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Khedr MA, Ali EA, Sanhoury MI, Hussein RM. The feasibility of motivational interviewing on adherence to care practices, emotional intelligence, and dispositional optimism among patients with permanent pacemakers. Eur J Cardiovasc Nurs 2024; 23:497-509. [PMID: 38165278 DOI: 10.1093/eurjcn/zvad113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 01/03/2024]
Abstract
AIMS Motivational interviewing (MI) has been recognized as highly effective for treating chronic diseases and various conditions, with encouraging results demonstrating its effectiveness in promoting health behaviour change. The current study was proposed to evaluate the feasibility of MI on adherence to care practices, emotional intelligence (EI), and dispositional optimism among patients with permanent pacemakers. METHODS AND RESULTS This study was a parallel arm randomized controlled trial. Seventy clients with permanent pacemakers were randomly allocated to a six-session MI intervention (n = 35) or a waiting list control group (n = 35). A statistically significant improvement in the mean scores of adherence to care practices, EI, and dispositional optimism, along with a significant reduction in pessimism, was registered among the study group compared with the control group. CONCLUSION Following the intervention for 1- and 2-month follow-up measurements, there were statistically significant improvements in self-care practice adherence. After 1 month of intervention, there were statistically significant gains in EI and dispositional optimism, but at the 2-month follow-up measurement, this improvement had somewhat lessened. The findings suggest that MI may be a feasible and practical approach for improving adherence to care practices, EI, and dispositional optimism in patients with permanent pacemakers. REGISTRATION ClinicalTrials.gov: NCT05883514.
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Affiliation(s)
- Mahmoud Abdelwahab Khedr
- Department of Psychiatric and Mental Health Nursing, Faculty of Nursing, Alexandria University, Smoha district, 21648, Alexandria, Egypt
- Department of Nursing, College of Applied Medical Sciences, Hafr Al Batin University, Hafr Al Batin, 39921, Saudi Arabia
| | - Eman Abdeen Ali
- Department of Medical-Surgical Nursing, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | | | - Rasha Mohamed Hussein
- Department of Psychiatric and Mental Health Nursing, Faculty of Nursing, Zagazig University, Zagazig, Egypt
- Department of Community, Psychiatric and Mental Health Nursing, College of Nursing, Qassim University, Buraidah, Saudi Arabia
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2
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Garweg C, Chinitz JS, Marijon E, Haeberlin A, Winter S, Iacopino S, Curnis A, Breitenstein A, Hussin A, Mela T, El-Chami MF, Roberts PR, Piccini JP, Stromberg K, Fagan DH, Clementy N. A leadless ventricular pacemaker providing atrioventricular synchronous pacing in the real-world setting: 12-Month results from the Micra AV post-approval registry. Heart Rhythm 2024:S1547-5271(24)02684-5. [PMID: 38878939 DOI: 10.1016/j.hrthm.2024.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/06/2024] [Accepted: 06/07/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Advances in leadless pacemaker technology have enabled accelerometer-based atrioventricular (AV) synchronous pacing by sensing atrial mechanical contraction. OBJECTIVE The purpose of this study was to report the performance of the Micra AV leadless pacemaker from the worldwide Micra AV post-approval registry (PAR) through 12 months. METHODS The Micra AV PAR is a prospective, single-arm, observational registry designed to assess the safety and effectiveness of Micra AV in a real-world setting. For the present interim analysis, major complications and system revisions through 12 months were summarized and compared to a historical cohort of 2667 patients implanted with a transvenous dual-chamber pacing system. RESULTS The device was successfully implanted in 796 of 801 patients (99.4%) at 97 centers in 19 countries. Micra AV patients were older (74.1 years vs 71.1 years; P < .0001) with a higher incidence of renal disease (22.3% vs 9.8%; P < .0001) compared with transvenous dual-chamber patients. Through 12 months, the major complication rate was 3.7% in Micra AV patients compared with 8.8% in transvenous dual-chamber patients (hazard ratio 0.42; 95% confidence interval 0.28-0.61; P < .001). The system revision rate was 1.5% in Micra AV patients compared with 5.5% for transvenous dual-chamber patients (hazard ratio 0.25; 95% confidence interval 0.13-0.47; P < .001); this reduction was largely driven by the absence of lead dislodgments requiring revision. The median AV synchrony index was 79.4% (interquartile range 65.2%-86.4%) in patients paced >90%. CONCLUSION The Micra AV leadless pacemaker was implanted with a high rate of success in patients with multiple comorbidities, with a significantly lower rate of complications and system revisions through 12 months compared to a historical cohort of patients with transvenous dual-chamber pacemakers.
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Affiliation(s)
| | | | - Eloi Marijon
- European Georges Pompidou Hospital, Paris, France
| | | | | | | | - Antonio Curnis
- Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | | | | | - Theofanie Mela
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Paul R Roberts
- University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Jonathan P Piccini
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | | | - Nicolas Clementy
- Department of Cardiologic Medicine, Centre Hospitalier Regional Universitaire de Tours-Hopital Trousseau, Tours, France
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3
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Margolis G, Hamuda N, Kobo O, Elbaz Greener G, Amir O, Homoud M, Madias C, Heist EK, Ruskin JN, Kazatsker M, Roguin A, Leshem E, Rozen G. Single- Versus Dual-Chamber Implantable Cardioverter-Defibrillator for Primary Prevention of Sudden Cardiac Death in the United States. J Am Heart Assoc 2023; 12:e029126. [PMID: 37522389 PMCID: PMC10492963 DOI: 10.1161/jaha.122.029126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/27/2023] [Indexed: 08/01/2023]
Abstract
Background Routine addition of an atrial lead during an implantable cardioverter-defibrillator (ICD) implantation for primary prevention of sudden cardiac death, in patients without pacing indications, was not shown beneficial in contemporary studies. We aimed to investigate the use and safety of single- versus dual-chamber ICD implantations in these patients. Methods and Results Using the National Inpatient Sample database, we identified patients with no pacing indications who underwent primary-prevention ICD implantation in the United States between 2015 and 2019. Sociodemographic and clinical characteristics, as well as in-hospital complications, were analyzed. Multivariable logistic regression was used to identify predictors of in-hospital complications. An estimated total of 15 940 patients, underwent ICD implantation for primary prevention of sudden cardiac death during the study period, 8860 (55.6%) received a dual-chamber ICD. The mean age was 64 years, and 66% were men. In-hospital complication rates in the dual-chamber ICD and single-chamber ICD group were 12.8% and 10.7%, respectively (P<0.001), driven by increased rates of pneumothorax/hemothorax (4.6% versus 3.4%; P<0.001) and lead dislodgement (3.6% versus 2.3%; P<0.001) in the dual-chamber ICD group. Multivariable analyses confirmed atrial lead addition as an independent predictor for "any complications" (odds ratio [OR], 1.1 [95% CI, 1.0-1.2]), for pneumo/hemothorax (odds ratio, 1.1 [95% CI, 1.0-1.4]), and for lead dislodgement (odds ratio, 1.3 [95% CI, 1.1-1.6]). Conclusions Despite lack of evidence for clinical benefit, dual-chamber ICDs are implanted for primary prevention of sudden cardiac death in a majority of patients who do not have pacing indication. This practice is associated with increased risk of periprocedural complications. Avoidance of routine implantation of atrial leads will likely improve safety outcomes.
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Affiliation(s)
- Gilad Margolis
- Division of Cardiovascular Medicine, Hillel Yaffe Medical CenterThe Ruth and Bruce Rappaport Faculty of MedicineTechnionHaifaIsrael
| | - Nashed Hamuda
- Division of Cardiovascular Medicine, Hillel Yaffe Medical CenterThe Ruth and Bruce Rappaport Faculty of MedicineTechnionHaifaIsrael
| | - Ofer Kobo
- Division of Cardiovascular Medicine, Hillel Yaffe Medical CenterThe Ruth and Bruce Rappaport Faculty of MedicineTechnionHaifaIsrael
| | - Gabby Elbaz Greener
- Department of Cardiology, Hadassah Medical CenterJerusalemIsrael
- Faculty of MedicineHebrew University of JerusalemJerusalemIsrael
| | - Offer Amir
- Department of Cardiology, Hadassah Medical CenterJerusalemIsrael
- Faculty of MedicineHebrew University of JerusalemJerusalemIsrael
| | - Munther Homoud
- Cardiovascular Center, Tufts Medical CenterTufts University School of MedicineBostonMAUSA
| | - Christopher Madias
- Cardiovascular Center, Tufts Medical CenterTufts University School of MedicineBostonMAUSA
| | - Edwin Kevin Heist
- Cardiac Arrhythmia Center, Massachusetts General HospitalHarvard Medical SchoolBostonMAUSA
| | - Jeremy N. Ruskin
- Cardiac Arrhythmia Center, Massachusetts General HospitalHarvard Medical SchoolBostonMAUSA
| | - Mark Kazatsker
- Division of Cardiovascular Medicine, Hillel Yaffe Medical CenterThe Ruth and Bruce Rappaport Faculty of MedicineTechnionHaifaIsrael
| | - Ariel Roguin
- Division of Cardiovascular Medicine, Hillel Yaffe Medical CenterThe Ruth and Bruce Rappaport Faculty of MedicineTechnionHaifaIsrael
| | - Eran Leshem
- Division of Cardiovascular Medicine, Hillel Yaffe Medical CenterThe Ruth and Bruce Rappaport Faculty of MedicineTechnionHaifaIsrael
| | - Guy Rozen
- Cardiovascular Center, Tufts Medical CenterTufts University School of MedicineBostonMAUSA
- Cardiac Arrhythmia Center, Massachusetts General HospitalHarvard Medical SchoolBostonMAUSA
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4
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Siskin M, Cerrone M, Shokr M, Aizer A, Barbhaiya C, Dai M, Bernstein S, Holmes D, Knotts R, Park DS, Spinelli M, Chinitz LA, Jankelson L. ICD shocks and complications in patients with inherited arrhythmia syndromes. IJC HEART & VASCULATURE 2021; 37:100908. [PMID: 34765721 PMCID: PMC8569698 DOI: 10.1016/j.ijcha.2021.100908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is limited information on the long-term outcomes of ICDs in patients with inherited arrhythmia syndromes. METHODS Prospective registry study of inherited arrhythmia patients with an ICD. Incidence of therapies and complications were measured as 5-year cumulative incidence proportions and analyzed with the Kaplan-Meier method. Incidence was compared by device indication, diagnosis type and device type. Cox-regression analysis was used to identify predictors of appropriate shock and device complication. RESULTS 123 patients with a mean follow up of 6.4 ± 4.8 years were included. The incidence of first appropriate shock was 56.52% vs 24.44%, p < 0.05 for cardiomyopathy and channelopathy patients, despite similar ejection fraction (61% vs 60%, p = 0.6). The incidence of first inappropriate shock was 13.46% vs 56.25%, p < 0.01 for single vs. multi-lead devices. The incidence of first lead complication was higher for multi-lead vs. single lead devices, 43.75% vs. 17.31%, p = 0.04. Patients with an ICD for secondary prevention were more likely to receive an appropriate shock than those with primary prevention indication (HR 2.21, CI 1.07-4.56, p = 0.03). Multi-lead devices were associated with higher risk of inappropriate shock (HR 3.99, CI 1.27-12.52, p = 0.02), with similar appropriate shock risk compared to single lead devices. In 26.5% of patients with dual chamber devices, atrial sensing or pacing was not utilized. CONCLUSION The rate of appropriate therapies and ICD complications in patients with inherited arrhythmia is high, particularly in cardiomyopathies with multi-lead devices. Risk-benefit ratio should be carefully considered when assessing the indication and type of device in this population.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Lior Jankelson
- Corresponding author at: Leon H. Charney Division of Cardiology New York University Langone Health 516 1st Avenue, New York 10016, USA.
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5
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Infeld M, Avram R, Wahlberg K, Silverman DN, Habel N, Lustgarten DL, Pletcher MJ, Olgin JE, Marcus GM, Meyer M. An approach towards individualized lower rate settings for pacemakers. Heart Rhythm O2 2021; 1:390-393. [PMID: 33604585 PMCID: PMC7889012 DOI: 10.1016/j.hroo.2020.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Margaret Infeld
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Robert Avram
- Division of Cardiology, Department of Medicine, and the Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California
| | - Kramer Wahlberg
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Daniel N Silverman
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Nicole Habel
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Daniel L Lustgarten
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Jeffrey E Olgin
- Division of Cardiology, Department of Medicine, and the Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California
| | - Gregory M Marcus
- Division of Cardiology, Department of Medicine, and the Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California
| | - Markus Meyer
- Lillehei Heart Institute, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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6
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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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7
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Phillips KA, Ponamgi S, Mundell B, Krushelnytskyy M, Li Z, Rea R, Deshmukh A, McLeod C, Espinosa RE, Osborn M, Friedman PA, Mulpuru SK, Cha YM, Neutzling LB, Munger T, Kancharla K, Asirvatham SJ. Clinical implications of elective replacement indicator setting changes in patients with dual-chamber pacemaker devices. J Cardiovasc Electrophysiol 2020; 31:2704-2710. [PMID: 32671902 DOI: 10.1111/jce.14677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/18/2020] [Accepted: 06/21/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study sought to determine if single-chamber operation and/or loss of rate response (RR) during elective replacement indicator (ERI) in patients with dual-chamber pacemakers lead to increased symptom burden, healthcare utilization, and atrial fibrillation (AF). BACKGROUND Dual-chamber pacemakers often change from dual- to single-chamber pacing mode and/or lose RR functionality at ERI to preserve battery. Single-chamber pacing increases the incidence of heart failure, AF, and pacemaker syndrome suggesting these changes may be deleterious. METHODS A retrospective analysis of 700 patients was completed. Three comparisons were analyzed: Comparison 1: mode change and RR loss versus no change; Comparison 2: RR loss only versus no change; Comparison 3: mode change only versus no change (in patients with no RR programmed at baseline). RESULTS In Comparison 1, 121 (46%) patients with setting changes experienced symptoms (most often dyspnea and fatigue/exercise intolerance) versus 3 (4%) without setting changes (p < .0001). Similar results were noted in Comparisons 2 and 3 (p = .0016 and p = .0001, respectively). In Comparison 1, patients with setting change sought provider contact more than patients without setting changes (p = .0001). A significant difference was not noted in Comparison 2 or 3. Overall 14 (2%) patients were hospitalized, all of whom had setting changes. CONCLUSIONS Setting changes at ERI including a change from dual- to single-chamber pacing and/or loss of RR results in a significantly increased symptom burden and increased healthcare utilization.
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Affiliation(s)
- Kari A Phillips
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Shiva Ponamgi
- Department of Hospital Medicine, Mayo Clinic Health Systems, Austin, Minnesota, USA.,Department of Cardiovascular Disease, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Mykhaylo Krushelnytskyy
- Department of Neurologic Surgery, McGraw Medical Center of Northwestern University, Chicago, Illinois, USA
| | - Zhuo Li
- Department of Statistics, Mayo Clinic, Jacksonville, Florida, USA
| | - Robert Rea
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Abhishek Deshmukh
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher McLeod
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Raul E Espinosa
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael Osborn
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul A Friedman
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Siva K Mulpuru
- Department of Cardiovascular Disease, Mayo Clinic, Scottsdale, Arizona, USA
| | - Yong-Mei Cha
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Lori B Neutzling
- Department of Cardiology, CentraCare Saint Cloud Hospital, St. Cloud, Minnesota, USA
| | - Thomas Munger
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Krishna Kancharla
- Department of Cardiovascular Disease, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
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8
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Oliveira SF, Carvalho MM, Adão L, Nunes JP. Clinical outcomes of leadless pacemaker: a systematic review. Minerva Cardiol Angiol 2020; 69:346-357. [PMID: 32657558 DOI: 10.23736/s2724-5683.20.05244-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Transvenous pacemakers are associated with a significant amount of complications. Leadless pacemakers (LP) are emerging as an alternative to conventional devices. This article provides a systematic review of patient eligibility, safety and clinical outcomes of the LP devices. EVIDENCE ACQUISITION A systematic search for articles describing the use of LP was conducted. Out of two databases, 24 articles were included in the qualitative analysis. These articles comprised a total of 4739 patients, with follow-up times of 1-38 months. Further information was obtained from 10 more studies. EVIDENCE SYNTHESIS From a population of 4739 patients included in the qualitative analysis, 4670 LP were implanted with success (98.5%). A total of 248 complications were described (5.23%) during the follow-up. The most common were pacing issues such as elevated thresholds, dislodgements or battery failure (68 patients), events at the femoral access site such as hemorrhage, hematoma or pseudoaneurysms (64 patients) and procedure related cardiac injuries such as cardiac perforation, tamponade or pericardial effusion (47 patients). There were 360 deaths during the follow-up and 11 were described as procedure or device related. Four studies presented the strategy of using a combined approach of atrioventricular node ablation (AVNA) and LP implantation. CONCLUSIONS Leadless pacemakers seem to have a relatively low complication rate. These devices may be a good option in patients with an indication for single-chamber pacing, in patients with conditions precluding conventional transvenous pacemaker implantations. Studies directly comparing LP and transvenous pacemakers and data on longer follow-up periods are needed.
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Affiliation(s)
| | - Miguel M Carvalho
- Faculty of Medicine, University of Porto, Porto, Portugal.,São João University Hospital, Porto, Portugal
| | - Luís Adão
- São João University Hospital, Porto, Portugal
| | - José P Nunes
- Faculty of Medicine, University of Porto, Porto, Portugal.,São João University Hospital, Porto, Portugal
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9
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Pasupula DK, Rajaratnam A, Rattan R, Munir MB, Ahmad S, Adelstein E, Jain S, Wang NC, Saba S. Trends in Hospital Admissions for and Readmissions After Cardiac Implantable Electronic Device Procedures in the United States: An Analysis From 2010 to 2014 Using the National Readmission Database. Mayo Clin Proc 2019; 94:588-598. [PMID: 30853259 DOI: 10.1016/j.mayocp.2018.10.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/22/2018] [Accepted: 10/17/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate inpatient trends in de novo complete cardiac implantable electronic device (CIED) procedures and subsequent all-cause 30-day readmissions in the United States. PATIENTS AND METHODS We accessed the National Readmission Database to identify CIED implantation-related hospitalizations between January 1, 2010, and December 31, 2014, using International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes. In-hospital mortality and postprocedure all-cause 30-day readmissions were also analyzed. RESULTS During the study period, a total of 800,250 CIED implantation hospitalizations were identified across the United States, with an in-hospital mortality rate of 0.9% (7423 of 800,250) and a 29% decrease in CIED-related index hospitalizations (188,086 in 2010 vs 134,276 in 2014). The all-cause 30-day readmission rate for the entire cohort was 13% (106,505 of 800,250), decreasing from 14% (26,134 of 188,085) in 2010 to only 13% (17,154 of 134,276) by 2014. Dual-chamber pacemakers were the most frequently implanted in-hospital CIEDs (473,615 of 800,250 [59%]). The most common cause for readmission was heart failure exacerbation, which remained unchanged over the study period. CONCLUSION Our data reveal a steady decline in overall in-hospital CIED implantations and only a modest decline in readmission rates. The cause for this decline may be an impact of medical and regulatory changes guiding CIED implantations, but it deserves further investigation.
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Affiliation(s)
| | - Arun Rajaratnam
- Department of Medicine, University of Pittsburgh Medical Center, PA
| | - Rohit Rattan
- Department of Medicine, University of Pittsburgh Medical Center, PA
| | | | - Shahzad Ahmad
- Department of Medicine, University of Pittsburgh Medical Center, PA
| | - Evan Adelstein
- Department of Cardiac Electrophysiology, Albany Medical Center, NY
| | - Sandeep Jain
- Heart and Vascular Institute, University of Pittsburgh Medical Center, PA
| | - Norman C Wang
- Heart and Vascular Institute, University of Pittsburgh Medical Center, PA
| | - Samir Saba
- Heart and Vascular Institute, University of Pittsburgh Medical Center, PA
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10
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Liu Y, Wang P, Ma F, Zheng M, Liu G, Kume S, Kurokawa T, Ono K. Asparagine-linked glycosylation modifies voltage-dependent gating properties of Ca V3.1-T-type Ca 2+ channel. J Physiol Sci 2019; 69:335-343. [PMID: 30600443 PMCID: PMC10717069 DOI: 10.1007/s12576-018-0650-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 12/05/2018] [Indexed: 01/11/2023]
Abstract
T-type channels are low-voltage-activated channels that play a role in the cardiovascular system particularly for pacemaker activity. Glycosylation is one of the most prevalent post-translational modifications in protein. Among various glycosylation types, the most common one is asparagine-linked (N-linked) glycosylation. The aim of this study was to elucidate the roles of N-linked glycosylation for the gating properties of the CaV3.1-T-type Ca2+ channel. N-linked glycosylation synthesis inhibitor tunicamycin causes a reduction of CaV3.1-T-type Ca2+ channel current (CaV3.1-ICa.T) when applied for 12 h or longer. Tunicamycin (24 h) significantly shifted the activation curve to the depolarization potentials, whereas the steady-state inactivation curve was unaffected. Use-dependent inactivation of CaV3.1-ICa.T was accelerated, and recovery from inactivation was prolonged by tunicamycin (24 h). CaV3.1-ICa.T was insensitive to a glycosidase PNGase F when the channels were expressed on the plasma membrane. These findings suggest that N-glycosylation contributes not only to the cell surface expression of the CaV3.1-T-type Ca2+ channel but to the regulation of the gating properties of the channel when the channel proteins were processed during the folding and trafficking steps in the cell.
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Affiliation(s)
- Yangong Liu
- Department of Cardiology, The First Hospital of Hebei Medical University, 89 Donggang Road, Shijiazhuang, Hebei Province, 050031, People's Republic of China
- Department of Pathophysiology, Oita University School of Medicine, Yufu, Oita, 879-5593, Japan
| | - Pu Wang
- Department of Cardiology, The First Hospital of Hebei Medical University, 89 Donggang Road, Shijiazhuang, Hebei Province, 050031, People's Republic of China
- Department of Pathophysiology, Oita University School of Medicine, Yufu, Oita, 879-5593, Japan
| | - Fangfang Ma
- Department of Cardiology, The First Hospital of Hebei Medical University, 89 Donggang Road, Shijiazhuang, Hebei Province, 050031, People's Republic of China
- Department of Pathophysiology, Oita University School of Medicine, Yufu, Oita, 879-5593, Japan
| | - Mingqi Zheng
- Department of Cardiology, The First Hospital of Hebei Medical University, 89 Donggang Road, Shijiazhuang, Hebei Province, 050031, People's Republic of China
| | - Gang Liu
- Department of Cardiology, The First Hospital of Hebei Medical University, 89 Donggang Road, Shijiazhuang, Hebei Province, 050031, People's Republic of China
| | - Shinichiro Kume
- Department of Pathophysiology, Oita University School of Medicine, Yufu, Oita, 879-5593, Japan
| | - Tatsuki Kurokawa
- Department of Pathophysiology, Oita University School of Medicine, Yufu, Oita, 879-5593, Japan
| | - Katsushige Ono
- Department of Pathophysiology, Oita University School of Medicine, Yufu, Oita, 879-5593, Japan.
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12
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Chinitz L, Ritter P, Khelae SK, Iacopino S, Garweg C, Grazia-Bongiorni M, Neuzil P, Johansen JB, Mont L, Gonzalez E, Sagi V, Duray GZ, Clementy N, Sheldon T, Splett V, Stromberg K, Wood N, Steinwender C. Accelerometer-based atrioventricular synchronous pacing with a ventricular leadless pacemaker: Results from the Micra atrioventricular feasibility studies. Heart Rhythm 2018; 15:1363-1371. [PMID: 29758405 DOI: 10.1016/j.hrthm.2018.05.004] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Micra is a leadless pacemaker that is implanted in the right ventricle and provides rate response via a 3-axis accelerometer (ACC). Custom software was developed to detect atrial contraction using the ACC enabling atrioventricular (AV) synchronous pacing. OBJECTIVE The purpose of this study was to sense atrial contractions from the Micra ACC signal and provide AV synchronous pacing. METHODS The Micra Accelerometer Sensor Sub-Study (MASS) and MASS2 early feasibility studies showed intracardiac accelerations related to atrial contraction can be measured via ACC in the Micra leadless pacemaker. The Micra Atrial TRacking Using A Ventricular AccELerometer (MARVEL) study was a prospective multicenter study designed to characterize the closed-loop performance of an AV synchronous algorithm downloaded into previously implanted Micra devices. Atrioventricular synchrony (AVS) was measured during 30 minutes of rest and during VVI pacing. AVS was defined as a P wave visible on surface ECG followed by a ventricular event <300 ms. RESULTS A total of 64 patients completed the MARVEL study procedure at 12 centers in 9 countries. Patients were implanted with a Micra for a median of 6.0 months (range 0-41.4). High-degree AV block was present in 33 patients, whereas 31 had predominantly intrinsic conduction during the study. Average AVS during AV algorithm pacing was 87.0% (95% confidence interval 81.8%-90.9%), 80.0% in high-degree block patients and 94.4% in patients with intrinsic conduction. AVS was significantly greater (P <.001) during AV algorithm pacing compared to VVI in high-degree block patients, whereas AVS was maintained in patients with intrinsic conduction. CONCLUSION Accelerometer-based atrial sensing is feasible and significantly improves AVS in patients with AV block and a single-chamber leadless pacemaker implanted in the right ventricle.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Lluis Mont
- Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | | | | | - Gabor Z Duray
- Military Hospital-State Health Center, Budapest, Hungary
| | | | | | | | | | | | - Clemens Steinwender
- Department of Cardiology, Kepler University Hospital, Linz, Austria; Paracelsus Medical University Salzburg, Salzburg, Austria
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Kancharla K, Deshmukh AJ, Friedman PA. Leadless Pacemakers - Implant, Explant and Long-Term Safety and Efficacy Data. J Atr Fibrillation 2017; 10:1581. [PMID: 29250229 DOI: 10.4022/jafib.1581] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/29/2017] [Accepted: 08/15/2017] [Indexed: 11/10/2022]
Abstract
Implantable cardiac pacemakers have seen remarkable progress in the last sixty years and remained as cornerstone therapy for symptomatic bradycardia. Despite this progress the current day traditional transvenous implanted pacemaker systems are limited by the need for a surgically created pocket for the generator, indwelling leads in the vascular system and lastly passage through the tricuspid valve. A majority of the implant and explant related complications are due to the surgical pocket and indwelling leads. Leadless pacemakers represent a major leap in technology and emerged as an alternative to traditional systems promises to eliminate lead and pocket associated complications. As with any disruptive technology, some questions remain unanswered with the leadless pacing systems, specifically longevity and end of life management for the device. Despite the unknowns, as the technology progresses, it is possible that pacing leads will become extinct and pacemakers will miniaturize even further. This review summarizes the available technology, implant and explant details, and long-term safety and efficacy data for leadless pacemakers.
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Affiliation(s)
- Krishna Kancharla
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Abhishek J Deshmukh
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Paul A Friedman
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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14
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Chang PM, Doshi RN. Implantation of a leadless cardiac pacemaker for recurrent pocket infections. HeartRhythm Case Rep 2017; 2:339-341. [PMID: 28491705 PMCID: PMC5419888 DOI: 10.1016/j.hrcr.2016.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Philip M Chang
- Keck School of Medicine of University of Southern California (USC), Keck Medical Center of USC, Los Angeles, California
| | - Rahul N Doshi
- Keck School of Medicine of University of Southern California (USC), Keck Medical Center of USC, Los Angeles, California
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15
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Santangeli P, Di Biase L, Basile E, Al-Ahmad A, Natale A. Outcomes in Women Undergoing Electrophysiological Procedures. Arrhythm Electrophysiol Rev 2016; 2:41-4. [PMID: 26835039 DOI: 10.15420/aer.2013.2.1.41] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The number of invasive electrophysiological procedures is steadily increasing in Western countries, as the age of the population increases and technologies advance. In recent years, gender-related differences in cardiac rhythm disorders have been increasingly appreciated, which can potentially have a great impact on the outcomes of invasive electrophysiological procedures. Among supraventricular arrhythmias, women have a higher incidence of atrioventricular nodal re-entrant tachycardia and a significantly lower incidence of atrioventricular re-entrant tachycardia compared with males, and present to ablation procedures later and after having failed more antiarrhythmic drugs. The results of catheter ablation of atrial fibrillation in women have been reported worse than in men. This finding is possibly due to a later referral of females to ablation procedures, who present older and with a higher incidence of long-standing persistent atrial fibrillation. With regard to cardiac device implantation procedures, a smaller survival benefit from prophylactic implantable cardioverter defibrillator (ICD) implantation has been shown in women, essentially due to gender-specific differences in the clinical course of patients with severe left ventricular dysfunction, with women dying predominantly from non-arrhythmic causes. On the other side, the clinical outcome of cardiac resynchronisation therapy seems to be more favourable in women, who experience a greater degree of reverse left ventricular remodelling and a striking decrease of heart failure events or mortality after biventricular pacing. This review will summarise the available evidence on gender-related differences in outcomes of invasive electrophysiological procedures.
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Affiliation(s)
- Pasquale Santangeli
- Division of Cardiology, Stanford University School of Medicine, California, US; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Texas, US; Department of Cardiology, University of Foggia, Foggia, Italy
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Texas, US; Department of Cardiology, University of Foggia, Foggia, Italy
| | - Eloisa Basile
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Amin Al-Ahmad
- Division of Cardiology, Stanford University School of Medicine, California, US
| | - Andrea Natale
- Division of Cardiology, Stanford University School of Medicine, California, US; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Texas, US
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16
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Wilkoff BL, Fauchier L, Stiles MK, Morillo CA, Al-Khatib SM, Almendral J, Aguinaga L, Berger RD, Cuesta A, Daubert JP, Dubner S, Ellenbogen KA, Estes NAM, Fenelon G, Garcia FC, Gasparini M, Haines DE, Healey JS, Hurtwitz JL, Keegan R, Kolb C, Kuck KH, Marinskis G, Martinelli M, McGuire M, Molina LG, Okumura K, Proclemer A, Russo AM, Singh JP, Swerdlow CD, Teo WS, Uribe W, Viskin S, Wang CC, Zhang S. 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing. J Arrhythm 2016; 32:1-28. [PMID: 26949427 PMCID: PMC4759125 DOI: 10.1016/j.joa.2015.12.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Key Words
- AF, atrial fibrillation
- ATP, antitachycardia pacing
- Bradycardia mode and rate
- CI, confidence interval
- CL, cycle length
- CRT, cardiac resynchronization therapy
- CRT-D, cardiac resynchronization therapy–defibrillator
- DT, defibrillation testing
- Defibrillation testing
- EEG, electroencephalography
- EGM, electrogram
- HF, heart failure
- HR, hazard ratio
- ICD, implantable cardioverter-defibrillator
- Implantable cardioverter-defibrillator
- LV, left ventricle
- LVEF, left ventricular ejection fraction
- MI, myocardial infarction
- MVP, managed ventricular pacing
- NCDR, National Cardiovascular Data Registry
- NYHA, New York Heart Association
- OR, odds ratio
- PEA, peak endocardial acceleration
- PVC, premature ventricular contraction
- Programming
- RCT, randomized clinical trial
- RV, right ventricle
- S-ICD, subcutaneous implantable cardioverter-defibrillator
- SCD, sudden cardiac death
- SVT, supraventricular tachycardia
- TIA, transient ischemic attack
- Tachycardia detection
- Tachycardia therapy
- VF, ventricular fibrillation
- VT, ventricular tachycardia (Heart Rhythm 2015;0:1–37)
- aCRT, adaptive cardiac resynchronization therapy
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Affiliation(s)
| | | | | | - Carlos A Morillo
- Department of Medicine, Cardiology Division, McMaster University-Population Health Research Institute, Hamilton, Canada
| | | | - Jesœs Almendral
- Grupo HM Hospitales, Universidad CEU San Pablo, Madrid, Spain
| | | | | | - Alejandro Cuesta
- Servicio de Arritmias, Instituto de Cardiologia Infantil, Montevideo, Uruguay
| | | | - Sergio Dubner
- Clinica y Maternidad Suizo Argentina; De Los Arcos Sanatorio, Buenos Aires, Argentina
| | | | | | | | - Fermin C Garcia
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - David E Haines
- William Beaumont Hospital Division of Cardiology, Royal Oak, Michigan
| | - Jeff S Healey
- Department of Medicine, Cardiology Division, McMaster University-Population Health Research Institute, Hamilton, Canada
| | | | | | | | | | | | | | | | - Luis G Molina
- Mexico's National University, Mexico's General Hospital, Mexico City, Mexico
| | - Ken Okumura
- Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Alessandro Proclemer
- Azienda Ospedaliero Universitaria S. Maria della Misericordia- Udine, Udine, Italy
| | | | - Jagmeet P Singh
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Wee Siong Teo
- National Heart Centre Singapore, Singapore, Singapore
| | - William Uribe
- CES Cardiología and Centros Especializados San Vicente Fundación, Medellín y Rionegro, Colombia
| | - Sami Viskin
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Shu Zhang
- National Center for Cardiovascular Disease and Beijing Fu Wai Hospital, Peking Union Medical College and China Academy of Medical Sciences, Beijing, China
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17
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2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing. Heart Rhythm 2015; 13:e50-86. [PMID: 26607062 DOI: 10.1016/j.hrthm.2015.11.018] [Citation(s) in RCA: 179] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Indexed: 12/12/2022]
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18
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Wilkoff BL, Fauchier L, Stiles MK, Morillo CA, Al-Khatib SM, Almendral J, Aguinaga L, Berger RD, Cuesta A, Daubert JP, Dubner S, Ellenbogen KA, Estes NAM, Fenelon G, Garcia FC, Gasparini M, Haines DE, Healey JS, Hurtwitz JL, Keegan R, Kolb C, Kuck KH, Marinskis G, Martinelli M, Mcguire M, Molina LG, Okumura K, Proclemer A, Russo AM, Singh JP, Swerdlow CD, Teo WS, Uribe W, Viskin S, Wang CC, Zhang S. 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing. Europace 2015; 18:159-83. [PMID: 26585598 DOI: 10.1093/europace/euv411] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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19
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Shea JB. Transvenous Lead Extraction for Cardiac Implantable Electronic Devices. AACN Adv Crit Care 2015. [DOI: 10.4037/nci.0000000000000114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
This article illustrates the important role that lead extraction plays in the management of patients with cardiac implantable electronic devices. Individualized care of the patient is paramount when considering lead management strategies. The critical care nurse must have a comprehensive understanding of the indications, procedural considerations, and preprocedural and postprocedural care for patients undergoing lead extraction procedures, thereby improving patient safety and maximizing patient outcomes.
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Affiliation(s)
- Julie B. Shea
- Julie B. Shea is Nurse Practitioner, Brigham and Women’s Hospital, Shapiro Cardiovascular Center, Room 3062, 70 Francis St, Boston, MA 02115
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21
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Diemberger I, Gardini B, Martignani C, Ziacchi M, Corzani A, Biffi M, Boriani G. Holter ECG for pacemaker/defibrillator carriers: what is its role in the era of remote monitoring? Heart 2015; 101:1272-8. [DOI: 10.1136/heartjnl-2015-307614] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 04/17/2015] [Indexed: 12/27/2022] Open
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22
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23
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Silver MT, Sterns LD, Piccini JP, Joung B, Ching CK, Pickett RA, Rabinovich R, Liu S, Peterson BJ, Lexcen DR. Feedback to providers improves evidence-based implantable cardioverter-defibrillator programming and reduces shocks. Heart Rhythm 2015; 12:545-553. [DOI: 10.1016/j.hrthm.2014.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Indexed: 10/24/2022]
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24
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Ferrari ADL, Borges AP, Albuquerque LC, Pelzer Sussenbach C, Rosa PRD, Piantá RM, Wiehe M, Goldani MA. Cardiomyopathy induced by artificial cardiac pacing: myth or reality sustained by evidence? Braz J Cardiovasc Surg 2014; 29:402-13. [PMID: 25372916 PMCID: PMC4412332 DOI: 10.5935/1678-9741.20140104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 08/05/2014] [Indexed: 01/27/2023] Open
Abstract
Implantable cardiac pacing systems are a safe and effective treatment for symptomatic
irreversible bradycardia. Under the proper indications, cardiac pacing might bring
significant clinical benefit. Evidences from literature state that the action of the
artificial pacing system, mainly when the ventricular lead is located at the apex of
the right ventricle, produces negative effects to cardiac structure (remodeling,
dilatation) and function (dissinchrony). Patients with previously compromised left
ventricular function would benefit the least with conventional right ventricle apical
pacing, and are exposed to the risk of developing higher incidence of morbidity and
mortality for heart failure. However, after almost 6 decades of cardiac pacing, just
a reduced portion of patients in general would develop these alterations. In this
context, there are not completely clear some issues related to cardiac pacing and the
development of this cardiomyopathy. Causality relationships among QRS widening with a
left bundle branch block morphology, contractility alterations within the left
ventricle, and certain substrates or clinical (previous systolic dysfunction,
structural heart disease, time from implant) or electrical conditions (QRS duration,
percentage of ventricular stimulation) are still subjecte of debate. This review
analyses contemporary data regarding this new entity, and discusses alternatives of
how to use cardiac pacing in this context, emphasizing cardiac resynchronization
therapy.
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Affiliation(s)
| | - Anibal Pires Borges
- São Lucas Hospital, Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | | | | | | | - Mario Wiehe
- São Lucas Hospital, Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Marco Antônio Goldani
- São Lucas Hospital, Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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25
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Cardiac arrhythmia induced by genetic silencing of 'funny' (f) channels is rescued by GIRK4 inactivation. Nat Commun 2014; 5:4664. [PMID: 25144323 PMCID: PMC4207211 DOI: 10.1038/ncomms5664] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 07/14/2014] [Indexed: 01/01/2023] Open
Abstract
The mechanisms underlying cardiac automaticity are still incompletely
understood and controversial. Here we report the complete conditional and
time-controlled silencing of the "funny" current
(If) by expression of a dominant-negative,
non-conductive HCN4-channel subunit (hHCN4-AYA). Heart-specific
If silencing caused altered
[Ca2+]i release and Ca2+ handling in the
sinoatrial node, impaired pacemaker activity, and symptoms reminiscent of severe
human disease of pacemaking. The effects of If
silencing critically depended on the activity of the autonomic nervous system.
We were able to rescue the failure of impulse generation and conduction by
additional genetic deletion of cardiac muscarinic G-protein-activated (GIRK4)
channels in If-deficient mice without impairing
heartbeat regulation. Our study establishes the role of f-channels in cardiac
automaticity and indicates that arrhythmia related to HCN
loss-of-function may be managed by pharmacological or genetic inhibition of
GIRK4 channels, thus offering a new therapeutic strategy for the treatment of
heart rhythm diseases.
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26
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Poole JE. The deleterious effects of RV pacing: applicable to all patients? BRITISH HEART JOURNAL 2014; 100:747-9. [DOI: 10.1136/heartjnl-2013-305422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Poole JE. Present guidelines for device implantation: clinical considerations and clinical challenges from pacing, implantable cardiac defibrillator, and cardiac resynchronization therapy. Circulation 2014; 129:383-94. [PMID: 24446408 DOI: 10.1161/circulationaha.112.000762] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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28
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T-type channels in the sino-atrial and atrioventricular pacemaker mechanism. Pflugers Arch 2014; 466:791-9. [DOI: 10.1007/s00424-014-1482-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 02/11/2014] [Accepted: 02/12/2014] [Indexed: 11/26/2022]
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29
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Biffi M, Melissano D, Rossi P, Kaliska G, Havli ek A, Pelargonio G, Romero R, Guastaferro C, Menichelli M, Vireca E, Frisoni J, Boriani G, Malacky T. The OPTI-MIND study: a prospective, observational study of pacemaker patients according to pacing modality and primary indications. Europace 2014; 16:689-97. [DOI: 10.1093/europace/eut387] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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30
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Coma Samartín R, Ruiz Mateas F, Fidalgo Andrés ML, Leal del Ojo González J, Pérez Álvarez L. Spanish pacemaker registry. 10th official report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2012). REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2013; 66:959-972. [PMID: 24774109 DOI: 10.1016/j.rec.2013.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 08/17/2013] [Indexed: 06/03/2023]
Abstract
INTRODUCTION AND OBJECTIVES Our aim was to analyze the pacemaker implantations and replacements reported to the Spanish Pacemaker Registry in 2012 with special reference to the selection of pacing modes. METHOD The analysis was based on information provided by the European Pacemaker Patient Identification Card. RESULTS Data were received from 115 hospitals, with a total of 12 856 cards. An estimated 745.8 pacemaker generators and 53.1 resynchronization devices were implanted per million population. Active fixation leads were implanted in more than 70% of the patients; of these leads, more than 20% were safe for use with magnetic resonance. The most common electrocardiographic indication for pacemaker implantation was atrioventricular block (56%). In all, 28% of the patients with sick sinus syndrome were paced in VVIR mode. CONCLUSIONS The use of conventional pacemakers remained stable, whereas the implantation of resynchronization devices increased. Active fixation leads are now employed in most patients. The findings of this study confirm the higher incidence of implantation in men and at an earlier age due to the higher rate of conduction disorders. Age is a factor that influences the choice of the appropriate pacing mode.
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Affiliation(s)
- Raúl Coma Samartín
- Sección de Estimulación Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Hospital 12 de Octubre, Madrid, Spain.
| | - Francisco Ruiz Mateas
- Sección de Estimulación Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Unidad de Estimulación Cardiaca, Área de Cardiología, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - María Luisa Fidalgo Andrés
- Sección de Estimulación Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Complejo Hospitalario de León, León, Spain
| | - Juan Leal del Ojo González
- Sección de Estimulación Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Hospital Nuestra Señora de Valme, Sevilla, Spain
| | - Luisa Pérez Álvarez
- Sección de Estimulación Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Hospital Juan Canalejo, A Coruña, Spain
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Coma Samartín R, Ruiz Mateas F, Fidalgo Andrés ML, Leal del Ojo González J, Perez Álvarez L. Registro Español de Marcapasos. X Informe Oficial de la Sección de Estimulación Cardiaca de la Sociedad Española de Cardiología (2012). Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2013.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Ion channel-kinase TRPM7 is required for maintaining cardiac automaticity. Proc Natl Acad Sci U S A 2013; 110:E3037-46. [PMID: 23878236 DOI: 10.1073/pnas.1311865110] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Sick sinus syndrome and atrioventricular block are common clinical problems, often necessitating permanent pacemaker placement, yet the pathophysiology of these conditions remains poorly understood. Here we show that Transient Receptor Potential Melastatin 7 (TRPM7), a divalent-permeant channel-kinase of unknown function, is highly expressed in embryonic myocardium and sinoatrial node (SAN) and is required for cardiac automaticity in these specialized tissues. TRPM7 disruption in vitro, in cultured embryonic cardiomyocytes, significantly reduces spontaneous Ca(2+) transient firing rates and is associated with robust down-regulation of Hcn4, Cav3.1, and SERCA2a mRNA. TRPM7 knockdown in zebrafish, global murine cardiac Trpm7 deletion (KO(αMHC-Cre)), and tamoxifen-inducible SAN restricted Trpm7 deletion (KO(HCN4-CreERT2)) disrupts cardiac automaticity in vivo. Telemetered and sedated KO(αMHC-Cre) and KO(HCN4-CreERT2) mice show episodes of sinus pauses and atrioventricular block. Isolated SAN from KO(αMHC-Cre) mice exhibit diminished Ca(2+) transient firing rates with a blunted diastolic increase in Ca(2+). Action potential firing rates are diminished owing to slower diastolic depolarization. Accordingly, Hcn4 mRNA and the pacemaker current, I(f), are diminished in SAN from both KO(αMHC-Cre) and KO(HCN4-CreERT2) mice. Moreover, heart rates of KO(αMHC-Cre) mice are less sensitive to the selective I(f) blocker ivabradine, and acute application of the recently identified TRPM7 blocker FTY720 has no effect on action potential firing rates of wild-type SAN cells. We conclude that TRPM7 influences diastolic membrane depolarization and automaticity in SAN indirectly via regulation of Hcn4 expression.
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Gutiérrez-Carretero E. Criterios de uso apropiado para implante de desfibrilador automático implantable y terapia de resincronización cardíaca 2013: comentarios y novedades. CIRUGIA CARDIOVASCULAR 2013. [DOI: 10.1016/s1134-0096(13)70021-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Russo AM, Stainback RF, Bailey SR, Epstein AE, Heidenreich PA, Jessup M, Kapa S, Kremers MS, Lindsay BD, Stevenson LW. ACCF/HRS/AHA/ASE/HFSA/SCAI/SCCT/SCMR 2013 appropriate use criteria for implantable cardioverter-defibrillators and cardiac resynchronization therapy: a report of the American College of Cardiology Foundation appropriate use criteria task force, Heart Rhythm Society, American Heart Association, American Society of Echocardiography, Heart Failure Society of America, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. Heart Rhythm 2013; 10:e11-58. [PMID: 23473952 DOI: 10.1016/j.hrthm.2013.01.008] [Citation(s) in RCA: 134] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Indexed: 01/27/2023]
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ACCF/HRS/AHA/ASE/HFSA/SCAI/SCCT/SCMR 2013 appropriate use criteria for implantable cardioverter-defibrillators and cardiac resynchronization therapy: a report of the American College of Cardiology Foundation appropriate use criteria task force, Heart Rhythm Society, American Heart Association, American Society of Echocardiography, Heart Failure Society of America, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol 2013; 61:1318-68. [PMID: 23453819 DOI: 10.1016/j.jacc.2012.12.017] [Citation(s) in RCA: 266] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Roka A, Schoenfeld MH. The pathway to physician reimbursement for cardiac implantable electronic devices (CIEDs): a history and brief synopsis. J Interv Card Electrophysiol 2012; 36:137-44. [PMID: 23242735 DOI: 10.1007/s10840-012-9747-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 09/14/2012] [Indexed: 11/25/2022]
Abstract
Cardiac implantable electronic devices (CIEDs), despite their proven effectiveness in large clinical trials for a wide range of patients with arrhythmia and heart failure, are frequent targets for criticism regarding cost-efficiency and alleged overuse. Newer indications, such as sinus node dysfunction for pacemakers and primary prevention for implantable cardioverter-defibrillators, increased eligible patient population significantly. This lead to heightened scrutiny from payors and legislative agencies, such as prior authorization and mandatory registry participation. Despite the significant administrative burden, the efficiency of these measures to decrease abuse is not clear. In addition, professional societies, regulatory agencies, and payors may not always agree whether use of a device is appropriate for a given patient. The review focuses on past and current issues related to utilization of CIEDs, which lead to increased regulatory oversight, and the effort of professional societies, payors, and governmental agencies to improve access to these life-saving therapeutical modalities while maintaining a just and cost-efficient healthcare system.
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Affiliation(s)
- Attila Roka
- Yale University School of Medicine, Yale-New Haven Hospital, St. Raphael Campus, New Haven, CT, USA
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Gillis AM. Successes, challenges, and the road ahead. Heart Rhythm 2012. [PMID: 23199891 DOI: 10.1016/j.hrthm.2012.10.037] [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: 10/27/2022]
Affiliation(s)
- Anne M Gillis
- University of Calgary, Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada.
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