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Shah Syed AR, Akram A, Azam MS, Ansari AI, Muzammil MA, Ahad Syed A, Ahmed S, Zakir SJ. Dual-chamber versus single chamber pacemakers, a systemic review and meta-analysis on sick sinus syndrome and atrioventricular block patients. Heliyon 2024; 10:e23877. [PMID: 38234924 PMCID: PMC10792191 DOI: 10.1016/j.heliyon.2023.e23877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 12/10/2023] [Accepted: 12/14/2023] [Indexed: 01/19/2024] Open
Abstract
Aims The atrioventricular block (AVB) is a conduction system problem that results from the impairment in the transmission of an impulse from the atria to the ventricle, the disease has many etiologies. This article aimed to evaluate the efficacy and safety of dual and single-chamber pacemakers in patients with SSS and AVB. Methods An electronic search of PubMed (Medline), EMBASE, and Google Scholar was performed from 2000 till August 15th, 2022. Retrieved articles were exported to Endnote Reference Library Software, where duplicate studies were removed from the list, and only articles meeting the eligibility criteria of this study were selected. RevMan 5.4 and STATA 16 software were used for the analysis. The modified Cochrane Collaboration's risk of bias and New-castle Ottawa scale were used for quality assessment of RCTs and observational studies respectively. Results This study is composed of 8953 patients with sick-sinus syndrome and atrioventricular block. A total of thirteen outcomes are included in this meta-analysis, out of which atrial fibrillation significantly favored dual chamber [OR = 1.29; 95 % CI = 1.05-1.59; P = 0.01 I2 = 29 %] and overall complications [OR = 0.48; 95 % CI = 0.29-0.77; p = 0.03 I2 = 0 %] and pneumothorax [OR = 0.31; 95 % CI = 0.10-0.93; p = 0.04, I2 = 0 %] were satisfied by single-chamber pacing. Conclusion This study concluded that neither single-chamber nor dual-chamber pacemakers are superior to each other, but they are unique in their own ways as the results of this study manifest remarkable reduction in atrial fibrillation rates and pneumothorax using dual-chamber and single-chamber pacemakers respectively.
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Affiliation(s)
| | | | | | | | | | | | - Shaheer Ahmed
- Dow University of Health Science (Medicine), Pakistan
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2
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Laksono S, Yuniadi Y, Soesanto AM, Raharjo SB, Lisnawati, Bardosono S, Angkasa IS, Hosanna C. Comparison of Global Longitudinal Strain in Dual-chamber versus Ventricular Pacemaker in Complete Heart Block. J Cardiovasc Echogr 2024; 34:14-18. [PMID: 38818320 PMCID: PMC11135818 DOI: 10.4103/jcecho.jcecho_78_23] [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: 12/05/2023] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 06/01/2024] Open
Abstract
Context Bradycardia caused by total atrioventricular block (TAVB) is treated by implantation of permanent pacemakers (PPMs) in either dual-chamber (DDD) versus ventricular (VVI) pacing modes. DDD is considered a more physiological pacing mode than VVI as it avoids atrioventricular dyssynchrony. However, previous trials have failed to demonstrate the superiority of DDD in improving quality of life and morbidity. Aims This study aims to provide postpacemaker function of the left ventricle (LV) measured with global longitudinal strain (GLS), in TAVB patients. Settings and Design This is a comparative study; samples included in the study are adult TAVB patients undergoing PPM implantation, without significant heart function, and structural abnormality. Echocardiographic parameters are obtained before, after 1 month, and after 3 months post-PPM. Subjects and Methods A total of 98 TAVB patients undergoes PPM implantation during the study period, 55 patients were excluded, and in the end, only 43 patients fulfill the inclusion criteria. Statistical Analysis Used Baseline data between DDD and VVI are compared using unpaired t-test. Statistical significance 1 month post-PPM and 3 months post-PPM is analyzed using paired t-test. Results There were no significant differences between both groups at baseline. However, significant GLS changes are observed 1 month after PPM in the VVI group (P = 0.002), but no significant change was observed in the DDD group even after 3 months (P = 0.055). Conclusions In our study, we conclude that DDD is superior in maintaining LV function in the short term in TAVB patients after PPM implantation.
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Affiliation(s)
- Sidhi Laksono
- Doctoral Program in Medical Sciences, Faculty of Medicine, University of Indonesia, Central Jakarta, Indonesia
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Prof. Dr. Hamka Muhammadiyah University, Banten, Indonesia
| | - Yoga Yuniadi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Central Jakarta, Indonesia
- Department of Cardiology and Vascular Medicine, Harapan Kita National Cardiovascular Center, West Jakarta, Indonesia
| | - Amiliana Mardiani Soesanto
- Doctoral Program in Medical Sciences, Faculty of Medicine, University of Indonesia, Central Jakarta, Indonesia
| | - Sunu Budhi Raharjo
- Doctoral Program in Medical Sciences, Faculty of Medicine, University of Indonesia, Central Jakarta, Indonesia
| | - Lisnawati
- Doctoral Program in Medical Sciences, Faculty of Medicine, University of Indonesia, Central Jakarta, Indonesia
| | - Saptawati Bardosono
- Doctoral Program in Medical Sciences, Faculty of Medicine, University of Indonesia, Central Jakarta, Indonesia
| | | | - Cliffian Hosanna
- Faculty of Medicine, Tarumanagara University, West Jakarta, Indonesia
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3
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Sahu P, Acharya S, Totade M. Evolution of Pacemakers and Implantable Cardioverter Defibrillators (ICDs) in Cardiology. Cureus 2023; 15:e46389. [PMID: 37927638 PMCID: PMC10620620 DOI: 10.7759/cureus.46389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
Pacemakers and implantable cardioverter defibrillators (ICDs) have revolutionized cardiology by providing life-saving interventions for patients with cardiac rhythm disturbances. Pacing the heart is an effective treatment for people suffering from bradycardia caused by sinus node dysfunction or atrioventricular (AV) block, and electronic pacing has saved countless lives since its introduction into clinical practice. AV synchronization is the typical cycle of atrial depolarization and contraction followed by ventricular depolarization and contraction. The continuation of this cycle leads to appropriate ventricular filling and cardiac output. By contrast, the failure of the cycle results in AV asynchrony, which may result in heart failure. Cardiac resynchronization treatment (CRT) involves using customized pacemakers with or without implantable cardioverter defibrillators and tries to resynchronize the failing heart by enhancing myocardial contraction without increasing energy consumption. This review delves into the extensive journey of pacemakers and ICDs in the field of cardiology. It highlights the transformative impact of these devices on patient care and quality of life, emphasizing technological advancements, clinical applications, and prospects. This comprehensive review aims to provide insights into the dynamic landscape of cardiac rhythm management.
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Affiliation(s)
- Palash Sahu
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research (Deemed to be University), Wardha, IND
| | - Sourya Acharya
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research (Deemed to be University), Wardha, IND
| | - Manisha Totade
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research (Deemed to be University), Wardha, IND
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4
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Togashi D, Sasaki K, Okuyama K, Izumo M, Nakajima I, Suchi T, Nakayama Y, Harada T, Akashi YJ. Two-year Outcomes of Ventricular-demand Leadless Pacemaker Therapy for Heart Block After Transcatheter Aortic Valve Replacement. J Innov Card Rhythm Manag 2023; 14:5491-5498. [PMID: 37388425 PMCID: PMC10306247 DOI: 10.19102/icrm.2023.14062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/23/2023] [Indexed: 07/01/2023] Open
Abstract
Ventricular-demand leadless pacemakers (VVI-LPMs) have often been used as an alternative to atrioventricular (AV) synchronous transvenous pacemakers (DDD-TPMs) in patients with high-grade AV block following transcatheter aortic valve replacement (TAVR). However, the clinical outcomes of this unusual usage are not elucidated. Patients who received permanent pacemakers (PPMs) owing to new-onset high-grade AV block after TAVR from September 2017 to August 2020 at a high-volume center in Japan were included in the analysis, and the clinical courses of VVI-LPM and DDD-TPM implants through 2 years of follow-up were compared retrospectively. Out of 413 consecutive patients who underwent TAVR, 51 (12%) patients received a PPM. After excluding 8 patients with chronic atrial fibrillation (AF), 3 with sick sinus syndrome, and 1 with incomplete data, 17 VVI-LPMs and 22 DDD-TPMs were included in our final cohort. The VVI-LPM group had lower serum albumin levels (3.2 ± 0.5 vs. 3.9 ± 0.4 g/dL, P < .01) than the DDD-TPM group. Follow-up revealed no significant differences between the 2 groups in terms of the incidence of late device-related adverse events (0% vs. 5%, log-rank P = .38) and new-onset AF (6% vs. 9%, log-rank P = .75); however, there were increases in the rates of all-cause death (41% vs. 5%, log-rank P < .01) and heart failure rehospitalization (24% vs. 0%, log-rank P = .01) in the VVI-LPM group. This small retrospective study reveals favorable post-procedural complication rates but higher all-cause mortality with VVI-LPM compared to DDD-TPM therapy for high-grade AV block after TAVR at 2 years of follow-up.
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Affiliation(s)
- Daisuke Togashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kenichi Sasaki
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kazuaki Okuyama
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ikutaro Nakajima
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Taro Suchi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yui Nakayama
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Tomoo Harada
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihiro J. Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
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Zhao J, Huang Y, Lei L, Yao Z, Liu T, Qiu H, Lin C, Liu X, Teng Y, Li X, Zhang Y, Zhuang J, Chen J, Wen S. Permanent epicardial pacing in neonates and infants less than 1 year old: 12-year experience at a single center. Transl Pediatr 2022; 11:825-833. [PMID: 35800290 PMCID: PMC9253933 DOI: 10.21037/tp-21-525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/17/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Permanent epicardial pacing is the primary choice for neonates and infants with bradyarrhythmia. We reviewed mid-term outcomes after epicardial permanent pacemaker (EPPM) implantation in this age group. METHODS From Dec 1, 2008 to Dec 1, 2019, children who underwent EPPM implantation within the first year of life were included in our study. Patients were followed up for as long as 12 years, until Jun 11, 2021, for all-cause mortality and pacemaker reoperation. Kaplan-Meier and log-rank tests were used for analysis. RESULTS Of 31 consecutive patients [18 boys (58.1%) and 2 neonates (6.5%)] included in this study, 30 (96.8%) were discharged alive and assessed at a median follow-up of 3.9 years [interquartile range (IQR) 4.7]. The median age and weight of the patients were 156 days (IQR 217) and 5.3 kg (IQR 3.5), respectively, at the time of their operation. Twenty-five (80.6%) patients had congenital heart disease, and the main indication for pacing was postoperative atrioventricular block (AVB) in 21 (67.7%) patients. During follow-up, 3 (9.7%) patients died and there were a total of 9 pacing lead failures in 7 (22.6%) patients. The median longevity of leads (unipolar steroid-eluting) was 2.9 years (IQR 3.6). Freedom from lead reoperation was 90.3%, 72.0%, 65.5% and 49.1% at 1, 3, 5, and 8 years, respectively. The median longevity of the pacing generators was 3.3 years (IQR 2.8). Freedom from generator reoperation was 90.3%, 75.6%, 52.4% and 43.6% at 1, 3, 5 and 6 years, respectively. CONCLUSIONS The mid-term outcome of EPPM implantation in neonates and infants was acceptable. Neonates and infants with EPPM implants face the risk of repeated reoperations and all-cause death. A patient's prognosis can depend on regular follow-up, type of pacing lead and the presence of congenital heart malformations, especially complex congenital heart disease.
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Affiliation(s)
- Junfei Zhao
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ying Huang
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Liming Lei
- Department of Cardiac Intensive Care Unit, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zeyang Yao
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Tian Liu
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hailong Qiu
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Canhui Lin
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaobing Liu
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yun Teng
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaohua Li
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yong Zhang
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jian Zhuang
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jimei Chen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shusheng Wen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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6
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Sasaki K, Togashi D, Nakajima I, Suchi T, Nakayama Y, Harada T, Akashi YJ. Clinical Outcomes of Non-Atrial Fibrillation Bradyarrhythmias Treated With a Ventricular Demand Leadless Pacemaker Compared With an Atrioventricular Synchronous Transvenous Pacemaker ― A Propensity Score-Matched Analysis ―. Circ J 2022; 86:1283-1291. [DOI: 10.1253/circj.cj-21-0889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Kenichi Sasaki
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Daisuke Togashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Ikutaro Nakajima
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Taro Suchi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Yui Nakayama
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Tomoo Harada
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
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7
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Arps K, Piccini JP, Yapejian R, Leguire R, Smith B, Al-Khatib SM, Bahnson TD, Daubert JP, Hegland DD, Jackson KP, Jackson LR, Lewis RK, Pokorney SD, Sun AY, Thomas KL, Frazier-Mills C. Optimizing mechanically sensed atrial tracking in patients with atrioventricular-synchronous leadless pacemakers: A single-center experience. Heart Rhythm O2 2021; 2:455-462. [PMID: 34667960 PMCID: PMC8505205 DOI: 10.1016/j.hroo.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Atrioventricular (AV)-synchronous single-chamber leadless pacing using a mechanical atrial sensing algorithm produced high AV synchrony in clinical trials, but clinical practice experience with these devices has not yet been described. Objective To describe pacing outcomes and programming changes with AV-synchronous leadless pacemakers in clinical practice. Methods Consecutive patients without persistent atrial fibrillation who received an AV-synchronous leadless pacemaker and completed follow-up between February 2020 and April 2021 were included. We evaluated tracking index (atrial mechanical sense followed by ventricular pace [AM-VP] divided by total VP), total AV synchrony (sum of AM-ventricular sense [AM-VS], AM-VP, and AV conduction mode switch), use of programming optimization, and improvement in AV synchrony after optimization. Results Fifty patients met the inclusion criteria. Mean age was 69 ± 16.8 years, 24 (48%) were women, 24 (48%) had complete heart block, and 17 (34%) required ≥50% pacing. Mean tracking index was 41% ± 34%. Thirty-five patients (70%) received ≥1 programming change. In 36 patients with 2 follow-up visits, tracking improved by +9% ± 28% (P value for improvement = .09) and +18% ± 19% (P = .02) among 15 patients with complete heart block. Average total AV synchrony increased from 89% [67%, 99%] to 93% [78%, 100%] in all patients (P = .22), from 86% [52%, 98%] to 97% [82%, 99%] in those with complete heart block (P = .04), and from 73% [52%, 80%] to 78% [70%, 85%] in those with ≥50% pacing (P = .09). Conclusion In patients with AV-synchronous leadless pacemakers, programming changes are frequent and are associated with increased atrial tracking and increased AV synchrony in patients with complete heart block.
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Affiliation(s)
- Kelly Arps
- Section of Cardiac Electrophysiology, Duke University Medical Center Division of Cardiovascular Disease, Durham, North Carolina
| | - Jonathan P Piccini
- Section of Cardiac Electrophysiology, Duke University Medical Center Division of Cardiovascular Disease, Durham, North Carolina.,Duke Clinical Research Institute, Durham, North Carolina
| | - Rebecca Yapejian
- Section of Cardiac Electrophysiology, Duke University Medical Center Division of Cardiovascular Disease, Durham, North Carolina
| | - Rhonda Leguire
- Section of Cardiac Electrophysiology, Duke University Medical Center Division of Cardiovascular Disease, Durham, North Carolina
| | - Brenda Smith
- Section of Cardiac Electrophysiology, Duke University Medical Center Division of Cardiovascular Disease, Durham, North Carolina
| | - Sana M Al-Khatib
- Section of Cardiac Electrophysiology, Duke University Medical Center Division of Cardiovascular Disease, Durham, North Carolina.,Duke Clinical Research Institute, Durham, North Carolina
| | - Tristram D Bahnson
- Section of Cardiac Electrophysiology, Duke University Medical Center Division of Cardiovascular Disease, Durham, North Carolina
| | - James P Daubert
- Section of Cardiac Electrophysiology, Duke University Medical Center Division of Cardiovascular Disease, Durham, North Carolina
| | - Donald D Hegland
- Section of Cardiac Electrophysiology, Duke University Medical Center Division of Cardiovascular Disease, Durham, North Carolina
| | - Kevin P Jackson
- Section of Cardiac Electrophysiology, Duke University Medical Center Division of Cardiovascular Disease, Durham, North Carolina
| | - Larry R Jackson
- Section of Cardiac Electrophysiology, Duke University Medical Center Division of Cardiovascular Disease, Durham, North Carolina.,Durham VA Medical Center, Durham, North Carolina
| | - Robert K Lewis
- Section of Cardiac Electrophysiology, Duke University Medical Center Division of Cardiovascular Disease, Durham, North Carolina.,Durham VA Medical Center, Durham, North Carolina
| | - Sean D Pokorney
- Section of Cardiac Electrophysiology, Duke University Medical Center Division of Cardiovascular Disease, Durham, North Carolina.,Duke Clinical Research Institute, Durham, North Carolina
| | - Albert Y Sun
- Section of Cardiac Electrophysiology, Duke University Medical Center Division of Cardiovascular Disease, Durham, North Carolina.,Durham VA Medical Center, Durham, North Carolina
| | - Kevin L Thomas
- Section of Cardiac Electrophysiology, Duke University Medical Center Division of Cardiovascular Disease, Durham, North Carolina.,Duke Clinical Research Institute, Durham, North Carolina
| | - Camille Frazier-Mills
- Section of Cardiac Electrophysiology, Duke University Medical Center Division of Cardiovascular Disease, Durham, North Carolina
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8
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Riesenhuber M, Spannbauer A, Rauscha F, Schmidinger H, Boszotta A, Pezawas T, Schukro C, Gwechenberger M, Stix G, Anvari A, Wrba T, Khazen C, Andreas M, Laufer G, Hengstenberg C, Gyöngyösi M. Sex Differences and Long-Term Outcome in Patients With Pacemakers. Front Cardiovasc Med 2020; 7:569060. [PMID: 33195457 PMCID: PMC7536343 DOI: 10.3389/fcvm.2020.569060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/24/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Evidence of sex-related differences in patients with pacemakers regarding comorbidities is insufficiently investigated. The aim of this study was to determine the relationship of cardiovascular comorbidities and sex category with properties of pacemaker implantation, pacemaker follow-up, and long-term survival. Methods: This retrospective, single-center cohort study consisted of 6,362 pacemaker-patients (39.7% female) enrolled between May 2000 and April 2015. Functional pacemaker parameters were registered at regular pacemaker controls. Survival status and cause of death were analyzed in relation to comorbidities, implanted pacing devices, and echocardiography. Survival analyses were plotted for a 10-year follow-up. Results: Patients with hypertension or hyperlipidemia had higher rates of implantations due to sick sinus syndrome (28.6 vs. 25.5% without hypertension, P < 0.001; 30.7 vs. 25.7% without hyperlipidemia, P < 0.001), while endocarditis was associated with higher rates of implantations due to AV block (46.7 vs. 33.4%, P < 0.001). Patients with valvular heart disease had higher rates of pacemaker implantation due to bradycardic atrial fibrillation (24.9 vs. 21.0% without valvular heart disease, P < 0.001). Ventricular pacing threshold increased in both sexes during the follow-up and was higher in women in the final follow-up (0.94 vs. 0.91 V in men, P = 0.002). During the 10-years follow-up, 6.1% of women and 8.6% of men underwent lead replacement (P = 0.054). Device and lead replacement rates were increased if the comorbidities coronary artery disease, heart failure, hypertension, hyperlipidemia, valvular heart disease, previous stroke/TIA, atrial arrhythmias, chronic kidney disease, or endocarditis were present. Diabetes and previous CABG increase the rates of device replacement, but not the rate of lead replacement. Severe tricuspid regurgitation after implantation of pacemaker was present in more men than women (14.4 vs. 6.1%, P < 0.001). In a multivariate COX regression, the following variables were associated with independent decrease of 10-year survival: hypertension (HR 1.34, 95% CI 1.09-1.64), chronic kidney disease (HR 1.83, 95% CI 1.53-2.19), tricuspid regurgitation after pacemaker implantation (HR 1.48, 95% CI 1.26-1.74). Survival was independently increased in female sex (HR 0.83, 95% CI 0.70-0.99) and hyperlipidemia (HR 0.81, 95% CI 0.67-0.97). Conclusions: Cardiovascular comorbidities influenced significantly pacemaker implantations and long-term outcome. Trial Registration: ClinicalTrials.gov Unique identifier: NCT03388281.
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Affiliation(s)
- Martin Riesenhuber
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Andreas Spannbauer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Friedrich Rauscha
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Herwig Schmidinger
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Adelinde Boszotta
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Thomas Pezawas
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christoph Schukro
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Marianne Gwechenberger
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Günter Stix
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Anahit Anvari
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Thomas Wrba
- IT Systems and Communications, Medical University of Vienna, Vienna, Austria
| | - Cesar Khazen
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Andreas
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Günther Laufer
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Mariann Gyöngyösi
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
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9
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Evaluating and managing bradycardia. Trends Cardiovasc Med 2019; 30:265-272. [PMID: 31311698 DOI: 10.1016/j.tcm.2019.07.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 11/22/2022]
Abstract
Bradycardia is a commonly observed arrhythmia and a frequent occasion for cardiac consultation. Defined as a heart rate of less than 50-60 bpm, bradycardia can be observed as a normal phenomenon in young athletic individuals, and in patients as part of normal aging or disease (Table 1). Pathology that produces bradycardia may occur within the sinus node, atrioventricular (AV) nodal tissue, and the specialized His-Purkinje conduction system. Given the overlap of heart rate ranges with non-pathologic changes, assessment of symptoms is a critical component in the evaluation and management of bradycardia. Treatment should rarely be prescribed solely on the basis of a heart rate lower than an arbitrary cutoff or a pause above certain duration. In the 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients with Bradycardia and Cardiac Conduction Delay (referred to hereafter as the 2018 Bradycardia Guideline), there was a significant shift in emphasis from prior guidelines that emphasized device-based implantation recommendations to a focus on evaluation and management of disease states [1,2]. In this review, we will highlight the changes in the new guideline as well as describe the key elements in evaluation and management of patients presenting with bradycardia.
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10
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Bonny A, Ngantcha M, Jeilan M, Okello E, Kaviraj B, Talle MA, Nel G, Marijon E, Sani MU, Yousef Z, Karaye KM, Touré IA, Awad MA, Millogo G, Kologo J, Kane A, Houndolo R, Dzudié A, Mbakwem A, Mayosi BM, Chin A. Statistics on the use of cardiac electronic devices and interventional electrophysiological procedures in Africa from 2011 to 2016: report of the Pan African Society of Cardiology (PASCAR) Cardiac Arrhythmias and Pacing Task Forces. Europace 2019; 20:1513-1526. [PMID: 29309556 PMCID: PMC6123943 DOI: 10.1093/europace/eux353] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/07/2017] [Indexed: 11/14/2022] Open
Abstract
Aims To provide comprehensive information on the access and use of cardiac implantable electronic devices (CIED) and catheter ablation procedures in Africa. Methods and results The Pan-African Society of Cardiology (PASCAR) collected data on invasive management of cardiac arrhythmias from 2011 to 2016 from 31 African countries. A specific template was completed by physicians, and additional information obtained from industry. Information on health care systems, demographics, economics, procedure rates, and specific training programs was collected. Considerable heterogeneity in the access to arrhythmia care was observed across Africa. Eight of the 31 countries surveyed (26%) did not perform pacemaker implantations. The median pacemaker implantation rate was 2.66 per million population per country (range: 0.14–233 per million population). Implantable cardioverter-defibrillator and cardiac resynchronization therapy were performed in 12/31 (39%) and 15/31 (48%) countries respectively, mostly by visiting teams. Electrophysiological studies, including complex catheter ablations were performed in all countries from Maghreb, but only one sub-Saharan African country (South Africa). Marked variation in cost (up to 1000-fold) was observed across countries with an inverse correlation between implant rates and the procedure fees standardized to the gross domestic product per capita. Lack of economic resources and facilities, high cost of procedures, deficiency of trained physicians, and non-existent fellowship programs were the main drivers of under-utilization of interventional cardiac arrhythmia care. Conclusion There is limited access to CIED and ablation procedures in Africa. A quarter of countries did not have pacemaker implantation services, and catheter ablations were only available in one country in sub-Saharan Africa.
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Affiliation(s)
- Aimé Bonny
- University Hospital Laquintinie, Cardiac unit, University of Douala, BP, Douala, Cameroon.,Cameroon Cardiovascular Research Network, BP, Douala, Cameroon.,Centre Hospitalier V. Dupouy, service de cardiologie, 69, rue du Lt-col Prudhon, Argenteuil Cedex, France
| | - Marcus Ngantcha
- Cameroon Cardiovascular Research Network, BP, Douala, Cameroon
| | - Mohamed Jeilan
- Aga Khan University hospital, Department of Medicine, 3rd Parklands Rd, Nairobi, Kenya
| | - Emmy Okello
- Makerere University, Uganda Heart Institute, Mulago Hospital Complex, Department of Cardiology, Mulago Hill Road, PO Box 7051, Kampala, Uganda
| | - Bundhoo Kaviraj
- Dr A.G Jeetoo Hospital, Department of Cardiology, Port Louis, Mauritius
| | - Mohammed A Talle
- Maiduguri Teaching University Hospital, Department of Cardiology, Maiduguri, Nigeria
| | - George Nel
- Pan-African Society of Cardiology (PASCAR), Department of Medicine, University of Cape Town, Observatory, Cape Town, South Africa
| | - Eloi Marijon
- European Georges Pompidou Hospital, Cardiology Department and Global Health Unit (Inserm U970), 20 rue Leblanc, Paris, France
| | - Mahmoud U Sani
- Bayero University/Aminu Kano Teaching Hospital, Department of Medicine, Kano, Nigeria
| | - Zaheer Yousef
- University Hospital of Wales, Department of Cardiology, Cardiff, UK
| | - Kamilu M Karaye
- Bayero University/Aminu Kano Teaching Hospital, Department of Medicine, Kano, Nigeria
| | - Ibrahim A Touré
- Centre Hospitalier Lamorde, service de médecine interne et de cardiologie, Niamey, Niger
| | - Mohamed A Awad
- University of Khartoum, Department of Medicine, Elgaasr street, Khartoum, Sudan
| | - George Millogo
- Centre Hospitalier Yalgado Ouedraogo, Ouagadougou, service de cardiologie, Burkina Faso
| | - Jonas Kologo
- Centre Hospitalier Yalgado Ouedraogo, Ouagadougou, service de cardiologie, Burkina Faso
| | - Adama Kane
- CHU Aristide Le Dantec, service de cardiologie, Dakar, Senegal
| | - Romain Houndolo
- CHU Aristide Le Dantec, service de cardiologie, Dakar, Senegal
| | - Anastase Dzudié
- Douala General Hospital, Department of Internal Medicine, BP, Douala, Cameroon
| | - Amam Mbakwem
- University of Lagos and Lagos University Teaching Hospital, College of Medicine, Department of Medicine, PMB, Lagos, Nigeria
| | - Bongani M Mayosi
- Dean's Office, Barnard Fuller Building, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa
| | - Ashley Chin
- Groote Schuur Hospital and University of Cape Town, Cardiac Clinic, Department of Medicine, Main Road, Observatory, Cape Town, South Africa
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Harky A, Bashir M, Grafton-Clarke C, Lees M, Fendius S, Roberts N. Severe Bradycardia Prior to Coronary Artery Bypass Graft Surgery: A Case Report. J Tehran Heart Cent 2018; 13:136-139. [PMID: 30745927 PMCID: PMC6368915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Intraventricular conduction abnormalities following cardiac surgery have been thoroughly described, especially after valvular surgery. It is also widely known that several anesthetic factors can cause autonomic disturbances resulting in the unmasking of sinus node dysfunction, significant bradycardia, and cardiovascular collapse during the intraoperative period. However, little is known about asymptomatic episodes, especially those occurring prior to coronary artery bypass grafting (CABG). We report a rare occurrence of an intraventricular conduction defect that presented in an asymptomatic patient following non-ST-elevation myocardial infarction prior to urgent CABG. Our patient presented with sudden-onset chest pain, and following coronary angiography he was found to have triple-vessel coronary disease. During anesthetic induction for inpatient CABG surgery, he developed episodes of acute sinus tachy-brady episodes, requiring a stat dose of adrenaline to maintain the heart rate prior to the establishment of cardiopulmonary bypass. The arrhythmia persisted postoperatively, necessitating the insertion of a permanent dual-chamber pacemaker for complete heart block. The patient was later discharged without further complications, and upon follow-up 12 months later, he remains in good health.
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Affiliation(s)
- Amer Harky
- Department of Cardiothoracic Surgery, Barts Heart Centre, St Bartholomew's Hospital, London, UK. ,Department of Vascular Surgery, Countess of Chester Hospital, Chester, UK.,Corresponding Author: Amer Harky, Department of Vascular Surgery, Countess of Chester, Chester, CH2 1UL, United Kingdom. Tel: +44 01244365000. Fax: +44 01244365000.E-mail: .
| | - Mohamad Bashir
- Department of Cardiothoracic Surgery, Barts Heart Centre, St Bartholomew's Hospital, London, UK.
| | | | - Martin Lees
- Department of Perioperative Medicine, Barts Heart Centre, St. Bartholomew’s Hospital, London, UK.
| | - Sarah Fendius
- Department of Cardiothoracic Surgery, Barts Heart Centre, St Bartholomew's Hospital, London, UK.
| | - Neil Roberts
- Department of Cardiothoracic Surgery, Barts Heart Centre, St Bartholomew's Hospital, London, UK.
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12
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Olaya Sanchez A, Trujillo GJ. Hallazgos electrocardiográficos en pacientes con marcapasos definitivos: revisión de la literatura. REPERTORIO DE MEDICINA Y CIRUGÍA 2017. [DOI: 10.1016/j.reper.2017.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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13
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Zhang T, Liu Y, Zou C, Zhang H. Single chamber permanent epicardial pacing for children with congenital heart disease after surgical repair. J Cardiothorac Surg 2016; 11:61. [PMID: 27067028 PMCID: PMC4828884 DOI: 10.1186/s13019-016-0439-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 04/03/2016] [Indexed: 11/10/2022] Open
Abstract
Background To analyze the 10-year experience of single chamber permanent epicardial pacemaker placement for children with congenital heart diseases (CHD) after surgical repair. Methods Between 2002 and 2014, a total of 35 patients with CHD (age: 26.9 ± 23.2 months, weight: 9.7 ± 5.6 kg) received permanent epicardial pacemaker placement following corrective surgery. Echocardiography and programming information of the pacemaker, as well as major adverse cardiac events (MACE) as heart failure or sudden death, were recorded during follow-up (46.8 ± 33.8 months). Results Acute ventricular stimulation threshold was 1.34 ± 0.72 V and no significant increase was observed at the last follow-up as 1.37 ± 0.81 V (p = 0.93). Compared with initial pacemaker implantation, the last follow-up didn’t show significant increases in impedance (p = 0.327) or R wave (p = 0.635). Four patients received pacemaker replacement because of battery depletion. 7/35 (20 %) of patients experienced MACE. Although the age and body weight were similar between patients with and without MACE, the patients with MACE were with complex CHD (100 % vs.55.6 %, p = 0.04). Conclusion High-degree iatrogenic atrioventricular block was the primary reason for placement of epicardial pacemaker for patients with CHD after surgical repair. Pacemaker placement with the steroid-eluting leads results in acceptable outcomes, however, the pacemaker type should be optimized for the children with complex CHD.
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Affiliation(s)
- Tao Zhang
- Department of Cardiac Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, China.,Center for Pediatric Cardiac Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Beijing, China.,Department of Cardio-Thoracic Surgery, Shouguang People's Hospital, Shouguang, China
| | - Yiwei Liu
- Center for Pediatric Cardiac Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Beijing, China
| | - Chengwei Zou
- Department of Cardiac Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, China.
| | - Hao Zhang
- Center for Pediatric Cardiac Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Beijing, China. .,Peking Union Medical College and Chinese Academy of Medical Sciences, 167 Beilishi Road, Beijing, 100037, P.R. China.
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14
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Chen BW, Wang ZG, Lv NQ, Cheng YM, Dang AM. The role of cardiac pacing in carotid sinus syndrome: a meta-analysis. Clin Auton Res 2014; 24:127-34. [PMID: 24682799 DOI: 10.1007/s10286-014-0238-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 03/05/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Cardiac pacing can be used to treat carotid sinus syndrome (CSS), but clinical studies have shown conflicting results. We conducted a systematic review and meta-analysis to evaluate the role of pacing for CSS. METHODS A systematic search of publications in PubMed, Embase, and the Cochrane Library without language restriction was performed. Prospective randomized studies that compared cardiac pacing with standard therapy or pacing with different algorithms were included if the recurrence of syncope or the number of falls was observed. RESULTS Eight studies enrolling 540 patients were identified. In open-label studies, the recurrence of syncope was reduced significantly by cardiac pacing compared with standard therapy. The recurrence of syncope was not different between single- and dual-chamber pacing, but a lower rate of patients with pre-syncope was observed in the group with dual-chamber pacing. Double-blind clinical studies failed to observe the role of cardiac pacing for preventing falls in patients with CSS. CONCLUSION The results of meta-analysis supported the use of cardiac pacing for patients with dominant cardioinhibitory CSS.
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Affiliation(s)
- Bing-Wei Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishilu, Beijing, 100037, People's Republic of China
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15
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16
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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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Burrage H. Sick sinus syndrome in a dog: treatment with dual-chambered pacemaker implantation. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2012; 53:565-568. [PMID: 23115373 PMCID: PMC3327600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A 2-year-old male castrated boxer dog was presented because of a history of syncope. Electrocardiogram tracings obtained with a cardiac event monitor showed bradycardia culminating in asystole. Sick sinus syndrome was diagnosed and treated with transvenous implantation of a dual-chambered permanent pacemaker.
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Affiliation(s)
- Heather Burrage
- Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, Prince Edward Island.
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18
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Zásady pro implantace kardiostimulátorů, implantabilních kardioverterů-defibrilátorů a systémů pro srdeční resynchronizační léčbu 2009. COR ET VASA 2009. [DOI: 10.33678/cor.2009.147] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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19
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Hildebrandt N, Stertmann W, Wehner M, Schneider I, Neu H, Schneider M. Dual Chamber Pacemaker Implantation in Dogs with Atrioventricular Block. J Vet Intern Med 2009; 23:31-8. [DOI: 10.1111/j.1939-1676.2008.0233.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Kaszala K, Huizar JF, Ellenbogen KA. Contemporary pacemakers: what the primary care physician needs to know. Mayo Clin Proc 2008; 83:1170-86. [PMID: 18828980 DOI: 10.4065/83.10.1170] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Pacemaker therapy is most commonly initiated because of symptomatic bradycardia, usually resulting from sinus node disease. Randomized multicenter trials assessing the relative benefits of different pacing modes have made possible an evidence-based approach to the treatment of bradyarrhythmias. During the past several decades, major advances in technology and in our understanding of cardiac pathophysiology have led to the development of new pacing techniques for the treatment of heart failure in the absence of bradycardia. Left ventricular or biventricular pacing may improve symptoms of heart failure and objective measurements of left ventricular systolic dysfunction by resynchronizing cardiac contraction. However, emerging clinical data suggest that long-term right ventricular apical pacing may have harmful effects. As the complexity of cardiac pacing devices continues to grow, physicians need to have a basic understanding of device indications, device function, and common problems encountered by patients with devices in the medical and home environment.
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Affiliation(s)
- Karoly Kaszala
- Medical College of Virginia, PO Box 980053, Richmond, VA 23298-0053, USA.
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21
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Benditt DG, Sakaguchi S, Lurie KG, Lu F. Sinus Node Dysfunction. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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22
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Hellkamp AS, Lee KL, Sweeney MO, Link MS, Lamas GA. Treatment Crossovers Did Not Affect Randomized Treatment Comparisons in the Mode Selection Trial (MOST). J Am Coll Cardiol 2006; 47:2260-6. [PMID: 16750693 DOI: 10.1016/j.jacc.2006.01.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2005] [Revised: 01/03/2006] [Accepted: 01/09/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We evaluated the impact of treatment crossovers on study results in the Mode Selection Trial (MOST). BACKGROUND The MOST study, a 2,010-patient, 6-year trial comparing dual-chamber pacing (DDDR) and ventricular pacing (VVIR) in sinus node dysfunction, demonstrated no difference in death or stroke and modest reductions in heart failure hospitalization (HFH) and atrial fibrillation (AF) with DDDR pacing. However, a moderate proportion of VVIR-randomized patients were temporarily or permanently crossed over to DDDR pacing. METHODS Intent-to-treat (ITT) analyses compared treatment arms by randomized pacing mode. On-treatment analyses used time-dependent covariates to account for all crossovers. All analyses used Cox proportional hazards models and included covariates prespecified in the study design: age, gender, Charlson index, and prior stroke, heart failure, myocardial infarction, supraventricular tachyarrhythmia, and ventricular tachycardia or fibrillation. RESULTS Of 996 VVIR-randomized patients, 375 (38%) were DDDR paced at some time, accounting for 27% of follow-up days among all VVIR-randomized patients. Of 1,014 DDDR-randomized patients, 53 (5%) were VVIR paced at some time, accounting for 1.5% of follow-up days among all DDDR-randomized patients. On-treatment analyses showed slightly lower hazard ratios favoring DDDR versus VVIR compared with ITT: death or stroke 0.88 (on-treatment) versus 0.91 (ITT); death 0.94 versus 0.95; stroke 0.74 versus 0.81; HFH 0.72 versus 0.73; and AF 0.72 versus 0.77. Interpretation of treatment effects was unchanged. CONCLUSIONS Although treatment crossovers accounted for >25% of follow-up time in the VVIR-randomized group, this did not affect study results. End point comparisons between randomized modes are accurate reflections of DDDR versus VVIR pacing in this study population.
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Affiliation(s)
- Anne S Hellkamp
- Duke Clinical Research Institute, Durham, North Carolina, USA.
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Caro J, Ward A, Moller J. Modelling the health benefits and economic implications of implanting dual-chamber vs. single-chamber ventricular pacemakers in the UK. ACTA ACUST UNITED AC 2006; 8:449-55. [PMID: 16690630 DOI: 10.1093/europace/eul042] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS To estimate the consequences of managing bradycardia due to sinoatrial node disease or atrioventricular block with dual-chamber vs. single-chamber ventricular pacemakers. METHODS AND RESULTS A discrete-event simulation was conducted to predict outcomes over 5 years. Patients could develop post-operative complications, clinically relevant pacemaker syndrome leading to replacement of single-chamber with dual-chamber, atrial fibrillation (AF; which if chronic might require anticoagulants) or stroke. Survival, quality-adjusted life years (QALYs), complications, and associated direct medical costs were estimated (2003 British Pounds pounds sterling). Identical patients were simulated after receiving a single-chamber device or a more expensive dual-chamber pacemaker. Probabilities of conditions were obtained from clinical trials. Benefits were discounted at 1.5% and costs at 6%. Post-operative complications increased from 6.4% with single-chamber to 7.7% with dual-chamber but AF decreased (22 vs. 18%) as did clinically relevant pacemaker symptoms (16.8 vs. 0%). Approximately 4300 pounds sterling were accrued per patient over 5 years. Additional health benefits with dual-chamber are achieved at a mean net cost of 43 pounds sterling per patient, leading to 0.09 QALY with a cost-effectiveness ratio of 477 pounds sterling/QALY. CONCLUSION Implanting the costlier device increases the cost of the initial operation; however, this is expected to be offset by a reduction in costs associated with re-operations and AF.
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Affiliation(s)
- Jaime Caro
- Caro Research Institute, 336 Baker Avenue, Concord, MA 01742, USA.
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Musilli N, Padeletti L. Pacemaker selection: time for a rethinking of complex pacing systems?The opinions expressed in this article are not necessarily those of the Editors of the European Heart Journal or of the European Society of Cardiology. Eur Heart J 2005; 27:132-5. [PMID: 16207737 DOI: 10.1093/eurheartj/ehi591] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Evidence from randomized trials indicates that the clinical benefits of dual-chamber (DDD) pacing are modest: (i) no significant differences exist between physiological pacing and single-chamber pacing in mortality and stroke; (ii) ventricular desynchronization resulting from chronic right-ventricular pacing in DDD mode, induces a significantly increased incidence of atrial fibrillation (AF) and heart failure hospitalizations; (iii) AF pacing prevention and therapy algorithms have shown a modest to minimal or absent efficacy; (iv) the widespread use of physiological pacemakers is not an economically attractive strategy. Thus, these data provide a reliable body of evidence on which to make more rationale clinical decisions for individual patients and policy decisions for health costs saving. The cheaper single-chamber AAI(R) or VVI(R) has been shown to satisfy both conditions in most cases of sinus node disease and AV block.
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Affiliation(s)
- Nicola Musilli
- Internal Medicine and Cardiology Institute, University of Florence, V.le Morgagni 85, 50134 Florence, Italy
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Abstract
This article reviews controversies in cardiac pacing in four areas: methods to prevent unnecessary right ventricular pacing and optimal ventricular pacing sites in the bradycardia population, pacing for prevention of atrial fibrillation (AF), a novel pacing technique for the treatment of heart failure, and pacing for the treatment of sleep apnea. Frequent right ventricular pacing has been reported to increase the incidence of AF and congestive heart failure. However, many patients with pacemakers for bradycardia have intrinsic atrioventricular conduction most of the time. Optimal programming of pacemakers and new algorithms designed to reduce unnecessary ventricular pacing are discussed. Pacing algorithms for prevention of AF have generally been shown to be ineffective. Atrial antitachycardia pacing has been shown to reduce the burden of atrial tachyarrhythmias in selected patients. Cardiac contractility modulation has recently been reported to be a promising new approach to the treatment of heart failure. Some pacing techniques may be effective in the treatment of sleep apnea but larger, long-term clinical trials are required to demonstrate a significant clinical benefit.
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Affiliation(s)
- Anne M Gillis
- Faculty of Medicine, University of Calgary, HSC Room 1634, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.
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Royle P, Waugh N. A simplified search strategy for identifying randomised controlled trials for systematic reviews of health care interventions: a comparison with more exhaustive strategies. BMC Med Res Methodol 2005; 5:23. [PMID: 16042789 PMCID: PMC1183214 DOI: 10.1186/1471-2288-5-23] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2005] [Accepted: 07/23/2005] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND It is generally believed that exhaustive searches of bibliographic databases are needed for systematic reviews of health care interventions. The CENTRAL database of controlled trials (RCTs) has been built up by exhaustive searching. The CONSORT statement aims to encourage better reporting, and hence indexing, of RCTs. Our aim was to assess whether developments in the CENTRAL database, and the CONSORT statement, mean that a simplified RCT search strategy for identifying RCTs now suffices for systematic reviews of health care interventions. METHODS RCTs used in the Cochrane reviews were identified. A brief RCT search strategy (BRSS), consisting of a search of CENTRAL, and then for variants of the word random across all fields (random$.af.) in MEDLINE and EMBASE, was devised and run. Any trials included in the meta-analyses, but missed by the BRSS, were identified. The meta-analyses were then re-run, with and without the missed RCTs, and the differences quantified. The proportion of trials with variants of the word random in the title or abstract was calculated for each year. The number of RCTs retrieved by searching with "random$.af." was compared to the highly sensitive search strategy (HSSS). RESULTS The BRSS had a sensitivity of 94%. It found all journal RCTs in 47 of the 57 reviews. The missing RCTs made some significant differences to a small proportion of the total outcomes in only five reviews, but no important differences in conclusions resulted. In the post-CONSORT years, 1997-2003, the percentage of RCTs with random in the title or abstract was 85%, a mean increase of 17% compared to the seven years pre-CONSORT (95% CI, 8.3% to 25.9%). The search using random$.af. reduced the MEDLINE retrieval by 84%, compared to the HSSS, thereby reducing the workload of checking retrievals. CONCLUSION A brief RCT search strategy is now sufficient to locate RCTs for systematic reviews in most cases. Exhaustive searching is no longer cost-effective, because in effect it has already been done for CENTRAL.
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Affiliation(s)
- Pamela Royle
- Department of Public Health, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, Scotland
| | - Norman Waugh
- Department of Public Health, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, Scotland
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