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The effect of comprehensive management of heart failure in adult with systemic right ventricle. Kardiol Pol 2024; 82:235-236. [PMID: 38230481 DOI: 10.33963/v.kp.98305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 11/23/2023] [Indexed: 01/18/2024]
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Permanent single-chamber atrial pacing: an obsolete or viable alternative to dual-chamber pacing in selected patients with sinus node disease? Pol Arch Intern Med 2023; 133:16509. [PMID: 37227294 DOI: 10.20452/pamw.16509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Single atrial stimulation (AAI) has been commonly used for permanent pacing in sick sinus syndrome and significant bradycardia. OBJECTIVE The study aimed to evaluate long‑term AAI pacing and to identify timing and reasons for pacing mode change. PATIENTS AND METHODS Retrospectively, we included 207 patients (60% women) with initial AAI pacing, who were followed‑up for an average of 12 years. RESULTS At the time of death or loss to follow‑up, 71 patients (34.3%) had unchanged AAI pacing mode. The reason for an upgrade of the pacing system was development of atrial fibrillation (AF) in 43 patients (20.78%) and atrioventricular block (AVB) in 34 patients (16.4%). The cumulative ratio for a pacemaker upgrade reoperation reached 2.77 per 100 patient‑years of the follow‑up. Cumulative ventricular pacing below 10% after an upgrade to dual‑chamber pacemaker was observed in 28.6% of the patients. Younger age at implant was the leading independent predictor of the change to dual‑chamber simulation (hazard ratio, 1.98; 95% CI, 1.976-1.988; P = 0.001). There were 11 (5%) lead malfunctions that required reoperation. Subclavian vein occlusion was noted in 9 upgrade procedures (11%). One cardiac device-related infection was observed. CONCLUSIONS The reliability of AAI pacing decreases with each year of observation due to development of AF and AVB. However, in the current era of effective AF treatment, the advantages of AAI pacemakers, such as lower incidence of lead malfunction, venous occlusion, and infection, as compared with dual-chamber pacemakers, may make AAI pacemakers a viable option.
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Employment of the Evolution RL sheath as a first-choice device shortens transvenous lead extraction time without affecting procedural safety and efficacy compared to its auxiliary use: Insights from the prospective multicenter EVO registry. ADV CLIN EXP MED 2023; 32:1249-1256. [PMID: 37078411 DOI: 10.17219/acem/161961] [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: 12/25/2022] [Revised: 02/18/2023] [Accepted: 03/07/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Transvenous lead extraction (TLE) is recommended in cases of local and systemic infections related to cardiac implantable electronic devices (CIEDs). Additionally, TLE is indicated in the event of lead damage or CIED malfunction. The extraction procedure is associated with a risk of life-threatening complications. OBJECTIVES The aim of the EVO registry was to assess the safety and efficacy of birotational Evolution tool usage. MATERIAL AND METHODS This registry study was prospectively conducted in 8 high-volume implantation centers in Poland. The study included 133 patients aged 63.5 ±15.1 years, and 76.69% were male. Indications for the procedure were: local or systemic infection (33.1%) and lead dysfunction (66.9%). The number of leads extracted varied from 1 (39.84%) to 3 (9.77%). RESULTS Clinical procedural success was achieved in 99.1% of cases. A total of 226 leads were extracted, and 206 used the Evolution system. Two procedural strategies were identified while using the Evolution system: (1) usage of locking stylet, propylene sheaths and the Evolution system (118 leads, 52%) - group A; (2) usage of locking stylet and Evolution (88 leads, 39%) - group B. There were no differences in the number of complications between these 2 groups. The extraction time was significantly shorter (p = 0.02) in group B than in group A. Major complications occurred in 5.2% of cases with 2 intraprocedural deaths. Minor complications occurred in 1.5% of patients. CONCLUSIONS The registry confirmed the efficacy and relative safety of the birotational Evolution sheath. Using the rotational sheath as a first attempt significantly reduces extraction time without compromising its safety.
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The usefulness of echo-based hemodynamic parameters in cardiac resynchronization therapy with conduction system pacing for optimal device programing. Echocardiography 2023; 40:1068-1078. [PMID: 37632153 DOI: 10.1111/echo.15679] [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: 03/03/2023] [Revised: 05/25/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND His bundle pacing (HBP) has proved to be a valuable alternative enabling the physiological activation of cardiac contraction in cardiac resynchronization therapy (CRT). At present, however, little is known about the optimal method of programming of the His bundle-paced CRT systems in terms of achieving the best cardiac output. AIM The aim of this study was to evaluate the impact of cardiac resynchronization therapy with conduction system pacing (CRT+CSP) on echo-based hemodynamic parameters in the early post-operative measurements. METHODS The study enrollment criteria included: permanent atrial fibrillation, heart failure and bundle branch block. All patients underwent implantation of CRT + HBP. During the post-operative phase, we aimed to optimize HOT-CRT settings in order to achieve the greatest cardiac output assessed by complex echocardiographic measurements. RESULTS The study included 21 patients, mean age 71.2 (6.3) years, predominantly men (71.4%) with non-ischemic cardiomyopathy 62%. All patients had heart failure with NYHA functional class III and IV (81%). Mean left ventricular ejection fraction was 27.5 (9.7%). The mean duration of the QRS complex was 148.8 ms. The effects of resynchronization pacing: HBP alone, HBP with left ventricular pacing, HBP with biventricular pacing (BiV) and BiV without HBP were analyzed consecutively. HBP combined with left ventricular pacing demonstrated the best hemodynamic response. CONCLUSION His bundle pacing coupled with LV pacing proved to be the most advantageous pacing program setting with regard to cardiac output. Moreover, it performed better than biventricular pacing and significantly better than RV pacing.
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A wearable cardioverter-defibrillator vest as a diagnostic and therapeutic tool after COVID-19. Kardiol Pol 2023; 81:800-801. [PMID: 37270834 DOI: 10.33963/kp.a2023.0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 06/06/2023]
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Initial experience with transvenous lead extraction of His bundle pacing leads. Kardiol Pol 2023; 81:775-777. [PMID: 37270831 DOI: 10.33963/kp.a2023.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 06/06/2023]
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Delayed perforation of the right ventricle by cardioverter-defibrillator lead - safe transvenous lead extraction by mechanical systems. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2023; 19:192-194. [PMID: 37465618 PMCID: PMC10351076 DOI: 10.5114/aic.2023.126180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/17/2023] [Indexed: 07/21/2023] Open
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Advances in Molecular Imaging in Infective Endocarditis. Vaccines (Basel) 2023; 11:vaccines11020420. [PMID: 36851297 PMCID: PMC9967666 DOI: 10.3390/vaccines11020420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/04/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
Infective endocarditis (IE) is a growing epidemiological challenge. Appropriate diagnosis remains difficult due to heterogenous etiopathogenesis and clinical presentation. The disease may be followed by increased mortality and numerous diverse complications. Developing molecular imaging modalities may provide additional insights into ongoing infection and support an accurate diagnosis. We present the current evidence for the diagnostic performance and indications for utilization in current guidelines of the hybrid modalities: single photon emission tomography with technetium99m-hexamethylpropyleneamine oxime-labeled autologous leukocytes (99mTc-HMPAO-SPECT/CT) along with positron emission tomography with fluorodeoxyglucose (18F-FDG PET/CT). The role of molecular imaging in IE diagnostic work-up has been constantly growing due to technical improvements and the increasing evidence supporting its added diagnostic and prognostic value. The various underlying molecular processes of 99mTc-HMPAO-SPECT/CT as well as 18F-FDG PET/CT translate to different imaging properties, which should be considered in clinical practice. Both techniques provide additional diagnostic value in the assessment of patients at risk of IE. Nuclear imaging should be considered in the IE diagnostic algorithm, not only for the insights gained into ongoing infection at a molecular level, but also for the determination of the optimal clinical therapeutic strategies.
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To what extent does prior antimicrobial therapy affect the diagnostic performance of radiolabeled leukocyte scintigraphy in infective endocarditis? J Nucl Cardiol 2023; 30:343-353. [PMID: 35819715 DOI: 10.1007/s12350-022-03048-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/16/2022] [Indexed: 11/28/2022]
Abstract
AIMS This prospective, single-center study sought to assess to what extent there is interference between the hybrid technique of single-photon emission tomography-computed tomography with technetium99m-hexamethylpropyleneamine oxime-labeled leukocytes (99mTc-HMPAO-SPECT/CT) and antimicrobial therapy in patients with infective endocarditis (IE). METHODS AND RESULTS During the years 2015-2019, we enrolled 205 consecutive adults with suspected IE, all underwent 99mTc-HMPAO-SPECT/CT. The study population was divided into those who had received antimicrobial therapy up to 30 days prior to 99mTc-HMPAO-SPECT/CT (group 1, n = 96) and those who had not (group 2, n = 109). Patients were prospectively observed for 12 ± 10 months. Group 1 presented higher positive predictive values (91.89% vs. 60.00%, = 0.001), and decreased negative predictive values (77.97% vs. 90.54%, P = 0.04). Patients treated with antimicrobial therapy displayed false-negative 99mTc-HMPAO-SPECT/CT results more often [odds ratio (OR), 4.63; 95% confidence interval (CI), 1.41-15.23, P = .01], particularly when intravenous (OR 5.37; 95% CI 1.73-16.62, P = .004), definite (OR 9.43; 95% CI 2.65-33.51, P = .001), and combination antibiotic regimens (OR 8.1; 95% CI 2.57-25.64, P = .001) had been administered. CONCLUSION Prior antibiotic therapy affects 99mTc-HMPAO-SPECT/CT diagnostic properties. Patients treated with antimicrobial therapy display false-negative 99mTc-HMPAO-SPECT/CT results more often, especially if intravenous, definite, or combination regimens are administered.
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Mechanical extraction of implantable cardioverter-defibrillator leads with a dwell time of more than 10 years: insights from a single high-volume centre. Europace 2023; 25:1100-1109. [PMID: 36660771 PMCID: PMC10062326 DOI: 10.1093/europace/euac272] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/15/2022] [Indexed: 01/21/2023] Open
Abstract
AIMS To analyze and compare the effectiveness and safety of transvenous lead extraction (TLE) of implantable cardioverter-defibrillator (ICD) leads with a dwell time of >10 years (Group A) vs. younger leads (Group B) using mechanical extraction systems. METHODS AND RESULTS Between October 2011 and July 2022, we performed TLE in 318 patients. Forty-six (14.4%) extracted ICD leads in 46 (14.5%) patients that had been implanted for >10 years. The median dwell time of all extracted ICD leads was 5.9 years. Cardiovascular implantable electronic device-related infection was an indication for TLE in 31.8% of patients. Complete ICD leads removal and complete procedural success in both groups were similar (95.7% in Group A vs. 99.6% in Group B, P = 0.056% and 95.6% in Group A vs. 99.6% in Group B, P = 0.056, respectively). We did not find a significant difference between major and minor complication rates in both groups (6.5% in Group A vs. 1.5% in Group B and 2.2% in Group A vs. 1.8% in Group B, P = 0.082, respectively). One death associated with the TLE procedure was recorded in Group B. CONCLUSION The TLE procedures involving the extraction of old ICD leads were effective and safe. The outcomes of ICD lead removal with a dwell time of >10 years did not differ significantly compared with younger ICD leads. However, extraction of older ICD leads required more frequent necessity for utilizing multiple extraction tools, more experience and versatility of the operator, and increased surgery costs.
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Radiofrequency catheter ablation of ventricular tachycardia using combined endocardial techniques in patients with structural heart disease improves procedural effectiveness and reduces arrhythmia episodes. Kardiol Pol 2023; 81:350-358. [PMID: 36475512 DOI: 10.33963/kp.a2022.0278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/04/2022] [Indexed: 05/03/2023]
Abstract
BACKGROUND Evidence indicates that radiofrequency catheter ablation (RFCA) of ventricular tachycardia (VT) in patients with structural heart disease (SHD) is safe and effective. However, arrhythmia recurrence is still relatively high, and the optimal procedural strategy is unclear. In clinical practice, several combinations of mapping and ablation techniques are used to improve VT ablation efficacy. AIM The study aimed to evaluate and provide evidence on the efficiency and safety of a systematized combination of VT ablation (mapping) techniques in patients with SHD. METHODS From 2016 to 2019, 47 patients (54 procedures) with SHD (89% heart failure, 94% ischemic heart disease, 37% VT storm) who underwent RFCA of VT were retrospectively analyzed from a group of 58 consecutive patients. During RFCA of VT, different combinations of three techniques, activation mapping (AM), pace mapping (PM), and substrate-based mapping (SbM), were used. The procedures were performed using the CARTO® 3 (Biosense Webster Inc., Diamond Bar, CA, US) electro-anatomical mapping system. RESULTS During a median (interquartile range [IQR]) follow-up of 25.5 months (11.75-52.25), VT-free survival after ablation was 68.5% (n = 37/54 procedures). Acute procedural success was achieved in 85% (n = 46/54 procedures). The number of induced VT morphologies, induction of non-clinical or non-sustained VT after ablation, and fewer VT mapping techniques used during the procedure were related to decreasing VT-free survival. CONCLUSIONS VT ablation strategy based on systemic use of combined techniques is effective and safe in long-term follow-up of patients with SHD.
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Atrial pacemaker implantation in an adult patient with Fontan circulation and chronotropic insufficiency. Kardiol Pol 2023; 81:1298-1299. [PMID: 38189513 DOI: 10.33963/v.kp.98423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/06/2023] [Indexed: 01/09/2024]
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Cardiac pacing in patients with Fontan circulation: Further considerations. Authors' reply. Kardiol Pol 2022:VM/OJS/J/89462. [PMID: 35390169 DOI: 10.33963/kp.a2022.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Indexed: 11/23/2022]
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Atrioventricular sequential pacemaker implantation in an adult patient with a Fontan circulation. Kardiol Pol 2022; 80:497-498. [PMID: 35258093 DOI: 10.33963/kp.a2022.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Indexed: 11/23/2022]
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The electrocardiographic interpretation of ventricular pacing suppression algorithms in the pacemaker. J Electrocardiol 2022; 72:1-5. [DOI: 10.1016/j.jelectrocard.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/06/2022] [Accepted: 02/14/2022] [Indexed: 11/27/2022]
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Contact Force-Sensing versus Standard Catheters in Non-Fluoroscopic Radiofrequency Catheter Ablation of Idiopathic Outflow Tract Ventricular Arrhythmias. J Clin Med 2022; 11:jcm11030593. [PMID: 35160043 PMCID: PMC8836481 DOI: 10.3390/jcm11030593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/10/2022] [Accepted: 01/21/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Adequate contact between the catheter tip and tissue is important for optimal lesion formation and, in some procedures, it has been associated with improved effectiveness and safety. We evaluated the potential benefits of contact force-sensing (CFS) catheters during non-fluoroscopic radiofrequency catheter ablation (NF-RFCA) of idiopathic ventricular arrhythmias (VAs) originating from outflow tracts (OTs). Methods: A group of 102 patients who underwent NF-RFCA (CARTO, Biosense Webster Inc., Irvine, CA, USA) of VAs from OTs between 2014 to 2018 was retrospectively analyzed. Results: We included 52 (50.9%) patients in whom NF-RFCA was performed using CFS catheters and 50 (49.1%) who were ablated using standard catheters. Arrhythmias were localized in the right and left OT in 70 (68.6%) and 32 (31.4%) patients, respectively. The RFCA acute success rate was 96.1% (n = 98) and long-term success during a minimum 12-month follow-up (mean 51.3 ± 21.6 months) was 85.3% (n = 87), with no difference between CFS and standard catheters. There was no difference in complications rate between CFS (n = 1) and standard catheter (n = 2) ablations. Conclusions: There is no additional advantage of CFS catheters use over standard catheters during NF-RFCA of OT-VAs in terms of procedural effectiveness and safety.
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His bundle pacing in a patient after heart transplant and complete atrioventricular block. Kardiol Pol 2020; 79:81-82. [PMID: 33198450 DOI: 10.33963/kp.15681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Thoracic impedance measurement in heart stimulation and cardiac arrhythmias. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 44:148-150. [PMID: 33165971 DOI: 10.1111/pace.14121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/21/2020] [Accepted: 11/01/2020] [Indexed: 12/01/2022]
Abstract
The electrocardiogram (ECG) interpretation in patients with implantable cardioverter defibrillator (ICD) is often a puzzling problem. The difficulty of the device function evaluation further increases in the presence of unfamiliar timing cycles and additional functions. We present an interesting ECG with a special function of a Biotronik ICD devices called the thoracic impedance monitoring, and demonstrate its behavior in a patient with atrial fibrillation, pacing beats, ventricular ectopic beats, and couple of ventricular beats. This report shows unexceptional occurrence of tricky ECG finding in patient with Biotronik ICDs.
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The Prognostic Value of 99mTc-HMPAO-Labeled Leucocyte SPECT/CT in Cardiac Device-Related Infective Endocarditis. JACC Cardiovasc Imaging 2020; 13:1739-1751. [DOI: 10.1016/j.jcmg.2020.01.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/08/2020] [Accepted: 01/16/2020] [Indexed: 01/08/2023]
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Indications, procedural and early results of transvenous lead extraction in elderly patients: single-centre experience. Pol Arch Intern Med 2020; 130:216-224. [DOI: 10.20452/pamw.15182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Transvenous extraction of His bundle pacing lead: New challenge in the field of lead extraction. Cardiol J 2020; 26:805. [PMID: 31970741 DOI: 10.5603/cj.2019.0120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 09/07/2019] [Accepted: 10/03/2019] [Indexed: 11/25/2022] Open
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Local infection associated with a nonfunctional lead in a patient with a VVI pacemaker: beyond the standard of care. Kardiol Pol 2020; 78:78-79. [DOI: 10.33963/kp.15044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
BACKGROUND Atrial fibrillation (AF) is thought to be a progressive arrhythmia. The impact of sex and position of right ventricular lead is not well recognized. Whilst nonparoxysmal AF compared with paroxysmal AF has been associated with increased mortality in the general population, its prognostic significance nin patients with a dual‑chamber (DDD) pacemaker is less clear. AIMS The aim of the study was to determine the incidence of permanent AF in patients with a DDD pacemaker, analyze the effect of selected baseline characteristics on permanent AF development, and examine the impact of permanent AF on patient survival. METHODS A retrospective cohort study included 3932 consecutive patients who underwent DDD pacing system implantation between 1984 and 2014. Follow‑up was completed in August 2016. We included 3771 patients (96%) with post‑operative follow‑up and known vital status. Occurrence of permanent AF and all‑cause mortality were the study endpoints. RESULTS During mean follow‑up of 6.5 years, permanent AF occurred in 717 patients (19%). Sex (hazard ratio [HR], 1.316; 95% CI, 1.134-1.528, for men), age at implant (HR, 1.041; 95% CI, 1.033-1.049, 1-year increase), history of AF (HR, 3.521; 95% CI, 3.002-4.128) were independently associated with permanent AF development, whereas position of right ventricular lead (apical versus nonapical) and primary pacing indication (atrioventricular block versus sick sinus syndrome) were not related to permanent AF. Permanent AF was a significant risk factor for increased mortality (age- and sex‑adjusted HR, 1.475; 95% CI, 1.294-1.682). CONCLUSIONS Permanent AF occurrence was independently predicted by advanced age at implant, male sex, and preexisting AF and associated with worse survival.
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The role of 99mTc-HMPAO-labelled white blood cell scintigraphy in the diagnosis of cardiac device-related infective endocarditis. Eur Heart J Cardiovasc Imaging 2019; 21:1022-1030. [DOI: 10.1093/ehjci/jez257] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 07/22/2019] [Accepted: 10/02/2019] [Indexed: 12/18/2022] Open
Abstract
Abstract
Aims
The hybrid technique of single-photon emission tomography and computed tomography with technetium99m-hexamethylpropyleneamine oxime–labelled leucocytes (99mTc-HMPAO-SPECT/CT) is an emerging diagnostic technique in patients with cardiac device-related infective endocarditis (CDRIE). This prospective study assessed the 99mTc-HMPAO-SPECT/CT diagnostic profile and its added value to the modified Duke criteria (mDuke) in CDRIE diagnostic work-up.
Methods and results
The study examined 103 consecutive patients with suspected CDRIE, who underwent 99mTc-HMPAO-SPECT/CT. Diagnostic accuracy was calculated based on a final clinical CDRIE diagnosis, including microbiology, echocardiography, and a 6-month follow-up. Subsequently, we compared the diagnostic value of the initial mDuke classification with a classification including 99mTc-HMPAO-SPECT/CT positive results as an additional major CDRIE criterion: mDuke-SPECT/CT.
Overall, CDRIE was diagnosed in 31 (31%) patients, whereas 35 (34%) 99mTc-HMPAO-SPECT/CT were positive. 99mTc-HMPAO-SPECT/CT was characterized by 86% accuracy, 0.69 Cohen’s kappa coefficient, 84% sensitivity, 88% specificity, 93% negative, and 74% positive predictive values. The original mDuke displayed 83% accuracy, 0.52 kappa, whereas mDuke-SPECT/CT had 88% accuracy, and 0.73 kappa. Compared with mDuke, mDuke-SPECT/CT showed significantly higher sensitivity (87% vs. 48%, P < 0.001). According to mDuke, 49.5% of patients had possible CDRIE, and after reclassification, that figure dropped to 37%. Furthermore, having assessed the diagnosis categorization improvement following the incorporation of 99mTc-HMPAO-SPECT/CT, the net reclassification index value was found to be 31.4%.
Conclusion
In patients with CDRIE, 99mTc-HMPAO-SPECT/CT provides high diagnostic accuracy, whereas a negative scan excludes CDRIE with high probability. Inclusion of 99mTc-HMPAO-SPECT/CT into mDuke diagnostic criteria yields significantly higher sensitivity and a reduction in possible CDRIE diagnoses.
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Transvenous extraction of 3-year-old Seldinger guide wire lost in venous system and causing superior vena cava syndrome - rare complication of implantable cardioverter-defibrillator implantation. POLSKI MERKURIUSZ LEKARSKI : ORGAN POLSKIEGO TOWARZYSTWA LEKARSKIEGO 2019; 47:65-66. [PMID: 31473754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A 65-year-old male patient underwent left-sided placement of implantable cardioverter-defibrillator. At three years after implantation he emerged complaining on left upper limb and left-sided neck edema. Left brachicephalic vein thrombosis due to device leads was recognized. The attending cardiologist referred the patient to university radiology department for venous angioplasty but the patient was admitted to cardiology department. Coronary angiography was performed due to suspicion of ischemic heart disease. However, it showed the presence of foreign body in cardiovascular system - completely intravascular round-tipped guide wire used in Seldinger technique for insertion of the endocardial lead abandoned in left subclavian vein and reaching to superior vena cava. Patient was transferred to third-degree reference lead extraction center. The procedure was performed under general anesthesia in hybrid operating room. Via femoral vein access we introduced Needle's Eye Snare and grasped the guide wire. Then, using polytetrafluoroethylene sheath the tissue adhesions were dissected and the complete guide wire was retrieved.
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Years of life lost as a measure of premature death among dual‑chamber pacemaker recipients from Małopolska Province. Kardiol Pol 2019; 77:683-687. [DOI: 10.33963/kp.14839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Inflammatory markers in the diagnostic workup of pacemaker- and defibrillator‑related infections in patients referred for transvenous lead extraction. Kardiol Pol 2019; 77:918-925. [PMID: 31424054 DOI: 10.33963/kp.14934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Infectious complications can be life‑threatening in patients with permanent transvenous pacemakers and their diagnosis can be challenging. AIMS The aim of the study was to assess the diagnostic utility of white blood cell (WBC) count and C‑reactive protein (CRP) concentrations in infectious complications in patients with cardiac pacemakers. METHODS The prospective study included patients who underwent transvenous lead extraction (TLE) due to various indications. The diagnosis of lead‑dependent infective endocarditis (LDIE) was based on the modified Duke criteria, and the diagnosis of local infection was based on symptoms related to device pocket. The study population consisted of 640 patients: 63 (9.9%) with LDIE, 61 (9.5%) with local infection, and 516 controls (80.6%) referred for TLE due to noninfectious indications. We evaluated WBC count and CRP concentrations in each group of patients and assessed the predictive value of these tests for the diagnosis of LDIE and local infection. RESULTS Patients with local infection did not differ in terms of median WBC and CRP values compared with controls (P = 0.99 and P = 0.13, respectively), whereas patients with LDIE had higher median WBC count and CRP level (P <0.001 and P <0.001, respectively). In the LDIE group, WBC diagnostic test showed 46.0% sensitivity, 95.3% specificity, 90.5% accuracy, 51.8% positive predictive value, and 94.2% negative predictive value. The diagnostic test based on CRP levels showed 84.1% sensitivity, 81.8% specificity, 82.0% accuracy, 33.5% positive predictive value, and 97.9% negative predictive value. CONCLUSIONS In patients undergoing TLE due to infectious indications, inflammatory markers (WBC count, CRP level) were within normal range in the local‑infection group and markedly elevated in the LDIE group. Inflammatory markers were useful to determine the extent of the infection in patients with local infection.
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Effectiveness and safety of transvenous extraction of single- versus dual-coil implantable cardioverter-defibrillator leads at single-center experience. Medicine (Baltimore) 2019; 98:e16548. [PMID: 31348275 PMCID: PMC6709158 DOI: 10.1097/md.0000000000016548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The available literature lacks data concerning direct comparison of the effectiveness and safety of single- versus dual-coil implantable cardioverter-defibrillator (ICD) leads transvenous extraction. Certainly, additional shocking coil in superior vena cava adds to the amount of metal in the vascular system. Adhesions developing around the superior vena cava coil add to the difficulty of extraction of ICD lead if lead removal is required. The aim of the study was to assess the effectiveness and safety of single- and dual-coil ICD leads transvenous extraction using mechanical systems. We performed transvenous lead extraction (TLE) of 197 ICD leads in 196 patients. There were 46 (23.3%) dual-coil leads removed from 46 (23.5%) patients. Cardiovascular implantable electronic device-related infection was an indication for TLE in 25.0% of patients. The following extracting techniques were used: manual direct traction, mechanical telescopic sheaths, controlled-rotation mechanical sheaths, and femoral approach. Complete ICD lead removal and complete procedural success in both groups were similar (99.3% in single-coil vs 97.8% in dual-coil, P = .41 and 99.3% in single-coil vs 97.8% in dual-coil, P = 0.41, respectively). We did not find significant difference between major and minor complication rates in both groups (2.0% in single-coil vs 4.3% in dual-coil, and 0.7% in single-coil vs 0.0% in dual-coil, P = .58, respectively). There was 1 death associated with the TLE procedure of single-coil lead.This study shows that extraction of dual-coil leads seems to be comparably safe and effective to extraction of single-coil leads. On the other hand, it requires longer fluoroscopy time and frequent utilization of advanced tools.
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Transvenous extraction of very old (over 20‐year‐old) pacemaker leads using mechanical systems: Effectiveness and safety. Pacing Clin Electrophysiol 2019; 42:998-1005. [DOI: 10.1111/pace.13714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 04/16/2019] [Accepted: 04/26/2019] [Indexed: 10/26/2022]
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Switch between AAI and DDD mode pacing-What is the mechanism? Ann Noninvasive Electrocardiol 2019; 24:e12648. [PMID: 30896054 DOI: 10.1111/anec.12648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 01/14/2019] [Accepted: 01/17/2019] [Indexed: 11/26/2022] Open
Abstract
The electrocardiogram (ECG) interpretation in patients with implantable pacemaker is often a perplexing problem. The difficulty in the device evaluation increases in the presence of novel timing cycles and additional functions. Authors describe a special function frequently encountered in Medtronic dual-chamber pacemakers and implantable cardioverter-defibrillator devices called managed ventricular pacing (MVP) and demonstrate its performance in the patient with undersensing episodes in ventricular channel. Intermittent ventricular undersensing in the device with MVP feature turned on caused repetitive mode switches between AAI and DDD mode. This report shows unexceptional occurrence of tricky ECG findings in patient with Medtronic dual-chamber device.
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Pacing spikes following QRS complexes: What is the mechanism? Ann Noninvasive Electrocardiol 2019; 24:e12545. [DOI: 10.1111/anec.12545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 03/02/2018] [Indexed: 11/30/2022] Open
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Cardiac resynchronization therapy with His bundle pacing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:374-380. [DOI: 10.1111/pace.13611] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 12/28/2022]
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The usefulness of SPECT-CT with radioisotope-labeled leukocytes in diagnosing lead-dependent infective endocarditis. ADV CLIN EXP MED 2019; 28:113-119. [PMID: 30411545 DOI: 10.17219/acem/92315] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Lead-dependent infective endocarditis (LDIE) is a life-threatening complication of permanent transvenous cardiac pacing. According to the 2015 European Society of Cardiology (ECS) guidelines, the diagnosis of LDIE is based on the modified Duke criteria (MDC), while single-photon emission computed tomography with conventional computed tomography (SPECT-CT) with radioisotope-labeled leukocytes serves as an additional tool in difficult cases. The major challenge is to differentiate between true vegetation and a thrombus. OBJECTIVES The aim of the study was to evaluate the usefulness of SPECT-CT with radioisotope-labeled leukocytes in diagnosing LDIE in patients with intracardiac masses (ICMs). MATERIAL AND METHODS The prospective registry included 40 consecutive patients admitted with an ICM on the lead and suspicion of LDIE. The confirmation or rejection of the LDIE diagnosis was made according to an algorithm based on the MDC. The cohort was divided into 2 groups: patients with definite and possible LDIE diagnoses based on the MDC (the LDIE-positive group), and patients with negative LDIE diagnoses according to the MDC (the LDIE-negative group). All patients underwent SPECT-CT with radioisotope-labeled leukocytes. The diagnostic ability of SPECT-CT was compared to the gold standard MDC. RESULTS The LDIE-positive group with diagnosis based on the MDC consisted of 19 patients (LDIE definite - 11; LDIE possible - 8). The LDIE diagnosis was rejected on the basis of the MDC in 21 patients. The SPECT-CT results were compared with the MDC results and showed 73.7% sensitivity, 81.0% specificity, 77.5% accuracy, 77.8% positive predictive value (PPV), 77.3% negative predictive value (NPV), likelihood ratio positive (LR+) 3.868, likelihood ratio negative (LR-) 0.325, and moderate agreement (κ = 0.548, p < 0.001). After the exclusion of 5 patients treated with antibiotics at the time of the SPECT-CT, LR+ and LRimproved to 5.250 and 0, respectively, and inter-test agreement amounted to almost perfect concordance (κ = 0.773, p < 0.001). CONCLUSIONS Single-photon emission computed tomography with conventional CT with radioisotopelabeled leukocytes is a useful, efficient, single-step test for diagnosing LDIE.
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Odelektrodowe zapalenie wsierdzia z dużą wegetacją — czy leczenie kardiochirurgiczne jest zawsze konieczne? FOLIA CARDIOLOGICA 2018. [DOI: 10.5603/fc.2018.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Association of selected factors with long-term prognosis and mortality after dual-chamber pacemaker implant. Cardiol J 2018; 26:717-726. [PMID: 30155863 DOI: 10.5603/cj.a2018.0093] [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: 02/19/2018] [Revised: 05/17/2018] [Accepted: 06/18/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Dual-chamber (DDD) pacing is the most widely utilised pacing modality in many parts of the world. The present study aimed to evaluate life expectancy of DDD pacemaker patients in comparison to the age- and sex-matched general population, assess changes in baseline characteristics over three decades of the inclusion period and determine the association between selected variables and patient survival. METHODS This longitudinal study of consecutive de novo DDD pacemaker implantations performed between 1984 and 2014, with all-cause mortality until 2016 as the endpoint, was conducted at a singlecenter university hospital. RESULTS Under assessment were 3928 patients with a total of 30,087 patient-years of survival time. Compared to the general population, the observed survival was significantly inferior until 12 years post DDD pacemaker implant (HR = 1.499, p < 0.001), whereas after 12 years of follow-up the observed survival was significantly superior (HR = 0.555, p < 0.001). A comparison of patient baseline characteristics over three decades revealed the following significant changes: more elderly patients, more female patients, less patients with atrioventricular block, more patients with atrial fibrillation/atrial flutter (AF/AFL) and fewer patients with an apical right ventricular (RV) lead position in the later decades. In multivariate analysis male sex and higher age were the only variables significantly associated with shorter survival time. Indication for pacing, history of pre-implant AF/AFL, RV lead position and device infection were not associated with survival. CONCLUSIONS In the very-long-term follow-up of DDD pacemaker patients, the parameters associated with survival were sex and baseline age at first implantation.
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Lead-related complications after DDD pacemaker implantation. Kardiol Pol 2018; 76:1224-1231. [DOI: 10.5603/kp.a2018.0089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/30/2018] [Accepted: 04/04/2018] [Indexed: 11/25/2022]
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Analysis of electrical lead failures in patients referred for transvenous lead extraction procedures. Pacing Clin Electrophysiol 2018; 41:1217-1223. [DOI: 10.1111/pace.13463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 07/09/2018] [Accepted: 07/16/2018] [Indexed: 12/01/2022]
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Temporary external implantable cardioverter-defibrillator as a bridge to reimplantation after infected device extraction. J Arrhythm 2018; 34:77-80. [PMID: 29721118 PMCID: PMC5828266 DOI: 10.1002/joa3.12026] [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: 10/10/2017] [Accepted: 11/21/2017] [Indexed: 11/11/2022] Open
Abstract
Patients with cardiac implantable electronic devices (CIED) and endovascular infection represent a difficult management group. The explantation of an implantable cardioverter-defibrillator (ICD) system deprives the patient of the protection against life-threatening ventricular tachyarrhythmias. In this study, we describe feasibility and clinical outcomes of bridging with temporary dual-coil ICD lead and external ICD following the extraction of a CIED due to endovascular infection and compare the performance of this approach to other available options.
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Inhibition and restoration of CRT pacing – What is the mechanism? J Electrocardiol 2018; 51:487-489. [DOI: 10.1016/j.jelectrocard.2018.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Indexed: 11/29/2022]
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Cardiac resynchronization therapy with His bundle pacing as a method of treatment of chronic heart failure in patients with permanent atrial fibrillation and left bundle branch block. J Electrocardiol 2018. [DOI: 10.1016/j.jelectrocard.2018.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Implantable cardioverter defibrillator does not cure the heart. POLSKI MERKURIUSZ LEKARSKI : ORGAN POLSKIEGO TOWARZYSTWA LEKARSKIEGO 2018; 44:23-25. [PMID: 29374419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A man with non-ischemic cardiomyopathy, EF 22%, permanent AF and ICD was admitted for elective device replacement. The need for the optimization of the ventricular rate and avoidance of right ventricular pacing made it necessary to up-grade the existing pacing system using direct His bundle pacing and dual chamber ICD. This enabled the regularization of ventricular rate, avoiding the RV pacing and optimize the beta-blocker dose. The one month follow-up already showed reduction in left ventricle diameter, improvement in ejection fraction, NYHA class decrease to II. The His bundle pacing enabled the optimal treatment of the patient resulting in excellent clinical improvement.
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Inhibition of left ventricular stimulation due to left ventricular lead failure and the left ventricular T-wave protection algorithm in patient with cardiac resynchronization therapy and pacemaker dependency. Ann Noninvasive Electrocardiol 2018; 23:e12473. [PMID: 28593660 PMCID: PMC6931795 DOI: 10.1111/anec.12473] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 04/27/2017] [Indexed: 11/30/2022] Open
Abstract
The electrocardiogram (ECG) interpretation in patients with cardiac resynchronization therapy (CRT) is often a perplexing problem. The difficulty in the device evaluation increases in the presence of unfamiliar timing cycles and a lead dysfunction. Authors describe a special function of a Biotronik CRT devices called the left ventricle T-wave protection (LVTP), and demonstrate its behavior in a patient with left ventricular (LV) lead failure. This report shows that sometimes it might be difficult to understand the loss of resynchronization in 12-lead ECG when LVTP feature is on, and a malfunction of left ventricular lead sensing occurs.
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The safety and utility of magnetic resonance imaging in a patient with conventional cardiac resynchronization therapy device. Pol Arch Intern Med 2017; 127:703-704. [PMID: 29162790 DOI: 10.20452/pamw.4126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Atrioventricular synchrony in the background of ventricular noise and undersensing. Ann Noninvasive Electrocardiol 2017; 22. [DOI: 10.1111/anec.12425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Sex differences in venous stenosis and occlusion in patients with endocardial leads. POLSKI MERKURIUSZ LEKARSKI : ORGAN POLSKIEGO TOWARZYSTWA LEKARSKIEGO 2017; 42:187-192. [PMID: 28557964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
UNLABELLED Venous stenosis and occlusion (VSO) in the presence of endocardial leads constitute one of the complications of permanent cardiac pacing. At present there are no scientific reports on the influence of sex on the incidence of VSO. AIM The aim of the study was to examine the influence of sex on the incidence of VSO in patients with earlier implanted endocardial leads in a single-center retrospective analysis. MATERIALS AND METHODS The material consists of 284 records of consecutive patients admitted to hospital to undergo electrotherapy procedures. In all patients a contrast venography for ipsilateral venous confluence was performed before the procedure. Patients were divided into two groups according to sex criterion. Groups were compared concerning following parameters: demographic characteristics, cardiac implantable electronic device (CIED) characteristics, comorbidities, CHA2DS2-VASc score, selected risk factors for VSO. RESULTS Group I consist of 101 females, whereas group II consist of 183 males. Both groups did not differ significantly for age, number of implanted endocardial leads and lead dwell time. In the cohort males were with significantly greater burden of morbidity, reflected by the mean result of CHA2DS2-VASc (P=0.0098). In males there was significantly more often chronic heart failure (P<0.0001), chronic obstructive pulmonary disease (P=0.0450) and tobacco use (P=0.0159). Males had more ICD implanted than females (P=0.0270). In the examine cohort 88 patients (31%) had VSO. There was no statistically significant difference in terms of presence of VSO between females and males (P=0.4685). The detailed analysis of the patients with VSO divided according to sex revealed higher morbidity in males. CONCLUSIONS The equality of VSO incidence in groups of males and females along with the predominance of factors protecting against VSO in group of males support the assumption that female gender is a protective factor against the development of VSO, equally as known protective factors in males.
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Elevated NT-proBNP is associated with unfavorably altered plasma fibrin clot properties in atrial fibrillation. Int J Cardiol 2017; 243:244-250. [PMID: 28571619 DOI: 10.1016/j.ijcard.2017.05.060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/09/2017] [Accepted: 05/15/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Dense fibrin clot formation and hypofibrinolysis have been reported in atrial fibrillation (AF). It is unclear which factors affect fibrin clot properties in AF. METHODS AND RESULTS We investigated plasma fibrin clot permeability (Ks), clot lysis time (CLT), endogenous thrombin potential (ETP) as well as other coagulation and fibrinolysis parameters along with N-terminal pro-B-type natriuretic peptide (NT-proBNP) in 160 AF patients (median age, 70.5years). Previous stroke (n=15; 9.4%) was associated with decreased Ks (P=0.04) and longer CLT (P=0.005), together with higher antiplasmin (P=0.03) and lower tissue-type plasminogen activator (P=0.01). Lower Ks (P=0.04) and tendency towards longer CLT (P=0.10) were observed in patients with a left atrium diameter>40mm. Patients with a CHA2DS2-VASc score of 3 or more (82.5%) were characterized by higher thrombin-activatable fibrinolysis inhibitor antigen (P=0.009). Ks was inversely correlated with log NT-proBNP (r=-0.34, P<0.0001), plasminogen activator inhibitor-1 (PAI-1) antigen (r=-0.24, P=0.002) and C-reactive protein (r=-0.18, P=0.02), while CLT was positively correlated with log NT-proBNP (R=0.61, P<0.0001) and ETP (r=0.37, P<0.0001), which were interrelated (r=0.59, P<0.0001). After adjustment for potential confounders, PAI-1 (odds ratio [OR]: 1.14; 95% confidence interval [CI]: 1.02-1.26) was the only independent predictor of low Ks (the lowest quartile,≤6×10-9cm2), while NT-proBNP (OR: 1.21; 95% CI: 1.12-1.31) and PAI-1 (OR: 1.30; 95% CI: 1.12-1.51) both predicted prolonged CLT (the top quartile,≥109min). CONCLUSION In AF patients prothrombotic fibrin clot properties assessed ex vivo are determined by PAI-1 and NT-proBNP and this phenotype is associated with prior ischemic stroke.
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Spontaneous dislocation of the endocardial lead into the left ventricle through the intraventricular septum. Kardiol Pol 2017; 75:79. [PMID: 28124788 DOI: 10.5603/kp.2017.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 04/20/2016] [Indexed: 11/25/2022]
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Successful transvenous extraction of an endocardial lead more than 35 years old using mechanical systems. Kardiol Pol 2016; 74:1357. [DOI: 10.5603/kp.2016.0161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 05/05/2016] [Indexed: 11/25/2022]
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The utility of a CHA2DS2-VASc score in predicting the presence of significant stenosis and occlusion of veins with indwelling endocardial leads. Int J Cardiol 2016; 218:164-169. [PMID: 27236109 DOI: 10.1016/j.ijcard.2016.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 05/12/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Currently, there are no studies in which a CHA2DS2-VASc score has been used to predict the risk of venous stenosis and occlusion (VSO) in patients after the implantation of a cardiac implantable electronic device (CIED). METHODS The material consists of the records of 223 consecutive patients qualified for transvenous lead extraction, generator change and system revisions or upgrades in whom we assessed the utility of a CHA2DS2-VASc score in the prediction of VSO. The CHA2DS2-VASc score was calculated retrospectively based on the clinical data. The whole study population was divided into two groups, based on the presence (group I) or absence (group II) of VSO. Using the receiver operating characteristic (ROC) curve, we identified the optimal cut-off point for the CHA2DS2-VASc score that allowed the prediction of the absence of VSO. RESULTS The venography was performed in 223 consecutive patients aged on average 68.2years (25.7-95.3), 77 females (34.5%). The presence of VSO was detected in 79 (35.4%) patients aged 68.3±14.1years, 30 female (40%) patients-group I. The level of the cut-off point for the CHA2DS2-VASc score that allowed the prediction of the absence of VSO was 3.0. CONCLUSION In the whole population the incidence of VSO amounted to 35.4%. The result of the CHA2DS2-VASc score was a destimulant of VSO occurrence and was characterized by moderate sensitivity (73.4%) and specificity (42.4%) in predicting the absence of VSO. The most significant factor, which prevented VSO development was diabetes.
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Infectious complications of electrotherapy: theory and practice. Pol Arch Intern Med 2016; 126:440-2. [DOI: 10.20452/pamw.3439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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