1
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Vezi B, Akinrimisi OP. Permanent Bi-Bundle Pacing in a Patient With Heart Failure and Left Bundle Branch Block. JACC Case Rep 2022; 4:101688. [PMID: 36684035 PMCID: PMC9847235 DOI: 10.1016/j.jaccas.2022.101688] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/13/2022] [Accepted: 10/21/2022] [Indexed: 12/24/2022]
Abstract
Left bundle branch pacing (LBBP) is effective in patients with heart failure, left ventricular ejection fraction (LVEF) of ≤35%, and a widened QRS complex. LBBP leads to iatrogenic incomplete right bundle branch block (iRBBB). Bi-bundle pacing can resolve iRBBB, further narrowing the QRS duration, and may improve LVEF. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Brian Vezi
- Gateway Hospital, Umhlanga, South Africa
| | - Olumuyiwa P. Akinrimisi
- University of California, Los Angeles Medical Center, Los Angeles, California, USA
- Address for correspondence: Dr. Olumuyiwa Akinrimisi, University of California, Los Angeles Medical Center, 757 Westwood Plaza, Suite 7236, Los Angeles, California 90095, USA. @drakinrimisi
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2
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Rosalia L, Ozturk C, Shoar S, Fan Y, Malone G, Cheema FH, Conway C, Byrne RA, Duffy GP, Malone A, Roche ET, Hameed A. Device-Based Solutions to Improve Cardiac Physiology and Hemodynamics in Heart Failure With Preserved Ejection Fraction. JACC Basic Transl Sci 2021; 6:772-795. [PMID: 34754993 PMCID: PMC8559325 DOI: 10.1016/j.jacbts.2021.06.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/03/2021] [Indexed: 12/28/2022]
Abstract
Characterized by a rapidly increasing prevalence, elevated mortality and rehospitalization rates, and inadequacy of pharmaceutical therapies, heart failure with preserved ejection fraction (HFpEF) has motivated the widespread development of device-based solutions. HFpEF is a multifactorial disease of various etiologies and phenotypes, distinguished by diminished ventricular compliance, diastolic dysfunction, and symptoms of heart failure despite a normal ejection performance; these symptoms include pulmonary hypertension, limited cardiac reserve, autonomic imbalance, and exercise intolerance. Several types of atrial shunts, left ventricular expanders, stimulation-based therapies, and mechanical circulatory support devices are currently under development aiming to target one or more of these symptoms by addressing the associated mechanical or hemodynamic hallmarks. Although the majority of these solutions have shown promising results in clinical or preclinical studies, no device-based therapy has yet been approved for the treatment of patients with HFpEF. The purpose of this review is to discuss the rationale behind each of these devices and the findings from the initial testing phases, as well as the limitations and challenges associated with their clinical translation.
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Key Words
- BAT, baroreceptor activation therapy
- CCM, cardiac contractility modulation
- CRT, cardiac resynchronization therapy
- HF, heart failure
- HFmEF, heart failure with mid-range ejection fraction
- HFpEF
- HFpEF, heart failure with preserved ejection fraction
- HFrEF, heart failure with reduced ejection fraction
- IASD, Interatrial Shunt Device
- LAAD, left atrial assist device
- LAP, left atrial pressure
- LV, left ventricular
- LVEF, left ventricular ejection fraction
- MCS, mechanical circulatory support
- NYHA, New York Heart Association
- PCWP, pulmonary capillary wedge pressure
- QoL, quality of life
- TAA, transapical approach
- atrial shunt devices
- electrostimulation
- heart failure devices
- heart failure with preserved ejection fraction
- left ventricular expanders
- mechanical circulatory support
- neuromodulation
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Affiliation(s)
- Luca Rosalia
- Health Sciences and Technology Program, Harvard–Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Caglar Ozturk
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | | | - Yiling Fan
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Grainne Malone
- Tissue Engineering Research Group (TERG), Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Faisal H. Cheema
- HCA Healthcare, Houston, Texas, USA
- University of Houston, College of Medicine, Houston, Texas, USA
| | - Claire Conway
- Tissue Engineering Research Group (TERG), Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Robert A. Byrne
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
- Cardiovascular Research, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Garry P. Duffy
- Tissue Engineering Research Group (TERG), Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Anatomy & Regenerative Medicine Institute, School of Medicine, College of Medicine, Nursing, and Health Sciences, National University of Ireland Galway, Galway, Ireland
- Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
- Advanced Materials for Biomedical Engineering and Regenerative Medicine, Trinity College Dublin, and National University of Ireland Galway, Galway, Ireland
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland
| | - Andrew Malone
- Tissue Engineering Research Group (TERG), Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ellen T. Roche
- Health Sciences and Technology Program, Harvard–Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Aamir Hameed
- Tissue Engineering Research Group (TERG), Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland
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3
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Ingraham BS, Chareonthaitawee P, Reddy YNV. Exercise-Induced Left Bundle Branch Block Resulting in Severe Mitral Regurgitation. JACC Case Rep 2021; 3:1287-90. [PMID: 34471879 DOI: 10.1016/j.jaccas.2021.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/26/2021] [Accepted: 06/17/2021] [Indexed: 11/21/2022]
Abstract
Exercise hemodynamic catheterization is helpful to evaluate exertional symptoms when noninvasive investigations fail to provide an explanation in non-ischemic cardiomyopathy. In this case, a rate-related left bundle branch block resulted in severe dynamic mitral regurgitation and acute increase in pulmonary capillary wedge pressure. Cardiac resynchronization therapy resolved her symptoms. (Level of Difficulty: Intermediate.).
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Key Words
- AO, aorta
- BMI, body mass index
- CRT, cardiac resynchronization therapy
- LA, left atrium
- LBBB, left bundle branch block
- MR, mitral regurgitation
- PA, pulmonary artery
- PCWP, pulmonary capillary wedge
- TTE, transthoracic echocardiogram
- Vo2, oxygen consumption
- cardiac resynchronization therapy
- exercise
- hemodynamics
- mitral valve
- right-sided catheterization
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4
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Malanchini G, Malacrida M, Ferrari P, Senni M, De Filippo P. Remote Monitoring of Respiratory Pattern in an ICD Patient With COVID-19 Pneumonia. JACC Case Rep 2021; 3:1007-9. [PMID: 33972934 DOI: 10.1016/j.jaccas.2021.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/16/2021] [Accepted: 03/18/2021] [Indexed: 11/23/2022]
Abstract
A 67-year-old man with history of heart failure developed dyspnea. In this report, we describe an increase in his device-detected respiratory rate. Monitoring respiratory rate is recommended for evaluating acute cardiac decompensation, but such an algorithm could also be used to diagnose episodes of pneumonia caused by severe acute respiratory syndrome-coronavirus-2 infection. (Level of Difficulty: Intermediate.)
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5
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Bajwa A, Dhoot J, Gupta S. Coronary Sinus Lead Placement in Patients With Coronary Sinus Ostial Atresia: An Innovative Approach. JACC Case Rep 2021; 3:614-618. [PMID: 34317588 PMCID: PMC8302785 DOI: 10.1016/j.jaccas.2021.02.027] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/21/2021] [Accepted: 02/15/2021] [Indexed: 11/25/2022]
Abstract
This case series demonstrates 2 innovative approaches to successful coronary sinus lead placement in the setting of coronary sinus ostial atresia. Use of venous phase coronary angiography, a computed tomography scan with venous phase, or a left-sided upper extremity venogram may help reveal a variant anatomy and guide tool selection. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Ata Bajwa
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA.,University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | | | - Sanjaya Gupta
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA.,University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
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6
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Akhtar Z, Chen Z, Leung LWM, Beeton I, Gallagher MM. Innovative Cardiac Resynchronization: Deployable Lead as an Anchor to Facilitate Guidewire Advancement. JACC Case Rep 2021; 3:594-596. [PMID: 34317584 PMCID: PMC8302769 DOI: 10.1016/j.jaccas.2021.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/08/2021] [Indexed: 12/01/2022]
Abstract
An acutely angulated coronary sinus ostium coupled with a dilated right atrium presents technical challenges for cardiac resynchronization therapy (CRT) implantation. Innovative use of a deployable left ventricle lead as an anchor to support guidewire navigation within the cardiac venous system permits optimal CRT deployment. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Zaki Akhtar
- St. George's University Hospital, London, United Kingdom.,Ashford and St. Peter's Hospitals NHS Trust, Surrey, United Kingdom
| | - Zhong Chen
- Ashford and St. Peter's Hospitals NHS Trust, Surrey, United Kingdom
| | - Lisa W M Leung
- St. George's University Hospital, London, United Kingdom
| | - Ian Beeton
- Ashford and St. Peter's Hospitals NHS Trust, Surrey, United Kingdom
| | - Mark M Gallagher
- St. George's University Hospital, London, United Kingdom.,Ashford and St. Peter's Hospitals NHS Trust, Surrey, United Kingdom
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7
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Sarrias A, Pereferrer D, Bazan V, Bisbal F, Adeliño R, Aranyó J, Gual F, Villuendas R, Bayés-Genís A. Atrioventricular Node Ablation to Enhance Resynchronization Therapy Response in a Patient With Complete Atrioventricular Block. JACC Case Rep 2021; 3:150-155. [PMID: 34317491 PMCID: PMC8305624 DOI: 10.1016/j.jaccas.2020.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/14/2020] [Accepted: 11/02/2020] [Indexed: 11/28/2022]
Abstract
Up to one-third of patients who undergo cardiac resynchronization therapy do not obtain clinical benefit. A systematic approach can identify treatable causes in many nonresponding patients. We present a case of nonresponse to cardiac resynchronization therapy that resolved by ablation of the atrioventricular node in a patient with complete atrioventricular block. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Axel Sarrias
- Department of Cardiology, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Damià Pereferrer
- Department of Cardiology, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Victor Bazan
- Department of Cardiology, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Felipe Bisbal
- Department of Cardiology, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Raquel Adeliño
- Department of Cardiology, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Júlia Aranyó
- Department of Cardiology, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Francisco Gual
- Department of Cardiology, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Roger Villuendas
- Department of Cardiology, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Antoni Bayés-Genís
- Department of Cardiology, Germans Trias i Pujol University Hospital, Barcelona, Spain
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8
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Minami K, Shtëmbari J, Petrů J, Chovanec M, Funasako M, Hála P, Janotka M, Škoda J, Šedivá L, Reddy VY, Neužil P. Successful Retrieval of a 4-Year-Old Micra Transcatheter Pacemaker System in a Patient With Leadless Biventricular Pacing Therapy. JACC Case Rep 2020; 2:2249-2252. [PMID: 34317150 PMCID: PMC8299839 DOI: 10.1016/j.jaccas.2020.09.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/08/2020] [Accepted: 09/18/2020] [Indexed: 06/13/2023]
Abstract
This is the first report of the management of a patient with cardiac resynchronization therapy using leadless biventricular pacing. Successful retrieval of a 4-year-old Micra transcatheter pacing system (TPS) and reimplantation of a new Micra TPS prevented device-to-device interactions from multiple pacing devices in the right ventricle. (Level of Difficulty: Advanced.).
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Affiliation(s)
| | | | - Jan Petrů
- Na Homolce Hospital, Prague, Czech Republic
| | | | | | - Pavel Hála
- Na Homolce Hospital, Prague, Czech Republic
| | | | - Jan Škoda
- Na Homolce Hospital, Prague, Czech Republic
| | | | - Vivek Y. Reddy
- Na Homolce Hospital, Prague, Czech Republic
- Icahn School of Medicine at Mount Sinai, New York, New York
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9
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Green PG, Herring N. Pneumopericardium and Pneumomediastinum After Implantation of a Cardiac Resynchronization Pacemaker. JACC Case Rep 2019; 1:381-384. [PMID: 31807734 PMCID: PMC6884155 DOI: 10.1016/j.jaccas.2019.07.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/25/2019] [Accepted: 07/24/2019] [Indexed: 10/26/2022]
Abstract
A patient with previous coronary artery bypass grafting developed an iatrogenic pneumothorax, along with pneumopericardium and pneumomediastinum, after elective implantation of a cardiac resynchronization therapy pacemaker. There was no evidence of lead perforation, and the patient remained well and was successfully managed conservatively. We hypothesize that air tracked from the pneumothorax via microscopic pleuropericardial fistulae. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Peregrine G Green
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Neil Herring
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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10
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Zhang W, Huang J, Qi Y, Shi X, Wang F, Zhou X, Li R. Left Bundle Branch Conduction Recovery Following Left Bundle Branch Pacing in a Heart Failure Patient. JACC Case Rep 2019; 1:592-596. [PMID: 34316886 PMCID: PMC8288571 DOI: 10.1016/j.jaccas.2019.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/30/2019] [Accepted: 09/03/2019] [Indexed: 10/25/2022]
Abstract
This report presents the application of left bundle branch pacing as a cardiac resynchronization therapy in a patient with systolic heart failure and complete left bundle branch block. At the 3-month follow-up, the patient had significant improvement in cardiac function accompanied by the recovery of left bundle branch conduction. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Weiwei Zhang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jingjuan Huang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yiding Qi
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xuerui Shi
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Fei Wang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaohong Zhou
- CRHF Division, Medtronic plc, Mounds View, Minnesota
| | - Ruogu Li
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China,Address for correspondence: Dr. Ruogu Li, Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Road, Xuhui District, Shanghai 200030, China.
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11
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Hollanda L, Sobral R, Luize C, Carvalho W, Carvalho M, Passos L. Cardiac Resynchronization Therapy in a Chagasic Patient With Persistent Left Superior Vena Cava. JACC Case Rep 2019; 1:387-390. [PMID: 34316831 PMCID: PMC8288688 DOI: 10.1016/j.jaccas.2019.07.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/07/2019] [Accepted: 07/24/2019] [Indexed: 11/22/2022]
Abstract
This report describes the case of a woman with Chagas' cardiomyopathy with severe left ventricular dysfunction and persistent left superior vena cava who presented with episodes of syncope without prodromes and who was referred for cardiac resynchronization therapy. Despite this venous anomaly, electrodes were safely positioned in suitable locations. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Lucas Hollanda
- Electrophysiology Department, Ana Nery Hospital, Salvador, Bahia, Brazil
| | - Ricardo Sobral
- Electrophysiology Department, Ana Nery Hospital, Salvador, Bahia, Brazil
| | - Christian Luize
- Electrophysiology Department, Ana Nery Hospital, Salvador, Bahia, Brazil
| | - William Carvalho
- Electrophysiology Department, Ana Nery Hospital, Salvador, Bahia, Brazil
| | - Marcel Carvalho
- Electrophysiology Department, Ana Nery Hospital, Salvador, Bahia, Brazil
| | - Luiz Passos
- Electrophysiology Department, Ana Nery Hospital, Salvador, Bahia, Brazil
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12
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Behar JM, Chin HMS, Fearn S, Ormerod JOM, Gamble J, Foley PWX, Bostock J, Claridge S, Jackson T, Sohal M, Antoniadis AP, Razavi R, Betts TR, Herring N, Rinaldi CA. Cost-Effectiveness Analysis of Quadripolar Versus Bipolar Left Ventricular Leads for Cardiac Resynchronization Defibrillator Therapy in a Large, Multicenter UK Registry. JACC Clin Electrophysiol 2019; 3:107-116. [PMID: 28280785 PMCID: PMC5328196 DOI: 10.1016/j.jacep.2016.04.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The objective of this study was to evaluate the cost-effectiveness of quadripolar versus bipolar cardiac resynchronization defibrillator therapy systems. BACKGROUND Quadripolar left ventricular (LV) leads for cardiac resynchronization therapy reduce phrenic nerve stimulation (PNS) and are associated with reduced mortality compared with bipolar leads. METHODS A total of 606 patients received implants at 3 UK centers (319 Q, 287 B), between 2009 and 2014; mean follow-up was 879 days. Rehospitalization episodes were costed at National Health Service national tariff rates, and EQ-5D utility values were applied to heart failure admissions, acute coronary syndrome events, and mortality data, which were used to estimate quality-adjusted life-year differences over 5 years. RESULTS Groups were matched with regard to age and sex. Patients with quadripolar implants had a lower rate of hospitalization than those with bipolar implants (42.6% vs. 55.4%; p = 0.002). This was primarily driven by fewer hospital readmissions for heart failure (51 [16%] vs. 75 [26.1%], respectively, for quadripolar vs. bipolar implants; p = 0.003) and generator replacements (9 [2.8%] vs. 19 [6.6%], respectively; p = 0.03). Hospitalization for suspected acute coronary syndrome, arrhythmia, device explantation, and lead revisions were similar. This lower health-care utilization cost translated into a cumulative 5-year cost saving for patients with quadripolar systems where the acquisition cost was <£932 (US $1,398) compared with bipolar systems. Probabilistic sensitivity analysis results mirrored the deterministic calculations. For the average additional price of £1,200 (US $1,800) over a bipolar system, the incremental cost-effective ratio was £3,692 per quality-adjusted life-year gained (US $5,538), far below the usual willingness-to-pay threshold of £20,000 (US $30,000). CONCLUSIONS In a UK health-care 5-year time horizon, the additional purchase price of quadripolar cardiac resynchronization defibrillator therapy systems is largely offset by lower subsequent event costs up to 5 years after implantation, which makes this technology highly cost-effective compared with bipolar systems.
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Key Words
- ACS, acute coronary syndrome
- CRT, cardiac resynchronization therapy
- CRTD, cardiac resynchronization defibrillator therapy device
- HF, heart failure
- ICER, incremental cost-effectiveness ratio
- LV, left ventricular
- NHS, National Health Service
- NICE, National Institute for Health and Care Excellence
- PNS, phrenic nerve stimulation
- QALY, quality-adjusted life-year
- cardiac resynchronization therapy
- cost-effectiveness
- implantable cardiac defibrillator
- left ventricular pacing
- quadripolar lead
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Affiliation(s)
- Jonathan M Behar
- Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Hui Men Selina Chin
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Steve Fearn
- St. Jude Medical, Stratford Upon Avon, United Kingdom
| | - Julian O M Ormerod
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - James Gamble
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Julian Bostock
- Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Simon Claridge
- Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Tom Jackson
- Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Manav Sohal
- Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Antonios P Antoniadis
- Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Reza Razavi
- Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom
| | - Tim R Betts
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Neil Herring
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Christopher Aldo Rinaldi
- Imaging Sciences & Biomedical Engineering, 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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13
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Yamamoto K, Kurata Y, Inoue Y, Adachi M, Tsuneto M, Miake J, Ogino K, Ninomiya H, Yoshida A, Shirayoshi Y, Suyama Y, Yagi S, Nishimura M, Yamamoto K, Hisatome I. Pretreatment with an angiotensin II receptor blocker abolished ameliorating actions of adipose-derived stem cell sheets on cardiac dysfunction and remodeling after myocardial infarction. Regen Ther 2018; 9:79-88. [PMID: 30525078 PMCID: PMC6223028 DOI: 10.1016/j.reth.2018.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/10/2018] [Accepted: 08/22/2018] [Indexed: 02/07/2023] Open
Abstract
Introduction Cell sheets using myoblasts have been developed for the treatment of heart failure after myocardial infarction (MI) bridging to heart transplantation. Stem cells are supposed to be better than myoblasts as a source of cells, since they possess a potential to proliferate and differentiate into cardiomyocytes, and also have capacity to secrete angiogenic factors. Adipose-derived stem cells (ASCs) obtained from fat tissues are expected to be a new cell source for ASC sheet therapies. Administration of angiotensin II receptor blockers (ARBs) is a standard therapy for heart failure after MI. However, it is not known whether ARBs affect the cell sheet therapy. This study aimed to examine ameliorating effects of ASC sheets on heart failure and remodeling after MI, and how pretreatment with ARBs prior to the creation of MI and ASC sheet transplantation modifies the effects of ASC sheets. Methods ASCs were isolated from fat tissues of wild-type rats, and ASC sheets were engineered on temperature-responsive dishes. In in vitro studies using cultured cells, mRNA levels of vascular endothelial growth factor (VEGF) in ASCs were determined by RT-PCR in the presence of angiotensin II and/or an ARB, irbesartan, under normoxia and hypoxia; mRNA and protein levels of angiotensin II receptor type 1a (AT1aR), type 1b (AT1bR) and type 2 (AT2R) were also determined by RT-PCR and western blotting. In in vivo studies using a rat MI model, effects of transplanted ASC sheets and/or irbesartan on cardiac functions and remodeling after MI were evaluated by echocardiography, histological analysis and molecular biological techniques. Results In the in vitro studies, ASCs expressed higher levels of VEGF mRNA under hypoxia. They also expressed mRNA and protein of AT1aR but not AT1bR or AT2R. Under normoxia, angiotensin II increased the level of VEGF mRNA in ASCs, which was abolished by irbesartan. Under hypoxia, irbesartan reduced the level of VEGF mRNA in ASCs regardless of whether angiotensin II was present or not. In the in vivo studies, ASC sheets improved cardiac functions after MI, leading to decreased interstitial fibrosis and increased capillary density in border zones. These effects of ASC sheets were abolished by oral administration of irbesartan before MI and their transplantation. Conclusions ASC sheets ameliorated cardiac dysfunctions and remodeling after MI via increasing VEGF expression, which was abolished by pretreatment with irbesartan before the creation of MI and transplantation.
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Key Words
- ANP, atrial natriuretic peptide
- ARB, angiotensin receptor blocker
- ASC, adipose-derived stem cell
- AT1(2)R, angiotensin II receptor type 1(2)
- Adipose-derived stem cell sheet
- Angiotensin II
- CRT, cardiac resynchronization therapy
- EF, ejection fraction
- FGF, fibroblast growth factor
- FS, fractional shortening
- HGF, hepatocyte growth factor
- Irbesartan
- LVEDD, left ventricular end-diastolic diameter
- LVESD, left ventricular end-systolic diameter
- MI, myocardial infarction
- MSC, mesenchymal stem cell
- Myocardial infarction
- RAS, renin–angiotensin system
- VEGF
- VEGF, vascular endothelial growth factor
- vWF, von Willebrand factor
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Affiliation(s)
- Kenshiro Yamamoto
- Division of Regenerative Medicine and Therapeutics, Department of Genetic Medicine and Regenerative Therapeutics, Tottori University Graduate School of Medical Science, 86 Nishi-cho, Yonago 683-8503, Japan
| | - Yasutaka Kurata
- Department of Physiology II, Kanazawa Medical University Faculty of Medicine, 1-1 Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa 920-0293, Japan
| | - Yumiko Inoue
- Division of Regenerative Medicine and Therapeutics, Department of Genetic Medicine and Regenerative Therapeutics, Tottori University Graduate School of Medical Science, 86 Nishi-cho, Yonago 683-8503, Japan
| | - Maya Adachi
- Division of Regenerative Medicine and Therapeutics, Department of Genetic Medicine and Regenerative Therapeutics, Tottori University Graduate School of Medical Science, 86 Nishi-cho, Yonago 683-8503, Japan
| | - Motokazu Tsuneto
- Division of Regenerative Medicine and Therapeutics, Department of Genetic Medicine and Regenerative Therapeutics, Tottori University Graduate School of Medical Science, 86 Nishi-cho, Yonago 683-8503, Japan
| | - Junichiro Miake
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Tottori University Faculty of Medicine, Yonago, Japan
| | - Kazuhide Ogino
- Department of Cardiology, Tottori Red Cross Hospital, Tottori, Japan
| | - Haruaki Ninomiya
- Department of Biological Regulation, Tottori University, Yonago, Japan
| | - Akio Yoshida
- Division of Regenerative Medicine and Therapeutics, Department of Genetic Medicine and Regenerative Therapeutics, Tottori University Graduate School of Medical Science, 86 Nishi-cho, Yonago 683-8503, Japan
| | - Yasuaki Shirayoshi
- Division of Regenerative Medicine and Therapeutics, Department of Genetic Medicine and Regenerative Therapeutics, Tottori University Graduate School of Medical Science, 86 Nishi-cho, Yonago 683-8503, Japan
| | - Yoshiko Suyama
- Department of Plastic and Reconstructive Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Shunjiro Yagi
- Department of Plastic and Reconstructive Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Motonobu Nishimura
- Department of Cardiovascular Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Kazuhiro Yamamoto
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Tottori University Faculty of Medicine, Yonago, Japan
| | - Ichiro Hisatome
- Division of Regenerative Medicine and Therapeutics, Department of Genetic Medicine and Regenerative Therapeutics, Tottori University Graduate School of Medical Science, 86 Nishi-cho, Yonago 683-8503, Japan
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Akpalu D, Newman G, Brice M, Powell M, Singh R, Quarshie A, Ofili E, Fonger J, Chronos N, Feldman D. Matrix Signaling Subsequent to a Myocardial Infarction: A Proteomic Profile of Tissue Factor Microparticles. JACC Basic Transl Sci 2017; 2:529-42. [PMID: 30062169 DOI: 10.1016/j.jacbts.2017.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/27/2017] [Accepted: 04/04/2017] [Indexed: 11/24/2022]
Abstract
The occurrence of an MI activates production of TFMPs. We induced an MI in Yucatan miniswine and collected plasma samples over a 6-month period post-MI. Experimental groups consisted of infarcted but untreated animals and infarcted animals treated with CRT plus β-blocker. Using proteomic profiling, we confirm the heterogeneity of TFMP protein content with respect to physiological status of the host temporally. Spatially, the contents of the TFMPs provided information about multiple entities supplemental to what we obtained from assessing a set of 8 currently used cardiac biomarkers. The results from this study support recommending TFMP protein content profiling be used prospectively as a viable investigative methodology for chronic ischemic cardiomyopathy to help improve our understanding of β-adrenergic receptor signaling after an MI.
This study investigated the release and proteomic profile of tissue factor microparticles (TFMPs) prospectively (up to 6 months) following a myocardial infarction (MI) in a chronic porcine model to establish their utility in tracking cellular level activities that predict physiologic outcomes. Our animal groups (n = 6 to 8 each) consisted of control, noninfarcted (negative control); infarcted only (positive control); and infarcted animals treated with cardiac resynchronization therapy (CRT) and a β-blocker (BB) (metoprolol succinate). The authors found different protein profiles in TFMPs between the control, infarcted only group, and the CRT + BB treated group with predictive impact on the outward phenotype of pathological remodeling after an MI within and between groups. This novel approach of monitoring cellular level activities by profiling the content of TFMPs has the potential of addressing a shortfall of the current crop of cardiac biomarkers, which is the inability to capture composite molecular changes associated with chronic maladaptive signaling in a spatial and temporal manner.
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Key Words
- ADRB1, β1-adrenergic receptor
- ADRB2, β2-adrenergic receptor
- AR, adrenergic receptor
- ARRB1, β1-arrestin
- BB, β-blocker
- CRT, cardiac resynchronization therapy
- EDV, end-diastolic volume
- EF, ejection fraction
- ELISA, enzyme-linked immunosorbent assay
- ESV, end-systolic volume
- FACS, fluorescence-activated cell sorting
- GRK, G-protein receptor kinase
- HSP, heat shock protein
- HUVEC, human umbilical vein endothelial cell
- LVAd MV, left ventricular area around the mitral valve at diastole
- LVAd PM, left ventricular area around the papillary muscle at diastole
- LVAs MV, left ventricular area around the mitral valve at systole
- LVAs PM, left ventricular area around the papillary muscle at systole
- MI, myocardial infarction
- MP, microparticle
- PCR, polymerase chain reaction
- TF, tissue factor
- TFMP, tissue factor–bearing microparticle
- TnT, troponin T
- Yucatan mini swine
- cAMP, cyclic adenosine monophosphate
- chronic ischemic cardiomyopathy
- matrix signaling
- myocardial infarction
- tissue factor-bearing microparticles
- βAR signaling
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Jackson T, Lenarczyk R, Sterlinski M, Sokal A, Francis D, Whinnett Z, Van Heuverswyn F, Vanderheyden M, Heynens J, Stegemann B, Cornelussen R, Rinaldi CA. Left ventricular scar and the acute hemodynamic effects of multivein and multipolar pacing in cardiac resynchronization. Int J Cardiol Heart Vasc 2018; 19:14-19. [PMID: 29946558 PMCID: PMC6016076 DOI: 10.1016/j.ijcha.2018.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 03/21/2018] [Indexed: 12/14/2022]
Abstract
Background We sought to determine whether presence, amount and distribution of scar impacts the degree of acute hemodynamic response (AHR) with multisite pacing. Multi-vein pacing (MVP) or multipolar pacing (MPP) with a multi-electrode left ventricular (LV) lead may offer benefits over conventional biventricular pacing in patients with myocardial scar. Methods In this multi-center study left bundle branch block patients underwent an hemodynamic pacing study measuring LV dP/dtmax. Patients had cardiac magnetic resonance scar imaging to assess the effect of scar presence, amount and distribution on AHR. Results 24 patients (QRS 171 ± 20 ms) completed the study (83% male). An ischemic etiology was present in 58% and the mean scar volume was 6.0 ± 7.0%. Overall discounting scar, MPP and MVP showed no significant AHR increase compared to an optimized “best BiV” (BestBiV) site. In a minority of patients (6/24) receiver-operator characteristic analysis of scar volume (cut off 8.48%) predicted a small AHR improvement with MPP (sensitivity 83%, specificity 94%) but not MVP. Patients with scar volume > 8.48% had a MPP-BestBiV of 3 ± 6.3% vs. −6.4 ± 7.7% for those below the cutoff. There was a significant correlation between the difference in AHR and scar volume for MPP-BestBiV (R = 0.49, p = 0.02) but not MVP-BestBiV(R = 0.111, p = 0.62). The multielectrode lead positioned in scar predicted MPP AHR improvement (p = 0.04). Conclusions Multisite pacing with MPP and MVP shows no AHR benefit in all-comers compared to optimized BestBiV pacing. There was a minority of patients with significant scar volume in relation to the LV site that exhibited a small AHR improvement with MPP. (Study identifier NCT01883141)
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Key Words
- AHR, acute hemodynamic response
- Acute hemodynamic response
- BiV, biventricular
- CI, confidence interval
- CMR, cardiac magnetic resonance
- CMR-LGE, cardiac magnetic resonance late gadolinium enhancement
- CRT, cardiac resynchronization therapy
- Cardiac resynchronization therapy
- ECG, electrocardiogram
- HF, heart failure
- LBBB, left bundle branch block
- LV, left ventricular
- Left ventricular scar
- MEL, multielectrode lead
- MPP, multipolar pacing
- MVP, multivein pacing
- Multisite pacing
- OR, odds ratio
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Affiliation(s)
- Tom Jackson
- Department of Cardiology, Guy's & St. Thomas' Hospitals & King's College London, London, United Kingdom
| | - Radoslaw Lenarczyk
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Zabrze, Poland
| | | | - Adam Sokal
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Zabrze, Poland
| | - Darrell Francis
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Zachary Whinnett
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | | | - Joeri Heynens
- Medtronic Inc., Bakken Research Centre, Maastricht, The Netherlands
| | | | | | - Christopher Aldo Rinaldi
- Department of Cardiology, Guy's & St. Thomas' Hospitals & King's College London, London, United Kingdom
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Ouali S, Kacem S, Gribaa R, Neffeti E, Remedi F, Boughzela E. Successful pregnancies after transvenous cardiac resynchronization therapy in a woman with congenitally corrected transposition of the great arteries. Egypt Heart J 2018; 69:219-222. [PMID: 29622980 PMCID: PMC5883487 DOI: 10.1016/j.ehj.2017.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 05/08/2017] [Indexed: 11/18/2022] Open
Abstract
Congenitally corrected transposition of the great arteries is a rare heart defect that can be associated with systemic ventricular dysfunction and conduction disturbances. The use of cardiac resynchronization therapy in patients with congenital heart disease is not fully established, and achievement of successful pregnancies after implantation of transvenous, biventricular system has never been described, and which resulted in a significant clinical improvement. We describe a 33-year-old female with congenitally corrected transposition of the great arteries, who achieved six pregnancies and successful vaginal deliveries. The two last pregnancies were achieved after cardiac resynchronization therapy for systemic ventricular dysfunction and complete heart block. A congenital cardiac disease has been identified in only one offspring.
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Key Words
- ASD, atrial septal defect
- AV, atrio-ventricular
- AVB, atrioventricular block
- CRT, cardiac resynchronization therapy
- CS, coronary sinus
- Cardiac resynchronization therapy
- Congenitally corrected transposition of the great arteries
- LV, left ventricle
- PLCV, posterolateral cardiac vein
- Pregnancy
- RV, right ventricle
- RVEF, right ventricle ejection fraction
- ccTGA, congenitally corrected transposition of the great arteries
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Affiliation(s)
- Sana Ouali
- La Rabta Hospital, Tunis, Tunisia
- Corresponding author at: Department of Cardiology, La Rabta Hospital, Tunis, La Rabta Jebbari, 1007 Tunis, Tunisia. Fax: +216 71 570 506.Department of CardiologyLa Rabta Hospital, TunisLa Rabta Jebbari1007 TunisTunisia
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Giammaria M, Quirino G, Alberio M, Parravicini U, Cipolla E, Rossetti G, Ruocco A, Senatore G, Rametta F, Pistelli P. Automatic atrial capture device control in real-life practice: A multicenter experience. J Arrhythm 2017; 33:139-43. [PMID: 28416982 DOI: 10.1016/j.joa.2016.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/27/2016] [Accepted: 06/06/2016] [Indexed: 11/20/2022] Open
Abstract
Background Device-based fully automatic pacing capture detection is useful in clinical practice and important in the era of remote care management. The main objective of this study was to verify the effectiveness of the new ACAP Confirm® algorithm in managing atrial capture in the medium term in comparison with early post-implantation testing. Methods Data were collected from 318 patients (66% male; mean age, 73±10 years); 237 of these patients underwent device implantation and 81 box changes in 31 Italian hospitals. Atrial threshold measurements were taken manually and automatically at different pulse widths before discharge and during follow-up (7±2 months) examination. Results The algorithm worked as expected in 73% of cases, considering all performed tests. The success rate was 65% and 88% pre-discharge and during follow-up examination (p<0.001), respectively, in patients who had undergone implantation. We did not detect any difference in the performance of the algorithm as a result of the type of atrial lead used. The success rate was 70% during pre-discharge testing in patients undergoing device replacement. Considering all examination types, manual and automatic measurements yielded threshold values of 1.07±0.47 V and 1.03±0.47 V at 0.2-ms pulse duration (p=0.37); 0.66±0.37 V and 0.67±0.36 V at 0.4 ms (p=0.42); and 0.5±0.28 V and 0.5±0.29 V at 1 ms (p=0.32). Conclusions The results show that the algorithm works before discharge, and its reliability increases over the medium term. The algorithm also proved accurate in detecting the atrial threshold automatically. The possibility of activating it does not seem to be influenced by the lead type used, but by the time from implantation.
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Behar JM, Jackson T, Hyde E, Claridge S, Gill J, Bostock J, Sohal M, Porter B, O'Neill M, Razavi R, Niederer S, Rinaldi CA. Optimized Left Ventricular Endocardial Stimulation Is Superior to Optimized Epicardial Stimulation in Ischemic Patients With Poor Response to Cardiac Resynchronization Therapy: A Combined Magnetic Resonance Imaging, Electroanatomic Contact Mapping, and Hemodynamic Study to Target Endocardial Lead Placement. JACC Clin Electrophysiol 2016; 2:799-809. [PMID: 28066827 PMCID: PMC5196018 DOI: 10.1016/j.jacep.2016.04.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The purpose of this study was to identify the optimal pacing site for the left ventricular (LV) lead in ischemic patients with poor response to cardiac resynchronization therapy (CRT). BACKGROUND LV endocardial pacing may offer benefit over conventional CRT in ischemic patients. METHODS We performed cardiac magnetic resonance, invasive electroanatomic mapping (EAM), and measured the acute hemodynamic response (AHR) in patients with existing CRT systems. RESULTS In all, 135 epicardial and endocardial pacing sites were tested in 8 patients. Endocardial pacing was superior to epicardial pacing with respect to mean AHR (% change in dP/dtmax vs. baseline) (11.81 [-7.2 to 44.6] vs. 6.55 [-11.0 to 19.7]; p = 0.025). This was associated with a similar first ventricular depolarization (Q-LV) (75 ms [13 to 161 ms] vs. 75 ms [25 to 129 ms]; p = 0.354), shorter stimulation-QRS duration (15 ms [7 to 43 ms] vs. 19 ms [5 to 66 ms]; p = 0.010) and shorter paced QRS duration (149 ms [95 to 218 ms] vs. 171 ms [120 to 235 ms]; p < 0.001). The mean best achievable AHR was higher with endocardial pacing (25.64 ± 14.74% vs. 12.64 ± 6.76%; p = 0.044). Furthermore, AHR was significantly greater pacing the same site endocardially versus epicardially (15.2 ± 10.7% vs. 7.6 ± 6.3%; p = 0.014) with a shorter paced QRS duration (137 ± 22 ms vs. 166 ± 30 ms; p < 0.001) despite a similar Q-LV (70 ± 38 ms vs. 79 ± 34 ms; p = 0.512). Lack of capture due to areas of scar (corroborated by EAM and cardiac magnetic resonance) was associated with a poor AHR. CONCLUSIONS In ischemic patients with poor CRT response, biventricular endocardial pacing is superior to epicardial pacing. This may reflect accessibility to sites that cannot be reached via coronary sinus anatomy and/or by access to more rapidly conducting tissue. Furthermore, guidance to the optimal LV pacing site may be aided by modalities such as cardiac magnetic resonance to target delayed activating sites while avoiding scar.
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Key Words
- AHR, acute hemodynamic response
- CMR, cardiac magnetic resonance
- CRT
- CRT, cardiac resynchronization therapy
- EAM, electroanatomic mapping
- LV, left ventricle/ventricular
- LVendo, left ventricular endocardium
- LVepi, optimal epicardial response
- LVepi1, implanted LV lead
- LVepi2, temporary LV lead
- Q-LV, first ventricular depolarization
- cardiac magnetic resonance imaging
- electroanatomic map
- endocardial pacing
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Affiliation(s)
- Jonathan M Behar
- Department of Imaging Sciences and Biomedical Engineering, King's College London & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Tom Jackson
- Department of Imaging Sciences and Biomedical Engineering, King's College London & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Eoin Hyde
- Department of Imaging Sciences and Biomedical Engineering, King's College London & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Simon Claridge
- Department of Imaging Sciences and Biomedical Engineering, King's College London & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Jaswinder Gill
- Department of Imaging Sciences and Biomedical Engineering, King's College London & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Julian Bostock
- Department of Imaging Sciences and Biomedical Engineering, King's College London & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Manav Sohal
- Department of Imaging Sciences and Biomedical Engineering, King's College London & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Bradley Porter
- Department of Imaging Sciences and Biomedical Engineering, King's College London & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Mark O'Neill
- Department of Imaging Sciences and Biomedical Engineering, King's College London & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Reza Razavi
- Department of Imaging Sciences and Biomedical Engineering, King's College London & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Steve Niederer
- Department of Imaging Sciences and Biomedical Engineering, King's College London & Guy's and St Thomas' Hospital, London, United Kingdom
| | - Christopher Aldo Rinaldi
- Department of Imaging Sciences and Biomedical Engineering, King's College London & Guy's and St Thomas' Hospital, London, United Kingdom
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Notomi Y, Isomura T, Kanai S, Maeda M, Hoshino J, Kondo T, Fukada Y, Furukawa K. Pre-Operative Left Ventricular Torsion, QRS Width/CRT, and Post-Mitral Surgery Outcomes in Patients With Nonischemic, Chronic, Severe Secondary Mitral Regurgitation. JACC Basic Transl Sci 2016; 1:193-202. [PMID: 30167512 PMCID: PMC6113356 DOI: 10.1016/j.jacbts.2016.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 04/25/2016] [Accepted: 04/26/2016] [Indexed: 11/20/2022]
Abstract
The selection of appropriate candidates for mitral surgery among symptomatic patients with nonischemic, chronic, secondary severe mitral regurgitation (NICSMR) remains a clinical challenge. We studied 50 consecutive symptomatic NICSMR patients for a median follow-up of 2.5 years after mitral surgery and concluded that the pre-operative 2-dimensional speckle tracking echocardiography-derived left ventricular torsional profile and QRS width/cardiac resynchronization therapy are potentially important prognostic indicators for post-surgery survival and reverse remodeling. Determining which patients with NICSMR will benefit from MS is a clinical dilemma. LV torsion (which is a shear strain, not volume strain such as ejection fraction and originates in LV myocardial architectures) may reveal the myopathic conditions and reflect intra-LV electrical conduction. The LV torsional profile predicted post-MS outcomes in NICSMR patients with a narrow QRS but not in those with a wide QRS. The findings may help to resolve the clinical dilemma and identify appropriate candidates for mitral surgery (and other resources) in patients with NICSMR.
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Affiliation(s)
- Yuichi Notomi
- Division of Cardiovascular Imaging, Department of Cardiology, The Hayama Heart Center, Kanagawa, Japan
| | - Tadashi Isomura
- Department of Cardiovascular Surgery, The Hayama Heart Center, Kanagawa, Japan
| | - Shunichi Kanai
- Division of Cardiovascular Imaging, Department of Cardiology, The Hayama Heart Center, Kanagawa, Japan
| | - Masami Maeda
- Department of Cardiovascular Surgery, The Hayama Heart Center, Kanagawa, Japan
| | - Joji Hoshino
- Department of Cardiovascular Surgery, The Hayama Heart Center, Kanagawa, Japan
| | - Taichi Kondo
- Department of Cardiovascular Surgery, The Hayama Heart Center, Kanagawa, Japan
| | - Yasuhisa Fukada
- Department of Cardiovascular Surgery, The Hayama Heart Center, Kanagawa, Japan
| | - Koji Furukawa
- Department of Cardiovascular Surgery, The Hayama Heart Center, Kanagawa, Japan
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Wilkoff BL, Fauchier L, Stiles MK, Morillo CA, Al-Khatib SM, Almendral J, Aguinaga L, Berger RD, Cuesta A, Daubert JP, Dubner S, Ellenbogen KA, Estes NAM, Fenelon G, Garcia FC, Gasparini M, Haines DE, Healey JS, Hurtwitz JL, Keegan R, Kolb C, Kuck KH, Marinskis G, Martinelli M, McGuire M, Molina LG, Okumura K, Proclemer A, Russo AM, Singh JP, Swerdlow CD, Teo WS, Uribe W, Viskin S, Wang CC, Zhang S. 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing. J Arrhythm 2016; 32:1-28. [PMID: 26949427 PMCID: PMC4759125 DOI: 10.1016/j.joa.2015.12.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Key Words
- AF, atrial fibrillation
- ATP, antitachycardia pacing
- Bradycardia mode and rate
- CI, confidence interval
- CL, cycle length
- CRT, cardiac resynchronization therapy
- CRT-D, cardiac resynchronization therapy–defibrillator
- DT, defibrillation testing
- Defibrillation testing
- EEG, electroencephalography
- EGM, electrogram
- HF, heart failure
- HR, hazard ratio
- ICD, implantable cardioverter-defibrillator
- Implantable cardioverter-defibrillator
- LV, left ventricle
- LVEF, left ventricular ejection fraction
- MI, myocardial infarction
- MVP, managed ventricular pacing
- NCDR, National Cardiovascular Data Registry
- NYHA, New York Heart Association
- OR, odds ratio
- PEA, peak endocardial acceleration
- PVC, premature ventricular contraction
- Programming
- RCT, randomized clinical trial
- RV, right ventricle
- S-ICD, subcutaneous implantable cardioverter-defibrillator
- SCD, sudden cardiac death
- SVT, supraventricular tachycardia
- TIA, transient ischemic attack
- Tachycardia detection
- Tachycardia therapy
- VF, ventricular fibrillation
- VT, ventricular tachycardia (Heart Rhythm 2015;0:1–37)
- aCRT, adaptive cardiac resynchronization therapy
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Affiliation(s)
| | | | | | - Carlos A Morillo
- Department of Medicine, Cardiology Division, McMaster University-Population Health Research Institute, Hamilton, Canada
| | | | - Jesœs Almendral
- Grupo HM Hospitales, Universidad CEU San Pablo, Madrid, Spain
| | | | | | - Alejandro Cuesta
- Servicio de Arritmias, Instituto de Cardiologia Infantil, Montevideo, Uruguay
| | | | - Sergio Dubner
- Clinica y Maternidad Suizo Argentina; De Los Arcos Sanatorio, Buenos Aires, Argentina
| | | | | | | | - Fermin C Garcia
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - David E Haines
- William Beaumont Hospital Division of Cardiology, Royal Oak, Michigan
| | - Jeff S Healey
- Department of Medicine, Cardiology Division, McMaster University-Population Health Research Institute, Hamilton, Canada
| | | | | | | | | | | | | | | | - Luis G Molina
- Mexico's National University, Mexico's General Hospital, Mexico City, Mexico
| | - Ken Okumura
- Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Alessandro Proclemer
- Azienda Ospedaliero Universitaria S. Maria della Misericordia- Udine, Udine, Italy
| | | | - Jagmeet P Singh
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Wee Siong Teo
- National Heart Centre Singapore, Singapore, Singapore
| | - William Uribe
- CES Cardiología and Centros Especializados San Vicente Fundación, Medellín y Rionegro, Colombia
| | - Sami Viskin
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Shu Zhang
- National Center for Cardiovascular Disease and Beijing Fu Wai Hospital, Peking Union Medical College and China Academy of Medical Sciences, Beijing, China
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Morishima I, Tomomatsu T, Morita Y, Tsuboi H. Intentional anodal capture of a left ventricular quadripolar lead enhances resynchronization equally with multipoint pacing. HeartRhythm Case Rep 2015; 1:386-8. [PMID: 28491592 DOI: 10.1016/j.hrcr.2015.06.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Gebska MA, Giudici MC, Rossen J, Wilson JS, Sigurdsson G, London B, Chatterjee K. Isolated right ventricular failure and abnormal hemodynamics caused by right ventricular pacing are reversed with cardiac resynchronization therapy. HeartRhythm Case Rep 2015; 1:182-185. [PMID: 28491544 PMCID: PMC5419251 DOI: 10.1016/j.hrcr.2015.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Milena A Gebska
- Division of Cardiovascular Diseases, University of Iowa, Iowa City, Iowa
| | - Michael C Giudici
- Division of Cardiovascular Diseases Electrophysiology, University of Iowa, Iowa City, Iowa
| | - James Rossen
- Division of Cardiovascular Diseases, University of Iowa, Iowa City, Iowa
| | - Jeffrey S Wilson
- Division of Pulmonary and Critical Care, University of Iowa, Iowa City, Iowa
| | - Gardar Sigurdsson
- Division of Cardiovascular Diseases, University of Iowa, Iowa City, Iowa
| | - Barry London
- Division of Cardiovascular Diseases, University of Iowa, Iowa City, Iowa
| | - Kanu Chatterjee
- Division of Cardiovascular Diseases, University of Iowa, Iowa City, Iowa
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Doblado-Calatrava M, Sánchez-Quintana D, García-Guerrero JJ, Pizarro G, de la Concha JF. Use of intracardiac echocardiography as a guide during interventricular septum puncture in a patient undergoing cardiac resynchronization therapy. HeartRhythm Case Rep 2015; 1:345-347. [PMID: 28507901 PMCID: PMC5426420 DOI: 10.1016/j.hrcr.2015.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Manuel Doblado-Calatrava
- Department of Cardiology, Hospital Universitario Infanta Cristina, Badajoz, Spain
- Address reprint requests and correspondence: Dr Manuel Doblado, Department of Cardiology, Hospital Universitario Infanta Cristina, Avenida de Elvas06080 Badajoz, Spain
| | - Damián Sánchez-Quintana
- Department of Anatomy and Cell Biology, Faculty of Medicine, University of Extremadura, Badajoz, Spain
| | | | - Gonzalo Pizarro
- Department of Cardiology, Hospital Universitario Quirón, European University of Madrid, Madrid, Spain
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Ghani A, Delnoy PPHM, Adiyaman A, Ottervanger JP, Ramdat Misier AR, Smit JJJ, Elvan A. Septal rebound stretch as predictor of echocardiographic response to cardiac resynchronization therapy. Int J Cardiol Heart Vasc 2015; 7:22-7. [PMID: 28785641 DOI: 10.1016/j.ijcha.2015.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 02/01/2015] [Indexed: 01/14/2023]
Abstract
Aim Septal rebound stretch (SRSsept) reflects an inefficient deformation of the septum during systole and is a potential new echocardiographic tool to predict response to Cardiac Resynchronization Therapy (CRT). However, there are only limited data on the potential predictive value of SRSsept on echocardiographic response. We evaluated the predictive value of SRSsept on echocardiographic response to CRT in a large population. Methods and results A total of 138 consecutive patients with functional class II–IV heart failure who underwent CRT were studied. Echocardiography was performed at baseline and after a mean follow-up period of 22 ± 8 months. Echocardiographic response to CRT was defined as a reduction in LV end-systolic volume ≥ 15%. Receiver operating characteristic curve analysis was performed to define the optimal cut-off value for SRSsept. Multivariable analyses were performed to adjust for potential confounders. Mean age was 68 ± 8 years (30% female). Mean baseline LV ejection fraction was 26 ± 7%, 51% had ischemic etiology. LBBB or LBBB like morphology was present in 95% of patients. Mean SRSsept was 4.4 ± 3.2%, 56% of patients had SRSsept ≥ 4%. Ninety six patients (70%) were echocardiographic responders. Baseline SRSsept was significantly higher in responders compared to non-responders (5.1 ± 3.2 vs 3.0 ± 2.7, P < 0.001). The optimal cut-off value for SRSsept to predict response to CRT was 4.0%. After both univariate (OR 3.74, 95% CI 1.72–8.10) and multivariate analyses (OR 3.71, 95% CI 1.49–9.2), baseline SRSsept > 4% independently predicted the response to CRT. Conclusions Baseline septal rebound stretch is independently associated with echocardiographic response to CRT. Septal rebound stretch was used to predict response to CRT in patient who underwent CRT-D implantation. Echocardiographic response to CRT was defined as a reduction in LV end-systolic volume ≥ 15%. Baseline SRSsept was significantly higher in echocardiographic responders compared to non-responders to CRT. The optimal cut-off value for SRSsept was 4%. Baseline septal rebound stretch was independently associated with echocardiographic response to CRT.
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Key Words
- CABG, coronary artery bypass grafting
- CRT, cardiac resynchronization therapy
- Cardiac resynchronization therapy
- Heart failure
- IVMD, inter-ventricular mechanical delay
- LBBB, left bundle branch block
- LV-dyssynchrony
- LVEDD, left ventricular end-diastolic diameter
- LVEDV, left ventricular end-diastolic volume
- LVEF, left ventricular ejection fraction
- LVESD, left ventricular end-systolic diameter
- LVESV, left ventricular end-systolic volume
- NYHA, New York Heart Association
- PCI, percutaneous coronary intervention
- RBBB, right bundle branch block
- Response
- SRSSept, septal rebound stretch
- Septal rebound stretch
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Yang Z, Eggen MD, Marquard KR, Asleson AJ, McVenes RD, Iaizzo PA. Direct visualization of an atrial transseptal left ventricular endocardial lead implantation within an isolated heart. HeartRhythm Case Rep 2015; 1:107-109. [PMID: 28507900 PMCID: PMC5426419 DOI: 10.1016/j.hrcr.2015.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | | | | | | | | | - Paul A Iaizzo
- Departments of Surgery, Biomedical Engineering, and Integrative Biology & Physiology, and the Institute for Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota
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Giannola G, Torcivia R, Airò Farulla R, Heynens J. Overcoming an impossible anatomy with a novel left ventricular active fixation lead in the coronary sinus: A case report. HeartRhythm Case Rep 2015; 1:130-132. [PMID: 28491530 PMCID: PMC5418610 DOI: 10.1016/j.hrcr.2015.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Gabriele Giannola
- Cardiology Unit, Fondazione Istituto San Raffaele, G. Giglio-Cefalù (PA), Italy
| | - Riccardo Torcivia
- Cardiology Unit, Fondazione Istituto San Raffaele, G. Giglio-Cefalù (PA), Italy
| | | | - Joeri Heynens
- Medtronic Bakken Research Center, Maastricht, The Netherlands
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Al Kandari F, Erglis A, Sweidan R, Dannheimer I, Sepsi M, Bénézet J, Padour M, Naik A, Escudero J, West T, Holbrook R, Lorgat F. Regional variations in baseline characteristics of cardiac rhythm device recipients: The PANORAMA observational cohort study. Int J Cardiol Heart Vessel 2014; 4:90-96. [PMID: 29450186 PMCID: PMC5801449 DOI: 10.1016/j.ijchv.2014.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 06/30/2014] [Indexed: 12/05/2022]
Abstract
Background The PANORAMA study was designed to collect concurrent data on subjects from different worldwide regions implanted with CRM devices. Methods In this prospective, multi-center study, we analyzed baseline data on 8586 subjects implanted with CRM devices with no additional selection criteria (66% pacemaker (IPG), 16% implantable cardiac defibrillators (ICD), 17% cardiac resynchronization therapy (CRT) and < 1% Internal Loop Recorder) from 156 hospitals across 6 geographical regions between 2005 and 2011. Results Regardless of the device implanted, subjects from the Middle East and India often had more diabetes than other regions. Eastern and Western Europe had higher rates of atrial fibrillation reported, and men were more likely to smoke than women (46% vs 11%, p < 0.001). Within the CRT cohort there was significant variation in the proportion of males receiving a device, ranging from 55% in India to 83% in Eastern Europe. Conclusions We provide comprehensive descriptive data on patients receiving CRM devices from a range of geographies that are not typically reported in literature. We found significant variations in clinical characteristics and implant practices. Long term follow-up data will help evaluate if these variations require adjustments to outcome expectations.
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Affiliation(s)
| | - Andrejs Erglis
- Cardiology Department, P. Stradins Clinical University Hospital, Riga, Latvia
| | - Raed Sweidan
- Cardiology Department, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Ingrid Dannheimer
- Cardiology Department, Eugene Marais Hospital, Pretoria, South Africa
| | - Milan Sepsi
- Department of Internal Medicine-Cardiology, University Hospital Brno, Brno, Czech Republic
| | - Juan Bénézet
- Cardiology Department, Hospital General de Ciudad Real, Ciudad Real, Spain
| | - Michal Padour
- Cardiology Department, Karlovarská Krajská Nemocnice a.s., Karlovy Vary, Czech Republic
| | - Ajay Naik
- Cardiology Department, Care Institute of Medical Sciences, CIMS Hospital, Gujarat, India
| | - Jaime Escudero
- Cardiology Department, Hospital Carlos Arvelo, Caracas, Venezuela
| | - Teena West
- Medtronic Bakken Research Center, Maastricht, The Netherlands
| | | | - Faizel Lorgat
- Cardiology Department, Christiaan Barnard Memorial Hospital, Cape Town, South Africa
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