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Zhao L, Jiang W, Zhou L, Wang Y, Zhang X, Wu S, Xu K, Liu X. Atrial autonomic denervation for the treatment of long-standing symptomatic sinus bradycardia in non-elderly patients. J Interv Card Electrophysiol 2015; 43:151-9. [PMID: 25693516 DOI: 10.1007/s10840-015-9981-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 01/28/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE Multiple lead and generator replacement and related complications often complicate the decision of pacemaker implantation in non-elderly patients with symptomatic bradycardia. This study sought to investigate the efficacy and safety of atrial autonomic denervation for treating the symptomatic long-standing sinus bradycardia (SB) in non-elderly patients. METHODS AND RESULTS Eleven non-elderly patients (mean age, 45.9 ± 10.9 years; eight men) with a long history of SB (106.2 ± 43.7 months; range, 60-189) were enrolled. Five atrial ganglionated plexies (GPs), identified by anatomic distribution and high-frequency stimulation, were targeted and ablated. The end point was elimination of the vagal response at ablation sites. The symptoms of SB and Holter were followed up at 3 days, 6, and 12 months and, thereafter, over a period of 18 months. Six patients were under 50 years old (group I) and 5 patients were between 50 and 60 years old (group II). There were 3.1 ± 0.7 GPs with positive vagal response and 11.3 ± 2.7 ablation sites in each patient. During the 18.4 ± 6.2 (range, 12-25) months of follow-up, all patients reported significant symptom improvement with a significant decrease of the SB-related symptoms score. The total heartbeats, mean, and minimum heart rate significantly increased that persisted for 12 months. Compared with patients in group II, those in group I had more increases in total heartbeats and mean heart rate (HR). CONCLUSION Atrial autonomic denervation increases sinus rate and improves symptoms in non-elderly patients with symptomatic long-standing SB, thus, potentially serving as an alternative to pacemaker implantation.
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Affiliation(s)
- Liang Zhao
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, 241 West Huaihai Road, Shanghai, 200030, China
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Lau DH, Volders PGA, Kohl P, Prinzen FW, Zaza A, Kaab S, Oto A, Schotten U. Opportunities and challenges of current electrophysiology research: a plea to establish 'translational electrophysiology' curricula. Europace 2015; 17:825-33. [DOI: 10.1093/europace/euu301] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Estes NAM. Examining Achilles' heel: improving response rates with cardiac resynchronization therapy. JACC Cardiovasc Imaging 2014; 7:1249-50. [PMID: 25496543 DOI: 10.1016/j.jcmg.2014.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 09/25/2014] [Indexed: 10/24/2022]
Affiliation(s)
- N A Mark Estes
- New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, Massachusetts.
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Abstract
Most cardiovascular implantable electronic devices (CIEDs) require a ventricular lead to be placed across the tricuspid valve. Tricuspid regurgitation (TR) is an understudied clinical complication of right ventricular lead implantation and its clinical significance is unknown. We review the incidence, predictors, and current management of TR as a complication of ventricular lead implantation. Emerging technologies, including leadless pacing devices and subcutaneous systems, offer the benefit of little or none tricuspid valve disruption.
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Takeuchi D, Tomizawa Y. Cardiac strangulation from epicardial pacemaker leads: diagnosis, treatment, and prevention. Gen Thorac Cardiovasc Surg 2014; 63:22-9. [DOI: 10.1007/s11748-014-0483-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 09/28/2014] [Indexed: 10/24/2022]
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Nattel S, Andrade J, Macle L, Rivard L, Dyrda K, Mondesert B, Khairy P. New directions in cardiac arrhythmia management: present challenges and future solutions. Can J Cardiol 2014; 30:S420-30. [PMID: 25432137 DOI: 10.1016/j.cjca.2014.09.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 09/25/2014] [Accepted: 09/26/2014] [Indexed: 12/19/2022] Open
Abstract
Cardiac arrhythmias are a major contributor to population morbidity and mortality. Enormous advances in arrhythmia management have occurred over the 60 years since the founding of the Montreal Heart Institute, but important challenges remain. The purpose of this article is to identify the areas of cardiac arrhythmia therapy that need improvement and to discuss the evolving approaches that promise solutions. Challenges in diagnosis, detection, and risk-stratification include difficulties in separating benign from high-risk syncope and pinpointing the underlying causes, the detection of silent atrial fibrillation in patients at risk of stroke, and inadequate identification of sudden-death risk. Implantable devices are limited by the need for battery and device replacements, device complications like infection and dysfunction, and lead complications like fracture, infection, or displacement. Antiarrhythmic drug therapy, although widely used, is plagued by a very limited range of available agents, supply issues, insufficient efficacy, and significant adverse effect risk. Health economic concerns include the high cost of new technologies, challenges in establishing cost effectiveness, and restrictive practices of government or third-party payers. Major improvements in arrhythmia management can be expected from new discoveries and technological developments in genetics, innovative diagnostic tools for arrhythmia monitoring, imaging and analysis, new approaches to antiarrhythmic drug development, biological therapies, and continuing improvement in implantable device technology like further miniaturization, leadless technology, and use of novel energy sources. As exciting as the developments in arrhythmia management have been in the past, we can look forward to exponential improvement in our ability to manage arrhythmia patients in the near future.
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Affiliation(s)
- Stanley Nattel
- Research Center and Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.
| | - Jason Andrade
- Research Center and Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Laurent Macle
- Research Center and Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Lena Rivard
- Research Center and Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Katia Dyrda
- Research Center and Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Blandine Mondesert
- Research Center and Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Paul Khairy
- Research Center and Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
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Abstract
PURPOSE OF REVIEW To consider the case of need that underpinned the development of the subcutaneous implantable cardioverter-defibrillator (SICD), the preclinical and clinical data obtained so far, its current role and likely future. RECENT FINDINGS The data from prospective clinical evaluation of the device demonstrated safety and efficacy leading to Food and Drug Administration approval. This superseded earlier reports from Europe that raised some clinical concerns, previously anticipated through the introduction of new technology. Recent estimates indicate maybe 55% of patients in routine clinical practice needing an ICD are potentially suitable for a subcutaneous device. SUMMARY The SICD provides a useful alternative for high-energy (ICD) therapy in those deemed at risk and who need defibrillation and in whom there are no indications for cardiac resynchronization, bradycardia support or antitachycardia pacing. There is the possibility of both higher specificity and the avoidance of myo-cellular damage with shock delivery, and if these two aspects play out subcutaneous defibrillation could become an option of choice in many settings.
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58
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Almendral J, Pombo M, Martínez-Alday J, González-Rebollo JM, Rodríguez-Font E, Martínez-Ferrer J, Castellanos E, García-Fernández FJ, Ruiz-Mateas F. Update on arrhythmias and cardiac pacing 2013. ACTA ACUST UNITED AC 2014; 67:294-304. [PMID: 24774592 DOI: 10.1016/j.rec.2013.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 12/12/2013] [Indexed: 11/19/2022]
Abstract
This report discusses a selection of the most relevant articles on cardiac arrhythmias and pacing published in 2013. The first section discusses arrhythmias, classified as regular paroxysmal supraventricular tachyarrhythmias, atrial fibrillation, and ventricular arrhythmias, together with their treatment by means of an implantable cardioverter defibrillator. The next section reviews cardiac pacing, subdivided into resynchronization therapy, remote monitoring of implantable devices, and pacemakers. The final section discusses syncope.
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Affiliation(s)
- Jesús Almendral
- Unidad de Arritmias, Centro Integral de Enfermedades Cardiovasculares, Grupo HM Hospitales, Universidad CEU San Pablo, Madrid, Spain.
| | - Marta Pombo
- Unidad de Estimulación Cardiaca, Área de Cardiología, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - Jesús Martínez-Alday
- Unidad de Arritmias, Servicio de Cardiología, Hospital de Basurto, Bilbao, Vizcaya, Spain
| | - José M González-Rebollo
- Unidad de Arritmias, Servicio de Cardiología, Complejo Asistencial Universitario de León, León, Spain
| | - Enrique Rodríguez-Font
- Unidad de Arritmias, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - José Martínez-Ferrer
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario de Araba, Vitoria, Álava, Spain
| | - Eduardo Castellanos
- Unidad de Arritmias, Centro Integral de Enfermedades Cardiovasculares, Grupo HM Hospitales, Universidad CEU San Pablo, Madrid, Spain
| | | | - Francisco Ruiz-Mateas
- Unidad de Estimulación Cardiaca, Área de Cardiología, Hospital Costa del Sol, Marbella, Málaga, Spain
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Rademakers LM, van Gelder BM, Scheffer MG, Bracke FA. Mid-term follow up of thromboembolic complications in left ventricular endocardial cardiac resynchronization therapy. Heart Rhythm 2014; 11:609-13. [DOI: 10.1016/j.hrthm.2014.01.031] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Indexed: 12/01/2022]
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60
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Almendral J, Pombo M, Martínez-Alday J, González-Rebollo JM, Rodríguez-Font E, Martínez-Ferrer J, Castellanos E, García-Fernández FJ, Ruiz-Mateas F. Novedades en arritmias y estimulación cardiaca en 2013. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.12.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Reddy VY, Knops RE, Sperzel J, Miller MA, Petru J, Simon J, Sediva L, de Groot JR, Tjong FVY, Jacobson P, Ostrosff A, Dukkipati SR, Koruth JS, Wilde AAM, Kautzner J, Neuzil P. Permanent leadless cardiac pacing: results of the LEADLESS trial. Circulation 2014; 129:1466-71. [PMID: 24664277 DOI: 10.1161/circulationaha.113.006987] [Citation(s) in RCA: 198] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Conventional cardiac pacemakers are associated with several potential short- and long-term complications related to either the transvenous lead or subcutaneous pulse generator. We tested the safety and clinical performance of a novel, completely self-contained leadless cardiac pacemaker. METHODS AND RESULTS The primary safety end point was freedom from complications at 90 days. Secondary performance end points included implant success rate, implant time, and measures of device performance (pacing/sensing thresholds and rate-responsive performance). The mean age of the patient cohort (n=33) was 77±8 years, and 67% of the patients were male (n=22/33). The most common indication for cardiac pacing was permanent atrial fibrillation with atrioventricular block (n=22, 67%). The implant success rate was 97% (n=32). Five patients (15%) required the use of >1 leadless cardiac pacemaker during the procedure. One patient developed right ventricular perforation and cardiac tamponade during the implant procedure, and eventually died as the result of a stroke. The overall complication-free rate was 94% (31/33). After 3 months of follow-up, the measures of pacing performance (sensing, impedance, and pacing threshold) either improved or were stable within the accepted range. CONCLUSIONS In a prospective nonrandomized study, a completely self-contained, single-chamber leadless cardiac pacemaker has shown to be safe and feasible. The absence of a transvenous lead and subcutaneous pulse generator could represent a paradigm shift in cardiac pacing. CLINICAL TRIAL REGISTRATION URL http://clinicaltrials.gov. Unique identifier: NCT01700244.
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Affiliation(s)
- Vivek Y Reddy
- Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY (V.Y.R., M.A.M., S.R.D., J.S.K.); Department of Cardiology, Academic Medical Center, University of Amsterdam, The Netherlands (R.E.K., J.R.d.G., A.A.M.W.); Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany (J.S.); Cardiology Department, Homolka Hospital, Prague, Czech Republic (J.P., J.S., L.S., P.N.); Nanostim, Inc, Sunnyvale, CA (P.J., A.O.); Department of Cardiology, Institute of Clinical and Experimental Medicine - IKEM, Prague, Czech Republic (J.K.)
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Sohal M, Chen Z, Sammut E, Jackson T, Behar J, Carr-White G, Razavi R, Rinaldi CA. New developments in the delivery of cardiac resynchronization therapy: targeted lead placement, multi-site and endocardial pacing. Expert Rev Med Devices 2014; 11:295-304. [DOI: 10.1586/17434440.2014.885320] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Auricchio A, Delnoy PP, Butter C, Brachmann J, Van Erven L, Spitzer S, Moccetti T, Seifert M, Markou T, Laszo K, Regoli F, Ramos MA, Pasotti E, Scopigni F, Ramos MA, Hagne C, Siclari F, Demertzis S, Sinha A, Schalji M, Wellens HJJ, Padeletti L, Van Hemel N. Feasibility, safety, and short-term outcome of leadless ultrasound-based endocardial left ventricular resynchronization in heart failure patients: results of the Wireless Stimulation Endocardially for CRT (WiSE-CRT) study. Europace 2014; 16:681-8. [DOI: 10.1093/europace/eut435] [Citation(s) in RCA: 143] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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García-Orta R, Mahía-Casado P, Gómez de Diego JJ, Barba-Cosials J, Rodriguez-Palomares JF, Aguadé-Bruix S, Candell-Riera J. Novedades en imagen cardiaca 2013. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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65
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García-Orta R, Mahía-Casado P, Gómez de Diego JJ, Barba-Cosials J, Rodriguez-Palomares JF, Aguadé-Bruix S, Candell-Riera J. Update on cardiac imaging techniques 2013. ACTA ACUST UNITED AC 2014; 67:127-34. [PMID: 24795120 DOI: 10.1016/j.rec.2013.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 10/02/2013] [Indexed: 11/29/2022]
Abstract
Cardiac imaging is a cornerstone of diagnosis in heart conditions, and an essential tool for assessing prognosis and establishing treatment decisions. This year, echocardiography stands out as a guide in interventional procedures and in choosing the size of the prosthesis. It is also proving to be a valuable technique in low-flow, low-gradient aortic stenosis. Three-dimensional echocardiography is advancing our knowledge of cardiac anatomy and valvular measurements. The parameters indicating tissue deformation have predictive power in valve disease and in the follow-up of drug-induced cardiotoxicity. Single-photon emission computed tomography and positron emission tomography are proving useful in ischemic heart disease and in the diagnosis of cardiac inflammation and infections. The role of computed tomography has been strengthened in noninvasive coronary angiography, the emergency room management of chest pain, assessment of chronic occlusions, and morphologic study of coronary plaque. Cardiac magnetic resonance imaging remains the gold standard for tissue characterization in ischemic heart disease and cardiomyopathies, and is assuming a greater role in stress studies and in the assessment of myocardial viability.
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Affiliation(s)
- Rocío García-Orta
- Servicio de Cardiología, Hospital Virgen de las Nieves, Granada, Spain.
| | | | | | - Joaquín Barba-Cosials
- Departamento de Cardiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | | | | | - Jaume Candell-Riera
- Servicio de Medicina Nuclear, Hospital Vall d'Hebron, Barcelona, Spain; Servicio de Cardiología, Hospital Vall d'Hebron, Barcelona, Spain
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Bongiorni MG, Proclemer A, Dobreanu D, Marinskis G, Pison L, Blomstrom-Lundqvist C, Blomstrom-Lundqvist C, Bongiorni MG, Chen J, Dagres N, Estner H, Hernandez-Madrid A, Hocini M, Larsen TB, Pison L, Potpara T, Proclemer A, Sciraffia E, Todd D. Preferred tools and techniques for implantation of cardiac electronic devices in Europe: results of the European Heart Rhythm Association survey. Europace 2013; 15:1664-8. [DOI: 10.1093/europace/eut345] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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