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Nasir M, Dejene K, Bedru M, Ahmed M, Markos S. Predictors of complications and mortality among patients undergoing pacemaker implantation in resource-limited settings: a 10-year retrospective follow-up study. BMC Cardiovasc Disord 2024; 24:400. [PMID: 39090565 PMCID: PMC11293136 DOI: 10.1186/s12872-024-04068-7] [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] [Received: 04/10/2024] [Accepted: 07/22/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION Pacemakers (PMs) are used to treat patients with severe bradycardia symptoms. They do, however, pose several complications. Even with these risks, there are only a few studies assessing PM implantation outcomes in resource-limited settings like Ethiopia and other sub-Saharan countries in general. Therefore, this study aims to assess the mid-term outcome of PM implantation in patients who have undergone PM implantation in the Cardiac Center of Ethiopia by identifying the rate and predictors of complications and death. METHODOLOGY This retrospective study was conducted at the Cardiac Center of Ethiopia from October 2023 to January 2024 on patients who had PM implantation from September 2012 to August 2023 to assess the midterm outcome of the patients. Complication rate and all-cause mortality rate were the outcomes of our study. Multivariable logistic regression was used to identify factors associated with complications and death. To analyze survival times, a Kaplan-Meier analysis was performed. RESULTS This retrospective follow-up study included 182 patients who underwent PM implantation between September 2012 and August 2023 and were at least 18 years old. The patients' median follow-up duration was 72 months (Interquartile range (IQR): 36-96 months). At the end of the study, 26.4% of patients experienced complications. The three most frequent complications were lead dislodgement, which affected 6.6% of patients, PM-induced tachycardia, which affected 5.5% of patients, and early battery depletion, which affected 5.5% of patients. Older age (Adjusted Odds Ratio (AOR) 1.1, 95% CI 1.04-1.1, p value < 0.001), being female (AOR 4.5, 95%CI 2-9.9, p value < 0.001), having dual chamber PM (AOR 2.95, 95%CI 1.14-7.6, p value = 0.006) were predictors of complications. Thirty-one (17%) patients died during the follow-up period. The survival rates of our patients at 3, 5, and 10 years were 94.4%, 92.1%, and 65.5% respectively with a median survival time of 11 years. Patients with a higher Charlson comorbidity index before PM implantation (AOR 1.2, 95% CI 1.1-1.8, p = 0.04), presence of complications (AOR 3.5, 95% CI 1.2-10.6, p < 0.03), and New York Heart Association (NYHA) class III or IV (AOR 3.3, 95% CI 1.05-10.1, p = 0.04) were associated with mortality. CONCLUSION Many complications were experienced by patients who had PMs implanted, and several factors affected their prognosis. Thus, it is essential to identify predictors of both complications and mortality to prioritize and address the manageable factors associated with both mortality and complications.
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Affiliation(s)
- Mohammed Nasir
- Pediatrics and Child Health Department, Hawassa University, Hawassa, Ethiopia.
| | | | | | - Muluken Ahmed
- Pediatrics and Child Health Department, Arba Minch University, Arba Minch, Ethiopia
| | - Sura Markos
- Internal Medicine Department, Division of Cardiology, Hawassa University, Hawassa, Ethiopia
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Teixeira RA, Fagundes AA, Baggio Junior JM, Oliveira JCD, Medeiros PDTJ, Valdigem BP, Teno LAC, Silva RT, Melo CSD, Elias Neto J, Moraes Júnior AV, Pedrosa AAA, Porto FM, Brito Júnior HLD, Souza TGSE, Mateos JCP, Moraes LGBD, Forno ARJD, D'Avila ALB, Cavaco DADM, Kuniyoshi RR, Pimentel M, Camanho LEM, Saad EB, Zimerman LI, Oliveira EB, Scanavacca MI, Martinelli Filho M, Lima CEBD, Peixoto GDL, Darrieux FCDC, Duarte JDOP, Galvão Filho SDS, Costa ERB, Mateo EIP, Melo SLD, Rodrigues TDR, Rocha EA, Hachul DT, Lorga Filho AM, Nishioka SAD, Gadelha EB, Costa R, Andrade VSD, Torres GG, Oliveira Neto NRD, Lucchese FA, Murad H, Wanderley Neto J, Brofman PRS, Almeida RMS, Leal JCF. Brazilian Guidelines for Cardiac Implantable Electronic Devices - 2023. Arq Bras Cardiol 2023; 120:e20220892. [PMID: 36700596 PMCID: PMC10389103 DOI: 10.36660/abc.20220892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | - Rodrigo Tavares Silva
- Universidade de Franca (UNIFRAN), Franca, SP - Brasil
- Centro Universitário Municipal de Franca (Uni-FACEF), Franca, SP - Brasil
| | | | - Jorge Elias Neto
- Universidade Federal do Espírito Santo (UFES), Vitória, ES - Brasil
| | - Antonio Vitor Moraes Júnior
- Santa Casa de Ribeirão Preto, Ribeirão Preto, SP - Brasil
- Unimed de Ribeirão Preto, Ribeirão Preto, SP - Brasil
| | - Anisio Alexandre Andrade Pedrosa
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Luis Gustavo Belo de Moraes
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | - Mauricio Pimentel
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | - Eduardo Benchimol Saad
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Hospital Samaritano, Rio de Janeiro, RJ - Brasil
| | | | | | - Mauricio Ibrahim Scanavacca
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Martino Martinelli Filho
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Batista de Lima
- Hospital Universitário da Universidade Federal do Piauí (UFPI), Teresina, PI - Brasil
- Empresa Brasileira de Serviços Hospitalares (EBSERH), Brasília, DF - Brasil
| | | | - Francisco Carlos da Costa Darrieux
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Sissy Lara De Melo
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Eduardo Arrais Rocha
- Hospital Universitário Walter Cantídio, Universidade Federal do Ceará (UFC), Fortaleza, CE - Brasil
| | - Denise Tessariol Hachul
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Silvana Angelina D'Orio Nishioka
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Roberto Costa
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Gustavo Gomes Torres
- Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN - Brasil
| | | | | | - Henrique Murad
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | - Rui M S Almeida
- Centro Universitário Fundação Assis Gurgacz, Cascavel, PR - Brasil
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Physiologic Pacing Targeting the His Bundle and Left Bundle Branch: a Review of the Literature. Curr Cardiol Rep 2022; 24:959-978. [PMID: 35678938 DOI: 10.1007/s11886-022-01723-3] [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] [Accepted: 05/18/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Conduction system pacing (CSP) has emerged as a means to preserve or restore physiological ventricular activation via pacing at the His bundle or at more distal targets in the conduction system, including the left bundle branch area. This review examines strengths, weaknesses, and clinical applications of CSP performed via these approaches. RECENT FINDINGS His bundle pacing (HBP) has been successfully utilized for standard bradyarrhythmia indications and for QRS correction among patients receiving devices for cardiac resynchronization therapy (CRT). Limitations of HBP pacing have included implant complexity and rising pacing thresholds over time. Left bundle branch area pacing (LBBAP) appears to deliver similar physiological benefits with shorter implant times and more stable thresholds. More recently, hybrid systems utilizing HBP or LBBAP in combination with left ventricular leads have been used to treat heart failure (HF) patients, and may be useful in multilevel or mixed conduction blocks. There is growing interest in CSP for bradycardia and HF indications, although high quality data with randomized controlled trials are needed to help guide future treatment paradigms.
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Infeld M, Wahlberg K, Cicero J, Meagher S, Habel N, Muthu Krishnan A, Silverman DN, Lustgarten DL, Meyer M. Personalized pacing for diastolic dysfunction and heart failure with preserved ejection fraction: Design and rationale for the myPACE randomized controlled trial. Heart Rhythm O2 2021; 3:109-116. [PMID: 35243443 PMCID: PMC8859799 DOI: 10.1016/j.hroo.2021.11.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Patients with pacemakers and heart failure with preserved ejection fraction (HFpEF) or isolated diastolic dysfunction (DD) may benefit from a higher backup heart rate (HR) setting compared with the standard setting of 60 bpm. Objective The purpose of this study was to assess the effects of a personalized backup HR setting (myPACE group) compared with 60 bpm (control group). Methods In this prospective, blinded, randomized controlled study, pacemaker patients with DD or HFpEF and atrial pacing with intrinsic ventricular conduction or conduction system or biventricular pacing are randomized to the myPACE group or control group for 1 year. The primary outcome is the change in Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores. Secondary endpoints include changes in N-terminal pro–brain natriuretic peptide levels, physical and emotional MLHFQ subscores, and pacemaker-detected atrial arrhythmia burden, patient activity levels, and thoracic impedance; hospitalization for heart failure, atrial fibrillation, cerebrovascular accident, or myocardial infarction; and loop diuretic or antiarrhythmic medication initiation or up-titration. A sample size of 118 subjects is expected to allow detection of a 5-point change in MLHFQ score in an intention-to-treat analysis and allow initial assessment of clinical outcomes and subgroup analyses. Results Enrollment began in July 2019. As of November 2020, 107 subjects have been enrolled. It is projected that the 1-year follow-up will be completed by December 2021. Conclusion Atrial pacing with intrinsic ventricular conduction or advanced ventricular pacing at a higher, personalized backup HR may be a therapeutic target for patients with isolated DD or HFpEF. The myPACE trial is designed to test this hypothesis.
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5
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Wang L, Bhakta M, Fernandez-Perez A, Munshi NV. Inducible cardiomyocyte injury within the atrioventricular conduction system uncovers latent regenerative capacity in mice. J Clin Invest 2021; 131:138637. [PMID: 34596051 DOI: 10.1172/jci138637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/05/2021] [Indexed: 11/17/2022] Open
Abstract
The cardiac conduction system (CCS) ensures regular contractile function, and injury to any of its components can cause cardiac dysrhythmia. Although all cardiomyocytes (CMs) originate from common progenitors, the CCS is composed of biologically distinct cell types with unique functional and developmental characteristics. In contrast to ventricular cardiomyocytes, which continue to proliferate after birth, most CCS cells terminally exit the cell cycle during fetal development. Although the CCS should thus provide a poor substrate for postnatal injury repair, its regenerative capacity remains untested. Here, we describe a genetic system for ablating CMs that reside within the atrioventricular conduction system (AVCS). Adult mouse AVCS ablation resulted in regenerative failure characterized by persistent atrioventricular conduction defects and contractile dysfunction. In contrast, AVCS injury in neonatal mice led to recovery in a subset of these mice, thus providing evidence for CCS plasticity. Furthermore, CM proliferation did not appear to completely account for the observed functional recovery, suggesting that mechanisms regulating recovery from dysrhythmia are likely to be distinct from cardiac regeneration associated with ventricular injury. Taken together, we anticipate that our results will motivate further mechanistic studies of CCS plasticity and enable the exploration of rhythm restoration as an alternative therapeutic strategy.
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Affiliation(s)
- Lin Wang
- Department of Internal Medicine (Cardiology Division)
| | - Minoti Bhakta
- Department of Internal Medicine (Cardiology Division)
| | | | - Nikhil V Munshi
- Department of Internal Medicine (Cardiology Division).,Department of Molecular Biology.,McDermott Center for Human Growth and Development, and.,Center for Regenerative Science and Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
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Piccini JP, Stromberg K, Jackson KP, Kowal RC, Duray GZ, El-Chami MF, Crossley GH, Hummel JD, Narasimhan C, Omar R, Ritter P, Roberts PR, Soejima K, Reynolds D, Zhang S, Steinwender C, Chinitz L. Patient selection, pacing indications, and subsequent outcomes with de novo leadless single-chamber VVI pacing. Europace 2020; 21:1686-1693. [PMID: 31681964 DOI: 10.1093/europace/euz230] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 07/29/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS Patient selection is a key component of securing optimal patient outcomes with leadless pacing. We sought to describe and compare patient characteristics and outcomes of Micra patients with and without a primary pacing indication associated with atrial fibrillation (AF) in the Micra IDE trial. METHODS AND RESULTS The primary outcome (risk of cardiac failure, pacemaker syndrome, or syncope related to the Micra system or procedure) was compared between successfully implanted patients from the Micra IDE trial with a primary pacing indication associated with AF or history of AF (AF group) and those without (non-AF group). Among 720 patients successfully implanted with Micra, 228 (31.7%) were in the non-AF group. Reasons for selecting VVI pacing in non-AF patients included an expectation for infrequent pacing (66.2%) and advanced age (27.2%). More patients in the non-AF group had a condition that precluded the use of a transvenous pacemaker (9.6% vs. 4.7%, P = 0.013). Atrial fibrillation patients programmed to VVI received significantly more ventricular pacing compared to non-AF patients (median 67.8% vs. 12.6%; P < 0.001). The overall occurrence of the composite outcome at 24 months was 1.8% with no difference between the AF and non-AF groups (hazard ratio 1.36, 95% confidence interval 0.45-4.2; P = 0.59). CONCLUSION Nearly one-third of patients selected to receive Micra VVI therapy were for indications not associated with AF. Non-AF VVI patients required less frequent pacing compared to patients with AF. Risks associated with VVI therapy were low and did not differ in those with and without AF.
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Affiliation(s)
- Jonathan P Piccini
- Electrophysiology Section, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | | | - Kevin P Jackson
- Electrophysiology Section, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | | | - Gabor Z Duray
- Clinical Electrophysiology Department of Cardiology, Medical Centre, Hungarian Defence Forces, Budapest, Hungary
| | | | | | | | | | - Razali Omar
- Electrophysiology and Pacing Unit, National Heart Institute, Kuala Lumpur, Malaysia
| | - Philippe Ritter
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Bordeaux, IHU LIRYC, Bordeaux, France
| | | | - Kyoko Soejima
- Department of Cardiology, Kyorin University Hospital, Tokyo, Japan
| | - Dwight Reynolds
- Cardiovascular Section, University of Oklahoma Health Sciences Center, OU Medical Center, Oklahoma City, OK, USA
| | | | - Clemens Steinwender
- Kepler University Hospital, Linz, Austria.,Paracelsus Medical University Salzburg, Salzburg, Austria
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7
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The Detrimental Effect of RA Pacing on LA Function and Clinical Outcome in Cardiac Resynchronization Therapy. JACC Cardiovasc Imaging 2020; 13:895-906. [DOI: 10.1016/j.jcmg.2019.04.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/05/2019] [Accepted: 04/05/2019] [Indexed: 01/01/2023]
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8
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Management of anticoagulation in patients undergoing leadless pacemaker implantation. Heart Rhythm 2019; 16:1849-1854. [DOI: 10.1016/j.hrthm.2019.05.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Indexed: 11/20/2022]
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9
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Technological and Clinical Challenges in Lead Placement for Cardiac Rhythm Management Devices. Ann Biomed Eng 2019; 48:26-46. [DOI: 10.1007/s10439-019-02376-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/25/2019] [Indexed: 01/29/2023]
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay. Heart Rhythm 2019; 16:e128-e226. [DOI: 10.1016/j.hrthm.2018.10.037] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Indexed: 12/13/2022]
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Abstract
This article represents an overview of the basic concepts of cardiac electrophysiology. This relatively new field became a subspecialty of cardiology in the mid-1990s due to the rapid development of equipment that allowed the study and cure of cardiac arrhythmias percutaneously. Simultaneously, technology provided the field with percutaneous cardiac implantable electronic devices designed to protect patients from life-threatening bradyarrhythmias and tachyarrhythmias. Recently, the field has focused on the ablative treatment of atrial fibrillation, the most common arrhythmia facing an aging population, and the diagnosis and management of many inherited arrhythmias through advances in understanding of their genetic cause.
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Affiliation(s)
- Otto Costantini
- Cardiovascular Disease Fellowship, Summa Health Heart and Vascular Institute, Summa Health System, 95 Arch Street, Suite 350, Akron, OH 44304, USA.
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13
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Elbanhawy N, Chalil S, Abozguia K. Bradyarrhythmias for the Internist. Med Clin North Am 2019; 103:897-912. [PMID: 31378333 DOI: 10.1016/j.mcna.2019.05.003] [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] [Indexed: 11/20/2022]
Abstract
In this article, the authors review the different types of sinus node and atrioventricular node diseases that lead to bradyarrhythmias with their associated symptoms, the diagnostic investigations needed to assess the degree of disease, and the therapeutic management, including the indications for permanent pacing.
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Affiliation(s)
- Noha Elbanhawy
- Lancashire Cardiac Center, Blackpool Victoria Hospital, Blackpool Teaching Hospitals Foundation Trust, Whinney Heys Road, Blackpool FY38NR, UK
| | - Shajil Chalil
- Lancashire Cardiac Center, Blackpool Victoria Hospital, Blackpool Teaching Hospitals Foundation Trust, Whinney Heys Road, Blackpool FY38NR, UK
| | - Khalid Abozguia
- Lancashire Cardiac Center, Blackpool Victoria Hospital, Blackpool Teaching Hospitals Foundation Trust, Whinney Heys Road, Blackpool FY38NR, UK.
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2019; 140:e382-e482. [DOI: 10.1161/cir.0000000000000628] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | | | - Kenneth A. Ellenbogen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- ACC/AHA Representative
| | - Michael R. Gold
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- HRS Representative
| | | | | | - José A. Joglar
- ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | | | | | | | | | | | | | - Cara N. Pellegrini
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- HRS Representative
- Dr. Pellegrini contributed to this article in her personal capacity. The views expressed are her own and do not necessarily represent the views of the US Department of Veterans Affairs or the US government
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay. J Am Coll Cardiol 2019; 74:e51-e156. [DOI: 10.1016/j.jacc.2018.10.044] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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16
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary. J Am Coll Cardiol 2019; 74:932-987. [DOI: 10.1016/j.jacc.2018.10.043] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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17
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: Executive summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. Heart Rhythm 2018; 16:e227-e279. [PMID: 30412777 DOI: 10.1016/j.hrthm.2018.10.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Indexed: 12/22/2022]
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18
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. Circulation 2018; 140:e333-e381. [PMID: 30586771 DOI: 10.1161/cir.0000000000000627] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | | | | | | | - Kenneth A Ellenbogen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information.,ACC/AHA Representative
| | - Michael R Gold
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information.,HRS Representative
| | | | | | - José A Joglar
- ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | | | | | | | | | | | | | - Cara N Pellegrini
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information.,HRS Representative.,Dr. Pellegrini contributed to this article in her personal capacity. The views expressed are her own and do not necessarily represent the views of the US Department of Veterans Affairs or the US government
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Gillam MH, Pratt NL, Inacio MCS, Shakib S, Sanders P, Lau DH, Roughead EE. Rehospitalizations for complications and mortality following pacemaker implantation: A retrospective cohort study in an older population. Clin Cardiol 2018; 41:1480-1486. [PMID: 30294784 DOI: 10.1002/clc.23091] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/26/2018] [Accepted: 10/02/2018] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION A large number of older people receive pacemakers each year but broad population-based studies that describe complications following pacemaker implantation in this population are lacking. METHODS We conducted a retrospective cohort study using data from the Australian Government Department of Veterans' Affairs database. The cohort consisted of patients who received a pacemaker from 2005 to 2014. The outcomes were subsequent rehospitalizations for infections, procedure-related complications, thromboembolism, cardiovascular events (heart failure, myocardial infarction, and atrial fibrillation), and reoperation of pacemaker, and mortality. RESULTS There were 10 883 pacemakers recipients, the median age was 86 years (interquartile range 83-89), 61% were males, and 74% received a dual-chamber pacemaker. Within 90 days postdischarge, rehospitalizations were occasioned by pacemaker infection in 0.5%, device-related complications in 1.5%, cerebral infarction in 0.7%, and heart failure in 6% of single-chamber pacemaker recipients. In dual-chamber pacemaker recipients rehospitalizations were occasioned by pacemaker infection in 0.4%, septicemia in 0.4%, device-related complications in 1.2%, cerebral infarction in 0.3%, and heart failure in 3%. Rehospitalizations for pacemaker adjustment occurred in 1.5% of patients. The 90-day postdischarge mortality was 5% and 3% in patients with single- and dual-chamber pacemaker, respectively. CONCLUSION Rehospitalizations for infection, procedure-related complications, or thromboembolism occurred in 1% to 2% of patients within 90 days postdischarge, while 10% of single chamber and 7% of dual-chamber recipients experienced a rehospitalization for a cardiovascular event.
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Affiliation(s)
- Marianne H Gillam
- School of Pharmacy and Medical Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Nicole L Pratt
- School of Pharmacy and Medical Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Maria C S Inacio
- School of Pharmacy and Medical Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Sepehr Shakib
- Department of Clinical Pharmacology, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australia Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, South Australia Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Elizabeth E Roughead
- School of Pharmacy and Medical Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
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Sick Sinus Syndrome and Takotsubo Cardiomyopathy. Case Rep Cardiol 2018; 2018:3868091. [PMID: 30210876 PMCID: PMC6120333 DOI: 10.1155/2018/3868091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/08/2018] [Accepted: 07/19/2018] [Indexed: 11/17/2022] Open
Abstract
Background. Takotsubo cardiomyopathy is associated with increased risk of ventricular arrhythmias, atrial fibrillation, and bradyarrhythmias. However, sinus node dysfunction is relatively infrequent in the setting of takotsubo cardiomyopathy. Case Report. We are reporting a case of a 73-year-old woman with a history of asymptomatic sinus bradycardia who developed sick sinus syndrome complicated by takotsubo cardiomyopathy. Conclusion. Acute symptomatic sick sinus syndrome in patients with preexisting silent sinus node dysfunction can trigger takotsubo cardiomyopathy. Understanding precipitating factors of takotsubo cardiomyopathy and identifying the patients at risk of life-threatening arrhythmia can help in refining risk stratification and therapy planning. Patients with sick sinus syndrome complicated by takotsubo cardiomyopathy may benefit from pacemaker implantation. However, evaluation on a case-by-case basis is mandatory.
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Xing F, Jiang J, Hu X, Feng C, He J, Dong Y, Ma Y, Tang A. Association between paced QRS duration and atrial fibrillation after permanent pacemaker implantation: A retrospective observational cohort study. Medicine (Baltimore) 2018; 97:e9839. [PMID: 29419690 PMCID: PMC5944699 DOI: 10.1097/md.0000000000009839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/07/2017] [Accepted: 01/19/2018] [Indexed: 01/23/2023] Open
Abstract
Right ventricular pacing often results in prolonged QRS duration (QRSd) as the result of right ventricular stimulation, and atrial fibrillation (AF) may result. The association of pacing-induced prolonged QRSd and AF in patients with permanent pacemakers is unknown.We selected 180 consecutive patients who underwent pacemaker implantation for complete/advanced atrioventricular block. All of the patients were paced from the right ventricular septum. Electrocardiography recordings were obtained at the beginning and the end of pacemaker implantation. QRSd was measured in all 12 leads. The QRSd variation was calculated by subtracting the preimplantation QRSd from the postimplantation QRSd.The occurrence of AF was observed in 64 (35.56%) patients (follow-up 33.62 ± 21.47 mo). No significant differences in preimplantation QRSd were observed between the AF occurrence and nonoccurrence groups. The QRSd variation in leads V4 (54.22 ± 29.03 vs 42.66 ± 33.79 ms, P = .022), and V6 (64.62 ± 23.16 vs 48.45 ± 34.40 ms, P = .001) differed significantly between the occurrence and nonoccurrence groups. More QRSd variation in lead V6 (P = .005, HR = 1.822, 95% CI 1.174-2.718, interval scale of QRSd was 40 ms) and left atrial diameter (P = .045, HR = 1.042, 95% CI 1.001-1.086) were independent risk factors for AF occurrence. Receiver operating characteristic curve suggested that QRSd variation in lead V6 could predict AF occurrence, especially for patients with long preimplantation QRSd (≥120 ms, area under the curve was 0.826, 95% CI 0.685-0.967).QRSd variation in lead V6 might be positively correlated with postimplantation AF occurrence. In patients with pacemaker implantation, QRSd could be a complementary criterion for optimizing the right ventricular septal pacing site, and smallest QRSd might be worth pursuing.
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Affiliation(s)
- FuWei Xing
- Department of Cardiology, The First Affiliated Hospital of
Sun Yat-Sen University
- Key Laboratory on Assisted Circulation, Ministry of
Health
| | - JingZhou Jiang
- Department of Cardiology, The First Affiliated Hospital of
Sun Yat-Sen University
- Key Laboratory on Assisted Circulation, Ministry of
Health
| | - XiaoLiang Hu
- Department of Cardiology, The Third Affiliated Hospital of
Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Chong Feng
- Department of Cardiology, The First Affiliated Hospital of
Sun Yat-Sen University
- Key Laboratory on Assisted Circulation, Ministry of
Health
| | - JianGui He
- Department of Cardiology, The First Affiliated Hospital of
Sun Yat-Sen University
- Key Laboratory on Assisted Circulation, Ministry of
Health
| | - YuGang Dong
- Department of Cardiology, The First Affiliated Hospital of
Sun Yat-Sen University
- Key Laboratory on Assisted Circulation, Ministry of
Health
| | - YueDong Ma
- Department of Cardiology, The First Affiliated Hospital of
Sun Yat-Sen University
- Key Laboratory on Assisted Circulation, Ministry of
Health
| | - AnLi Tang
- Department of Cardiology, The First Affiliated Hospital of
Sun Yat-Sen University
- Key Laboratory on Assisted Circulation, Ministry of
Health
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Narasimhan C, Sanyal J, Sethi R, Kothari Y, Malik FTN, Pandurangi U, Khan N, Sahu S, Lande J, Sachanandani H, Naik A. Under-utilization of pacemaker therapy for sinus node dysfunction - Real world data from South Asia. Indian Heart J 2017; 69:607-612. [PMID: 29054184 PMCID: PMC5650562 DOI: 10.1016/j.ihj.2017.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 02/20/2017] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Chronic symptomatic sinus node dysfunction (SND), the most common bradyarrhythmia, can be effectively managed by permanent cardiac pacing. Yet the care pathway and barriers to adoption of pacing therapy are not well understood - particularly in low volume implanting countries. The IMPROVE Brady study is a quality improvement initiative being conducted at centers in South Asia, Latin America, and Russia. We assessed the rates of SND diagnosis and pacemaker treatment for SND in the South Asia cohort. METHODS The prospective study enrolled patients with heart rate of ≤50 beats per minute presenting with symptoms including syncope, dizziness, and/or dyspnea from ten centers in India and Bangladesh. Patients were followed to identify the proportion diagnosed with SND and subsequently treated with pacemaker therapy. RESULTS A total of 508 patients meeting criteria were enrolled and followed on average for 8.3±8.0months. Patients were on average 58 years of age, 77% were male, and 91% had completed at least primary education. An SND diagnosis was made in 368 (72%) of patients, with the majority (80%) of diagnoses occurring within 1 month of enrollment. Of the patients with an SND diagnosis, 63 (17%) were treated with a pacemaker. Reasons for not receiving treatment were: subject refusal or deferred decision (45%), unaffordability (34%), physician determined - not-indicated (20%), and other (1%). Older age, female gender, history of hypertension, lower resting heart rate, and syncopal or pre-syncopal symptoms were associated with a higher probability of implant. CONCLUSIONS In a care pathway assessment for the diagnosis and treatment of symptomatic SND in South Asia only 1 in 6 patients received pacemaker indicated therapy, largely due to patient refusal and physician decision. Phase II of the study will be aimed to improve this treatment rate.
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Affiliation(s)
- C Narasimhan
- Division of Electrophysiology, Department of Cardiology, CARE Hospitals and CARE Foundation, Hyderabad, India.
| | - J Sanyal
- Mission Hospital, Bidhannagar Durgapur, West Bengal, India
| | - R Sethi
- King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Y Kothari
- RajaRajeswari Medical College & Hospital, Bangalore, Karnataka, India
| | - F T N Malik
- National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - U Pandurangi
- Madras Medical Mission Institute of Cardiovascular Diseases, Chennai, Tamil Nadu, India
| | - N Khan
- United Hospital Limited, Dhaka, Bangladesh
| | - S Sahu
- India Medtronic Pvt. Ltd., Mumbai, Maharashtra, India
| | - J Lande
- Medtronic plc, Mounds View, MN, USA
| | | | - A Naik
- Care Institute of Medical Sciences, Ahmedabad, Gujarat, India
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Sennhauser S, Anand R, Kusumoto F, Goldschlager N. Heart Rhythm Society: expert consensus statements-part 1. Clin Cardiol 2017; 40:177-185. [PMID: 28273360 PMCID: PMC6490615 DOI: 10.1002/clc.22666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 11/23/2016] [Indexed: 01/06/2023] Open
Abstract
One of the most important roles for professional societies in medicine is assembling multiple stakeholders and experts to develop documents that can help guide and define policies and strategies for best medical care. Each year the Heart Rhythm Society (HRS) develops several consensus documents that address critical clinical subjects that have been identified by input from HRS members and HRS committees. Over the past 5 years, HRS has produced documents with multiple professional societies from around the world, and although the topics chosen for exploration center around arrhythmia management, the reviews and recommendations made in the documents are important for clinical cardiologists and generalists who are not arrhythmia specialists. When an internist or other primary care provider identifies a patient who may be having symptoms from an arrhythmia, the referral first is made to the clinical cardiologist and only later, if necessary, does an arrhythmia specialist become involved. These expert consensus statements are developed for specific clinical questions regarding arrhythmia management where there is controversy or uncertainty, often with less data from randomized controlled trials to help guide recommendations, which must then be made by extrapolation of existing data, observational data, and expert opinion. In this 2-part review, the consensus statements developed by the HRS over the past 5 years that pertain to adults are discussed in part 1; part 2 focuses on consensus statements that HRS has developed in conjunction with the Pediatric and Congenital Electrophysiology Society that address arrhythmia issues in children and adults with congenital heart disease.
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Affiliation(s)
- Susie Sennhauser
- University of Miami Miller School of MedicineHoly Cross HospitalFort LauderdaleFlorida
| | - Rishi Anand
- University of Miami Miller School of MedicineHoly Cross HospitalFort LauderdaleFlorida
| | - Fred Kusumoto
- Electrophysiology and Pacing Service, Division of Cardiovascular Disease, Department of MedicineMayo ClinicJacksonvilleFlorida
| | - Nora Goldschlager
- Cardiology Division, Department of MedicineSan Francisco General HospitalSan FranciscoCalifornia
- Department of MedicineUniversity of CaliforniaSan Francisco, San FranciscoCalifornia
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Rafiq A, Sklyar E, Bella JN. Cardiac Evaluation and Monitoring of Patients Undergoing Noncardiac Surgery. Health Serv Insights 2017; 9:1178632916686074. [PMID: 28469459 PMCID: PMC5398290 DOI: 10.1177/1178632916686074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 09/24/2016] [Indexed: 12/25/2022] Open
Abstract
Surgical management of disease has a tremendous impact on our health system. Millions of people worldwide undergo surgeries every year. Cardiovascular complications in the perioperative period are one of the most common events leading to increased morbidity and mortality. Although such events are very small in number, they are associated with a high mortality rate making it essential for physicians to understand the importance of perioperative cardiovascular risk assessment and evaluation. Its involves a detailed process of history taking, patient's medical profile, medications being used, functional status of the patient, and knowledge about the surgical procedure and its inherent risks. Different risk assessment tools and calculators have also been developed to aid in this process, each with their own advantages and limitations. After such a comprehensive evaluation, a physician will be able to provide a risk assessment or it may all lead to further testing if it is believed that a change in management after such testing will help to reduce perioperative morbidity and mortality. There is extensive literature on the significance of multiple perioperative testing modalities and how they can change management. The purpose of our review is to provide a concise but comprehensive analysis on all such aspects of perioperative cardiovascular risk assessment for noncardiac surgeries and provide a basic methodology toward such assessment and decision making.
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Affiliation(s)
- Arsalan Rafiq
- Division of Cardiology, Department of Medicine, Bronx-Lebanon Hospital Center, Bronx, NY, USA
- Internal medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eduard Sklyar
- Division of Cardiology, Department of Medicine, Bronx-Lebanon Hospital Center, Bronx, NY, USA
- Internal medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jonathan N Bella
- Division of Cardiology, Department of Medicine, Bronx-Lebanon Hospital Center, Bronx, NY, USA
- Internal medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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WORDEN NICOLEE, ALQASRAWI MUSAB, MAZUR ALEXANDER. Long-Term Stability and Clinical Utility of Amplified Atrial Electrograms in a Single-Lead ICD System with Floating Atrial Electrodes. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:1327-1334. [DOI: 10.1111/pace.12967] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 10/04/2016] [Accepted: 10/09/2016] [Indexed: 12/11/2022]
Affiliation(s)
- NICOLE E. WORDEN
- Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics; University of Iowa Carver College of Medicine; Iowa City Iowa
| | - MUSAB ALQASRAWI
- Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics; University of Iowa Carver College of Medicine; Iowa City Iowa
| | - ALEXANDER MAZUR
- Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics; University of Iowa Carver College of Medicine; Iowa City Iowa
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Worden NE, Alqasrawi M, Krothapalli SM, Mazur A. "Two for the Price of One": A Single-Lead Implantable Cardioverter-Defibrillator System with a Floating Atrial Dipole. J Atr Fibrillation 2016; 8:1396. [PMID: 27909501 DOI: 10.4022/jafib.1396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/06/2016] [Accepted: 04/09/2016] [Indexed: 12/28/2022]
Abstract
In patients known to be a high risk for sudden cardiac arrest, implantable cardioverter defibrillators (ICD) are a proven therapy to reduce risk of death. However, in patients without conventional indications for pacing, the optimal strategy for type of device, dual- versus single-chamber, remains debatable. The benefit of prophylactic pacing in this category of patients has never been documented. Although available atrial electrograms in a dual chamber system improve interpretation of stored arrhythmia events, allow monitoring of atrial fibrillation and may potentially reduce the risk of inappropriate shocks by enhancing automated arrhythmia discrimination, the use of dual-chamber ICDs has a number of disadvantages. The addition of an atrial lead adds complexity to implantation and extraction procedures, increases procedural cost and is associated with a higher risk of periprocedural complications. The single lead pacing system with ability to sense atrial signals via floating atrial electrodes (VDD) clinically became available in early 1980's but did not gain much popularity due to inconsistent atrial sensing and concerns about the potential need for an atrial lead if sinus node fails. Most ICD patients do not have indications for pacing at implantation and subsequent risk of symptomatic bradycardia seems to be low. The concept of atrial sensing via floating electrodes has recently been revitalized in the Biotronik DX ICD system (Biotronik, SE & Co., Berlin, Germany) aiming to provide all of the potential advantages of available atrial electrograms without the risks and incremental cost of an additional atrial lead. Compared to a traditional VDD pacing system, the DX ICD system uses an optimized (15 mm) atrial dipole spacing and improved atrial signal processing to offer more reliable atrial sensing. The initial experience with the DX system indicates that the clinically useful atrial signal amplitude in sinus rhythm remains stable over time. Future studies are needed to determine reliability of atrial sensing during tachyarrhythmias, particularly atrial fibrillation as well as clinical utility and cost-effectiveness of this technology in different populations of patients.
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Affiliation(s)
- Nicole E Worden
- Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Musab Alqasrawi
- Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Siva M Krothapalli
- Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Alexander Mazur
- Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Chen S, Wang Z, Kiuchi MG, Andrea BR, Krucoff MW, Liu S, Pürerfellner H. Cardiac pacing strategies and post-implantation risk of atrial fibrillation and heart failure events in sinus node dysfunction patients: a collaborative analysis of over 6000 patients. Clin Res Cardiol 2016; 105:687-698. [DOI: 10.1007/s00392-016-0973-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 02/12/2016] [Indexed: 10/22/2022]
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Miller MA, Neuzil P, Dukkipati SR, Reddy VY. Leadless Cardiac Pacemakers. J Am Coll Cardiol 2015; 66:1179-89. [PMID: 26337997 DOI: 10.1016/j.jacc.2015.06.1081] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 06/10/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Marc A Miller
- Helmsley Electrophysiology Center, Icahn School of Medicine, New York, New York
| | | | | | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Icahn School of Medicine, New York, New York.
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Ritter P, Duray GZ, Steinwender C, Soejima K, Omar R, Mont L, Boersma LVA, Knops RE, Chinitz L, Zhang S, Narasimhan C, Hummel J, Lloyd M, Simmers TA, Voigt A, Laager V, Stromberg K, Bonner MD, Sheldon TJ, Reynolds D. Early performance of a miniaturized leadless cardiac pacemaker: the Micra Transcatheter Pacing Study. Eur Heart J 2015; 36:2510-9. [PMID: 26045305 PMCID: PMC4589655 DOI: 10.1093/eurheartj/ehv214] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 05/04/2015] [Indexed: 11/13/2022] Open
Abstract
AIMS Permanent cardiac pacing is the only effective treatment for symptomatic bradycardia, but complications associated with conventional transvenous pacing systems are commonly related to the pacing lead and pocket. We describe the early performance of a novel self-contained miniaturized pacemaker. METHODS AND RESULTS Patients having Class I or II indication for VVI pacing underwent implantation of a Micra transcatheter pacing system, from the femoral vein and fixated in the right ventricle using four protractible nitinol tines. Prespecified objectives were >85% freedom from unanticipated serious adverse device events (safety) and <2 V 3-month mean pacing capture threshold at 0.24 ms pulse width (efficacy). Patients were implanted (n = 140) from 23 centres in 11 countries (61% male, age 77.0 ± 10.2 years) for atrioventricular block (66%) or sinus node dysfunction (29%) indications. During mean follow-up of 1.9 ± 1.8 months, the safety endpoint was met with no unanticipated serious adverse device events. Thirty adverse events related to the system or procedure occurred, mostly due to transient dysrhythmias or femoral access complications. One pericardial effusion without tamponade occurred after 18 device deployments. In 60 patients followed to 3 months, mean pacing threshold was 0.51 ± 0.22 V, and no threshold was ≥2 V, meeting the efficacy endpoint (P < 0.001). Average R-wave was 16.1 ± 5.2 mV and impedance was 650.7 ± 130 ohms. CONCLUSION Early assessment shows the transcatheter pacemaker can safely and effectively be applied. Long-term safety and benefit of the pacemaker will further be evaluated in the trial. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov ID NCT02004873.
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Affiliation(s)
- Philippe Ritter
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Bordeaux, IHU LIRYC, Bordeaux, France
| | - Gabor Z Duray
- Clinical Electrophysiology Department of Cardiology, Medical Centre, Hungarian Defence Forces, Budapest, Hungary
| | - Clemens Steinwender
- Department of Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine Linz, Linz, Austria
| | - Kyoko Soejima
- Department of Cardiology, Kyorin University Hospital, Tokyo, Japan
| | - Razali Omar
- Electrophysiology and Pacing Unit, National Heart Institute, Kuala Lumpur, Malaysia
| | - Lluís Mont
- Hospital Clínic, Universitat de Barcelona, Catalonia, Spain
| | | | - Reinoud E Knops
- Academisch Medisch Centrum (AMC), Amsterdam, the Netherlands
| | | | - Shu Zhang
- State Key Laboratory of Cardiovascular Disease Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Calambur Narasimhan
- Division of Electrophysiology, Department of Cardiology, CARE Hospitals and CARE Foundation, Hyderabad, India
| | - John Hummel
- The Ohio State University, Columbus, OH, USA
| | | | | | - Andrew Voigt
- University of Pittsburgh Medical Center UPMC Presbyterian, Pittsburgh, PA, USA
| | | | | | | | | | - Dwight Reynolds
- Cardiovascular Section, University of Oklahoma Health Sciences Center, OU Medical Center, Oklahoma City, OK, USA
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Abstract
Long QT syndromes encompass the most prevalent group of ion channelopathies. Long QT syndromes are predominantly familial and predispose the affected individual to ventricular arrhythmias and sudden death. Permanent pacemaker insertion for long QT syndrome is discouraged apart from younger patients exhibiting 2:1 atrioventricular block. However, permanent pacemaker insertion is a relatively common procedure in neonates with atrioventricular block, and dual-chamber permanent pacemaker insertion in low birth weight infants is challenging. We describe the management of long QT syndrome - type 2 - presenting in an extremely preterm neonate including epicardial, dual-chamber permanent pacemaker insertion.
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Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, Davila-Roman VG, Gerhard-Herman MD, Holly TA, Kane GC, Marine JE, Nelson MT, Spencer CC, Thompson A, Ting HH, Uretsky BF, Wijeysundera DN. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol 2014; 64:e77-137. [PMID: 25091544 DOI: 10.1016/j.jacc.2014.07.944] [Citation(s) in RCA: 823] [Impact Index Per Article: 82.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, Davila-Roman VG, Gerhard-Herman MD, Holly TA, Kane GC, Marine JE, Nelson MT, Spencer CC, Thompson A, Ting HH, Uretsky BF, Wijeysundera DN. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 130:e278-333. [PMID: 25085961 DOI: 10.1161/cir.0000000000000106] [Citation(s) in RCA: 209] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Proclemer A, Grazia Bongiorni M, Etsner H, Todd D, Sciaraffia E, Blomstrom-Lundqvist C, Blomstrom-Lundqvist C, Bongiorni MG, Chen J, Dagres N, Estner H, Hernandez-Madrid A, Hocini M, Larsen TB, Pison L, Potpara T, Proclemer A, Sciraffia E, Todd D. Current implantable cardioverter-defibrillator programming in Europe: the results of the European Heart Rhythm Association survey. Europace 2014; 16:935-8. [DOI: 10.1093/europace/euu143] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Reddy VY, Knops RE, Sperzel J, Miller MA, Petru J, Simon J, Sediva L, de Groot JR, Tjong FVY, Jacobson P, Ostrosff A, Dukkipati SR, Koruth JS, Wilde AAM, Kautzner J, Neuzil P. Permanent leadless cardiac pacing: results of the LEADLESS trial. Circulation 2014; 129:1466-71. [PMID: 24664277 DOI: 10.1161/circulationaha.113.006987] [Citation(s) in RCA: 198] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Conventional cardiac pacemakers are associated with several potential short- and long-term complications related to either the transvenous lead or subcutaneous pulse generator. We tested the safety and clinical performance of a novel, completely self-contained leadless cardiac pacemaker. METHODS AND RESULTS The primary safety end point was freedom from complications at 90 days. Secondary performance end points included implant success rate, implant time, and measures of device performance (pacing/sensing thresholds and rate-responsive performance). The mean age of the patient cohort (n=33) was 77±8 years, and 67% of the patients were male (n=22/33). The most common indication for cardiac pacing was permanent atrial fibrillation with atrioventricular block (n=22, 67%). The implant success rate was 97% (n=32). Five patients (15%) required the use of >1 leadless cardiac pacemaker during the procedure. One patient developed right ventricular perforation and cardiac tamponade during the implant procedure, and eventually died as the result of a stroke. The overall complication-free rate was 94% (31/33). After 3 months of follow-up, the measures of pacing performance (sensing, impedance, and pacing threshold) either improved or were stable within the accepted range. CONCLUSIONS In a prospective nonrandomized study, a completely self-contained, single-chamber leadless cardiac pacemaker has shown to be safe and feasible. The absence of a transvenous lead and subcutaneous pulse generator could represent a paradigm shift in cardiac pacing. CLINICAL TRIAL REGISTRATION URL http://clinicaltrials.gov. Unique identifier: NCT01700244.
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Affiliation(s)
- Vivek Y Reddy
- Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY (V.Y.R., M.A.M., S.R.D., J.S.K.); Department of Cardiology, Academic Medical Center, University of Amsterdam, The Netherlands (R.E.K., J.R.d.G., A.A.M.W.); Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany (J.S.); Cardiology Department, Homolka Hospital, Prague, Czech Republic (J.P., J.S., L.S., P.N.); Nanostim, Inc, Sunnyvale, CA (P.J., A.O.); Department of Cardiology, Institute of Clinical and Experimental Medicine - IKEM, Prague, Czech Republic (J.K.)
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Yamada S, Arrell DK, Kane GC, Nelson TJ, Perez-Terzic CM, Behfar A, Purushothaman S, Prinzen FW, Auricchio A, Terzic A. Mechanical dyssynchrony precedes QRS widening in ATP-sensitive K⁺ channel-deficient dilated cardiomyopathy. J Am Heart Assoc 2013; 2:e000410. [PMID: 24308936 PMCID: PMC3886734 DOI: 10.1161/jaha.113.000410] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Contractile discordance exacerbates cardiac dysfunction, aggravating heart failure outcome. Dissecting the genesis of mechanical dyssynchrony would enable an early diagnosis before advanced disease. Methods and Results High‐resolution speckle‐tracking echocardiography was applied in a knockout murine surrogate of adult‐onset human cardiomyopathy caused by mutations in cardioprotective ATP‐sensitive K+ (KATP) channels. Preceding the established criteria of cardiac dyssynchrony, multiparametric speckle‐based strain resolved nascent erosion of dysfunctional regions within cardiomyopathic ventricles of the KATP channel–null mutant exposed to hemodynamic stress. Not observed in wild‐type counterparts, intraventricular disparity in wall motion, validated by the degree, direction, and delay of myocardial speckle patterns, unmasked the disease substrate from asymptomatic to overt heart failure. Mechanical dyssynchrony preceded widening of the QRS complex and exercise intolerance and progressed into global myocardial discoordination and decompensated cardiac pump function, precipitating a low output syndrome. Conclusions The present study, with the use of high‐resolution imaging, prospectively resolved the origin and extent of intraventricular motion disparity in a KATP channel–knockout model of dilated cardiomyopathy. Mechanical dyssynchrony established as an early marker of cardiomyopathic disease offers novel insight into the pathodynamics of dyssynchronous heart failure.
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Affiliation(s)
- Satsuki Yamada
- Center for Regenerative Medicine, Marriott Heart Disease Research Program, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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Affiliation(s)
- Panos E Vardas
- Cardiology Department, Heraklion University Hospital, PO Box 1352, 71110 Heraklion, Greece.
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