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Tonko JB, Rinaldi CA. Non-traditional implantable cardioverter-defibrillator configurations and insertion techniques: a review of contemporary options. Europace 2021; 24:181-192. [PMID: 34453529 PMCID: PMC8824518 DOI: 10.1093/europace/euab178] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/01/2021] [Indexed: 11/14/2022] Open
Abstract
Implantable cardioverter-defibrillators (ICDs) have revolutionized the treatment of acquired or inherited cardiac diseases associated with a high risk of sudden cardiac death due to ventricular tachyarrhythmias. Contemporary ICD devices offer reliable arrhythmia detection and discrimination algorithms and deliver highly efficient tachytherapies. Percutaneously inserted transvenous defibrillator coils with pectoral generator placement are the first-line approach in the majority of adults due to their extensively documented clinical benefit and efficiency with comparably low periprocedural implantation risks as well as the option of providing pain-free tachycardia treatment via anti-tachycardia pacing (ATP), concomitant bradycardiaprotection, and incorporation in a cardiac resynchronization therapy if indicated. Yet, expanding ICD indications particularly among younger and more complex patient groups as well as the increasingly evident long-term consequences and complications associated with intravascular lead placements promoted the development of alternative ICD configurations. Most established in daily clinical practice is the subcutaneous ICD but other innovative extravascular approaches like epicardial, pericardial, extra-pleural, and most recently substernal defibrillator coil placements have been introduced as well to overcome shortcomings associated with traditional devices and allow for individualized treatment strategies tailored to the patients characteristics and needs. The review aims to provide practical solutions for common complications encountered with transvenous ICD systems including restricted venous access, high defibrillation/fibrillation thresholds (DFTs), and recurrent device infections. We summarize the contemporary options for non-traditional extravascular ICD configurations outlining indications, advantages, and disadvantages.
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Affiliation(s)
- Johanna B Tonko
- Department of Cardiology, St. Thomas' Hospital, Westminster Bridge Rd, London SE1 7EH, UK.,Department of Cardiovascular Imaging, Arrhythmia Research Group, King's College London, School of Biomedical Engineering & Imaging Sciences, London, UK
| | - Christopher A Rinaldi
- Department of Cardiology, St. Thomas' Hospital, Westminster Bridge Rd, London SE1 7EH, UK.,Department of Cardiovascular Imaging, Arrhythmia Research Group, King's College London, School of Biomedical Engineering & Imaging Sciences, London, UK
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Cardiac Implantable Electronic Devices in Hemodialysis and Chronic Kidney Disease Patients-An Experience-Based Narrative Review. J Clin Med 2021; 10:jcm10081745. [PMID: 33920553 PMCID: PMC8073061 DOI: 10.3390/jcm10081745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/03/2021] [Accepted: 04/13/2021] [Indexed: 11/17/2022] Open
Abstract
Cardiovascular implantable electronic devices (CIEDs) are a standard therapy utilized for different cardiac conditions. They are implanted in a growing number of patients, including those with chronic kidney disease (CKD) and end-stage kidney disease (ESKD). Cardiovascular diseases, including heart failure and malignant arrhythmia, remain the leading cause of mortality among CKD patients, especially in ESKD. CIED implantation procedures are considered minor surgery, typically with transvenous leads inserted via upper central veins, followed by an impulse generator introduced subcutaneously. A decision regarding optimal hemodialysis (HD) modality and the choice of permanent vascular access (VA) could be particularly challenging in CIED recipients. The potential consequences of arteriovenous access on the CIED side are related to (1) venous hypertension from lead-related central vein stenosis and (2) the risk of systemic infection. Therefore, when creating permanent vascular access, the clinical scenario may be complicated by the CIED presence on one side and the lack of suitable vessels for arteriovenous fistula on the contralateral arm. These factors suggest the need for an individualized approach according to different clinical situations: (1) CIED in a CKD patient; (2) CIED in a patient on hemodialysis CIED; and (3) VA in a patient with CIED. This complex clinical conundrum creates the necessity for close cooperation between cardiologists and nephrologists.
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Karki R, Friedman PA, Killu AM. The Future of Percutaneous Epicardial Interventions. Card Electrophysiol Clin 2020; 12:419-430. [PMID: 32771195 DOI: 10.1016/j.ccep.2020.04.007] [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] [Indexed: 01/06/2023]
Abstract
The pericardial space provides a unique vantage point to access different cardiac structures for diagnosis and treatment of arrhythmias and other nonelectrophysiologic conditions, such as heart failure. There have been notable innovations to improve safety of percutaneous pericardial access and its use for various procedures. Percutaneous pericardial device therapies for pacing and defibrillation have been in development, success of which will be a significant advance in treatment of bradyarrhythmias, cardiac resynchronization therapy, and prevention of arrhythmic deaths. There is need for continued efforts in development and expansion of this technique and a systematic approach to monitor efficacy and safety outcomes.
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Affiliation(s)
- Roshan Karki
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 1st Street, Rochester, MN 55905, USA. https://twitter.com/roshankarkimd
| | - Paul A Friedman
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 1st Street, Rochester, MN 55905, USA. https://twitter.com/drpaulfriedman
| | - Ammar M Killu
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 1st Street, Rochester, MN 55905, USA.
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Caluori G, Wojtaszczyk A, Yasin O, Pesl M, Wolf J, Belaskova S, Crha M, Sugrue A, Vaidya VR, Naksuk N, DeSimone CV, Killu AM, Padmanabhan D, Asirvatham SJ, Stárek Z. Comparing the incidence of ventricular arrhythmias during epicardial ablation in swine versus canine models. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:862-867. [PMID: 30989679 DOI: 10.1111/pace.13698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 03/14/2019] [Accepted: 04/11/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Choosing the appropriate animal model for development of novel technologies requires an understanding of anatomy and physiology of these different models. There are little data about the characteristics of different animal models for the study of technologies used for epicardial ablation. We aimed to compare the incidence of ventricular arrhythmias during epicardial radiofrequency ablation between swine and canine models using novel epicardial ablation catheters. METHODS We conducted a retrospective study using data obtained from epicardial ablation experiments performed on swine (Sus Scrofa) and canine (Canis familiaris) models. We compared the incidence of ventricular arrhythmias during ablation between swine and canine using multivariate regression analysis. Six swine and six canine animals underwent successful epicardial radiofrequency ablation. A total of 103 ablation applications were recorded. RESULTS Ventricular arrhythmias requiring cardioversion occurred in 13.11% of radiofrequency ablation applications in swine and 9.75% in canine (relative risk: 117.6%, 95% confidence interval [CI]: 83.97-164.69, animal-based odds ratio [OR]: .55, 95% CI: .23-61.33; P = .184). When adjusting for application position, duration of ablation and power, the odds of developing potentially lethal ventricular arrhythmia in swine increased significantly compared to canine (OR: 3.60, 95% CI: 1.35-9.55; P = .010). CONCLUSIONS The swine myocardium is more susceptible to developing ventricular arrhythmias compared to canine model during epicardial ablation. This issue should be carefully considered in future studies.
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Affiliation(s)
- Guido Caluori
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.,CEITEC, Masaryk University, Brno, Czech Republic
| | - Adam Wojtaszczyk
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.,3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Omar Yasin
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Martin Pesl
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.,First Department of Internal Medicine/Cardioangiology, St. Anne´s Hospital, Masaryk University, Brno, Czech Republic.,Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiří Wolf
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Silvie Belaskova
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Michal Crha
- University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic
| | - Alan Sugrue
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Vaibhav R Vaidya
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Niyada Naksuk
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | | | - Ammar M Killu
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | | | - Samuel J Asirvatham
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota.,Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Zdeněk Stárek
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.,First Department of Internal Medicine/Cardioangiology, St. Anne´s Hospital, Masaryk University, Brno, Czech Republic
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Vaidya VR, Sugrue A, Padmanabhan D, Killu AM, Naksuk N, Al‐Masry AA, Isath A, Pedersen J, Yngsdal L, Ladewig DJ, Friedman PA, Asirvatham SJ. Percutaneous epicardial pacing using a novel transverse sinus device. J Cardiovasc Electrophysiol 2018; 29:1308-1316. [DOI: 10.1111/jce.13661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/23/2018] [Accepted: 05/29/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | - Alan Sugrue
- Department of Cardiovascular DiseasesMayo Clinic Rochester MN USA
| | | | - Ammar M. Killu
- Department of Cardiovascular DiseasesMayo Clinic Rochester MN USA
| | - Niyada Naksuk
- Department of Cardiovascular DiseasesMayo Clinic Rochester MN USA
| | | | - Ameesh Isath
- Department of Cardiovascular DiseasesMayo Clinic Rochester MN USA
| | - Joanne Pedersen
- Department of Cardiovascular SurgeryMayo Clinic Rochester MN USA
| | - Lisa Yngsdal
- Department of Cardiovascular SurgeryMayo Clinic Rochester MN USA
| | | | - Paul A. Friedman
- Department of Cardiovascular DiseasesMayo Clinic Rochester MN USA
| | - Samuel J. Asirvatham
- Department of Cardiovascular DiseasesMayo Clinic Rochester MN USA
- Department of Pediatrics and Adolescent MedicineMayo Clinic Rochester MN USA
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Vaidya VR, Sugure A, Asirvatham SJ. Innovations in Clinical Cardiac Electrophysiology: Challenges and Upcoming Solutions in 2018 and Beyond. J Innov Card Rhythm Manag 2017; 8:2943-2955. [PMID: 32477763 PMCID: PMC7252723 DOI: 10.19102/icrm.2017.081206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Vaibhav R. Vaidya
- Division of Cardiac Electrophysiology, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Alan Sugure
- Division of Cardiac Electrophysiology, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Samuel J. Asirvatham
- Division of Cardiac Electrophysiology, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
- Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
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