% of all implanted patients; infections occurred in 1.7% patients. Healthcare costs up to 36 months post complication were on average €4627 higher than for pacemaker patients without a complication. Conclusion: Pacemaker complications are common and represent a burden for patients and healthcare systems generating substantial costs. Most of the pacemaker complications involved the pacing lead or pacemaker pocket.
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Affiliation(s)
- Saskia Ludwig
- HGC GesundheitsConsult GmbH, Mörsenbroicher Weg 200, 40470 Duesseldorf, Germany
| | - Cathrin Theis
- Robert-Bosch-Krankenhaus, Zentrum für Innere Medizin III Kardiologie, Auerbachstraße 110, 70376 Stuttgart, Germany
| | - Claudia Wolff
- Medtronic International Trading Sàrl, Route du Molliau 31, 1131 Tolochenaz, Switzerland
| | - Emmanuelle Nicolle
- Medtronic International Trading Sàrl, Route du Molliau 31, 1131 Tolochenaz, Switzerland
| | | | - Andreas Götte
- St. Vincenz Hospital Paderborn, Dept of Cardiology & Intensive Care Medicine, Am Busdorf 2, 33098 Paderborn, Germany
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Bonhorst D, Guerreiro S, Fonseca C, Cardim N, Macedo F, Adragão P. Real-life data on heart failure before and after implantation of resynchronization and/or defibrillation devices – The Síncrone study. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2018.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Lazarus A, Guy-Moyat B, Mondoly P, Pons F, Quaglia C, Elkaim JP, Bayle S, Victor F. Active periodic electrograms in remote monitoring of pacemaker recipients: the PREMS study. Europace 2019; 21:130-136. [PMID: 29955890 PMCID: PMC6321961 DOI: 10.1093/europace/euy140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 05/29/2018] [Indexed: 11/12/2022] Open
Abstract
AIMS Remote monitoring (RM) is considered as a standard of care for pacemaker recipients. Remote monitoring systems provide calendar-based intracardiac electrogram recordings (IEGM) only with the current pacemaker settings (passive IEGM). PREMS (Pacemaker Remote Electrogram Monitoring Study), an observational, multicentre trial, prospectively evaluated the clinical value of an active IEGM (aIEGM), including three 10-s sections (passive IEGM, encouraged sensing, and encouraged pacing), compared to other RM data and to its passive IEGM section. Secondary objectives included the added value of the aIEGM to fully assess the sensing and pacing functions of each lead. METHODS AND RESULTS Patients were enrolled within 3 months after pacemaker implantation and followed until the first transmitted aIEGM, which was analysed together with all other RM data. In total, 567 patients were enrolled (79 ± 9 years, 62% men, 19% single-chamber, and 81% dual-chamber pacemakers). Of 547 aIEGMs transmitted in 547 patients, 161 [29.4%; 95% confidence interval (95% CI) 25.6-33.3%] indicated at least one anomaly non-detectable with certainty-or at all-on other RM data, including atrial arrhythmia, extrasystoles, undersensing, oversensing, and loss of capture. In 21.7% of cases the detected events deserved a corrective action. The sensing and pacing function of each lead could be fully assessed in 77.3% of aIEGM (95% CI 72.6-82.0%) vs. 15.5% (95% CI 11.4-19.6%) when considering only the passive IEGM section (P < 0.001). CONCLUSION An active IEGM improves the clinical value of remote pacemaker follow-up. Furthermore, compared to a passive IEGM, the aIEGM increases the capability to fully assess remotely the sensing and pacing functions.
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Affiliation(s)
- Arnaud Lazarus
- Rhythmology Unit, Clinique Ambroise Paré, 25-27 boulevard Victor Hugo, Neuilly-Sur-Seine, France
| | - Benoit Guy-Moyat
- Cardiology Unit, Centre Hospitalier Universitaire de Limoges, 2 avenue Martin Luther King, Limoges, France
| | - Pierre Mondoly
- Cardiology Unit, Centre Hospitalier Rangueil, 1 avenue du Pr Jean Poulhès, Toulouse, France
| | - Frédéric Pons
- Cardiology Unit, Hôpital d’Instruction des Armées Saint-Anne, 2 boulevard Sainte-Anne, Toulon, France
| | - Carlo Quaglia
- Cardiology Unit, Centre Hospitalier de Roanne, 28 rue de Charlieu, Roanne, France
| | - Jean-Philippe Elkaim
- Cardiology Unit, Centre Hospitalier de Douarnenez, 85 rue Laennec, Douarnenez, France
| | - Sandrine Bayle
- Cardiology Unit, Centre Hospitalier Louis Pasteur, 4 rue Claude Bernard, Le Coudray, France
| | - Frédéric Victor
- Cardiology Unit, Polyclinique Saint-Laurent, 320 avenue Général George S. Patton, Rennes, France
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Bonhorst D, Guerreiro S, Fonseca C, Cardim N, Macedo F, Adragão P. Implantação de dispositivos de ressincronização e/ou desfibrilhação em doentes com insuficiência cardíaca: dados da vida real ‐ o Estudo Síncrone. Rev Port Cardiol 2019; 38:33-41. [DOI: 10.1016/j.repc.2018.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 03/12/2018] [Accepted: 04/08/2018] [Indexed: 10/27/2022] Open
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Reddy S, Coletta J, Mizuguchi KA. Anesthetic Management of a Patient With a Leadless Pacemaker Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth 2019; 33:176-180. [DOI: 10.1053/j.jvca.2018.05.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Indexed: 11/11/2022]
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Christensen AM, Bjerre J, Schou M, Jons C, Vinther M, Gislason GH, Johansen JB, Nielsen JC, Petersen HH, Riahi S, Ruwald AC. Clinical outcome in patients with implantable cardioverter-defibrillator and cancer: a nationwide study. Europace 2018; 21:465-474. [DOI: 10.1093/europace/euy268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/20/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anne M Christensen
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegårdsvej 28, Copenhagen, Hellerup, Denmark
| | - Jenny Bjerre
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegårdsvej 28, Copenhagen, Hellerup, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegårdsvej 28, Copenhagen, Hellerup, Denmark
| | - Christian Jons
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Michael Vinther
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegårdsvej 28, Copenhagen, Hellerup, Denmark
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegårdsvej 28, Copenhagen, Hellerup, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
- National Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, University of Southern Denmark, Odense, Denmark
| | - Jens B Johansen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jens C Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Anne-Christine Ruwald
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegårdsvej 28, Copenhagen, Hellerup, Denmark
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
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Lyu H, John M, Burkland D, Greet B, Xi Y, Sampaio LC, Taylor DA, Babakhani A, Razavi M. Leadless multisite pacing: A feasibility study using wireless power transfer based on Langendorff rodent heart models. J Cardiovasc Electrophysiol 2018; 29:1588-1593. [PMID: 30203520 DOI: 10.1111/jce.13738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 06/19/2018] [Accepted: 07/16/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Fifteen to thirty percent of patients with impaired cardiac function have ventricular dyssynchrony and warrant cardiac resynchronization therapy (CRT). While leadless pacemakers eliminate lead-related complications, their current form factor is limited to single-chamber pacing. In this study, we demonstrate the feasibility of multisite, simultaneous pacing using miniaturized pacing nodes powered through wireless power transfer (WPT). METHODS A wireless energy transfer system was developed based on resonant coupling at approximately 200 MHz to power multiple pacing nodes. The pacing node comprises circuitry to efficiently convert the harvested energy to output stimuli. To validate the use of these pacing nodes, ex vivo studies were carried out on Langendorff rodent heart models (n = 4). To mimic biventricular pacing, two beating Langendorff rodent heart models, kept 10 cm apart, were paced using two distinct pacing nodes, each attached on the ventricular epicardial surface of a given heart. RESULTS All ex vivo Langendorff heart models were successfully paced with a simple coil antenna at 2 to 3 cm from the pacing node. The coil was operated at 198 MHz and 0.3 W. Subsequently, simultaneous pacing of two Langendorff heart models 30 cm apart using an output power of 5 W was reliably demonstrated. CONCLUSION WPT provides a feasible option for multisite, wireless cardiac pacing. While the current system remains limited in design, it offers support and a conceptual framework for future iterations and eventual clinical utility.
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Affiliation(s)
- Hongming Lyu
- Department of Electrical and Computer Engineering, University of California Los Angeles, Los Angeles, California
| | - Mathews John
- Electrophysiology Clinical Research and Innovation, Texas Heart Institute, Houston, Texas
| | - David Burkland
- Electrophysiology Clinical Research and Innovation, Texas Heart Institute, Houston, Texas.,Department of Internal Medicine, Section of Cardiology, School of Medicine, Baylor College of Medicine, Houston, Texas
| | - Brian Greet
- Electrophysiology Clinical Research and Innovation, Texas Heart Institute, Houston, Texas.,Department of Internal Medicine, Section of Cardiology, School of Medicine, Baylor College of Medicine, Houston, Texas
| | - Yutao Xi
- Electrophysiology Clinical Research and Innovation, Texas Heart Institute, Houston, Texas
| | - Luiz C Sampaio
- Electrophysiology Clinical Research and Innovation, Texas Heart Institute, Houston, Texas
| | - Doris A Taylor
- Electrophysiology Clinical Research and Innovation, Texas Heart Institute, Houston, Texas
| | - Aydin Babakhani
- Department of Electrical and Computer Engineering, University of California Los Angeles, Los Angeles, California
| | - Mehdi Razavi
- Electrophysiology Clinical Research and Innovation, Texas Heart Institute, Houston, Texas.,Department of Internal Medicine, Section of Cardiology, School of Medicine, Baylor College of Medicine, Houston, Texas
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Sperzel J, Hamm C, Hain A. Leadless pacing. Herz 2018; 43:605-611. [PMID: 30255304 DOI: 10.1007/s00059-018-4752-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Leadless self-contained intracardiac pacemakers were developed with the aim of abolishing the short- and long-term risk of lead- and pocket-related complications associated with transvenous devices. Leadless pacemakers promise minimally invasive procedures, long battery lives, and small amounts of foreign materials in the body. Experiences with the pioneering single-chamber devices have provided reasons for optimism about the future of the leadless concept. In the future, as more patients receive and live longer with implantable devices, the total risk of procedure- and lead-related complications is expected to increase, adding a sense of urgency to the need for leadless alternatives to transvenous pacemakers. This review surveys the performance of currently available leadless pacemakers as well as emerging new innovative adaptations and applications of the leadless concept.
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Affiliation(s)
- J Sperzel
- Herzzentrum, Kerckhoff-Klinik GmbH, Bad Nauheim, Germany. .,Electrophysiology/Device Therapies, Kerckhoff-Klinik GmbH, Benekestr. 2-8, 61231, Bad Nauheim, Germany.
| | - C Hamm
- Herzzentrum, Kerckhoff-Klinik GmbH, Bad Nauheim, Germany
| | - A Hain
- Herzzentrum, Kerckhoff-Klinik GmbH, Bad Nauheim, Germany
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Magnusson P, Liv P. Living with a pacemaker: patient-reported outcome of a pacemaker system. BMC Cardiovasc Disord 2018; 18:110. [PMID: 29866050 PMCID: PMC5987385 DOI: 10.1186/s12872-018-0849-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 05/24/2018] [Indexed: 11/22/2022] Open
Abstract
Background The aim of this study was to assess among pacemaker patients their overall satisfaction with the pacemaker system, pain, soreness/discomfort, cosmetic results, restrictions due to impaired movement of the shoulder/arm/chest, related sleep disturbances, and concern about possible device malfunction. Methods The seven-item questionnaire was mailed to patients from a single center who had a pacemaker implant or replacement between 2006 and 2016. A higher score indicated worse outcome on a visual analog scale (VAS) of 0–100 mm. Results The response rate was 75.5% and 342 questionniares were analyzed. Median age of respondents was 77.6 years and 57.0% were males. In total, 65 complications requiring surgery (10 pocket corrections (2.9%), 5 in females) occurred during a median follow-up of 5.6 years.The distribution of the primary outcome had a median score of 5 while the 75th percentile was 13. Cosmetic appearance was significantly associated with reoperation (but not other variables). Overall scores for men and women were 5 vs. 6, respectively, which achieved significance (p = 0.042). Median ratings of pain, soreness/discomfort, cosmetic appearance, range of motion, sleep, and concern about device malfunction were all ≤5. Females reported worse outcomes for all questions, except for cosmetic results and concern about malfunction. Conclusions The vast majority of patients report excellent overall satisfaction with the pacemaker system, and are not affected by pain, soreness/discomfort, or concern about device malfunction. They also reported favourable outcomes with respect to cosmetic results, shoulder movement, and sleep. However, some patients underwent a surgical correction of the pacemaker pocket.
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Affiliation(s)
- Peter Magnusson
- Cardiology Research Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital/Solna, SE-171 76, Stockholm, Sweden. .,Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden.
| | - Per Liv
- Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
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Röger S, Rudic B, Akin I, Shchetynska-Marinova T, Fastenrath F, Tülümen E, Liebe V, El-Battrawy I, Baumann S, Kuschyk J, Borggrefe M. Long-term results of combined cardiac contractility modulation and subcutaneous defibrillator therapy in patients with heart failure and reduced ejection fraction. Clin Cardiol 2018; 41:518-524. [PMID: 29697870 PMCID: PMC5947638 DOI: 10.1002/clc.22919] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/28/2018] [Accepted: 02/04/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Cardiac contractility modulation (CCM) is an electrical-device therapy for patients with heart failure with reduced ejection fraction (HFrEF). Patients with left ventricular ejection fraction (LVEF) ≤35% also have indication for an implantable cardioverter-defibrillator (ICD), and in some cases subcutaneous ICD (S-ICD) is selected. HYPOTHESIS CCM and S-ICD can be combined to work efficaciously and safely. METHODS We report on 20 patients with HFrEF and LVEF ≤35% who received CCM and S-ICD. To exclude device interference, patients received intraoperative crosstalk testing, S-ICD testing, and bicycle exercise testing while CCM was activated. Clinical and QOL measures before CCM activation and at last follow-up were analyzed. S-ICD performance was evaluated while both CCM and S-ICD were active. RESULTS Mean follow-up was 34.3 months. NYHA class improved from 2.9 ± 0.4 to 2.1 ± 0.7 (P < 0.0001), Minnesota Living With Heart Failure Questionnaire score improved from 50.2 ± 23.7 to 29.6 ± 22.8 points (P < 0.0001), and LVEF improved from 24.4% ± 8.1% to 30.9% ± 9.6% (P = 0.002). Mean follow-up time with both devices active was 22 months. Three patients experienced a total of 6 episodes of sustained ventricular tachycardia, all successfully treated with first ICD shock. One case received an inappropriate shock unrelated to the concomitant CCM. One patient received an LVAD, so CCM and S-ICD were discontinued. CONCLUSIONS CCM and S-ICD can be successfully combined in patients with HFrEF. S-ICD and CCM remain efficacious when used together, with no interference affecting their function.
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Affiliation(s)
- Susanne Röger
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Germany
| | - Boris Rudic
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Germany
| | - Tetyana Shchetynska-Marinova
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Germany
| | - Fabian Fastenrath
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Germany
| | - Erol Tülümen
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Germany
| | - Volker Liebe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Germany
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Germany
| | - Stefan Baumann
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Germany
| | - Jürgen Kuschyk
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Germany
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von Bary C, Laski V, Fricke H, Linhardt F, Reithmann C, Fiek M. Impact of intraoperative mechanical ventilation on left ventricular lead function in cardiac resynchronization therapy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:578-582. [PMID: 29577341 DOI: 10.1111/pace.13332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/04/2018] [Accepted: 03/13/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intraoperative controlled mechanical ventilation (CMV) changes the intrathoracic geometry and may impact postoperative left ventricular (LV) lead function after CRT implantation. This multicenter study investigates the effect of intraoperative ventilation setting (spontaneous breathing [SB] vs CMV) on postoperative LV lead function taking into account patients' body mass index (BMI). METHODS CRT implantation was performed at two centers during SB in 92 and during CMV in 73 patients. Follow-up was carried out after 3 ± 5 and 36 ± 53 days. Functional lead parameters (FLP; pacing threshold and impedance), postoperative adverse events (A; phrenic nerve stimulation [PNS] and lead malfunction), and patients' BMI were assessed. Delta values of FLP between baseline and follow-up visits were analyzed applying an analysis of covariance model to detect subclinical alterations in LV lead function. RESULTS AE occurred in a total of 36 (21%) patients. PNS was observed in 26 (15%) patients and LV lead repositioning due to malfunction was necessary in 10 (6%) patients. Both AE and FLP delta values between baseline and follow-up were not associated with intraoperative ventilation settings nor the patients' BMI. CONCLUSIONS This study demonstrates that there is no impact of the intraoperative ventilation setting (SB vs CMV) on postoperative FLP or the occurrence of AE. This is also the case taking into account the BMI. With respect to these findings both approaches-sedation only or general anaesthesia including CMV-can be safely implemented during CRT implantation.
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Affiliation(s)
- Christian von Bary
- Medizinische Klinik I, Rotkreuzklinikum München, Akademisches Lehrkrankenhaus der Technischen Universität München, München, Germany
| | - Viktoria Laski
- Medizinische Klinik I, Rotkreuzklinikum München, Akademisches Lehrkrankenhaus der Technischen Universität München, München, Germany
| | - Hannes Fricke
- Medizinische Klinik I, Rotkreuzklinikum München, Akademisches Lehrkrankenhaus der Technischen Universität München, München, Germany
| | - Florian Linhardt
- Medizinische Klinik I, Rotkreuzklinikum München, Akademisches Lehrkrankenhaus der Technischen Universität München, München, Germany
| | - Christopher Reithmann
- Medizinische Klinik I, Helios Klinikum München West, Lehrkrankenhaus der Ludwig-Maximilans-Universität München, München, Germany
| | - Michael Fiek
- Medizinische Klinik I, Helios Klinikum München West, Lehrkrankenhaus der Ludwig-Maximilans-Universität München, München, Germany
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Placement Of Cardiac PacemaKEr Trial (POCKET) - rationale and design: a randomized controlled trial. Heart Int 2017; 12:e8-e11. [PMID: 29114383 PMCID: PMC5421194 DOI: 10.5301/heartint.5000235] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2017] [Indexed: 12/02/2022] Open
Abstract
Background A pacemaker system consists of one or two leads connected to a device that is
implanted into a pocket formed just below the collarbone. This pocket is
typically subcutaneous, that is, located just above the pectoral fascia.
Even though the size of pacemakers has decreased markedly, complications due
to superficial implants do occur. An alternative technique would be
intramuscular placement of the pacemaker device, but there are no randomized
controlled trials (RCTs) to support this approach, which is the rationale
for the Placement Of Cardiac PacemaKEr Trial (POCKET). The aim is to study
if intramuscular is superior to subcutaneous placement of a pacemaker
pocket. Methods In October 2016, we started to enroll 200 consecutive patients with an
indication for bradycardia pacemaker implantation. Patients are randomized
to random block sizes, stratified by age group (cut-off: 65 years) and sex,
and then randomized to either subcutaneous or intramuscular implant. A
concealed allocation procedure is employed, using sequentially numbered,
sealed envelopes. Pocket site is blinded to the patient and in all
subsequent care. The primary endpoint is patient overall satisfaction with
the pocket location at 24 months as measured using a visual analog scale
(VAS) 0-10. Secondary endpoints are: complications, patient-reported
satisfaction at 1, 12, and 24 months (overall satisfaction, pain,
discomfort, degree of unsightly appearance, movement problems, and sleep
problems due to device). Conclusions POCKET is a prospective interventional RCT designed to evaluate if
intramuscular is superior to subcutaneous placement of a bradycardia
pacemaker during a two-year follow-up.
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Incidence, predictors, and outcomes associated with pneumothorax during cardiac electronic device implantation: A 16-year review in over 3.7 million patients. Heart Rhythm 2017; 14:1764-1770. [PMID: 28735733 DOI: 10.1016/j.hrthm.2017.07.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Pneumothorax (PTX) is a potential complication of vascular access during cardiac implantable electronic device (CIED) procedures and is being scrutinized as a health care-acquired condition. OBJECTIVE The purpose of this study was to determine the trends in PTX incidence in the United Stated over a 16-year period and to determine whether PTX is associated with increased mortality after adjustment for other factors. METHODS Using weighted sampling in the largest inpatient health database in the United States (National Inpatient Sample), we evaluated data from patients with a primary procedure of CIED implantation from 1998 to 2013 who had at least 1 new vascular access (new or upgrade of prior CIED). The unadjusted and adjusted associations of PTX with mortality and other parameters were examined. RESULTS Among 3,764,703 CIED procedures, PTX occurred in 47,839 cases (1.3%). The apparent incidence of PTX peaked at 1.6% in 2012 and 2013, although this result may have been affected by a concomitant decrease of inpatient (vs outpatient) CIED. PTX was significantly associated with pulmonary complications, chest tube insertion, length of stay, and costs. Mortality was statistically higher in patients with PTX (1.2% vs 0.7%; P <.001), a relationship that remained significant in a multivariate logistic regression analysis (odds ratio 1.50, 95% confidence interval 1.36-1.65; P <.001). Age >80 years, female gender, Caucasian race, chronic obstructive pulmonary disease, and dual-chamber (vs single-chamber) device were all associated with higher odds for PTX occurrence. Placement of a chest tube was a major determinant of worse outcomes and higher costs. CONCLUSION PTX remains an important complication of CIED procedures and is associated with increased morbidity, mortality, and costs.
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Bogachev-Prokophiev A, Sharifulin R, Elesin D, Zheleznev S, Pivkin A, Karaskov A. Successful totally thoracoscopic management of a superior vena cava perforation with a pacemaker lead. HeartRhythm Case Rep 2017; 2:300-302. [PMID: 28491695 PMCID: PMC5419831 DOI: 10.1016/j.hrcr.2016.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
| | - Ravil Sharifulin
- Heart Valve Surgery Department, State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Dmitry Elesin
- Heart Valve Surgery Department, State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Sergey Zheleznev
- Heart Valve Surgery Department, State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Alexey Pivkin
- Heart Valve Surgery Department, State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Alexander Karaskov
- Heart Valve Surgery Department, State Research Institute of Circulation Pathology, Novosibirsk, Russia
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Marine JE. A new ALARA: Keeping leadless pacing thresholds as low as reasonably achievable. Heart Rhythm 2017; 14:692-693. [DOI: 10.1016/j.hrthm.2017.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Indexed: 10/20/2022]
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Nowak B, Misselwitz B, Przibille O, Mehta RH. Is mortality a useful parameter for public reporting in pacemaker implantation? Results of an obligatory external quality control programme. Europace 2017; 19:568-572. [PMID: 28431064 DOI: 10.1093/europace/euw079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 03/01/2016] [Indexed: 11/12/2022] Open
Abstract
AIMS To evaluate if public reporting of pacemaker implantation-associated mortality is meaningful in a large contemporary patient cohort. METHODS AND RESULTS The database of the obligatory external quality control programme in the Federal State of Hessen, Germany, of patients undergoing permanent pacemaker (PPM) implantation was evaluated retrospectively. We compared the baseline features of patients who died compared with those who did not during hospitalization after PPM. Of 5079 patients who underwent PPM implantation in 2009, 74 (1.5%) died during the hospital stay. Cause of death was available in 70/74 patients (94.6%) who died. Deceased patients were older (79.6 ± 8.7 vs. 76.3 ± 9.9 years, P = 0.006), had worse American Society of Anesthesiologists (ASA) physical status (P < 0.001), lower ejection fraction (P < 0.001), a greater prevalence of high-degree atrioventricular-block (44.3 vs. 35.0%, P = 0.001), and were more likely to receive single-chamber devices (41.4 vs. 25.0%, P < 0.002). Perioperative complications were similar in both cohorts. Death was not attributable directly to PPM procedure in any patients but was related to (i) non-device-related infections (28.6%), (ii) heart failure (25.7%), (iii) extracardiac diseases (21.4%), (iv) multiorgan failure (8.6%), (v) previous resuscitation with hypoxic brain damage (8.6%), and (vi) arrhythmogenic death (7.1%). CONCLUSION Mortality associated with PPM implantation in vast majority of cases was not related to the procedure, but to comorbidities and other existing diseases at the time of PPM implantation. Thus, PPM implantation in-hospital mortality should not be chosen for public reporting comparing hospital quality, even after adjusting for baseline risk.
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MESH Headings
- Aged
- Arrhythmias, Cardiac/mortality
- Arrhythmias, Cardiac/prevention & control
- Cardiac Pacing, Artificial/mortality
- Cardiac Pacing, Artificial/statistics & numerical data
- Causality
- Cohort Studies
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/prevention & control
- Female
- Hospital Mortality
- Hospitalization/statistics & numerical data
- Humans
- Incidence
- Male
- Outcome Assessment, Health Care/standards
- Outcome Assessment, Health Care/statistics & numerical data
- Pacemaker, Artificial/statistics & numerical data
- Quality Control
- Risk Assessment/methods
- Risk Management/statistics & numerical data
- Survival Analysis
- Treatment Outcome
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Affiliation(s)
- Bernd Nowak
- CCB, Cardioangiologisches Centrum Bethanien, Im Pruefling 23, D-60389 Frankfurt a.M., Germany
| | | | - Oliver Przibille
- CCB, Cardioangiologisches Centrum Bethanien, Im Pruefling 23, D-60389 Frankfurt a.M., Germany
| | - Rajendra H Mehta
- Duke Clinical Research Institute and Duke University Medical Center, Durham, NC, USA
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Modi S, Yee R, Scholl D, Stirrat J, Wong JA, Lydell C, Kotha V, Gula LJ, Skanes AC, Leong-Sit P, McCarty D, Drangova M, White JA. Ventricular pacing site separation by cardiac computed tomography: validation for the prediction of clinical response to cardiac resynchronization therapy. Int J Cardiovasc Imaging 2017; 33:1433-1442. [DOI: 10.1007/s10554-017-1120-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 03/20/2017] [Indexed: 12/01/2022]
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Hansen PB, Sommer A, Nørgaard BL, Kronborg MB, Nielsen JC. Left atrial size and function as assessed by computed tomography in cardiac resynchronization therapy: Association to echocardiographic and clinical outcome. Int J Cardiovasc Imaging 2017; 33:917-925. [DOI: 10.1007/s10554-017-1070-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 01/10/2017] [Indexed: 12/12/2022]
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Ruwald AC, Vinther M, Gislason GH, Johansen JB, Nielsen JC, Petersen HH, Riahi S, Jons C. The impact of co-morbidity burden on appropriate implantable cardioverter defibrillator therapy and all-cause mortality: insight from Danish nationwide clinical registers. Eur J Heart Fail 2016; 19:377-386. [PMID: 27905161 DOI: 10.1002/ejhf.685] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/14/2016] [Accepted: 10/07/2016] [Indexed: 11/06/2022] Open
Abstract
AIMS In a nationwide cohort of primary (PP-ICD) and secondary prevention (SP-ICD) implantable cardioverter defibrillator (ICD) patients, we aimed to investigate the association between co-morbidity burden and risk of appropriate ICD therapy and mortality. METHODS AND RESULTS We identified all patients >18 years, implanted with first-time PP-ICD (n = 1873) or SP-ICD (n = 2461) in Denmark from 2007 to 2012. Co-morbidity was identified in administrative registers of hospitalization and drug prescription from pharmacies. Co-morbidity burden was defined as the number of pre-existing non-ICD indication-related co-morbidities including atrial fibrillation, diabetes, chronic obstructive pulmonary disease, chronic renal disease, liver disease, cancer, chronic psychiatric disease, and peripheral and/or cerebrovascular disease, and divided into four groups (co-morbidity burden 0, 1, 2, and ≥3). Through Cox models, we assessed the impact of co-morbidity burden on appropriate ICD therapy and mortality. Increasing co-morbidity burden was not associated with increased risk of appropriate therapy, irrespective of implant indication [all hazard ratios (HRs) 1.0-1.4, P = NS]. Using no co-morbidities as reference, increasing co-morbidity burden was associated with increased mortality risk in PP-ICD patients (co-morbidity burden 1, HR 2.1; comorbidity burden 2, HR 3.7; co-morbidity burden ≥3, HR 6.6) (all P < 0.001) and SP-ICD patients (co-morbidity burden 1, HR 2.2; co-morbidity burden 2, HR 3.8; co-morbidity burden ≥3, HR 5.8). With increasing co-morbidity burden, an increasing frequency of patients died without having utilized their device, with 72% PP-ICD and 45% SP-ICD patients with co-morbidity burden ≥3 dying without prior appropriate ICD therapy. CONCLUSION Increasing co-morbidity burden was not associated with increased risk of appropriate ICD therapy. With increasing co-morbidity burden, mortality increased, and a higher proportion of patients died, without ever having utilized their device.
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Affiliation(s)
| | - Michael Vinther
- Department of Cardiology, Herlev-Gentofte University Hospitals, Copenhagen, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Herlev-Gentofte University Hospitals, Copenhagen, Denmark.,National Institute of Public Health, Copenhagen, Denmark.,Department of Cardiology, University of Southern Denmark, Odense, Denmark.,The Danish Heart Foundation
| | | | | | | | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Christian Jons
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
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Kirkfeldt RE, Johansen JB, Nielsen JC. Management of Cardiac Electronic Device Infections: Challenges and Outcomes. Arrhythm Electrophysiol Rev 2016; 5:183-187. [PMID: 28116083 DOI: 10.15420/aer.2016:21:2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Cardiac implantable electronic device (CIED) infection is an increasing problem. Reasons for this are uncertain, but likely relate to an increasing proportion of implantable cardioverter defibrillator (ICD) and cardiac resynchronisation therapy (CRT) devices implanted, as well as implantations in 'higher risk' candidates, i.e. patients with heart failure, diabetes and renal failure. Challenges within the field of CIED infections are multiple with prevention being the most important challenge. Careful prescription of CIED treatment and careful patient preparation before implantation is important. Diagnosis is often difficult and delayed by subtle signs of infection. Treatment of CIED infection includes complete system removal in centres experienced in CIED extraction and prolonged antibiotic therapy. Meticulous planning and preparation before system extraction and later CIED re-implantation is essential for better patient outcome. Future strategies for reducing CIED infection should be tested in sufficiently powered, multicentre, randomised controlled trials.
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Procedural Success of Left Ventricular Lead Placement for Cardiac Resynchronization Therapy: A Meta-Analysis. JACC Clin Electrophysiol 2015; 2:69-77. [PMID: 29766856 DOI: 10.1016/j.jacep.2015.08.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 07/20/2015] [Accepted: 08/13/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The goal of this study was to assess the contemporary and historical success rates of transvenous left ventricular (LV) lead placement for cardiac resynchronization therapy (CRT), their change over time, and the reasons for failure. BACKGROUND In selected patients, CRT improves morbidity and mortality, but the placement of the LV lead can be technically challenging. METHODS A literature search was used to identify all studies reporting success rates of LV lead placement for CRT via the coronary sinus (CS) route. A total of 164 studies were identified, and a meta-analysis was performed. RESULTS The studies included 29,503 patients: 74% (95% confidence interval [CI]: 72% to 76%) were male; their mean age was 66 years (95% CI: 65 to 67); their mean New York Heart Association functional class was 2.8 (95% CI: 2.7 to 2.9); the mean LV ejection fraction was 26% (95% CI: 25% to 28%); and the mean QRS duration was 155 ms (95% CI: 150 to 160). The overall rate of failure of implantation of an LV lead was 3.6% (95% CI: 3.1 to 4.3). The rate of failure in studies commencing before 2005 was 5.4% (95% CI: 4.4% to 6.5%), and from 2005 onward it was 2.4% (95% CI: 1.9% to 3.1%; p < 0.001). Causes of failure (reported for 39% of failures) also changed over time. Failure to cannulate and navigate the CS decreased from 53% to 30% (p = 0.01), and the absence of any suitable, acceptable vein increased from 39% to 64% (p = 0.007). The proportion of leads in a lateral or posterolateral final position (reported for 26% of leads) increased from 66% to 82% (p = 0.004). CONCLUSIONS The reported rate of failure to place an LV lead via the CS has decreased steadily over time. A greater proportion of failures in recent studies are due to coronary venous anatomy that is unsuitable for this technique.
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Asif SM, Hansen J, Khan MS, Walden SD, Jensen MO, Braaten BD, Ewert DL. Design and In Vivo Test of a Batteryless and Fully Wireless Implantable Asynchronous Pacing System. IEEE Trans Biomed Eng 2015; 63:1070-1081. [PMID: 26357395 DOI: 10.1109/tbme.2015.2477403] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Goal: The aim of this study is to develop a novel fully wireless and batteryless technology for cardiac pacing. METHODS This technology uses radio frequency (RF) energy to power the implanted electrode in the heart. An implantable electrode antenna was designed for 1.2 GHz; then, it was tested in vitro and, subsequently, integrated with the rectifier and pacing circuit to make a complete electrode. The prototype implanted electrode was tested in vivo in an ovine subject, implanting it on the epicardial surface of the left ventricle. The RF energy, however, was transmitted to the implanted electrode using a horn antenna positioned 25 cm above the thorax of the sheep. RESULTS It was demonstrated that a small implanted electrode can capture and harvest enough safe recommended RF energy to achieve pacing. Electrocardiogram signals were recorded during the experiments, which demonstrated asynchronous pacing achieved at three different rates. CONCLUSION These results show that the proposed method has a great potential to be used for stimulating the heart and provides pacing, without requiring any leads or batteries. It hence has the advantage of potentially lasting indefinitely and may never require replacement during the life of the patient. SIGNIFICANCE The proposed method brings forward transformational possibilities in wireless cardiac pacing, and also in powering up the implantable devices.
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Droghetti A, Bottoli MC, Ragusa M, Pepi P, Giovanardi M, Reggiani A, Pozzetti D, Malacrida M, Colombo A, Muriana G. Minimally invasive thoracoscopic technique for cardiac resynchronization therapy. Multimed Man Cardiothorac Surg 2015; 2015:mmv008. [PMID: 26085492 DOI: 10.1093/mmcts/mmv008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 05/14/2015] [Indexed: 11/12/2022]
Abstract
Outcome of surgical left ventricular (LV) lead placement is not well defined in patients with failed percutaneous cardiac resynchronization therapy. An extended experience with epicardial LV lead placement is here reported, describing the minimally invasive procedure performed at our institution using a thoracoscopic surgical approach.
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Affiliation(s)
| | | | - Mark Ragusa
- Thoracic Surgery Unit, Perugia University Medical School, Terni, Italy
| | - Patrizia Pepi
- Cardiology Unit, Carlo Poma Hospital, Mantova, Italy
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Association between hospital procedure volume and early complications after pacemaker implantation: results from a large, unselected, contemporary cohort of the German nationwide obligatory external quality assurance programme. Europace 2015; 17:787-93. [DOI: 10.1093/europace/euv003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 01/05/2015] [Indexed: 11/14/2022] Open
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