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Park YM. Does Age Play a Role in Patients with Heart Failure Receiving Cardiac Implantable Electronic Devices? Cardiology 2024:1-3. [PMID: 38763128 DOI: 10.1159/000538631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 03/28/2024] [Indexed: 05/21/2024]
Affiliation(s)
- Yae Min Park
- Cardiology Division, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
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Ahmed FZ, Sammut-Powell C, Martin GP, Callan P, Cunnington C, Kahn M, Kale M, Weldon T, Harwood R, Fullwood C, Gerritse B, Lanctin D, Soken N, Campbell NG, Taylor JK. Association of a device-based remote management heart failure pathway with outcomes: TriageHF Plus real-world evaluation. ESC Heart Fail 2024. [PMID: 38712903 DOI: 10.1002/ehf2.14821] [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: 11/28/2023] [Revised: 03/08/2024] [Accepted: 04/02/2024] [Indexed: 05/08/2024] Open
Abstract
AIMS Clinical pathways have been shown to improve outcomes in patients with heart failure (HF). Although patients with HF often have a cardiac implantable electronic device, few studies have reported the utility of device-derived risk scores to augment and organize care. TriageHF Plus is a device-based HF clinical pathway (DHFP) that uses remote monitoring alerts to trigger structured telephone assessment for HF stability and optimization. We aimed to evaluate the impact of TriageHF Plus on hospitalizations and describe the associated workforce burden. METHODS AND RESULTS TriageHF Plus was a multi-site, prospective study that compared outcomes for patients recruited between April 2019 and February 2021. All alert-triggered assessments were analysed to determine the appropriateness of the alert and the workload burden. A negative-binomial regression with inverse probability treatment weighting using a time-matched usual care cohort was applied to estimate the effect of TriageHF Plus on non-elective hospitalizations. A post hoc pre-COVID-19 sensitivity analysis was also performed. The TriageHF Plus cohort (n = 443) had a mean age of 68.8 ± 11.2 years, 77% male (usual care cohort: n = 315, mean age of 66.2 ± 14.5 years, 65% male). In the TriageHF Plus cohort, an acute medical issue was identified following an alert in 79/182 (43%) cases. Fifty assessments indicated acute HF, requiring clinical action in 44 cases. At 30 day follow-up, 39/66 (59%) of initially symptomatic patients reported improvement, and 20 (19%) initially asymptomatic patients had developed new symptoms. On average, each assessment took 10 min. The TriageHF Plus group had a 58% lower rate of hospitalizations across full follow-up [incidence relative ratio: 0.42, 95% confidence interval (CI): 0.23-0.76, P = 0.004]. Across the pre-COVID-19 window, hospitalizations were 31% lower (0.69, 95% CI: 0.46-1.04, P = 0.077). CONCLUSIONS These data represent the largest real-world evaluation of a DHFP based on multi-parametric risk stratification. The TriageHF Plus clinical pathway was associated with an improvement in HF symptoms and reduced all-cause hospitalizations.
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Affiliation(s)
- Fozia Zahir Ahmed
- Department of Cardiology, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Camilla Sammut-Powell
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Glen P Martin
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Paul Callan
- Department of Cardiology, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Colin Cunnington
- Department of Cardiology, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Matthew Kahn
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Mita Kale
- Department of Cardiology, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Toni Weldon
- Department of Cardiology, Northern Care Alliance NHS Foundation Trust, Manchester, UK
| | - Rachel Harwood
- Statistics Department, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, UK
- Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Catherine Fullwood
- Statistics Department, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, UK
- Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | | | | | - Niall G Campbell
- Department of Cardiology, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Joanne K Taylor
- Department of Cardiology, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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D'lima J, Thijs V, Lim H, Rodrigues TS, Beaudoin AM. Temporal Association Between Atrial Fibrillation and Ischemic Stroke: Systematic Review and Meta-Analysis. Int J Stroke 2024:17474930241253482. [PMID: 38676601 DOI: 10.1177/17474930241253482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
BACKGROUND Paroxysmal atrial fibrillation (PAF) is strongly associated with ischemic stroke. Continuous cardiac implantable electronic devices (CIEDs) can assess PAF episodes over prolonged periods. Studies that attempted to find a temporal association between PAF and ischemic stroke were inconclusive. Thus, we performed a systematic review and meta-analysis to assess this relationship. AIMS To assess the temporal association between AF episodes and stroke within 30 days of the arrhythmic episode. The secondary outcome is a temporal association within a 90-day period. SUMMARY OF REVIEW A total of 2804 studies that discussed the temporal relationship between PAF and ischemic stroke were screened, and 7 studies were included in the meta-analysis. Amongst the 4041 patients included in these studies, there were 138 patients with device detected PAF episodes and stroke. Four studies used a 30-day window for temporality and the pooled OR showed a significant association (OR 4.11 [95% CI 1.03-16.40]). The 3 studies reporting on AF and stroke within a 90 day window did not find a significant temporal relationship (OR of 0.43 [95% CI 0.13-1.41]). Finally, the pooled result of those 7 studies did not show a significant association (OR 1.51 [95% CI 0.44 - 5.17]). CONCLUSIONS This meta-analysis supports a temporal relationship between PAF and ischemic stroke within a 30-day window. Establishing this relationship is important for individualized risk prediction and targeted anticoagulation treatment.
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Affiliation(s)
- Jessica D'lima
- Medical Student, PhD Candidate University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Parkville and The Florey Institute of Neuroscience and Mental Health, Victoria, Australia
| | - Vincent Thijs
- Director of Neurology, Austin Health and The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria 3084, Australia
| | - Han Lim
- Senior Cardiologist and Electrophysiologist, Austin Health, Heidelberg, Victoria 3084, Australia
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Mohamed K, Sengodan PM, Mohammad A, Carabello BA. Clinical Implications of Variability in Left Ventricular Ejection Fraction Determined by Echocardiography and Cardiac Magnetic Resonance. J Am Soc Echocardiogr 2024:S0894-7317(24)00168-8. [PMID: 38593887 DOI: 10.1016/j.echo.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 04/11/2024]
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Russo A, Serraino R, Serapide F, Trecarichi EM, Torti C. New advances in management and treatment of cardiac implantable electronic devices infections. Infection 2024; 52:323-336. [PMID: 37996646 PMCID: PMC10955036 DOI: 10.1007/s15010-023-02130-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023]
Abstract
Cardiac implantable electronic devices (CIED) are increasingly used worldwide, and infection of these devices remains one of the most feared complications.CIED infections (CDIs) represent a challenge for physicians and the healthcare system in general as they require prolonged hospitalization and antibiotic treatment and are burdened by high mortality and high costs, so management of CDIs must be multidisciplinary.The exact incidence of CDIs is difficult to define, considering that it is influenced by various factors mainly represented by the implanted device and the type of procedure. Risk factors for CDIs could be divided into three categories: device related, patient related, and procedural related and the etiology is mainly sustained by Gram-positive bacteria; however, other etiologies cannot be underestimated. As a matter of fact, the two cornerstones in the treatment of these infections are device removal and antimicrobial treatment. Finally, therapeutic drug monitoring and PK/PD correlations should be encouraged in all patients with CDIs receiving antibiotic therapy and may result in a better clinical outcome and a reduction in antibiotic resistance and economic costs.In this narrative review, we look at what is new in the management of these difficult-to-treat infections.
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Affiliation(s)
- Alessandro Russo
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, 'Magna Graecia' University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy.
| | - Riccardo Serraino
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, 'Magna Graecia' University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Francesca Serapide
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, 'Magna Graecia' University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Enrico Maria Trecarichi
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, 'Magna Graecia' University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Carlo Torti
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, 'Magna Graecia' University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
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De Leon-Benedetti LS, Ramirez-Suarez KI, Otero HJ, Rapp JB, Biko DM, Smith C, Serai SD, Janson C, Shah M, Englehardt G, Fogel M, White AM. How we do it: Cardiac implantable devices are not a contraindication to MRI: time for a paradigm shift. Pediatr Radiol 2024:10.1007/s00247-024-05902-y. [PMID: 38488925 DOI: 10.1007/s00247-024-05902-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
Magnetic resonance imaging (MRI) is now an indispensable diagnostic tool in medicine due to its outstanding contrast resolution and absence of radiation exposure, enabling detailed tissue characterization and three-dimensional anatomical representation. This is especially important when evaluating individuals with congenital heart disease (CHD) who frequently require cardiac implantable electrical devices (CIEDs). While MRI safety issues have previously limited its use in patients with CIEDs, new advances have called these limitations into question. However, difficulties persist in the pediatric population due to the continued lack of specific safety data both related to imaging young children and the specific CIED devices they often require. This paper discusses MRI safety considerations related to imaging patients with CIEDs, investigates pediatric-specific problems, and describes thorough methods for safe MRI access, highlighting the significance of specialized institutional guidelines.
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Affiliation(s)
- Laura S De Leon-Benedetti
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - Karen I Ramirez-Suarez
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Hansel J Otero
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Jordan B Rapp
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - David M Biko
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Christopher Smith
- Department of Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Suraj D Serai
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Christopher Janson
- Department of Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Maully Shah
- Department of Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - George Englehardt
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Mark Fogel
- Department of Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Ammie M White
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
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Talaei F, Ang QX, Tan MC, Hassan M, Scott L, Cha YM, Lee JZ, Tamirisa K. Impact of infective versus sterile transvenous lead removal on 30-day outcomes in cardiac implantable electronic devices. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01775-1. [PMID: 38459202 DOI: 10.1007/s10840-024-01775-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 02/27/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Transvenous lead removal (TLR) is associated with increased mortality and morbidity. This study sought to evaluate the impact of TLR on in-hospital mortality and outcomes in patients with and without CIED infection. METHODS From January 1, 2017, to December 31, 2020, we utilized the nationally representative, all-payer, Nationwide Readmissions Database to assess patients who underwent TLR. We categorized TLR as indicated for infection, if the patient had a diagnosis of bacteremia, sepsis, or endocarditis during the initial admission. Conversely, if none of these conditions were present, TLR was considered sterile. The impact of infective vs sterile indications of TLR on mortality and major adverse events was studied. RESULTS Out of the total 25,144 patients who underwent TLR, 14,030 (55.8%) received TLR based on sterile indications, while 11,114 (44.2%) received TLR due to device infection, with 40.5% having systemic infection and 59.5% having isolated pocket infection. TLR due to infective indications was associated with a significant in-hospital mortality (5.59% vs 1.13%; OR = 5.16; 95% CI 4.33-6.16; p < 0.001). Moreover, when compared with sterile indications, TLR performed due to device infection was associated with a considerable risk of thromboembolic events including pulmonary embolism and stroke (OR = 3.80; 95% CI 3.23-4.47, p < 0.001). However, there was no significant difference in the conversion to open heart surgery (1.72% vs. 1.47%, p < 0.111), and infection was not an independent predictor of cardiac (OR = 1.12; 95% CI 0.97-1.29) or vascular complications (OR = 1.12; 95% CI 0.73-1.72) between the two groups. CONCLUSION Higher in-hospital mortality and rates of thromboembolic events associated with TLR resulting from infective indications may warrant further pursuing this diagnosis in patients.
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Affiliation(s)
- Fahimeh Talaei
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
- Department of Internal Medicine, McLaren Health System and Michigan State University, Flint, MI, USA
| | - Qi-Xuan Ang
- Department of Internal Medicine, Sparrow Health System and Michigan State University, East Lansing, MI, USA
| | - Min-Choon Tan
- Department of Internal Medicine, New York Medical College at Saint Michael's Medical Center, Newark, NJ, USA
| | - Mustafa Hassan
- Department of Cardiovascular Medicine, McLaren Health System and Michigan State University, Flint, MI, USA
| | - Luis Scott
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Justin Z Lee
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Kamala Tamirisa
- Texas Cardiac Arrhythmia Institute, Austin and Dallas, TX, USA.
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Kewcharoen J, Shah K, Bhardwaj R, Contractor T, Turagam MK, Mandapati R, Lakkireddy D, Garg J. New-generation electronic appliances and cardiac implantable electronic devices: a systematic literature review of mechanisms and in vivo studies. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01777-z. [PMID: 38443707 DOI: 10.1007/s10840-024-01777-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/27/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Cardiac implantable electronic device (CIED) functions are susceptible to electromagnetic interference (EMI) from electromagnetic fields (EMF). Data on EMI risks from new-generation electronic appliances (EA) are limited. OBJECTIVE We performed a systematic literature review on the mechanisms of EMI, current evidence, and recently published trials evaluating the effect of EMF on CIEDs from electric vehicles (EV), smartphone, and smartwatch technology and summarize its safety data. METHODS Electronic databases, including PubMed and EMBASE, were searched for in vivo studies evaluating EMF strength and incidence between CIEDs and commercial EVs, new-generation smartphones, and new-generation smartwatches. RESULTS A total of ten studies (three on EVs, five on smartphones, one on smartphones, one on smartphones and smartwatches) were included in our systematic review. There was no report of EMI incidence associated with EVs or smartwatches. Magnet-containing smartphones (iPhone 12) can cause EMI when placed directly over CIEDs - thereby triggering the magnet mode; otherwise, no report of EMI was observed with other positions or smartphone models. CONCLUSION Current evidence suggests CIED recipients are safe from general interaction with EVs/HEVs, smartphones, and smartwatches. Strictly, results may only be applied to commercial brands or models tested in the published studies. There is limited data on EMI risk from EVs wireless charging and smartphones with MagSafe technology.
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Affiliation(s)
- Jakrin Kewcharoen
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Kuldeep Shah
- Division of Cardiology, Cardiac Arrhythmia Service, MercyOne Siouxland Heart and Vascular Center, Sioux City, IA, USA
| | - Rahul Bhardwaj
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Tahmeed Contractor
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Mohit K Turagam
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ravi Mandapati
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | | | - Jalaj Garg
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA.
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Leventopoulos G, Patrinos P, Papageorgiou A, Katechis S, Perperis A, Travlos CK, Spyropoulou P, Koutsogiannis N, Moulias A, Tsigkas G, Davlouros P. Left Bundle Branch Area Pacing Versus Conventional Pacing in Patients with Advanced Atrioventricular Conduction Abnormalities: a Prospective Cohort Study. Hellenic J Cardiol 2024:S1109-9666(24)00060-5. [PMID: 38453017 DOI: 10.1016/j.hjc.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/20/2024] [Accepted: 03/03/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Left bundle branch area pacing (LBBAP) is an emerging pacing method, which may prevent the deleterious effects of right ventricular pacing. The aim of this study is to compare the effects of LBBAP with right ventricular septal pacing (RVSP) in patients with advanced atrioventricular conduction abnormalities and preserved left ventricular ejection fraction. METHODS The effect of pacing was evaluated by echocardiographic indices of dyssynchrony, including global myocardial work efficiency (GWE) and peak systolic dispersion (PSD). The primary endpoint was GWE postprocedural, at 3, 6 and 12 months after the procedure. RESULTS Twenty patients received LBBAP and 18 RVSP. Complete follow-up was accomplished in 37 patients (97.4%), due to the death of a patient (RVSP arm), from non-related cause. GWE was significantly increased in the group of LBBAP compared to RVSP at all timepoints (90.8% in LBBAP vs 85.8% in RVSP group at 12 months, p=0.01). PSD was numerically lower in the LBBAP arm at all timepoints, yet not statistically significant (56.4 msec in LBBP vs 65.1 msec in RVSP arm at 12 months, p=0.178). The implantation time was increased (median 93 min in LBBAP vs 45 min in RVSP group, p<0.01), along with fluoroscopy time and dose area product (DAP), in the arm of LBBAP. There were no severe perioperative acute complications in either group. CONCLUSIONS LBBAP is an emerging and safe technique for patients with a pacing indication. Despite the longer procedural and fluoroscopy time, as well as higher DAP, LBBAP seems to offer better left ventricular synchrony compared to RVSP, according to GWE measurements.
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Affiliation(s)
| | | | | | - Spyridon Katechis
- Department of Rheumatology, General Hospital Asklepieio Voulas, Athens, Greece.
| | - Angelos Perperis
- Department of Cardiology, University Hospital of Patras, Greece.
| | - Christoforos K Travlos
- Department of Medicine, McGill University Health Centre and Research Institute, Montreal, Quebec, Canada.
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Durand J, Bonnet JL, Lazarus A, Taieb J, Rosier A, Mittal S. Using technology to improve reconnection to remote monitoring in cardiac implantable electronic device patients. Cardiovasc Digit Health J 2024; 5:1-7. [PMID: 38390582 PMCID: PMC10878941 DOI: 10.1016/j.cvdhj.2023.11.020] [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] [Indexed: 02/24/2024] Open
Abstract
Background Remote monitoring (RM) of cardiac implantable electronic device (CIED) patients is now considered standard of care. However, a fundamental requirement of RM is continuous connectivity between the patient's implanted device and the CIED manufacturer's central server. This study examined the rate of RM disconnections in CIED recipients and the impact of short message service (SMS) to facilitate reconnections. Methods Using a platform that collects RM data from CIED manufacturers, we retrospectively examined the disconnection and reconnection events in 6085 patients from 20 medical centers. Each medical center reported their usual practice regarding RM disconnections, which consisted of either an automatic SMS from the platform to patients who were disconnected for 2 weeks or the standard of care (SC) of a phone call to patients. Results During a 1-year period, 43% of patients had at least 1 disconnection. Half of these patients experienced multiple disconnections. The use of SMS reduced the time to reconnection by 43% in comparison to SC. The median time to reconnect a disconnected patient was 11.0 [3.2, 29.0] days for SC vs 6.3 [1.3, 22.0] days for SMS (P < .0001). Furthermore, there was a high rate of reconnections within the first 48 hours of the SMS message, which was nearly double that in the SC arm. Conclusion This study demonstrates the feasibility of an automatic system to deliver an SMS to patients with a disconnected CIED to facilitate early reconnection to RM.
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Affiliation(s)
| | | | | | - Jérôme Taieb
- Centre Hospitalier Intercommunal Aix Pertuis, Aix en Provence, France
| | - Arnaud Rosier
- Implicity, Paris, France
- Jacques Cartier Private Hospital, Massy, France
| | - Suneet Mittal
- Valley Health System and Snyder Center for Comprehensive Atrial Fibrillation, Ridgewood, New Jersey
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Frausing MHJP, Nielsen JC, Westergaard CL, Gerdes C, Kjellberg J, Boriani G, Kronborg MB. Economic analyses in cardiac electrophysiology: from clinical efficacy to cost utility. Europace 2024; 26:euae031. [PMID: 38289720 PMCID: PMC10858642 DOI: 10.1093/europace/euae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/24/2024] [Indexed: 02/01/2024] Open
Abstract
Cardiac electrophysiology is an evolving field that relies heavily on costly device- and catheter-based technologies. An increasing number of patients with heart rhythm disorders are becoming eligible for cardiac interventions, not least due to the rising prevalence of atrial fibrillation and increased longevity in the population. Meanwhile, the expansive costs of healthcare face finite societal resources, and a cost-conscious approach to new technologies is critical. Cost-effectiveness analyses support rational decision-making in healthcare by evaluating the ratio of healthcare costs to health benefits for competing therapies. They may, however, be subject to significant uncertainty and bias. This paper aims to introduce the basic concepts, framework, and limitations of cost-effectiveness analyses to clinicians including recent examples from clinical electrophysiology and device therapy.
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Affiliation(s)
- Maria Hee Jung Park Frausing
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Bvld 99, DK-8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Bvld. 99, DK-8200 Aarhus, Denmark
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Bvld 99, DK-8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Bvld. 99, DK-8200 Aarhus, Denmark
| | - Caroline Louise Westergaard
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Christian Gerdes
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Bvld 99, DK-8200 Aarhus, Denmark
| | - Jakob Kjellberg
- The Danish Center for Social Science Research, VIVE, Copenhagen, Denmark
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Mads Brix Kronborg
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Bvld 99, DK-8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Bvld. 99, DK-8200 Aarhus, Denmark
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Kim M, Kwon CH. Perioperative Management of Patients with Cardiac Implantable Electronic Devices. Korean J Anesthesiol 2024:kja.23826. [PMID: 38287213 DOI: 10.4097/kja.23826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/09/2024] [Indexed: 01/31/2024] Open
Abstract
The use of cardiac implantable electronic devices (CIEDs) has increased significantly in recent years. Consequently, more patients with CIEDs will undergo surgery during their lifetime, and thus the involvement of anesthesiologists in the perioperative management of CIEDs is increasing. With ongoing advancements in technology, many types of CIEDs have been developed, including permanent pacemakers, leadless pacemakers, implantable cardioverter defibrillators, cardiac resynchronization therapy-pacemakers/defibrillators, and implantable loop recorders. The functioning of CIEDs exposed to an electromagnetic field can be affected by electromagnetic interference, potential sources of which can be found in the operating room. Thus, to prevent potential adverse events caused by electromagnetic interference in the operating room, anesthesiologists must have knowledge of CIEDs and be able to identify each type. This review focuses on the perioperative management of patients with CIEDs, including indications for CIED implantation to determine the baseline cardiovascular status of patients; concerns associated with CIEDs before and during surgery; perioperative management of CIEDs, including magnet application and device reprogramming; and additional perioperative provisions for patients with CIEDs. As issues such as variations in programming capabilities and responses to magnet application according to device can be challenging, this review provides essential information for the safe perioperative management of patients with CIEDs.
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Affiliation(s)
- Minsu Kim
- Department of Internal Medicine, Division of Cardiology, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Republic of Korea
| | - Chang Hee Kwon
- Department of Internal Medicine, Division of Cardiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
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Zhou M, Zhou H, Zhang X, Jin X, Su X, Bai Y, Wei W, Zhang Y, Ma F. A qualitative study on patients' and health care professionals' perspectives regarding care delivered during CIED operation. BMC Health Serv Res 2024; 24:73. [PMID: 38225638 PMCID: PMC10789075 DOI: 10.1186/s12913-024-10546-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/02/2024] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Cardiac implantable electronic devices (CIEDs) has proven to be an invaluable tool in the practice of cardiology. Patients who have undergone CIED surgery with local anesthesia may result in fear, insecurity and suffering. Some studies have put efforts on ways to improve intraoperative experience of patients with local anesthesia, but researches concerning experiences of CIED patients during surgery is in its infancy. METHODS Based on semi-structured and in-depth interviews, a qualitative design was conducted in a tertiary general hospital in China from May 2022 to July 2023.Purposeful sampling of 17 patients received CIED surgery and 20 medical staff were interviewed. Thematic analysis with an inductive approach was used to identify dominant themes. RESULTS Four themes emerged from the data: (1) Safety and success is priority; (2) Humanistic Caring is a must yet be lacking; (3) Paradox of surgery information given; (4) Ways to improve surgery experiences in the operation. CONCLUSIONS Intraoperative care is significant for CIED surgery. To improve care experience during surgery, healthcare professionals should pay attention to patients' safety and the factors that affecting humanistic caring in clinical practice. In addition, information support should consider information-seeking styles and personal needs. Besides, the four approaches presented in this study are effective to improve the intraoperative care experience.
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Affiliation(s)
- Min Zhou
- Department of Nursing, The First Affiliated Hospital of Kunming Medical University, No. 295, Xichang Road, 650032, Kunming, China
- School of Nursing, Kunming Medical University, Kunming, China
| | - Huilin Zhou
- Department of Nursing, The First Affiliated Hospital of Kunming Medical University, No. 295, Xichang Road, 650032, Kunming, China
| | - Xiong Zhang
- Department of Nursing, The First Affiliated Hospital of Kunming Medical University, No. 295, Xichang Road, 650032, Kunming, China
| | - Xiaorong Jin
- Department of Nursing, The First Affiliated Hospital of Kunming Medical University, No. 295, Xichang Road, 650032, Kunming, China
| | - Xu Su
- Department of Nursing, The First Affiliated Hospital of Kunming Medical University, No. 295, Xichang Road, 650032, Kunming, China
| | - Yangjuan Bai
- Cardiology Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Wei Wei
- Digestive Surgery Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yimei Zhang
- Department of Nursing, The First Affiliated Hospital of Kunming Medical University, No. 295, Xichang Road, 650032, Kunming, China
| | - Fang Ma
- Department of Nursing, The First Affiliated Hospital of Kunming Medical University, No. 295, Xichang Road, 650032, Kunming, China.
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Brignoli M, Mattera A, Chianese R, Simonetti A, Vittoria D, Viscusi M. Real-world use of a novel ventricular tachyarrhythmia detection algorithm: A case report. HeartRhythm Case Rep 2023; 9:929-934. [PMID: 38204833 PMCID: PMC10774585 DOI: 10.1016/j.hrcr.2023.10.002] [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: 01/12/2024] Open
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15
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Yousuf Q, Rashid A, Hafeez I, Rather H, Syed I, Mir AH, Mir SA, Lone A. Prevalence and Predictors of Venous Stenosis Following First Transvenous Cardiac Implantable Electronic Device Implantation. J Saudi Heart Assoc 2023; 35:301-310. [PMID: 38116403 PMCID: PMC10727134 DOI: 10.37616/2212-5043.1358] [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: 09/17/2023] [Revised: 10/21/2023] [Accepted: 11/01/2023] [Indexed: 12/21/2023] Open
Abstract
Objectives Very few studies have been done on Venous stenosis following the first transvenous cardiac device implantation. We aimed to assess the prevalence and predictors of Venous stenosis/Occlusion following the first transvenous cardiac device implantation with venous angiography at one year of follow-up. Methods This study was a single-center prospective, observational study. Demographic, clinical, procedural, and device data was collected. All patients underwent a preimplant contrast and repeated venography at twelve months to look for upper limb venous anatomy, obstruction, or collaterals. Results A total of 146 patients were included in the final analysis. 60 (41 %) patients developed some degree of venous stenosis. Most patients had mild to moderate stenosis, and almost all were asymptomatic. Among patient-related factors increasing age (64.66 ± 10.07 vs 60.91 ± 11.94 years p = 0.04), presence of hypertension (50.5 % vs 19.6 % p = 0.0004), diabetes (73 % vs 29.6 % p = 0.000) and dyslipidemia (66.7 % vs 36.3 p = 0.009) were significantly associated with Venous stenosis/occlusion. Among procedure-related factors, larger total lead diameter (3.88 ± 1.09 vs. 3.50 ± 1.03 mm p = 0.03) and implantation of biventricular devices (p = 0.0037) seem to be significantly associated with venous obstruction. In logistic regression analysis, hypertension (p = 0.018), total lead diameter (p = 0.024), and use of CRT-P/CRTD/ICD (p = 0.03) remained significant predictors of severe venous stenosis. Conclusions Our study demonstrates venous obstruction in 40 % of cardiac implantable electronic device patients at one-year follow-up. Most patients have mild to moderate stenosis, and almost all are asymptomatic. Increasing age, hypertension, diabetes, dyslipidemia, larger total lead diameter, and implantation of biventricular devices are significantly associated with venous obstruction.
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Affiliation(s)
- Qayoom Yousuf
- Department of Cardiology, SKIMS Soura, Srinagar, J&K,
India
| | - Aamir Rashid
- Department of Cardiology, SKIMS Soura, Srinagar, J&K,
India
| | - Imran Hafeez
- Department of Cardiology, SKIMS Soura, Srinagar, J&K,
India
| | - Hilal Rather
- Department of Cardiology, SKIMS Soura, Srinagar, J&K,
India
| | - Ishrath Syed
- Department of Medicine, SKIMS Soura, Srinagar, J&K,
India
| | - Altaf H. Mir
- Department of Anesthesiology, SKIMS Soura, Srinagar, J&K,
India
| | - Suheel A. Mir
- Department of Cardiology, SKIMS Soura, Srinagar, J&K,
India
| | - Ajaz Lone
- Department of Cardiology, SKIMS Soura, Srinagar, J&K,
India
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16
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Wu PJ, Chen HC, Fang YN, Chong SZ, Chen YL, Chen MC. Device-related infection and mortality in patients with chronic kidney disease receiving cardiac implantable electronic devices: a propensity score-matched cohort study. BMC Infect Dis 2023; 23:787. [PMID: 37957553 PMCID: PMC10644567 DOI: 10.1186/s12879-023-08773-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) was reported to be a risk factor of cardiac implantable electronic device (CIED) infection. The application of bundled skin antiseptic preparation before CIED implantation decreased the risk of CIED infection, even in patients undergoing complex procedures. However, the effect of bundled skin antiseptic preparation to prevent CIED infection in patients with CKD was not tested. METHODS Between July 2012 and December 2019, 1668 patients receiving CIEDs comprised this retrospective cohort study and were categorized into two groups by the diagnosis of CKD: group with CKD (n = 750, 45%) and group without CKD (n = 918, 55%). The primary outcome was clinical CIED infection, including major and minor infection, and the secondary outcomes were cardiovascular mortality and all-cause mortality. Propensity score matching (PSM) was applied to reduce selection bias between the study groups. RESULTS During a 4-year follow-up period, 30 patients (1.8%) had a CIED infection. After PSM, the incidence of CIED infection was similar between the patients with CKD and without CKD (1.0% vs. 1.8%). The incidences of cardiovascular mortality and all-cause mortality were higher in patients with CKD compared to patients without CKD (6.5% vs. 3.0%, P = 0.009; 22.8% vs. 11.8%, P < 0.001, respectively). CONCLUSION The incidence of clinical CIED infection in patients with CKD was as lower as in patients without CKD after applying the bundled skin antiseptic preparation strategy. The cumulative incidences of cardiovascular mortality and all-cause mortality were significantly higher in the matched CIED recipients with CKD compared to the matched cohort without CKD.
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Affiliation(s)
- Po-Jui Wu
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, 123 Ta Pei Road, Niao Sung District, Kaohsiung City, 83301, Taiwan
| | - Huang-Chung Chen
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, 123 Ta Pei Road, Niao Sung District, Kaohsiung City, 83301, Taiwan
| | - Yen-Nan Fang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, 123 Ta Pei Road, Niao Sung District, Kaohsiung City, 83301, Taiwan
| | - Shaur-Zheng Chong
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, 123 Ta Pei Road, Niao Sung District, Kaohsiung City, 83301, Taiwan
| | - Yung-Lung Chen
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, 123 Ta Pei Road, Niao Sung District, Kaohsiung City, 83301, Taiwan
| | - Mien-Cheng Chen
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, 123 Ta Pei Road, Niao Sung District, Kaohsiung City, 83301, Taiwan.
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Rinaldi CA, Diemberger I, Biffi M, Gao YR, Sizto E, Jin N, Epstein LM, Defaye P. Safety and success of transvenous lead extraction using excimer laser sheaths: a meta-analysis of over 1700 patients. Europace 2023; 25:euad298. [PMID: 37757839 PMCID: PMC10655058 DOI: 10.1093/europace/euad298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/24/2023] [Indexed: 09/29/2023] Open
Abstract
AIMS While numerous studies have demonstrated favourable safety and efficacy of the excimer laser sheath for transvenous lead extraction (TLE) in smaller cohorts, comprehensive large-scale investigations with contemporary data remain scarce. This study aims to evaluate the safety and performance of laser-assisted TLE through a meta-analysis of contemporary data. METHODS AND RESULTS A systematic literature search was conducted to identify articles that assessed the safety and performance of the spectranetics laser sheath (SLS) II and GlideLight Excimer laser sheaths in TLE procedures between 1 April 2016 and 31 March 2021. Safety outcomes included procedure-related death and major/minor complications. Performance outcomes included procedural and clinical success rates. A random-effects, inverse-variance-weighting meta-analysis was performed to obtain the weighted average of the evaluated outcomes. In total, 17 articles were identified and evaluated, including 1729 patients with 2887 leads. Each patient, on average, had 2.3 ± 0.3 leads with a dwell time of 7.9 ± 3.0 years. The TLE procedural successes rate was 96.8% [1440/1505; 95% CI: (94.9-98.2%)] per patient and 96.3% [1447/1501; 95% CI: (94.8-97.4%)] per lead, and the clinical success rate per patient was 98.3% [989/1010, 95% CI: (97.4-99.0%)]. The procedure-related death rate was 0.08% [7/1729, 95% CI: (0.00%, 0.34%)], with major and minor complication rates of 1.9% [41/1729; 95% CI: (1.2-2.8%)] and 1.9% [58/1729; 95% CI: (0.8-3.6%)], respectively. CONCLUSION This meta-analysis demonstrated that excimer laser sheath-assisted TLE has high success and low procedural mortality rates. It provides clinicians with a reliable and valuable resource for extracting indwelling cardiac leads which require advanced extraction techniques.
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Affiliation(s)
- Christopher Aldo Rinaldi
- Cardiovascular Department, Guy's & St Thomas' NHS Foundation Trust, Lambeth Palace Road, London SE1 7EH, UK
- Heart Vascular and Thoracic Institute, Cleveland Clinic London, 33 Grosvenor Pl, London SW1X 7HY, UK
| | - Igor Diemberger
- Department of Medical and Surgical Sciences, University of Bologna, Policlinico S.Orsola-Malpighi, via Massarenti 9, 40138 Bologna, Italy
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S Orsola-Malpighi, via Massarenti 9, 40138 Bologna, Italy
| | - Mauro Biffi
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S Orsola-Malpighi, via Massarenti 9, 40138 Bologna, Italy
| | - Yu-Rong Gao
- Image Guided Therapy, Philips North America LLC, Cambridge, MA, USA
| | - Enoch Sizto
- Image Guided Therapy, Philips North America LLC, Cambridge, MA, USA
| | - Nancy Jin
- Image Guided Therapy, Philips North America LLC, Cambridge, MA, USA
| | | | - Pascal Defaye
- Department of Cardiology, University Hospital of Grenoble Alpes, Grenoble, France
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18
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Abdelazeem A, Ahmed A, Curnis A, Arabia G, Cerini M, Aboelhassan M, Salghetti F, Milidoni A, Nawar M, Magdy G. Transvenous lead extraction, factors affecting procedural difficulty. Acta Cardiol 2023; 78:992-999. [PMID: 37318077 DOI: 10.1080/00015385.2023.2222986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/19/2023] [Accepted: 05/31/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND A complex transvenous lead extraction (TLE) procedure could be associated with lower success and higher complication rates in inexperienced hands. In this study, we aim to assess the factors that determine procedural difficulty in TLE. METHODS We retrospectively studied 200 consecutive patients undergoing TLE in a single referral centre from June 2020 to December 2021. Lead extraction difficulty was assessed by the success of simple manual traction with or without a locking stylet, the need for advanced extraction tools and the number of tools required to extract the lead. Logistic and linear regression analyses were used to determine the factors independently affecting these 3 parameters. RESULTS 363 leads were extracted from 200 patients (79% males, mean age 66.85 years). The indication for TLE was device-related infection in 51.5%. Multivariate analysis revealed the lead indwelling time to be the only factor affecting the 3 parameters of difficulty. Passive fixation leads and dual coil leads increased procedural difficulty by affecting 2 parameters each. Factors that affected one parameter included infected leads, coronary sinus leads, older age of the patient and a history of valvular heart disease, all associated with a simpler procedure. Right ventricular leads were associated with a more complex one. CONCLUSION The most important factor that increased TLE procedural difficulty was a longer lead indwelling time, followed by passive fixation and dual-coil leads. Other contributing factors were the presence of infection, coronary sinus leads, older patients, a history of valvular heart disease and right ventricular leads.
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Affiliation(s)
- Ahmed Abdelazeem
- Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ashraf Ahmed
- Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Antonio Curnis
- Cardio-Thoracic Department, Electrophysiology and Electrostimulation Laboratory, University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | - Gianmarco Arabia
- Cardio-Thoracic Department, Electrophysiology and Electrostimulation Laboratory, University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | - Manuel Cerini
- Cardio-Thoracic Department, Electrophysiology and Electrostimulation Laboratory, University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | - Mohamed Aboelhassan
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Assiut University, Assiut, Egypt
| | - Francesca Salghetti
- Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Mostafa Nawar
- Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Gehan Magdy
- Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Petit C, Escande A, Sarrade T, Vaugier L, Kirova Y, Tallet A. Radiation therapy in the thoracic region: Radio-induced cardiovascular disease, cardiac delineation and sparing, cardiac dose constraints, and cardiac implantable electronic devices. Cancer Radiother 2023; 27:588-598. [PMID: 37648559 DOI: 10.1016/j.canrad.2023.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 09/01/2023]
Abstract
Radiation therapy in the thoracic region may deliver incidental ionizing radiation to the surrounding healthy structures, including the heart. Radio-induced heart toxicity has long been a concern in breast cancer and Hodgkin's lymphoma and was deemed a long-term event. However, recent data highlight the need to limit the dose to the heart in less favorable thoracic cancers too, such as lung and esophageal cancers in which incidental irradiation led to increased mortality. This article will summarize available cardiac dose constraints in various clinical settings and the types of radio-induced cardiovascular diseases encountered as well as delineation of cardiac subheadings and management of cardiac devices. Although still not completely deciphered, heart dose constraints remain intensively investigated and the mean dose to the heart is no longer the only dosimetric parameter to consider since the left anterior descending artery as well as the left ventricle should also be part of dosimetry constraints.
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Affiliation(s)
- C Petit
- Radiation Oncology Department, institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13273 Marseille cedex 09, France
| | - A Escande
- Service de radiothérapie, centre Léonard-de-Vinci, Dechy, France; UMR 9189, laboratoire Cristal, université de Lille, Villeneuve-d'Ascq, France
| | - T Sarrade
- Department of Radiation Oncology, hôpital Tenon, Sorbonne université, 75020 Paris, France
| | - L Vaugier
- Department of Radiation Oncology, institut de cancérologie de l'Ouest, Saint-Herblain, France
| | - Y Kirova
- Department of Radiation Oncology, institut Curie, Paris, France
| | - A Tallet
- Radiation Oncology Department, institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13273 Marseille cedex 09, France; UMR 1068, CRCM Inserm, Marseille, France.
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Akhtar Z, Sohal M, Gallagher MM. Comment on 'Leadless Pacemakers: Current Achievements and Future Perspectives'. Eur Cardiol 2023; 18:e50. [PMID: 37655135 PMCID: PMC10466268 DOI: 10.15420/ecr.2022.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 09/02/2023] Open
Affiliation(s)
- Zaki Akhtar
- Cardiology Academic Group, St George's University Hospital London, UK
| | - Manav Sohal
- Cardiology Academic Group, St George's University Hospital London, UK
| | - Mark M Gallagher
- Cardiology Academic Group, St George's University Hospital London, UK
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21
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Vázquez-Calvo S, Roca-Luque I, Althoff TF. Management of Ventricular Arrhythmias in Heart Failure. Curr Heart Fail Rep 2023; 20:237-253. [PMID: 37227669 DOI: 10.1007/s11897-023-00608-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE OF REVIEW Despite substantial progress in medical and device-based heart failure (HF) therapy, ventricular arrhythmias (VA) and sudden cardiac death (SCD) remain a major challenge. Here we review contemporary management of VA in the context of HF with one particular focus on recent advances in imaging and catheter ablation. RECENT FINDINGS Besides limited efficacy of antiarrhythmic drugs (AADs), their potentially life-threatening side effects are increasingly acknowledged. On the other hand, with tremendous advances in catheter technology, electroanatomical mapping, imaging, and understanding of arrhythmia mechanisms, catheter ablation has evolved into a safe, efficacious therapy. In fact, recent randomized trials support early catheter ablation, demonstrating superiority over AAD. Importantly, CMR imaging with gadolinium contrast has emerged as a central tool for the management of VA complicating HF: CMR is not only essential for an accurate diagnosis of the underlying entity and subsequent treatment decisions, but also improves risk stratification for SCD prevention and patient selection for ICD therapy. Finally, 3-dimensional characterization of arrhythmogenic substrate by CMR and imaging-guided ablation approaches substantially enhance procedural safety and efficacy. VA management in HF patients is highly complex and should be addressed in a multidisciplinary approach, preferably at specialized centers. While recent evidence supports early catheter ablation of VA, an impact on mortality remains to be demonstrated. Moreover, risk stratification for ICD therapy may have to be reconsidered, taking into account imaging, genetic testing, and other parameters beyond left ventricular function.
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Affiliation(s)
- Sara Vázquez-Calvo
- Arrhythmia Section, Cardiovascular Institute (ICCV), CLÍNIC Barcelona University Hospital, C/Villarroel N° 170, 08036, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Ivo Roca-Luque
- Arrhythmia Section, Cardiovascular Institute (ICCV), CLÍNIC Barcelona University Hospital, C/Villarroel N° 170, 08036, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Till F Althoff
- Arrhythmia Section, Cardiovascular Institute (ICCV), CLÍNIC Barcelona University Hospital, C/Villarroel N° 170, 08036, Barcelona, Catalonia, Spain.
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.
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Thompson L, Alkhayru A, Ahmad U, Hughes J, Ebrahimi A, Degheim G, Jabbar AA. Novel Use of the Penumbra CAT 12 Lightning Aspiration System for the Treatment of a Complex Thrombus. Cardiovasc Revasc Med 2023; 53S:S271-S275. [PMID: 35725691 DOI: 10.1016/j.carrev.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 11/24/2022]
Abstract
Debulking procedures using aspiration devices have been previously described in the literature to treat vegetations or thrombi on intracardiac structures such as the tricuspid valve. Transcatheter therapy has also been shown to be an effective alternative to surgical treatment for managing high risk or non-surgical patients. Furthermore, aspiration procedures can help identify the unique etiologies of intracardiac masses which can greatly impact differing treatment modalities. Utilization of aspiration devices combined with blood-loss limiting technologies have led to an increased interest in using aspiration systems to address a wider array of clinical situations that can occur. Herein we describe our experience in using the Penumbra CAT 12 Lightning Aspiration System in addressing and treating a mobile mass attached to the lead of an implantable cardiac device.
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Affiliation(s)
- Luke Thompson
- HCA Healthcare GME at Northside Hospital, USF Morsani College of Medicine, The Heart Institute, St. Petersburg, FL, United States of America
| | - Ali Alkhayru
- HCA Healthcare GME at Northside Hospital, USF Morsani College of Medicine, The Heart Institute, St. Petersburg, FL, United States of America
| | - Usman Ahmad
- HCA Healthcare GME at Northside Hospital, USF Morsani College of Medicine, The Heart Institute, St. Petersburg, FL, United States of America
| | - John Hughes
- HCA Healthcare GME at Northside Hospital, USF Morsani College of Medicine, The Heart Institute, St. Petersburg, FL, United States of America
| | - Ali Ebrahimi
- HCA Healthcare GME at Northside Hospital, USF Morsani College of Medicine, The Heart Institute, St. Petersburg, FL, United States of America; University of Alabama at Birmingham, Department of Cardiovascular Disease, Birmingham, AL, United States of America
| | - George Degheim
- HCA Healthcare GME at Northside Hospital, USF Morsani College of Medicine, The Heart Institute, St. Petersburg, FL, United States of America
| | - Ali Abdul Jabbar
- HCA Healthcare GME at Northside Hospital, USF Morsani College of Medicine, The Heart Institute, St. Petersburg, FL, United States of America.
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Roberts H, Matheson K, Sapp J, Gardner M, Gray C, AbdelWahab A, Lee D, MacIntyre C, Parkash R. Prevalence and management of electrical lead abnormalities in cardiac implantable electronic device leads. Heart Rhythm O2 2023; 4:417-426. [PMID: 37520017 PMCID: PMC10373148 DOI: 10.1016/j.hroo.2023.05.002] [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] [Indexed: 08/01/2023] Open
Abstract
Background Electrical lead abnormalities (ELAs) can result in device malfunction, leading to significant morbidity in patients with cardiac implantable electronic devices (CIEDs). Objective We sought to determine the prevalence and management of ELAs in patients with CIEDs. Methods This was a retrospective cohort study of patients implanted with a CIED between 2012 and 2019 at a tertiary care center. The primary outcome was ELA defined as increased capture threshold (≥2× implantation value), decreased sensing (≤0.5 implantation value), change in impedance (>50% over 3 months), or nonphysiologic potentials. A secondary outcome of device clinic utilization was also collected. Results There were 2996 unique patients (35% female) included with 4600 leads (57% Abbott, 43% Medtronic). ELAs were observed in 135 (3%) leads, including 124 (92%) Abbott and 10 (7%) Medtronic leads (hazard ratio 9.25, P < .001). Mean follow-up was 4.5 ± 2.2 years. ELAs were associated smaller lead French size, atrial location, and Abbott leads. Lead revision was required in 28% of cases. Patients with lead abnormalities had 38% more in-clinic visits per patient year of follow-up compared with those without (P < .001). Conclusion ELAs were more frequent in certain models, which increased rates of revision and follow-up. Identification of factors that mitigate these abnormalities to improve lead performance are required to improve care for these devices and provide efficient healthcare.
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Affiliation(s)
- Hilary Roberts
- Department of Medicine, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Kara Matheson
- Research Methods Unit, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - John Sapp
- Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Martin Gardner
- Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Chris Gray
- Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Amir AbdelWahab
- Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - David Lee
- Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | | | - Ratika Parkash
- Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
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Banz M, Memisevic N, Diab M, Malouhi A, Hagel S. [Recurrent Serratia marcescens bacteremia: seek and you shall find]. Inn Med (Heidelb) 2023:10.1007/s00108-023-01508-y. [PMID: 37138097 DOI: 10.1007/s00108-023-01508-y] [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] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 05/05/2023]
Abstract
A 79-year-old patient was hospitalized due to recurrent Serratia marcescens bacteremia. An implantable cardioverter-defibrillator (ICD) electrode infection with septic pulmonary emboli and vertebral osteomyelitis were diagnosed. In addition to antibiotic therapy, the ICD system was completely extracted. In patients with cardiac implantable electronic devices (CIED) and bacteremia that cannot be adequately explained or recurs, regardless of the pathogen involved, a CIED-associated infection always needs to be ruled out.
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Affiliation(s)
- Micha Banz
- Institut für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Am Klinikum 1, 07747, Jena, Deutschland.
| | - Nedim Memisevic
- Klinik für Innere Medizin I, Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Jena, Deutschland
| | - Mahmoud Diab
- Klinik für Herz- und Thoraxchirurgie, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Jena, Deutschland
| | - Amer Malouhi
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Jena, Deutschland
| | - Stefan Hagel
- Institut für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Am Klinikum 1, 07747, Jena, Deutschland
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25
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Barreiro-Pérez M, Cabeza B, Calvo D, Reyes-Juárez JL, Datino T, Vañó Galván E, Maceira González AM, Delgado Sánchez-Gracián C, Prat-González S, Perea RJ, Bastarrika G, Sánchez M, Jiménez-Borreguero LJ, Fernández-Golfín Lobán C, Rodríguez Palomares JF, Tolosana JM, Hidalgo Pérez JA, Pérez-David E, Bertomeu-González V, Cuéllar H. Magnetic resonance in patients with cardiovascular devices. SEC-GT CRMTC/SEC-Heart Rhythm Association/SERAM/SEICAT consensus document. Radiologia (Engl Ed) 2023; 65:269-284. [PMID: 37268369 DOI: 10.1016/j.rxeng.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/21/2022] [Indexed: 06/04/2023]
Abstract
Magnetic resonance has become a first-line imaging modality in various clinical scenarios. The number of patients with different cardiovascular devices, including cardiac implantable electronic devices, has increased exponentially. Although there have been reports of risks associated with exposure to magnetic resonance in these patients, the clinical evidence now supports the safety of performing these studies under specific conditions and following recommendations to minimize possible risks. This document was written by the Working Group on Cardiac Magnetic Resonance Imaging and Cardiac Computed Tomography of the Spanish Society of Cardiology (SEC-GT CRMTC), the Heart Rhythm Association of the Spanish Society of Cardiology (SEC-Heart Rhythm Association), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Cardiothoracic Imaging (SEICAT). The document reviews the clinical evidence available in this field and establishes a series of recommendations so that patients with cardiovascular devices can safely access this diagnostic tool.
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Affiliation(s)
- M Barreiro-Pérez
- Imagen Cardiaca, Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain.
| | - B Cabeza
- Servicio de Diagnóstico por Imagen, Hospital Clínico San Carlos, Madrid, Spain; Servicio de Tomografía Computarizada y Resonancia Magnética, Hospital Nuestra Señora del Rosario, Madrid, Spain
| | - D Calvo
- Unidad de Arritmias, Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain; Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - J L Reyes-Juárez
- Área de Imagen Cardiovascular, Servicio de Radiodiagnóstico, Instituto de Diagnóstico por la Imagen (IDI), Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - T Datino
- Unidad de Arritmias, Departamento de Cardiología, Hospital Universitario Quirónsalud Madrid, Madrid, Spain; Unidad de Arritmias, Servicio de Cardiología, Complejo Hospitalario Ruber Juan Bravo, Madrid, Spain; Departamento de Medicina, Universidad Europea de Madrid, Madrid, Spain
| | - E Vañó Galván
- Servicio de Tomografía Computarizada y Resonancia Magnética, Hospital Nuestra Señora del Rosario, Madrid, Spain
| | - A M Maceira González
- Unidad Cardiovascular, Grupo Biomético Ascires, Valencia, Spain; Departamento de Medicina, Facultad de Ciencias de la Salud, Universidad CEU Cardenal Herrera, Valencia, Spain
| | | | - S Prat-González
- Servicio de Cardiología, Instituto Clínic Cardiovascular (ICCV), Hospital Clínic, Barcelona, Spain
| | - R J Perea
- Servicio de Radiología, Centro de Diagnóstico por la Imagen (CDI), Hospital Clínic, Barcelona, Spain
| | - G Bastarrika
- Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - M Sánchez
- Servicio de Radiología, Centro de Diagnóstico por la Imagen (CDI), Hospital Clínic, Barcelona, Spain
| | | | - C Fernández-Golfín Lobán
- Unidad de Imagen Cardiaca, Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - J F Rodríguez Palomares
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - J M Tolosana
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - J A Hidalgo Pérez
- Servicio de Radiología, Hospital Universitario de la Santa Creu i Sant Pau, Barcelona, Spain
| | - E Pérez-David
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - V Bertomeu-González
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - H Cuéllar
- Área de Imagen Cardiovascular, Servicio de Radiodiagnóstico, Instituto de Diagnóstico por la Imagen (IDI), Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Abstract
Purpose of Review Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) is an important part of patient follow-up. The increasing number of patients with CIEDs and the recent pandemic pose several challenges for already limited device clinic resources. This review focuses on recent evolutions in RM and identifies future needs to improve RM. Recent Findings RM has been associated with multiple clinical benefits, including improved survival, early detection of actionable events, reduction in inappropriate shocks, longer battery lives, and more efficient healthcare utilization. The survival benefit was driven by studies using alert-based continuous RM with daily transmissions and fast reaction times. Patients report a high satisfaction rate without significant differences in quality of life between RM and in-office follow-up.The increasing workload, due to the increasing number of CIEDs implanted with daily remote transmissions, results in several challenges for the future of RM. RM requires appropriate reimbursement for RM device clinics to optimize patient/staff ratios, including sufficient non-clinical and administrative support. Universal alert programming and data processing may minimize inter-manufacturer differences, improve the signal-to-noise ratio, and allow the development of standard operating protocols and workflows. In the future, programming by remote control and true remote programming may further improve remote CIED management, patient quality of life, and device clinic workflows. Summary RM should be considered standard of care in management of patients with CIEDs. The clinical benefits of RM can be maximized by an alert-based continuous RM model. Adapted healthcare policies are required to keep RM manageable for the future.
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Affiliation(s)
- Bert Vandenberk
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Satish R. Raj
- Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, GAC70 HRIC Building, 3280 Hospital Dr NW, Calgary, AB T2N 4Z6 Canada
- Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN USA
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Matteucci A, Bonanni M, Massaro G, Chiricolo G, Stifano G, Forleo GB, Biondi-Zoccai G, Sangiorgi G. Treatment with gentamicin-impregnated collagen sponges in reducing infection of implantable cardiac devices: 10-year analysis with propensity score matching. Rev Port Cardiol 2023:S0870-2551(23)00220-2. [PMID: 37085085 DOI: 10.1016/j.repc.2023.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/01/2023] [Indexed: 04/23/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES The incidence of device infection has increased over time and is associated with increased mortality in patients with cardiac implantable electronic devices (CIEDs). Gentamicin-impregnated collagen sponges (GICSs) are useful in preventing surgical site infection (SSI) in cardiac surgery. Nevertheless, to date, there is no evidence concerning their use in CIED procedures. Our study aims to determine the effectiveness of treatment with GICSs in preventing CIED infection. METHODS A total of 2986 adult patients who received CIEDs between 2010 and 2020 were included. Before device implantation, all patients received routine periprocedural systemic antibiotic prophylaxis. The study endpoints were the CIED infection rate at one year and the effectiveness of the use of GICSs in reducing CIED infection. RESULTS Among 1524 pacemaker, 942 ICD and 520 CRT implantations, CIED infection occurred in 36 patients (1.2%). Early reintervention (OR 9 [95% CI 3.180-25.837], p<0.001), pocket hematoma (OR 11 [95% CI 4.195-28.961], p<0.001), diabetes (OR 2.9 [95% CI 1.465-5.799], p=0.002) and prolonged procedural time (OR 1.02 [95% CI 1.008-1.034], p=0.001) were independent risk factors for CIED infection. Treatment with GICSs reduced CIED infections significantly ([95% CI -0.031 to -0.001], p<0.001). CONCLUSIONS The use of GICSs may help in reducing infections associated with CIED implantation.
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Affiliation(s)
- Andrea Matteucci
- Division of Cardiology, University Hospital "Tor Vergata", Rome, Italy; Division of Cardiology, San Filippo Neri Hospital, Via Martinotti, 20, Rome, Italy.
| | - Michela Bonanni
- Division of Cardiology, University Hospital "Tor Vergata", Rome, Italy
| | - Gianluca Massaro
- Division of Cardiology, University Hospital "Tor Vergata", Rome, Italy
| | - Gaetano Chiricolo
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Giuseppe Stifano
- Division of Cardiology, University Hospital "Tor Vergata", Rome, Italy; Division of Cardiology, San Filippo Neri Hospital, Via Martinotti, 20, Rome, Italy; Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy; Arrhythmology, Luigi Sacco Hospital, Milan, Italy; Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy; Mediterranea Cardiocentro, Napoli, Italy
| | | | - Giuseppe Biondi-Zoccai
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy; Mediterranea Cardiocentro, Napoli, Italy
| | - Giuseppe Sangiorgi
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
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28
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Barreiro-Pérez M, Cabeza B, Calvo D, Reyes-Juárez JL, Datino T, Vañó Galván E, Maceira González AM, Delgado Sánchez-Gracián C, Prat-González S, Perea RJ, Bastarrika G, Sánchez M, Jiménez-Borreguero LJ, Fernández-Golfín Lobán C, Rodríguez Palomares JF, Tolosana JM, Hidalgo Pérez JA, Pérez-David E, Bertomeu-González V, Cuéllar H. Magnetic resonance in patients with cardiovascular devices. SEC-GT CRMTC/SEC-Heart Rhythm Association/SERAM/SEICAT consensus document. Rev Esp Cardiol (Engl Ed) 2023; 76:183-196. [PMID: 36539182 DOI: 10.1016/j.rec.2022.12.002] [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] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/21/2022] [Indexed: 12/23/2022]
Abstract
Magnetic resonance has become a first-line imaging modality in various clinical scenarios. The number of patients with different cardiovascular devices, including cardiac implantable electronic devices, has increased exponentially. Although there have been reports of risks associated with exposure to magnetic resonance in these patients, the clinical evidence now supports the safety of performing these studies under specific conditions and following recommendations to minimize possible risks. This document was written by the Working Group on Cardiac Magnetic Resonance Imaging and Cardiac Computed Tomography of the Spanish Society of Cardiology (SEC-GT CRMTC), the Heart Rhythm Association of the Spanish Society of Cardiology (SEC-Heart Rhythm Association), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Cardiothoracic Imaging (SEICAT). The document reviews the clinical evidence available in this field and establishes a series of recommendations so that patients with cardiovascular devices can safely access this diagnostic tool.
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Affiliation(s)
- Manuel Barreiro-Pérez
- Imagen Cardiaca, Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain.
| | - Beatriz Cabeza
- Servicio de Diagnóstico por Imagen, Hospital Clínico San Carlos, Madrid, Spain; Servicio de Tomografía Computarizada y Resonancia Magnética, Hospital Nuestra Señora del Rosario, Madrid, Spain
| | - David Calvo
- Unidad de Arritmias, Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain; Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - José Luis Reyes-Juárez
- Área de Imagen Cardiovascular, Servicio de Radiodiagnóstico, Instituto de Diagnóstico por la Imagen (IDI), Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Tomás Datino
- Unidad de Arritmias, Departamento de Cardiología, Hospital Universitario Quirónsalud Madrid, Madrid, Spain; Unidad de Arritmias, Servicio de Cardiología, Complejo Hospitalario Ruber Juan Bravo, Madrid, Spain; Departamento de Medicina, Universidad Europea de Madrid, Madrid, Spain
| | - Eliseo Vañó Galván
- Servicio de Tomografía Computarizada y Resonancia Magnética, Hospital Nuestra Señora del Rosario, Madrid, Spain
| | - Alicia M Maceira González
- Unidad Cardiovascular, Grupo Biomético Ascires, Valencia, Spain; Departamento de Medicina, Facultad de Ciencias de la Salud, Universidad CEU Cardenal Herrera, Valencia, Spain
| | | | - Susanna Prat-González
- Servicio de Cardiología, Instituto Clínic Cardiovascular (ICCV), Hospital Clínic, Barcelona, Spain
| | - Rosario J Perea
- Servicio de Radiología, Centro de Diagnóstico por la Imagen (CDI), Hospital Clínic, Barcelona, Spain
| | - Gorka Bastarrika
- Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Marcelo Sánchez
- Servicio de Radiología, Centro de Diagnóstico por la Imagen (CDI), Hospital Clínic, Barcelona, Spain
| | | | - Covadonga Fernández-Golfín Lobán
- Unidad de Imagen Cardiaca, Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | | | - José F Rodríguez Palomares
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - José María Tolosana
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - Esther Pérez-David
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - Vicente Bertomeu-González
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - Hug Cuéllar
- Área de Imagen Cardiovascular, Servicio de Radiodiagnóstico, Instituto de Diagnóstico por la Imagen (IDI), Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Matsubara H. Neutron dose from a 6-MV X-ray beam in radiotherapy. Radiol Phys Technol 2023; 16:186-194. [PMID: 36780121 DOI: 10.1007/s12194-023-00705-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/14/2023]
Abstract
Although a 6-MV X-ray beam is employed clinically as a non-neutron-producing beam, no studies have reported how few neutrons are produced from a 6-MV beam. This study aimed to theoretically deduce the neutron dose from a 6-MV beam using Monte Carlo simulations for the notification of safety and risk in radiotherapy. Nuclei from a nuclear database with neutron separation energies below 6 MeV were surveyed, suggesting that the certain content of 2H in the human body may result in some contribution. Thus, Monte Carlo calculation considering 2H in a phantom was performed. The calculation suggested that the distribution of the neutron dose from a 6-MV beam consisted of two components: one had neutrons from 2H concentrated within an irradiation field, and the other had those due to other elements such as 183W spreading from a gantry head to a treatment room. Although uncertainty owing to the normalization factor of the Monte Carlo calculations was a factor of three, the neutron doses at distances of 0 and 50 cm from an irradiation field were calculated as 27 and 1.5 nSv/MU, respectively, under intensity-modulated radiotherapy (IMRT) or volumetric modulated arc therapy (VMAT). The calculations suggest that neutrons produced by a 6-MV beam are approximately 70 and 20 times safer than those by a 10-MV beam in the case of IMRT/VMAT and total body irradiation, respectively. Thus, this study theoretically reported the approximate number of neutrons delivered by a 6-MV beam for the first time.
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Affiliation(s)
- Hiroaki Matsubara
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan. .,Faculty of Radiological Technology, Fujita Health University, Aichi, 470-1192, Japan.
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30
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Pitman BM, Ariyaratnam J, Williams K, Evans M, Reid-Smith N, Wilson L, Teo K, Young GD, Roberts-Thomson KC, Wong CX, Sanders P, Lau DH. The Burden of Cardiac Implantable Electronic Device Checks in the Peri-MRI Setting: The CHECK-MRI Study. Heart Lung Circ 2023; 32:252-260. [PMID: 36443175 DOI: 10.1016/j.hlc.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/01/2022] [Accepted: 10/07/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Most modern cardiac implantable electronic device (CIED) systems are now compatible with magnetic resonance imaging (MRI) scans. The requirement for both pre- and post-MRI CIED checks imposes significant workload to the cardiac electrophysiology service. Here, we sought to determine the burden of CIED checks associated with MRI scans. METHODS We identified all CIED checks performed peri-MRI scans at our institution over a 3-year period between 1 July 2017 to 30 June 2020, comprising three separate financial years (FY). Device check reports, MRI scan reports and clinical summaries were collated. The workload burden was determined by assessing the occasions and duration of service. Analysis was performed to determine cost burden/projections for this service and identify factors contributing to the workload. RESULTS A total of 739 CIED checks were performed in the peri-MRI scan setting (370 pre- and 369 post-MRI scan), including 5% (n=39) that were performed outside of routine hours (weekday <8 am or >5 pm, and weekends). MRIs were performed for 295 patients (75±13 years old, 64% male) with a CIED (88% permanent pacemaker, and 12% high voltage device), including 49 who had more than one MRI scan. The proportion of total MRI scans for patients with a CIED in-situ increased each FY (from 0.5% of all MRIs in FY1, to 0.9% in FY2, to 1.0% in FY3). The weekly workload increased (R2=0.2, p<0.001), but with week-to-week variability due to ad hoc scheduling (209 days with only one MRI vs 78 days with ≥2 MRIs for CIED patients). The projected annual cost of this service will increase to AUD$161,695 in 10 years for an estimated annual 546 MRI scans for CIED patients. CONCLUSIONS There is an increasing workload burden and expense associated with CIED checks in the peri-MRI setting. Appropriate budgeting, staff allocation and standardisation of automated CIED pre-programming features among manufacturers are urgently needed.
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Affiliation(s)
- Bradley M Pitman
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia. http://www.twitter.com/pitmabm
| | - Jonathan Ariyaratnam
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Kerry Williams
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Michelle Evans
- Southern Area Local Health Network, Adelaide, SA, Australia
| | - Nicole Reid-Smith
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Lauren Wilson
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Karen Teo
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Glenn D Young
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Kurt C Roberts-Thomson
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Christopher X Wong
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia.
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31
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Xu B, Wang Y, Tse G, Chen J, Li G, Korantzopoulos P, Liu T. Radiotherapy-induced malfunctions of cardiac implantable electronic devices: A meta-analysis. Heart Rhythm 2023; 20:689-698. [PMID: 36708909 DOI: 10.1016/j.hrthm.2023.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/18/2022] [Accepted: 01/20/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Radiation therapy (RT) may pose acute and long-term risks for patients with cardiac implantable electronic devices (CIEDs), including pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs). OBJECTIVE We conducted a systematic review and meta-analysis to examine the association between RT and PM/ICD malfunctions in patients with cancer. METHODS We searched the literature using the PubMed, the Cochrane Library the Web of Science, and Embase for relative publications until April 2022. Of the 550 initially identified studies, 17 retrospective observational studies including 2454 patients were finally analyzed. RESULTS The meta-analysis showed that RT was associated with an increased risk of ICD malfunctions (odds ratio [OR] 2.75; 95% confidence interval [CI] 1.74-4.33). Five studies were included in the subgroup analysis regarding photon beam energy, showing that radiation-induced CIED failure was more likely to occur in ICDs when beam energy was ≥10 MV (OR 5.28; 95% CI 2.14-13.03). Neutron-generating RT significantly increased the risk of CIED malfunctions (OR 3.97; 95% CI 1.70-9.26), especially the risk of reset (OR 5.79; 95% CI 2.37-14.12; P = .0001). We did not find significant differences in the risk of CIED failure between chest RT and other RT sites (OR 1.09; 95% CI 0.63-1.88). CONCLUSION Our meta-analysis suggests that ICDs are more likely to be affected by RT than PMs. These adverse events, especially reset, in patients with cancer were associated with neutron-generating RT and beam energy ≥10 MV. Given the increasing requirement for RT in several patients with cancer as well as the increasing implantation rates of CIEDs, a better risk stratification is needed in this setting.
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Affiliation(s)
- Beizheng Xu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yueying Wang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China; Epidemiology Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration, Hong Kong; Kent and Medway Medical School, Canterbury, Kent, United Kingdom; School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Jiayi Chen
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | | | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.
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Theriault Lauzier P, Gomes DG, Weng W, Sadek MM, Zakutney T, Bernier ML, Birnie D. Detection and identification of cardiac implanted electronic devices in a large data set of chest radiographs using semi-supervised artificial intelligence methods. Heart Rhythm 2023; 20:642-643. [PMID: 36621589 DOI: 10.1016/j.hrthm.2022.12.038] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/07/2023]
Affiliation(s)
| | - Daniel Garcia Gomes
- Department of Electrophysiology, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | - Willy Weng
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Mouhannad M Sadek
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Timothy Zakutney
- Department of Systems and Computer Engineering, Carleton University, Ottawa, Ontario, Canada
| | - Martin L Bernier
- Division of Cardiology, McGill University Health Centre, Montreal, Québec, Canada
| | - David Birnie
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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Lorenzo Ruiz I, Arrizabalaga Arostegi H, Gaztañaga Arantzamendi L. Knowledge and preferences of postexplant management and opinions on the reuse of cardiac implantable electronic devices. Heart Rhythm 2023; 20:644-645. [PMID: 36610525 DOI: 10.1016/j.hrthm.2022.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/09/2022] [Accepted: 12/20/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Iñigo Lorenzo Ruiz
- Nursing department I, Faculty of Medicine and Nursing, University of the Basque Country - UPV/EHU, Sarriena, Leioa, Spain; BioCruces-Bizkaia Health Research Institute, Barakaldo, Spain.
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Atteya G, Alston M, Sweat A, Saleh M, Beldner S, Mitra R, Willner J, John RM, Epstein LM. Same-day discharge after transvenous lead extraction: feasibility and outcomes. Europace 2022; 25:586-590. [PMID: 36575941 PMCID: PMC9934987 DOI: 10.1093/europace/euac185] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 04/06/2022] [Accepted: 08/31/2022] [Indexed: 12/29/2022] Open
Abstract
AIMS Same-day discharge (SDD) is safe for patients undergoing electrophysiology procedures. There is no existing data regarding SDD for patients undergoing transvenous lead extraction (TLE). We report our experience with SDD for patients undergoing TLE. METHODS AND RESULTS The study group included patients undergoing TLE between February 2020 and July 2021 without an infectious indication. A modified SDD protocol for device implants/ablations was applied to TLE patients. Patient characteristics, extraction details, outcomes, and complications were reviewed. Of 239 patients undergoing TLE, 210 were excluded (94 infections and 116 did not meet SDD criteria). Of the remaining 29 patients, seven stayed due to patient preference and 22 were discharged home the same day. The SDD group had an average age of 65.9 ± 12 (47-84), 41% female, and LVEF of 52.2 ± 18% (10-80). The indication for TLE was malfunction (20), upgrade (4), advisory lead (2), and magnetic resonance imaging compatibility (1). Extractions included four implantable cardioverter-defibrillators (ICDs), 17 pacemakers (PPM), and one cardiac resynchronization therapy (CRT)-P system. The leads were 9.6 years (1.5-21.7) old, and 1.8 leads were removed per patient (1-3); the lead extraction difficulty (LED) score was 11.6 ± 7. Twenty underwent cardiovascular implantable electronic device (CIED) re-implantation (2 ICD, 3 CRT-D, 13 PPM, and 2 CRT-P). For CIED re-implants, patients sent a remote transmission the next day, and all patients received a next-day call. There were no procedure or device-related issues, morbidities, or mortalities in the 30 days after discharge. CONCLUSION Same-day discharge after TLE for non-infectious aetiologies is safe and feasible in a select group of patients with early procedure completion who meet strict SDD criteria.
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Affiliation(s)
- Gourg Atteya
- Corresponding author. Tel: 516 562-1430, Fax: 516 562-3978, E-mail address:
| | - Michael Alston
- Cardiovascular Division, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
| | - Austin Sweat
- Cardiovascular Division, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
| | - Moussa Saleh
- Cardiovascular Division, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
| | - Stuart Beldner
- Cardiovascular Division, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
| | - Raman Mitra
- Cardiovascular Division, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
| | - Jonathan Willner
- Cardiovascular Division, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
| | - Roy M John
- Stanford School of Medicine Cardiology, 300 Pasteur Drive, 2nd Floor, Palo Alto, CA 94305, USA
| | - Laurence M Epstein
- Cardiovascular Division, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
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Fluschnik N, Tahir E, Erley J, Müllerleile K, Metzner A, Wenzel JP, Guerreiro H, Adam G, Blankenberg S, Kirchhof P, Tönnis T, Nikorowitsch J. 3 Tesla magnetic resonance imaging in patients with cardiac implantable electronic devices: a single centre experience. Europace 2022; 25:571-577. [PMID: 36413601 PMCID: PMC9935018 DOI: 10.1093/europace/euac213] [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: 07/31/2022] [Accepted: 11/01/2022] [Indexed: 11/23/2022] Open
Abstract
AIMS Three Tesla (T) magnetic resonance imaging (MRI) provides critical imaging information for many conditions. Owing to potential interactions of the magnetic field, it is largely withheld from patients with cardiac implantable electronic devices (CIEDs). Therefore, we assessed the safety of 3T MRI in patients with '3T MRI-conditional' and 'non-3T MRI-conditional' CIEDs. METHODS AND RESULTS We performed a retrospective single-centre analysis of clinically indicated 3T MRI examinations in patients with conventional pacemakers, cardiac resynchronization devices, and implanted defibrillators from April 2020 to May 2022. All CIEDs were interrogated and programmed before and after scanning. Adverse events included all-cause death, arrhythmias, loss of capture, inappropriate anti-tachycardia therapies, electrical reset, and lead or generator failure during or shortly after MRI. Changes in signal amplitude and lead impedance were systematically assessed. Statistics included median and interquartile range. A total of 132 MRI examinations were performed on a 3T scanner in 97 patients. Thirty-five examinations were performed in patients with 'non-3T MRI-conditional' CIEDs. Twenty-six scans were performed in pacemaker-dependent patients. No adverse events occurred during or shortly after MRI. P-wave or R-wave reductions ≥ 50 and ≥ 25%, respectively, were noted after three (2.3%) scans, all in patients with '3T MRI-conditional' CIEDs. Pacing and shock impedance changed by ± 30% in one case (0.7%). Battery voltage and stimulation thresholds did not relevantly change after MRI. CONCLUSION Pending verification in independent series, our data suggest that clinically indicated MRI scans at 3T field strength should not be withheld from patients with cardiac pacemakers or defibrillators.
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Affiliation(s)
- Nina Fluschnik
- Corresponding author. Phone: +49 (0) 40 7410 18576, Fax: +49 (0) 40 7410 58206, E-mail address:
| | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr 52, 20251 Hamburg, Germany
| | - Jennifer Erley
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr 52, 20251 Hamburg, Germany
| | - Kai Müllerleile
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Andreas Metzner
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Jan-Per Wenzel
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Martinistr 52, 20251 Hamburg, Germany
| | - Helena Guerreiro
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr 52, 20251 Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Martinistr 52, 20251 Hamburg, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Martinistr 52, 20251 Hamburg, Germany,Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Tobias Tönnis
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Julius Nikorowitsch
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Martinistr 52, 20251 Hamburg, Germany
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Manyam H, Burri H, Casado-Arroyo R, Varma N, Lennerz C, Klug D, Carr-White G, Kolli K, Reyes I, Nabutovsky Y, Boriani G. Smartphone-based cardiac implantable electronic device remote monitoring: improved compliance and connectivity. Eur Heart J Digit Health 2022; 4:43-52. [PMID: 36743871 PMCID: PMC9890086 DOI: 10.1093/ehjdh/ztac071] [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] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/04/2022] [Indexed: 11/13/2022]
Abstract
Aims Remote monitoring (RM) is the standard of care for follow up of patients with cardiac implantable electronic devices. The aim of this study was to compare smartphone-based RM (SM-RM) using patient applications (myMerlinPulse™ app) with traditional bedside monitor RM (BM-RM). Methods and results The retrospective study included de-identified US patients who received either SM-RM or BM-RM capable of implantable cardioverter defibrillators or cardiac resynchronization therapy defibrillators (Abbott, USA). Patients in SM-RM and BM-RM groups were propensity-score matched on age and gender, device type, implant year, and month. Compliance with RM was quantified as the proportion of patients enrolling in the RM system (Merlin.net™) and transmitting data at least once. Connectivity was measured by the median number of days between consecutive transmissions per patient. Of the initial 9714 patients with SM-RM and 26 679 patients with BM-RM, 9397 patients from each group were matched. Remote monitoring compliance was higher in SM-RM; significantly more patients with SM-RM were enrolled in RM compared with BM-RM (94.4 vs. 85.0%, P < 0.001), similar number of patients in the SM-RM group paired their device (95.1 vs. 95.0%, P = 0.77), but more SM-RM patients transmitted at least once (98.1 vs. 94.3%, P < 0.001). Connectivity was significantly higher in the SM-RM, with patients transmitting data every 1.2 (1.1, 1.7) vs. every 1.7 (1.5, 2.0) days with BM-RM (P < 0.001) and remained better over time. Significantly more SM-RM patients utilized patient-initiated transmissions compared with BM-RM (55.6 vs. 28.1%, P < 0.001). Conclusion In this large real-world study, patients with SM-RM demonstrated improved compliance and connectivity compared with BM-RM.
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Affiliation(s)
- Harish Manyam
- Corresponding author. Tel: +1 423 778 5661, Fax: +1 423 778 5664,
| | - Haran Burri
- Cardiac Pacing Unit, Cardiology Department, University Hospital of Geneva, Rue Gabrielle Perret Gentil 4, 1205 Geneva, Switzerland
| | - Ruben Casado-Arroyo
- Department of Cardiology, Université Libre de Bruxelles, 1070 Bruxelles, Belgium
| | - Niraj Varma
- Cleveland Clinic Heart and Vascular Institute, Cleveland, OH, USA
| | - Carsten Lennerz
- Department of Electrophysiology, German Heart Centre Munich, 80636 Munich, Germany
| | - Didier Klug
- Department of Cardiology, University Hospital of Lille, 59037 Lille, France
| | - Gerald Carr-White
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Kranthi Kolli
- Abbott, Global Data Science and Analytics, CA 95054, USA
| | - Ignacio Reyes
- Abbott, Global Data Science and Analytics, CA 95054, USA
| | | | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy
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Nowak B, Przibille O, Napp A. [Electromagnetic interference : Pacemakers, cardiac resynchronization therapy devices, implantable cardioverter-defibrillator]. Herzschrittmacherther Elektrophysiol 2022; 33:297-304. [PMID: 35781834 DOI: 10.1007/s00399-022-00875-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
Patients with cardiac pacemakers, implantable cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy devices (CRT) are exposed to different types of electromagnetic interference (EMI) at home and at work. Due to the constantly increasing role of electrically active appliances in daily use and the introduction of new therapy concepts such as the leadless cardiac pacemaker and the subcutaneous defibrillator, this topic is of great relevance. The further development of the implanted devices and the almost complete use of bipolar leads has reduced the overall risk of EMI. This review article provides information about the current status of possible interference in the private environment and how to avoid it. In addition, information is provided on how to deal with occupational sources of interference.
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Affiliation(s)
- Bernd Nowak
- Cardioangiologisches Centrum Bethanien, Im Prüfling 23, 60389, Frankfurt a.M., Deutschland.
| | - Oliver Przibille
- Cardioangiologisches Centrum Bethanien, Im Prüfling 23, 60389, Frankfurt a.M., Deutschland
| | - Andreas Napp
- Medizinische Klinik I, - Kardiologie, Angiologie und Internistische Intensivmedizin, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
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Barmore W, Patel H, Voong C, Tarallo C, Calkins Jr JB. Effects of medically generated electromagnetic interference from medical devices on cardiac implantable electronic devices: A review. World J Cardiol 2022; 14:446-453. [PMID: 36160813 PMCID: PMC9453256 DOI: 10.4330/wjc.v14.i8.446] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/15/2022] [Accepted: 08/16/2022] [Indexed: 02/05/2023] Open
Abstract
As cardiac implantable electronic devices (CIED) become more prevalent, it is important to acknowledge potential electromagnetic interference (EMI) from other sources, such as internal and external electronic devices and procedures and its effect on these devices. EMI from other sources can potentially inhibit pacing and trigger shocks in permanent pacemakers (PPM) and implantable cardioverter defibrillators (ICD), respectively. This review analyzes potential EMI amongst CIED and left ventricular assist device, deep brain stimulators, spinal cord stimulators, transcutaneous electrical nerve stimulators, and throughout an array of procedures, such as endoscopy, bronchoscopy, and procedures involving electrocautery. Although there is evidence to support EMI from internal and external devices and during procedures, there is a lack of large multicenter studies, and, as a result, current management guidelines are based primarily on expert opinion and anecdotal experience. We aim to provide a general overview of PPM/ICD function, review documented EMI effect on these devices, and acknowledge current management of CIED interference.
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Affiliation(s)
- Walker Barmore
- Department of Cardiology, Augusta University Medical Center, Augusta, GA 30912, United States
| | - Himax Patel
- Department of Internal Medicine, Augusta University Medical Center, Augusta, GA 30912, United States
| | - Cassandra Voong
- Department of Internal Medicine, Augusta University Medical Center, Augusta, GA 30912, United States
| | - Caroline Tarallo
- Medical College of Georgia, Medical College of Georgia, Augusta, GA 30912, United States
| | - Joe B Calkins Jr
- Department of Cardiology, Augusta University Medical Center, Augusta, GA 30912, United States
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Mahtani K, Maclean E, Schilling RJ. Prevention and Management of Cardiac Implantable Electronic Device Infections: State-of-the-Art and Future Directions. Heart Lung Circ 2022:S1443-9506(22)01001-0. [PMID: 35989213 DOI: 10.1016/j.hlc.2022.06.690] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 06/09/2022] [Accepted: 06/19/2022] [Indexed: 11/23/2022]
Abstract
Cardiac implantable electronic device (CIED) infection is an increasingly common complication of device therapy. CIED infection confers significant patient morbidity and health care expenditure, hence it is essential that clinicians recognise the contemporary strategies for predicting, reducing and treating these events. Recent technological advances-in particular, the development of antimicrobial envelopes, leadless devices and validated risk scores-present decision-makers with novel strategies for managing this expanding patient population. This review summarises the key issues facing CIED patients and their physicians, and explores the supporting evidence for the latest therapeutic developments in this field.
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Ruiz IL, Arantzamendi LG, Mendia XM. Spanish Rhythm Association member´s perspectives on cardiac implantable electronic device reuse in low- and middle-income countries. J Interv Card Electrophysiol 2022:10.1007/s10840-022-01304-y. [PMID: 35835889 DOI: 10.1007/s10840-022-01304-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 07/08/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Postmortem explanted cardiac implantable electronic devices (CIEDs) from developed countries could provide patients unable to afford new devices in low- and middle-income countries (LMIC) a treatment they lack. This study describes the preferences of electrophysiologists and device implanting cardiologists from Spain on the management of explanted CIEDs and opinions and concerns regarding reuse in LMIC. METHODS A nationwide self-administered questionnaire was sent to members of the Spanish Rhythm Association (n = 1110), between December 2020 and January 2021. RESULTS Forty-two physician responses were obtained (response rate 5%). There was a strong preference to donate explanted devices for reuse in humans (61.9%) or animals (31%). The vast majority of the participants thought device reutilization was safe, ethical, and a reasonable alternative if a new device is not accessible. Moreover, they indicated they would be comfortable asking patients to consider post-mortem donation, and willing to implant post-mortem explanted and resterilized devices if they were unable to obtain new ones. 57.1% of respondents considered it would be beneficial for patients to have a document so they could reflect their wishes regarding device handling after their death. The most mentioned concerns regarding device reuse were malfunction (57.1%) and infection (54.8%). CONCLUSIONS The majority of respondents support reusable CIED donation to LMIC. It would be interesting to study the feasibility of a nationwide device reutilization program.
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Affiliation(s)
- Iñigo Lorenzo Ruiz
- Nursing Department I, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, Sarriena, Leioa, Spain.
- BioCruces-Bizkaia Health Research Institute, Baracaldo, Spain.
| | | | - Xabier Marichalar Mendia
- Nursing Department I, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, Sarriena, Leioa, Spain
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Shanmugasundaram M, Chatterjee A, Lee K. Percutaneous Large Thrombus and Vegetation Evacuation in the Catheterization Laboratory. Interv Cardiol Clin 2022; 11:349-358. [PMID: 35710288 DOI: 10.1016/j.iccl.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Intracardiac and intravascular thrombi are associated with significant morbidity and mortality. Although surgery remains the gold standard treatment option, these patients often have multiple comorbidities that can make surgical options challenging. With advancements in catheter-based technologies, there are now percutaneous treatment options for these patients. The AngioVac is a percutaneous vacuum-assisted thrombectomy device FDA-approved for removal of intravascular debris that uses a venovenous extracorporeal membranous oxygenation circuit with a filter. Use of this device has now been reported in the removal of right atrial or iliocaval thrombi, debulking tricuspid vegetations, removal of vegetations from implantable cardiac devices, and pulmonary embolism.
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Affiliation(s)
- Madhan Shanmugasundaram
- Section of Cardiology, Department of Internal Medicine, Banner University Medical Center, Sarver Heart Center, 1501 North Campbell Avenue, Tucson, AZ 85724, USA.
| | - Arka Chatterjee
- Section of Cardiology, Department of Internal Medicine, Banner University Medical Center, Sarver Heart Center, 1501 North Campbell Avenue, Tucson, AZ 85724, USA
| | - Kwan Lee
- Section of Cardiology, Department of Internal Medicine, Banner University Medical Center, Sarver Heart Center, 1501 North Campbell Avenue, Tucson, AZ 85724, USA
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Kreimer F, Mügge A, Gotzmann M. How should I treat patients with subclinical atrial fibrillation and atrial high-rate episodes? Current evidence and clinical importance. Clin Res Cardiol 2022; 111:994-1009. [PMID: 35292844 PMCID: PMC9424173 DOI: 10.1007/s00392-022-02000-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/07/2022] [Accepted: 03/01/2022] [Indexed: 11/28/2022]
Abstract
Long-term and continuous ECG monitoring using cardiac implantable electronic devices and insertable cardiac monitors has improved the capability of detecting subclinical atrial fibrillation (AF) and atrial high-rate episodes. Previous studies demonstrated a high prevalence (more than 20%) in patients with cardiac implantable electronic devices or insertable cardiac monitors. Subclinical AF and atrial high-rate episodes are often suspected as the cause of prior or potential future ischemic stroke. However, the clinical significance is still uncertain, and the evidence is limited. This review aims to present and discuss the current evidence on the clinical impact of subclinical AF and atrial high-rate episodes. It focuses particularly on the association between the duration of the episodes and major clinical outcomes like thromboembolic events. As subclinical AF and atrial high-rate episodes are presumed to be associated with ischemic strokes, detection will be particularly important in patients with cryptogenic stroke and in high-risk patients for thromboembolism. In this context, it is also interesting whether there is a temporal relationship between the detection of subclinical AF and atrial high-rate episodes and the occurrence of thromboembolic events. In addition, the review will examine the question whether there is a need for a therapy with oral anticoagulation.
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Affiliation(s)
- Fabienne Kreimer
- University Hospital St Josef-Hospital Bochum, Cardiology and Rhythmology, Ruhr University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - Andreas Mügge
- University Hospital St Josef-Hospital Bochum, Cardiology and Rhythmology, Ruhr University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - Michael Gotzmann
- University Hospital St Josef-Hospital Bochum, Cardiology and Rhythmology, Ruhr University Bochum, Gudrunstraße 56, 44791, Bochum, Germany.
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Gauter-Fleckenstein B, Tülümen E, Rudic B, Borggrefe M, Polednik M, Fleckenstein J. Local dose rate effects in implantable cardioverter-defibrillators with flattening filter free and flattened photon radiation. Strahlenther Onkol 2022; 198:566-572. [PMID: 35267050 PMCID: PMC9165256 DOI: 10.1007/s00066-022-01911-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/24/2021] [Accepted: 02/08/2022] [Indexed: 11/28/2022]
Abstract
Purpose In the beam penumbra of stereotactic body radiotherapy volumes, dose rate effects in implantable cardioverter–defibrillators (ICDs) may be the predominant cause for failures in the absence of neutron-generating photon energies. We investigate such dose rate effects in ICDs and provide evidence for safe use of lung tumor stereotactic radioablation with flattening filter free (FFF) and flattened 6 Megavolt (MV) beams in ICD-bearing patients. Methods Sixty-two ICDs were subjected to scatter radiation in 1.0, 2.5, and 7.0 cm distance to 100 Gy within a 5 × 5 cm2 radiation field. Radiation was applied with 6 MV FFF beams (constant dose rate of 1400 cGy/min) and flattened (FLAT) 6 MV beams (430 cGy/min). Local dose rates (LDR) at the position of all ICDs were measured. All ICDs were monitored continuously. Results With 6 MV FFF beams, ICD errors occurred at distances of 1.0 cm (LDR 46.8 cGy/min; maximum ICD dose 3.4 Gy) and 2.5 cm (LDR 15.6 cGy/min; 1.1 Gy). With 6 MV FLAT beams, ICD errors occurred only at 1 cm distance (LDR 16.8 cGy/min; 3.9 Gy). No errors occurred at an LDR below 7 cGy/min, translating to a safe distance of 2.5 cm (1.5 Gy) in flattened and 7 cm (0.4 Gy) in 6 MV FFF beams. Conclusion A LDR in ICDs larger than 7 cGy/min may cause ICD malfunction. At identical LDR, differences between 6 MV FFF and 6 MV FLAT beams do not yield different rates of malfunction. The dominant reason for ICD failures could be the LDR and not the total dose to the ICD. For most stereotactic treatments, it is recommended to generate a planning risk volume around the ICD in which LDR larger than 7 cGy/min are avoided.
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Affiliation(s)
- Benjamin Gauter-Fleckenstein
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Erol Tülümen
- I. Medizinische Klinik, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.,Partner Site Heidelberg/Mannheim, German Center for Cardiovascular Research (DZHK), Mannheim, Germany
| | - Boris Rudic
- I. Medizinische Klinik, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.,Partner Site Heidelberg/Mannheim, German Center for Cardiovascular Research (DZHK), Mannheim, Germany
| | - Martin Borggrefe
- I. Medizinische Klinik, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.,Partner Site Heidelberg/Mannheim, German Center for Cardiovascular Research (DZHK), Mannheim, Germany
| | - Martin Polednik
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Jens Fleckenstein
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Simovic S, Providencia R, Barra S, Kircanski B, Guerra JM, Conte G, Duncker D, Marijon E, Anic A, Boveda S. The use of remote monitoring of cardiac implantable devices during the COVID-19 pandemic: an EHRA physician survey. Europace 2022; 24:473-480. [PMID: 34410364 PMCID: PMC8499732 DOI: 10.1093/europace/euab215] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Indexed: 12/15/2022] Open
Abstract
It is unclear to what extent the COVID-19 pandemic has influenced the use of remote monitoring (RM) of cardiac implantable electronic devices (CIEDs). The present physician-based European Heart Rhythm Association (EHRA) survey aimed to assess the influence of the COVID-19 pandemic on RM of CIEDs among EHRA members and how it changed the current practice. The survey comprised 27 questions focusing on RM use before and during the pandemic. Questions focused on the impact of COVID-19 on the frequency of in-office visits, data filtering, reasons for initiating in-person visits, underutilization of RM during COVID-19, and RM reimbursement. A total of 160 participants from 28 countries completed the survey. Compared to the pre-pandemic period, there was a significant increase in the use of RM in patients with pacemakers (PMs) and implantable loop recorders (ILRs) during the COVID-19 pandemic (PM 24.2 vs. 39.9%, P = 0.002; ILRs 61.5 vs. 73.5%, P = 0.028), while there was a trend towards higher utilization of RM for cardiac resynchronization therapy-pacemaker (CRT-P) devices during the pandemic (44.5 vs. 55%, P = 0.063). The use of RM with implantable cardioverter-defibrillators (ICDs) and CRT-defibrillator (CRT-D) did not significantly change during the pandemic (ICD 65.2 vs. 69.6%, P = 0.408; CRT-D 65.2 vs. 68.8%, P = 0.513). The frequency of in-office visits was significantly lower during the pandemic (P < 0.001). Nearly two-thirds of participants (57 out of 87 respondents), established new RM connections for CIEDs implanted before the pandemic with 33.3% (n = 29) delivering RM transmitters to the patient's home address, and the remaining 32.1% (n = 28) activating RM connections during an in-office visit. The results of this survey suggest that the crisis caused by COVID-19 has led to a significant increase in the use of RM of CIEDs.
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Affiliation(s)
- Stefan Simovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, 34000 Kragujevac, Serbia
- Clinic for Cardiology, University Clinical Center Kragujevac, Kragujevac, Serbia
| | - Rui Providencia
- St Bartholomew’s Hospital, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Institute of Health Informatics, University College of London, London, UK
| | - Sergio Barra
- Cardiology Department, Hospital da Luz Arrabida, V. N. Gaia, Portugal
- Cardiology Department, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Bratislav Kircanski
- University Clinical Centre of Serbia, Pacemaker Centre, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universidad Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Giulio Conte
- Cardiology Department, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Eloi Marijon
- University of Paris, Paris, France
- European Georges Pompidou Hospital, Cardiology Department and Cardiovascular Research Center, Paris, France
- Institut National de la Sante et de la Recherche Medicale U970, 75908 Paris Cedex 15, France
| | - Ante Anic
- Department for Cardiovascular diseases, University Hospital Center Split, Split, Croatia
| | - Serge Boveda
- Institut National de la Sante et de la Recherche Medicale U970, 75908 Paris Cedex 15, France
- Heart Rhythm Department, Clinique Pasteur, 31076 Toulouse, France
- Universitair Ziekenhuis Brussel—VUB, Heart Rhythm Management Centre, Brussels, Belgium
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de Groot NMS, Shah D, Boyle PM, Anter E, Clifford GD, Deisenhofer I, Deneke T, van Dessel P, Doessel O, Dilaveris P, Heinzel FR, Kapa S, Lambiase PD, Lumens J, Platonov PG, Ngarmukos T, Martinez JP, Sanchez AO, Takahashi Y, Valdigem BP, van der Veen AJ, Vernooy K, Casado-Arroyo Co-Chair R. Critical appraisal of technologies to assess electrical activity during atrial fibrillation: a position paper from the European Heart Rhythm Association and European Society of Cardiology Working Group on eCardiology in collaboration with the Heart Rhythm Society, Asia Pacific Heart Rhythm Society, Latin American Heart Rhythm Society and Computing in Cardiology. Europace 2021; 24:313-330. [PMID: 34878119 DOI: 10.1093/europace/euab254] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/21/2021] [Indexed: 11/13/2022] Open
Abstract
We aim to provide a critical appraisal of basic concepts underlying signal recording and processing technologies applied for (i) atrial fibrillation (AF) mapping to unravel AF mechanisms and/or identifying target sites for AF therapy and (ii) AF detection, to optimize usage of technologies, stimulate research aimed at closing knowledge gaps, and developing ideal AF recording and processing technologies. Recording and processing techniques for assessment of electrical activity during AF essential for diagnosis and guiding ablative therapy including body surface electrocardiograms (ECG) and endo- or epicardial electrograms (EGM) are evaluated. Discussion of (i) differences in uni-, bi-, and multi-polar (omnipolar/Laplacian) recording modes, (ii) impact of recording technologies on EGM morphology, (iii) global or local mapping using various types of EGM involving signal processing techniques including isochronal-, voltage- fractionation-, dipole density-, and rotor mapping, enabling derivation of parameters like atrial rate, entropy, conduction velocity/direction, (iv) value of epicardial and optical mapping, (v) AF detection by cardiac implantable electronic devices containing various detection algorithms applicable to stored EGMs, (vi) contribution of machine learning (ML) to further improvement of signals processing technologies. Recording and processing of EGM (or ECG) are the cornerstones of (body surface) mapping of AF. Currently available AF recording and processing technologies are mainly restricted to specific applications or have technological limitations. Improvements in AF mapping by obtaining highest fidelity source signals (e.g. catheter-electrode combinations) for signal processing (e.g. filtering, digitization, and noise elimination) is of utmost importance. Novel acquisition instruments (multi-polar catheters combined with improved physical modelling and ML techniques) will enable enhanced and automated interpretation of EGM recordings in the near future.
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Affiliation(s)
- Natasja M S de Groot
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, Delft University of Technology, Delft the Netherlands
| | - Dipen Shah
- Cardiology Service, University Hospitals Geneva, Geneva, Switzerland
| | - Patrick M Boyle
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Elad Anter
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University, Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, USA
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich and Technical University of Munich, Munich, Germany
| | - Thomas Deneke
- Department of Cardiology, Rhon-klinikum Campus Bad Neustadt, Germany
| | - Pascal van Dessel
- Department of Cardiology, Medisch Spectrum Twente, Twente, the Netherlands
| | - Olaf Doessel
- Karlsruher Institut für Technologie (KIT), Karlsruhe, Germany
| | - Polychronis Dilaveris
- 1st University Department of Cardiology, National & Kapodistrian University of Athens School of Medicine, Hippokration Hospital, Athens, Greece
| | - Frank R Heinzel
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum and DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Suraj Kapa
- Department of Cardiology, Mayo Clinic, Rochester, USA
| | | | - Joost Lumens
- Cardiovascular Research Institute Maastricht (CARIM) Maastricht University, Maastricht, the Netherlands
| | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Tachapong Ngarmukos
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Juan Pablo Martinez
- Aragon Institute of Engineering Research/IIS-Aragon and University of Zaragoza, Zaragoza, Spain, CIBER Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Zaragoza, Spain
| | - Alejandro Olaya Sanchez
- Department of Cardiology, Hospital San José, Fundacion Universitaia de Ciencas de la Salud, Bogota, Colombia
| | - Yoshihide Takahashi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Bruno P Valdigem
- Department of Cardiology, Hospital Rede D'or São Luiz, hospital Albert einstein and Dante pazzanese heart institute, São Paulo, Brasil
| | - Alle-Jan van der Veen
- Department Circuits and Systems, Delft University of Technology, Delft, the Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands
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Azraai M, D'Souza D, Nadurata V. Current Clinical Practice in Patients With Cardiac Implantable Electronic Devices (CIED) Undergoing Radiotherapy (RT). Heart Lung Circ 2021; 31:327-340. [PMID: 34844904 DOI: 10.1016/j.hlc.2021.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/05/2021] [Accepted: 10/25/2021] [Indexed: 11/26/2022]
Abstract
Patients with cardiac implantable electronic devices (CIED) undergoing radiotherapy (RT) are more common due to ageing of the population. With newer CIEDs implementing the complementary metal-oxide semiconductor (CMOS) technology which allows the miniaturisation of CIED, it is also more susceptible to RT. Effects of RT on CIED ranges from device interference, device operational/memory errors of permanent damage. These malfunctions can cause life threatening clinical effects. Cumulative dose is not the only component of RT that causes CIED malfunction, as neutron use and dose rate effect also affects CIEDs. The management of this patient cohort in clinical practice is inconsistent due to lack of a consistent guideline from manufacturers and physician specialty societies. Our review will focus on the current clinical practice and the recent updated guidelines of managing patients with CIED undergoing RT. We aim to simplify the evidence and provide a simple and easy to use guide based on the recent guidelines.
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Affiliation(s)
- Meor Azraai
- Department of Cardiology, Bendigo Health, Bendigo, Vic, Australia.
| | - Daniel D'Souza
- Department of Cardiology, Bendigo Health, Bendigo, Vic, Australia
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Hashimoto T, Demizu Y, Numajiri H, Isobe T, Fukuda S, Wakatsuki M, Yamashita H, Murayama S, Takamatsu S, Katoh H, Murata K, Kohno R, Arimura T, Matsuura T, Ito YM. Particle therapy using protons or carbon ions for cancer patients with cardiac implantable electronic devices (CIED): a retrospective multi-institutional study. Jpn J Radiol 2021; 40:525-533. [PMID: 34779984 PMCID: PMC9068656 DOI: 10.1007/s11604-021-01218-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/05/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the outcomes of particle therapy in cancer patients with cardiac implantable electronic devices (CIEDs). MATERIALS AND METHODS From April 2001 to March 2013, 19,585 patients were treated with proton beam therapy (PBT) or carbon ion therapy (CIT) at 8 institutions. Of these, 69 patients (0.4%, PBT 46, CIT 22, and PBT + CIT 1) with CIEDs (64 pacemakers, 4 implantable cardioverter defibrillators, and 1 with a cardiac resynchronization therapy defibrillator) were retrospectively reviewed. All the patients with CIEDs in this study were treated with the passive scattering type of particle beam therapy. RESULTS Six (13%) of the 47 PBT patients, and none of the 23 CIT patients experienced CIED malfunctions (p = 0.105). Electrical resets (7) and over-sensing (3) occurred transiently in 6 patients. The distance between the edge of the irradiation field and the CIED was not associated with the incidence of malfunctions in 20 patients with lung cancer. A larger field size had a higher event rate but the test to evaluate trends as not statistically significant (p = 0.196). CONCLUSION Differences in the frequency of occurrence of device malfunctions for patients treated with PBT and patients treated with CIT did not reach statistical significance. The present study can be regarded as a benchmark study about the incidence of malfunctioning of CIED in passive scattering particle beam therapy and can be used as a reference for active scanning particle beam therapy.
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Affiliation(s)
- Takayuki Hashimoto
- Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, North 15 West 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Yusuke Demizu
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Kouto, Shingu-cho, Tatsuno, Hyogo, Japan
| | - Haruko Numajiri
- Department of Radiation Oncology, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Tomonori Isobe
- Department of Radiation Oncology, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Shigekazu Fukuda
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, Japan
| | - Masaru Wakatsuki
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, Japan
| | - Haruo Yamashita
- Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
| | - Shigeyuki Murayama
- Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
| | - Shigeyuki Takamatsu
- Department of Radiation Therapy, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, Japan
| | - Hiroyuki Katoh
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, Japan
- Department of Radiation Oncology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa, Japan
| | - Kazutoshi Murata
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, Japan
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, Japan
| | - Ryosuke Kohno
- National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, Japan
- Department of Accelerator and Medical Physics, National Institute for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, Japan
| | - Takeshi Arimura
- Medipolis Proton Therapy and Research Center, 4423, Higashikata, Ibusuki, Kagoshima, Japan
| | - Taeko Matsuura
- Faculty of Engineering, Hokkaido University, Kita 13, Nishi 8, Kita-ku, Sapporo, Hokkaido, Japan
| | - Yoichi M Ito
- Biostatistics Division, Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, Japan
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Doundoulakis I, Tsiachris D, Gatzoulis KA, Stefanadis C, Tsioufis K. Atrial high rate episodes as a marker of atrial cardiomyopathy: In the quest of the Holy Grail. Eur J Intern Med 2021; 93:115-116. [PMID: 34417088 DOI: 10.1016/j.ejim.2021.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 08/09/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Ioannis Doundoulakis
- First Department of Cardiology, University of Athens Medical School, Athens, Greece; Athens Heart Center, Athens Medical Center, Athens, Greece.
| | | | | | - Christodoulos Stefanadis
- Athens Heart Center, Athens Medical Center, Athens, Greece; Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
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Al-Maisary S, Kremer J, Romano G, Karck M, De Simone R. Risk of venous occlusion after lead laser extraction preventing future lead implantation. J Cardiothorac Surg 2021; 16:321. [PMID: 34717698 DOI: 10.1186/s13019-021-01706-5] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 10/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background Lead laser extraction is a well-established method for removing unwanted leads with low morbidity and mortality. Objective In this observational study, we documented our experience with venous occlusion after lead laser extraction. Methods Retrospective data of patients who underwent lead laser extraction between May 2010 and August 2018 was analyzed. Two subgroups of patients were identified. First group represented patients after lead laser extraction who suffered postoperative venous occlusion. Second group represents patients after lead laser extraction, who has documented patent venous access after lead laser extraction. Results 219 patients underwent percutaneous laser lead extraction. The mean age of patients was 65 ± 14 years. Of these patients, 74% were male. The Most common indication for extraction was Nonfunctional lead (45.2%, n = 99) followed by pocket infection with 33.8% and endocarditis (17.3%). A total number of 447 leads underwent laser extraction. In 7.8% of the patients, lead extraction was partially successful and lead extraction was not successful in only 2.3% of the patients. Only 13 patients developed a documented venous occlusion postoperatively and 26 patients has documented absence of venous occlusion, of whom 17 were under oral anticoagulation. Conclusion Lead laser extraction may lead to venous occlusion, which is mostly asymptomatic but it prevents future lead implantation. The use of oral anticoagulant may prevent postoperative venous occlusion.
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Gillam MH, Pratt NL, Inacio MCS, Shakib S, Caughey GE, Sanders P, Lau DH, Roughead EE. Cardiac Implantable Electronic Devices: Reoperations and the Competing Risk of Death. Heart Lung Circ 2021; 31:537-543. [PMID: 34674955 DOI: 10.1016/j.hlc.2021.08.027] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 07/28/2021] [Accepted: 08/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The use of cardiac implantable electronic devices (CIED), which includes pacemakers, implantable cardioverter-defibrillators (ICD), cardiac resynchronisation therapy pacemakers (CRT-P) and cardiac resynchronisation therapy defibrillators (CRT-D) has increased over the past 20 years, but there is a lack of real world evidence on the longevity of these devices in the older population which is essential to inform health care delivery and support clinical decisions. METHODS AND RESULTS We conducted a retrospective cohort study using data from the Australian Government Department of Veterans' Affairs database. The cohort consisted of people who had a CIED procedure between 2005 and 2015. The cumulative risk of generator replacement/reoperations was estimated accounting for the competing risk of death. A total of 16,662 patients were included. In pacemaker recipients with an average age of 85 years, the 5-year risk of reoperation ranged from 2.8% in single chamber, 3.6% in dual chamber to 7.6% in CRT-P recipients, while the 5-year risk of dying with the index pacemaker in situ was 63% in single chamber, 46% in dual chamber and 56% in CRT-P recipients. In defibrillator recipients with an average age of 80 years, the 5-year risk of reoperation ranged from 11% in single chamber, 13% in dual chamber to 24% in CRT-D recipients, while the 5-year risk of dying with the index defibrillator in situ was 46% in single chamber, 40% in dual chamber and 41% in CRT-D recipients. CONCLUSION In this cohort of older patients the 5-year risk of generator reoperation was low in pacemaker recipients whereas up to one in four CRT-D recipients would have a reoperation within 5 years.
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Affiliation(s)
- Marianne H Gillam
- School of Pharmacy and Medical Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, SA, Australia.
| | - Nicole L Pratt
- School of Pharmacy and Medical Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, SA, Australia
| | - Maria C S Inacio
- School of Pharmacy and Medical Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, SA, Australia
| | - Sepehr Shakib
- Discipline of Pharmacology, School of Medicine, University of Adelaide, Adelaide, SA, Australia; Department of Medicine, University of Adelaide, Adelaide, SA, Australia; Australia and South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Gillian E Caughey
- School of Pharmacy and Medical Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, SA, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australia Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, South Australia Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Elizabeth E Roughead
- School of Pharmacy and Medical Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, SA, Australia
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