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Maier J, Lambert T, Senoner T, Dobner S, Hoppe UC, Fellner A, Pfeifer BE, Feuchtner GM, Friedrich G, Semsroth S, Bonaros N, Holfeld J, Müller S, Reinthaler M, Steinwender C, Barbieri F. Impact of route of access and stenosis subtype on outcome after transcatheter aortic valve replacement. Front Cardiovasc Med 2023; 10:1256112. [PMID: 38028449 PMCID: PMC10665844 DOI: 10.3389/fcvm.2023.1256112] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Previous analyses have reported the outcomes of transcatheter aortic valve replacement (TAVR) for patients with low-flow, low-gradient (LFLG) aortic stenosis (AS), without stratifying according to the route of access. Differences in mortality rates among access routes have been established for high-gradient (HG) patients and hypothesized to be even more pronounced in LFLG AS patients. This study aims to compare the outcomes of patients with LFLG or HG AS following transfemoral (TF) or transapical (TA) TAVR. Methods A total of 910 patients, who underwent either TF or TA TAVR with a median follow-up of 2.22 (IQR: 1.22-4.03) years, were included in this multicenter cohort study. In total, 146 patients (16.04%) suffered from LFLG AS. The patients with HG and LFLG AS were stratified according to the route of access and compared statistically. Results The operative mortality rates of patients with HG and LFLG were found to be comparable following TF access. The operative mortality rate was significantly increased for patients who underwent TA access [odds ratio (OR): 2.91 (1.54-5.48), p = 0.001] and patients with LFLG AS [OR: 2.27 (1.13-4.56), p = 0.02], which could be corroborated in a propensity score-matched subanalysis. The observed increase in the risk of operative mortality demonstrated an additive effect [OR for TA LFLG: 5.45 (2.35-12.62), p < 0.001]. LFLG patients who underwent TA access had significantly higher operative mortality rates (17.78%) compared with TF LFLG (3.96%, p = 0.016) and TA HG patients (6.36%, p = 0.024). Conclusions HG patients experienced a twofold increase in operative mortality rates following TA compared with TF access, while LFLG patients had a fivefold increase in operative mortality rates. TA TAVR appears suboptimal for patients with LFLG AS. Prospective studies should be conducted to evaluate alternative options in cases where TF is not possible.
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Affiliation(s)
- Julian Maier
- Department of Cardiology, Kepler University Hospital, Linz, Austria
- Johannes Kepler University Linz, Medical Faculty, Linz, Austria
- Institute for Cardiovascular and Metabolic Research (ICMR), Johannes Kepler University Linz, Linz, Austria
- Institute of Pharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Thomas Lambert
- Department of Cardiology, Kepler University Hospital, Linz, Austria
- Johannes Kepler University Linz, Medical Faculty, Linz, Austria
| | - Thomas Senoner
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Stephan Dobner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- 3rd Medical Department of Cardiology and Intensive Care Medicine, Clinic Ottakring (former Wilhelminenhospital), Vienna, Austria
| | - Uta Caroline Hoppe
- University Clinic of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Alexander Fellner
- Department of Cardiology, Kepler University Hospital, Linz, Austria
- Johannes Kepler University Linz, Medical Faculty, Linz, Austria
| | - Bernhard Erich Pfeifer
- Institute of Clinical Epidemiology, Tirol Kliniken, Innsbruck, Austria
- Division of Digital Medicine and Telehealth, University for Health Sciences, Medical Informatics and Technology (UMIT), Hall in Tirol, Austria
| | | | - Guy Friedrich
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Severin Semsroth
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Johannes Holfeld
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Silvana Müller
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Markus Reinthaler
- Department of Cardiology, Campus Benjamin Franklin, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt–Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Institute of Active Polymers and Berlin-Brandenburg Center for Regenerative Therapies, Helmholtz-Zentrum Hereon, Teltow, Germany
| | - Clemens Steinwender
- Department of Cardiology, Kepler University Hospital, Linz, Austria
- Johannes Kepler University Linz, Medical Faculty, Linz, Austria
- Institute for Cardiovascular and Metabolic Research (ICMR), Johannes Kepler University Linz, Linz, Austria
| | - Fabian Barbieri
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
- Department of Cardiology, Campus Benjamin Franklin, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt–Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Spitaler P, Pfeifer BE, Mayr A, Bachler R, Bilgeri V, Adukauskaite A, Bauer A, Stühlinger M, Barbieri F, Dichtl W. Visualization of the SyncAV ® Algorithm for CRT Optimization by Non-invasive Imaging of Cardiac Electrophysiology: NICE-CRT Trial. J Clin Med 2023; 12:4510. [PMID: 37445543 DOI: 10.3390/jcm12134510] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
(1) Background: Periodic repetitive AV interval optimization using a device-based algorithm in cardiac resynchronization therapy (CRT) devices may improve clinical outcomes. There is an unmet need to successfully transform its application into clinical routine. (2) Methods: Non-invasive imaging of cardiac electrophysiology was performed in different device programming settings of the SyncAV® algorithm in 14 heart failure patients with left bundle branch block and a PR interval ≤ 250 milliseconds to determine the shortest ventricular activation time. (3) Results: the best offset time (to be manually programmed) permitting automatic dynamic adjustment of the paced atrioventricular interval after every 256 heart beats was found to be 30 and 50 milliseconds, decreasing mean native QRS duration from 181.6 ± 23.9 milliseconds to 130.7 ± 10.0 and 130.1 ± 10.5 milliseconds, respectively (p = 0.01); this was followed by an offset of 40 milliseconds (decreasing QRS duration to 130.1 ± 12.2 milliseconds; p = 0.08). (4) Conclusions: The herein presented NICE-CRT study supports the current recommendation to program an offset of 50 milliseconds as default in patients with left bundle branch block and preserved atrioventricular conduction after implantation of a CRT device capable of SyncAV® optimization. Alternatively, offset programming of 30 milliseconds may also be applied as default programming. In patients with no or poor CRT response, additional efforts should be spent to individualize best offset programming with electrocardiographic optimization techniques.
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Affiliation(s)
- Philipp Spitaler
- Department of Internal Medicine III, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Bernhard Erich Pfeifer
- Institute of Clinical Epidemiology, Tirol Kliniken, 6020 Innsbruck, Austria
- Institute of Medical Informatics, UMIT TIROL, Eduart Wallnöfer Zentrum, 6600 Hall in Tirol, Austria
| | - Agnes Mayr
- Department of Radiology, Medical University Innsbruck, 6020 Innsbruck, Austria
| | | | - Valentin Bilgeri
- Department of Internal Medicine III, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Agne Adukauskaite
- Department of Internal Medicine III, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Axel Bauer
- Department of Internal Medicine III, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Markus Stühlinger
- Department of Internal Medicine III, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Fabian Barbieri
- Department of Internal Medicine III, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Wolfgang Dichtl
- Department of Internal Medicine III, Medical University of Innsbruck, 6020 Innsbruck, Austria
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Barbieri F, Adukauskaite A, Heidbreder A, Brandauer E, Bergmann M, Stefani A, Holzknecht E, Senoner T, Rubatscher A, Schgör W, Stühlinger M, Pfeifer BE, Bauer A, Hintringer F, Högl B, Dichtl W. Central Sleep Apnea and Pacing-Induced Cardiomyopathy. Am J Cardiol 2021; 139:97-104. [PMID: 33002463 DOI: 10.1016/j.amjcard.2020.09.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 01/13/2023]
Abstract
The role of central sleep apnea (CSA) in pacing-induced cardiomyopathy (PICM) remains speculative. In a prospective trial entitled UPGRADE, the presence of CSA was assessed by single-night polysomnography (PSG) in 54 PICM patients within 1 month after left ventricular lead implantation (with biventricular stimulation still not activated). CSA was diagnosed in half of patients (n = 27). Patients with moderate or severe CSA were randomized to cardiac resynchronization therapy (CRT) versus right ventricular pacing (RVP) in a double-blinded cross-over design and re-scheduled for a follow-up PSG within 3 to 5 months. After crossing-over of stimulation mode another PSG was conducted 3 to 5 months later. CRT led to a significant increase in left ventricular ejection fraction and significant reduction in left ventricular end systolic volumes and N-terminal pro brain natriuretic peptide plasma levels, whereas no significant effects were observed with ongoing RVP. CSA was significantly improved after 3.9 (3.2 to 4.4) months of CRT: apnea-hypopnea index decreased from 39.1 (32.1 to 54.0) events per hour at baseline to 22.2/h (10.9 to 36.7) by CRT (p <0.001). Central apnea index decreased from 27.1/h (17.7 to 36.1) at baseline to 6.8/h (1.1 to 14.4) after CRT activation (p <0.001). Ongoing RVP yielded only a minor improvement in apnea-hypopnea index and central apnea index. Pre-existent CSA did not affect structural response rate and had no impact on mid-term follow-up (median 2.8 years). In conclusion, CSA is highly prevalent in patients with PICM. CRT upgrading significantly improves CSA leading to a similar outcome in PICM patients without pre-existent CSA.
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Affiliation(s)
- Fabian Barbieri
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Agne Adukauskaite
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Sleep Disorders Clinic, Medical University Innsbruck, Innsbruck, Austria
| | - Elisabeth Brandauer
- Department of Neurology, Sleep Disorders Clinic, Medical University Innsbruck, Innsbruck, Austria
| | - Melanie Bergmann
- Department of Neurology, Sleep Disorders Clinic, Medical University Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Sleep Disorders Clinic, Medical University Innsbruck, Innsbruck, Austria
| | - Evi Holzknecht
- Department of Neurology, Sleep Disorders Clinic, Medical University Innsbruck, Innsbruck, Austria
| | - Thomas Senoner
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Andrea Rubatscher
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Wilfried Schgör
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Markus Stühlinger
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Bernhard Erich Pfeifer
- Institute of Clinical Epidemiology, Tirol Kliniken, Innsbruck, Austria; Institute of Medical Informatics, UMIT TIROL, Eduart Wallnöfer Zentrum, Hall in Tirol, Austria
| | - Axel Bauer
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Florian Hintringer
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Sleep Disorders Clinic, Medical University Innsbruck, Innsbruck, Austria
| | - Wolfgang Dichtl
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria.
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Barbieri F, Adukauskaite A, Senoner T, Rubatscher A, Schgör W, Stühlinger M, Pfeifer BE, Bauer A, Hintringer F, Dichtl W. Supplemental dataset on the influence of cardiac resynchronisation therapy in pacing-induced cardiomyopathy and concomitant central sleep Apnea. Data Brief 2020; 33:106461. [PMID: 33294502 PMCID: PMC7689044 DOI: 10.1016/j.dib.2020.106461] [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: 09/29/2020] [Accepted: 10/21/2020] [Indexed: 11/30/2022] Open
Abstract
This article contains supplemental data to the publication “Central Sleep Apnea and Pacing-Induced Cardiomyopathy” [1], which was the most recent publication of the “UPGRADE” study. It provides in-depth analysis of the effects of cardiac resynchronisation therapy (CRT) in patients suffering from pacing-induced cardiomyopathy (PICM) on cardiac remodeling as well as functional cardiac parameters in comparison to continuous right ventricular pacing (RVP). Furthermore, it also covers additional data on several sleep parameters, which were not presented in the main article including the index for obstructive sleep apnea (OSA), the index for mixed sleep apnea and the oxygen saturation measurements during polysomnography. Further, Kaplan-Meier curves are presented for major adverse cardiac events (MACE) and overall mortality by severity of sleep apnea. Generally, the “UGRADE” study was a single-center prospective double-blinded randomized controlled trial lasting from 2014 to 2020. The methodology included a cross-over design giving the possibility to detect differences while CRT was activated and while continuous RVP was applied. The presented data should aid clinicians in daily practice as upgrading to CRT is not limited to improvement in cardiac parameters, but also modifies sleep apnea in patients with PICM, a generally sparsely studied entity of heart failure.
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Affiliation(s)
- Fabian Barbieri
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Agne Adukauskaite
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Thomas Senoner
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Andrea Rubatscher
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Wilfried Schgör
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Markus Stühlinger
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Bernhard Erich Pfeifer
- Institute of Clinical Epidemiology, Tirol Kliniken, Innsbruck, Austria.,Institute of Medical Informatics, UMIT TIROL, Eduart Wallnöfer Zentrum, Hall in Tirol, Austria
| | - Axel Bauer
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Florian Hintringer
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Wolfgang Dichtl
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
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Barbieri F, Senoner T, Adukauskaite A, Dobner S, Holfeld J, Semsroth S, Lambert T, Zweiker D, Theurl T, Rainer PP, Schmidt A, Feuchtner GM, Steinwender C, Hoppe UC, Hintringer F, Bauer A, Müller S, Grimm M, Pfeifer BE, Dichtl W. Long-Term Prognostic Value of High-Sensitivity Troponin T Added to N-Terminal Pro Brain Natriuretic Peptide Plasma Levels Before Valve Replacement for Severe Aortic Stenosis. Am J Cardiol 2019; 124:1932-1939. [PMID: 31699359 DOI: 10.1016/j.amjcard.2019.09.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/12/2019] [Accepted: 09/12/2019] [Indexed: 11/18/2022]
Abstract
Natriuretic peptide plasma levels help to manage patients with severe aortic stenosis (AS). The role of troponin plasma levels in this patient cohort remains speculative. A consortium of 4 university hospital centers in Austria analyzed retrospectively 3,595 patients admitted for valve replacement because of severe AS since 2007. The aim was to compare the additive preprocedural value of high-sensitivity troponin T (hsTnT) to N-terminal pro brain natriuretic peptide (NT-proBNP) plasma levels in predicting postoperative long-term survival in a large cohort undergoing either surgical (57.8%) or transcatheter (42.2%) aortic valve replacement. During a median follow-up of 2.93 (1.91 to 4.92) years, 919 patients (25.6%) died, in them 556 (15.5%) due to cardiovascular causes. Both normal hsTnT (<14 ng/l) and NT-proBNP (within age- and sex-corrected normal range) plasma levels were found in 481 patients (14.3%, group 1). Normal hsTnT but elevated NT-proBNP plasma levels were found in 748 patients (22.3%, group 2). Elevated hsTnT but normal NT-proBNP plasma levels were found in 258 patients (7.7%, group 3). Both elevated hsTnT and elevated NT-proBNP plasma levels were found in 1,869 patients (55.7%, group 4). Using Log Rank tests for comparison there was a highly significant difference in both cardiovascular mortality (p <0.0001) and all-cause mortality (p <0.0001). All-cause mortality rates after 1, 3, and 5 years were 2.1%, 5.4%, 7.7% in group 1; 4.0%, 7.5%, 11.5% in group 2; 5.8%, 8.9%, 14.0% in group 3; and 12.3%, 22.6%, 28.4% in group 4. In conclusion, hsTnT adds additional impact to NT-proBNP as a routinely available biomarker for risk stratification concerning postoperative survival in patients with severe AS admitted for valve replacement. The present study supports the concept to integrate hsTnT plasma levels in the management of severe AS.
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Affiliation(s)
- Fabian Barbieri
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Thomas Senoner
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Agne Adukauskaite
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Stephan Dobner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johannes Holfeld
- University Clinic of Heart Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Severin Semsroth
- University Clinic of Heart Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Thomas Lambert
- Department of Cardiology, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Austria
| | - David Zweiker
- Department of Internal Medicine, Division of Cardiology, Medical University Graz, Graz, Austria
| | - Thomas Theurl
- University Clinic of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Peter Paul Rainer
- Department of Internal Medicine, Division of Cardiology, Medical University Graz, Graz, Austria
| | - Albrecht Schmidt
- Department of Internal Medicine, Division of Cardiology, Medical University Graz, Graz, Austria
| | | | - Clemens Steinwender
- Department of Cardiology, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Austria
| | - Uta Charlotte Hoppe
- University Clinic of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Florian Hintringer
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Axel Bauer
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Silvana Müller
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Michael Grimm
- University Clinic of Heart Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Bernhard Erich Pfeifer
- Institute of Clinical Epidemiology, Tirol Kliniken, Innsbruck, Austria; Institute of Electrical and Biomedical Engineering, University for Health Sciences, Medical Informatics and Technology (UMIT), Hall in Tirol, Austria
| | - Wolfgang Dichtl
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria.
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Senoner T, Barbieri F, Semmler G, Adukauskaite A, Rubatscher A, Schgör W, Stühlinger M, Bauer A, Pfeifer BE, Fiedler L, Roithinger FX, Hintringer F, Suessenbacher A, Wollmann CG, Dichtl W. Long-term performance of an atrial lead capable of accelerometer based detection of cardiac contractility in patients receiving cardiac resynchronisation therapy. PLoS One 2019; 14:e0222269. [PMID: 31498840 PMCID: PMC6733485 DOI: 10.1371/journal.pone.0222269] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 08/26/2019] [Indexed: 11/19/2022] Open
Abstract
Objectives To evaluate the long-term performance of the SonRtip atrial lead. Background To optimize atrioventricular and interventricular timing and thereby potentially improving cardiac resynchronization therapy (CRT) responder rates, a lead integrated technology and a cardioverter/defibrillator-based algorithm measuring peak endocardial acceleration have been introduced. Long-term performance of the atrial lead (SonRtip PS55D, Sorin/MicroPort CRM, Italy) embedded with such a sensor has not been reported so far. Methods Between 2012 and 2018, 143 patients underwent implantation of the SonRtip atrial lead in four Austrian medical centers. Conventional bipolar atrial leads implanted during the same period in 526 patients receiving CRT were used as control cohort. Results Among 669 patients included in the study, 10 (1.5%) showed increased atrial pacing thresholds and/or decreased atrial sensing amplitudes and/or sudden increase in atrial lead impedance (above 3000 Ω) after an uneventful early postoperative period. Seven (70%) of the malfunctioning leads were SonRtip leads (p <0.001). Lead replacement was needed in 4.2% of SonRtip leads (six out of 143) and in 0.38% of all other conventional atrial leads (two out of 526) (p <0.001). Because of unaltered atrial sensing properties, a wait and see strategy was chosen in two patients–one of them with a SonRtip lead. The implanted atrial lead in the latter person experienced a sudden increase in pacing threshold (4V/0.35ms). Conclusions While short-term safety and stable technical performance of the SonRtip atrial lead could be confirmed, our study found an unexpectedly high malfunction rate over a longer follow-up period.
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Affiliation(s)
- Thomas Senoner
- University Clinic of Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | - Fabian Barbieri
- University Clinic of Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | - Georg Semmler
- Department of Internal Medicine III, University Clinic St. Pölten, St. Pölten, Austria
- Karl Landsteiner University, St. Pölten, Austria
| | - Agne Adukauskaite
- University Clinic of Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | - Andrea Rubatscher
- University Clinic of Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | - Wilfried Schgör
- University Clinic of Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | - Markus Stühlinger
- University Clinic of Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | - Axel Bauer
- University Clinic of Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | - Bernhard Erich Pfeifer
- Landesinstitut für Integrierte Versorgung, Tirol Kliniken GmbH, Innsbruck, Austria
- Austrian Institute of Technology, Center for Health & Bioresources, Digital Health Information Systems, Eduar Wallnöfer Zentrum 1, Hall in Tirol, Austria
| | - Lukas Fiedler
- Landesklinikum Wiener Neustadt, Department of Internal Medicine III, Wiener Neustadt, Austria
| | - Franz Xaver Roithinger
- Landesklinikum Wiener Neustadt, Department of Internal Medicine III, Wiener Neustadt, Austria
| | - Florian Hintringer
- University Clinic of Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | | | - Christian Georg Wollmann
- Department of Internal Medicine III, University Clinic St. Pölten, St. Pölten, Austria
- Karl Landsteiner University, St. Pölten, Austria
| | - Wolfgang Dichtl
- University Clinic of Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
- * E-mail:
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