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Farraha M, Rao R, Igoor S, Le TYL, Barry MA, Davey C, Kok C, Chong JJ, Kizana E. Recombinant Adeno-Associated Viral Vector-Mediated Gene Transfer of hTBX18 Generates Pacemaker Cells from Ventricular Cardiomyocytes. Int J Mol Sci 2022; 23:ijms23169230. [PMID: 36012498 PMCID: PMC9408910 DOI: 10.3390/ijms23169230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 12/03/2022] Open
Abstract
Sinoatrial node dysfunction can manifest as bradycardia, leading to symptoms of syncope and sudden cardiac death. Electronic pacemakers are the current standard of care but are limited due to a lack of biological chronotropic control, cost of revision surgeries, and risk of lead- and device-related complications. We therefore aimed to develop a biological alternative to electronic devices by using a clinically relevant gene therapy vector to demonstrate conversion of cardiomyocytes into sinoatrial node-like cells in an in vitro context. Neonatal rat ventricular myocytes were transduced with recombinant adeno-associated virus vector 6 encoding either hTBX18 or green fluorescent protein and maintained for 3 weeks. At the endpoint, qPCR, Western blot analysis and immunocytochemistry were used to assess for reprogramming into pacemaker cells. Cell morphology and Arclight action potentials were imaged via confocal microscopy. Compared to GFP, hTBX18-transduced cells showed that hTBX18, HCN4 and Cx45 were upregulated. Cx43 was significantly downregulated, while sarcomeric α-actinin remained unchanged. Cardiomyocytes transduced with hTBX18 acquired the tapering morphology of native pacemaker cells, as compared to the block-like, striated appearance of ventricular cardiomyocytes. Analysis of the action potentials showed phase 4 depolarization and a significant decrease in the APD50 of the hTBX18-transduced cells. We have demonstrated that rAAV-hTBX18 gene transfer to ventricular myocytes results in morphological, molecular, physiological, and functional changes, recapitulating the pacemaker phenotype in an in vitro setting. The generation of these induced pacemaker-like cells using a clinically relevant vector opens new prospects for biological pacemaker development.
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Affiliation(s)
- Melad Farraha
- Sydney Medical School, the University of Sydney, Sydney 2006, Australia
- Centre for Heart Research, the Westmead Institute for Medical Research, Sydney 2145, Australia
| | - Renuka Rao
- Centre for Heart Research, the Westmead Institute for Medical Research, Sydney 2145, Australia
| | - Sindhu Igoor
- Centre for Heart Research, the Westmead Institute for Medical Research, Sydney 2145, Australia
| | - Thi Y. L. Le
- Centre for Heart Research, the Westmead Institute for Medical Research, Sydney 2145, Australia
| | - Michael A. Barry
- Department of Cardiology, Westmead Hospital, Sydney 2145, Australia
| | - Christopher Davey
- Centre for Heart Research, the Westmead Institute for Medical Research, Sydney 2145, Australia
- School of Physics, the University of Sydney, Sydney 2006, Australia
| | - Cindy Kok
- Centre for Heart Research, the Westmead Institute for Medical Research, Sydney 2145, Australia
| | - James J.H. Chong
- Sydney Medical School, the University of Sydney, Sydney 2006, Australia
- Centre for Heart Research, the Westmead Institute for Medical Research, Sydney 2145, Australia
- Department of Cardiology, Westmead Hospital, Sydney 2145, Australia
| | - Eddy Kizana
- Sydney Medical School, the University of Sydney, Sydney 2006, Australia
- Centre for Heart Research, the Westmead Institute for Medical Research, Sydney 2145, Australia
- Department of Cardiology, Westmead Hospital, Sydney 2145, Australia
- Correspondence:
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Rosero EB, Rajan N, Joshi GP. Pro-Con Debate: Are Patients With a Cardiovascular Implantable Electronic Device Suitable to Receive Care in a Free-Standing Ambulatory Surgery Center? Anesth Analg 2022; 134:919-925. [PMID: 35427265 DOI: 10.1213/ane.0000000000005776] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Migration of surgical and other procedures that require anesthesia care from a hospital to a free-standing ambulatory surgery center (ASC) continues to grow. Patients with cardiac implantable electronic devices (CIED) might benefit from receiving their care in a free-standing ASC setting. However, these patients have cardiovascular comorbidities that can elevate the risk of major adverse cardiovascular events. CIEDs are also complex devices and perioperative management varies between devices marketed by various manufacturers and require consultation and ancillary services, which may not be available in a free-standing ASC. Thus, perioperative care of these patients can be challenging. Therefore, the suitability of this patient population in a free-standing ASC remains highly controversial. Although applicable advisories exist, considerable discussion continues with surgeons and other proceduralists about the concerns of anesthesiologists. In this Pro-Con commentary article, we discuss the arguments for and against scheduling a patient with a CIED in a free-standing ASC.
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Affiliation(s)
- Eric B Rosero
- From the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Niraja Rajan
- Department of Anesthesiology and Perioperative Medicine, Penn State Health, Hershey, Pennsylvania
| | - Girish P Joshi
- From the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
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Uchida T, Matsubara H, Nakajima H. Pneumothorax in a child due to physical irritation caused by an implantable cardioverter-defibrillator. BMJ Case Rep 2022; 15:e249878. [PMID: 35387799 PMCID: PMC8987700 DOI: 10.1136/bcr-2022-249878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 06/14/2023] Open
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Evaluation and Interventional Management of Cardiac Dysrhythmias. Surg Clin North Am 2022; 102:365-391. [DOI: 10.1016/j.suc.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Bonenberger M, Rice AN, Thompson A, Thompson J, Simmons VC. Standardized Perioperative Note to Improve Perioperative Management of Patients With Cardiac Implantable Electronic Devices. J Perianesth Nurs 2022; 37:312-316. [DOI: 10.1016/j.jopan.2021.06.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/21/2021] [Accepted: 06/26/2021] [Indexed: 10/18/2022]
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de Carellán Mateo AG, Casamián-Sorrosal D. The perioperative management of small animals with previously implanted pacemakers undergoing anaesthesia. Vet Anaesth Analg 2021; 49:7-17. [PMID: 34916163 DOI: 10.1016/j.vaa.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/26/2020] [Accepted: 05/25/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE There is little information in the veterinary literature about the perioperative management of small animal patients with previously implanted pacemakers undergoing elective or emergency non-cardiac procedures. The purpose of this article is to review the current literature with regard to human patients, with previously implanted pacemakers, undergoing general anaesthesia. Using this and the current information on pacemakers and anaesthesia in dogs and cats, we provide recommendations for small animal patients in this situation. DATABASES USED Google Scholar, PubMed and CAB Abstracts using and interlinking and narrowing the search terms: "dog", "cat", "small animals", "anaesthesia", "pacemaker", "perioperative", "transvenous pacing", "temporary pacing". Scientific reports and human and small animal studies from the reference lists of the retrieved papers were reviewed. In addition, related human and veterinary cardiology and anaesthesia textbooks were also included to create a narrative review of the subject. CONCLUSIONS The best perioperative care for these animals comes from a multidisciplinary approach involving the anaesthetist, cardiologist, surgeon and intensive care unit team. When such an approach is not feasible, the anaesthetist should be familiar with pacemaker technology and how to avoid perioperative complications such as electromagnetic interference, lead damage and reprogramming of the device. The preanaesthetic assessment should be thorough. Information regarding the indication for pacemaker placement, complications during the procedure, location, type and programming of the pacemaker should be readily available. The anaesthetic management of these veterinary patients aims to preserve cardiovascular function while avoiding hypotension, and backup pacing should be available during the perioperative period. Further prospective studies are needed to describe the best perioperative care in small animals with a previously implanted pacemaker.
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Affiliation(s)
- Alejandra García de Carellán Mateo
- Anaesthesia and Analgesia Service, Teaching Veterinary Hospital, Department of Animal Medicine and Surgery, School of Veterinary Science, Catholic University of Valencia, Valencia, Spain.
| | - Domingo Casamián-Sorrosal
- Cardiology and Interventional Cardiology Service, Teaching Veterinary Hospital, Department of Animal Medicine and Surgery, School of Veterinary Science, Catholic University of Valencia, Valencia, Spain
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Liu M, Lin X, Tan Q, Han X. Evidence-Based Analysis of the Emergency Temporary Cardiac Pacing (Electrical Stimulation from Metal Wire Electrode). Bioinorg Chem Appl 2021; 2021:5677598. [PMID: 34484317 PMCID: PMC8413046 DOI: 10.1155/2021/5677598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 08/14/2021] [Indexed: 12/13/2022] Open
Abstract
The patient's Cr (creatinine), BUN (blood urea nitrogen), HBG (hemoglobin), VT (ventricular tachycardia), pacing frequency, puncture point, emergency to permanent pacing time, pacing current (mA), pacing threshold current (mA), and admission diagnosis data were collected. The data were subjected to frequency statistics, curve regression analysis, PLS regression analysis, adjustment analysis, chi-square test, ridge regression analysis, discriminant analysis, negative binomial regression analysis, Poisson regression analysis, and stepwise regression analysis. Some findings include the following: (1) Cr has a significant positive effect on HBG, and BUN has a significant negative effect on HBG. (2) VT has a negative correlation with age and a positive correlation with CK-MB and CK (creatinine kinase). (3) Myocarditis has a negative correlation with age and a significant positive correlation with CTnI (cardiac troponin I). (4) AST (aspartate transaminase) and ALT (alanine aminotransferase) have a significant positive impact on DDI (D-dimer), while CTnI has a significant negative impact on DDI. MYO (myoglobin) has no impact relationship to DDI. (5) ALT has a significant positive relationship with APTT (partial thromboplastin time). (6) Alb (albumin) and TBIL (total bilirubin) have a significant positive effect on PLT (platelet) count, while pro-BNP (B-type natriuretic peptide) and MYO have a significant negative effect on PLT. (7) CK has a significant positive effect on INR (international normalized ratio). (8) The relationship between sinus node dysfunction and VT significantly affect the pacing frequency (beats/minute). For third-degree atrioventricular block, different samples of sinus node dysfunction showed significant differences. (9) There is a significant positive correlation between pacing current (mA) and pacing threshold current (mA). (10) There was a significant positive correlation between perceived voltage (mV) and the time from emergency to permanent pacing. Admission diagnosis has a significant positive impact on the time from emergency to permanent pacing. The change (increase) in time from emergency to permanent pacing was 1.137-fold when an additional condition was diagnosed on admission.
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Affiliation(s)
- Meng Liu
- Emergency Department, Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), Changsha 410005, Hunan, China
| | - Xuming Lin
- Electromyogram Department, Hunan Province Hospital of Chinese Medicine (The Second-Affiliate Hospital of Hunan University of Chiniese Medicine), Changsha 410005, China
| | - Qiaoyin Tan
- College of Teacher Education, Zhejiang Normal University, Jinhua 321004, Zhejiang, China
| | - Xiaotong Han
- Emergency Department, Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), Changsha 410005, Hunan, China
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Lopez-Lopez D, Gestal Vazquez M, Rama-Maceiras P, Gonzalez Pereira A, Casas Reza P. Perioperative management of epicardial pacemakers: A case report. J Clin Anesth 2021; 75:110478. [PMID: 34358851 DOI: 10.1016/j.jclinane.2021.110478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/25/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Affiliation(s)
- David Lopez-Lopez
- Anesthesiology, Perioperative Care and Pain Medicine, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | - MarIa Gestal Vazquez
- Anesthesiology, Perioperative Care and Pain Medicine, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | - Pablo Rama-Maceiras
- Anesthesiology, Perioperative Care and Pain Medicine, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | - Almudena Gonzalez Pereira
- Anesthesiology, Perioperative Care and Pain Medicine, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | - Pablo Casas Reza
- Anesthesiology, Perioperative Care and Pain Medicine, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain.
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Sepúlveda López FA, Jiménez Muñoz LM, Agudelo Uribe JF, Castro Pérez JA. Patient with an implantable cardiac electrical stimulation device. What should the anesthesiologist know? COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2021. [DOI: 10.5554/22562087.e976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Patients with implantable electric stimulation devices are challenging to the anesthesiologist since these cases demand a comprehensive knowledge about how the device operates, the indications for the implant and the implications that must be addressed during the perioperative period . This article is intended to provide the reader with clear and structured information so that the anesthesiologist will be able to safely deal with the situation of a patient with an implantable cardiac stimulation device, who has been programmed for emergent surgery. A search for the scientific evidence available was conducted in Pubmed / Medline, ScienceDirect, OVID, SciELO), for a non-systematic review. The incidence of the use of cardiac electric stimulation devices has been growing. Their operation is increasingly complex, and demands being constantly updated on the knowledge in the area.
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Implementation of a Postoperative Electronic Health Record Alert for Cardiac Implantable Electronic Device Patients. J Perianesth Nurs 2021; 36:345-350.e1. [PMID: 33714713 DOI: 10.1016/j.jopan.2020.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 09/25/2020] [Accepted: 09/27/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE Approximately 2% of surgical patients have an existing cardiac implantable electronic device (CIED). Perioperative device reprogramming requires postoperative care to ensure that device settings are restored. Electronic health record (EHR) alerts have been shown to improve communication between providers and decrease time to necessary interventions in other areas of medicine. The aim of this quality improvement project was to create an EHR alert for postoperative CIED patients who require device reprogramming to help clinicians track, remember, and document the timely and safe restoration of device settings. DESIGN This project used a pre-post observational design. METHODS This project was conducted at a major academic medical center using a pre-post observational design. To prevent anesthesia providers from closing an encounter in the EHR before postoperative restoration of device settings, an alert was developed and embedded within the intraoperative EHR to track preoperative device reprogramming, and alert anesthesia providers to perform and document postoperative restoration of safe settings. FINDINGS The postimplementation group (n = 272) had fewer unknown or undocumented preoperative CIED interventions (12.9% vs 30.9%), a 7.3% shorter device suspension time (median = 165 minutes vs 178 minutes), 6.8% improvement in documentation of postoperative re-enabling of device therapies (78.8% vs 72.0%), and a 72.48% decrease in length of stay (median = 625 hours vs 172 hours) when compared with the preimplementation group (n = 132). CONCLUSION Electronic prompts effectively captured patients who received preoperative CIED reprogramming and provided a process for reprogramming devices to safe settings, both significant steps in preventing negative patient outcomes associated with undocumented CIED interventions. Perioperative CIED documentation improved, and length of stay decreased after project implementation.
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Cronin B, Dalia A, Nguyen QS, Sandoval K, Birgersdotter-Green U, Maus T, Essandoh MK. Perioperative Interrogation of Medtronic Cardiovascular Implantable Electronic Devices: A Guide for Anesthesiologists. J Cardiothorac Vasc Anesth 2020; 34:2465-2475. [DOI: 10.1053/j.jvca.2019.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/03/2019] [Accepted: 09/09/2019] [Indexed: 11/11/2022]
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12
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Dalia AA, Streckenbach S. Consumer Electronics Show for the Anesthesiologist: Updates on Cardiac Implantable Electronic Devices. J Cardiothorac Vasc Anesth 2020; 34:1419-1422. [DOI: 10.1053/j.jvca.2020.01.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 01/28/2020] [Indexed: 11/11/2022]
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Dalia A, Essandoh M, Poorsattar S, Kothari P, O'Brien EO, Dimitrov T, Rudnick D, Hussain N, Cronin B. The Year in Electrophysiology: Selected Highlights from 2019. J Cardiothorac Vasc Anesth 2020; 34:1406-1415. [DOI: 10.1053/j.jvca.2020.01.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 01/30/2020] [Indexed: 12/24/2022]
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Cronin B, Dalia A, Sandoval K, Birgersdotter-Green U, Sherer E, Essandoh MK. Perioperative Interrogation of Biotronik Cardiovascular Implantable Electronic Devices: A Guide for Anesthesiologists. J Cardiothorac Vasc Anesth 2019; 33:3427-3436. [DOI: 10.1053/j.jvca.2019.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 02/27/2019] [Accepted: 03/04/2019] [Indexed: 11/11/2022]
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Essandoh M, Holecko J, Warsame I, Papadimos TJ. Predictors of Intensive Care Unit Admission After Transvenous Lead Extraction: A Plea for a Risk Scoring System. J Cardiothorac Vasc Anesth 2019; 33:1852-1854. [DOI: 10.1053/j.jvca.2019.02.047] [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: 02/24/2019] [Accepted: 02/26/2019] [Indexed: 11/11/2022]
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Farraha M, Kumar S, Chong J, Cho HC, Kizana E. Gene Therapy Approaches to Biological Pacemakers. J Cardiovasc Dev Dis 2018; 5:jcdd5040050. [PMID: 30347716 PMCID: PMC6306875 DOI: 10.3390/jcdd5040050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 01/01/2023] Open
Abstract
Bradycardia arising from pacemaker dysfunction can be debilitating and life threatening. Electronic pacemakers serve as effective treatment options for pacemaker dysfunction. They however present their own limitations and complications. This has motivated research into discovering more effective and innovative ways to treat pacemaker dysfunction. Gene therapy is being explored for its potential to treat various cardiac conditions including cardiac arrhythmias. Gene transfer vectors with increasing transduction efficiency and biosafety have been developed and trialed for cardiovascular disease treatment. With an improved understanding of the molecular mechanisms driving pacemaker development, several gene therapy targets have been identified to generate the phenotypic changes required to correct pacemaker dysfunction. This review will discuss the gene therapy vectors in use today along with methods for their delivery. Furthermore, it will evaluate several gene therapy strategies attempting to restore biological pacing, having the potential to emerge as viable therapies for pacemaker dysfunction.
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Affiliation(s)
- Melad Farraha
- Centre for Heart Research, the Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW 2145, Australia.
- Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia.
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Westmead, NSW 2145, Australia.
| | - James Chong
- Centre for Heart Research, the Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW 2145, Australia.
- Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia.
- Department of Cardiology, Westmead Hospital, Westmead, NSW 2145, Australia.
| | - Hee Cheol Cho
- Departments of Pediatrics and Biomedical Engineering, Emory University, Atlanta, GA 30322, USA.
| | - Eddy Kizana
- Centre for Heart Research, the Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW 2145, Australia.
- Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia.
- Department of Cardiology, Westmead Hospital, Westmead, NSW 2145, Australia.
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Evans AS, Weiner M, Jain A, Patel PA, Jayaraman AL, Townsley MM, Shah R, Gutsche JT, Renew JR, Ha B, Martin AK, Linganna R, Leong R, Bhatt HV, Garcia H, Feduska E, Shaefi S, Feinman JW, Eden C, Weiss SJ, Silvay G, Augoustides JG, Ramakrishna H. The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights from 2018. J Cardiothorac Vasc Anesth 2018; 33:2-11. [PMID: 30472017 DOI: 10.1053/j.jvca.2018.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Indexed: 01/28/2023]
Affiliation(s)
- Adam S Evans
- Anesthesia Associates of Morristown, Morristown, NJ
| | - Menachem Weiner
- Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | - Ankit Jain
- Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta University, Augusta, GA
| | - Prakash A Patel
- Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Arun L Jayaraman
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Scottsdale, AZ
| | - Mathew M Townsley
- Anesthesiology and Perioperative Medicine, School of Medicine, University of Alabama, Birmingham, AL
| | - Ronak Shah
- Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jacob T Gutsche
- Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - J Ross Renew
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Bao Ha
- Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Archer K Martin
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Regina Linganna
- Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ron Leong
- Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Himani V Bhatt
- Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | - Harry Garcia
- Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Eric Feduska
- Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Shahzad Shaefi
- Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA
| | - Jared W Feinman
- Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Caroline Eden
- Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | - Stuart J Weiss
- Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - George Silvay
- Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | - John G Augoustides
- Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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Neubauer H, Wellmann M, Herzog-Niescery J, Wutzler A, Weber TP, Mügge A, Vogelsang H. Comparison of perioperative strategies in ICD patients: The perioperative ICD management study (PIM study). PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1536-1542. [PMID: 30264871 DOI: 10.1111/pace.13514] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 09/01/2018] [Accepted: 09/13/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The prevalence of patients with implanted cardioverter defibrillators (ICDs) and the frequency of surgery on these patients are steadily on the rise. Guidelines recommend preoperative ICD reprogramming, although this is sometimes difficult in clinical practice. Placing a magnet on the ICD is a practical alternative and even no inactivation is possible in selected cases. METHODS In this prospective observational study, we compared different perioperative ICD management strategies depending on the location of the surgery and the type of electrocautery used. Patients undergoing surgery above the umbilicus with monopolar electrocautery had their ICD therapy inactivated by reprogramming. When surgery below the navel or surgery above the navel with bipolar electrocautery was completed, ICD inactivation was performed using a magnet. No inactivation was performed on patients undergoing lower extremity surgery with bipolar electrocautery. Only ICD patients who were not pacemaker dependent were enrolled. After surgery, the ICDs were assessed regarding documented arrhythmias and parameters. RESULTS Out of 101 patients included in this study, the ICD was preoperatively reprogrammed in 42 patients (41.6%), a magnet was used on 45 patients (44.5%), and ICDs were not deactivated at all in 14 patients (13.9%). No intraoperative electromagnetic interference was detected. Postoperative ICD analysis demonstrated no changes of preset parameters. CONCLUSIONS All three tested ICD management strategies were proved safe in this study. Keeping the location of surgery and the type of electrocautery in mind, an intraoperative magnet or even no ICD deactivation at all could be feasible alternatives in surgery on patients with ICDs.
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Affiliation(s)
- Horst Neubauer
- Cardiovascular Center, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Malte Wellmann
- Cardiovascular Center, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Jennifer Herzog-Niescery
- Department of Anaesthesiology and Intensive Care Medicine, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Alexander Wutzler
- Cardiovascular Center, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Thomas Peter Weber
- Department of Anaesthesiology and Intensive Care Medicine, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Andreas Mügge
- Cardiovascular Center, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Heike Vogelsang
- Department of Anaesthesiology and Intensive Care Medicine, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
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