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Akerström F, Arias MA, Pachón M, Puchol A, Jiménez-López J, Rodríguez-Padial L. The reverse mode switch algorithm: how well does it work? Heart Rhythm 2013; 10:1146-52. [PMID: 23732226 DOI: 10.1016/j.hrthm.2013.05.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND The performance of the Reverse Mode Switch (RMS) algorithm, aimed at minimizing right ventricular pacing by operating in the AAI(R) mode with switch to the DDD(R) mode if atrioventricular (AV) conduction loss is detected, is not well known. OBJECTIVE To determine the appropriateness of the RMS episodes available from patient follow-up data at our center. METHODS Patients with the TELIGEN dual-chamber implantable cardioverter-defibrillator and the RMS algorithm activated were identified. The RMS episodes with available electrograms were analyzed and classified as appropriate (AV conduction loss) or inappropriate (non-AV conduction loss) events. Cumulative percentage of ventricular pacing and amount of premature ventricular complexes (PVCs) were recorded. RESULTS Of 21 patients, RMS episodes had occurred in 19 of them, with a mean of 527 episodes per month. Of the 172 RMS episodes available for analysis, 27 (16%) were classified as appropriate and 145 (84%) as inappropriate. Almost all (91%) inappropriate RMS episodes were due to PVC, and there was a positive correlation between the number of total RMS episodes per month and the number of PVCs per month (P < .0005). Considering patients with only inappropriate RMS episodes (n = 11), there was a positive correlation between the percentage of ventricular pacing and the number of RMS episodes per month (P < .05). CONCLUSIONS A large majority of the RMS episodes available for analysis inappropriately triggered switch from the AAI(R) mode to the DDD(R) mode owing to PVCs. Patients with the RMS algorithm and elevated PVC burden are probably at risk of a high percentage of unnecessary right ventricular pacing.
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Affiliation(s)
- Finn Akerström
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de Salud, Toledo, Spain
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DeMazumder D, Lake DE, Cheng A, Moss TJ, Guallar E, Weiss RG, Jones SR, Tomaselli GF, Moorman JR. Dynamic analysis of cardiac rhythms for discriminating atrial fibrillation from lethal ventricular arrhythmias. Circ Arrhythm Electrophysiol 2013; 6:555-61. [PMID: 23685539 DOI: 10.1161/circep.113.000034] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Implantable cardioverter-defibrillators (ICDs), the first line of therapy for preventing sudden cardiac death in high-risk patients, deliver appropriate shocks for termination of ventricular tachycardia (VT)/ventricular fibrillation. A common shortcoming of ICDs is imperfect rhythm discrimination, resulting in the delivery of inappropriate shocks for atrial fibrillation (AF). An underexplored area for rhythm discrimination is the difference in dynamic properties between AF and VT/ventricular fibrillation. We hypothesized that the higher entropy of rapid cardiac rhythms preceding ICD shocks distinguishes AF from VT/ventricular fibrillation. METHODS AND RESULTS In a multicenter, prospective, observational study of patients with primary prevention ICDs, 119 patients received shocks from ICDs with stored, retrievable intracardiac electrograms. Blinded adjudication revealed shocks were delivered for VT/ventricular fibrillation (62%), AF (23%), and supraventricular tachycardia (15%). Entropy estimation of only 9 ventricular intervals before ICD shocks accurately distinguished AF (receiver operating characteristic curve area, 0.98; 95% confidence intervals, 0.93-1.0) and outperformed contemporary ICD rhythm discrimination algorithms. CONCLUSIONS This new strategy for AF discrimination based on entropy estimation expands on simpler concepts of variability, performs well at fast heart rates, and has potential for broad clinical application.
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Affiliation(s)
- Deeptankar DeMazumder
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
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Peterson PN, Varosy PD, Heidenreich PA, Wang Y, Dewland TA, Curtis JP, Go AS, Greenlee RT, Magid DJ, Normand SLT, Masoudi FA. Association of single- vs dual-chamber ICDs with mortality, readmissions, and complications among patients receiving an ICD for primary prevention. JAMA 2013; 309:2025-34. [PMID: 23677314 PMCID: PMC3752924 DOI: 10.1001/jama.2013.4982] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Randomized trials of implantable cardioverter-defibrillators (ICDs) for primary prevention predominantly used single-chamber devices. In clinical practice, patients often receive dual-chamber ICDs, even without clear indications for pacing. The outcomes of dual- vs single-chamber devices are uncertain. OBJECTIVE To compare outcomes of single- and dual-chamber ICDs for primary prevention of sudden cardiac death. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of admissions in the National Cardiovascular Data Registry's (NCDR) ICD registry from 2006-2009 that could be linked to Centers for Medicare & Medicaid Services fee-for-service Medicare claims data. Patients were included if they received an ICD for primary prevention and did not have a documented indication for pacing. MAIN OUTCOMES AND MEASURES Adjusted risks of 1-year mortality, all-cause readmission, heart failure readmission, and device-related complications within 90 days were estimated with propensity-score matching based on patient, clinician, and hospital factors. RESULTS Among 32,034 patients, 12,246 (38%) received a single-chamber device and 19,788 (62%) received a dual-chamber device. In a propensity-matched cohort, rates of complications were lower for single-chamber devices (3.51% vs 4.72%; P < .001; risk difference, -1.20 [95% CI, -1.72 to -0.69]), but device type was not significantly associated with 1-year mortality (unadjusted rate, 9.85% vs 9.77%; hazard ratio [HR], 0.99 [95% CI, 0.91 to 1.07]; P = .79), 1-year all-cause hospitalization (unadjusted rate, 43.86% vs 44.83%; HR, 1.00 [95% CI, 0.97-1.04]; P = .82), or hospitalization for heart failure (unadjusted rate, 14.73% vs 15.38%; HR, 1.05 [95% CI, 0.99-1.12]; P = .19). CONCLUSIONS AND RELEVANCE Among patients receiving an ICD for primary prevention without indications for pacing, the use of a dual-chamber device compared with a single-chamber device was associated with a higher risk of device-related complications and similar 1-year mortality and hospitalization outcomes. Reasons for preferentially using dual-chamber ICDs in this setting remains unclear.
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Affiliation(s)
- Pamela N Peterson
- Department of Medicine, Denver Health Medical Center, 777 Bannock St, MC 0960, Denver, CO 80204, USA.
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Sood N, Crespo E, Friedman M, Guertin D, Zweibel S, Kluger J, Clyne CA. Predictors of pacemaker dependence and pacemaker dependence as a predictor of mortality in patients with implantable cardioverter defibrillator. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:945-51. [PMID: 23668483 DOI: 10.1111/pace.12164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 02/26/2013] [Accepted: 03/01/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND The prevalence, predictors, and survival for the development of pacemaker dependence (PD) in patients implanted with an implantable cardioverter defibrillator (ICD) are unknown. METHODS This was a retrospective analysis of 1,550 consecutive patients with ICD implantation at a single center from 1996 to 2008 with a mean of 4.2 ± 3.4 years. Patients with implant intrinsic heart rates less than 40 beats/min (n = 48) and cardiac resynchronization therapy (n = 444) were excluded leaving 1,058 patients in this study. PD was defined as an intrinsic rhythm <40 beats/min after inhibiting the pacemaker, <50 beats/min with transient symptoms of dizziness relieved by resumption of pacing and right ventricle pacing despite algorithms to promote intrinsic conduction at the 3 monthly follow-up ICD clinic visits. Multivariate regression and Cox proportional hazard models were used for analysis. RESULTS The mean age was 64 ± 13 years; 79% were male with a primary indication for the ICD in 57%. PD occurred in 142 (13.4%) of patients, with a mean time to PD of 2.6 ± 1.9 years. PD was associated with a 48% increased odds for mortality versus non-PD ICD patients during the mean follow-up time of 4.2 ± 3.4 years (adjusted odds ratio = 1.48 [95% confidence interval 1.080-2.042]; P = 0.015). Older age, a history of atrial fibrillation, amiodarone use, and secondary prevention were the strongest predictors for the development of PD. CONCLUSIONS In this single-center ICD cohort, the development of PD was not uncommon and was associated with decreased survival.
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Affiliation(s)
- Nitesh Sood
- Division of Cardiology, Lahey Clinic, Burlington, Massachusetts, USA
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Schuger C, Daubert JP, Brown MW, Cannom D, Estes NAM, Hall WJ, Kayser T, Klein H, Olshansky B, Power KA, Wilber D, Zareba W, Moss AJ. Multicenter automatic defibrillator implantation trial: reduce inappropriate therapy (MADIT-RIT): background, rationale, and clinical protocol. Ann Noninvasive Electrocardiol 2012; 17:176-85. [PMID: 22816536 DOI: 10.1111/j.1542-474x.2012.00531.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The implantable cardioverter defibrillator (ICD) is highly effective in reducing mortality due to cardiac arrhythmias in high-risk cardiac patients. However, inappropriate therapies caused predominantly by supraventricular tachyarrhythmias (SVTs) remain a significant side effect of ICD therapy despite medical treatment, affecting 8-40% of patients. The MADIT-RIT is a global, prospective, randomized, nonblinded, three-arm, multicenter clinical investigation to be performed in the Unites States, Europe, Canada, Israel and Japan, and will utilize approximately 90 centers with plan to enroll 1500 patients programmed to three treatment arms. The objective of the MADIT-RIT trial is to determine if dual-chamber ICD or CRT-D devices with high rate cutoff (MADIT-RIT-Arm B) and/or long delay in combination with detection enhancements (MADIT-RIT-Arm C) are associated with fewer patients experiencing inappropriate therapies than standard programming (MADIT-RIT-Arm A) during postimplant follow-up of patients with indication for primary prevention device therapy. This paper describes design and analytic plan for the MADIT-RIT trial.
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Affiliation(s)
- Claudio Schuger
- Department of Electrophysiology, Henry Ford Hospital, Detroit, MI 48202, USA.
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Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Tracy CM, Epstein AE, Darbar D, DiMarco JP, Dunbar SB, Estes NAM, Ferguson TB, Hammill SC, Karasik PE, Link MS, Marine JE, Schoenfeld MH, Shanker AJ, Silka MJ, Stevenson LW, Stevenson WG, Varosy PD. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2012; 61:e6-75. [PMID: 23265327 DOI: 10.1016/j.jacc.2012.11.007] [Citation(s) in RCA: 560] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation 2012; 127:e283-352. [PMID: 23255456 DOI: 10.1161/cir.0b013e318276ce9b] [Citation(s) in RCA: 378] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Recommendations for the Programming of Implantable Cardioverter-Defibrillators in New Zealand. Heart Lung Circ 2012; 21:765-77. [DOI: 10.1016/j.hlc.2012.07.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 07/17/2012] [Accepted: 07/21/2012] [Indexed: 11/23/2022]
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Gillis AM, Russo AM, Ellenbogen KA, Swerdlow CD, Olshansky B, Al-Khatib SM, Beshai JF, McComb JM, Nielsen JC, Philpott JM, Shen WK. HRS/ACCF Expert Consensus Statement on Pacemaker Device and Mode Selection. J Am Coll Cardiol 2012; 60:682-703. [DOI: 10.1016/j.jacc.2012.06.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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MARTIN DAVIDO, DAY JOHND, LAI PETERY, MURPHY ALLANL, NAYAK HEMALM, VILLAREAL ROLLOP, WEINER STANISLAV, KRAUS STACIAM, STOLEN KIRAQ, GOLD MICHAELR. Atrial Support Pacing in Heart Failure: Results from the Multicenter PEGASUS CRT Trial. J Cardiovasc Electrophysiol 2012; 23:1317-25. [DOI: 10.1111/j.1540-8167.2012.02402.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Matlock DD, Peterson PN, Wang Y, Curtis JP, Reynolds MR, Varosy PD, Masoudi FA. Variation in use of dual-chamber implantable cardioverter-defibrillators: results from the national cardiovascular data registry. ACTA ACUST UNITED AC 2012; 172:634-41; discussion 641. [PMID: 22529229 DOI: 10.1001/archinternmed.2012.394] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Among patients without an indication for a pacemaker, current evidence is inconclusive whether a dual-chamber implantable cardioverter-defibrillator (ICD) is superior to a single-chamber ICD. The current use of dual-chamber ICDs is not well characterized. METHODS We conducted a cross-sectional study exploring hospital-level variation in the use of dual-chamber ICDs across the United States. Patients receiving a primary prevention ICD from 2006 through 2009 without a documented indication for a pacemaker were included. Multivariate hierarchical logistic regression was used to explore patient, health care provider, and physician factors related to the use of a dual-chamber device. RESULTS Dual-chamber devices were implanted in 58% of the 87,115 patients without a pacing indication among 1293 hospitals, with hospital rates ranging from 0% in 33 centers to 100% in 109 centers. In multivariate analysis, geographic region was a strong independent predictor of dual-chamber device use, ranging from 36.4% in New England (reference region) to 66.4% in the Pacific region (odds ratio [OR], 5.25; 95% CI, 3.35-8.21). Hospital clustering was assessed using a median OR which was 3.96, meaning that 2 identical patients at different hospitals would have nearly a 4-fold difference in their chance of receiving a dual-chamber ICD. CONCLUSIONS Use of dual-chamber ICDs for the primary prevention of sudden cardiac death among patients without an indication for permanent pacing varies markedly at the hospital level in the United States. This is a clear example of how practice can vary independent of patient factors.
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Affiliation(s)
- Dan D Matlock
- Department of Medicine, University of Colorado Denver School of Medicine, Aurora, 80045, USA.
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Corcoran SJ, Davis LM. Cardiac Implantable Electronic Device Therapy for Bradyarrhythmias and Tachyarrhythmias. Heart Lung Circ 2012; 21:328-37. [DOI: 10.1016/j.hlc.2012.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 03/12/2012] [Accepted: 03/14/2012] [Indexed: 11/27/2022]
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Poghosyan HR, Jamalyan SV. Comparison of pacing algorithms to avoid unnecessary ventricular pacing in patients with sick sinus node syndrome: a single-centre, observational, parallel study. Europace 2012; 14:1483-9. [PMID: 22628453 DOI: 10.1093/europace/eur415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Reduction of unnecessary ventricular pacing (uVP) is an essential component in the treatment strategy in any pacing population in general. The aim of this study was to evaluate the efficacy of different algorithms to reduce uVP in an adult population with sick sinus syndrome (SSS) treated outside of clinical trials. Evaluation of the relationship between different types of pacing algorithms and clinical outcomes is also provided. METHODS AND RESULTS This was a single-centre, observational, parallel study, based on retrospective analysis of the Arrhythmology Cardiology Center of Armenia electronic clinical database. This study evaluated atrial pacing percentage (AP%), ventricular pacing percentage (VP%), and the incidence of atrial high rate episodes in 56 patients with SSS using three different pacing strategies: managed VP, search atrioventricular (AV), and fixed long AV. We did not find statistically significant differences in the amount of VP between the groups. Although the atrial high rate percentage (AHR%) tended to be higher in the fixed long AV group, this difference was not statistically significant. Mean VP% and AP% were similar in all three groups. CONCLUSIONS In our study, all three programmed strategies produced the same mean AP% and VP%, and were equally efficient in uVP reduction. There was no relationship between chosen algorithms and the incidence of pacemaker syndrome, hospitalizations, or change in New York Heart Association class. The percentage of AHR was not associated with pacing strategy or co-morbidities but showed borderline correlation with left atrial size.
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Pacemaker-mediated tachycardia initiated by an atrioventricular search algorithm to minimize right ventricular pacing. J Electrocardiol 2012; 45:336-9. [DOI: 10.1016/j.jelectrocard.2011.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Indexed: 11/23/2022]
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SISTI ANTONIODE, MÁRQUEZ MANLIOF, TONET JOELCI, BONNY AIM, FRANK ROBERT, HIDDEN-LUCET FRANÇOISE. Adverse Effects of Long-Term Right Ventricular Apical Pacing and Identification of Patients at Risk of Atrial Fibrillation and Heart Failure. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:1035-43. [DOI: 10.1111/j.1540-8159.2012.03371.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Němec J. Antitachycardia pacing or shock therapy—trick or treat? Heart Rhythm 2012; 9:359-60. [DOI: 10.1016/j.hrthm.2011.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Indexed: 11/25/2022]
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Sullivan RM, Russo AM, Berg KC, Stolen KQ, Seth M, Perschbacher D, Day JD, Olshansky B. Arrhythmia rate distribution and tachyarrhythmia therapy in an ICD population: Results from the INTRINSIC RV trial. Heart Rhythm 2012; 9:351-8. [DOI: 10.1016/j.hrthm.2011.10.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 10/13/2011] [Indexed: 11/28/2022]
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Arrhythmia discrimination by physician and defibrillator: Importance of atrial channel. Int J Cardiol 2012; 154:134-40. [DOI: 10.1016/j.ijcard.2010.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 07/02/2010] [Accepted: 09/05/2010] [Indexed: 11/19/2022]
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Right Ventricular Pacing, Mechanical Dyssynchrony, and Heart Failure. J Cardiovasc Transl Res 2011; 5:219-31. [DOI: 10.1007/s12265-011-9341-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 12/11/2011] [Indexed: 11/25/2022]
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Jones DG, Mortsell DH, Rajaruthnam D, Hamour I, Hussain W, Markides V, Banner NR, Wong T. Permanent pacemaker implantation early and late after heart transplantation: Clinical indication, risk factors and prognostic implications. J Heart Lung Transplant 2011; 30:1257-65. [DOI: 10.1016/j.healun.2011.05.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 05/21/2011] [Accepted: 05/28/2011] [Indexed: 10/18/2022] Open
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Dewland TA, Pellegrini CN, Wang Y, Marcus GM, Keung E, Varosy PD. Dual-chamber implantable cardioverter-defibrillator selection is associated with increased complication rates and mortality among patients enrolled in the NCDR implantable cardioverter-defibrillator registry. J Am Coll Cardiol 2011; 58:1007-13. [PMID: 21867834 DOI: 10.1016/j.jacc.2011.04.039] [Citation(s) in RCA: 132] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Revised: 03/23/2011] [Accepted: 04/27/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to compare single- versus dual-chamber implantable cardioverter-defibrillator (ICD) implantation and complication rates in a large, real-world population. BACKGROUND The majority of patients enrolled in ICD efficacy trials received single-chamber devices. Although dual-chamber ICDs offer theoretical advantages over single-chamber defibrillators, the clinical superiority of dual-chamber models has not been conclusively proven, and they may increase complications. METHODS The National Cardiovascular Data Registry ICD Registry was used to examine the association between baseline characteristics and device selection in 104,049 patients receiving single- and dual-chamber ICDs between January 1, 2006, and December 31, 2007. A longitudinal cohort design was then used to determine in-hospital complication rates. RESULTS Dual-chamber devices were implanted in 64,489 patients (62%). Adverse events were more frequent with dual-chamber than with single-chamber device implantation (3.17% vs. 2.11%, p < 0.001), as was the rate of in-hospital mortality (0.40% vs. 0.23%, p < 0.001). After adjusting for demographics, medical comorbidities, diagnostic test data, and ICD indication, the odds of any complication (odds ratio: 1.40; 95% confidence interval: 1.28 to 1.52; p < 0.001) and in-hospital mortality (odds ratio: 1.45; 95% confidence interval: 1.20 to 1.74; p < 0.001) were increased with dual-chamber versus single-chamber ICD implantation. CONCLUSIONS In this large, multicenter cohort of patients, dual-chamber ICD use was common. Dual-chamber device implantation was associated with increases in periprocedural complications and in-hospital mortality compared with single-chamber defibrillator selection.
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Affiliation(s)
- Thomas A Dewland
- Division of Cardiology, University of California-San Francisco, CA, USA
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Abstract
Cardiac pacing has played a significant role in mitigating morbidity and mortality associated with bradyarrhythmias. Throughout the years, advances made in battery reliability, lead performance, and device portability have rapidly expanded the use of cardiac pacemakers in many different disease states. Despite the benefits, there has been growing awareness of the potential deleterious effects of long-term artificial electrical stimulation including the development of ventricular dyssynchrony and atrial fibrillation. Given their association with an increased risk for heart failure and possibly death, several advances aimed at minimizing them have been made in recent years including changes in atrioventricular pacing algorithms, novel pacing mode modifications, and better identification of hemodynamically optimal pacing sites. This article reviews the advances made and the future direction of innovations in cardiac pacing.
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Affiliation(s)
- Alan Cheng
- Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, Johns Hopkins Medical Institutes, Baltimore, MD, USA.
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Stockburger M, Krebs A, Celebi O, Nitardy A, Habedank D, Knaus T, Rauchhaus M, Dietz R. Long-Term Survival of Routine Implantable Cardioverter/Defibrillator Recipients Appears to be Significantly Impaired with Concomitant Diuretics and Improved with Aldosterone Antagonists. Cardiovasc Ther 2011; 29:243-50. [DOI: 10.1111/j.1755-5922.2009.00127.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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Kolb C, Tzeis S, Andrikopoulos G, Asbach S, Lemke B, Hansen C, Deisenhofer I, Zrenner B, Birkenhauer F, Vardas PE. Rationale and design of the SPICE study—septal positioning of ventricular ICD electrodes. J Interv Card Electrophysiol 2011; 31:247-54. [DOI: 10.1007/s10840-011-9575-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Accepted: 04/04/2011] [Indexed: 10/18/2022]
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Robinson MR, Epstein AE, Callans DJ. Secondary prevention in heart failure. Heart Fail Clin 2011; 7:185-94, vii-viii. [PMID: 21439497 DOI: 10.1016/j.hfc.2010.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although most recent investigations into sudden cardiac death prevention in heart failure patients have been focused on primary prevention, secondary indications for defibrillators and medical therapy remain vitally important in this complex patient group. Antiarrhythmic therapy is currently used primarily as adjuvant therapy to implantable defibrillators. Secondary prophylaxis defibrillator trials have shown clear benefit in preventing recurrent sudden cardiac death, despite concern over inappropriate shocks and the potential detrimental effects of appropriate shocks. Device programming for secondary prophylaxis can help ameliorate these issues. This article discusses these issues as well as the continued underuse of defibrillators in specific populations.
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Affiliation(s)
- Melissa R Robinson
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Founders Pavilion, 3400 Spruce Street, Philadelphia, PA 19104, USA
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KOLB CHRISTOF, SCHMIDT ROLAND, DIETL JOSEFU, WEYERBROCK SONJA, MORGENSTERN MARTIN, FLECKENSTEIN MARTIN, BEIER THOMAS, VON BARY CHRISTIAN, MACKES KARLG, WIDMAIER JOCHEN, KREUZER JÖRG, SEMMLER VERENA, ZRENNER BERNHARD. Reduction of Right Ventricular Pacing with Advanced Atrioventricular Search Hysteresis: Results of the PREVENT Study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:975-83. [DOI: 10.1111/j.1540-8159.2011.03075.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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80
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Choy AM, Su HHM, Elder DHJ, Noman A, Pauriah M, Struthers AD, Lang CC. Right ventricular pacing impairs endothelial function in man. Europace 2011; 13:853-8. [DOI: 10.1093/europace/eur028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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81
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Older Persons with Diabetes Receive Fewer Inappropriate ICD Shocks: Results from the INTRINSIC RV Trial. J Cardiovasc Transl Res 2010; 4:27-34. [DOI: 10.1007/s12265-010-9236-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Accepted: 10/28/2010] [Indexed: 10/18/2022]
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82
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Braunschweig F, Boriani G, Bauer A, Hatala R, Herrmann-Lingen C, Kautzner J, Pedersen SS, Pehrson S, Ricci R, Schalij MJ. Management of patients receiving implantable cardiac defibrillator shocks: Recommendations for acute and long-term patient management. Europace 2010; 12:1673-90. [PMID: 20974757 DOI: 10.1093/europace/euq316] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Frieder Braunschweig
- Department of Cardiology, Karolinska University Hospital, S-171 76 Stockholm, Stockholm, Sweden.
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83
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Soonawala D, Middelburg RA, Egger M, Vandenbroucke JP, Dekkers OM. Efficacy of experimental treatments compared with standard treatments in non-inferiority trials: a meta-analysis of randomized controlled trials. Int J Epidemiol 2010; 39:1567-81. [DOI: 10.1093/ije/dyq136] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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84
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KOLB CHRISTOF, TZEIS STYLIANOS, STURMER MARCIO, BABUTY DOMINIQUE, SCHWAB JÖRGO, MANTOVANI GIUSEPPE, JANKO SABINE, AIMÉ EZIO, OCKLENBURG ROLF, SICK PETER. Rationale and Design of the OPTION Study: Optimal Antitachycardia Therapy in ICD Patients without Pacing Indications. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:1141-8. [DOI: 10.1111/j.1540-8159.2010.02790.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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85
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Sweeney MO, Ellenbogen KA, Tang ASL, Whellan D, Mortensen PT, Giraldi F, Sandler DA, Sherfesee L, Sheldon T. Atrial pacing or ventricular backup-only pacing in implantable cardioverter-defibrillator patients. Heart Rhythm 2010; 7:1552-60. [PMID: 20685401 DOI: 10.1016/j.hrthm.2010.05.038] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Accepted: 05/27/2010] [Indexed: 12/27/2022]
Abstract
BACKGROUND The need for pacing support in typical ICD patients is unknown. OBJECTIVE This study sought to determine whether atrial pacing with ventricular backup pacing is equivalent to ventricular backup pacing only in implantable cardioverter-defibrillator (ICD) patients. METHODS We randomized 1,030 patients from 84 sites with indications for ICDs, with sinus rhythm, and without symptomatic bradycardia to atrial pacing with ventricular backup at 60 beats/min (518) or ventricular backup pacing at 40 beats/min (512). The primary end points were time to death, heart failure hospitalization (HFH), and heart failure-related urgent care (HFUC). RESULTS Follow-up was 2.4 ± 0.8 years when the trial was stopped for futility. There were 355 end point events (103 deaths, 252 HFH/HFUC) in 194 patients favoring ventricular backup pacing (event-free rate 77.7% vs. 80.3% for atrial pacing at 30 months; hazard ratio 1.14, upper confidence bound 1.59, prespecified noninferiority threshold 1.21), therefore equivalence between pacing arms was not demonstrated. Overall HFH/HFUC rates were slightly higher during atrial pacing (event-free rate 85.4% vs. 86.4% for ventricular backup pacing). Exploratory analyses revealed that the difference in HFH/HFUC rates was largely seen in patients with a PR interval ≥230 ms. There were no differences between groups for atrial fibrillation, ventricular tachycardia/ventricular fibrillation, quality of life, or echocardiographic measurements. Fewer patients in the atrial pacing group were reported to develop an indication for bradycardia pacing (3.7% vs. 7.3%, P = .0053). CONCLUSION Equivalence between atrial pacing and ventricular backup pacing only could not be demonstrated. CLINICAL TRIALS IDENTIFIER NCT00281099.
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Affiliation(s)
- Michael O Sweeney
- Cardiac Pacing and Heart Failure Device Therapies, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
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86
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Murakami Y, Tsuboi N, Inden Y, Yoshida Y, Murohara T, Ihara Z, Takami M. Difference in percentage of ventricular pacing between two algorithms for minimizing ventricular pacing: results of the IDEAL RVP (Identify the Best Algorithm for Reducing Unnecessary Right Ventricular Pacing) study. Europace 2010; 12:96-102. [PMID: 19762332 PMCID: PMC2793021 DOI: 10.1093/europace/eup252] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
AIMS Managed ventricular pacing (MVP) and Search AV+ are representative dual-chamber pacing algorithms for minimizing ventricular pacing (VP). This randomized, crossover study aimed to examine the difference in ability to reduce percentage of VP (%VP) between these two algorithms. METHODS AND RESULTS Symptomatic bradyarrhythmia patients implanted with a pacemaker equipped with both algorithms (Adapta DR, Medtronic) were enrolled. The %VPs of the patients during two periods were compared: 1 month operation of either one of the two algorithms for each period. All patients were categorized into subgroups according to the atrioventricular block (AVB) status at baseline: no AVB (nAVB), first-degree AVB (1AVB), second-degree AVB (2AVB), episodic third-degree AVB (e3AVB), and persistent third-degree AVB (p3AVB). Data were available from 127 patients for the analysis. For all patient subgroups, except for p3AVB category, the median %VPs were lower during the MVP operation than those during the Search AV+ (nAVB: 0.2 vs. 0.8%, P < 0.0001; 1AVB: 2.3 vs. 27.4%, P = 0.001; 2AVB: 16.4% vs. 91.9%, P = 0.0052; e3AVB: 37.7% vs. 92.7%, P = 0.0003). CONCLUSION Managed ventricular pacing algorithm, when compared with Search AV+, offers further %VP reduction in patients implanted with a dual-chamber pacemaker, except for patients diagnosed with persistent loss of atrioventricular conduction.
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Affiliation(s)
- Yoshimasa Murakami
- Cardiovascular Center, Higashi Municipal Hospital, City of Nagoya, 1-2-23 Wakamizu, Chikusa-ku, Nagoya 464-8547, Japan.
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87
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Martinelli Filho M, de Siqueira SF, Costa R, Greco OT, Moreira LF, D'avila A, Heist EK. Conventional versus biventricular pacing in heart failure and bradyarrhythmia: the COMBAT study. J Card Fail 2010; 16:293-300. [PMID: 20350695 DOI: 10.1016/j.cardfail.2009.12.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Revised: 11/30/2009] [Accepted: 12/10/2009] [Indexed: 02/06/2023]
Abstract
BACKGROUND Worsening in clinical and cardiac status has been noted after chronic right ventricular pacing, but it is uncertain whether atriobiventricular (BiVP) is preferable to atrio-right ventricular pacing (RVP). Conventional versus Multisite Pacing for BradyArrhythmia Therapy study (COMBAT) sought to compare BiVP versus RVP in patients with symptomatic heart failure (HF) and atrioventricular (AV) block. METHODS AND RESULTS COMBAT is a prospective multicenter randomized double blind crossover study. Patients with New York Heart Association functional class (FC) II-IV, left ventricular ejection fraction (LVEF) <40%, and AV block as an indication for pacing were enrolled. All patients underwent biventricular system implantation and then were randomized to receive successively (group A) RVP-BiVP-RVP, or (group B) BiVP-RVP-BiVP. At the end of each 3-month crossover period, patients were evaluated according to Quality of Life (QoL), FC, echocardiographic parameters, 6-Minute Walk Test (6MWT), and peak oxygen consumption (VO(2 max)). Sixty patients were enrolled, and the mean follow-up period was 17.5 +/- 10.7 months. There were significant improvements in QoL, FC, LVEF, and left ventricular end-systolic volume with BiVP compared with RVP. The effects of pacing mode on 6MWT and VO(2 max) were not significantly different. Death occurred more frequently with RVP. CONCLUSION In patients with systolic HF and AV block requiring permanent ventricular pacing, BiVP is superior to RVP and should be considered the preferred pacing mode.
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Affiliation(s)
- Paul A. Levine
- Corresponding author. Tel: +1 818 493 2900, Fax: +1 818 362 2242,
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89
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Lian J, Garner G, Kratschmer H, Mussig D. Simulation of AV hysteresis pacing using an integrated dual chamber heart and pacer model. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2009; 2009:3932-5. [PMID: 19963804 DOI: 10.1109/iembs.2009.5333095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Long term right ventricular apical pacing has been known to have adverse effects in cardiac function. The AV hysteresis (AVH) is a feature existing in many dual-chamber cardiac pacemakers that aims to minimize the right ventricular pacing, but its clinical efficacy remains inconclusive due to conflicting evidence from different studies. We have recently developed a novel integrated dual-chamber heart and pacer (IDHP) model, which can simulate various interactions between intrinsic heart activity and extrinsic cardiac pacing. In this study, we use the IDHP model to simulate various atrio-ventricular (AV) conduction pathologies, and to investigate the effects of an AVH algorithm on reducing right ventricular pacing. Our results show that the efficacy of AVH is dependent on the underlying cardiac conditions. While it can preserve intrinsic conduction during minor or moderate first degree AV block, its efficacy is reduced at higher degree AV block conditions. This pilot study further supports using the IDHP model to design and evaluate more advanced pacemaker algorithms for therapeutic interventions.
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Affiliation(s)
- Jie Lian
- Micro Systems Engineering, Inc., Lake Oswego, OR 97035, USA.
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90
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Ahmadi-Kashani M, Kessler DJ, Day J, Bunch TJ, Stolen KQ, Brown S, Sbaity S, Olshansky B. Heart Rate Predicts Outcomes in an Implantable Cardioverter-Defibrillator Population. Circulation 2009; 120:2040-5. [DOI: 10.1161/circulationaha.108.847608] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Elevated heart rate (HR) is associated with adverse cardiovascular events and total mortality in the general population and in individuals with heart disease. Our hypothesis was that mean HR predicts total mortality and heart failure hospitalization in patients undergoing implantable cardioverter-defibrillator (ICD) implantation.
Methods and Results—
The Inhibition of Unnecessary RV Pacing With AV Search Hysteresis in ICDs (INTRINSIC RV) trial included 1530 patients undergoing ICD implantation. After implantation of a dual-chamber ICD, patients were followed for a mean of 10.4 months. The mean HR for 1436 patients over the follow-up period was determined from device histograms. Patients were grouped into strata by mean HR, and the relationship between the primary end point and mean HR was analyzed with Mantel-Haenszel ordinal χ
2
tests. Higher intrinsic (unpaced) HR was associated with greater risk of achieving the primary end point of death or heart failure hospitalization (
P
<0.001). Of patients with a mean HR <75 bpm, 5.8% died or were hospitalized for heart failure, whereas 20.9% with a mean HR >90 bpm achieved the same end point, a 3.6-fold difference (
P
<0.0001). In a multivariate model with the use of Cox regression, HR was a significant predictor with a hazard ratio of 1.34 (
P
=0.0001; 95% confidence interval, 1.19 to 1.50), as were age, New York Heart Association functional class, and percent right ventricular pacing, but it was independent of gender and β-blocker dosing. When considered as continuous or discrete variables grouped by 5-bpm increments, HR remained a significant predictor.
Conclusions—
In this ICD population, the mean intrinsic HR was strongly associated with outcomes.
Clinical Trial Registration—
http://www.clinicaltrials.gov. Identifier: NCT00148967.
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Affiliation(s)
- Mastaneh Ahmadi-Kashani
- From the University of Iowa Hospitals, Iowa City (M.A.-K., S.S., B.O.); Austin Heart PA, Austin, Tex (D.J.K.); Intermountain Medical Center, Murray, Utah (J.D., T.J.B.); Boston Scientific Corporation, St. Paul, Minn (K.S.); and The Integra Group, Brooklyn Park, Minn (S.B.)
| | - David J. Kessler
- From the University of Iowa Hospitals, Iowa City (M.A.-K., S.S., B.O.); Austin Heart PA, Austin, Tex (D.J.K.); Intermountain Medical Center, Murray, Utah (J.D., T.J.B.); Boston Scientific Corporation, St. Paul, Minn (K.S.); and The Integra Group, Brooklyn Park, Minn (S.B.)
| | - John Day
- From the University of Iowa Hospitals, Iowa City (M.A.-K., S.S., B.O.); Austin Heart PA, Austin, Tex (D.J.K.); Intermountain Medical Center, Murray, Utah (J.D., T.J.B.); Boston Scientific Corporation, St. Paul, Minn (K.S.); and The Integra Group, Brooklyn Park, Minn (S.B.)
| | - T. Jared Bunch
- From the University of Iowa Hospitals, Iowa City (M.A.-K., S.S., B.O.); Austin Heart PA, Austin, Tex (D.J.K.); Intermountain Medical Center, Murray, Utah (J.D., T.J.B.); Boston Scientific Corporation, St. Paul, Minn (K.S.); and The Integra Group, Brooklyn Park, Minn (S.B.)
| | - Kira Q. Stolen
- From the University of Iowa Hospitals, Iowa City (M.A.-K., S.S., B.O.); Austin Heart PA, Austin, Tex (D.J.K.); Intermountain Medical Center, Murray, Utah (J.D., T.J.B.); Boston Scientific Corporation, St. Paul, Minn (K.S.); and The Integra Group, Brooklyn Park, Minn (S.B.)
| | - Scott Brown
- From the University of Iowa Hospitals, Iowa City (M.A.-K., S.S., B.O.); Austin Heart PA, Austin, Tex (D.J.K.); Intermountain Medical Center, Murray, Utah (J.D., T.J.B.); Boston Scientific Corporation, St. Paul, Minn (K.S.); and The Integra Group, Brooklyn Park, Minn (S.B.)
| | - Salam Sbaity
- From the University of Iowa Hospitals, Iowa City (M.A.-K., S.S., B.O.); Austin Heart PA, Austin, Tex (D.J.K.); Intermountain Medical Center, Murray, Utah (J.D., T.J.B.); Boston Scientific Corporation, St. Paul, Minn (K.S.); and The Integra Group, Brooklyn Park, Minn (S.B.)
| | - Brian Olshansky
- From the University of Iowa Hospitals, Iowa City (M.A.-K., S.S., B.O.); Austin Heart PA, Austin, Tex (D.J.K.); Intermountain Medical Center, Murray, Utah (J.D., T.J.B.); Boston Scientific Corporation, St. Paul, Minn (K.S.); and The Integra Group, Brooklyn Park, Minn (S.B.)
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91
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Tops LF, Schalij MJ, Bax JJ. The effects of right ventricular apical pacing on ventricular function and dyssynchrony implications for therapy. J Am Coll Cardiol 2009; 54:764-76. [PMID: 19695453 DOI: 10.1016/j.jacc.2009.06.006] [Citation(s) in RCA: 271] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Revised: 06/16/2009] [Accepted: 06/17/2009] [Indexed: 10/20/2022]
Abstract
Cardiac pacing is the only effective treatment for patients with sick sinus syndrome and atrioventricular conduction disorders. In cardiac pacing, the endocardial pacing lead is typically positioned at the right ventricular (RV) apex. At the same time, there is increasing indirect evidence, derived from large pacing mode selection trials and observational studies, that conventional RV apical pacing may have detrimental effects on cardiac structure and left ventricular function, which are associated with the development of heart failure. These detrimental effects may be related to the abnormal electrical and mechanical activation pattern of the ventricles (or ventricular dyssynchrony) caused by RV apical pacing. Still, it remains uncertain if the deterioration of left ventricular function as noted in a proportion of patients receiving RV apical pacing is directly related to acutely induced left ventricular dyssynchrony. The upgrade from RV pacing to cardiac resynchronization therapy may partially reverse the deleterious effects of RV pacing. It has even been suggested that selected patients with a conventional pacemaker indication should receive cardiac resynchronization therapy to avoid the deleterious effects. This review will provide a contemporary overview of the available evidence on the detrimental effects of RV apical pacing. Furthermore, the available alternatives for patients with a standard pacemaker indication will be discussed. In particular, the role of cardiac resynchronization therapy and alternative RV pacing sites in these patients will be reviewed.
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Affiliation(s)
- Laurens F Tops
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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92
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KNOPS PAUL, THEUNS DOMINICAMJ, RES JANCJ, JORDAENS LUC. Analysis of Implantable Defibrillator Longevity Under Clinical Circumstances: Implications for Device Selection. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:1276-85. [DOI: 10.1111/j.1540-8159.2009.02482.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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93
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DAS MITHILESHK, DANDAMUDI GOPI, STEINER HILLELA. Modern Pacemakers: Hope or Hype? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:1207-21. [DOI: 10.1111/j.1540-8159.2009.02467.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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94
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RUSSO ANDREAM, DAY JOHND, STOLEN KIRA, MULLIN CHRISTOPHERM, DORAISWAMY VINAYAK, LEREW DARINL, OLSHANSKY BRIAN. Implantable Cardioverter Defibrillators: Do Women Fare Worse Than Men? Gender Comparison in the INTRINSIC RV Trial. J Cardiovasc Electrophysiol 2009; 20:973-8. [DOI: 10.1111/j.1540-8167.2009.01489.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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95
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LAU CHUPAK, WANG CHUNCHIEH, NGARMUKOS TACHAPONG, KIM YOUHO, KONG CHIWOON, OMAR RAZALI, SRIRATANASATHAVORN CHARN, MUNAWAR MUHAMMAD, KAM RUTH, LEE KATHYLF, LAU ELIZABETHOIYAN, TSE HUNGFAT. A Prospective Randomized Study to Assess the Efficacy of Rate and Site of Atrial Pacing on Long-Term Development of Atrial Fibrillation. J Cardiovasc Electrophysiol 2009; 20:1020-5. [DOI: 10.1111/j.1540-8167.2009.01484.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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96
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GOLD MICHAELR, NIAZI IMRAN, GIUDICI MICHAEL, LEMAN ROBERTB, STURDIVANT JOHNL, KIM MICHAELH, WAGGONER ALAND, DING JIANG, ARCOT-KRISHNAMURTHY SHANTHA, DAUM DOUGLAS, YU YINGHONG. Acute Hemodynamic Effects of Atrial Pacing with Cardiac Resynchronization Therapy. J Cardiovasc Electrophysiol 2009; 20:894-900. [DOI: 10.1111/j.1540-8167.2009.01460.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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97
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CAO MICHAELK, SAXON LESLIEA. Complete Heart Block and Preserved LV Function: Does Right Ventricular Pacing Site Matter? J Cardiovasc Electrophysiol 2009; 20:906-7. [DOI: 10.1111/j.1540-8167.2009.01513.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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98
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Stockburger M, Celebi O, Krebs A, Knaus T, Nitardy A, Habedank D, Dietz R. Right ventricular pacing is associated with impaired overall survival, but not with an increased incidence of ventricular tachyarrhythmias in routine cardioverter/defibrillator recipients with reservedly programmed pacing. Europace 2009; 11:924-30. [DOI: 10.1093/europace/eup118] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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99
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Wilkoff BL, Kudenchuk PJ, Buxton AE, Sharma A, Cook JR, Bhandari AK, Biehl M, Tomassoni G, Leonen A, Klevan LR, Hallstrom AP. The DAVID (Dual Chamber and VVI Implantable Defibrillator) II trial. J Am Coll Cardiol 2009; 53:872-80. [PMID: 19264245 DOI: 10.1016/j.jacc.2008.10.057] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2008] [Revised: 10/15/2008] [Accepted: 10/21/2008] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The purpose of this study was to determine whether atrial pacing is a safe alternative to minimal (backup-only) ventricular pacing in defibrillator recipients with impaired ventricular function. BACKGROUND The DAVID (Dual Chamber and VVI Implantable Defibrillator) trial demonstrated that dual chamber rate responsive pacing as compared with ventricular backup-only pacing worsens the combined end point of mortality and heart failure hospitalization. Although altered ventricular activation from right ventricular pacing was presumed to be the likely cause for these maladaptive effects, this supposition is unproven. METHODS In all, 600 patients with impaired ventricular function from 29 North American sites, who required an implanted defibrillator for primary or secondary prevention, with no clinical indication for pacing, were randomly assigned to atrial pacing (at 70 beats/min) versus minimal ventricular pacing (at 40 beats/min) and followed up for a mean of 2.7 years. RESULTS There were no significant differences between pacing arms in patients' baseline characteristics, use of heart failure medications, and combined primary end point of time to death or heart failure hospitalization during follow-up, with an overall incidence of 11.1%, 16.9%, and 24.6% at 1, 2, and 3 years, respectively. Similarly, the incidence of atrial fibrillation, syncope, appropriate or inappropriate shocks, and quality of life measures did not significantly differ between treatment groups. CONCLUSIONS The effect of atrial pacing on event-free survival and quality of life was not substantially worse than, and was likely equivalent to, backup-only ventricular pacing. Atrial pacing may be considered a "safe alternative" when pacing is desired in defibrillator recipients, but affords no clear advantage or disadvantage over a ventricular pacing mode that minimizes pacing altogether. (Dual Chamber and VVI Implantable Defibrillator [DAVID] Trial II; NCT00187187).
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STOCKBURGER MARTIN, KREBS ALICE, NITARDY AISCHA, HABEDANK DIRK, CELEBI ÖZLEM, KNAUS THOMAS, DIETZ RAINER. Survival and Appropriate Device Interventions in Recipients of Cardioverter Defibrillators Implanted for the Primary Versus Secondary Prevention of Sudden Cardiac Death. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32 Suppl 1:S16-20. [DOI: 10.1111/j.1540-8159.2008.02222.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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