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Velayuthan R, Sukumar SK, Bootla D, Balaguru S, Anantharaj A, Satheesh S, Selvaraj RJ. Pacing mode survival in patients with single chamber atrial pacemaker for sinus node dysfunction. Indian Heart J 2024; 76:27-30. [PMID: 38070672 PMCID: PMC10943561 DOI: 10.1016/j.ihj.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 11/13/2023] [Accepted: 12/02/2023] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Single chamber atrial pacemaker should be sufficient for patients with sinus node dysfunction (SND) with normal atrioventricular (AV) conduction. However, most patients undergo dual chamber pacemaker implantation because of concern of new onset AV block. The annual incidence of new AV block has been reported from 0.6 to 4.4 % in various studies. OBJECTIVES Our aim is to assess mode survival in sinus node dysfunction with normal AV conduction patients implanted with AAIR. METHODS Patients who underwent single chamber atrial pacemaker implantation for SND with normal AV conduction between January 2014 and December 2021 were followed up for pacemaker device change, new onset AV block, bundle branch block, atrial fibrillation (AF), lead complications, reoperation and mortality rate. RESULTS A total of 113 patients underwent single chamber atrial pacemaker implantation for SND during the study period. Mean age was 55.6 ± 12.7 years. During a mean follow up of 48.7 ± 24.9 months, none of the patients required pacemaker device change to VVIR/DDDR. Nine patients underwent reoperation, 5 for lead dislodgment, 1 for high threshold, 1 for pocket site erosion and 3 for pulse generator change. None developed AV block or AF with slow ventricular rate. Only 4 patients developed AF (3 paroxysmal,1 permanent). There were 3 deaths during follow up and none were sudden deaths. CONCLUSION Single chamber atrial pacing is an acceptable mode of pacing in patients with SND in developing countries. Development of AV conduction abnormalities is rare in this relatively younger population.
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Affiliation(s)
- Ramanathan Velayuthan
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Suresh Kumar Sukumar
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Dinakar Bootla
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sridhar Balaguru
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Avinash Anantharaj
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Santhosh Satheesh
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Raja J Selvaraj
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
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Egas D, Rodriguez F, Jaswal A, Jeilan M, Milasinovic G, Al Fagih A. Burden of bradycardia and barriers to accessing bradycardia therapy in underserved countries. Eur Heart J Suppl 2023; 25:H1-H17. [PMID: 38046890 PMCID: PMC10689927 DOI: 10.1093/eurheartjsupp/suad125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Bradycardia, a condition characterized by an abnormally slow heart rate, poses significant challenges in terms of diagnosis and treatment. While it is a concern world-wide, low- and middle-income countries (LMICs) face substantial barriers in accessing appropriate bradycardia therapy. This article aims to explore the global aetiology and incidence of bradycardia, compare the prevalence and management of the condition in high-income countries versus LMICs, identify the key reasons behind the disparities in access to bradycardia therapy in LMICs, and emphasize the urgent need to address these disparities to ensure equitable healthcare on a global scale.
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Affiliation(s)
- Diego Egas
- Impulso Especialistas en Enfermedades Cardíacas, Department of Cardiology and Electrophysiology, Metropolitano Hospital of Quito, Ecuador, Medical Towers Metropolitano Hospital, Office 214, Quito 170135, Ecuador
- PUCE-TEC Technologies, Pontifical Catholic University of Ecuador, Quito 170143, Ecuador
| | - Francisco Rodriguez
- Impulso Especialistas en Enfermedades Cardíacas, Department of Cardiology and Electrophysiology, Metropolitano Hospital of Quito, Ecuador, Medical Towers Metropolitano Hospital, Office 214, Quito 170135, Ecuador
| | - Aparna Jaswal
- Department of Cardiac Pacing & Electropysiology, Fortis Escorts Heart Institute, New Delhi, Delhi 110025, India
| | - Mohamed Jeilan
- Section of Cardiology, Aga Khan University Hospital, Box 30270, Nairobi, Kenya
| | - Goran Milasinovic
- Referral Pacemaker Center, Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Ahmed Al Fagih
- Electrophysiology Division, Prince Sultan Cardiac Center, As Sulimaniyah, Riyadh 13213, Saudi Arabia
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Alyesh D, Pavri BB, Choe W, Chandara M, Sani MU, Phan PD, Bonny A, Khairy P, Sinha SK, Srivatsa U, Marine JE, Eagle K, Crawford TC, Lakkireddy D, Sundaram S. Advancing global equity in cardiac care as cardiac implantable electronic device reuse comes of age. Heart Rhythm O2 2022; 3:799-806. [PMID: 36589002 DOI: 10.1016/j.hroo.2022.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
A nation's health and economic development are inextricably and synergistically connected. Stark differences exist between wealthy and developing nations in the use of cardiac implantable electronic devices (CIEDs). Cardiovascular disease is now the leading cause of death in low- and middle-income countries (LMIC), with a significant burden from rhythm-related diseases. As science, technology, education, and regulatory frameworks have improved, CIED recycling for exportation and reuse in LMIC has become possible and primed for widespread adoption. In our manuscript, we outline the science and regulatory pathways regarding CIED reuse. We propose a pathway to advance this technology that includes creating a task force to establish standards for CIED reuse, leveraging professional organizations in areas of need to foster the professional skills for CIED reuse, collaborating with regulatory agencies to create more efficient regulatory expectations and bring the concept to scale, and establishing a global CIED reuse registry for quality assurance and future science.
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Sethi R, Nesa Malik FT, Naik A, Afroz N, Reynolds DW, Kothari Y, Reddy V, Rajan V, Bergemann T, Dedrick A, Pandurangi UM, Khan KN, Narasimhan C. Interventions in the Diagnosis and Adoption of Pacemaker Therapy in Sinus Node Dysfunction Patients: Results from the IMPROVE Brady study. Indian Heart J 2022:S0019-4832(22)00142-0. [PMID: 36130635 DOI: 10.1016/j.ihj.2022.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 11/30/2022] Open
Abstract
Aims IMPROVE Brady assessed whether a process improvement intervention could increase adoption of guideline-based therapy in sinus node dysfunction (SND) patients. Methods /Results: IMPROVE Brady was a sequential, prospective, quality improvement initiative conducted in India and Bangladesh. Patients with symptomatic bradycardia were enrolled. In Phase I, physicians assessed and treated patients per standard care. Phase II began after implementing educational materials for physicians and patients. Primary objectives were to evaluate the impact of the intervention on SND diagnosis and pacemaker (PPM) implant. SF-12 quality of life (QoL) and Zarit burden surveys were collected pre- and post-PPM implant. A total of 978 patients were enrolled (57.7 ± 14.8 years, 75% male), 508 in Phase I and 470 in Phase II. The diagnosis of SND and implantation of PPM increased significantly from Phase I to Phase II (72% vs. 87%, P < 0.001 and 17% vs. 32%, P < 0.001, respectively). Pacemaker implantation was not feasible in 41% of patients due to insurance/cost barriers which was unaltered by the intervention. Both patient QoL and caregiver burden improved at 6-months post-PPM implant (P < 0.001). Conclusions A process improvement initiative conducted at centers across India and Bangladesh significantly increased the diagnosis of SND and subsequent treatment with PPM therapy despite the socio-economic constraints.
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Abstract
Many low- and middle-income countries (LMICs) are undergoing an epidemiological transition. With an improvement in socioeconomic conditions and an aging population, cardiovascular diseases (CVDs), like cardiac arrhythmias, are expected to increase in these countries. However, there are limited studies on the epidemiology and management of cardiac arrhythmias in LMICs. This review will highlight the unique challenges and opportunities that these countries face when managing cardiac arrhythmias.
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Affiliation(s)
- Philasande Mkoko
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Ehete Bahiru
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Olujimi A Ajijola
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Aime Bonny
- Department of internal medicine, District hospital Bonassama, University of Douala, Douala, Cameroon.,Service de cardiologie, Hôpital Forcilles, Ferolles-Attilly, France, Unité de rythmologie, Centre hospitalier Le Raincy-Montfermeil, Montfermeil, France
| | - Ashley Chin
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
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Abstract
Although studies have evaluated the quality of life (QoL) of patients undergoing permanent pacemaker (PPM) placement, their results are inconsistent. To assess arrhythmia perceptions and QoL in bradyarrhythmia patients following PPM implantation, 137 patients completed demographic, arrhythmia perception, and QoL questionnaires before and six months after implantation. Before implantation, they reported fatigue (74.1%), dizziness (72.9%), dyspnea (64.7%), chest pain (62.4%), and heart fluttering (54.1%). After implantation, arrhythmia perceptions and QoL showed significant improvement (p < .05), except vitality (p > .05). However, patients with arrhythmia for more than three years, three or more PPM implants, two or more comorbidities, or were 41-50 years showed no significant QoL improvement. Doctors and hospital educators, rather than nurses, provided the most PPM information to patients. Since nurses provide primary in-hospital care to PPM patients, they should impart more patient education while considering individual characteristics in caring situations to enhance patients' QoL.
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Affiliation(s)
- Shu-Fen Su
- Department of Nursing, National Taichung University of Science and Technology, Taichung City,Taiwan (R.O.C)
| | - Meng-Shan Wu
- Department of Nursing, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City, Taiwan (R.O.C)
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