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El-Chami MF, Shah AD. How to implant leadless pacemakers and mitigate major complications. Heart Rhythm 2023; 20:754-759. [PMID: 36717008 DOI: 10.1016/j.hrthm.2023.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/05/2023] [Accepted: 01/20/2023] [Indexed: 01/29/2023]
Affiliation(s)
- Mikhael F El-Chami
- Section of Electrophysiology, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
| | - Anand D Shah
- Section of Electrophysiology, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
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2
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Blank EA, El-Chami MF, Wenger NK. Leadless Pacemakers: State of the Art and Selection of the Ideal Candidate. Curr Cardiol Rev 2023; 19:43-50. [PMID: 36999695 PMCID: PMC10518884 DOI: 10.2174/1573403x19666230331094647] [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] [Received: 08/08/2022] [Revised: 01/17/2023] [Accepted: 01/24/2023] [Indexed: 04/01/2023] Open
Abstract
The field of cardiac pacing has been defined by constant development to provide efficacious, safe, and reliable therapy. Traditional pacing utilizes transvenous leads, which dwell in the venous system and place patients at risk for complications, including pneumothorax, bleeding, infection, vascular obstruction, and valvular compromise. Leadless pacemakers have been developed to overcome many of the challenges of transvenous pacing while providing safe and effective pacing therapy for an increasing population of patients. The Medtronic Micra transcatheter pacing system was approved by the FDA in April of 2016 and the Abbott Aveir pacemaker was approved in April of 2022. Several additional leadless pacemakers are in various stages of development and testing. There exists limited guidance on the selection of the ideal candidate for leadless pacemakers. Advantages of leadless pacemakers include decreased infection risk, overcoming limited vascular access, and avoidance of interaction with the tricuspid valve apparatus. Disadvantages of leadless pacemakers include right ventricular-only pacing, unclear lifecycle management, cost, perforation risk, and lack of integration with defibrillator systems. This review aims to provide an overview of the current state of the art of leadless pacemakers, currently approved systems, clinical trials and real-world evidence, considerations for patient selection, and future directions of this promising technology.
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Affiliation(s)
- Evan A Blank
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Mikhael F El-Chami
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Nanette K Wenger
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
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Saleem-Talib S, van Driel VJ, Nikolic T, van Wessel H, Louman H, Borleffs CJW, van der Heijden J, Cox M, Ramanna H. The jugular approach for leadless pacing. A novel and safe alternative. Pacing Clin Electrophysiol 2022; 45:1248-1254. [PMID: 36031774 DOI: 10.1111/pace.14587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 07/10/2022] [Accepted: 08/11/2022] [Indexed: 11/30/2022]
Abstract
AIMS To evaluate safety of leadless pacemaker implantation through the internal jugular vein in a larger cohort with longer follow-up. Moreover, feasibility of non-apical pacing as well as relation between pacing site and QRS duration were assessed. METHODS 82 consecutive patients, who received a leadless pacemaker though the internal jugular vein were included. Electrical parameters were measured at regular follow-up and any complications were registered. Paced QRS interval was compared for three pacing sites, RVOT, RV mid septum and RV apical septum. RESULTS In all patients the leadless pacemaker was implanted successfully. In 69 patients the device was implanted in a non-apical position. In 71% of cases, the device could be deployed at first attempt. The median fluoroscopy time was 4.4minutes (range 0.9-51-) The paced QRS interval was significantly narrower for non-apical pacing compared to apical pacing 156ms. vs 179 ms. P = 0.04 respectively. During mean follow-up of 16 months (range 0-43 months) electrical parameters remained stable. Two complications occurred which could be resolved during the implant procedure. There were no access site related complications. CONCLUSION The jugular approach for leadless pacemaker implantation is feasibly and may avoid vascular complications. It facilitates non-apical positioning of leadless pacemakers leading to a narrower paced QRS interval. The jugular approach allows for immediate post procedural ambulation. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | | | - Tanja Nikolic
- Department of Cardiology Haga Teaching hospital, the Hague, The Netherlands
| | - Harry van Wessel
- Department of Cardiology Haga Teaching hospital, the Hague, The Netherlands
| | - Hellen Louman
- Department of Cardiology Haga Teaching hospital, the Hague, The Netherlands
| | | | | | - Moniek Cox
- Department of Cardiology Haga Teaching hospital, the Hague, The Netherlands
| | - Hemanth Ramanna
- Department of Cardiology Haga Teaching hospital, the Hague, The Netherlands
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4
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Implantation of a leadless pacemaker in patients with a mechanical tricuspid valve. HeartRhythm Case Rep 2022; 8:284-287. [PMID: 35497483 PMCID: PMC9039116 DOI: 10.1016/j.hrcr.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Chen X, Huang W. Strategies to overcome complicated situations in leadless pacemaker implantation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1959-1962. [PMID: 34693538 DOI: 10.1111/pace.14385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/27/2021] [Accepted: 10/17/2021] [Indexed: 11/29/2022]
Abstract
Although leadless pacemaker implantation is not complicated, challenges exist in complex situations, which can be prevented and resolved with appropriate treatments including dealing with the abnormal venous access or choosing a superior vena cava approach, implanting at the septum rather than the apex, a snare assistant technique to deployment, assurance of solid fixation, and snaring dislodged device.
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Affiliation(s)
- Xueying Chen
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, P. R. China
| | - Weijian Huang
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, P. R. China.,The Key Lab of Cardiovascular Disease, Science and Technology of Wenzhou, Wenzhou, P. R. China
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Imamura T, Koi T, Kataoka N, Tanaka S, Ueno H, Kinugawa K. Micra trans-catheter leadless pacemaker implantation in a patient with large right heart. J Cardiol Cases 2021; 24:136-139. [PMID: 34466178 DOI: 10.1016/j.jccase.2021.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/06/2021] [Accepted: 02/22/2021] [Indexed: 11/15/2022] Open
Abstract
The use of leadless trans-catheter pacemakers is increasing particularly in the elderly population. However, its indication for those with anatomical anomaly remains unknown. We had a 75-year-old woman with atrial standstill and ventricular escape. Micra leadless pacemaker (Medtronic, Inc, Minneapolis, MN, USA) failed to be deployed due to too enlarged right atrium accompanied by atrial septal deficiency, followed by successful implantation of transvenous pacemaker lead by using SelectSecure lead (Medtronic) with a C315 delivery catheter that enhanced back-up force toward the ventricular septum against significant tricuspid regurgitation. The Micra is a promising system, but we should understand its limitations as well as alternative systems particularly for such an anatomical anatomy. <Learning objective: A Micra leadless trans-catheter pacemaker is a promising system with less invasiveness, particularly for elderly patients, but we should understand its technical limitation and consider alternative systems if necessary, particularly for those with enlarged right heart.>.
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Affiliation(s)
- Teruhiko Imamura
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Takahisa Koi
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Naoya Kataoka
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Shuhei Tanaka
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Hiroshi Ueno
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Koichiro Kinugawa
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
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Kataoka N, Imamura T, Koi T, Ueno H, Kinugawa K. The Large Right Heart Is Associated with the Prolongation of the Procedure Time of Leadless Pacemaker Implantation. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:685. [PMID: 34356966 PMCID: PMC8306467 DOI: 10.3390/medicina57070685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/17/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022]
Abstract
Background and objectives: Leadless pacemakers are less invasive but are as effective as conventional pacemakers and are increasingly implanted in elderly patients. However, the implantation procedure is sometimes challenging in patients with abnormal anatomy, particularly those with an enlarged right heart. We aimed to determine the right heart parameters that were associated with longer procedure times for leadless pacemaker implantation. Materials and Methods: Among 19 consecutive patients in whom Micra leadless pacemakers (Micra TPS, Medtronic, Minneapolis, MN) were implanted, the diameter and area of both the right atrium and right ventricle were measured by transthoracic echocardiography before the procedure. The right heart parameters that were associated with a procedure time > 60 min were investigated. Results: In the 19 patients (median 81 years old, 10 male) who underwent implantation of the Micra system, 6 (32%) required a procedure time > 60 min. Among the baseline right heart echocardiographic parameters, right atrial diameter and area were significantly associated with a procedure time > 60 min (odds ratio 11.3, 95% confidence interval 1.09-1.17, p = 0.042; and odds ratio 1.57, 95% confidence interval 1.05-2.34, p = 0.029, respectively) at a cutoff of 4.0 cm and 17.0 cm2, respectively. Conclusions: Patients with an enlarged right atrium may not be good candidates for leadless pacemakers given the longer procedure time, and conventional pacemakers should perhaps be recommended as an alternative.
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Affiliation(s)
| | - Teruhiko Imamura
- Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan; (N.K.); (T.K.); (H.U.); (K.K.)
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Chau EMC, Wong RKP. Bilateral external iliac vein compression-An important consideration in implantation of leadless permanent pacemaker. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1636-1640. [PMID: 34018224 DOI: 10.1111/pace.14259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 04/21/2021] [Accepted: 05/02/2021] [Indexed: 11/28/2022]
Abstract
We report on an unusual case with asymptomatic bilateral external iliac vein non-thrombotic obstruction causing difficulty in delivery of the leadless permanent pacemaker and discuss on the strategies to overcome the problem.
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Houmsse M, Karki R, Gabriels J, Reinig M, Patel D, Hussain SK, Gandhi GD, Lloyd MS, Makary MS, Okabe T, Tamirisa K, Joza J, Patel A, Afzal MR, Epstein LM, Cha Y. Implantation of leadless pacemakers via inferior vena cava filters is feasible and safe: Insights from a multicenter experience. J Cardiovasc Electrophysiol 2020; 31:3277-3285. [DOI: 10.1111/jce.14776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/03/2020] [Accepted: 09/10/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Mahmoud Houmsse
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wexner Medical Center The Ohio State University Columbus Ohio USA
| | - Roshan Karki
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota USA
| | - James Gabriels
- Department of Cardiology Northwell Health, Manhasset, NY/Long Island Jewish Medical Center New Hyde Park New York USA
| | | | | | - Sarah K. Hussain
- Division of Cardiology Penn State Health Milton S Hershey Medical Center Hershey Pennsylvania USA
| | | | - Michael S. Lloyd
- Division of Cardiology, Department of Medicine Emory University Atlanta Georgia USA
| | - Mina S. Makary
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wexner Medical Center The Ohio State University Columbus Ohio USA
| | - Toshimasa Okabe
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wexner Medical Center The Ohio State University Columbus Ohio USA
| | | | - Jacqueline Joza
- Division of Cardiology McGill University Health Center Montreal Canada
| | - Apoor Patel
- Department of Cardiology Northwell Health, Manhasset, NY/Long Island Jewish Medical Center New Hyde Park New York USA
| | - Muhammad R. Afzal
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wexner Medical Center The Ohio State University Columbus Ohio USA
| | - Laurence M. Epstein
- Department of Cardiology Northwell Health, Manhasset, NY/Long Island Jewish Medical Center New Hyde Park New York USA
| | - Yong‐Mei Cha
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota USA
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Surti AK, Ambrose M, Cortez D. First description of a successful leadless pacemaker implantation via the left internal jugular vein (in a 20 kg patient). J Electrocardiol 2020; 60:1-2. [DOI: 10.1016/j.jelectrocard.2020.02.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/02/2020] [Accepted: 02/29/2020] [Indexed: 12/23/2022]
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Afzal MR, Shah N, Daoud G, Houmsse M. Current state of leadless pacemakers: state of the art review. Expert Rev Cardiovasc Ther 2019; 17:699-706. [DOI: 10.1080/14779072.2019.1664288] [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)
- Muhammad R. Afzal
- Division of Cardiovascular Medicine, Wexner Medical Center at the Ohio State University Medical Center, Columbus, OH, USA
| | - Nupur Shah
- Department of internal Medicine, St. Mary Mercy Hospital, Livonia, MI, USA
| | - Georges Daoud
- Division of Cardiovascular Medicine, Wexner Medical Center at the Ohio State University Medical Center, Columbus, OH, USA
| | - Mahmoud Houmsse
- Division of Cardiovascular Medicine, Wexner Medical Center at the Ohio State University Medical Center, Columbus, OH, USA
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12
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Gallotti RG, Biniwale R, Shannon K, Russell M, Moore JP. Leadless pacemaker placement in an 18-kilogram child: Procedural approach and technical considerations. HeartRhythm Case Rep 2019; 5:555-558. [PMID: 31890573 PMCID: PMC6926214 DOI: 10.1016/j.hrcr.2019.08.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/29/2019] [Accepted: 08/17/2019] [Indexed: 12/15/2022] Open
Affiliation(s)
- Roberto G Gallotti
- Division of Pediatric Cardiology, UCLA Medical Center, Los Angeles, California
| | - Reshma Biniwale
- Department of Cardiothoracic Surgery, UCLA Medical Center, Los Angeles, California
| | - Kevin Shannon
- Division of Pediatric Cardiology, UCLA Medical Center, Los Angeles, California.,Ahmanson/UCLA Congenital Heart Disease Center, Los Angeles, California
| | - Matthew Russell
- Division of Pediatric Cardiology, UCLA Medical Center, Los Angeles, California
| | - Jeremy P Moore
- Division of Pediatric Cardiology, UCLA Medical Center, Los Angeles, California.,Ahmanson/UCLA Congenital Heart Disease Center, Los Angeles, California
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13
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Saleem-Talib S, van Driel VJ, Chaldoupi SM, Nikolic T, van Wessel H, Borleffs CJW, Ramanna H. Leadless pacing: Going for the jugular. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:395-399. [PMID: 30653690 PMCID: PMC6850455 DOI: 10.1111/pace.13607] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/23/2018] [Accepted: 01/05/2019] [Indexed: 11/30/2022]
Abstract
Background Leadless pacing is generally performed from a femoral approach. However, the femoral route is not always available. Until now, data regarding implantation using a jugular approach other than a single‐case report were lacking. Methods The case records of all patients who underwent internal jugular venous (IJV) leadless pacemaker implantation (Micra, Medtronic, Dublin, Ireland) at our center were analyzed retrospectively. Results Nineteen patients underwent IJV leadless pacemaker implantation, nine females, mean age of 77.5 ±9.6 years; permanent atrial fibrillation in all patients with normal left ventricular ejection fraction. Implant indication was atrioventricular conduction disturbance in 10, pre‐AV node ablation in seven, and replacement of a conventional VVI pacemaker in two (infection in one and lead malfunction in the other). The device was positioned at the superior septum in seven patients, apicoseptal in seven patients, and midseptal in five patients. In 12 patients, a sufficient device position was obtained at the first attempt, in three at the second, in one at the third, in one at the fourth, and in two at the sixth attempt. The mean pacing threshold was 0.56 ± 0.39V at 0.24‐ms pulse width, sensed amplitude was 9.1 ± 3.2 mV, mean fluoroscopy duration was 3.1 ± 1.6 min. There were no vascular or other complications. At follow‐up, electrical parameters remained stable in 18 of 19 patients. Conclusion Although experience is minimal, we suggest that the IJV approach is safe and may be considered in patients where the femoral approach is contraindicated.
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Affiliation(s)
| | - Vincent J van Driel
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
| | | | - Tanja Nikolic
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Harry van Wessel
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
| | | | - Hemanth Ramanna
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
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Steinwender C, Blessberger H, Kiblböck D, Saleh K, Kammler J. [Micra™ leadless pacemaker : Clinical experience and perspectives]. Herzschrittmacherther Elektrophysiol 2018; 29:334-339. [PMID: 30456580 DOI: 10.1007/s00399-018-0592-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 09/10/2018] [Indexed: 10/27/2022]
Abstract
Leadless pacemakers have the potential to fundamentally change the field of device therapy. As leads and generator pockets are no longer needed with this technology, many potentially dangerous complications of conventional pacemaker systems like lead fractures, lead endocarditis or pocket infections can be effectively avoided. At present, Micra™ (Medtronic Inc., Minneapolis, MN, USA) is the only commercially available leadless pacemaker. Since its first-in-human implantation in 2013, thousands of these devices have been implanted worldwide. This article presents an overview of the present clinical evidence and future perspectives of this promising new technology.
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Affiliation(s)
- Clemens Steinwender
- Klinik für Kardiologie und Internistische Intensivmedizin, Kepler Universitätsklinikum Linz, Medizinische Fakultät, Johannes Kepler Universität Linz, Altenberger Straße 69, 4040, Linz, Österreich.
| | - Hermann Blessberger
- Klinik für Kardiologie und Internistische Intensivmedizin, Kepler Universitätsklinikum Linz, Medizinische Fakultät, Johannes Kepler Universität Linz, Altenberger Straße 69, 4040, Linz, Österreich
| | - Daniel Kiblböck
- Klinik für Kardiologie und Internistische Intensivmedizin, Kepler Universitätsklinikum Linz, Medizinische Fakultät, Johannes Kepler Universität Linz, Altenberger Straße 69, 4040, Linz, Österreich
| | - Karim Saleh
- Klinik für Kardiologie und Internistische Intensivmedizin, Kepler Universitätsklinikum Linz, Medizinische Fakultät, Johannes Kepler Universität Linz, Altenberger Straße 69, 4040, Linz, Österreich
| | - Jürgen Kammler
- Klinik für Kardiologie und Internistische Intensivmedizin, Kepler Universitätsklinikum Linz, Medizinische Fakultät, Johannes Kepler Universität Linz, Altenberger Straße 69, 4040, Linz, Österreich
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Cay S, Ozeke O, Ozcan F, Topaloglu S, Aras D. Use of permanent pacemaker systems as temporary pacemakers. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:875-876. [DOI: 10.1111/pace.13358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 01/28/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Serkan Cay
- Division of Arrhythmia and Electrophysiology, Department of Cardiology, University of Health SciencesYuksek Ihtisas Heart‐Education and Research Hospital Ankara Turkey
| | - Ozcan Ozeke
- Division of Arrhythmia and Electrophysiology, Department of Cardiology, University of Health SciencesYuksek Ihtisas Heart‐Education and Research Hospital Ankara Turkey
| | - Firat Ozcan
- Division of Arrhythmia and Electrophysiology, Department of Cardiology, University of Health SciencesYuksek Ihtisas Heart‐Education and Research Hospital Ankara Turkey
| | - Serkan Topaloglu
- Division of Arrhythmia and Electrophysiology, Department of Cardiology, University of Health SciencesYuksek Ihtisas Heart‐Education and Research Hospital Ankara Turkey
| | - Dursun Aras
- Division of Arrhythmia and Electrophysiology, Department of Cardiology, University of Health SciencesYuksek Ihtisas Heart‐Education and Research Hospital Ankara Turkey
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