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O'Neill P, Osler B, Junarta J, Zivan T, Hoeltzel G, Ford R, Flomenberg P, Greenspon A, Mehrotra P. Combined transcatheter vegetectomy and leadless pacemaker implantation for endocarditis and complete heart block. Future Cardiol 2024:1-5. [PMID: 39041543 DOI: 10.1080/14796678.2024.2357946] [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: 12/19/2023] [Accepted: 05/17/2024] [Indexed: 07/24/2024] Open
Abstract
We describe a case of culture-negative right-sided endocarditis for which simultaneous transcatheter vegetectomy was performed with leadless pacemaker implantation and removal of a temporary externalized pacing system. The patient did not have a recurrence of endocarditis highlighting the safety and efficacy of same-procedure vegetation removal and pacemaker implantation. This report documents a novel approach for the treatment of cardiac implantable electronic device-associated endocarditis in poor surgical candidates who are pacemaker-dependent.
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Affiliation(s)
- Parker O'Neill
- Department of Medicine, Thomas Jefferson University Hospital, 1025 Walnut Street, Room 822, Philadelphia, PA 19107, USA
| | - Brian Osler
- Division of Cardiology, Thomas Jefferson University Hospital, 925 Chestnut Street, Mezzanine Level, Philadelphia, PA 19107, USA
| | - Joey Junarta
- Department of Medicine, Thomas Jefferson University Hospital, 1025 Walnut Street, Room 822, Philadelphia, PA 19107, USA
| | - Tal Zivan
- Division of Cardiology, Thomas Jefferson University Hospital, 925 Chestnut Street, Mezzanine Level, Philadelphia, PA 19107, USA
| | - Gerard Hoeltzel
- Department of Medicine, Thomas Jefferson University Hospital, 1025 Walnut Street, Room 822, Philadelphia, PA 19107, USA
| | - Robert Ford
- Department of Radiology, Thomas Jefferson University Hospital, 132 S. Tenth Street, Suite 1087, Philadelphia, PA 19107, USA
| | - Phyllis Flomenberg
- Division of Infectious Diseases, Thomas Jefferson University Hospital, 1015 Chestnut Street, Suite 1020, Philadelphia, PA 19107, USA
| | - Arnold Greenspon
- Division of Cardiology, Thomas Jefferson University Hospital, 925 Chestnut Street, Mezzanine Level, Philadelphia, PA 19107, USA
| | - Praveen Mehrotra
- Division of Cardiology, Thomas Jefferson University Hospital, 925 Chestnut Street, Mezzanine Level, Philadelphia, PA 19107, USA
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2
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Mitacchione G, Schiavone M, Gasperetti A, Tripepi GL, Cerini M, Montemerlo E, Del Monte A, Bontempi L, Moltrasio M, Breitenstein A, Monaco C, Palmisano P, Rovaris G, Chierchia GB, Russo AD, Biffi M, de Asmundis C, Mazzone P, Di Biase L, Gallieni M, Tondo C, Curnis A, Forleo GB. Leadless pacemakers in patients with different stages of chronic kidney disease: real-world data from the updated i-LEAPER registry. Heart Rhythm 2024:S1547-5271(24)02909-6. [PMID: 39029882 DOI: 10.1016/j.hrthm.2024.07.027] [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: 06/03/2024] [Revised: 07/08/2024] [Accepted: 07/13/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Limited data are available on leadless pacemaker (LPM) outcomes according to different stages of chronic kidney disease (CKD). OBJECTIVE To investigate differences regarding safety and efficacy in LPMs patients stratified per different stages of renal function. METHODS Consecutive patients enrolled in the multicenter, international i-LEAPER registry were analyzed. Patients were divided into three groups according to CKD stage. The primary endpoint was the comparison of LPM-related major complication rate at implant and during follow-up. Differences in electrical performance were deemed secondary outcomes. RESULTS Among 1748 patients enrolled, 33% were CKD stage G3a/G3b and 9.4% were CKD stage G4/G5. CKD patients presented cardiovascular comorbidities more frequently. During a median follow-up of 39 [interquartile range (IQR) 18-59] months, major complications rate did not differ between groups (normal kidney function, NKF=1.8% vs CKD stage-G3a/G3b 2.9% vs CKD stage-G4/G5 2.4%, p=0.418). All-cause mortality resulted higher in CKD stage-G4/G5 when compared with NKF group (19.5% vs 9.8%, aHR:1.9, 95%CI 1.25-2.89, p=0.003). LPM electrical performance was comparable between groups, except for CKD patients who showed a slightly higher pacing threshold during the 1-month follow-up (NKF group 0.50 [IQR 0.35-0.70]V vs G3a/G3b group 0.56 [IQR 0.38-0.81]V vs G4/G5 group, 0.51 [0.38-0.84]V @0.24 msec, p<.001). CONCLUSION In a real-world setting, advanced CKD patients who underwent LPM implantation were underrepresented. Although all-cause mortality was higher in end-stage CKD, periprocedural complications and LPM performance were overall comparable between NKF and different stages of CKD, except for higher values of pacing threshold in CKD patients up to first-month follow-up.
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Affiliation(s)
- Gianfranco Mitacchione
- Department of Electrophysiology and Cardiac Pacing, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
| | - Marco Schiavone
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Alessio Gasperetti
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Giovanni L Tripepi
- National Research Council-Institute of Clinical Physiology (CNR-IFC) of Reggio Calabria, Italy
| | - Manuel Cerini
- Department of Electrophysiology and Cardiac Pacing, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | - Alvise Del Monte
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Luca Bontempi
- Department of Cardiology, Bolognini Hospital, Seriate, Italy
| | - Massimo Moltrasio
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | - Cinzia Monaco
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | - Giovanni Rovaris
- Cardiology Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Salesi-Lancisi", Ancona, Italy
| | - Mauro Biffi
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Italy
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Patrizio Mazzone
- Cardio-Thoraco-Vascular Department, Electrophysiology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Luigi Di Biase
- Cardiac Arrhythmia Center, Division of Cardiology at Montefiore-Einstein Center, Bronx, New York, USA
| | - Maurizio Gallieni
- Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Claudio Tondo
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Antonio Curnis
- Department of Electrophysiology and Cardiac Pacing, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Giovanni B Forleo
- Department of Cardiology, Luigi Sacco University Hospital, Milan, Italy
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Maille B, Behar N, Jacon P, Hourdain J, Franceschi F, Koutbi L, Tovmassian L, Bierme C, Seder E, Klein V, Postzich M, Resseguier N, Leclerq C, Defaye P, Deharo JC. Two-in-one procedure for transvenous lead extraction and leadless pacemaker reimplantation in pacemaker-dependent patients with device infection: streamlined patient flow. Europace 2024; 26:euae162. [PMID: 39031020 PMCID: PMC11259849 DOI: 10.1093/europace/euae162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 05/27/2024] [Indexed: 07/22/2024] Open
Affiliation(s)
- Baptiste Maille
- Department of Cardiology, Timone University Hospital, 264 rue Saint-Pierre, 13005 Marseille, France
| | - Nathalie Behar
- Department of Cardiology and Vascular Disease Division, Rennes University Hospital, Rennes, France
| | - Peggy Jacon
- Department of Cardiology, CHU Grenoble Alpes, Grenoble, France
| | - Jerome Hourdain
- Department of Cardiology, Timone University Hospital, 264 rue Saint-Pierre, 13005 Marseille, France
| | - Frederic Franceschi
- Department of Cardiology, Timone University Hospital, 264 rue Saint-Pierre, 13005 Marseille, France
| | - Linda Koutbi
- Department of Cardiology, Timone University Hospital, 264 rue Saint-Pierre, 13005 Marseille, France
| | - Lilith Tovmassian
- Department of Cardiology, Timone University Hospital, 264 rue Saint-Pierre, 13005 Marseille, France
| | - Cédric Bierme
- Department of Cardiology, Timone University Hospital, 264 rue Saint-Pierre, 13005 Marseille, France
| | - Elena Seder
- Department of Cardiology, Timone University Hospital, 264 rue Saint-Pierre, 13005 Marseille, France
| | - Victor Klein
- Department of Cardiology, Timone University Hospital, 264 rue Saint-Pierre, 13005 Marseille, France
| | - Martin Postzich
- CEReSS-Health Service Research and Quality of Life Center, School of Medicine, Aix-Marseille University, Marseille, France
| | - Noemie Resseguier
- CEReSS-Health Service Research and Quality of Life Center, School of Medicine, Aix-Marseille University, Marseille, France
| | - Christophe Leclerq
- Department of Cardiology and Vascular Disease Division, Rennes University Hospital, Rennes, France
| | - Pascal Defaye
- Department of Cardiology, CHU Grenoble Alpes, Grenoble, France
| | - Jean-Claude Deharo
- Department of Cardiology, Timone University Hospital, 264 rue Saint-Pierre, 13005 Marseille, France
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Panagides V, Sakka E, Cheneau E, Bouharaoua A, Vicat J, Leude-Vaillant E, Rochas P, Collet F, Giacomoni MP. Prognosis and Predictor Factors of Permanent Pacemaker Implantation after Transcatheter Aortic Valve Replacement: A Retrospective Analysis of the Post-Transcatheter Aortic Replacement Clairval Hospital Registry. J Clin Med 2024; 13:3050. [PMID: 38892761 PMCID: PMC11173049 DOI: 10.3390/jcm13113050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/13/2024] [Accepted: 05/17/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: Despite procedural improvements, post-transcatheter aortic valve replacement (TAVR) conduction disorders remain high. Analyzing the data from a monocentric TAVR registry, this study aims to determine predictive factors for PPI (primary outcome), the indication for PPI, and long-term outcomes among these patients (secondary outcomes). Methods: Conducted at Clairval Hospital in Marseille, France, this retrospective study included all consecutive patients from June 2012 to June 2019. Clinical, electrocardiographic, echocardiographic, and procedural data were collected, with outcomes assessed annually. Logistic regression identified PPI predictors and survival analyses were performed. Results: Of the 1458 patients initially considered, 1157 patients were included. PPI was needed in 21.5% of patients, primarily for third-degree atrioventricular block (46.4%). Predictor factors for PPI included baseline right bundle branch block (ORadj 2.49, 95% CI 1.44 to 4.30; p = 0.001), longer baseline QRS duration (ORadj 1.01, 95% CI 1.00 to1.02, p = 0.002), and self-expandable valves (ORadj 1.82, 95% CI, 1.09 to 3.03; p = 0.021). Seven-year estimated mortality was higher in PPI (43.3%) vs. non-PPI patients (30.9%) (log rank p = 0.048). PPI was an independent predictive factor of death (ORadj 2.49, 95% CI 1.4 to 4.3; p = 0.002). Conclusions: This study reveals elevated rates of PPI post-TAVR associated with increased mortality. These results underscore the pressing necessity to refine our practices, delineate precise indications, and enhance the long-term prognosis for implanted patients.
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Affiliation(s)
- Vassili Panagides
- Service de Cardiologie, Ramsay Santé, Hôpital Privé Clairval, 13009 Marseille, France; (V.P.); (E.S.); (E.C.); (A.B.); (P.R.); (F.C.)
| | - Emna Sakka
- Service de Cardiologie, Ramsay Santé, Hôpital Privé Clairval, 13009 Marseille, France; (V.P.); (E.S.); (E.C.); (A.B.); (P.R.); (F.C.)
| | - Edouard Cheneau
- Service de Cardiologie, Ramsay Santé, Hôpital Privé Clairval, 13009 Marseille, France; (V.P.); (E.S.); (E.C.); (A.B.); (P.R.); (F.C.)
| | - Ahmed Bouharaoua
- Service de Cardiologie, Ramsay Santé, Hôpital Privé Clairval, 13009 Marseille, France; (V.P.); (E.S.); (E.C.); (A.B.); (P.R.); (F.C.)
| | - Jacques Vicat
- Service de Chirurgie Cardiaque, Ramsay Santé, Hôpital Privé Clairval, 13009 Marseille, France; (J.V.); (E.L.-V.)
| | - Elisabeth Leude-Vaillant
- Service de Chirurgie Cardiaque, Ramsay Santé, Hôpital Privé Clairval, 13009 Marseille, France; (J.V.); (E.L.-V.)
| | - Philippe Rochas
- Service de Cardiologie, Ramsay Santé, Hôpital Privé Clairval, 13009 Marseille, France; (V.P.); (E.S.); (E.C.); (A.B.); (P.R.); (F.C.)
| | - Frédéric Collet
- Service de Cardiologie, Ramsay Santé, Hôpital Privé Clairval, 13009 Marseille, France; (V.P.); (E.S.); (E.C.); (A.B.); (P.R.); (F.C.)
| | - Marie-Paule Giacomoni
- Service de Cardiologie, Ramsay Santé, Hôpital Privé Clairval, 13009 Marseille, France; (V.P.); (E.S.); (E.C.); (A.B.); (P.R.); (F.C.)
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Jelisejevas J, Regoli F, Hofer D, Conte G, Oezkartal T, Saguner AM, Caputo ML, Grazioli L, Steffel J, Auricchio A, Breitenstein A. Leadless Pacemaker Implantation in Patients With a Prior Conventional Pacing System. CJC Open 2024; 6:649-655. [PMID: 38708054 PMCID: PMC11065736 DOI: 10.1016/j.cjco.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/11/2023] [Indexed: 05/07/2024] Open
Abstract
Background Leadless pacing has been established as an alternative approach to transvenous devices for selected patients. Often, leadless pacemaker (LP) implantation is a de novo procedure, but in an increasing number of patients, an LP is used after previous implantation of a conventional pacing system (CPS). Methods A retrospective analysis was conducted of the efficacy and safety of LP implantation in the context of a previously implanted CPS, from 2 large Swiss centres. Results A total of 257 consecutive patients undergoing LP implantation were included. They were divided into 2 groups: group 1 consisted of 233 patients who did not have a previous CPS, and group 2 consisted of 24 patients with an in situ CPS. In group 2, a total of 20 patients (83%) required transvenous lead extraction due to infection, malfunction, or other reasons. In 3 patients with device-related infection, lead extraction and LP implantation was performed as a single procedure, whereas in the remaining 11 cases, a time window occurred between the 2 procedures (median: 11.5 days; range: 2-186 days). Electrical device parameters at implantation and during follow-up did not differ between the 2 groups (mean: 12.5 ± 9.3 months). Eight major periprocedural complications (3.1%) were encountered (4 pericardial effusions, 3 instances of femoral bleeding, and 1 instance of intra-abdominal bleeding) in the entire cohort within a 30-day period. No complications occurred in the group with a previous device. No infections were registered, even when complete extraction of an infected CPS was performed prior to LP implantation. Conclusions Implantation of an LP in patients with a prior CPS (with or without extraction of the previous system) was effective and safe in our population of patients.
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Affiliation(s)
- Julius Jelisejevas
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - François Regoli
- Fondazione Cardiocentro Ticino, Lugano, Switzerland
- Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Daniel Hofer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Giulio Conte
- Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | | | - Ardan M. Saguner
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Jan Steffel
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
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Mitacchione G, Migliore F. Co-presence of subcutaneous implantable cardioverter-defibrillator and leadless pacemaker in high-risk infection patients: are we out of the woods? J Interv Card Electrophysiol 2024:10.1007/s10840-023-01726-2. [PMID: 38227124 DOI: 10.1007/s10840-023-01726-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 01/17/2024]
Affiliation(s)
| | - Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani 2, Padua, Italy.
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Burger H, Strauß M, Chung DU, Richter M, Ziegelhöffer T, Hakmi S, Reichenspurner H, Choi YH, Pecha S. Infection remediation after septic device extractions: analysis of three treatment strategies including a 1-year follow-up. Front Cardiovasc Med 2024; 10:1342886. [PMID: 38274307 PMCID: PMC10808596 DOI: 10.3389/fcvm.2023.1342886] [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: 11/22/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction In CIED infections, all device material needs to be removed. But, especially in pacemaker-dependent patients it is often not possible to realize a device-free interval for infection remediation. In those patients, different treatment options are available, however the ideal solution needs still to be defined. Methods This retrospective analysis includes 190 patients undergoing CIED extractions due to infection. Three different treatment algorithms were analyzed: Group 1 included 89 patients with system removal only (System removal group). In Group 2, 28 patients received an epicardial electrode during extraction procedure (Epicardial lead group) while 78 patients in group 3 (contralateral reimplantation group) received implantation of a new system contralaterally during extraction procedure. We analyzed peri- and postoperative data as well as 1-year outcomes of the three groups. Results Patients in the system removal and epicardial lead groups were significantly older, had more comorbidities, and suffered more frequently from systemic infections than those in contralateral reimplantation group. Lead extraction procedures had comparable success rates: 95.5%, 96.4%, and 93.2% of complete lead removal in the System removal, Epicardial Lead, Contralateral re-implantation group respectively. Device reimplantation was performed in all patients in Epicardial lead and Contralateral reimplantation group, whereas only 49.4% in System removal group received device re-implantation. At 1-year follow-up, freedom from infection and absence of pocket irritation were comparable for all groups (94.7% Contralateral reimplantation group and Epicardial lead group, 100% System removal group). No procedure-related mortality was observed, whereas 1-year mortality was 3.4% in System removal group, 4.1% in Contralateral re-implantation group and 21.4% in Epicardial lead group (p < 0.001). Conclusion In patients with CIED infection, systems should be removed completely and reimplanted after infection remediation. In pacemaker-dependent patients, simultaneous contralateral CIED re-implantation or epicardial lead placement may be performed, depending on route, severity and location of infection.
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Affiliation(s)
- Heiko Burger
- Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany
- CampusKerckhoff-Klinik, Justus-Liebig-University Gießen, Bad Nauheim, Germany
- Department of Angiology and Cardiology, CardioVascular Center, Frankfurt/Main, Germany
| | - Mona Strauß
- CampusKerckhoff-Klinik, Justus-Liebig-University Gießen, Bad Nauheim, Germany
| | - Da-Un Chung
- Department of Cardiology& Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Manfred Richter
- Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany
- CampusKerckhoff-Klinik, Justus-Liebig-University Gießen, Bad Nauheim, Germany
| | - Tibor Ziegelhöffer
- Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany
- CampusKerckhoff-Klinik, Justus-Liebig-University Gießen, Bad Nauheim, Germany
| | - Samer Hakmi
- Department of Cardiovascular Surgery, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart and Vascular Center, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany
- CampusKerckhoff-Klinik, Justus-Liebig-University Gießen, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site RhineMain, Frankfurt/Main, Germany
| | - Simon Pecha
- Department of Cardiovascular Surgery, University Heart and Vascular Center, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany
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Mitacchione G, Schiavone M, Gasperetti A, Arabia G, Tundo F, Breitenstein A, Montemerlo E, Monaco C, Gulletta S, Palmisano P, Hofer D, Rovaris G, Dello Russo A, Biffi M, Pisanò ECL, Della Bella P, Di Biase L, Chierchia GB, Saguner AM, Tondo C, Curnis A, Forleo GB. Sex differences in leadless pacemaker implantation: A propensity-matched analysis from the i-LEAPER registry. Heart Rhythm 2023; 20:1429-1435. [PMID: 37481220 DOI: 10.1016/j.hrthm.2023.07.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND The impact of sex in clinical and procedural outcomes in leadless pacemaker (LPM) patients has not yet been investigated. OBJECTIVE The purpose of this study was to investigate sex-related differences in patients undergoing LPM implantation. METHODS Consecutive patients enrolled in the i-LEAPER registry were analyzed. Comparisons between sexes were performed within the overall cohort using an adjusted analysis with 1:1 propensity matching for age and comorbidities. The primary outcome was the comparison of major complication rates. Sex-related differences regarding electrical performance and all-cause mortality during follow-up were deemed secondary outcomes. RESULTS In the overall population (n = 1179 patients; median age 80 years), 64.3% were men. After propensity matching, 738 patients with no significant baseline differences among groups were identified. During median follow-up of 25 [interquartile range 24-39] months, female sex was not associated with LPM-related major complications (hazard ratio [HR] 2.03; 95% confidence interval [CI] 0.70-5.84; P = .190) or all-cause mortality (HR 0.98; 95% CI 0.40-2.42; P = .960). LPM electrical performance results were comparable between groups, except for a higher pacing impedance in women at implant and during follow-up (24 months: 670 [550-800] Ω vs 616 [530-770] Ω; P = .014) that remained within normal limits. CONCLUSION In a real-world setting, we found differences in sex-related referral patterns for LPM implantation with an underrepresentation of women, although major complication rate and LPM performance were comparable between sexes. Female patients showed higher impedance values, which had no impact on overall device performance. Electrical parameters remained within normal limits in both groups during the entire follow-up.
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Affiliation(s)
| | - Marco Schiavone
- Department of Cardiology, Luigi Sacco University Hospital, Milan, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Alessio Gasperetti
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Gianmarco Arabia
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Fabrizio Tundo
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | | | - Cinzia Monaco
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - Simone Gulletta
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy
| | | | - Daniel Hofer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Giovanni Rovaris
- Department of Cardiology, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Salesi-Lancisi", Ancona, Italy
| | - Mauro Biffi
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico S. Orsola, Bologna, Italy
| | - Ennio C L Pisanò
- U.O.S.V.D. Elettrofisiologia Cardiologica-Ospedale "V. Fazzi", Lecce, Italy
| | - Paolo Della Bella
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Luigi Di Biase
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Hospital, New York
| | - Gian Battista Chierchia
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ardan M Saguner
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Claudio Tondo
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Antonio Curnis
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Giovanni B Forleo
- Department of Cardiology, Luigi Sacco University Hospital, Milan, Italy
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9
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Ju C, Xie X, Tang S, Cao S. Predictors of permanent pacemaker implantation in aortic valve diseases after TAVI with vitaFlow liberty system. Front Cardiovasc Med 2023; 10:1277528. [PMID: 37840951 PMCID: PMC10570722 DOI: 10.3389/fcvm.2023.1277528] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Permanent pacemaker implantation (PPI) is a known complication in patients with aortic stenosis following transcatheter aortic valve implantation (TAVI). However, there is limited research on TAVI for pure aortic regurgitation (PAR), and more investigation is needed to determine the occurrence of postoperative cardiac conduction block and the need for PPI in this population. Therefore, this retrospective analysis aimed to evaluate the incidence of cardiac conduction block and the necessity of PPI after TAVI in patients with different types of aortic valve disease, including pure aortic stenosis (PAS), aortic stenosis with regurgitation (ASR), and PAR. Methods Clinical data of 100 patients who TAVI were analyzed retrospectively. The incidence of conduction block was assessed, and clinical factors were examined to predict the necessity of PPI. Results Cardiac conduction block was found to be a common complication following TAVI, particularly in patients with PAR. PAR was identified as an independent risk factor for requiring PPI. Additionally, first-degree atrioventricular block emerged as a sensitive predictor for PPI in patients with PAR. Discussion These findings provide valuable insights into the safety and effectiveness of TAVI, which can help enhance patient management and reduce complications.
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Affiliation(s)
- Changlin Ju
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of Cardiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Xiangrong Xie
- Department of Cardiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Shengxin Tang
- Department of Cardiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Shiping Cao
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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10
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Yogev D, Goldberg T, Arami A, Tejman-Yarden S, Winkler TE, Maoz BM. Current state of the art and future directions for implantable sensors in medical technology: Clinical needs and engineering challenges. APL Bioeng 2023; 7:031506. [PMID: 37781727 PMCID: PMC10539032 DOI: 10.1063/5.0152290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Implantable sensors have revolutionized the way we monitor biophysical and biochemical parameters by enabling real-time closed-loop intervention or therapy. These technologies align with the new era of healthcare known as healthcare 5.0, which encompasses smart disease control and detection, virtual care, intelligent health management, smart monitoring, and decision-making. This review explores the diverse biomedical applications of implantable temperature, mechanical, electrophysiological, optical, and electrochemical sensors. We delve into the engineering principles that serve as the foundation for their development. We also address the challenges faced by researchers and designers in bridging the gap between implantable sensor research and their clinical adoption by emphasizing the importance of careful consideration of clinical requirements and engineering challenges. We highlight the need for future research to explore issues such as long-term performance, biocompatibility, and power sources, as well as the potential for implantable sensors to transform healthcare across multiple disciplines. It is evident that implantable sensors have immense potential in the field of medical technology. However, the gap between research and clinical adoption remains wide, and there are still major obstacles to overcome before they can become a widely adopted part of medical practice.
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Affiliation(s)
| | | | | | | | | | - Ben M. Maoz
- Authors to whom correspondence should be addressed: and
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11
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Lin HC, Hung MJ, Wang CH, Chen TH, Chen WS, Cheng CW. Development and Validation of a Novel Risk Score for All-Cause Mortality Risk Stratification Prior to Permanent Pacemaker Implantation in Octogenarians or Older. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1499. [PMID: 37629789 PMCID: PMC10456785 DOI: 10.3390/medicina59081499] [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: 07/17/2023] [Revised: 08/07/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: The demand for permanent pacemaker (PPM) implantation for extremely old patients is increasing. Prior to implanting PPMs, life expectancy evaluation is essential but difficult. We aimed to develop and validate a scoring system for all-cause mortality risk stratification prior to PPM implantation in patients aged ≥80. Materials and Methods: A total of 210 patients aged ≥80 who received PPM implantation were included. Multivariable analysis was performed to assess the effects of different variables on all-cause mortality in a derivation cohort (n = 100). We developed the MELODY score for stratifying all-cause mortality prior to PPM implantation and tested the scoring system in a validation cohort (n = 102). Results: After 4.0 ± 2.7 years of follow-up, 54 patients (54%) had died. The 0.5-, 1- and 2-year all-cause mortality rates were 7%, 10% and 24%, respectively. The MELODY score based on body mass index <21 kg/m2 (HR: 2.21, 95% CI: 1.06-4.61), estimated glomerular filtration rate <30 mL/min/1.73 m2 (3.35, 1.77-6.35), length of hospitalization before PPM implantation >7 days (1.87, 1.02-3.43) and dyspnea as the major presenting symptom (1.90, 1.03-3.50) successfully distinguished patients at high risk of mortality. Patients with MELODY scores ≥3 had a higher risk of mortality compared to those with MELODY scores <3 (8.49, 4.24-17.00). The areas under the receiver operating characteristic curves in predicting 0.5, 1 and 2 years mortality rates were 0.86, 0.81 and 0.74, respectively. The predictive value of the model was confirmed in a validation cohort. Conclusions: The novel scoring system is a simple and effective tool for all-cause mortality risk stratification prior to PPM implantation in patients aged ≥80.
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Affiliation(s)
- Hsuan-Ching Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung 204201, Taiwan
| | - Ming-Jui Hung
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung 204201, Taiwan
- Chang Gung University College of Medicine, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333323, Taiwan
| | - Chao-Hung Wang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung 204201, Taiwan
- Chang Gung University College of Medicine, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333323, Taiwan
| | - Tien-Hsing Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung 204201, Taiwan
- Chang Gung University College of Medicine, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333323, Taiwan
| | - Wei-Siang Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung 204201, Taiwan
| | - Chi-Wen Cheng
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung 204201, Taiwan
- Chang Gung University College of Medicine, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333323, Taiwan
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12
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Wu S, Jin Y, Lu W, Chen Z, Dai Y, Chen K. Efficacy and Safety of Leadless Pacemakers for Atrioventricular Synchronous Pacing: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12072512. [PMID: 37048596 PMCID: PMC10095093 DOI: 10.3390/jcm12072512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/16/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
Leadless pacemakers with an atrioventricular synchrony algorithm represent a novel technology for patients qualified for VDD pacing. The current evidence of their performance is limited to several small-scale observational studies. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of this new technology. We systematically searched the PubMed, Embase, and Cochrane library databases from their inception to 12 September 2022. The primary efficacy outcome was atrioventricular synchrony after implantation, whereas the secondary efficacy outcome was the change in cardiac output represented by the left ventricular outflow tract velocity time integral (LVOT-VTI). The primary safety outcome was major complications related to the procedures and the algorithm. Means or mean differences with 95% confidence interval (95% CI) were combined using a random-effects model or a fixed-effects model. Finally, 8 published studies with 464 participants were included in the qualitative analysis. The pooled atrioventricular synchrony proportion was 78.9% (95% CI 71.9–86.0%), and a further meta-regression did not screen factors that contributed significantly to the heterogeneity. Additionally, a significant increase in atrioventricular synchrony of 11.3% (95% CI 7.0–15.7%, p < 0.01) was achieved in patients experiencing programming optimization. LVOT-VTI was significantly increased by 1.9 cm (95% CI 1.2–2.6, p < 0.01), compared with the VVI pacing mode. The overall incidence of complications was approximately 6.3%, with major complications related to the algorithm being extremely low. Overall, leadless pacemakers with atrioventricular synchronous pacing demonstrated favorable safety and efficacy. Future data on their long-term performance are required to facilitate their widespread adoption in clinical practice.
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Tong F, Sun Z. Strategies for Safe Implantation and Effective Performance of Single-Chamber and Dual-Chamber Leadless Pacemakers. J Clin Med 2023; 12:jcm12072454. [PMID: 37048538 PMCID: PMC10094832 DOI: 10.3390/jcm12072454] [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: 01/03/2023] [Revised: 03/02/2023] [Accepted: 03/14/2023] [Indexed: 04/14/2023] Open
Abstract
Leadless pacemakers (LPMs) have emerged as an alternative to conventional transvenous pacemakers to eliminate the complications associated with leads and subcutaneous pockets. However, LPMs still present with complications, such as cardiac perforation, dislodgment, vascular complications, infection, and tricuspid valve regurgitation. Furthermore, the efficacy of the leadless VDD LPMs is influenced by the unachievable 100% atrioventricular synchrony. In this article, we review the available data on the strategy selection, including appropriate patient selection, procedure techniques, device design, and post-implant programming, to minimize the complication rate and maximize the efficacy, and we summarize the clinical settings in which a choice must be made between VVI LPMs, VDD LPMs, or conventional transvenous pacemakers. In addition, we provide an outlook for the technology for the realization of true dual-chamber leadless and battery-less pacemakers.
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Affiliation(s)
- Fei Tong
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Zhijun Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
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14
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Baykaner T, John RM. Leadless pacing after transvenous lead extraction: Are we out of the woods? Heart Rhythm 2023; 20:405-406. [PMID: 36572151 DOI: 10.1016/j.hrthm.2022.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Tina Baykaner
- Department of Medicine, Stanford University, Stanford, California
| | - Roy M John
- Department of Medicine, Stanford University, Stanford, California.
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15
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Concomitant leadless pacing in pacemaker-dependent patients undergoing transvenous lead extraction for active infection: Mid-term follow-up. Heart Rhythm 2023; 20:853-860. [PMID: 36764351 DOI: 10.1016/j.hrthm.2023.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/15/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND The rate of transvenous lead extraction (TLE) due to cardiac implantable electronic device (CIED) infection continues to rise. CIED infections are associated with significant morbidity and mortality. Temporary pacing in patients with active CIED infections after TLE can be challenging. Leadless pacing has emerged as an alternative approach in this patient population. OBJECTIVE The purpose of this study was to describe the outcomes of a strategy using concomitant leadless pacemaker implantation and TLE in patients with active infections and ongoing pacing requirements. METHODS This study involved all leadless pacemaker implantation procedures performed during TLE between June 2018 and September 2022 in the setting of active infection. Demographic characteristics, procedural details, and clinical outcomes were analyzed. RESULTS The study included 86 patients with indications for ongoing pacing, 60 (70%) men with mean age 77.4 ± 10.5 years, who underwent TLE and concomitant leadless pacemaker implantation in the setting of active infection. There were no procedure-related complications. Sixty-five patients (76%) had evidence of bacteremia, 80% of whom were discharged to complete their antimicrobial treatment. During a median follow-up of 163 days (interquartile range 57-403 days), there were no recurrent infections. Of the 25 deaths (29%) during the study period, 22 (88%) were unrelated to the initial infection. Nine deceased patients (36%) had methicillin-resistant Staphylococcus aureus or Candida infections, 3 of whom had persistent infection despite TLE. CONCLUSION Leadless pacing is a safe and efficacious approach for the management of patients with pacing requirements that undergo CIED extraction in the setting of active infection.
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