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Li T, Marashly Q, Kim JA, Li N, Chelu MG. Cardiac conduction diseases: understanding the molecular mechanisms to uncover targets for future treatments. Expert Opin Ther Targets 2024:1-16. [PMID: 38700451 DOI: 10.1080/14728222.2024.2351501] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 05/01/2024] [Indexed: 05/05/2024]
Abstract
INTRODUCTION The cardiac conduction system (CCS) is crucial for maintaining adequate cardiac frequency at rest and modulation during exercise. Furthermore, the atrioventricular node and His-Purkinje system are essential for maintaining atrioventricular and interventricular synchrony and consequently maintaining an adequate cardiac output. AREAS COVERED In this review article, we examine the anatomy, physiology, and pathophysiology of the CCS. We then discuss in detail the most common genetic mutations and the molecular mechanisms of cardiac conduction disease (CCD) and provide our perspectives on future research and therapeutic opportunities in this field. EXPERT OPINION Significant advancement has been made in understanding the molecular mechanisms of CCD, including the recognition of the heterogeneous signaling at the subcellular levels of sinoatrial node, the involvement of inflammatory and autoimmune mechanisms, and the potential impact of epigenetic regulations on CCD. However, the current treatment of CCD manifested as bradycardia still relies primarily on cardiovascular implantable electronic devices (CIEDs). On the other hand, an If specific inhibitor was developed to treat inappropriate sinus tachycardia and sinus tachycardia in heart failure patients with reduced ejection fraction. More work is needed to translate current knowledge into pharmacologic or genetic interventions for the management of CCDs.
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Affiliation(s)
- Tingting Li
- Department of Medicine (Section of Cardiovascular Research), Baylor College of Medicine, Houston, TX, USA
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, USA
| | - Qussay Marashly
- Department of Cardiology, Montefiore Medical Center, New York, NY, USA
| | - Jitae A Kim
- Division of CardiovasculMedicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Na Li
- Department of Medicine (Section of Cardiovascular Research), Baylor College of Medicine, Houston, TX, USA
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, USA
| | - Mihail G Chelu
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, USA
- Department of Medicine (Division of Cardiology), Baylor College of Medicine, Houston, TX, USA
- Division of Cardiology, Baylor St. Luke's Medical Center, Houston, TX, USA
- Division of Cardiology, Texas Heart Institute, Houston, TX, USA
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2
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O'Leary E, Valente AM, Tadros T. Tempering the Storm of Arrhythmias in Adults With Congenital Heart Disease. J Am Heart Assoc 2024; 13:e9566. [PMID: 38629434 DOI: 10.1161/jaha.124.034536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/13/2024] [Indexed: 04/21/2024]
Affiliation(s)
- Edward O'Leary
- Department of Cardiology Boston Children's Hospital Boston MA USA
- Harvard Medical School Boston MA USA
| | - Anne Marie Valente
- Department of Cardiology Boston Children's Hospital Boston MA USA
- Department of Cardiology Medicine Division of Cardiology Brigham and Women's Hospital Boston MA USA
- Harvard Medical School Boston MA USA
| | - Thomas Tadros
- Department of Cardiology Medicine Division of Cardiology Brigham and Women's Hospital Boston MA USA
- Harvard Medical School Boston MA USA
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3
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Kuschyk J, Sattler K, Fastenrath F, Rudic B, Akin I. [Treatment with cardiac electronic implantable devices]. Herz 2024:10.1007/s00059-024-05246-1. [PMID: 38709278 DOI: 10.1007/s00059-024-05246-1] [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] [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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Aguayo JA, Cortez D. Atrial placement of Aveir-VR leadless pacemaker in a patient with complex cardiac anatomy. Indian Pacing Electrophysiol J 2024:S0972-6292(24)00048-2. [PMID: 38697395 DOI: 10.1016/j.ipej.2024.04.009] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 04/21/2024] [Accepted: 04/30/2024] [Indexed: 05/05/2024] Open
Abstract
Leadless pacemakers have provided new treatment modalities that can be especially useful in patients with complex cardiac anatomy and contraindications toward other pacemaker approaches. The Aveir™ single-chamber (VR) leadless pacemaker (LP) (Abbott Laboratories, Chicago, IL) is a recently approved device that can be placed in the right ventricle for patients with bradycardia. In this case, we present a novel use for the device through placement in the atrium to control atrial flutter in a patient with a hypoplastic right ventricle.
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Affiliation(s)
| | - Daniel Cortez
- Adult Congenital Cardiology, UC Davis Medical Center, Sacramento, USA.
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Balanescu DV, Ward RC, Amin H, Noseworthy PA, Asirvatham SJ, Friedman PA, Mulpuru SK. First-in-man report of transsubclavian venous implantation of the Aveir leadless cardiac pacing system. J Cardiovasc Electrophysiol 2024; 35:1041-1045. [PMID: 38462703 DOI: 10.1111/jce.16241] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/19/2024] [Accepted: 02/24/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Transsubclavian venous implantation of the Aveir leadless cardiac pacemaker (LCP) has not been previously reported. METHODS AND RESULTS Three cases of transsubclavian implantation of the Aveir LCP are reported. Two cases were postbilateral orthotopic lung transplant, without appropriate femoral or jugular access due to recent ECMO cannulation and jugular central venous catheters. In one case, there was strong patient preference for same-day discharge. Stability testing confirmed adequate fixation and electrical testing confirmed stable parameters in all cases. All patients tolerated the procedure well without significant immediate complications. CONCLUSIONS We demonstrate the feasibility of transsubclavian implantation of the Aveir LCP.
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Affiliation(s)
- Dinu V Balanescu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert C Ward
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hina Amin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Siva K Mulpuru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Hindricks G, Doshi R, Defaye P, Exner DV, Reddy VY, Knops RE, Canby R, Shoda M, Bongiorni MG, Neužil P, Callahan T, Sundaram S, Badie N, Ip JE. Six-month Electrical Performance of the First Dual-Chamber Leadless Pacemaker. Heart Rhythm 2024:S1547-5271(24)02525-6. [PMID: 38697271 DOI: 10.1016/j.hrthm.2024.04.091] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 04/23/2024] [Accepted: 04/26/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND The first dual-chamber leadless pacemaker (DC-LP) system consists of two separate atrial and ventricular devices that communicate to maintain synchronous atrioventricular pacing and sensing. The initial safety and efficacy were previously reported. OBJECTIVE Evaluate the chronic electrical performance of the DC-LP system. METHODS Patients meeting standard dual-chamber pacing indications were enrolled and implanted with the DC-LP system (Aveir DR, Abbott), including right atrial and ventricular helix-fixation LPs (ALP, VLP). Pacing capture threshold, sensed amplitude, and pacing impedance were collected using the device programmer at prespecified time points from 0-6 months post-implant. RESULTS De novo devices were successfully implanted in 381 patients with complete 6M data (62% male; age 69±14 years; weight 82±20 kg; 65% sinus node dysfunction, 30% AV block). ALPs were implanted predominantly in the right atrial appendage anterior base; VLPs primarily at the mid-to-apical right ventricular septum. From implant to 1 month, pacing capture thresholds (0.4 ms pulse width) improved in both ALPs (2.4±1.5 to 0.8±0.8 V, P<0.001) and VLPs (0.8±0.6 to 0.6±0.4 V, P<0.001). Sensed amplitudes improved in both ALPs (1.8±1.3 to 3.4±1.9 mV, P<0.001) and VLPs (8.8±4.0 to 11.7±4.2 mV, P<0.001). Impedances were stable in ALPs (334±68 to 329±52 Ω, P=0.17) and reduced in VLPs (789±351 to 646±190 Ω, P<0.001). Electrical measurements remained relatively stable from 1-6 months post-implant. No differences in electrical metrics were observed among ALP or VLP implant locations. CONCLUSION This first in-human evaluation of the new dual-chamber leadless pacemaker system demonstrated reliable electrical performance throughout the initial 6-month evaluation period.
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Affiliation(s)
| | - Rahul Doshi
- HonorHealth Cardiac Arrhythmia Group, Scottsdale, Arizona, USA
| | - Pascal Defaye
- Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | | | - Vivek Y Reddy
- Mount Sinai Fuster Heart Hospital, New York, NY, USA
| | | | - Robert Canby
- Texas Cardiac Arrhythmia Institute, Austin, Texas, USA
| | - Morio Shoda
- Tokyo Women's Medical University, Tokyo, Japan
| | | | | | | | | | | | - James E Ip
- Weill Cornell Medicine/ New York Presbyterian Hospital, New York, NY, USA.
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7
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Steinberg BA, Tandar A, Whitehead KJ. Helix-fixed leadless pacemaker implantation through a valve-in-valve tricuspid prosthesis via the femoral approach. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01814-x. [PMID: 38684636 DOI: 10.1007/s10840-024-01814-x] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/17/2024] [Indexed: 05/02/2024]
Abstract
Leadless pacemakers offer the opportunity to avoid transvenous hardware among patients with tricuspid valve prostheses. We present the first case of a helix-based fixation leadless pacemaker implanted through valve-in-valve tricuspid prostheses in a 43-year-old female with extensive prior cardiac history. At the time of presentation, epicardial pacing was no longer a viable option in the setting of pacemaker dependence. Placement of a helix-fixed, leadless right ventricular pacemaker was performed as a bridge to dual-chamber leadless pacing. This was safely and effectively performed and highlighted favorable procedural characteristics that included RV cavity dimensions and prosthesis type.
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Affiliation(s)
- Benjamin A Steinberg
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, 30 North Mario Capecchi Drive, 3 North, Salt Lake City, UT, 84112, USA.
| | - Anwar Tandar
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, 30 North Mario Capecchi Drive, 3 North, Salt Lake City, UT, 84112, USA
| | - Kevin J Whitehead
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, 30 North Mario Capecchi Drive, 3 North, Salt Lake City, UT, 84112, USA
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Vardas PE. Leadless and scarless pacing: towards symbiotic nanogenerators. Eur Heart J 2024; 45:1252-1254. [PMID: 38442144 DOI: 10.1093/eurheartj/ehae124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Affiliation(s)
- Panos E Vardas
- Medical School, University of Crete, Heraklion, Greece
- Biomedical Research Foundation Academy of Athens, Heart Sector, Hygeia Hospitals Group, HHG, 5, Erithrou Stavrou, Marousi, Athens 15123, Greece
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Król R, Karnaś M, Ziobro M, Bednarek J, Kollias G, Sohns C, Matusik PT. New Frontiers in Electrocardiography, Cardiac Arrhythmias, and Arrhythmogenic Disorders. J Clin Med 2024; 13:2047. [PMID: 38610811 PMCID: PMC11012577 DOI: 10.3390/jcm13072047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
In recent decades, diagnosing, risk-stratifying, and treating patients with primary electrical diseases, as well as heart rhythm disorders, have improved substantially [...].
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Affiliation(s)
- Rafał Król
- Department of Electrocardiology, St. John Paul II Hospital, Prądnicka 80, 31-202 Kraków, Poland
| | - Michał Karnaś
- Faculty of Medicine, Jagiellonian University Medical College, Św. Anny 12, 31-008 Kraków, Poland
| | - Michał Ziobro
- Faculty of Medicine, Jagiellonian University Medical College, Św. Anny 12, 31-008 Kraków, Poland
| | - Jacek Bednarek
- Department of Electrocardiology, St. John Paul II Hospital, Prądnicka 80, 31-202 Kraków, Poland
| | - Georgios Kollias
- Ordensklinikum Linz Elisabethinen, Fadingerstraße 1, 4020 Linz, Austria
| | - Christian Sohns
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Georgstr. 11, 32545 Bad Oeynhausen, Germany
| | - Paweł T. Matusik
- Department of Electrocardiology, St. John Paul II Hospital, Prądnicka 80, 31-202 Kraków, Poland
- Department of Electrocardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, Prądnicka 80, 31-202 Kraków, Poland
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10
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Ip JE. Postmortem examination of a dual-chamber leadless pacemaker system: Implications for chronic atrial leadless pacemaker removal. Heart Rhythm 2024; 21:488-489. [PMID: 38184058 DOI: 10.1016/j.hrthm.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 12/29/2023] [Accepted: 12/30/2023] [Indexed: 01/08/2024]
Affiliation(s)
- James E Ip
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York.
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11
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Wong T. Aveir VR leadless pacemaker: interview with professor Tom Wong. Expert Rev Cardiovasc Ther 2024; 22:149-151. [PMID: 38725191 DOI: 10.1080/14779072.2024.2340260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Affiliation(s)
- Tom Wong
- Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Cardiovascular Medicine and Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
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12
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Da Costa A, Benali K. Leadless pacemaker: The revolution is underway. Trends Cardiovasc Med 2024:S1050-1738(24)00029-X. [PMID: 38555030 DOI: 10.1016/j.tcm.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 03/17/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Antoine Da Costa
- From the Division of Cardiology, Jean Monnet University (ADC), Saint-Etienne, France.
| | - Karim Benali
- From the Division of Cardiology, Jean Monnet University (ADC), Saint-Etienne, France
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13
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Pinon P, Iserin L, Hachem F, Waldmann V. First in man right atrial appendage implantation of a Micra leadless pacemaker. J Cardiovasc Electrophysiol 2024. [PMID: 38534004 DOI: 10.1111/jce.16261] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/01/2024] [Accepted: 03/12/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION Pacemaker implantation can be challenging in patients with congenital heart disease. METHODS AND RESULTS In a patient with Ebstein disease and symptomatic sinus node dysfunction, despite multiple attempts, the Micra® pacemaker could not be implanted in the severely dilated right ventricle. In that context, and after iodine injection to confirm the appropriate location, the Micra® pacemaker was successfully implanted in the right appendage at the first attempt. CONCLUSION Despite the recent development of dedicated dual-chamber leadless pacemaker, to the best of our knowledge, this case is the first off-label Micra® implantation in a right appendage.
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Affiliation(s)
- Pauline Pinon
- Electrophysiology Unit, European Georges Pompidou Hospital, Paris, France
- Adult Congenital Heart Disease Unit, European Georges Pompidou Hospital, Paris, France
| | - Laurence Iserin
- Adult Congenital Heart Disease Unit, European Georges Pompidou Hospital, Paris, France
| | - Fatma Hachem
- Imaging Unit, European Georges Pompidou Hospital, Paris, France
| | - Victor Waldmann
- Electrophysiology Unit, European Georges Pompidou Hospital, Paris, France
- Adult Congenital Heart Disease Unit, European Georges Pompidou Hospital, Paris, France
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Beccarino N, Saleh M, Epstein LM. Leadless pacemakers: Where are we? Trends Cardiovasc Med 2024:S1050-1738(24)00018-5. [PMID: 38522582 DOI: 10.1016/j.tcm.2024.03.001] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 03/10/2024] [Accepted: 03/10/2024] [Indexed: 03/26/2024]
Abstract
Pacemakers have been the cornerstone of brady-arrhythmia management since the mid-20th century. Despite the widespread use and success of traditional transvenous pacemakers, they are associated with an estimated 15 % complication rate at three years. Driven by the advantages over traditional transvenous pacemakers including a lack of transvenous leads, resistance to infection, and ease of implantation, the number of leadless pacemakers placed annually in the United States has dramatically increased since their initial approval. While current iterations of leadless pacemakers lack the versatility offered by transvenous devices, recent advances in leadless pacing offer an increasingly diverse range of therapeutic options. This review will discuss the past, present, and future emerging technologies, and strategies in leadless pacing.
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Affiliation(s)
- Nicholas Beccarino
- Department of Cardiology/Cardiac Surgery, Northwell Health. Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset 11030, NY, United States.
| | - Moussa Saleh
- Department of Cardiology/Cardiac Surgery, Northwell Health. Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset 11030, NY, United States
| | - Laurence M Epstein
- Department of Cardiology/Cardiac Surgery, Northwell Health. Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset 11030, NY, United States
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15
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Kakarla J, Nair K. The leadless pacemaker in ACHD - Cautiously optimistic. Indian Pacing Electrophysiol J 2024; 24:63-67. [PMID: 38499085 PMCID: PMC11010445 DOI: 10.1016/j.ipej.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Affiliation(s)
- Jayant Kakarla
- University Health Network, Peter Munk Cardiac Centre, and University of Toronto, Toronto, Ontario, Canada
| | - Krishnakumar Nair
- University Health Network, Peter Munk Cardiac Centre, and University of Toronto, Toronto, Ontario, Canada.
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16
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Rahmat ZS, Cortez D. Retrievable leadless pacemakers (Aveir VR) may be beneficial in adult patients with congenital heart disease. Indian Pacing Electrophysiol J 2024; 24:57-62. [PMID: 38272181 PMCID: PMC11010452 DOI: 10.1016/j.ipej.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/31/2023] [Accepted: 01/23/2024] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION Congenital heart disease may present in up to 1.6 % of newborns. Given high burden of pacing need in adult patients with repaired congenital heart disease and availability of different pacing options, more information on outcomes of newer pacemaker types are needed. Retrievable leadless pacemaker implants in adult congenital patients have not been described. METHODS Retrospective review of three Aveir (Abbott) retrievable leadless pacemaker implants were reviewed at the UC Davis Medical Center. All patients underwent implant via femoral access. RESULTS All patients had one deployment only, after mapping prior. No complications occurred. Implant thresholds were 0.5 V (V) @0.2msilliseconds (ms) for patients 1 and 2 and 1 V @0.4 ms for patient 3. With impedances between 500 and 1290 Ω. Sensing was 5.5-8 mV (mV). Follow-up occurred up to one year (for two patients) with similar values overall. The predicted longevities of each device were between 22.6 and >25 years. CONCLUSION Safety and short-mid-term parameters of retrievable leadless pacemaker implantation is reported in three patients with adult congenital heart disease.
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Affiliation(s)
- Zainab Syyeda Rahmat
- Department of Electrophysiology, UC Davis Medical Center, USA; Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Pakistan
| | - Daniel Cortez
- Department of Electrophysiology, UC Davis Medical Center, USA.
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17
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Linde C. Electrical therapies in heart failure: Evolving technologies and indications. Presse Med 2024; 53:104192. [PMID: 37898311 DOI: 10.1016/j.lpm.2023.104192] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/06/2023] [Indexed: 10/30/2023] Open
Abstract
Device therapy for heart failure has rapidly evolved over 2 decades. The knowledge of indications, assessment lead and device technology has expanded to include CRT, leadless pacing and conduction system pacing such as His bundle and left bundle branch area pacing. But there is still a lack of evidence for these new technologies as well as for common indications such as atrial fibrillation and upgrading from a previous device. The role of personalized medicine will become increasingly important when selecting candidates for CRT, primary preventive ICD ablation procedures and emerging new devices such as cardiac contractility modulation (CCM). Rapidity of therapy is associated with outcome which will be a challenge. If properly implemented devices and drugs will have a large positive affect of HF outcomes.
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Affiliation(s)
- Cecilia Linde
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Karolinska Universitetssjukhuset, Stockholm, Sweden.
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18
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Tanabe K, Gilliland S. Perioperative Considerations for Modern Leadless Pacemakers. Semin Cardiothorac Vasc Anesth 2024; 28:38-46. [PMID: 38284295 DOI: 10.1177/10892532241230368] [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] [Indexed: 01/30/2024]
Abstract
Since their initial approval by the Food and Drug Administration in 2016, leadless pacemakers have become increasingly prevalent. This growth has been driven by an improved adverse effect profile when compared to traditional pacemakers, including lower rates of infection, as well as eliminated risk of pocket hematoma and lead complications. More recently, technology enabling leadless synchronized atrioventricular pacing in patients with atrioventricular block has vastly expanded the indications for these devices. Anesthesiologists will increasingly be relied upon to safely care for patients with leadless pacemakers undergoing non-electrophysiology procedures and surgery. This article provides an overview of the technology, evidence base, current indications, and unique perioperative considerations for leadless pacemakers.
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Affiliation(s)
- Kenji Tanabe
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Samuel Gilliland
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA
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Haines D, Kertai MD, Abrams B, Huang J. Understanding Physiology and Using Technology to Care for Challenging Patients. Semin Cardiothorac Vasc Anesth 2024; 28:5-7. [PMID: 38378200 DOI: 10.1177/10892532241233106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Daniel Haines
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA
| | - Miklos D Kertai
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Benjamin Abrams
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jiapeng Huang
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA
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20
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Knorr D, Bandorski D, Bogossian H, Iliodromitis K, Schiedat F, Karosiene Z, Mijic D, Lemke B, Seyfarth M, Voß S, Knippschild S, Aweimer A, Zarse M, Kloppe A, Botsios S. Cephalic Vein Cutdown Is Superior to Subclavian Puncture as Venous Access for Patients with Cardiac Implantable Devices after Long-Term Follow-Up. J Clin Med 2024; 13:1044. [PMID: 38398357 PMCID: PMC10888737 DOI: 10.3390/jcm13041044] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Cephalic vein cutdown (CVC) and subclavian vein puncture (SVP) are the most commonly used access sites for transvenous lead placement of cardiac implantable electronic devices (CIEDs). Limited knowledge exists about the long-term patency of the vascular lumen housing the leads. METHODS Among the 2703 patients who underwent CIED procedures between 2005 and 2013, we evaluated the phlebographies of 162 patients scheduled for an elective CIED replacement (median of 6.4 years after the first operation). The phlebographies were divided into four stenosis types: Type I = 0%, Type II = 1-69%, Type III = 70-99%, and Type IV = occlusion. Due to the fact that no standardized stenosis categorization exists, experienced physicians in consensus with the involved team made the applied distribution. The primary endpoint was the occurrence of stenosis Type III or IV in the CVC group and in the SVP group. RESULTS In total, 162 patients with venography were enrolled in this study. The prevalence of high-degree stenosis was significantly lower in the CVC group (7/89, 7.8%) than in the SVP group (15/73, 20.5%, p = 0.023). In the CVC group, venographies showed a lower median stenosis (33%) than in the SVP group (median 42%). CONCLUSIONS The present study showed that the long-term patency of the subclavian vein is higher after CVC than after SVP for venous access in patients with CIED.
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Affiliation(s)
- Dario Knorr
- Department of Cardiology, University Witten/Herdecke, 58455 Witten, Germany; (D.K.); (K.I.); (M.S.); (M.Z.); (S.B.)
| | - Dirk Bandorski
- Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary;
| | - Harilaos Bogossian
- Department of Cardiology, University Witten/Herdecke, 58455 Witten, Germany; (D.K.); (K.I.); (M.S.); (M.Z.); (S.B.)
- Cardiology and Rhythmology, Ev. Krankenhaus Hagen, 58135 Hagen, Germany
| | - Konstantinos Iliodromitis
- Department of Cardiology, University Witten/Herdecke, 58455 Witten, Germany; (D.K.); (K.I.); (M.S.); (M.Z.); (S.B.)
- Cardiology and Rhythmology, Ev. Krankenhaus Hagen, 58135 Hagen, Germany
| | - Fabian Schiedat
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, 44789 Bochum, Germany; (F.S.); (A.A.); (A.K.)
- Department of Cardiology and Angiology, Marienhospital Gelsenkirchen, 45886 Gelsenkirchen, Germany
| | - Zana Karosiene
- Department of Cardiology, Elektrophysiology and Angiology, Klinikum Lüdenscheid, 58515 Luedenscheid, Germany; (Z.K.); (D.M.); (B.L.)
| | - Dejan Mijic
- Department of Cardiology, Elektrophysiology and Angiology, Klinikum Lüdenscheid, 58515 Luedenscheid, Germany; (Z.K.); (D.M.); (B.L.)
| | - Bernd Lemke
- Department of Cardiology, Elektrophysiology and Angiology, Klinikum Lüdenscheid, 58515 Luedenscheid, Germany; (Z.K.); (D.M.); (B.L.)
| | - Melchior Seyfarth
- Department of Cardiology, University Witten/Herdecke, 58455 Witten, Germany; (D.K.); (K.I.); (M.S.); (M.Z.); (S.B.)
- Department of Cardiology, Helios Klinikum Wuppertal, 42283 Wuppertal, Germany
| | - Sabrina Voß
- Faculty of Health, Institute for Medical Biometry and Epidemiology, Witten/Herdecke University, 58455 Witten, Germany (S.K.)
| | - Stephanie Knippschild
- Faculty of Health, Institute for Medical Biometry and Epidemiology, Witten/Herdecke University, 58455 Witten, Germany (S.K.)
| | - Assem Aweimer
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, 44789 Bochum, Germany; (F.S.); (A.A.); (A.K.)
| | - Markus Zarse
- Department of Cardiology, University Witten/Herdecke, 58455 Witten, Germany; (D.K.); (K.I.); (M.S.); (M.Z.); (S.B.)
- Department of Cardiology, Elektrophysiology and Angiology, Klinikum Lüdenscheid, 58515 Luedenscheid, Germany; (Z.K.); (D.M.); (B.L.)
| | - Axel Kloppe
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, 44789 Bochum, Germany; (F.S.); (A.A.); (A.K.)
- Department of Cardiology and Angiology, Marienhospital Gelsenkirchen, 45886 Gelsenkirchen, Germany
| | - Spiridon Botsios
- Department of Cardiology, University Witten/Herdecke, 58455 Witten, Germany; (D.K.); (K.I.); (M.S.); (M.Z.); (S.B.)
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Affiliation(s)
- Sana M Al-Khatib
- From the Division of Cardiology and the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
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Bhatt HV, Fritz AV, Feinman JW, Subramani S, Malhotra AK, Townsley MM, Weiner MM, Sharma A, Teixeira MT, Lee J, Linganna RE, Waldron NH, Shapiro AB, Mckeon J, Hanada S, Ramakrishna H, Martin AK. The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights From 2023. J Cardiothorac Vasc Anesth 2024; 38:16-28. [PMID: 38040533 DOI: 10.1053/j.jvca.2023.10.030] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 10/21/2023] [Indexed: 12/03/2023]
Abstract
This special article is the 16th in an annual series for the Journal of Cardiothoracic and Vascular Anesthesia. The authors thank the editor-in-chief, Dr. Kaplan, and the editorial board for the opportunity to continue this series, namely the research highlights of the past year in the specialty of cardiothoracic and vascular anesthesiology. The major themes selected for 2023 are outlined in this introduction, and each highlight is reviewed in detail in the main article. The literature highlights in the specialty for 2023 begin with an update on perioperative rehabilitation in cardiothoracic surgery, with a focus on novel methods to best assess patients in the preoperative and postoperative periods, and the impact of rehabilitation on outcomes. The second major theme is focused on cardiac surgery, with the authors discussing new insights into inhaled pulmonary vasodilators, coronary revascularization surgery, and discussion of causes of coronary graft failure after surgery. The third theme is focused on cardiothoracic transplantation, with discussions focusing on bridge-to-transplantation strategies. The fourth theme is focused on mechanical circulatory support, with discussions focusing on both temporary and durable support. The fifth and final theme is an update on medical cardiology, with a focus on outcomes of invasive approaches to heart disease. The themes selected for this article are only a few of the diverse advances in the specialty during 2023. These highlights will inform the reader of key updates on various topics, leading to improved perioperative outcomes for patients with cardiothoracic and vascular disease.
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Affiliation(s)
- Himani V Bhatt
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ashley Virginia Fritz
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Jared W Feinman
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sudhakar Subramani
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Anita K Malhotra
- Division of Cardiothoracic Anesthesiology and Critical Care, Penn State Hershey Medical Center, Hershey, PA
| | - Matthew M Townsley
- Department of Anesthesiology and Perioperative Medicine, The University of Alabama at Birmingham School of Medicine, Birmingham, AL; Bruno Pediatric Heart Center, Children's of Alabama, Birmingham, AL
| | - Menachem M Weiner
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Archit Sharma
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Miguel T Teixeira
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Jennifer Lee
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Regina E Linganna
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Nathan H Waldron
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Anna Bovill Shapiro
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - John Mckeon
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Satoshi Hanada
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Archer Kilbourne Martin
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL.
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Tang JE, Awad H, Essandoh MK, Iyer MH. Dual-Chamber Leadless Pacing: The Future is Wireless. J Cardiothorac Vasc Anesth 2024; 38:1-3. [PMID: 38016818 DOI: 10.1053/j.jvca.2023.08.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 08/20/2023] [Indexed: 11/30/2023]
Affiliation(s)
- Jonathan E Tang
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH.
| | - Hamdy Awad
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Michael K Essandoh
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Manoj H Iyer
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
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Somani S, Rogers AJ. Advances in cardiac pacing with leadless pacemakers and conduction system pacing. Curr Opin Cardiol 2024; 39:1-5. [PMID: 37751365 DOI: 10.1097/hco.0000000000001092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
PURPOSE OF REVIEW The field of cardiac pacing has undergone significant evolution with the introduction and adoption of conduction system pacing (CSP) and leadless pacemakers (LLPMs). These innovations provide benefits over conventional pacing methods including avoiding lead related complications and achieving more physiological cardiac activation. This review critically assesses the latest advancements in CSP and LLPMs, including their benefits, challenges, and potential for future growth. RECENT FINDINGS CSP, especially of the left bundle branch area, enhances ventricular depolarization and cardiac mechanics. Recent studies show CSP to be favorable over traditional pacing in various patient populations, with an increase in its global adoption. Nevertheless, challenges related to lead placement and long-term maintenance persist. Meanwhile, LLPMs have emerged in response to complications from conventional pacemaker leads. Two main types, Aveir and Micra, have demonstrated improved outcomes and adoption over time. The incorporation of new technologies allows LLPMs to cater to broader patient groups, and their integration with CSP techniques offers exciting potential. SUMMARY The advancements in CSP and LLPMs present a transformative shift in cardiac pacing, with evidence pointing towards enhanced clinical outcomes and reduced complications. Future innovations and research are likely to further elevate the clinical impact of these technologies, ensuring improved patient care for those with conduction system disorders.
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Affiliation(s)
- Sulaiman Somani
- Department of Medicine
- Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Albert J Rogers
- Department of Medicine
- Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
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Sundaram S, Alyesh D, Walker L, Zipse MM. The 1 st implantation of an atrial only leadless pacemaker in right atrial appendage. J Interv Card Electrophysiol 2023; 66:1955-1958. [PMID: 37773557 DOI: 10.1007/s10840-023-01644-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/10/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Sri Sundaram
- Electrophysiology Section, South Denver Cardiology Associates, 1000 SouthPark Drive, Littleton, 80120, CO, USA.
| | - Daniel Alyesh
- Electrophysiology Section, South Denver Cardiology Associates, 1000 SouthPark Drive, Littleton, 80120, CO, USA
| | - Lisa Walker
- Department of Radiology, University of Colorado, Aurora, CO, USA
| | - Matthew M Zipse
- Division of Cardiology, University of Colorado, Aurora, CO, USA
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26
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Toon LT, Roberts PR. The Micra Transcatheter Pacing System: past, present and the future. Future Cardiol 2023; 19:735-746. [PMID: 38059460 DOI: 10.2217/fca-2023-0093] [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] [Indexed: 12/08/2023] Open
Abstract
Leadless permanent pacemakers represent an important innovation in cardiac device developments. Although transvenous permanent pacemakers have become indispensable in managing bradyarrhythmia and saving numerous lives, the use of transvenous systems comes with notable risks tied to intravascular leads and subcutaneous pockets. This drawback has spurred the creation of leadless cardiac pacemakers. Within this analysis, we compile existing clinical literature and proceed to evaluate the efficacy and safety of the Micra Transcatheter Pacing System. We also delve into the protocols for addressing a malfunctioning or end-of-life Micra as well as device extraction. Lastly, we explore prospects in this domain, such as the emergence of entirely leadless cardiac resynchronization therapy-defibrillator devices.
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Affiliation(s)
- Lin-Thiri Toon
- Cardiac Rhythm Management, University Hospital Southampton NHS Trust, Southampton, SO16 6YD, UK
- Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
| | - Paul R Roberts
- Cardiac Rhythm Management, University Hospital Southampton NHS Trust, Southampton, SO16 6YD, UK
- Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
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27
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Steinwender C, Blessberger H, Saleh K. [Leadless pacemakers : A "permanently" good solution?]. Herzschrittmacherther Elektrophysiol 2023; 34:272-277. [PMID: 37870606 PMCID: PMC10682231 DOI: 10.1007/s00399-023-00970-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 09/25/2023] [Indexed: 10/24/2023]
Abstract
The two currently available leadless pacemakers are highly effective and safe in the respective approval studies and also real-world registries. Compared to conventional pacemakers, there are lower long-term complication rates compared to conventional pacemaker systems (especially regarding lead dislocations and systemic infections). Increasing evidence (currently largely for the Micra™ [Medtronic, Minneapolis, MN, USA] device) shows that these advantages are also valid in the long-term. Leadless pacemakers can therefore be regarded a "permanently good solution", when appropriately implanted in suitable patients.
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Affiliation(s)
- Clemens Steinwender
- Klinik für Kardiologie und Internistische Intensivmedizin, Kepler Universitätsklinikum Linz, Medizinische Fakultät, Johannes Kepler Universität Linz, Linz, Österreich.
- Klinik für Kardiologie und Internistische Intensivmedizin, Klinisches Forschungsinstitut für Kardiovaskuläre und Metabolische Erkrankungen, Kepler Universitätsklinikum Linz, Medizinische Fakultät, Johannes Kepler Universität, Krankenhausstr. 9, 4021, Linz, Österreich.
| | - Hermann Blessberger
- Klinik für Kardiologie und Internistische Intensivmedizin, Kepler Universitätsklinikum Linz, Medizinische Fakultät, Johannes Kepler Universität Linz, Linz, Österreich
| | - Karim Saleh
- Klinik für Kardiologie und Internistische Intensivmedizin, Kepler Universitätsklinikum Linz, Medizinische Fakultät, Johannes Kepler Universität Linz, Linz, Österreich
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28
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Watanabe E. Short-Term Safety and Performance of a Single-Chamber Leadless Pacemaker. Circ J 2023; 87:1817-1819. [PMID: 37673646 DOI: 10.1253/circj.cj-23-0573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Affiliation(s)
- Eiichi Watanabe
- Department of Internal Medicine, Fujita Health University Bantane Hospital
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Xu F, Meng L, Lin H, Xu W, Guo H, Peng F. Systematic review of leadless pacemaker. Acta Cardiol 2023:1-11. [PMID: 37961771 DOI: 10.1080/00015385.2023.2276537] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023]
Abstract
Conventional pacing systems consist of a pacemaker and one or more leads threaded from the device pocket through veins into the heart conducting the pacing therapy to the desired pacing site. Although these devices are effective, approximately one in eight patients treated with these traditional pacing systems experiences a complication attributed to the pacemaker pocket or leads. With the technological advances in electronics, leadless pacemakers that small enough to implant within the heart were introduced. Leadless pacemakers have been developed to overcome many of the challenges of transvenous pacing including complications related to leads or pacemaker pockets. This review aims to provide an overview of advantages of leadless pacemaker, complications and limitations of leadless pacemaker, leadless pacemaker candidate, and future directions of this promising technology.
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Affiliation(s)
- Fukang Xu
- Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Liping Meng
- Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Hui Lin
- Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Weiyuan Xu
- Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Hangyuan Guo
- Shaoxing Wen li Medical College, Shaoxing, China
| | - Fang Peng
- Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
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Calvagna GM, Valsecchi S. Simultaneous subcutaneous implantable cardioverter-defibrillator and leadless pacemaker implantation for patients at high risk of infection: a retrospective case series report. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01684-9. [PMID: 37938506 DOI: 10.1007/s10840-023-01684-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/25/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND The subcutaneous implantable cardioverter defibrillator (S-ICD) and leadless pacemaker (LP) are alternative options for patients at high risk of infection requiring ICD and pacing therapy. In this analysis, we described the simultaneous implantation of S-ICD and LP in patients with high infectious risk. METHODS The study cohort comprised patients referred to our institution for ICD implantation due to high-risk factors of infection. RESULTS Between 2018 and 2022, 13 patients were referred, including 11 with infected ICD and 2 for first ICD implantation in the presence of high-risk factors. In cases of infected ICD, successful extraction was performed using a mechanical dilatation technique. Reimplantation was delayed until resolution of infection with antibiotic therapy. The devices were implanted during a single procedure, with S-ICD implantation following LP placement for verification of sensing adequacy through surface ECG screening. Suitable vectors for sensing during inhibited and ventricular pacing were identified in all patients. Defibrillation testing was effective, and no issues with double counting or undersensing were observed. The postoperative period was uneventful, and during a median follow-up of 35 months, no complications or infections were reported. The median ventricular pacing percentage was 5%, and a single inappropriate shock episode due to myopotential interference was reported and resolved by reprogramming the sensing vector. CONCLUSION Simultaneous implantation of S-ICD and LP is feasible and safe in patients at high risk of infection requiring both ICD and pacing therapy. This combined approach provides an effective solution for these patients.
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Gabriels JK, Schaller RD, Koss E, Rutkin BJ, Carrillo RG, Epstein LM. Lead management in patients undergoing percutaneous tricuspid valve replacement or repair: a 'heart team' approach. Europace 2023; 25:euad300. [PMID: 37772978 PMCID: PMC10629975 DOI: 10.1093/europace/euad300] [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: 08/03/2023] [Revised: 09/11/2023] [Accepted: 09/24/2023] [Indexed: 09/30/2023] Open
Abstract
Clinically significant tricuspid regurgitation (TR) has historically been managed with either medical therapy or surgical interventions. More recently, percutaneous trans-catheter tricuspid valve (TV) replacement and tricuspid trans-catheter edge-to-edge repair have emerged as alternative treatment modalities. Patients with cardiac implantable electronic devices (CIEDs) have an increased incidence of TR. Severe TR in this population can occur for multiple reasons but most often results from the interactions between the CIED lead and the TV apparatus. Management decisions in patients with CIED leads and clinically significant TR, who are undergoing evaluation for a percutaneous TV intervention, need careful consideration as a trans-venous lead extraction (TLE) may both worsen and improve TR severity. Furthermore, given the potential risks of 'jailing' a CIED lead at the time of a percutaneous TV intervention (lead fracture and risk of subsequent infections), consideration should be given to performing a TLE prior to a percutaneous TV intervention. The purpose of this 'state-of-the-art' review is to provide an overview of the causes of TR in patients with CIEDs, discuss the available therapeutic options for patients with TR and CIED leads, and advocate for including a lead management specialist as a member of the 'heart team' when making treatment decisions in patients TR and CIED leads.
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Affiliation(s)
- James K Gabriels
- Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset, NY, USA
| | - Robert D Schaller
- Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Elana Koss
- Department of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY, USA
| | - Bruce J Rutkin
- Department of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY, USA
| | | | - Laurence M Epstein
- Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset, NY, USA
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32
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Yiu KKH, Lau CP. Pacing induced tricuspid regurgitation: Does the lead matter? J Cardiovasc Electrophysiol 2023; 34:2243-2245. [PMID: 37870154 DOI: 10.1111/jce.16114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/24/2023]
Affiliation(s)
- Kelvin Kai-Hang Yiu
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
- Division of Cardiology, The University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - Chu-Pak Lau
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
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Katritsis DG, Calkins H. Septal and Conduction System Pacing. Arrhythm Electrophysiol Rev 2023; 12:e25. [PMID: 37860698 PMCID: PMC10583155 DOI: 10.15420/aer.2023.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/18/2023] [Indexed: 10/21/2023] Open
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Knops RE, Ganz L, Nevo JR. A Dual-Chamber Leadless Pacemaker. Reply. N Engl J Med 2023; 389:1056-1057. [PMID: 37703567 DOI: 10.1056/nejmc2308513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Affiliation(s)
- Reinoud E Knops
- Amsterdam University Medical Center, Amsterdam, the Netherlands
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35
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Yan CL, Chaparro S, Thakkar Rivera N. Leadless pacemaker in heart transplantation: a case report and literature review. BMJ Case Rep 2023; 16:e256054. [PMID: 37696609 PMCID: PMC10496664 DOI: 10.1136/bcr-2023-256054] [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] [Indexed: 09/13/2023] Open
Abstract
Our case demonstrates the safe and effective use of a leadless pacemaker in a heart transplant recipient. A man in his 60s with a history of heart transplantation with biatrial anastomosis 7 months prior presented to the emergency department after several syncopal episodes. Telemetry monitoring revealed a paroxysmal complete atrioventricular block. Given his immunocompromised state and prior dual chamber pacemaker extraction at the time of heart transplantation, the patient underwent successful implantation of a leadless pacemaker. Over the past 5 years since device implantation, the patient has not had any syncopal events nor has he had any device-related complications, such as infection.
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Affiliation(s)
| | - Sandra Chaparro
- Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Nina Thakkar Rivera
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Florida, Weston, Florida, USA
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36
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Narducci ML, Volpe M. The revolution of beat-to-beat wireless bidirectional communication between intra-cardiac devices. Eur Heart J 2023; 44:3215-3216. [PMID: 37525532 DOI: 10.1093/eurheartj/ehad457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Affiliation(s)
- Maria Lucia Narducci
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo A. Gemelli 8, Rome 00168, Italy
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, Sapienza University of Rome and IRCCS San Raffaele Roma, Via di Grottarossa 1035, Rome 00189, Italy
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Defaye P, Biffi M, El-Chami M, Boveda S, Glikson M, Piccini J, Vitolo M. Cardiac pacing and lead devices management: 25 years of research at EP Europace journal. Europace 2023; 25:euad202. [PMID: 37421338 PMCID: PMC10450798 DOI: 10.1093/europace/euad202] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 07/10/2023] Open
Abstract
AIMS Cardiac pacing represents a key element in the field of electrophysiology and the treatment of conduction diseases. Since the first issue published in 1999, EP Europace has significantly contributed to the development and dissemination of the research in this area. METHODS In the last 25 years, there has been a continuous improvement of technologies and a great expansion of clinical indications making the field of cardiac pacing a fertile ground for research still today. Pacemaker technology has rapidly evolved, from the first external devices with limited longevity, passing through conventional transvenous pacemakers to leadless devices. Constant innovations in pacemaker size, longevity, pacing mode, algorithms, and remote monitoring highlight that the fascinating and exciting journey of cardiac pacing is not over yet. CONCLUSION The aim of the present review is to provide the current 'state of the art' on cardiac pacing highlighting the most important contributions from the Journal in the field.
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Affiliation(s)
- Pascal Defaye
- Cardiology Department, University Hospital and Grenoble Alpes University, CS 10217, Grenoble Cedex 9, Grenoble 38043, France
| | - Mauro Biffi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Mikhael El-Chami
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Serge Boveda
- Clinique Pasteur, Heart Rhythm Department, Toulouse, France
| | - Michael Glikson
- Cardiology Department, Jesselson Integrated Heart Center Shaare Zedek Medical Center and Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Jonathan Piccini
- Duke University, Duke Clinical Research Institute, Durham, NC, USA
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
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38
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O’Connor M, Barbero U, Kramer DB, Lee A, Hua A, Ismail T, McCarthy KP, Niederer S, Rinaldi CA, Markides V, Clarke JRD, Babu-Narayan S, Ho SY, Wong T. Anatomic, histologic, and mechanical features of the right atrium: implications for leadless atrial pacemaker implantation. Europace 2023; 25:euad235. [PMID: 37523771 PMCID: PMC10473833 DOI: 10.1093/europace/euad235] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/26/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Leadless pacemakers (LPs) may mitigate the risk of lead failure and pocket infection related to conventional transvenous pacemakers. Atrial LPs are currently being investigated. However, the optimal and safest implant site is not known. OBJECTIVES We aimed to evaluate the right atrial (RA) anatomy and the adjacent structures using complementary analytic models [gross anatomy, cardiac magnetic resonance imaging (MRI), and computer simulation], to identify the optimal safest location to implant an atrial LP human. METHODS AND RESULTS Wall thickness and anatomic relationships of the RA were studied in 45 formalin-preserved human hearts. In vivo RA anatomy was assessed in 100 cardiac MRI scans. Finally, 3D collision modelling was undertaken assessing for mechanical device interaction. Three potential locations for an atrial LP were identified; the right atrial appendage (RAA) base, apex, and RA lateral wall. The RAA base had a wall thickness of 2.7 ± 1.6 mm, with a low incidence of collision in virtual implants. The anteromedial recess of the RAA apex had a wall thickness of only 1.3 ± 0.4 mm and minimal interaction in the collision modelling. The RA lateral wall thickness was 2.6 ± 0.9 mm but is in close proximity to the phrenic nerve and sinoatrial artery. CONCLUSIONS Based on anatomical review and 3D modelling, the best compromise for an atrial LP implantation may be the RAA base (low incidence of collision, relatively thick myocardial tissue, and without proximity to relevant epicardial structures); the anteromedial recess of the RAA apex and lateral wall are alternate sites. The mid-RAA, RA/superior vena cava junction, and septum appear to be sub-optimal fixation locations.
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Affiliation(s)
- Matthew O’Connor
- Department of Electrophysiology, Royal Brompton and Harefield Hospitals, Guy's and St Thomas’ NHS Foundation Trust, London SW3 6NP, UK
- Department of Electrophysiology, Auckland City Hospital, Auckland, New Zealand
| | - Umberto Barbero
- Cardiac Morphology Unit, Royal Brompton Hospital, London, UK
- Cardiology Unit, Santissima Annunziata Hospital, Savigliano ASL CN1, Italy
| | - Daniel B Kramer
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Angela Lee
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Alina Hua
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Tevfik Ismail
- Department of Cardiology, Guy’s and St Thomas’ Hospital Guy's and St Thomas’ NHS Foundation Trust, London, UK
- Department of Cardiology, Kings College Hospital, London SE5 9RS, UK
| | - Karen P McCarthy
- Cardiology Unit, Santissima Annunziata Hospital, Savigliano ASL CN1, Italy
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | | | - Vias Markides
- Department of Electrophysiology, Royal Brompton and Harefield Hospitals, Guy's and St Thomas’ NHS Foundation Trust, London SW3 6NP, UK
| | - John-Ross D Clarke
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sonya Babu-Narayan
- Department of Electrophysiology, Royal Brompton and Harefield Hospitals, Guy's and St Thomas’ NHS Foundation Trust, London SW3 6NP, UK
| | - Siew Yen Ho
- Cardiac Morphology Unit, Royal Brompton Hospital, London, UK
| | - Tom Wong
- Department of Electrophysiology, Royal Brompton and Harefield Hospitals, Guy's and St Thomas’ NHS Foundation Trust, London SW3 6NP, UK
- Department of Cardiology, Kings College Hospital, London SE5 9RS, UK
- Department of Cardiology, National Heart & Lung Institute, Imperial College London, London SW3 6LY, UK
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