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Killu AM, Alkhouli MA. Performing transcatheter left atrial appendage closure: Techniques and challenges. Heart Rhythm 2022; 19:1899-1906. [PMID: 35944890 DOI: 10.1016/j.hrthm.2022.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/13/2022] [Accepted: 07/18/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Ammar M Killu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
| | - Mohamad A Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Al-Sinan A, Chan KH, Young GD, Martin A, Sepahpour A, Sy RW. Systematic review of electrophysiology procedures in patients with obstruction of the inferior vena cava. J Cardiovasc Electrophysiol 2022; 33:1300-1311. [PMID: 35441755 PMCID: PMC9323496 DOI: 10.1111/jce.15505] [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: 01/03/2022] [Revised: 04/04/2022] [Accepted: 04/13/2022] [Indexed: 11/28/2022]
Abstract
AIMS The objective of the study was to conduct a systematic review to describe and compare the different approaches for performing cardiac electrophysiology (EP) procedures in patients with interrupted inferior vena cava (IVC) or equivalent entities causing IVC obstruction. METHODS We conducted a structured search to identify manuscripts reporting EP procedures with interrupted IVC or IVC obstruction of any aetiology published up until August 2020. No restrictions were applied in the search strategy. We also included seven local cases that met inclusion criteria. RESULTS The analysis included 142 patients (mean age 48.9 years; 48% female) undergoing 143 procedures. Obstruction of the IVC was not known before the index procedure in 54% of patients. Congenital interruption of IVC was the most frequent cause (80%); and, associated congenital heart disease (CHD) was observed in 43% of patients in this setting. The superior approach for ablation was the most frequently used strategy (52%), followed by inferior approach via the azygos or hemiazygos vein (24%), transhepatic approach (14%), and retroaortic approach (10%). Electroanatomical mapping (58%), use of long sheaths (41%), intracardiac echocardiography (19%), transesophageal echocardiography (15%) and remote controlled magnetic navigation (13%) were used as adjuncts to aid performance. Ablation was successful in 135 of 140 procedures in which outcomes were reported. Major complications were only reported in patients undergoing AF ablation, including two patients with pericardial effusion, one of whom required surgical repair, and another patient who died after inadvertent entry into an undiagnosed atrioesophageal fistula from a previous procedure. CONCLUSION The superior approach is most frequent approach for performing EP procedures in the setting of obstructed IVC. Transhepatic approach is a feasible alternative, and may provide a "familiar approach" for transseptal access when it is required. Adjunctive use of long sheaths, intravascular echocardiography, electro-anatomical mapping and remote magnetic navigation may be helpful, especially if there is associated complex CHD. With careful planning, EP procedures can usually be successfully performed with a low risk of complications.
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Affiliation(s)
- Ali Al-Sinan
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia.,Department of Cardiology, Waikato Hospital, Hamilton, New Zealand
| | - Kim H Chan
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Glenn D Young
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| | - Andrew Martin
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Ali Sepahpour
- Department of Cardiology, St. George Hospital, Sydney, Australia
| | - Raymond W Sy
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Okabe T, Afzal MR, Houmsse M, Makary MS, Elliot ED, Daoud EG, Augostini RS, Hummel JD. Tine-Based Leadless Pacemaker: Strategies for Safe Implantation in Unconventional Clinical Scenarios. JACC Clin Electrophysiol 2021; 6:1318-1331. [PMID: 33092762 DOI: 10.1016/j.jacep.2020.08.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/19/2020] [Accepted: 08/24/2020] [Indexed: 12/28/2022]
Abstract
Leadless pacemakers (LPs) have emerged as a meaningful alternative to transvenous pacemakers for single-ventricular pacing. LPs eliminate many of lead- and pocket-associated complications observed with transvenous pacemakers. Owing to the lack of atrioventricular synchronous pacing until recently, the use of LP was generally reserved for those patients who either required minimal ventricular pacing or had permanent atrial fibrillation. The only commercially available LP is the Micra transcatheter pacing system (Micra-TPS, Medtronic Inc. Fridley, Minnesota), which requires insertion of a 27-F (outer diameter) introducer sheath in the femoral vein. The LP is delivered to the right ventricle using a 23-F delivery catheter. Owing to the need for a large-bore sheath, the pivotal studies for the Micra transcatheter pacing system excluded patients with indwelling inferior vena cava filters and included only a few patients with bioprosthetic or repaired tricuspid valve. Subsequent real-world experience has demonstrated the overall safety and feasibility of LP placement, and use in various unconventional clinical settings has been validated, albeit with specific precautions. Additionally, incorporation of adjunctive techniques and strategies can improve the safety of the procedure in routine clinical settings as well. The objective of this state-of-the-art review is to highlight the key procedural elements to facilitate safe and efficient implantation of LP in routine as well as in unique clinical settings.
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Affiliation(s)
- Toshimasa Okabe
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
| | - Muhammad R Afzal
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mahmoud Houmsse
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mina S Makary
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Eric D Elliot
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Emile G Daoud
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ralph S Augostini
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John D Hummel
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Shah K, Patel S, Hanson I, Williamson B, Kutinsky I, Dixon S, Haines DE, Mehta NK. Navigating inferior vena cava filters in invasive cardiology procedures: A systematic review. J Cardiovasc Electrophysiol 2021; 32:1440-1448. [PMID: 33772931 DOI: 10.1111/jce.15010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/25/2021] [Accepted: 03/10/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Transfemoral venous access (TFV) is the cornerstone of minimally invasive cardiac procedures. Although the presence of inferior vena cava filters (IVCFs) was considered a relative contraindication to TFV procedures, small experiences have suggested safety. We conducted a systematic review of the available literature on cardiac procedural success of TFV with IVCF in-situ. METHODS Two independent reviewers searched PubMed, EMBASE, SCOPUS, and Google Scholar from inception to October 2020 for studies that reported outcomes in patients with IVCFs undergoing TFV for invasive cardiac procedures. We investigated a primary outcome of acute procedural success and reviewed the pooled data for patient demographics, procedural complications, types of IVCF, IVCF dwell time, and procedural specifics. RESULTS Out of the 120 studies initially screened, 8 studies were used in the final analysis with a total of 100 patients who underwent 110 procedures. The most common IVCF was the Greenfield Filter (36%), 60% of patients were males and the mean age was 67.8 years. The overall pooled incidence of acute procedural success was 95.45% (95% confidence interval = 89.54-98.1) with no heterogeneity (I2 = 0%, p = 1) and there were no reported filter-related complications. CONCLUSION This systematic review is the largest study of its kind to demonstrate the safety and feasibility of TFV access in a variety of cardiac procedures in the presence of IVCF.
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Affiliation(s)
- Kuldeep Shah
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Sati Patel
- Department of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Ivan Hanson
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Brian Williamson
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Ilana Kutinsky
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Simon Dixon
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - David E Haines
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Nishaki Kiran Mehta
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA.,Department of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia, USA
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Houmsse M, Karki R, Gabriels J, Reinig M, Patel D, Hussain SK, Gandhi GD, Lloyd MS, Makary MS, Okabe T, Tamirisa K, Joza J, Patel A, Afzal MR, Epstein LM, Cha Y. Implantation of leadless pacemakers via inferior vena cava filters is feasible and safe: Insights from a multicenter experience. J Cardiovasc Electrophysiol 2020; 31:3277-3285. [DOI: 10.1111/jce.14776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/03/2020] [Accepted: 09/10/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Mahmoud Houmsse
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wexner Medical Center The Ohio State University Columbus Ohio USA
| | - Roshan Karki
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota USA
| | - James Gabriels
- Department of Cardiology Northwell Health, Manhasset, NY/Long Island Jewish Medical Center New Hyde Park New York USA
| | | | | | - Sarah K. Hussain
- Division of Cardiology Penn State Health Milton S Hershey Medical Center Hershey Pennsylvania USA
| | | | - Michael S. Lloyd
- Division of Cardiology, Department of Medicine Emory University Atlanta Georgia USA
| | - Mina S. Makary
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wexner Medical Center The Ohio State University Columbus Ohio USA
| | - Toshimasa Okabe
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wexner Medical Center The Ohio State University Columbus Ohio USA
| | | | - Jacqueline Joza
- Division of Cardiology McGill University Health Center Montreal Canada
| | - Apoor Patel
- Department of Cardiology Northwell Health, Manhasset, NY/Long Island Jewish Medical Center New Hyde Park New York USA
| | - Muhammad R. Afzal
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wexner Medical Center The Ohio State University Columbus Ohio USA
| | - Laurence M. Epstein
- Department of Cardiology Northwell Health, Manhasset, NY/Long Island Jewish Medical Center New Hyde Park New York USA
| | - Yong‐Mei Cha
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota USA
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