1
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Deharo JC, Dreyfus J, Bongiorni MG, Burri H, Defaye P, Glikson M, Lever N, Mangieri A, Mondésert B, Nielsen JC, Shah M, Starck CT, Rao A, Leclercq C, Praz F. Management of patients with transvalvular right ventricular leads undergoing transcatheter tricuspid valve interventions: a scientific statement of the European Heart Rhythm Association and the European Association of Percutaneous Cardiovascular Interventions of the ESC endorsed by the Heart Rhythm Society, the Asian Pacific Heart Rhythm Society and the Canadian Heart Rhythm Society. Europace 2025; 27:euaf061. [PMID: 40163675 PMCID: PMC12077151 DOI: 10.1093/europace/euaf061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2025] [Revised: 03/04/2025] [Accepted: 03/14/2025] [Indexed: 04/02/2025] Open
Abstract
Up to one-third of patients referred for transcatheter tricuspid valve intervention (TTVI) have a transvalvular pacemaker (PPM) or implantable cardioverter-defibrillator (ICD) lead in place. Both the electrophysiology and interventional cardiology communities have been alerted to the complexity of decision-making in this situation due to potential interactions between the leads and the TTVI material, including the risk of jailing or damage to the leads. This document, commissioned by the European Heart Rhythm Association and the European Association of Percutaneous Cardiovascular Interventions of the ESC, reviews the scientific evidence to inform Heart Team discussions on the management of patients with a PPM or ICD who are scheduled for or have undergone TTVI.
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Affiliation(s)
- Jean-Claude Deharo
- Assistance Publique − Hôpitaux de Marseille, Centre Hospitalier Universitaire La Timone, Service de Cardiologie, 264 Rue Saint-Pierre, 13005 Marseille, France
- Aix Marseille Université, C2VN, 13005 Marseille, France, Bd Jean Moulin, 13005 Marseille, France
| | - Julien Dreyfus
- Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France
| | | | - Haran Burri
- Cardiac Pacing Unit, Cardiology Departement, University Hospital of Geneva, Geneva, Switzerland
| | - Pascal Defaye
- Cardiology Department, Université de Grenoble Alpes, INSERM, CHU Grenoble Alpes, LRB, 38000 Grenoble, France
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Nigel Lever
- Department of Cardiology, University of Auckland and Auckland City Hospital, Auckland, New Zealand
| | - Antonio Mangieri
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Blandine Mondésert
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Maully Shah
- Division of Pediatric Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christoph Thomas Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center of Charité, Berlin, Germany
| | - Archana Rao
- Department of Cardiology, Liverpool Heart & Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Christophe Leclercq
- Department of Cardiology, University of Rennes, CHU Rennes, lTSI-UMR1099, Rennes F-35000, France
| | - Fabien Praz
- Bern University Hospital, University of Bern, Bern, Switzerland
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2
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Serbetci YA, Jaryal S, Bhasin I, Elhassan M, Muslim A, Aquilini P, Reddy A L, Tavera D, Caicco AP, Rai M. Pacemakers in Modern Cardiology and Their Transition From Traditional to Leadless Models. Cureus 2025; 17:e82182. [PMID: 40364882 PMCID: PMC12074492 DOI: 10.7759/cureus.82182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2025] [Indexed: 05/15/2025] Open
Abstract
Cardiac rhythm disorders are a major subset of cardiovascular diseases and continue to pose significant global health challenges. Pacemakers remain central to their management, with evolving technologies offering improved therapeutic outcomes. This narrative review traces the progression of pacemaker technology from traditional cardiac pacemakers (TCPs) to leadless cardiac pacemakers (LCPs), emphasizing key differentiators such as implantation techniques, complication profiles, and long-term clinical performance. While TCPs have proven effective, they are associated with issues like lead-related complications, infections, and mechanical failures. In contrast, LCPs, which are implanted via minimally invasive transcatheter approaches and lack transvenous leads, significantly reduce these risks, resulting in improved patient satisfaction and fewer hospitalizations. Although limited to single-chamber pacing and higher initial costs, LCPs may prove cost-effective over time due to lower complication-related expenses. This review synthesizes current evidence on safety, efficacy, and patient outcomes and explores recent advancements, including multicomponent systems, energy-harvesting mechanisms, and biocompatible materials. Many of these innovations are in preclinical or early clinical stages but hold promise for broader applicability and long-term sustainability. Despite challenges, the trajectory of pacemaker technology underscores its potential to revolutionize cardiac care, driven by increasing clinical adoption of leadless systems, evolving regulatory approvals, and a growing emphasis on equitable access and personalized management.
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Affiliation(s)
| | - Shelly Jaryal
- Medicine, Medical University of the Americas (MUA), Charlestown, KNA
| | - Ira Bhasin
- Internal Medicine, Kasturba Medical College, Manipal, IND
| | | | - Amna Muslim
- Internal Medicine, Karachi Medical and Dental College, Karachi, PAK
| | - Parisa Aquilini
- Internal Medicine, The Royal College of Surgeons of Ireland, Dublin, IRL
| | | | - David Tavera
- Surgery, Jose Felix Patino's School of Medicine, Bogotá, COL
| | | | - Manju Rai
- Biotechnology, Shri Venkateshwara University, Gajraula, IND
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3
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Saleem-Talib S, Hoevenaars CPR, Molitor N, van Driel VJ, van der Heijden J, Breitenstein A, van Wessel H, van Schie MS, de Groot NMS, Ramanna H. Leadless pacing: a comprehensive review. Eur Heart J 2025:ehaf119. [PMID: 40105878 DOI: 10.1093/eurheartj/ehaf119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 11/29/2024] [Accepted: 02/10/2025] [Indexed: 03/20/2025] Open
Abstract
Over the past decade, leadless pacing has undergone a rapid evolution, resulting in multiple leadless pacemaker (LPM) devices that offer advancements such as atrioventricular synchronized pacing in VDD mode, atrial stimulation, dual-chamber pacing, and longer battery longevity. Studies comparing LPMs with transvenous pacemakers (TVPMs) show a lower rate of device-related complications with LPMs. In the near future, LPMs could be combined with other devices such as non-transvenous implantable cardioverter-defibrillators to provide anti-tachycardia pacing or bradycardia pacing. Future prospectives for leadless cardiac resynchronization therapy and leadless conduction system pacing are being investigated. As LPMs continue to improve, their applications are anticipated to expand further improving patient outcome, promising a bright future for leadless pacing. In this review, the past, present, and future of leadless pacing are discussed with a focus on cutting-edge implantation techniques, clinical outcomes, and modern advancements of LPMs.
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Affiliation(s)
| | | | - Nadine Molitor
- Electrophysiology, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Vincent J van Driel
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
| | | | - Alexander Breitenstein
- Electrophysiology, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Harry van Wessel
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Mathijs S van Schie
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Hemanth Ramanna
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
- University of Applied Sciences of The Hague, The Netherlands
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Chinitz L, Boveda S, Richard-Vitton R, Mela T. Applications of leadless pacing. Eur Heart J Suppl 2025; 27:ii8-ii13. [PMID: 40135097 PMCID: PMC11932089 DOI: 10.1093/eurheartjsupp/suae089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2025]
Abstract
Leadless pacemakers are being used with increased frequency due to improvements in the technologies, and the recognition of the substantial benefits over traditional transvenous devices. Current information shows a substantial reduction in morbidity with leadless devices which has resulted in a significant expansion in the indication for these devices. Patient selection now includes a younger population as well as those commonly excluded from consideration. Understanding these new applications will allow a larger group of patients to benefit from the significant advantages of leadless devices while not compromising quality and effective pacing. Further improvements in this technology will result in even more availability of these transformative devices.
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Affiliation(s)
- Larry Chinitz
- Cardiac Electrophysiology, NYU Langone Heart Rhythm Center, 530 1st Ave, HCC 6th floor, New York, NY 10016, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse 31300, France
- Brussels University VUB, Brussels, Belgium
| | | | - Theofanie Mela
- The Demoulas Center for Cardiac Arrhythmias, Mass General Brigham, Harvard Medical School, Boston, MA 02114, USA
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Wijesuriya N, Mehta V, De Vere F, Howell S, Mannakkara N, Sidhu B, Elliott M, Bosco P, Sanders P, Singh JP, Walsh MN, Niederer SA, Rinaldi CA. Left ventricular electrical delay predicts volumetric response to leadless cardiac resynchronization therapy. Heart Rhythm 2025; 22:357-364. [PMID: 39209224 DOI: 10.1016/j.hrthm.2024.08.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 08/08/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Leadless left ventricular (LV) endocardial pacing is an emerging cardiac resynchronization therapy (CRT) technology. Predictors of response to leadless CRT are poorly understood. Implanting the LV endocardial pacing electrode in sites with increased electrical latency (Q-LV) may improve response rates. OBJECTIVE The purpose of this study was to examine the association between Q-LV and echocardiographic remodeling response to leadless CRT delivered with the WiSE-CRT system. METHODS A post hoc analysis (n = 122) of the SOLVE-CRT trial examined the relationship between LV pacing site Q-LV with rate of left ventricular end-systolic volume (LVESV) reduction >15% at 6 months. Multivariable regression analysis, adjusting for age, sex, previous CRT nonresponse, cardiomyopathy etiology, QRS morphology, and QRS duration was performed, followed by receiver operating characteristic analysis and analysis of variance by Q-LV quartile. A subgroup analysis of the ischemic cardiomyopathy cohort was undertaken. RESULTS Complete Q-LV data were available for 122 of 153 patients (80%) in the active arms SOLVE-CRT. Overall, the 6-month LVESV response rate was 46%. Logistic regression identified Q-LV as an independent response predictor with borderline significance (adjusted odds ratio 1.015; P = .05). Analysis by Q-LV quartile demonstrated a significant improvement in response rate in quartile 4 (longest Q-LV 64%) compared to quartile 1 (shortest Q-LV 28%) (P <.01). This association was primarily driven by strong Q-LV-response correlation in patients with ischemic cardiomyopathy, demonstrated by subgroup logistic regression (adjusted odds ratio 1.034; P = .004). CONCLUSION Increased Q-LV was associated with improved reverse remodeling following leadless CRT. Targeting LV endocardial sites of high Q-LV may deliver additional benefit compared to empirical LV electrode implantation.
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Affiliation(s)
- Nadeev Wijesuriya
- King's College London, London, United Kingdom; Guy's and St. Thomas's NHS Foundation Trust, London, United Kingdom.
| | - Vishal Mehta
- King's College London, London, United Kingdom; Guy's and St. Thomas's NHS Foundation Trust, London, United Kingdom
| | - Felicity De Vere
- King's College London, London, United Kingdom; Guy's and St. Thomas's NHS Foundation Trust, London, United Kingdom
| | - Sandra Howell
- King's College London, London, United Kingdom; Guy's and St. Thomas's NHS Foundation Trust, London, United Kingdom
| | - Nilanka Mannakkara
- King's College London, London, United Kingdom; Guy's and St. Thomas's NHS Foundation Trust, London, United Kingdom
| | | | | | - Paolo Bosco
- Guy's and St. Thomas's NHS Foundation Trust, London, United Kingdom
| | | | - Jagmeet P Singh
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Steven A Niederer
- King's College London, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom; Alan Turing Institute, London, United Kingdom
| | - Christopher A Rinaldi
- King's College London, London, United Kingdom; Guy's and St. Thomas's NHS Foundation Trust, London, United Kingdom
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Trohman RG. Leadless Pacing: Current Status and Ongoing Developments. MICROMACHINES 2025; 16:89. [PMID: 39858744 PMCID: PMC11767621 DOI: 10.3390/mi16010089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Revised: 01/01/2025] [Accepted: 01/06/2025] [Indexed: 01/27/2025]
Abstract
Although significant strides have been made in cardiac pacing, the field is still evolving. While transvenous permanent pacing is highly effective in the management of bradyarrhythmias, it is not risk free and may result in significant morbidity and, rarely, mortality. Transvenous leads are often the weakest link in a pacing system. They may dislodge, fracture, or suffer breaches in their insulation. This review was undertaken to clarify leadless risks, benefits, and alternatives to transvenous cardiac pacing for bradyarrhythmias and heart failure management. In order to clarify the role(s) of leadless pacing, this narrative review was undertaken by searching MEDLINE to identify peer-reviewed clinical trials, randomized controlled trials, meta-analyses, and review articles, as well as other clinically relevant reports and studies. The search was limited to English-language reports published between 1932 and 2024. Leadless pacing was searched using the terms Micra™, Nanostim™, AVEIR™, single-chamber leadless pacemaker, dual-chamber leadless pacemaker, cardiac resynchronization therapy (CRT), cardiac physiological pacing (CPP) and biventricular pacing (BiV). Google and Google Scholar, as well as bibliographies of identified articles were also reviewed for additional references. The advantages and limitations of leadless pacing as well as options that are under investigation are discussed in detail.
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Affiliation(s)
- Richard G Trohman
- Section of Electrophysiology, Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, 1653 W. Congress, Chicago, IL 60612, USA
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7
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Ip JE. The complex decision of leadless cardiac pacing: How to choose among the expanding options? Heart Rhythm 2024; 21:1948-1952. [PMID: 38944319 DOI: 10.1016/j.hrthm.2024.06.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/01/2024]
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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Singh JP, Rinaldi CA, Sanders P, Kubo SH, James S, Niazi IK, Betts T, Butter C, Okabe T, Cunnane R, Aziz E, Biffi M, Zaidi A, Alison J, Defaye P, Aurrichio A, Gold MR, Lindenfeld J, Rogers T, Walsh MN. Leadless Ultrasound-Based Cardiac Resynchronization System in Heart Failure. JAMA Cardiol 2024; 9:871-879. [PMID: 39083254 PMCID: PMC11292567 DOI: 10.1001/jamacardio.2024.2050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 04/04/2024] [Indexed: 08/03/2024]
Abstract
Importance Approximately 40% of patients with heart failure (HF) who are eligible for cardiac resynchronization therapy (CRT) either fail to respond or are untreatable due to anatomical constraints. Objective To assess the safety and efficacy of a novel, leadless, left ventricular (LV) endocardial pacing system for patients at high risk for a CRT upgrade or whose coronary sinus (CS) lead placement/pacing with a conventional CRT system failed. Design, Setting, and Participants The SOLVE-CRT study was a prospective multicenter trial enrolling January 2018 through July 2022, with follow-up at 6 months. Data were analyzed from January 17, 2018, through February 15, 2023. The trial combined data from an initial randomized, double-blind study (n = 108) and a subsequent single-arm part (n = 75). It took place at 36 centers across Australia, Europe, and the US. Participants were nonresponders, previously untreatable (PU), or high-risk upgrades (HRU). All participants contributed to the safety analysis. The primary efficacy analysis (n = 100) included 75 PU-HRU patients from the single-arm part and 25 PU-HRU patients from the randomized treatment arm. Interventions Patients were implanted with the WiSE CRT System (EBR Systems) consisting of a leadless LV endocardial pacing electrode stimulated with ultrasound energy delivered by a subcutaneously implanted transmitter and battery. Main Outcomes and Measures The primary safety end point was freedom from type I complications. The primary efficacy end point was a reduction in mean LV end systolic volume (LVESV). Results The study included 183 participants; mean age was 68.1 (SD, 10.3) years and 141 were male (77%). The trial was terminated at an interim analysis for meeting prespecified stopping criteria. In the safety population, patients were either New York Heart Association Class II (34.6%) or III (65.4%). The primary efficacy end point was met with a 16.4% (95% CI, -21.0% to -11.7%) reduction in mean LVESV (P = .003). The primary safety end point was met with an 80.9% rate of freedom from type I complications (P < .001), which included 12 study device system events (6.6%), 5 vascular events (2.7%), 3 strokes (1.6%), and 7 cardiac perforations which mostly occurred early in the study (3.8%). Conclusions and Relevance The SOLVE-CRT study has demonstrated that leadless LV endocardial pacing with the WiSE CRT system is associated with a reduction in LVESV in patients with HF. This novel system may represent an alternative to conventional CRT implants in some HF patient populations. Trial Registration ClinicalTrials.gov Identifier: NCT0292203.
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Affiliation(s)
- Jagmeet P. Singh
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher A. Rinaldi
- St Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Kings College London, London, United Kingdom
| | - Prashanthan Sanders
- University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Simon James
- The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | | | - Timothy Betts
- Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Christian Butter
- Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, Germany
| | - Toshimasa Okabe
- The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Emad Aziz
- Rutgers-New Jersey Medical School, New Jersey
| | - Mauro Biffi
- Policlinico S. Orsola, Malpighi Bologna, Italy
| | - Amir Zaidi
- Manchester Heart Centre, Manchester, United Kingdom
| | | | - Pascal Defaye
- University Hospital and University Grenoble Alpes, Grenoble, France
| | - Angelo Aurrichio
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Michael R. Gold
- Cardiology Division, Medical University of South Carolina, Charleston, South Carolina
| | - JoAnn Lindenfeld
- Section of Heart Failure and Cardiac Transplantation, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee
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Wijesuriya N, Strocchi M, Elliott M, Mehta V, De Vere F, Howell S, Mannakkara N, Sidhu BS, Kwan J, Bosco P, Niederer SA, Rinaldi CA. Optimizing electrical efficacy of leadless cardiac resynchronization therapy and leadless left ventricular septal pacing: Insights on left and right ventricular activation from electrocardiographic imaging. Heart Rhythm O2 2024; 5:551-560. [PMID: 39263609 PMCID: PMC11385406 DOI: 10.1016/j.hroo.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024] Open
Abstract
Background Leadless cardiac resynchronization therapy (CRT) is an emerging heart failure treatment. An implanted electrode delivers lateral or septal endocardial left ventricular (LV) pacing (LVP) upon detection of a right ventricular (RV) pacing stimulus from a coimplanted device, thus generating biventricular pacing (BiVP). Electrical efficacy data regarding this therapy, particularly leadless LV septal pacing (LVSP) for potential conduction system capture, are limited. Objectives The purpose of this study was to evaluate the acute performance of leadless CRT using electrocardiographic imaging (ECGi) and assess the optimal pacing modality (OPM) of LVSP on the basis of RV and LV activation. Methods Ten WiSE-CRT recipients underwent an ECGi study testing: RV pacing, BiVP, LVP only, and LVP with an optimized atrioventricular delay (LV-OPT). BiV, LV, and RV activation times (shortest time taken to activate 90% of the ventricles [BIVAT-90], shortest time taken to activate 95% of the LV, and shortest time taken to activate 90% of the RV) plus LV and BiV dyssynchrony index (standard deviation of LV activation times and standard deviation of all activation times) were calculated from reconstructed epicardial electrograms. The individual OPM yielding the greatest improvement from baseline was determined. Results BiVP generated a 23.7% improvement in BiVAT-90 (P = .002). An improvement of 43.3% was observed at the OPM (P = .0001), primarily through reductions in shortest time taken to activate 90% of the RV. At the OPM, BiVAT-90 improved in patients with lateral (43.3%; P = .0001; n = 5) and septal (42.4%; P = .009; n = 5) LV implants. The OPM varied by individual. LVP and LV-OPT were mostly superior in patients with LVSP, and in those with sinus rhythm and left bundle branch block (n = 4). Conclusion Leadless CRT significantly improves acute ECGi-derived activation and dyssynchrony metrics. Using an individualized OPM improves efficacy in selected patients. Effective LVSP is feasible, with fusion pacing at LV-OPT mitigating the potential deleterious effects on RV activation.
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Affiliation(s)
- Nadeev Wijesuriya
- King's College London, London, United Kingdom
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Marina Strocchi
- King's College London, London, United Kingdom
- Imperial College London, London, United Kingdom
| | - Mark Elliott
- King's College London, London, United Kingdom
- Imperial College London, London, United Kingdom
| | - Vishal Mehta
- King's College London, London, United Kingdom
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Felicity De Vere
- King's College London, London, United Kingdom
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sandra Howell
- King's College London, London, United Kingdom
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Nilanka Mannakkara
- King's College London, London, United Kingdom
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Jane Kwan
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Paolo Bosco
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Steven A Niederer
- King's College London, London, United Kingdom
- Imperial College London, London, United Kingdom
- Alan Turing Institute, London, United Kingdom
| | - Christopher A Rinaldi
- King's College London, London, United Kingdom
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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10
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Park YS, Cha MJ, Cho MS, Kim J, Nam GB, Choi KJ. Triventricular pacing with leadless pacemaker combined with cardiac resynchronization therapy in severe heart failure. HeartRhythm Case Rep 2024; 10:537-540. [PMID: 39155904 PMCID: PMC11328587 DOI: 10.1016/j.hrcr.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2024] Open
Affiliation(s)
- Young-Sun Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Myung-Jin Cha
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Soo Cho
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jun Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Gi-Byoung Nam
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kee-Joon Choi
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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11
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Najjar SN, Bruno MA, Lam WW. Transient 2:1 Atrioventricular Block with Peri-Conduction System Pacing After Leadless Pacemaker Implantation. Tex Heart Inst J 2024; 51:e238268. [PMID: 38564374 PMCID: PMC11075511 DOI: 10.14503/thij-23-8268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
This report discusses a case of transient 2:1 atrioventricular block with conduction system pacing 4 hours after leadless right ventricular pacemaker implantation in a 19-year-old patient with a history of cardioinhibitory syncope and asystole cardiac arrest but without preexisting atrioventricular block. The atrioventricular block was resolved spontaneously. Pacing morphology was suggestive of right bundle branch pacing. Neither 2:1 atrioventricular block nor conduction system pacing has previously been a reported outcome of right ventricular leadless pacemaker implantation. The report demonstrates that conduction system pacing with leadless devices is achievable. Further study of techniques, limitations, and complications related to intentional right ventricular leadless conduction system pacing is warranted.
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Affiliation(s)
- Salim N. Najjar
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Michael A. Bruno
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, Texas
| | - Wilson W. Lam
- Department of Medicine, Baylor College of Medicine, Houston, Texas
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, Texas
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12
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Neuzil P, Petrů J, Šedivá L, Chovanec M, Šorf J, Funasako M. Retrieval and replacement feasibility of 7-year-old implanted leadless pacemaker with tines fixation. HeartRhythm Case Rep 2024; 10:2-5. [PMID: 38264113 PMCID: PMC10801068 DOI: 10.1016/j.hrcr.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Affiliation(s)
- Petr Neuzil
- Cardiology Department, Na Homolce Hospital, Prague, Czech Republic
| | - Jan Petrů
- Cardiology Department, Na Homolce Hospital, Prague, Czech Republic
| | - Lucie Šedivá
- Cardiology Department, Na Homolce Hospital, Prague, Czech Republic
| | - Milan Chovanec
- Cardiology Department, Na Homolce Hospital, Prague, Czech Republic
| | - Jan Šorf
- Medtronic Czechia, Prague, Czech Republic
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13
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Niazi I. Electrical Therapy for Heart Failure: The Year 2023 in Review. J Innov Card Rhythm Manag 2024; 15:5709-5712. [PMID: 38304089 PMCID: PMC10829410 DOI: 10.19102/icrm.2024.15018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Affiliation(s)
- Imran Niazi
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, University of Wisconsin School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
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14
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Clark BC, Berul CI. Emerging Technologies for the Smallest Patients. Card Electrophysiol Clin 2023; 15:505-513. [PMID: 37865523 DOI: 10.1016/j.ccep.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Pediatric and congenital heart disease patients may require cardiac implantable electronic device implantation, inclusive of pacemaker, ICD, and implantable cardiac monitor, for a variety of etiologies. While leads, generators, and monitors have decreased in size over the years, they remain less ideal for the smallest patients. The potential for a miniature pacemaker, fetal micropacemaker, improving leadless technology, and rechargeable devices creates hope that the development of pediatric-focused devices will increase. Further, alternative approaches that avoid the need for a transvenous or surgical approach may add more options to the toolbox for the pediatric and congenital electrophysiologist.
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Affiliation(s)
- Bradley C Clark
- Division of Pediatric Cardiology, Department of Pediatrics, Masonic Children's Hospital, University of Minnesota Medical School, 2450 Riverside Avenue South, AO-405, Minneapolis, MN 55454, USA.
| | - Charles I Berul
- Division of Cardiology, Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, 111 Michigan Avenue, NW, Washington, DC 20010, USA
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15
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Wijesuriya N, Mehta V, Vere FD, Howell S, Behar JM, Shute A, Lee M, Bosco P, Niederer SA, Rinaldi CA. Cost-effectiveness analysis of leadless cardiac resynchronization therapy. J Cardiovasc Electrophysiol 2023; 34:2590-2598. [PMID: 37814470 PMCID: PMC10946454 DOI: 10.1111/jce.16102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/11/2023] [Accepted: 09/30/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND The Wireless Stimulation Endocardially for CRT (WiSE-CRT) system is a novel technology used to treat patients with dyssynchronous heart failure (HF) by providing leadless cardiac resynchronization therapy (CRT). Observational studies have demonstrated its safety and efficacy profile, however, the treatment cost-effectiveness has not previously been examined. METHODS A cost-effectiveness evaluation of the WiSE-CRT System was performed using a cohort-based economic model adopting a "proportion in state" structure. In addition to the primary analysis, scenario analyses and sensitivity analyses were performed to test for uncertainty in input parameters. Outcomes were quantified in terms of quality-adjusted life year (QALY) differences. RESULTS The primary analysis demonstrated that treatment with the WiSE-CRT system is likely to be cost-effective over a lifetime horizon at a QALY reimbursement threshold of £20 000, with a net monetary benefit (NMB) of £3781 per QALY. Cost-effectiveness declines at time horizons shorter than 10 years. Sensitivity analyses demonstrated that average system battery life had the largest impact on potential cost-effectiveness. CONCLUSION Within the model limitations, these findings support the use of WiSE-CRT in indicated patients from an economic standpoint. However, improving battery technology should be prioritized to maximize cost-effectiveness in times when health services are under significant financial pressures.
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Affiliation(s)
- Nadeev Wijesuriya
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Department of CardiologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Vishal Mehta
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Department of CardiologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Felicity De Vere
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Department of CardiologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Sandra Howell
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Department of CardiologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Jonathan M. Behar
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Department of CardiologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | | | | | - Paolo Bosco
- Department of CardiologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Steven A. Niederer
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | - Christopher A. Rinaldi
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Department of CardiologyGuy's and St Thomas' NHS Foundation TrustLondonUK
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16
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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] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/13/2023] [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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17
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Mehlhorn D, Patel S, Verghese D, Azad H, Sharma D. Long-Term Outcome of the First Completely Leadless Cardiac Resynchronization Therapy in the United States. JACC Case Rep 2023; 24:102020. [PMID: 37869212 PMCID: PMC10589444 DOI: 10.1016/j.jaccas.2023.102020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 10/24/2023]
Abstract
Completely leadless cardiac resynchronization therapy is feasible with the combination of Micra AV pacemaker (Medtronic Inc) and WiSE-CRT (EBR Inc) systems. Several reports have highlighted this combination in Europe. This case report presents a 1- year follow-up the first reported concomitant use of the leadless systems in the United States. (Level of Difficulty: Advanced.).
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Affiliation(s)
| | - Sankalp Patel
- Naples Heart Institute (Rooney Heart), Naples, Florida, USA
| | | | | | - Dinesh Sharma
- Naples Heart Institute (Rooney Heart), Naples, Florida, USA
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18
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Ellenbogen KA, Auricchio A, Burri H, Gold MR, Leclercq C, Leyva F, Linde C, Jastrzebski M, Prinzen F, Vernooy K. The evolving state of cardiac resynchronization therapy and conduction system pacing: 25 years of research at EP Europace journal. Europace 2023; 25:euad168. [PMID: 37622580 PMCID: PMC10450796 DOI: 10.1093/europace/euad168] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 08/26/2023] Open
Abstract
Cardiac resynchronization therapy (CRT) was proposed in the 1990s as a new therapy for patients with heart failure and wide QRS with depressed left ventricular ejection fraction despite optimal medical treatment. This review is aimed first to describe the rationale and the physiologic effects of CRT. The journey of the landmark randomized trials leading to the adoption of CRT in the guidelines since 2005 is also reported showing the high level of evidence for CRT. Different alternative pacing modalities of CRT to conventional left ventricular pacing through the coronary sinus have been proposed to increase the response rate to CRT such as multisite pacing and endocardial pacing. A new emerging alternative technique to conventional biventricular pacing, conduction system pacing (CSP), is a promising therapy. The different modalities of CSP are described (Hirs pacing and left bundle branch area pacing). This new technique has to be evaluated in clinical randomized trials before implementation in the guidelines with a high level of evidence.
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Affiliation(s)
- Kenneth A Ellenbogen
- Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Angelo Auricchio
- Division of Cardiology, Università della Svizzera Italiana and Istituto Cardiocentro Ticino, Lugano, Switzerland
| | - Haran Burri
- Cardiac Pacing Unit, Cardiology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Michael R Gold
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | | | - Francisco Leyva
- Aston University, Birmingham NHS Trust at Queen Elizabeth Hospital, Birmingham, UK
| | - Cecilia Linde
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Marek Jastrzebski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
| | - Frits Prinzen
- Physiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC), Maastricht, the Netherlands
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19
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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: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [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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20
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Wijesuriya N, De Vere F, Mehta V, Niederer S, Rinaldi CA, Behar JM. Leadless Pacing: Therapy, Challenges and Novelties. Arrhythm Electrophysiol Rev 2023; 12:e09. [PMID: 37427300 PMCID: PMC10326662 DOI: 10.15420/aer.2022.41] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/15/2023] [Indexed: 07/11/2023] Open
Abstract
Leadless pacing is a rapidly growing field. Initially designed to provide right ventricular pacing for those who were contraindicated for conventional devices, the technology is growing to explore the potential benefit of avoiding long-term transvenous leads in any patient who requires pacing. In this review, we first examine the safety and performance of leadless pacing devices. We then review the evidence for their use in special populations, such as patients with high risk of device infection, patients on haemodialysis, and patients with vasovagal syncope who represent a younger population who may wish to avoid transvenous pacing. We also summarise the evidence for leadless cardiac resynchronisation therapy and conduction system pacing and discuss the challenges of managing issues, such as system revisions, end of battery life and extractions. Finally, we discuss future directions in the field, such as completely leadless cardiac resynchronisation therapy-defibrillator devices and whether leadless pacing has the potential to become a first-line therapy in the near future.
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Affiliation(s)
- Nadeev Wijesuriya
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Felicity De Vere
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Vishal Mehta
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Jonathan M Behar
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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21
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Malaczynska-Rajpold K, Elliot M, Wijesuriya N, Mehta V, Wong T, Rinaldi CA, Behar JM. Leadless Cardiac Pacing: New Horizons. Cardiol Ther 2023; 12:21-33. [PMID: 36417178 PMCID: PMC9986180 DOI: 10.1007/s40119-022-00288-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022] Open
Abstract
Since the introduction of transvenous cardiac pacing leads, pacemaker system design has remained similar for several decades. Progressive miniaturisation of electronic circuitry and batteries has enabled a smaller, single pacing unit comprising the intracardiac electrodes, generator and computer. This review explores the development of leadless pacing, the clinical trials comparing leadless to transvenous pacing in addition to the future developments of multi-chamber leadless pacing.
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Affiliation(s)
- Katarzyna Malaczynska-Rajpold
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1, UK
| | - Mark Elliot
- St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- Imaging Sciences and Biomedical Engineering, Kings College London, London, UK
| | - Nadeev Wijesuriya
- St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- Imaging Sciences and Biomedical Engineering, Kings College London, London, UK
| | - Vishal Mehta
- St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- Imaging Sciences and Biomedical Engineering, Kings College London, London, UK
| | - Tom Wong
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1, UK
| | - Christopher Aldo Rinaldi
- St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- Imaging Sciences and Biomedical Engineering, Kings College London, London, UK
| | - Jonathan M Behar
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1, UK.
- St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
- Imaging Sciences and Biomedical Engineering, Kings College London, London, UK.
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22
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Lancini D, Smith C, Elkhateeb O, Sapp J, Parkash R. Leadless Micra pacemaker implantation in patient with previous Senning procedure for dextro-transposition of the great arteries. Acta Cardiol 2023; 78:357-361. [PMID: 36803008 DOI: 10.1080/00015385.2023.2176043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Leadless pacemakers have been developed with key advantages over traditional transvenous pacemakers by substantially mitigating the risks of device infection and lead related complications, and providing an alternative pacing strategy in patients with barriers to superior venous access. The Medtronic Micra leadless pacing system is designed for implantation through a femoral venous approach across the tricuspid valve, via Nitinol tine fixation into the trabeculated subpulmonic right ventricle. Patients with surgically corrected dextro-transposition of the great arteries (d-TGA) have an increased risk of pacing requirement. There is limited published experience of implantation of leadless Micra pacemakers in this population, with key challenges relating to trans-baffle access, and deployment of the device into the less trabeculated subpulmonic left ventricle. Here we describe a case report of leadless Micra implantation in a 49 year old male with d-TGA and Senning procedure in childhood, who required pacing for symptomatic sinus node disease, with anatomic barriers to transvenous pacing. Micra implantation was successfully performed following careful consideration of patient anatomy, including the utilisation of 3D modelling to guide the implantation procedure.
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Affiliation(s)
- Daniel Lancini
- Department of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Corey Smith
- Department of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Osama Elkhateeb
- Department of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - John Sapp
- Department of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Ratika Parkash
- Department of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
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23
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Elliott MK, Strocchi M, Sieniewicz BJ, Sidhu B, Mehta V, Wijesuriya N, Behar JM, Thorpe A, Martic D, Wong T, Niederer S, Rinaldi CA. Biventricular endocardial pacing and left bundle branch area pacing for cardiac resynchronization: Mechanistic insights from electrocardiographic imaging, acute hemodynamic response, and magnetic resonance imaging. Heart Rhythm 2023; 20:207-216. [PMID: 36575808 DOI: 10.1016/j.hrthm.2022.10.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/13/2022] [Accepted: 10/21/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Biventricular endocardial pacing (BiV-endo) has demonstrated superior cardiac resynchronization compared to conventional biventricular epicardial pacing (BiV-epi). Left bundle branch area pacing (LBBAP) may also achieve effective cardiac resynchronization therapy (CRT). OBJECTIVE The purpose of this study was to compare the acute electrical and hemodynamic effects of BiV-epi, BiV-endo, and LBBAP delivered from the LV endocardium and to assess how myocardial scar affects response. METHODS Eleven patients with heart failure and indications for CRT underwent a temporary pacing study with electrocardiographic imaging (ECGi) and hemodynamic assessment. BiV-endo was delivered by stimulation of the left ventricular (LV) lateral wall, and LBBAP was delivered by stimulation of the LV septum, at the site of a Purkinje potential. LV activation time (LVAT-95), LV dyssynchrony index (LVDI), biventricular activation time (BIVAT-90), and biventricular dyssynchrony index (BIVDI) were calculated. Myocardial scar was assessed using magnetic resonance imaging (MRI). RESULTS The protocol was completed in 10 patients. Compared to BiV-epi (LVAT-95: 79.2 ± 13.1 ms; LVDI: 26.6 ± 3.4 ms) LV resynchronization was superior during BiV-endo (LVAT-95: 48.5 ± 14.9 ms; P = .001; LVDI: 16.6 ± 6.4 ms; P = .002) and LBBAP (LVAT-95: 48.9 ± 12.5 ms; P = .001; LVDI: 15.3 ± 3.4 ms; P = .001). Biventricular resynchronization was similarly superior during BiV-endo and LBBAP vs BiV-epi (BIVAT-90 and BIVDI; P <.05). The rate of acute hemodynamic responders was higher during BiV-endo (90%) and LBBAP (70%) vs BiV-epi (50%). The benefits of LBBAP (but not BiV-endo) on LV resynchronization were attenuated when septal scar was present in a subset of 8 patients who underwent MRI. CONCLUSION Our findings suggest superior electrical resynchronization and a higher proportion of acute hemodynamic responders during BiV-endo and LBBAP compared to BiV-epi. Electrical resynchronization was similar between BiV-endo and LBBAP; however, septal scar seemed to attenuate response to LBBAP.
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Affiliation(s)
- Mark K Elliott
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Marina Strocchi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Benjamin J Sieniewicz
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Baldeep Sidhu
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Vishal Mehta
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Nadeev Wijesuriya
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Jonathan M Behar
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Andrew Thorpe
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Dejana Martic
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Tom Wong
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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24
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Blank EA, El-Chami MF, Wenger NK. Leadless Pacemakers: State of the Art and Selection of the Ideal Candidate. Curr Cardiol Rev 2023; 19:43-50. [PMID: 36999695 PMCID: PMC10518884 DOI: 10.2174/1573403x19666230331094647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/17/2023] [Accepted: 01/24/2023] [Indexed: 04/01/2023] Open
Abstract
The field of cardiac pacing has been defined by constant development to provide efficacious, safe, and reliable therapy. Traditional pacing utilizes transvenous leads, which dwell in the venous system and place patients at risk for complications, including pneumothorax, bleeding, infection, vascular obstruction, and valvular compromise. Leadless pacemakers have been developed to overcome many of the challenges of transvenous pacing while providing safe and effective pacing therapy for an increasing population of patients. The Medtronic Micra transcatheter pacing system was approved by the FDA in April of 2016 and the Abbott Aveir pacemaker was approved in April of 2022. Several additional leadless pacemakers are in various stages of development and testing. There exists limited guidance on the selection of the ideal candidate for leadless pacemakers. Advantages of leadless pacemakers include decreased infection risk, overcoming limited vascular access, and avoidance of interaction with the tricuspid valve apparatus. Disadvantages of leadless pacemakers include right ventricular-only pacing, unclear lifecycle management, cost, perforation risk, and lack of integration with defibrillator systems. This review aims to provide an overview of the current state of the art of leadless pacemakers, currently approved systems, clinical trials and real-world evidence, considerations for patient selection, and future directions of this promising technology.
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Affiliation(s)
- Evan A. Blank
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Mikhael F. El-Chami
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Nanette K. Wenger
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
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25
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Elliott MK, Vergara P, Wijesuriya N, Mehta VS, Bosco P, Jacon P, Lee M, Taloni S, Niederer S, Alison J, Piot O, Roberts PR, Paisey J, Defaye P, Shute A, Rinaldi CA. Feasibility of leadless left ventricular septal pacing with the WiSE-CRT system to target the left bundle branch area: A porcine model and multicenter patient experience. Heart Rhythm 2022; 19:1974-1983. [PMID: 35940464 DOI: 10.1016/j.hrthm.2022.07.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 07/01/2022] [Accepted: 07/16/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The WiSE-CRT system delivers leadless endocardial left ventricular (LV) pacing to achieve cardiac resynchronization therapy. The electrode is conventionally placed on the lateral wall, but implanting on the LV septum may have advantages, including capture of the left bundle branch, and improved battery longevity owing to reduced distance from the transmitter. OBJECTIVE The purpose of this study was to assess the feasibility of leadless LV septal pacing via the WiSE-CRT system. METHODS Two pigs underwent electrode implantation on the LV septum with subsequent anatomical and histological examination. Eight patients underwent implantation of the WiSE-CRT system with deployment of the electrode on the LV septum via an interatrial transseptal approach. RESULTS Deployment of the electrode on the LV septum was successful in both animals. Histological examination demonstrated electrode tines in close proximity to Purkinje tissue. WiSE-CRT implantation with an LV septal electrode was successful in all patients. Biventricular capture was confirmed, with a significant reduction in QRS duration (187.1 ± 33.8 ms vs 149.5 ± 15.7 ms; P = .009). Temporary LV pacing achieved further QRS reduction (139.8 ± 12.4 ms), and in 4 patients the peak LV activation time in lead V5/V6 was <90 ms, suggesting left bundle branch capture. At early follow-up, the median LV pacing percentage was 98.5% and 5 patients (62.5%) improved symptomatically. The transmitter-to-electrode distance was lower than the distance to the lateral wall during acoustic window screening (8.8 ± 1.6 cm vs 11.9 ± 1.5 cm; P = .002). CONCLUSION Leadless LV septal pacing with the WiSE-CRT system to target the left bundle branch appears feasible. Further study is required to assess the efficacy and safety of this technique.
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Affiliation(s)
- Mark K Elliott
- Department of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Pasquale Vergara
- Arrhythmia Unit and Electrophysiology Laboratories, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nadeev Wijesuriya
- Department of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Vishal S Mehta
- Department of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Paolo Bosco
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Peggy Jacon
- Arrhythmias Unit, Grenoble Alpes University Hospital, Grenobles, France
| | | | | | - Steven Niederer
- Department of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | | | | | - Paul R Roberts
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - John Paisey
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Pascal Defaye
- Arrhythmias Unit, Grenoble Alpes University Hospital, Grenobles, France
| | | | - Christopher A Rinaldi
- Department of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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26
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Hua J, Kong Q, Chen Q. Alternative pacing strategies for optimal cardiac resynchronization therapy. Front Cardiovasc Med 2022; 9:923394. [PMID: 36237907 PMCID: PMC9551024 DOI: 10.3389/fcvm.2022.923394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/06/2022] [Indexed: 12/02/2022] Open
Abstract
Cardiac resynchronization therapy (CRT) via biventricular pacing (BVP) improves morbidity, mortality, and quality of life, especially in subsets of patients with impaired cardiac function and wide QRS. However, the rate of unsuccessful or complicated left ventricular (LV) lead placement through coronary sinus is 5-7%, and the rate of "CRT non-response" is approximately 30%. These reasons have pushed physicians and engineers to collaborate to overcome the challenges of LV lead implantation. Thus, various alternatives to BVP have been proposed to improve CRT effectiveness. His bundle pacing (HBP) has been increasingly used by activating the His-Purkinje system but is constrained by challenging implantation, low success rates, high and often unstable thresholds, and low perception. Therefore, the concept of pacing a specialized conduction system distal to the His bundle to bypass the block region was proposed. Multiple clinical studies have demonstrated that left bundle branch area pacing (LBBAP) has comparable electrical resynchronization with HBP but is superior in terms of simpler operation, higher success rates, lower and stable capture thresholds, and higher perception. Despite their well-demonstrated effectiveness, the transvenous lead-related complications remain major limitations. Recently, leadless LV pacing has been developed and demonstrated effective for these challenging patient cohorts. This article focuses on the current state and latest progress in HBP, LBBAP, and leadless LV pacing as alternatives for failed or non-responsive conventional CRT as well as their limits and prospects.
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Affiliation(s)
| | | | - Qi Chen
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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27
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Ibrahim R, Khoury A, El-Chami MF. Leadless Pacing: Where We Currently Stand and What the Future Holds. Curr Cardiol Rep 2022; 24:1233-1240. [PMID: 35951261 DOI: 10.1007/s11886-022-01752-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW Leadless pacemakers (LPs) are emerging as alternative cardiac implantable devices for the treatment of bradyarrhythmia. This article aims to review the data behind the safety and efficacy of these devices while highlighting their pros and cons. RECENT FINDINGS Prospective non-randomized studies and registries have found that LPs are associated with lower rate of device-related complications mainly driven by lower need for lead-related interventions as compared to traditional pacemakers. On the other hand, cardiac perforation appears to occur more frequently with LPs. LPs are associated with lower rate of device-related complications as compared to the traditional pacemakers. However, the rate of pericardial effusion is higher and is more severe. As we transition to multi-chamber LPs, it is important to ensure the safety and efficacy of these devices.
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Affiliation(s)
- Rand Ibrahim
- Department of Medicine, Division of Cardiology-Emory University School of Medicine, 12thFloor Medical Office Tower, 550 Peachtree Street NE, Atlanta, GA, 30308, USA
| | - Alexandre Khoury
- Universite St Joseph School of Medicine-Beirut Lebanon, Beirut, Lebanon
| | - Mikhael F El-Chami
- Department of Medicine, Division of Cardiology-Emory University School of Medicine, 12thFloor Medical Office Tower, 550 Peachtree Street NE, Atlanta, GA, 30308, USA.
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28
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Boersma LV, El-Chami M, Steinwender C, Lambiase P, Murgatroyd F, Mela T, Theuns DAMJ, Khelae SK, Kalil C, Zabala F, Stuehlinger M, Lenarczyk R, Clementy N, Tamirisa KP, Rinaldi CA, Knops R, Lau CP, Crozier I, Boveda S, Defaye P, Deharo JC, Botto GL, Vassilikos V, Oliveira MM, Tse HF, Figueroa J, Stambler BS, Guerra JM, Stiles M, Marques M. Practical considerations, indications, and future perspectives for leadless and extravascular cardiac implantable electronic devices: a position paper by EHRA/HRS/LAHRS/APHRS. Europace 2022; 24:1691-1708. [PMID: 35912932 DOI: 10.1093/europace/euac066] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lucas V Boersma
- Cardiology Department, St Antonius Hospital, Nieuwegein, The Netherlands.,Cardiology Department, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Mikhael El-Chami
- Medicine/Cardiology Department, Emory University, Atlanta, GA, USA
| | - Clemens Steinwender
- Department of Cardiology and Internal Intensive Care, Kepler University Hospital Linz, Krankenhausstraße 9, Linz, Austria
| | - Pier Lambiase
- Department of Cardiology, UCL & Barts Heart Centre, Institute of Cardiovascular Science, UCL, Barts Heart Centre, London, UK
| | | | - Theofania Mela
- Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Dominic A M J Theuns
- Erasmus MC, Cardiology, Clinical Electrophysiology, CA Rotterdam, The Netherlands
| | | | - Carlos Kalil
- Cardiology Department, Hospital São Francisco da Santa Casa de Misericórdia, Porto Alegre, Brazil
| | - Federico Zabala
- Electrophysiology Unit, Hospital San Martin de La Plata, Buenos Aires, Argentina
| | - Markus Stuehlinger
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Radoslaw Lenarczyk
- Department of Cardiology, Congenital Heart Disease and Electrotherapy, Medical University of Silesia, Silesian Center for Heart Disease, Curie-Sklodowska Str 9, 41-800 Zabrze, Poland
| | - Nicolas Clementy
- Cardiology Department, Centre Hospitalier Régional Universitaire de Tours, France
| | - Kamala P Tamirisa
- Cardiac Electrophysiology, Cardiac MRI, Texas Cardiac Arrhythmia Institute, 11970 N, Central Expressway, Dallas, TX, USA
| | | | - Reinoud Knops
- Cardiology Department, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Chu-Pak Lau
- Department of Medicine, Queen Mary Hospital, Suite 1303, Central Building, 1 Pedder Street, Central, Hong Kong
| | - Ian Crozier
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, 31076 Toulouse, France.,Universitair Ziekenhuis Brussel-VUB, Heart Rhythm Management Centre, Brussels, Belgium, and INSERM U970, 75908 Paris Cedex 15 France
| | - Pascal Defaye
- CHU Grenoble Alpes, Unite de Rythmologie Service De Cardiologie, CS10135, 38043 Grenoble Cedex 09, France
| | - Jean Claude Deharo
- Aix-Marseille Université, Faculté de Médecine, F-13385 Marseille, France.,Cardiology Department, Hospital de Santa Cruz, Lisbon, Portugal
| | | | - Vassilios Vassilikos
- Medical School, Aristotle University of Thessaloniki, Greece & Hippokrateio General Hospital, Thessaloniki, Greece
| | - Mario Martins Oliveira
- Department of Cardiology, Hospital Santa Marta, Rua Santa Marta, 1167-024 Lisbon, Portugal
| | - Hung Fat Tse
- The Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Hong Kong-Guangdong Stem Cell and Regenerative Medicine Research Centre, The University of Hong Kong and Guangzhou Institutes of Biomedicine and Health, Hong Kong SAR, China
| | - Jorge Figueroa
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Bruce S Stambler
- Unidad de Arritmias y Marcapasos, Sanatorio Allende, Obispo Oro 42, CP 5000, Córdoba, Argentina
| | - Jose M Guerra
- Piedmont Heart Institute, 275 Collier Road Northwest, Suite 500, Atlanta, GA 30309, USA
| | - Martin Stiles
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universidad Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Manlio Marques
- Waikato Clinical School, University of Auckland, Auckland, New Zealand.,National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico
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29
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Wijesuriya N, Elliott MK, Mehta V, Sidhu BS, Behar JM, Niederer S, Rinaldi CA. Leadless left ventricular endocardial pacing for cardiac resynchronization therapy: A systematic review and meta-analysis. Heart Rhythm 2022; 19:1176-1183. [PMID: 35189383 DOI: 10.1016/j.hrthm.2022.02.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/01/2022] [Accepted: 02/14/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Leadless left ventricular (LV) endocardial pacing to achieve cardiac resynchronization therapy (CRT) is a novel procedure for treatment of patients with dyssynchronous heart failure. Current evidence is limited to observational studies with small patient numbers. OBJECTIVE The purpose of this systematic review and meta-analysis was to assess the safety and efficacy of leadless LV endocardial pacing. METHODS A literature search was conducted through PubMed, EMBASE, and Cochrane databases. Mean differences (MDs) in New York Heart Association (NYHA) functional class and LV ejection fraction (LVEF) from baseline to 6 months postprocedure were combined using a random effects model. Heterogeneity was evaluated using the Cochrane Q test, I2, meta-regression, and sensitivity analysis. Funnel plots were constructed to detect publication bias. RESULTS Five studies with 181 patients were included in the final analysis. Procedural success rate was 90.6%. Clinical response rate was 63%, with mean improvement in NYHA functional class of 0.43 (MD -0.43; 95% confidence interval [CI] -0.76 to -0.1; P = .01), with high heterogeneity (P <.001; I2 = 81.1%). There was a mean increase in LVEF of 6.3% (MD 6.3; 95% CI 4.35-8.19; P <.001, with low heterogeneity (P = 0.84; I2 <0.001%). The echocardiographic response rate was 54%. Procedure-related complication and mortality rates were 23.8% and 2.8%, respectively. CONCLUSION The efficacy of leadless LV endocardial pacing for CRT supports its use as a second-line therapy in patients in whom standard CRT is not possible or has been ineffective. Improvements in safety profile will facilitate widespread uptake in the treatment of these patients.
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Affiliation(s)
- Nadeev Wijesuriya
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Mark K Elliott
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Vishal Mehta
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Baldeep S Sidhu
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Jonathan M Behar
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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30
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Wijesuriya N, Elliott MK, Mehta V, Sidhu BS, Strocchi M, Behar JM, Niederer S, Rinaldi CA. Leadless Left Bundle Branch Area Pacing in Cardiac Resynchronisation Therapy: Advances, Challenges and Future Directions. Front Physiol 2022; 13:898866. [PMID: 35733988 PMCID: PMC9208327 DOI: 10.3389/fphys.2022.898866] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/20/2022] [Indexed: 11/20/2022] Open
Abstract
Leadless left bundle branch area pacing (LBBAP) represents the merger of two rapidly progressing areas in the field of cardiac resynchronisation therapy (CRT). It combines the attractive concepts of pacing the native conduction system to allow more physiological activation of the myocardium than conventional biventricular pacing, with the potential added benefits of avoiding long-term complications associated with transvenous leads via leadless left ventricular endocardial pacing. This perspective article will first review the evidence for the efficacy of leadless pacing in CRT. We then summarise the procedural steps and pilot data for leadless LBBAP, followed by a discussion of the safety and efficacy of this novel technique. Finally, we will examine how further mechanistic evidence may shed light to which patients may benefit most from leadless LBBAP, and how improvements in current experience and technology could promote widespread uptake and expand current clinical indications.
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Affiliation(s)
- Nadeev Wijesuriya
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Mark K. Elliott
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Vishal Mehta
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Baldeep S. Sidhu
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Marina Strocchi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Jonathan M. Behar
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Christopher A. Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
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31
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Nguyen DQ, Huntley GD, Zaki TA, McGuire DK. Recurrent pericardial effusion and tamponade after epicardial pacemaker lead placement: a case report. Eur Heart J Case Rep 2022; 6:ytac114. [PMID: 35652087 PMCID: PMC9149784 DOI: 10.1093/ehjcr/ytac114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/24/2021] [Accepted: 03/08/2022] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Epicardial pacemaker placement is often necessary in pacemaker-dependent patients with ongoing device pocket infection or lack of venous access. Pericardial effusion and tamponade are rare but serious complications of this procedure.
Case summary
A 38-year-old woman presented with nausea, diaphoresis, and hypotension 7 days after epicardial lead placement. Echocardiography revealed a large pericardial effusion with signs of tamponade. Despite initial improvement after pericardiocentesis, she continued to develop symptomatic pericardial effusions. The patient ultimately underwent pleuro-pericardial window surgery, which resulted in sustained resolution of effusion recurrence.
Discussion
Cases of recurrent pericardial effusion and tamponade following epicardial lead placement have been reported in the literature, although they are rare. While extensive partial pericardiectomy or total pericardiectomy was required to achieve adequate control of fluid accumulation in prior case reports, our patient was successfully managed with a pleuro-pericardial window.
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Affiliation(s)
- Danh Q Nguyen
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Parkland Health and Hospital System, Dallas, TX, USA
| | - Geoffrey D Huntley
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Parkland Health and Hospital System, Dallas, TX, USA
| | - Timothy A Zaki
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Parkland Health and Hospital System, Dallas, TX, USA
| | - Darren K McGuire
- Parkland Health and Hospital System, Dallas, TX, USA
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235-8830, USA
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32
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Cang J, Liu Y, Zhu D, Liu S, Shen J, Miao H, Zhou Q, Chen L. WiSE CRT Is Beneficial for Heart Failure Patients as a Rescue Therapy: Evidence From a Meta-Analysis. Front Cardiovasc Med 2022; 9:823797. [PMID: 35369306 PMCID: PMC8964787 DOI: 10.3389/fcvm.2022.823797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundLeadless endocardial left ventricular (LV) pacing resynchronization therapy is a novel solution for patients with heart failure (HF) in whom conventional cardiac resynchronization therapy (CRT) failed.MethodsPubMed and the Cochrane Library were searched for relevant cohort studies. Clinical outcomes of interest such as ejection fraction (EF), QRS duration (QRSd), and left ventricular end-systolic volume (LVESV) were extracted and analyzed.ResultsFive studies involving 175 HF patients for WiSE CRT were included, and patients were followed-up for 6 months. The implanted success rate ranged from 76.5 to 100%. WiSE CRT resulted in significantly narrower QRSd [mean difference (MD): −38.21 ms, 95% confidence interval (CI): −44.36 to −32.07, p < 0.001], improved left ventricular ejection fraction (MD: 6.07%, 95% CI: 4.43 to 7.71, I2 = 0%, p < 0.001), reduced left ventricular end-systolic volume (MD: −23.47 ml, 95% CI: −37.18 to −9.13, p < 0.001), and reduced left ventricular end-diastolic volume (MD: −24.02 ml, 95% CI: −37.01 to −11.03, p = 0.02).ConclusionEvidence from current studies suggests that leadless endocardial LV pacing resynchronization is effective for HF patients who failed conventional CRT or needed a device upgrade, and it may be an interesting rescue therapy.
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33
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Ryan DK, Banerjee D, Jouhra F. Management of Heart Failure in Patients with Chronic Kidney Disease. Eur Cardiol 2022; 17:e17. [PMID: 35990402 PMCID: PMC9376857 DOI: 10.15420/ecr.2021.33] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 04/11/2022] [Indexed: 11/19/2022] Open
Abstract
Chronic kidney disease (CKD) is increasingly prevalent in patients with heart failure (HF) and HF is one of the leading causes of hospitalisation, morbidity and mortality in patients with impaired renal function. Currently, there is strong evidence to support the symptomatic and prognostic benefits of β-blockers, renin-angiotensin-aldosterone inhibitors (RAASis), angiotensin receptor-neprilysin inhibitors (ARNIs) and mineralocorticoid receptor antagonists (MRA) in patients with HF and CKD stages 1-3. However, ARNIs, RAASis and MRAs are often suboptimally prescribed for patients with CKD owing to concerns about hyperkalaemia and worsening renal function. There is growing evidence for the use of sodium-glucose co-transporter 2 inhibitors and IV iron therapy in the management of HF in patients with CKD. However, few studies have included patients with CKD stages 4-5 and patients receiving dialysis, limiting the assessment of the safety and efficacy of these therapies in advanced CKD. Interdisciplinary input from HF and renal specialists is required to provide integrated care for the growing number of patients with HF and CKD.
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Affiliation(s)
- David K Ryan
- Clinical Pharmacology and Therapeutics, University College London Hospitals NHS Foundation Trust London, UK
| | - Debasish Banerjee
- Renal and Transplantation Unit, St George's University Hospitals NHS Foundation Trust, and Transactional and Clinical Research Institute London, UK
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's University of London London, UK
| | - Fadi Jouhra
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's University of London London, UK
- Cardiology Department, St George's University Hospitals NHS Foundation Trust London, UK
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34
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Elliott MK, Mehta VS, Sidhu BS, Niederer S, Rinaldi CA. Endocardial left ventricular pacing. Herz 2021; 46:526-532. [PMID: 34694427 PMCID: PMC8543431 DOI: 10.1007/s00059-021-05074-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 11/23/2022]
Abstract
Cardiac resynchronization therapy (CRT) is an effective treatment for dyssynchronous heart failure; however, 30–50% of patients fail to improve after implant. Endocardial left ventricular (LV) pacing is an alternative therapy for patients who do not respond to conventional CRT or in whom placement of a lead via the coronary sinus is not possible. It enables pacing at a wide variety of sites, without restrictions due to coronary sinus anatomy, and there is evidence of superior electrical resynchronization and hemodynamic response compared with conventional epicardial CRT. In this article, we discuss the potential advantages and disadvantages of endocardial LV pacing compared with conventional CRT, review the evidence for the delivery of endocardial LV pacing using both lead-based and leadless systems, and explore possible future directions of this novel technology.
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Affiliation(s)
- Mark K Elliott
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College London, SE1 7EH, London, UK. .,Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Vishal S Mehta
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College London, SE1 7EH, London, UK
| | - Baldeep Singh Sidhu
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College London, SE1 7EH, London, UK.,Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College London, SE1 7EH, London, UK
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College London, SE1 7EH, London, UK.,Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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35
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Doldi F, Biller B, Reinke F, Eckardt L. [New developments in leadless pacing systems]. Herz 2021; 46:513-519. [PMID: 34686910 DOI: 10.1007/s00059-021-05075-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 11/29/2022]
Abstract
Leadless pacing systems, especially the Micra™ TPS system, deliver an effective and safe alternative to the previous conventional transvenous systems in patients with impossible transvenous access and seem to be compatible with other implantable devices (S-ICD, deep brain stimulators) with no limitations in efficacy or safety. Also, new outlooks on leadless resynchronization therapy seem promising and could prevent future patients from lead- or operation-associated complications. Current limits to the implementation in everyday clinical practice are mostly the unavailability of the devices or cost issues through lack of health insurance reimbursement. However, more promising data through further studies and rising implantation rates are expected based on the positive current clinical data.
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Affiliation(s)
- Florian Doldi
- Klinik für Kardiologie II - Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149, Münster, Deutschland.
| | - Benedikt Biller
- Klinik für Kardiologie II - Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149, Münster, Deutschland
| | - Florian Reinke
- Klinik für Kardiologie II - Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149, Münster, Deutschland
| | - Lars Eckardt
- Klinik für Kardiologie II - Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149, Münster, Deutschland
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36
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Stazi F. The wireless pacemaker is on again; from electro-stimulation to synchronization. Eur Heart J Suppl 2021; 23:E156-E160. [PMID: 34650377 PMCID: PMC8503492 DOI: 10.1093/eurheartj/suab111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Leadless stimulation of the right ventricle is now a reality, especially in patients with very specific indications and clinical characteristics, even in the absence of randomized studies to support its use. The reduction of device costs and the refinement of atrioventricular synchronization algorithms will sanction its greater diffusion in the future. The possibility of using leadless technology also for resynchronization therapy, on the other hand, is currently a promising option but, pending randomized studies with robust case histories and adequate follow-ups, it should still be considered as a niche therapy, to be limited to centres highly specialized and in patients in whom conventional resynchronization has been impossible or ineffective.
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Affiliation(s)
- Filippo Stazi
- UOC Cardiologia d'Urgenza, Ospedale San Giovanni Addolorata, Roma
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Elliott MK, Sidhu BS, Mehta VS, Gould J, Martic D, Rinaldi CA. The importance of leadless pacemaker positioning in relation to subcutaneous implantable cardioverter-defibrillator sensing in completely leadless cardiac resynchronization and defibrillation systems. HeartRhythm Case Rep 2021; 7:628-632. [PMID: 34552857 PMCID: PMC8441212 DOI: 10.1016/j.hrcr.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Mark K Elliott
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Baldeep Singh Sidhu
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Vishal S Mehta
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Justin Gould
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Dejana Martic
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Cardiac Implantable Electronic Devices in Hemodialysis and Chronic Kidney Disease Patients-An Experience-Based Narrative Review. J Clin Med 2021; 10:jcm10081745. [PMID: 33920553 PMCID: PMC8073061 DOI: 10.3390/jcm10081745] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/03/2021] [Accepted: 04/13/2021] [Indexed: 11/17/2022] Open
Abstract
Cardiovascular implantable electronic devices (CIEDs) are a standard therapy utilized for different cardiac conditions. They are implanted in a growing number of patients, including those with chronic kidney disease (CKD) and end-stage kidney disease (ESKD). Cardiovascular diseases, including heart failure and malignant arrhythmia, remain the leading cause of mortality among CKD patients, especially in ESKD. CIED implantation procedures are considered minor surgery, typically with transvenous leads inserted via upper central veins, followed by an impulse generator introduced subcutaneously. A decision regarding optimal hemodialysis (HD) modality and the choice of permanent vascular access (VA) could be particularly challenging in CIED recipients. The potential consequences of arteriovenous access on the CIED side are related to (1) venous hypertension from lead-related central vein stenosis and (2) the risk of systemic infection. Therefore, when creating permanent vascular access, the clinical scenario may be complicated by the CIED presence on one side and the lack of suitable vessels for arteriovenous fistula on the contralateral arm. These factors suggest the need for an individualized approach according to different clinical situations: (1) CIED in a CKD patient; (2) CIED in a patient on hemodialysis CIED; and (3) VA in a patient with CIED. This complex clinical conundrum creates the necessity for close cooperation between cardiologists and nephrologists.
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