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Kuschyk J, Sattler K, Fastenrath F, Rudic B, Akin I. [Treatment with cardiac electronic implantable devices]. Herz 2024; 49:233-246. [PMID: 38709278 DOI: 10.1007/s00059-024-05246-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 05/07/2024]
Abstract
Cardiac device therapy provides not only treatment options for bradyarrhythmia but also advanced treatment for heart failure and preventive measures against sudden cardiac death. In heart failure treatment it enables synergistic reverse remodelling and reduces pharmacological side effects. Cardiac resynchronization therapy (CRT) has revolutionized the treatment of reduced left ventricular ejection fraction (LVEF) and left bundle branch block by decreasing the mortality and morbidity with improvement of the quality of life and resilience. Conduction system pacing (CSP) as an alternative method of physiological stimulation can improve heart function and reduce the risk of pacemaker-induced cardiomyopathy. Leadless pacers and subcutaneous/extravascular defibrillators offer less invasive options with lower complication rates. The prevention of infections through preoperative and postoperative strategies enhances the safety of these therapies.
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Affiliation(s)
- Jürgen Kuschyk
- I. Medizinische Klinik, Kardiologie, Angiologie, Hämostaseologie und Internistische Intensivmedizin, Sektion für Invasive Kardiologie und Elektrophysiologie, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - Katherine Sattler
- I. Medizinische Klinik, Sektion für Invasive Kardiologie und Elektrophysiologie, Universitätsmedizin Mannheim, Mannheim, Deutschland
| | - Fabian Fastenrath
- I. Medizinische Klinik, Sektion für Invasive Kardiologie und Elektrophysiologie, Universitätsmedizin Mannheim, Mannheim, Deutschland
| | - Boris Rudic
- I. Medizinische Klinik, Sektion für Invasive Kardiologie und Elektrophysiologie, Universitätsmedizin Mannheim, Mannheim, Deutschland
| | - Ibrahim Akin
- I. Medizinische Klinik, Sektion für Invasive Kardiologie und Elektrophysiologie, Universitätsmedizin Mannheim, Mannheim, Deutschland
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2
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Saleem M, Arshad V, Nabavizadeh P, Rajsheker S, Costea A. Subcutaneous Versus Transvenous Implantable Defibrillators: A Systematic Review and Meta-Analysis. Am J Cardiol 2024; 218:32-33. [PMID: 38395120 DOI: 10.1016/j.amjcard.2024.01.026] [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: 03/08/2023] [Revised: 01/15/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Affiliation(s)
- Maryam Saleem
- Division of Cardiovascular Health and Disease, Department of Cardiovascular Medicine, University of Cincinnati Medical Center College of Medicine, Cincinnati, Ohio
| | - Verda Arshad
- Department of Internal Medicine, University of Cincinnati Medical Center College of Medicine, Cincinnati, Ohio
| | - Pooneh Nabavizadeh
- Division of Cardiovascular Health and Disease, Department of Cardiovascular Medicine, University of Cincinnati Medical Center College of Medicine, Cincinnati, Ohio
| | - Srinivas Rajsheker
- Division of Cardiovascular Health and Disease, Department of Cardiovascular Medicine, University of Cincinnati Medical Center College of Medicine, Cincinnati, Ohio
| | - Alexandru Costea
- Division of Cardiovascular Health and Disease, Department of Cardiovascular Medicine, University of Cincinnati Medical Center College of Medicine, Cincinnati, Ohio.
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3
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Weipert KF, Kostic S, Gökyildirim T, Johnson V, Chasan R, Gemein C, Rosenbauer J, Erkapic D, Schmitt J. Safety and Performance of the Subcutaneous Implantable Cardioverter Defibrillator Detection Algorithm INSIGHT TM in Pacemaker Patients. J Clin Med 2023; 13:129. [PMID: 38202136 PMCID: PMC10779836 DOI: 10.3390/jcm13010129] [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: 11/16/2023] [Revised: 12/17/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The use of the S-ICD is limited by its inability to provide backup pacing. Combined use of the S-ICD with a pacemaker may be a good choice in certain situations, yet current experience concerning the compatibility is limited. The goal of this study was to determine the safety and efficacy of the S-ICD in patients with a pacemaker. METHODS A total of 74 consecutive patients with a bipolar pacemaker were prospectively enrolled. First, surface rhythm strips were recorded in all possible pacemaker stimulation modes, to screen for T-wave oversensing (TWOS). Second, a S-ICD functional dummy was placed epicutaneously on the patient in the typical implant position. The same standardized pacing protocol was used as mentioned above, and every stimulation mode was recorded via S-ECG in all vectors. RESULTS In 16 patients (21.6%), programmed stimulation would have led to VT/VF detection. Triggered episodes were due to counting of the pacing spike(s), QRS complex, premature ventricular contractions, and/or additional TWOS. Three cases triggered in the bipolar stimulation mode. Oversensing was associated with lung emphysema and a reduced QRS amplitude in the S-ECG. CONCLUSION The combination of an S-ICD and a pacemaker may lead to inadequate shock delivery due to oversensing, even under programmed bipolar stimulation. Oversensing cannot be sufficiently predicted by the screening tool in pacemaker patients. Testing with an epicutaneous S-ICD dummy in all vectors and stimulation settings is recommended in patients with pre-existing pacemakers.
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Affiliation(s)
- Kay F. Weipert
- Department of Cardiology, Rhythmology and Angiology, Medizinische Klinik II, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany; (R.C.); (J.R.); (D.E.)
| | - Srdjan Kostic
- Department of Cardiology, Kantonsspital Aarau, 5001 Aarau, Switzerland;
| | - Timur Gökyildirim
- Department of Cardiology, Lahn-Dill Kliniken, 35578 Wetzlar, Germany
| | - Victoria Johnson
- Department of Cardiology and Angiology, Medizinische Klinik I, Universitätsklinikum Gießen und Marburg, 35392 Giessen, Germany
| | - Ritvan Chasan
- Department of Cardiology, Rhythmology and Angiology, Medizinische Klinik II, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany; (R.C.); (J.R.); (D.E.)
| | - Christopher Gemein
- Department of Cardiology, Nephrology, Pneumology and Rhythmology, Klinikum Aschaffenburg-Alzenau, 63739 Aschaffenburg, Germany
| | - Josef Rosenbauer
- Department of Cardiology, Rhythmology and Angiology, Medizinische Klinik II, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany; (R.C.); (J.R.); (D.E.)
| | - Damir Erkapic
- Department of Cardiology, Rhythmology and Angiology, Medizinische Klinik II, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany; (R.C.); (J.R.); (D.E.)
| | - Jörn Schmitt
- Department of Cardiology, Pneumology and Angiology, Medizinische Klinik II, Westpfalz-Klinikum, 67655 Kaiserslautern, Germany;
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4
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Migliore F, Biffi M, Viani S, Pittorru R, Francia P, Pieragnoli P, De Filippo P, Bisignani G, Nigro G, Dello Russo A, Pisanò E, Palmisano P, Rapacciuolo A, Silvetti MS, Lavalle C, Curcio A, Rordorf R, Lovecchio M, Valsecchi S, D’Onofrio A, Botto GL. Modern subcutaneous implantable defibrillator therapy in patients with cardiomyopathies and channelopathies: data from a large multicentre registry. Europace 2023; 25:euad239. [PMID: 37536671 PMCID: PMC10438213 DOI: 10.1093/europace/euad239] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/01/2023] [Indexed: 08/05/2023] Open
Abstract
AIMS Patients with cardiomyopathies and channelopathies are usually younger and have a predominantly arrhythmia-related prognosis; they have nearly normal life expectancy thanks to the protection against sudden cardiac death provided by the implantable cardioverter defibrillator (ICD). The subcutaneous ICD (S-ICD) is an effective alternative to the transvenous ICD and has evolved over the years. This study aimed to evaluate the rate of inappropriate shocks (IS), appropriate therapies, and device-related complications in patients with cardiomyopathies and channelopathies who underwent modern S-ICD implantation. METHODS AND RESULTS We enrolled consecutive patients with cardiomyopathies and channelopathies who had undergone implantation of a modern S-ICD from January 2016 to December 2020 and who were followed up until December 2022. A total of 1338 S-ICD implantations were performed within the observation period. Of these patients, 628 had cardiomyopathies or channelopathies. The rate of IS at 12 months was 4.6% [95% confidence interval (CI): 2.8-6.9] in patients with cardiomyopathies and 1.1% (95% CI: 0.1-3.8) in patients with channelopathies (P = 0.032). No significant differences were noted over a median follow-up of 43 months [hazard ratio (HR): 0.76; 95% CI: 0.45-1.31; P = 0.351]. The rate of appropriate shocks at 12 months was 2.3% (95% CI: 1.1-4.1) in patients with cardiomyopathies and 2.1% (95% CI: 0.6-5.3) in patients with channelopathies (P = 1.0). The rate of device-related complications was 0.9% (95% CI: 0.3-2.3) and 3.2% (95% CI: 1.2-6.8), respectively (P = 0.074). No significant differences were noted over the entire follow-up. The need for pacing was low, occurring in 0.8% of patients. CONCLUSION Modern S-ICDs may be a valuable alternative to transvenous ICDs in patients with cardiomyopathies and channelopathies. Our findings suggest that modern S-ICD therapy carries a low rate of IS. CLINICAL TRIAL REGISTRATION URL: http://clinicaltrials.gov/Identifier: NCT02275637.
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Affiliation(s)
- Federico Migliore
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Mauro Biffi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Stefano Viani
- Second Cardiology Division, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Raimondo Pittorru
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Pietro Francia
- Cardiology, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, University Sapienza, Rome, Italy
| | - Paolo Pieragnoli
- Arrhythmic Disease Unit, University of Florence, Florence, Italy
| | - Paolo De Filippo
- Cardiac Electrophysiology and Pacing Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Gerardo Nigro
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Università Politecnica delle Marche, Ancona, Italy
| | - Ennio Pisanò
- Cardiology Unit, ‘Vito Fazzi’ Hospital, Lecce, Italy
| | | | - Antonio Rapacciuolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Massimo Stefano Silvetti
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Carlo Lavalle
- Cardiology Department, Policlinico Umberto I - La Sapienza University, Rome, Italy
| | - Antonio Curcio
- Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi Magna Graecia, Campus di Germaneto, Catanzaro, Italy
| | - Roberto Rordorf
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
| | | | - Sergio Valsecchi
- Cardiac Rhythm Management Division, Boston Scientific, Milan, Italy
| | - Antonio D’Onofrio
- ‘Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie’, Monaldi Hospital, Naples, Italy
| | - Giovanni Luca Botto
- Department of Clinical cardiology and Electrophysiology ASST Rhodense, Rho and Garbagnate M.se, Milan, Italy
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Guarracini F, Preda A, Bonvicini E, Coser A, Martin M, Quintarelli S, Gigli L, Baroni M, Vargiu S, Varrenti M, Forleo GB, Mazzone P, Bonmassari R, Marini M, Droghetti A. Subcutaneous Implantable Cardioverter Defibrillator: A Contemporary Overview. Life (Basel) 2023; 13:1652. [PMID: 37629509 PMCID: PMC10455445 DOI: 10.3390/life13081652] [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: 06/06/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023] Open
Abstract
The difference between subcutaneous implantable cardioverter defibrillators (S-ICDs) and transvenous ICDs (TV-ICDs) concerns a whole extra thoracic implantation, including a defibrillator coil and pulse generator, without endovascular components. The improved safety profile has allowed the S-ICD to be rapidly taken up, especially among younger patients. Reports of its role in different cardiac diseases at high risk of SCD such as hypertrophic and arrhythmic cardiomyopathies, as well as channelopathies, is increasing. S-ICDs show comparable efficacy, reliability, and safety outcomes compared to TV-ICD. However, some technical issues (i.e., the inability to perform anti-bradycardia pacing) strongly limit the employment of S-ICDs. Therefore, it still remains only an alternative to the traditional ICD thus far. This review aims to provide a contemporary overview of the role of S-ICDs compared to TV-ICDs in clinical practice, including technical aspects regarding device manufacture and implantation techniques. Newer outlooks and future perspectives of S-ICDs are also brought up to date.
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Affiliation(s)
- Fabrizio Guarracini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Alberto Preda
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Eleonora Bonvicini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Alessio Coser
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Marta Martin
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Silvia Quintarelli
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Lorenzo Gigli
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Matteo Baroni
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Sara Vargiu
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Marisa Varrenti
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Giovanni Battista Forleo
- Department of Thoracic Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Turin, Italy;
| | - Patrizio Mazzone
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Roberto Bonmassari
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Massimiliano Marini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Andrea Droghetti
- Cardiology Unit, Luigi Sacco University Hospital, 20157 Milan, Italy;
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Radial and Circumferential CMR-Based RV Strain Predicts Low R Wave Amplitude after ICD Implantation in Patients with Arrhythmogenic Cardiomyopathy. J Clin Med 2023; 12:jcm12030886. [PMID: 36769534 PMCID: PMC9917584 DOI: 10.3390/jcm12030886] [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: 12/24/2022] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 01/25/2023] Open
Abstract
Inadequate R wave amplitude (RWA) after implantable cardiac defibrillator (ICD) implantation in patients with arrhythmogenic cardiomyopathy (ACM) was suspected to relate to right ventricle impairment. However, little data-based evidence was provided to quantify the association. We retrospectively enrolled ACM patients receiving CMR examinations before transvenous ICD implantation from Fuwai Hospital. The RWA was obtained within 24 h and at 2-6-month follow-up after the operation. Structural, functional, as well as tissue characterization of the left ventricle (LV) and right ventricle (RV), were analyzed in relation to RWA. Among the 87 ACM patients (median RWA: 8.0 mV), 19 (21.8%) patients were found with low initial RWA (<5 mV) despite attempts in multiple positions. RV end diastolic diameter (RVEDD), (r = -0.44), RV ejection fraction (RVEF, r = 0.43), RV end diastolic volume index (RVEDVi, r = -0.49), RV end systolic volume index (RVESVi, r = -0.53), RV global circumferential (RVGCS, r = -0.64), and radial strain (RVGRS, r = 0.61, all p < 0.001) rather than LV metrics correlated strongly with initial RWA. RVGCS, RVESVi, and RVGRS were decent predictors of low RWA (areas under the curve AUC: 0.814, 0.769, 0.757, respectively) early after implantation and during 2-6-month follow-up. To summarize, low RWA of ICD lead in ACM patients was associated with RV abnormalities. The RVGCS, RVGRS, and RVESVi can be valuable predictors for identifying low RWA prior to ICD implantation.
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7
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Regoli FD, Cattaneo M, Kola F, Thartori A, Bytyci H, Saccarello L, Amoruso M, Di Valentino M, Menafoglio A. Management of hemodynamically stable wide QRS complex tachycardia in patients with implantable cardioverter defibrillators. Front Cardiovasc Med 2023; 9:1011619. [PMID: 36684577 PMCID: PMC9846131 DOI: 10.3389/fcvm.2022.1011619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023] Open
Abstract
Management of hemodynamically stable, incessant wide QRS complex tachycardia (WCT) in patients who already have an implantable cardioverter defibrillator (ICD) is challenging. First-line treatment is performed by medical staff who have no knowledge on programmed ICD therapy settings and there is always some concern for unexpected ICD shock. In these patients, a structured approach is necessary from presentation to therapy. The present review provides a systematic approach in four distinct phases to guide any physician involved in the management of these patients: PHASE I: assessment of hemodynamic status and use of the magnet to temporarily suspend ICD therapies, especially shocks; identification of possible arrhythmia triggers; risk stratification in case of electrical storm (ES). PHASE II The preparation phase includes reversal of potential arrhythmia "triggers", mild patient sedation, and patient monitoring for therapy delivery. Based on resource availability and competences, the most adequate therapeutic approach is chosen. This choice depends on whether a device specialist is readily available or not. In the case of ES in a "high-risk" patient an accelerated patient management protocol is advocated, which considers urgent ventricular tachycardia transcatheter ablation with or without mechanical cardiocirculatory support. PHASE III Therapeutic phase is based on the use of intravenous anti-arrhythmic drugs mostly indicated in this clinical context are presented. Device interrogation is very important in this phase when sustained monomorphic VT diagnosis is confirmed, then ICD ATP algorithms, based on underlying VT cycle length, are proposed. In high-risk patients with intractable ES, intensive patient management considers MCS and transcatheter ablation. PHASE IV The patient is hospitalized for further diagnostics and management aimed at preventing arrhythmia recurrences.
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Affiliation(s)
- François D. Regoli
- Cardiology Service, Ospedale San Giovanni, Cardiocentro Institute, Ente Ospedaliero Cantonale, Bellinzona, Switzerland,Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland,*Correspondence: François D. Regoli,
| | - Mattia Cattaneo
- Cardiology Service, Ospedale San Giovanni, Cardiocentro Institute, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Florenc Kola
- Department of Internal Medicine, Ospedale San Giovanni, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Albana Thartori
- Department of Internal Medicine, Ospedale San Giovanni, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Hekuran Bytyci
- Department of Internal Medicine, Ospedale San Giovanni, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Luca Saccarello
- Department of Internal Medicine, Ospedale San Giovanni, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Marco Amoruso
- Cardiology Service, Ospedale San Giovanni, Cardiocentro Institute, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Marcello Di Valentino
- Cardiology Service, Ospedale San Giovanni, Cardiocentro Institute, Ente Ospedaliero Cantonale, Bellinzona, Switzerland,Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Andrea Menafoglio
- Cardiology Service, Ospedale San Giovanni, Cardiocentro Institute, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
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Rordorf R. The ATLAS Randomised Clinical Trial: What do the Superiority Results
Mean for Subcutaneous ICD Therapy and Sudden Cardiac Death Prevention as a Whole? Arrhythm Electrophysiol Rev 2022; 11. [DOI: 10.15420/aer.2022.11.s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/08/2022] [Indexed: 11/04/2022] Open
Abstract
This review sets out the key evidence comparing subcutaneous ICDs (S-ICDs) and transvenous ICDs and uses it to empower clinical cardiologists and those who implant ICDs to make optimum patient selections for S-ICD use. The evidence demonstrates that clinical trials performed until recently have proven the performance of S-ICDs. However, the latest data now available from the ATLAS randomised controlled trial have added new insights to this body of evidence. ATLAS demonstrates the superiority of S-ICDs over transvenous ICDs regarding lead-related complications, findings that point to promising opportunities for patients who are at risk of sudden cardiac death.
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Affiliation(s)
- Roberto Rordorf
- Arrhythmias and Electrophysiology Unit, Policlinico San Matteo Foundation, Pavia, Italy
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9
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Migliore F, Corrado D. Implantable defibrillator in patients with inherited arrhythmogenic diseases: Are inapproppriate shocks preventable? Int J Cardiol 2022; 360:36-38. [PMID: 35568056 DOI: 10.1016/j.ijcard.2022.05.019] [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: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy.
| | - Domenico Corrado
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
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10
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Khanra D, Hamid A, Patel P, Tomson J, Abdalla A, Khan N, Dowd R, Chandan N, Osagie C, Jinadu T, Velu S, Arya A, Spencer C, Barr C, Petkar S. A real‐world experience of subcutaneous and transvenous implantable cardiac defibrillators—comparison with the
PRAETORIAN
study. J Arrhythm 2022; 38:199-212. [PMID: 35387142 PMCID: PMC8977574 DOI: 10.1002/joa3.12687] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 11/06/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Dibbendhu Khanra
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Abdul Hamid
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Peysh Patel
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - John Tomson
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Ahmed Abdalla
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Nasrin Khan
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Rory Dowd
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Nakul Chandan
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Christopher Osagie
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Tomilola Jinadu
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Selvakumar Velu
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Anita Arya
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Charles Spencer
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Craig Barr
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Sanjiv Petkar
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
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Christensen AH, Platonov PG, Svensson A, Jensen HK, Rootwelt-Norberg C, Dahlberg P, Madsen T, Frederiksen TC, Heliö T, Haugaa KH, Bundgaard H, Svendsen JH. Complications of implantable cardioverter-defibrillator treatment in arrhythmogenic right ventricular cardiomyopathy. Europace 2021; 24:306-312. [PMID: 34279601 DOI: 10.1093/europace/euab112] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/08/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Treatment with implantable cardioverter-defibrillators (ICD) is a cornerstone for prevention of sudden cardiac death in arrhythmogenic right ventricular cardiomyopathy (ARVC). We aimed at describing the complications associated with ICD treatment in a multinational cohort with long-term follow-up. METHODS AND RESULTS The Nordic ARVC registry was established in 2010 and encompasses a large multinational cohort of ARVC patients, including their clinical characteristics, treatment, and events during follow-up. We included 299 patients (66% males, median age 41 years). During a median follow-up of 10.6 years, 124 (41%) patients experienced appropriate ICD shock therapy, 28 (9%) experienced inappropriate shocks, 82 (27%) had a complication requiring surgery (mainly lead-related, n = 75), and 99 (33%) patients experienced the combined endpoint of either an inappropriate shock or a surgical complication. The crude rate of first inappropriate shock was 3.4% during the first year after implantation but decreased after the first year and plateaued over time. Contrary, the risk of a complication requiring surgery was 5.5% the first year and remained high throughout the study period. The combined risk of any complication was 7.9% the first year. In multivariate cox regression, presence of atrial fibrillation/flutter was a risk factor for inappropriate shock (P < 0.05), whereas sex, age at implant, and device type were not (all P > 0.05). CONCLUSION Forty-one percent of ARVC patients treated with ICD experienced potentially life-saving ICD therapy during long-term follow-up. A third of the patients experienced a complication during follow-up with lead-related complications constituting the vast majority.
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Affiliation(s)
- Alex Hørby Christensen
- Department of Cardiology, Copenhagen University Hospital-Herlev-Gentofte, Borgmester Ib Juuls Vej 1, DK-2730 Herlev, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | - Pyotr G Platonov
- Department of Cardiology, Lund University, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Anneli Svensson
- Department of Cardiology, Linköping University, Linköping, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Henrik K Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Christine Rootwelt-Norberg
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Pia Dahlberg
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Trine Madsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Tanja Charlotte Frederiksen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Tiina Heliö
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.,University of Helsinki, Helsinki, Finland
| | - Kristina H Haugaa
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Henning Bundgaard
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | - Jesper H Svendsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
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12
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Cheema MA, Almas T, Ullah W, Haas D. RV lead placement - A forgotten cause of right heart failure. Ann Med Surg (Lond) 2021; 67:102461. [PMID: 34158932 PMCID: PMC8203726 DOI: 10.1016/j.amsu.2021.102461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/26/2021] [Accepted: 06/01/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Cardiac implantable electronic devices (CIEDs) have opened new doors, improving the quality, and increasing the duration of life by providing support of heart rate, atrioventricular and interventricular synchrony, thereby preventing sudden cardiac death. Nevertheless, these devices can pose some risks to the patients, including pacemaker-mediated cardiomyopathy and endocarditis. Case presentation We elucidate the case of a patient who had severe Tricuspid Regurgitation as a result of single chamber Implantable Cardioverter Defibrillator (ICD) placement which led to right heart failure (RHF). His chief complaints were generalized fatigability and difficulty climbing steps at home. He also had orthopnea but denies paroxysmal nocturnal dyspnea. Despite using home diuretic regimen (Torsemide 40 gm daily), his continued to increase. He did not respond well to intravenous diuretics that time so decision was made to start Aquapheresis to which he responded very well Discussion TV dysfunction associated with CIED leads can be investigated and diagnosed using different techniques. These pillars of diagnostic tests include two-dimensional (2D), 3D, and Doppler echocardiography. Presence of holosystolic hepatic vein flow reversal is key in diagnosing severe TR, whereas normal antegrade systolic flow excludes the possibility of moderate and severe TR. Conclusion CIED leads causing tricuspid valve impairment has become increasingly recognized over the recent times; however, the evidence underlying this trend has been derived primarily from retrospective analyses. In order to circumvent these issues, leadless pacemakers and subcutaneous ICD devices should be considered. •CIED leads causing TV dysfunction has gained increasing recognition recently but all evidence supporting this premise emanates from retrospective analyses. •When clinical, hemodynamic, and echocardiographic assessment provides compelling evidence of lead related severe TR, corrective intervention should be provided in a timely fashion, before the onset of severe annular and chamber dilation and severe RV dysfunction because, by that time, the lead itself will no longer be the problem, and the extant problem may not be as amenable to corrective intervention. •Leadless pacemakers and subcutaneous ICD devices likely to be associated with a reduction in lead-related cardiac dysfunction.
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Affiliation(s)
| | - Talal Almas
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
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