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Banker RS, Rippy MK, Cooper N, Neužil P, Exner DV, Nair DG, Booth DF, Ligon D, Badie N, Krans M, Ando K, Knops RE, Ip JE, Doshi RN, Rashtian M, Reddy VY. Retrieval of Chronically Implanted Dual-chamber Leadless Pacemakers in an Ovine Model. Circ Arrhythm Electrophysiol 2023; 16:e012232. [PMID: 37767710 DOI: 10.1161/circep.123.012232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND The clinical utilization of leadless pacemakers (LPs) as an alternative to traditional transvenous pacemakers is likely to increase with the advent of dual-chamber LP systems. Since device retrieval to allow LP upgrade or replacement will become an important capability, the first such dual-chamber, helix-fixation LP system (Aveir DR; Abbott, Abbott Park, IL) was specifically designed to allow catheter-based retrieval. In this study, the preclinical performance and safety of retrieving chronically implanted dual-chamber LPs was evaluated. METHODS Atrial and ventricular LPs were implanted in the right atrial appendage and right ventricular apex of 9 healthy ovine subjects. After ≈2 years, the LPs were retrieved using a dedicated transvenous retrieval catheter (Aveir Retrieval Catheter; Abbott) by snaring, docking, and unscrewing from the myocardium. Comprehensive necropsy/histopathology studies were conducted to evaluate device- and procedure-related outcomes. RESULTS At a median of 1.9 years postimplant (range, 1.8-2.6), all 18 of 18 (100%) LPs were retrieved from 9 ovine subjects without complications. The median retrieval procedure duration for both LPs, from first-catheter-in to last-catheter-out, was 13.3 minutes (range, 2.5-36.4). Postretrieval, all right atrial, and right ventricular implant sites demonstrated minimal tissue disruption, with intact fibrous tissue limited to the distal device body. No significant device-related trauma, perforation, pericardial effusion, right heart or tricuspid valve injury, or chronic pulmonary thromboembolism were observed at necropsy. CONCLUSIONS This preclinical study demonstrated the safe and effective retrieval of chronically implanted, helix-fixation, dual-chamber LP systems, paving the way for clinical studies of LP retrieval.
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Affiliation(s)
| | | | | | - Petr Neužil
- Na Homolce Hospital, Prague, Czech Republic (P.N., V.Y.R.)
| | - Derek V Exner
- Libin Cardiovascular Institute of Alberta, Calgary, Canada (D.V.E.)
| | - Devi G Nair
- St. Bernards Healthcare, Jonesboro, AR (D.G.N.)
| | | | - David Ligon
- Abbott, Sylmar, CA (N.C., D.F.B., D.L., N.B., M.K.)
| | - Nima Badie
- Abbott, Sylmar, CA (N.C., D.F.B., D.L., N.B., M.K.)
| | - Mark Krans
- Abbott, Sylmar, CA (N.C., D.F.B., D.L., N.B., M.K.)
| | - Kenji Ando
- Kokura Memorial Hospital, Kitakyushu, Japan (K.A.)
| | | | - James E Ip
- Weill Cornell Medical Center, NY (J.E.I.)
| | | | | | - Vivek Y Reddy
- Na Homolce Hospital, Prague, Czech Republic (P.N., V.Y.R.)
- Icahn School of Medicine at Mount Sinai Hospital, NY (V.Y.R.)
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Hsu JC, Banker RS, Gibson DN, Gomez T, Berman D, Datta K, Chen Q, Doshi SK. Comprehensive dose-response study of pulsed field ablation using a circular catheter compared with radiofrequency ablation for pulmonary vein isolation: A preclinical study. Heart Rhythm O2 2023; 4:662-667. [PMID: 37936668 PMCID: PMC10626186 DOI: 10.1016/j.hroo.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Affiliation(s)
- Jonathan C. Hsu
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine University of California San Diego, La Jolla, California
| | | | - Douglas N. Gibson
- Interventional Electrophysiology, Scripps Clinic and Prebys Cardiovascular Institute, La Jolla, California
| | | | | | | | - Qi Chen
- Biosense Webster, Irvine, California
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Reddy VY, Neuzil P, Booth DF, Knops RE, Doshi RN, Rashtian M, Exner DV, Banker RS, Nair D, Hadadi CA, Badie N, Yang W, Ligon D, Ip JE. Dual-Chamber Leadless Pacing: Atrioventricular Synchrony in Preclinical Models of Normal or Blocked Atrioventricular Conduction. Heart Rhythm 2023:S1547-5271(23)02104-5. [PMID: 37075958 DOI: 10.1016/j.hrthm.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/29/2023] [Accepted: 04/09/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Dual-chamber leadless pacemakers (LP) require robust communication between distinct right atrial (RA) and right ventricular (RV) LPs to achieve atrioventricular (AV) synchrony. OBJECTIVE This preclinical study evaluated a novel, continuous implant-to-implant (i2i™) communication methodology for maintaining AV-synchronous, dual-chamber DDD(R) pacing by the 2 LPs. METHODS RA and RV LPs were implanted and paired in 7 ovine subjects, 4 of 7 with induced complete heart block. AV synchrony (% AV intervals <300 ms) and i2i communication success (% successful i2i transmissions between LPs) were evaluated acutely and chronically. During acute testing, 12-lead ECG and LP diagnostic data were collected from 5-minute recordings, in 4 postures and 2 rhythms (AP-VP and AS-VP or AP-VS and AS-VS) per subject. Chronic i2i performance was evaluated through 23 weeks post-implant (final i2i evaluation period: week 16-23). RESULTS Acute AV synchrony and i2i communication success across multiple postures and rhythms were 100.0% [100.0-100.0] (median [interquartile range]) and 99.9% [99.9-99.9], respectively. AV synchrony and i2i success rates did not differ across postures (P=0.59, P=0.11) or rhythms (P=1.00, P=0.82). During the final i2i evaluation period, the overall i2i success was 98.9% [98.1-99.0]. CONCLUSION Successful AV-synchronous, dual-chamber DDD(R) leadless pacing using a novel, continuous, wireless communication modality was demonstrated across variations in posture and rhythm in a preclinical model.
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Affiliation(s)
- Vivek Y Reddy
- Icahn School of Medicine at Mount Sinai, New York, New York, USA; Na Homolce Hospital, Prague, Czech Republic.
| | | | | | | | - Rahul N Doshi
- HonorHealth Research Institute, Scottsdale, Arizona, USA
| | | | - Derek V Exner
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | | | - Devi Nair
- St. Bernard's Heart and Vascular Center, Jonesboro, Arkansas, USA
| | | | | | | | | | - James E Ip
- Weill Cornell Medical Center, New York, New York, USA
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Knops R, Cantillon DJ, Neuzil P, Banker RS, Rashtian M, Doshi RN, Booth D, Yang W, Goil A, Badie N, Ligon D, Fishler MG. PO-621-03 DUAL-CHAMBER LEADLESS PACEMAKER ENABLES ROBUST ATRIOVENTRICULAR SYNCHRONY IN VARIOUS POSTURES AND PACING CONFIGURATIONS. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Aryana A, Singh SM, Kowalski M, Pujara DK, Cohen AI, Singh SK, Aleong RG, Banker RS, Fuenzalida CE, Prager NA, Bowers MR, D'Avila A, O'Neill PG. Acute and Long-Term Outcomes of Catheter Ablation of Atrial Fibrillation Using the Second-Generation Cryoballoon versus Open-Irrigated Radiofrequency: A Multicenter Experience. J Cardiovasc Electrophysiol 2015; 26:832-839. [PMID: 25917655 DOI: 10.1111/jce.12695] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 04/14/2015] [Accepted: 04/17/2015] [Indexed: 12/11/2022]
Abstract
INTRODUCTION There are limited comparative data on catheter ablation of atrial fibrillation (CAAF) using the second-generation cryoballoon (CB-2) versus point-by-point radiofrequency (RF). This study examines the acute/long-term CAAF outcomes using these 2 strategies. METHODS AND RESULTS In this multicenter, retrospective, nonrandomized analysis, procedural and clinical outcomes of 1,196 patients (76% with paroxysmal AF) undergoing CAAF using CB-2 (n = 773) and open-irrigated, non-force sensing RF (n = 423) were evaluated. Pulmonary vein isolation was achieved in 98% with CB-2 and 99% with RF (P = 0.168). CB-2 was associated with shorter ablation time (40 ± 14 min vs. 66 ± 26 min; P < 0.001) and procedure time (145 ± 49 minutes vs. 188 ± 42 minutes; P < 0.001), but greater fluoroscopic utilization (29 ± 13 minutes vs. 23 ± 14 minutes; P < 0.001). While transient (7.6% vs. 0%; P < 0.001) and persistent (1.2% vs. 0%; P = 0.026) phrenic nerve palsy occurred exclusively with CB-2, other adverse event rates were similar between CB-2 (1.6%) and RF (2.6%); P = 0.207. However, freedom from AF/atrial flutter/tachycardia at 12 months following a single procedure without antiarrhythmic therapy was greater with CB-2 (76.6%) versus RF (60.4%); P < 0.001. While this difference was evident in patients with paroxysmal AF (P < 0.001), it did not reach significance in those with persistent AF (P = 0.089). Additionally, CB-2 was associated with reduced long-term need for antiarrhythmic therapy (16.7% vs. 22.0%; P = 0.024) and repeat ablations (14.6% vs. 24.1%; P < 0.001). CONCLUSION In this multicenter, retrospective, nonrandomized study, CAAF using CB-2 coupled with RF as occasionally required was associated with greater freedom from atrial arrhythmias at 12 months following a single procedure without antiarrhythmic therapy when compared to open-irrigated, non-force sensing RF, alone.
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Affiliation(s)
- Arash Aryana
- Regional Cardiology Associates and Dignity Health Heart & Vascular Institute, Sacramento, California, USA
| | - Sheldon M Singh
- Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Marcin Kowalski
- Division of Cardiac Electrophysiology, Staten Island University Hospital, Staten Island, New York, USA
| | - Deep K Pujara
- Department of Cardiothoracic Surgery, CHI Baylor St. Luke's Medical Center, Texas Heart Institute, Houston, Texas, USA
| | - Andrew I Cohen
- Aurora Denver Cardiology Associates, Aurora, Colorado, USA
| | - Steve K Singh
- Department of Cardiothoracic Surgery, CHI Baylor St. Luke's Medical Center, Texas Heart Institute, Houston, Texas, USA
| | - Ryan G Aleong
- Division of Cardiac Electrophysiology, University of Colorado, Denver, Colorado, USA
| | - Rajesh S Banker
- Hoag Hospital, Newport Beach, CA and University of California Irvine Medical Center, Orange, California, USA
| | | | | | - Mark R Bowers
- Regional Cardiology Associates and Dignity Health Heart & Vascular Institute, Sacramento, California, USA
| | - André D'Avila
- Instituto de Pesquisa em Arritmia Cardiaca (IPAC), Hospital Cardiologico-Florianopolis, Florianopolis, South Carolina, Brazil
| | - Padraig Gearoid O'Neill
- Regional Cardiology Associates and Dignity Health Heart & Vascular Institute, Sacramento, California, USA
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