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Ballantyne BA, Chew DS, Vandenberk B. Paradigm Shifts in Cardiac Pacing: Where Have We Been and What Lies Ahead? J Clin Med 2023; 12:jcm12082938. [PMID: 37109274 PMCID: PMC10146747 DOI: 10.3390/jcm12082938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/07/2023] [Accepted: 04/09/2023] [Indexed: 04/29/2023] Open
Abstract
The history of cardiac pacing dates back to the 1930s with externalized pacing and has evolved to incorporate transvenous, multi-lead, or even leadless devices. Annual implantation rates of cardiac implantable electronic devices have increased since the introduction of the implantable system, likely related to expanding indications, and increasing global life expectancy and aging demographics. Here, we summarize the relevant literature on cardiac pacing to demonstrate the enormous impact it has had within the field of cardiology. Further, we look forward to the future of cardiac pacing, including conduction system pacing and leadless pacing strategies.
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Affiliation(s)
- Brennan A Ballantyne
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Derek S Chew
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Bert Vandenberk
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium
- Department of Cardiology, University Hospitals Leuven, 3000 Leuven, Belgium
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2
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Chung DU, Burger H, Kaiser L, Osswald B, Bärsch V, Nägele H, Knaut M, Reichenspurner H, Gessler N, Willems S, Butter C, Pecha S, Hakmi S. Transvenous lead extraction in patients with systemic cardiac device-related infection-Procedural outcome and risk prediction: A GALLERY subgroup analysis. Heart Rhythm 2023; 20:181-189. [PMID: 36240993 DOI: 10.1016/j.hrthm.2022.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Transvenous lead extraction (TLE) has evolved as one of the most crucial treatment options for patients with cardiac device-related systemic infection (CDRSI). OBJECTIVE The aim of this study was to characterize the procedural outcome and risk factors of patients with CDRSI undergoing TLE. METHODS A subgroup analysis of patients with CDRSI of the GALLERY (GermAn Laser Lead Extraction RegistrY) database was performed. Predictors for complications, procedural failure, and all-cause mortality were evaluated. RESULTS A total of 722 patients (28.6%) in the GALLERY had "systemic infection" as extraction indication. Patients with CDRSI were older (70.1 ± 12.2 years vs 67.3 ± 14.3 years; P < .001) and had more comorbidities than patients with local infections or noninfectious extraction indications. There were no differences in complete procedural success (90.6% vs 91.7%; P = .328) or major complications (2.5% vs 1.9%; P = .416) but increased procedure-related (1.4% vs 0.3%; P = .003) and all-cause in-hospital mortality (11.1% vs 0.6%; P < .001) for patients with CDRSI. Multivariate analyses revealed lead age ≥10 years as a predictor for procedural complications (odds ratio [OR] 3.23; 95% confidence interval [CI] 1.58-6.60; P = .001). Lead age ≥10 years (OR 2.57; 95% CI 1.03-6.46; P = .04) was also a predictor for procedural failure. We identified left ventricular ejection fraction <30% (OR 1.70; 95% CI 1.00-2.99; P = .049), age ≥75 years (OR 2.1; 95% CI 1.27-3.48; P = .004), chronic kidney disease (OR 1.92; 95% CI 1.17-3.14; P = .01), and overall procedural complications (OR 5.15; 95% CI 2.44-10.84; P < .001) as predictors for all-cause mortality. CONCLUSION Patients with CDRSI undergoing TLE demonstrate an increased rate of all-cause in-hospital, as well as procedure-related mortality, despite having comparable procedural success rates. Given these data, it seems paramount to develop preventive strategies to detect and treat CDRSI in its earliest stages.
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Affiliation(s)
- Da-Un Chung
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany.
| | - Heiko Burger
- Department of Cardiac Surgery, Kerckhoff Klinik, Bad Nauheim, Germany
| | - Lukas Kaiser
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Brigitte Osswald
- Division of Electrophysiological Surgery, Johanniter-Hospital Duisburg-Rheinhausen, Duisburg, Germany
| | - Volker Bärsch
- Department of Cardiology, St. Marien Krankenhaus, Siegen, Germany
| | - Herbert Nägele
- Department for Cardiac Insufficiency and Device Therapy, Albertinen-Hospital, Hamburg, Germany
| | | | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg at University Hospital Hamburg-Eppendorf, Hamburg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Nele Gessler
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg Bernau, Neuruppin, Germany
| | - Simon Pecha
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg at University Hospital Hamburg-Eppendorf, Hamburg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Samer Hakmi
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
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3
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Teixeira RA, Fagundes AA, Baggio Junior JM, Oliveira JCD, Medeiros PDTJ, Valdigem BP, Teno LAC, Silva RT, Melo CSD, Elias Neto J, Moraes Júnior AV, Pedrosa AAA, Porto FM, Brito Júnior HLD, Souza TGSE, Mateos JCP, Moraes LGBD, Forno ARJD, D'Avila ALB, Cavaco DADM, Kuniyoshi RR, Pimentel M, Camanho LEM, Saad EB, Zimerman LI, Oliveira EB, Scanavacca MI, Martinelli Filho M, Lima CEBD, Peixoto GDL, Darrieux FCDC, Duarte JDOP, Galvão Filho SDS, Costa ERB, Mateo EIP, Melo SLD, Rodrigues TDR, Rocha EA, Hachul DT, Lorga Filho AM, Nishioka SAD, Gadelha EB, Costa R, Andrade VSD, Torres GG, Oliveira Neto NRD, Lucchese FA, Murad H, Wanderley Neto J, Brofman PRS, Almeida RMS, Leal JCF. Brazilian Guidelines for Cardiac Implantable Electronic Devices - 2023. Arq Bras Cardiol 2023; 120:e20220892. [PMID: 36700596 PMCID: PMC10389103 DOI: 10.36660/abc.20220892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | - Rodrigo Tavares Silva
- Universidade de Franca (UNIFRAN), Franca, SP - Brasil
- Centro Universitário Municipal de Franca (Uni-FACEF), Franca, SP - Brasil
| | | | - Jorge Elias Neto
- Universidade Federal do Espírito Santo (UFES), Vitória, ES - Brasil
| | - Antonio Vitor Moraes Júnior
- Santa Casa de Ribeirão Preto, Ribeirão Preto, SP - Brasil
- Unimed de Ribeirão Preto, Ribeirão Preto, SP - Brasil
| | - Anisio Alexandre Andrade Pedrosa
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Luis Gustavo Belo de Moraes
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | - Mauricio Pimentel
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | - Eduardo Benchimol Saad
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Hospital Samaritano, Rio de Janeiro, RJ - Brasil
| | | | | | - Mauricio Ibrahim Scanavacca
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Martino Martinelli Filho
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Batista de Lima
- Hospital Universitário da Universidade Federal do Piauí (UFPI), Teresina, PI - Brasil
- Empresa Brasileira de Serviços Hospitalares (EBSERH), Brasília, DF - Brasil
| | | | - Francisco Carlos da Costa Darrieux
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Sissy Lara De Melo
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Eduardo Arrais Rocha
- Hospital Universitário Walter Cantídio, Universidade Federal do Ceará (UFC), Fortaleza, CE - Brasil
| | - Denise Tessariol Hachul
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Silvana Angelina D'Orio Nishioka
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Roberto Costa
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Gustavo Gomes Torres
- Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN - Brasil
| | | | | | - Henrique Murad
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | - Rui M S Almeida
- Centro Universitário Fundação Assis Gurgacz, Cascavel, PR - Brasil
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4
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Sanghavi R, Ravikumar N, Sarodaya V, Haq M, Sherif M, Harky A. Outcomes in cardiac implantable electronic device-related infective endocarditis: a systematic review of current literature. Future Cardiol 2022; 18:891-899. [PMID: 36073290 DOI: 10.2217/fca-2021-0155] [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: 01/26/2023] Open
Abstract
Aim: Cardiac implantable electronic device infective endocarditis is a serious infection with poor prognosis. Materials & methods: The systematic review of the literature was conducted using searches from the various databases. We included studies published between January 2010 and June 2021. Results: A total of 35 articles met the inclusion criteria. Patients were approximately 70 years old and an average of 71.2% of patients were male. The most common presenting feature was a fever. The modified Duke criteria was used to aid diagnosis. Management entailed extraction of the cardiac implantable electronic device in 80.5% of the studies. The overall mortality rates ranged from 4 to 36%. The most frequently isolated organism was Staphylococcus aureus. Conclusion: Cardiac implantable electronic device infective endocarditis needs timely diagnosis and effective management for promising outcomes.
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Affiliation(s)
- Ria Sanghavi
- Department of Medical Sciences, College of Life Sciences, University Of Leicester, Leicester, UK
| | - Nidhruv Ravikumar
- Department of Medicine, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Varun Sarodaya
- Department of General Surgery, Junior Clinical fellow, Barts Health NHS Trust, London, UK
| | - Mawiyah Haq
- Faculty of Medicine, St George's University of London, London, UK
| | - Mohamed Sherif
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, UK
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5
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Kouijzer JJP, Noordermeer DJ, van Leeuwen WJ, Verkaik NJ, Lattwein KR. Native valve, prosthetic valve, and cardiac device-related infective endocarditis: A review and update on current innovative diagnostic and therapeutic strategies. Front Cell Dev Biol 2022; 10:995508. [PMID: 36263017 PMCID: PMC9574252 DOI: 10.3389/fcell.2022.995508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
Infective endocarditis (IE) is a life-threatening microbial infection of native and prosthetic heart valves, endocardial surface, and/or indwelling cardiac device. Prevalence of IE is increasing and mortality has not significantly improved despite technological advances. This review provides an updated overview using recent literature on the clinical presentation, diagnosis, imaging, causative pathogens, treatment, and outcomes in native valve, prosthetic valve, and cardiac device-related IE. In addition, the experimental approaches used in IE research to improve the understanding of disease mechanisms and the current diagnostic pipelines are discussed, as well as potential innovative diagnostic and therapeutic strategies. This will ultimately help towards deriving better diagnostic tools and treatments to improve IE patient outcomes.
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Affiliation(s)
- Joop J. P. Kouijzer
- Thoraxcenter, Department of Biomedical Engineering, Erasmus MC University Medical Center, Rotterdam, Netherlands
- *Correspondence: Joop J. P. Kouijzer,
| | - Daniëlle J. Noordermeer
- Thoraxcenter, Department of Biomedical Engineering, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Wouter J. van Leeuwen
- Department of Cardiothoracic Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Nelianne J. Verkaik
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Kirby R. Lattwein
- Thoraxcenter, Department of Biomedical Engineering, Erasmus MC University Medical Center, Rotterdam, Netherlands
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Østergaard L, Voldstedlund M, Bruun NE, Bundgaard H, Iversen K, Køber N, Christensen JJ, Rosenvinge FS, Jarløv JO, Moser C, Andersen CØ, Coia J, Marmolin ES, Søgaard KK, Lemming L, Køber L, Fosbøl EL. Temporal Changes, Patient Characteristics, and Mortality, According to Microbiological Cause of Infective Endocarditis: A Nationwide Study. J Am Heart Assoc 2022; 11:e025801. [PMID: 35946455 PMCID: PMC9496298 DOI: 10.1161/jaha.122.025801] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Monitoring of microbiological cause of infective endocarditis (IE) remains key in the understanding of IE; however, data from large, unselected cohorts are sparse. We aimed to examine temporal changes, patient characteristics, and in‐hospital and long‐term mortality, according to microbiological cause in patients with IE from 2010 to 2017. Methods and Results Linking Danish nationwide registries, we identified all patients with first‐time IE. In‐hospital and long‐term mortality rates were assessed according to microbiological cause and compared using multivariable adjusted logistic regression analysis and Cox proportional hazard analysis, respectively. A total of 4123 patients were included. Staphylococcus aureus was the most frequent cause (28.1%), followed by Streptococcus species (26.0%), Enterococcus species (15.5%), coagulase‐negative staphylococci (6.2%), and “other microbiological causes” (5.3%). Blood culture–negative IE was registered in 18.9%. The proportion of blood culture–negative IE declined during the study period, whereas no significant changes were seen for any microbiological cause. Patients with Enterococcus species were older and more often had a prosthetic heart valve compared with other causes. For Streptococcus species IE, in‐hospital and long‐term mortality (median follow‐up, 2.3 years) were 11.1% and 58.5%, respectively. Compared with Streptococcus species IE, the following causes were associated with a higher in‐hospital mortality: S aureus IE (odds ratio [OR], 3.48 [95% CI, 2.74–4.42]), Enterococcus species IE (OR, 1.48 [95% CI, 1.11–1.97]), coagulase‐negative staphylococci IE (OR, 1.79 [95% CI, 1.21–2.65]), “other microbiological cause” (OR, 1.47 [95% CI, 0.95–2.27]), and blood culture–negative IE (OR, 1.99 [95% CI, 1.52–2.61]); and the following causes were associated with higher mortality following discharge (median follow‐up, 2.9 years): S aureus IE (hazard ratio [HR], 1.39 [95% CI, 1.19–1.62]), Enterococcus species IE (HR, 1.31 [95% CI, 1.11–1.54]), coagulase‐negative staphylococci IE (HR, 1.07 [95% CI, 0.85–1.36]), “other microbiological cause” (HR, 1.45 [95% CI, 1.13–1.85]), and blood culture–negative IE (HR, 1.05 [95% CI, 0.89–1.25]). Conclusions This nationwide study showed that S aureus was the most frequent microbiological cause of IE, followed by Streptococcus species and Enterococcus species. Patients with S aureus IE had the highest in‐hospital mortality.
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Affiliation(s)
- Lauge Østergaard
- The Heart Centre, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Department of Cardiology Bispebjerg-Frederiksberg Hospital University of Copenhagen Copenhagen Denmark
| | | | - Niels Eske Bruun
- Department of Cardiology Zealand University Hospital Roskilde Denmark.,Department of Cardiology Herlev-Gentofte Hospital University of Copenhagen Copenhagen Denmark.,Clinical Institutes Copenhagen and Aalborg University Denmark
| | - Henning Bundgaard
- The Heart Centre, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Kasper Iversen
- Department of Cardiology Herlev-Gentofte Hospital University of Copenhagen Copenhagen Denmark
| | - Nana Køber
- Department of Cardiology Bispebjerg-Frederiksberg Hospital University of Copenhagen Copenhagen Denmark
| | - Jens Jørgen Christensen
- The Regional Department of Clinical Microbiology Zealand University Hospital Køge and Institute of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Flemming Schønning Rosenvinge
- Department of Clinical Microbiology Odense University Hospital and Research Unit of Clinical Microbiology University of Southern Denmark Odense Denmark
| | - Jens Otto Jarløv
- Department of Clinical Microbiology Herlev-Gentofte Hospital University of Copenhagen Copenhagen Denmark
| | - Claus Moser
- Department of Clinical Microbiology Rigshospitalet University of Copenhagen Copenhagen Denmark.,Department of Immunology and Microbiology University of Copenhagen Copenhagen Denmark
| | | | - John Coia
- Department of Clinical Microbiology Esbjerg Hospital Esbjerg Denmark
| | | | - Kirstine K Søgaard
- Department of Clinical Microbiology Aalborg University Hospital Aalborg Denmark.,Department of Clinical Medicine Aalborg University Aalborg Denmark
| | - Lars Lemming
- Department of Clinical Microbiology Aarhus University Hospital Aarhus Denmark
| | - Lars Køber
- The Heart Centre, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Emil Loldrup Fosbøl
- The Heart Centre, Rigshospitalet University of Copenhagen Copenhagen Denmark
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7
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(Cardiac electronic device extraction - our experience). COR ET VASA 2022. [DOI: 10.33678/cor.2021.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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8
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2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Translation of the document prepared by the Czech Society of Cardiology. COR ET VASA 2022. [DOI: 10.33678/cor.2022.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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9
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJ, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. Grupo de trabajo sobre estimulación cardiaca y terapia de resincronización cardiaca de la Sociedad Europea de Cardiología (ESC). Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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10
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM, Leyva F, Linde C, Abdelhamid M, Aboyans V, Arbelo E, Asteggiano R, Barón-Esquivias G, Bauersachs J, Biffi M, Birgersdotter-Green U, Bongiorni MG, Borger MA, Čelutkienė J, Cikes M, Daubert JC, Drossart I, Ellenbogen K, Elliott PM, Fabritz L, Falk V, Fauchier L, Fernández-Avilés F, Foldager D, Gadler F, De Vinuesa PGG, Gorenek B, Guerra JM, Hermann Haugaa K, Hendriks J, Kahan T, Katus HA, Konradi A, Koskinas KC, Law H, Lewis BS, Linker NJ, Løchen ML, Lumens J, Mascherbauer J, Mullens W, Nagy KV, Prescott E, Raatikainen P, Rakisheva A, Reichlin T, Ricci RP, Shlyakhto E, Sitges M, Sousa-Uva M, Sutton R, Suwalski P, Svendsen JH, Touyz RM, Van Gelder IC, Vernooy K, Waltenberger J, Whinnett Z, Witte KK. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Europace 2022; 24:71-164. [PMID: 34455427 DOI: 10.1093/europace/euab232] [Citation(s) in RCA: 111] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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11
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J 2021; 42:3427-3520. [PMID: 34455430 DOI: 10.1093/eurheartj/ehab364] [Citation(s) in RCA: 783] [Impact Index Per Article: 261.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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12
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Frausing MHJP, Kronborg MB, Johansen JB, Nielsen JC. Avoiding implant complications in cardiac implantable electronic devices: what works? Europace 2021; 23:163-173. [PMID: 33063088 DOI: 10.1093/europace/euaa221] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/08/2020] [Indexed: 01/14/2023] Open
Abstract
Nearly one in ten patients experience complications in relation to cardiac implantable electronic device (CIED) implantations. CIED complications have serious implications for the patients and for the healthcare system. In light of the rising rates of new implants and consistent rate of complications, primary prevention remains a major concern. To guide future efforts, we sought to review the evidence base underlying common preventive actions made during a primary CIED implantation.
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Affiliation(s)
| | - Mads Brix Kronborg
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Bvld. 99, DK-8200, Aarhus, Denmark
| | - Jens Brock Johansen
- Department of Cardiology, Odense University Hospital, J. B. Winsløvs Vej 4, DK-5000, Odense, Denmark
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Bvld. 99, DK-8200, Aarhus, Denmark
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13
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Ibrahim W, Hoschtitzky A, Thakuria L, Li W, Semple T, Clague J, Ghonim S, Seitler S, Gatzoulis MA, Al-Sakini N. Follow the Lead: The Challenges of Cardiogenic Shock in Device-Related Infective Endocarditis. JACC Case Rep 2021; 3:1163-1169. [PMID: 34401751 PMCID: PMC8353571 DOI: 10.1016/j.jaccas.2021.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 05/17/2021] [Indexed: 01/19/2023]
Abstract
We present the challenging case of a young man with congenital heart disease who survived severe device-related infective endocarditis and new pulmonary hypertension. He required prolonged mechanical circulatory support and had multiple significant complications. His case posed a management dilemma that was successfully resolved by effective multidisciplinary, tertiary center care. (Level of Difficulty: Beginner.).
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Key Words
- CT, computed tomography
- DRE, device-related endocarditis
- ECMO
- ECMO, extracorporeal membrane oxygenation
- ICU, intensive care unit
- MCS, mechanical circulatory support
- MDT, multidisciplinary team
- PET, positron emission tomography
- PH, pulmonary hypertension
- PPM, permanent pacemaker
- RV, right ventricular
- TEE, transesophageal echocardiography
- TTE, transthoracic echocardiography
- congenital
- infective endocarditis
- mechanical circulatory support
- mycotic aneurysm
- pulmonary embolism
- pulmonary hypertension
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Affiliation(s)
- Wasyla Ibrahim
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Andreas Hoschtitzky
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.,National Heart and Lung Institute, Imperial College, London, United Kingdom.,Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Louit Thakuria
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Wei Li
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.,National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Thomas Semple
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Jonathan Clague
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Sarah Ghonim
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Samuel Seitler
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.,National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Nada Al-Sakini
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
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14
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Willems D, Bak M, Tan H, Lindinger G, Kocar A, Seperhi Shamloo A, Schmidt G, Hindricks G, Dagres N. Ethical issues in two parallel trials of personalised criteria for implantation of implantable cardioverter defibrillators for primary prevention: the PROFID project-a position paper. Open Heart 2021; 8:openhrt-2021-001686. [PMID: 34261778 PMCID: PMC8280899 DOI: 10.1136/openhrt-2021-001686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/26/2022] Open
Abstract
Aim To discuss ethical issues related to a complex study (PROFID) involving the development of a new, partly artificial intelligence-based, prediction model to enable personalised decision-making about the implantation of an implantable cardioverter defibrillator (ICD) in postmyocardial infarction patients, and a parallel non-inferiority and superiority trial to test decision-making informed by that model. Method The position expressed in this paper is based on an analysis of the PROFID trials using concepts from high-profile publications in the ethical literature. Results We identify ethical issues related to the testing of the model in the treatment setting, and to both the superiority and the non-inferiority trial. We underline the need for ethical-empirical studies about these issues, also among patients, as a parallel to the actual trials. The number of ethics committees involved is an organisational, but also an ethical challenge. Conclusion The PROFID trials, and probably other studies of similar scale and complexity, raise questions that deserve dedicated parallel ethics and social science research, but do not constitute a generic obstacle. A harmonisation procedure, comparable to the Voluntary Harmonization Procedure (VHP) for medication trials, could be needed for this type of trials.
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Affiliation(s)
- Dick Willems
- Ethics, Law, and Humanities, Amsterdam Public Health, Amsterdam UMC Locatie Meibergdreef, Amsterdam, The Netherlands
| | - Marieke Bak
- Ethics, Law, and Humanities, Amsterdam Public Health, Amsterdam UMC Locatie Meibergdreef, Amsterdam, The Netherlands
| | - Hanno Tan
- Department of Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Georg Lindinger
- Institute for Health Care Management and Health Sciences, University of Bayreuth, Bayreuth, Bayern, Germany
| | - Ayca Kocar
- Institute for Health Care Management and Health Sciences, University of Bayreuth, Bayreuth, Bayern, Germany
| | | | - Georg Schmidt
- Medizinische Klinik und Poliklinik, Technische Universität München, München, Bayern, Germany
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15
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Mateos Gaitán R, Boix-Palop L, Muñoz García P, Mestres CA, Marín Arriaza M, Pedraz Prieto Á, de Alarcón Gonzalez A, Gutiérrez Carretero E, Hernández Meneses M, Goenaga Sánchez MÁ, Cobo Belaustegui M, Oteo Revuelta JA, Gainzarain Arana JC, García Vázquez E, Martínez-Sellés M. Infective endocarditis in patients with cardiac implantable electronic devices: a nationwide study. Europace 2021; 22:1062-1070. [PMID: 32390046 DOI: 10.1093/europace/euaa076] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 03/12/2020] [Indexed: 12/17/2022] Open
Abstract
AIMS Patients with infective endocarditis (IE) frequently have cardiac implantable electronic devices (CIEDs). Here, we aim to define the clinical profile and prognostic factors of IE in these patients. METHODS AND RESULTS Infective endocarditis cases were prospectively identified in the Spanish National Endocarditis Registry. From 3996 IE, 708 (17.7%) had a CIED and 424 CIED-related IE (lead vegetation). Patients with a CIED were older (68 ± 11 vs. 73 ± 8 years); had more comorbidities {pulmonary disease [176 (24.8%) vs. 545 (16.7%)], renal disease [239 (33.8%) vs. 740 (22.7%)], diabetes [248 (35.0%) vs. 867 (26.6%)], and heart failure [348 (49.2%) vs. 978 (29.9%)]}; and fewer complications {intracardiac destruction [106 (15%) vs. 1077 (33.1%)], heart failure [215 (30.3%) vs. 1340 (41.1%)], embolism [107 (15.1%) vs. 714 (21.9%)], and neurological involvement [77 (10.8%) vs. 702 (21.5%)]} (all P-values <0.001) in comparison to subjects without a CIED. In-hospital mortality was similar in patients with and without CIED [171 (24.2%) vs. 881 (27.0%), P = 0.82]. In subjects with a CIED, CIED-related IE was independently associated with in-hospital survival: odds ratio (OR) 0.4 [95% confidence interval (CI) 0.3-0.7, P = 0.001]. Surgery was independently associated with in-hospital survival in CIED-related IE: OR 0.4 (95% CI 0.2-0.7, P = 0.004); but not in subjects with valve IE and no CIED lead involvement: OR 0.9 (95% CI 0.5-1.7, P = 0.77). CONCLUSION Over a sixth of IE patients have a CIED. This group of patients is older, with more comorbidities and fewer IE-related complications in comparison to subjects without a CIED. In-hospital mortality was similar in patients with and without a CIED.
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Affiliation(s)
- Roberto Mateos Gaitán
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, CIBERCV, Calle Doctor Esquerdo, 46, 28007 Madrid, Spain
| | - Lucía Boix-Palop
- Unit of Infectious Diseases and Microbiology, Department of Internal Medicine, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - Patricia Muñoz García
- Clinical Unit of Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Gregorio Marañón Health Research Institute, CIBER Enfermedades Respiratorias-CIBERES, Madrid, Spain
| | - Carlos A Mestres
- Department of Cardiovascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Mercedes Marín Arriaza
- Clinical Unit of Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Gregorio Marañón Health Research Institute, CIBER Enfermedades Respiratorias-CIBERES, Madrid, Spain
| | - Álvaro Pedraz Prieto
- Department of Cardiovascular Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Arístides de Alarcón Gonzalez
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine Infectious Diseases, Research Group Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Sevilla, Spain
| | - Encarnación Gutiérrez Carretero
- Cardiac Surgery Department, University of Sevilla/CSIC/University Hospital Virgen del Rocío Seville, Institute of Biomedicine-Sevilla (IBiS), CIBERCV, Sevilla, Spain
| | | | | | | | - José Antonio Oteo Revuelta
- Department of Infectious Diseases, Hospital Universitario San Pedro, Centre for Biomedical Research La Rioja (CIBIR), Logroño, Spain
| | | | - Elisa García Vázquez
- Department of Internal Medicine/Infectious Diseases, Hospital Clínico Universitario Virgen de la Arrixaca, Biohealth Research Institute (IMIB), Faculty of Medicine, Universidad de Murcia, Murcia, Spain
| | - Manuel Martínez-Sellés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, CIBERCV, Calle Doctor Esquerdo, 46, 28007 Madrid, Spain.,Universidad Europea, Universidad Complutense, Madrid, Spain
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16
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Constantine A, Condliffe R, Clift P, Tulloh R, Dimopoulos K. Palliative care in pulmonary hypertension associated with congenital heart disease: systematic review and expert opinion. ESC Heart Fail 2021; 8:1901-1914. [PMID: 33660435 PMCID: PMC8120400 DOI: 10.1002/ehf2.13263] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/13/2021] [Accepted: 01/29/2021] [Indexed: 01/10/2023] Open
Abstract
AIMS Pulmonary arterial hypertension (PAH) is common amongst patients with congenital heart disease (CHD). It is a severe and complex condition that adversely affects quality of life and prognosis. While quality of life questionnaires are routinely used in clinical pulmonary hypertension practice, little is known on how to interpret their results and manage PAH-CHD patients with evidence of impaired health-related quality of life, especially those with advanced disease and palliative care needs. METHODS AND RESULTS We performed a systematic review of studies concerning palliative care for people with PAH-CHD, also reviewing the health-related quality of life literature pertaining to these patients. Of 330 papers identified through initial screening, 17 were selected for inclusion. Underutilization of advance care planning and palliative care resources was common. Where palliative care input was sought, this was frequently late in the course of the disease. No studies provided evidence-based clinical criteria for triggering referral to palliative care, a framework for providing tailored care in this patient group, or how to manage the risk of sudden cardiac death and implantable cardioverter defibrillators in advanced PAH-CHD. We synthesize this information into eight important areas, including the impact of PAH-CHD on quality of life, barriers to and benefits of palliative care involvement, advance care planning discussions, and end-of-life care issues in this complex patient group, and provide expert consensus on best practice in this field. CONCLUSIONS This paper presents the results of a systematic review and expert statements on the preferred palliative care strategy for patients with PAH-CHD.
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Affiliation(s)
- Andrew Constantine
- Adult Congenital Heart Centre and Centre for Pulmonary HypertensionRoyal Brompton HospitalSydney StreetLondonSW3 6NPUK
- National Heart and Lung InstituteImperial College LondonLondonUK
| | - Robin Condliffe
- Pulmonary Vascular Disease UnitRoyal Hallamshire HospitalSheffieldUK
| | - Paul Clift
- Department of CardiologyQueen Elizabeth Hospital BirminghamBirminghamUK
| | - Robert Tulloh
- Bristol Heart InstituteUniversity Hospitals Bristol, Weston NHS Foundation TrustBristolUK
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Centre and Centre for Pulmonary HypertensionRoyal Brompton HospitalSydney StreetLondonSW3 6NPUK
- National Heart and Lung InstituteImperial College LondonLondonUK
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17
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Ostrowska B, Gkiouzepas S, Kurland S, Blomström-Lundqvist C. Device infections related to cardiac resynchronization therapy in clinical practice-An analysis of its prevalence, risk factors and routine surveillance at a single center university hospital. Clin Cardiol 2021; 44:739-747. [PMID: 34032293 PMCID: PMC8207984 DOI: 10.1002/clc.23620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/13/2021] [Accepted: 04/27/2021] [Indexed: 01/22/2023] Open
Abstract
Background The implantation rates of cardiac implantable electronic devices have steadily increased, accompanied by a steeper rise of device related infections (DRI). Hypothesis The prevalence of DRI for cardiac resynchronization therapy (CRT) is higher in clinical practice than reported previously, even at a university hospital, and likely higher than reported to the national device registry. Methods Electronic medical records of consecutive patients undergoing a CRT procedure between January 2016 and December 2017 were analyzed. Clinical history, procedure related variables and complications were reviewed by specialists in cardiology and infectious diseases. Results A total of 171 patients, mean aged 74 years, 138 males (80.7%) were included. Twelve DRI occurred in 10 patients during mean 2.5 years follow‐up, giving a prevalence of 7% (incidence of 29/1000 person‐years). Reoperation, pocket haematoma, ≥3 procedures, previous device infection and indwelling central venous line were the strongest predictive factors according to univariate analysis. Out of 63/171 (36.8%) major complications, 31(49.2%) were lead‐related. There were 49/171 (28.7%) reoperations and 15/171 (8.8%) minor complications. The number major complications and DRI reported to the national device registry were 7/171 (4.1%) and 2/171 (0.6%), respectively, reflecting a 5‐fold underreporting. Conclusions The high rate of CRT device infections is in sharp contrast to those reported by others and to the national device registry. Although a center specific explanation cannot be excluded, the high rates highlight a major issue with registries, reinforcing the need for better surveillance and automatic reporting of device related complications.
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Affiliation(s)
- Bozena Ostrowska
- Department of Cardiology, Uppsala University, Uppsala, Sweden.,Department of Medical Sciences and Cardiology, Uppsala University, Uppsala, Sweden
| | - Spyridon Gkiouzepas
- Department of Medical Sciences and Cardiology, Uppsala University, Uppsala, Sweden.,Department of Internal Medicine, Uppsala University, Uppsala, Sweden
| | - Siri Kurland
- Department of Infectious Diseases, Uppsala University, Uppsala, Sweden
| | - Carina Blomström-Lundqvist
- Department of Cardiology, Uppsala University, Uppsala, Sweden.,Department of Medical Sciences and Cardiology, Uppsala University, Uppsala, Sweden
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18
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Ursaru AM, Haba CM, Popescu ȘE, Crișu D, Petriș AO, Tesloianu ND. A Rare Entity-Percutaneous Lead Extraction in a Very Late Onset Pacemaker Endocarditis: Case Report and Review of Literature. Diagnostics (Basel) 2021; 11:diagnostics11010096. [PMID: 33435384 PMCID: PMC7827933 DOI: 10.3390/diagnostics11010096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/28/2020] [Accepted: 01/05/2021] [Indexed: 11/16/2022] Open
Abstract
The number of infections related to cardiac implantable electronic devices (CIEDs) has increased as the number of devices implanted around the world has grown exponentially in recent years. CIED complications can sometimes be difficult to diagnose and manage, as in the case of lead-related infective endocarditis. We present the case of a 48-year-old male diagnosed with Staphylococcus aureus device-related infective endocarditis, 12 years after the implant of a single chamber pacemaker. A recent history of the patient includes two urinary catheterizations due to obstructive uropathy in the context of a prostatic adenoma, 2 months previously, both without antibiotic prophylaxis; no other possible entry sites were found and no history of other invasive procedures. After initiation of antibiotic therapy according to antibiotic susceptibility testing, we decided to remove the right ventricular passive fixation lead along with the vegetation and pacemaker generator; because of severe lead adhesions in the costoclavicular region, and especially in the right ventricle, we needed mechanical sheaths to remove the abundant fibrous tissue that encompassed the lead. After a difficult, but successful, lead extraction along with a large vegetation and 6 weeks' antibiotic therapy, the clinical and biological evolution was favorable, without reappearance of symptoms. While very late lead endocarditis is a rarity, late lead-related infective endocarditis (more than 12 months elapsed since implant) is not an exception; this is why we find that endocarditis prophylaxis should be reconsidered in certain patient categories, our patient being proof that procedures with neglectable endocarditis risk according to the guidelines can lead to bacterial endocarditis.
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Affiliation(s)
- Andreea Maria Ursaru
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iași, Romania; (C.M.H.); (D.C.); (A.O.P.); (N.D.T.)
- Correspondence: (A.M.U.); (Ș.E.P.); Tel.: +40-753-731-523 (A.M.U.); +40-752-114-139 (Ș.E.P.)
| | - Cristian Mihai Haba
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iași, Romania; (C.M.H.); (D.C.); (A.O.P.); (N.D.T.)
- Department of Cardiology, “Grigore. T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Ștefan Eduard Popescu
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iași, Romania; (C.M.H.); (D.C.); (A.O.P.); (N.D.T.)
- Correspondence: (A.M.U.); (Ș.E.P.); Tel.: +40-753-731-523 (A.M.U.); +40-752-114-139 (Ș.E.P.)
| | - Daniela Crișu
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iași, Romania; (C.M.H.); (D.C.); (A.O.P.); (N.D.T.)
| | - Antoniu Octavian Petriș
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iași, Romania; (C.M.H.); (D.C.); (A.O.P.); (N.D.T.)
- Department of Cardiology, “Grigore. T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Nicolae Dan Tesloianu
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iași, Romania; (C.M.H.); (D.C.); (A.O.P.); (N.D.T.)
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19
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Rav Acha M, Soifer E, Hasin T. Cardiac Implantable Electronic Miniaturized and Micro Devices. MICROMACHINES 2020; 11:E902. [PMID: 33003460 PMCID: PMC7600795 DOI: 10.3390/mi11100902] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/21/2020] [Accepted: 09/25/2020] [Indexed: 12/13/2022]
Abstract
Advancement in the miniaturization of high-density power sources, electronic circuits, and communication technologies enabled the construction of miniaturized electronic devices, implanted directly in the heart. These include pacing devices to prevent low heart rates or terminate heart rhythm abnormalities ('arrhythmias'), long-term rhythm monitoring devices for arrhythmia detection in unexplained syncope cases, and heart failure (HF) hemodynamic monitoring devices, enabling the real-time monitoring of cardiac pressures to detect and alert for early fluid overload. These devices were shown to prevent HF hospitalizations and improve HF patients' life quality. Pacing devices include permanent pacemakers (PPM) that maintain normal heart rates, defibrillators that are capable of fast detection and the termination of life-threatening arrhythmias, and cardiac re-synchronization devices that improve cardiac function and the survival of HF patients. Traditionally, these devices are implanted via the venous system ('endovascular') using conductors ('endovascular leads/electrodes') that connect the subcutaneous device battery to the appropriate cardiac chamber. These leads are a potential source of multiple problems, including lead-failure and systemic infection resulting from the lifelong exposure of these leads to bacteria within the venous system. One of the important cardiac innovations in the last decade was the development of a leadless PPM functioning without venous leads, thus circumventing most endovascular PPM-related problems. Leadless PPM's consist of a single device, including a miniaturized power source, electronic chips, and fixating mechanism, directly implanted into the cardiac muscle. Only rare device-related problems and almost no systemic infections occur with these devices. Current leadless PPM's sense and pace only the ventricle. However, a novel leadless device that is capable of sensing both atrium and ventricle was recently FDA approved and miniaturized devices that are designed to synchronize right and left ventricles, using novel intra-body inner-device communication technologies, are under final experiments. This review will cover these novel implantable miniaturized cardiac devices and the basic algorithms and technologies that underlie their development. Advancement in the miniaturization of high-density power sources, electronic circuits, and communication technologies enabled the construction of miniaturized electronic devices, implanted directly in the heart. These include pacing devices to prevent low heart rates or terminate heart rhythm abnormalities ('arrhythmias'), long-term rhythm monitoring devices for arrhythmia detection in unexplained syncope cases, and heart failure (HF) hemodynamic monitoring devices, enabling the real-time monitoring of cardiac pressures to detect and alert early fluid overload. These devices were shown to prevent HF hospitalizations and improve HF patients' life quality. Pacing devices include permanent pacemakers (PPM) that maintain normal heart rates, defibrillators that are capable of fast detection and termination of life-threatening arrhythmias, and cardiac re-synchronization devices that improve cardiac function and survival of HF patients. Traditionally, these devices are implanted via the venous system ('endovascular') using conductors ('endovascular leads/electrodes') that connect the subcutaneous device battery to the appropriate cardiac chamber. These leads are a potential source of multiple problems, including lead-failure and systemic infection that result from the lifelong exposure of these leads to bacteria within the venous system. The development of a leadless PPM functioning without venous leads was one of the important cardiac innovations in the last decade, thus circumventing most endovascular PPM-related problems. Leadless PPM's consist of a single device, including a miniaturized power source, electronic chips, and fixating mechanism, implanted directly into the cardiac muscle. Only rare device-related problems and almost no systemic infections occur with these devices. Current leadless PPM's sense and pace only the ventricle. However, a novel leadless device that is capable of sensing both atrium and ventricle was recently FDA approved and miniaturized devices designed to synchronize right and left ventricles, using novel intra-body inner-device communication technologies, are under final experiments. This review will cover these novel implantable miniaturized cardiac devices and the basic algorithms and technologies that underlie their development.
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Affiliation(s)
- Moshe Rav Acha
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University, Jerusalem 910000, Israel;
| | - Elina Soifer
- Vectorious Medical Technologies, Tel Aviv 610000, Israel;
| | - Tal Hasin
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University, Jerusalem 910000, Israel;
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20
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Raza SA, Opie NL, Morokoff A, Sharma RP, Mitchell PJ, Oxley TJ. Endovascular Neuromodulation: Safety Profile and Future Directions. Front Neurol 2020; 11:351. [PMID: 32390937 PMCID: PMC7193719 DOI: 10.3389/fneur.2020.00351] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 04/08/2020] [Indexed: 12/16/2022] Open
Abstract
Endovascular neuromodulation is an emerging technology that represents a synthesis between interventional neurology and neural engineering. The prototypical endovascular neural interface is the StentrodeTM, a stent-electrode array which can be implanted into the superior sagittal sinus via percutaneous catheter venography, and transmits signals through a transvenous lead to a receiver located subcutaneously in the chest. Whilst the StentrodeTM has been conceptually validated in ovine models, questions remain about the long term viability and safety of this device in human recipients. Although technical precedence for venous sinus stenting already exists in the setting of idiopathic intracranial hypertension, long term implantation of a lead within the intracranial veins has never been previously achieved. Contrastingly, transvenous leads have been successfully employed for decades in the setting of implantable cardiac pacemakers and defibrillators. In the current absence of human data on the StentrodeTM, the literature on these structurally comparable devices provides valuable lessons that can be translated to the setting of endovascular neuromodulation. This review will explore this literature in order to understand the potential risks of the StentrodeTM and define avenues where further research and development are necessary in order to optimize this device for human application.
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Affiliation(s)
- Samad A Raza
- Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Nicholas L Opie
- Department of Medicine, Vascular Bionics Laboratory, Melbourne Brain Centre, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrew Morokoff
- Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Rahul P Sharma
- Interventional Cardiology, Stanford Health Care, Palo Alto, CA, United States
| | - Peter J Mitchell
- Department of Radiology, The University of Melbourne & The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Thomas J Oxley
- Department of Medicine, Vascular Bionics Laboratory, Melbourne Brain Centre, The University of Melbourne, Melbourne, VIC, Australia.,Departments of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia.,Department of Neurosurgery, Mount Sinai Hospital, New York, NY, United States
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21
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Seifert M, Möller V, Claus T, Hölschermann F, Butter C. [Septicemia and endocarditis with multiple implants : CIED, TAVI, MK clip and LAA occluders]. Herzschrittmacherther Elektrophysiol 2019; 30:197-203. [PMID: 30969355 DOI: 10.1007/s00399-019-0618-y] [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: 03/15/2019] [Accepted: 03/24/2019] [Indexed: 11/27/2022]
Abstract
Infective endocarditis (IE) as well as septicemia in patients with implanted cardiac devices are severe diseases and diagnosis is often delayed due to a variety of misleading symptoms. Imaging with transesophageal echocardiography (TEE) and also microbiology play a key role in both the diagnosis and management. They are also useful for the prognostic assessment of patients with IE, for follow-up during treatment, during extraction of the implant and after surgery. In addition to antibiotic treatment, removal of the implant is also necessary, at least if vegetation is detected. Not only the removal of the implant but also the underlying cardiac disease, the frequently occurring severe cardiac insufficiency, the advanced age and the not uncommon high degree of fragility of the patients mean that decision making for treatment and management as well as renewed implantation after completion of treatment are a challenge. The optimal treatment is only possible with a close cooperation between various specialist disciplines and should therefore be carried out in experienced centers.
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Affiliation(s)
- M Seifert
- Abteilung für Kardiologie, Immanuel Klinikum Bernau und Herzzentrum Brandenburg, Hochschulklinikum der Medizinischen Hochschule Brandenburg, Ladeburger Str. 17, 16321, Bernau, Deutschland.
| | - V Möller
- Abteilung für Kardiologie, Immanuel Klinikum Bernau und Herzzentrum Brandenburg, Hochschulklinikum der Medizinischen Hochschule Brandenburg, Ladeburger Str. 17, 16321, Bernau, Deutschland
| | - T Claus
- Abteilung für Herzchirurgie, Immanuel Klinikum Bernau und Herzzentrum Brandenburg, Hochschulklinikum der Medizinischen Hochschule Brandenburg, Ladeburger Str. 17, 16321, Bernau, Deutschland
| | - F Hölschermann
- Abteilung für Kardiologie, Immanuel Klinikum Bernau und Herzzentrum Brandenburg, Hochschulklinikum der Medizinischen Hochschule Brandenburg, Ladeburger Str. 17, 16321, Bernau, Deutschland
| | - C Butter
- Abteilung für Kardiologie, Immanuel Klinikum Bernau und Herzzentrum Brandenburg, Hochschulklinikum der Medizinischen Hochschule Brandenburg, Ladeburger Str. 17, 16321, Bernau, Deutschland
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22
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Umamaheshwar KL, Singh AS, Sivakumar K. Endocardial transvenous pacing in patients with surgically palliated univentricular hearts: A review on different techniques, problems and management. Indian Pacing Electrophysiol J 2018; 19:15-22. [PMID: 30508590 PMCID: PMC6354237 DOI: 10.1016/j.ipej.2018.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 11/04/2022] Open
Abstract
Fontan surgery and its modifications have improved survival in various forms of univentricular hearts. A regular atrial rhythm with atrioventricular synchrony is one of the most important prerequisite for the long-term effective functioning of this preload dependent circulation. A significant proportion of these survivors need various forms of pacing for bradyarrhythmias, often due to sinus nodal dysfunction and sometimes due to atrioventricular nodal block. The diversion of the venous flows away from the cardiac chambers following this surgery takes away the simpler endocardial pacing options through the superior vena cava. The added risks of thromboembolism associated with endocardial leads in systemic ventricles have made epicardial pacing as the procedure of choice. However challenges in epicardial pacing include surgical adhesions, increased pacing thresholds leading to early battery depletion and frequent lead fractures. When epicardial pacing fails, endocardial lead placement is equally challenging due to lack of access to the cardiac chambers in Fontan circulation. This review discusses the univentricular heart morphologies that may warrant pacing, issues about epicardial pacing, different techniques for endocardial pacing in patients with disconnected superior vena cava, pacing in different modifications of Fontan surgeries, issues of systemic thromboembolism with endocardial leads, atrioventricular valve regurgitation attributed to pacing leads and device infections. In a vast majority of patients following Glenn shunt and Senning surgery, an epicardial pacing and lead replacement is always feasible though technically very difficult. This article highlights the different options of transatrial and transventricular endocardial pacing. Fontan surgery prolongs the mean survival of patients with univentricular hearts beyond 30 years. 9-20% of survivors need permanent pacing for bradyarrhythmias. Epicardial pacing is preferred as the first choice for permanent pacemaker. There is 20-40% failure of permanent pacing at 10 years due to high threshold, lead fractures. Repeated epicardial pacing with surgical revisions are difficult. Endocardial pacing involves special techniques. Manoeuvring through fenestrations,venous collaterals, hepatic veins, pulmonary valve or hybrid peratrial routes is needed. Systemic thromboembolism, endocarditis and systemic AV valve regurgitation should be prevented by meticulously measures.
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Østergaard L, Valeur N, Wang A, Bundgaard H, Aslam M, Gislason G, Torp-Pedersen C, Bruun NE, Søndergaard L, Køber L, Fosbøl EL. Incidence of infective endocarditis in patients considered at moderate risk. Eur Heart J 2018; 40:1355-1361. [DOI: 10.1093/eurheartj/ehy629] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/01/2018] [Accepted: 09/18/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lauge Østergaard
- Heart Center, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 8, KBH N, Denmark
| | - Nana Valeur
- Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Andrew Wang
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Henning Bundgaard
- Heart Center, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 8, KBH N, Denmark
| | - Mohsin Aslam
- Heart Center, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 8, KBH N, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Roskilde University Hospital, Roskilde, Denmark
- Department of Cardiovascular Epidemiology and Research, The Danish Heart Foundation, Copenhagen, Denmark
| | | | - Niels Eske Bruun
- Department of Cardiology, Roskilde University Hospital, Roskilde, Denmark
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Denmark
- Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Lars Søndergaard
- Heart Center, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 8, KBH N, Denmark
| | - Lars Køber
- Heart Center, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 8, KBH N, Denmark
| | - Emil Loldrup Fosbøl
- Heart Center, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 8, KBH N, Denmark
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Sudden Death and Ventricular Arrhythmias in Athletes: Screening, De-Training and the Role of Catheter Ablation. Heart Lung Circ 2018; 28:155-163. [PMID: 30554599 DOI: 10.1016/j.hlc.2018.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/05/2018] [Indexed: 01/29/2023]
Abstract
Athletes enjoy excellent health outcomes including greater longevity relative to non-athletic counterparts. Paradoxically, however, endurance athletic conditioning is associated with an increase in some arrhythmias. This review discusses the potential mechanisms for this paradox and strategies enabling early identification of potentially serious pathologies. Screening remains contentious due to the challenges of identifying relatively rare entities amongst a healthy cohort. The imperfect diagnostic accuracy of all current tests means that screening strategies have potential for harm through incorrect diagnoses as well as the potential for identification of important sub-clinical pathologies. Management of athletes at risk of ventricular arrhythmias and sudden cardiac death is similarly complex. There is much yet to learn about the specific patterns of ventricular arrhythmias in athletes, and the separation of benign from potentially life-threatening remains imperfect. There are some promising advances, however, such as specialised imaging modalities combined with improved electrophysiological diagnostics and therapeutics. Some unique clinical patterns are emerging to advance our understanding and management of athletes with ventricular arrhythmias, requiring specialised skillsets for evaluation and management.
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Abstract
Infections associated with cardiac implantable electronic devices are increasing and are associated with significant morbidity and mortality. This article reviews the epidemiology, microbiology, and risk factors for acquisition of these infections. The complex diagnostic and management strategies associated with these serious infections are reviewed with an emphasis on recent updates and advances, as well as existing controversies. Additionally, the latest in preventative strategies are reviewed.
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Affiliation(s)
- Christopher J Arnold
- Division of Infectious Diseases and International Health, University of Virginia Health System, PO Box 800545, Charlottesville, VA 22908-0545, USA
| | - Vivian H Chu
- Division of Infectious Diseases, Duke University Hospital, Duke Box 102359, Durham, NC 27710, USA.
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26
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Differences in laser lead extraction of infected vs. non-infected leads. Heart Vessels 2018; 33:1245-1250. [DOI: 10.1007/s00380-018-1162-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/30/2018] [Indexed: 12/17/2022]
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