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Jamil S, Khan A, Ansari H. Comment on "Severe Sleep Apnea as a Predictor of Failure to Respond to Cardiac Resynchronization Therapy". Curr Probl Cardiol 2023; 48:101971. [PMID: 37473938 DOI: 10.1016/j.cpcardiol.2023.101971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 07/16/2023] [Indexed: 07/22/2023]
Affiliation(s)
| | - Ayesha Khan
- Dow University of Health Sciences, Karachi, Pakistan
| | - Hamza Ansari
- Dow University of Health Sciences, North Karachi, Pakistan
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Feijen M, Egorova AD, Kuijken T, Bootsma M, Schalij MJ, van Erven L. One-Year Mortality in Patients Undergoing an Implantable Cardioverter Defibrillator or Cardiac Resynchronization Therapy Pulse Generator Replacement: Identifying Patients at Risk. J Clin Med 2023; 12:5654. [PMID: 37685719 PMCID: PMC10489035 DOI: 10.3390/jcm12175654] [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: 07/31/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Implantable cardioverter defibrillators (ICDs) significantly contribute to the prevention of sudden cardiac death in selected patients. However, it is essential to identify those who are likely to not have benefit from an ICD and to defer a pulse generator exchange. Easily implementable guidelines for individual risk stratification and decision making are lacking. This study investigates the 1-year mortality of patients who underwent an ICD or cardiac resynchronization therapy with defibrillator function (CRT-D) pulse generator replacement in a contemporary real-world tertiary hospital setting. The cause of death and patient- and procedure-related factors are stratified, and predictive values for 1-year mortality are evaluated. Patients with a follow-up of ≥365 days (or prior mortality) after an ICD or CRT-D exchange at the Leiden University Medical Center from 1 January 2018 until 31 December 2021 were eligible. In total, 588 patients were included (77% male, 69 [60-76] years old, 59% primary prevention, 46% ischemic cardiomyopathy and 37% mildly reduced left ventricular ejection fraction (LVEF)). Patients undergoing a CRT-D replacement or upgrade had a significantly higher 1-year all-cause mortality (10.7% and 11.9%, respectively) compared to patients undergoing ICD (2.8%) exchange (p = 0.002). LVEF ≤ 30%, New York Heart Association class ≥ 3, estimated glomerular filtration rate ≤ 30 mL/min/m2 and haemoglobin ≤ 7 mmol/L were independently associated with mortality within 1 year after pulse generator replacement. There is a growing need for prospectively validated risk scores to weight individualized risk of mortality with the expected ICD therapy benefit and to support a well-informed, shared decision-making process.
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Affiliation(s)
| | - Anastasia D. Egorova
- Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (M.F.); (L.v.E.)
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Ben Messaoud R, Khouri C, Pépin JL, Cracowski JL, Tamisier R, Barbieri F, Heidbreder A, Joyeux-Faure M, Defaye P. Implantable cardiac devices in sleep apnoea diagnosis: A systematic review and meta-analysis. Int J Cardiol 2021; 348:76-82. [PMID: 34906614 DOI: 10.1016/j.ijcard.2021.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/06/2021] [Accepted: 12/09/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND A particularly high burden of sleep apnoea is reported in patients treated with cardiac implants such as pacemakers and defibrillators. Sleep apnoea diagnosis remains a complex procedure mainly based on sleep and respiratory indices captured by polysomnography (PSG) or respiratory polygraphy (PG). AIM We aimed to evaluate the performance of implantable cardiac devices for sleep apnoea diagnosis compared to reference methods. METHOD Systematic structured literature searches were performed in PubMed, Embase and. Cochrane Library was performed to identify relevant studies. Quantitative characteristics of the studies were summarized and a qualitative synthesis was performed by a randomized bivariate meta-analysis and completed by pre-specified sensitivity analyses for different implant types and brands. RESULTS 16 studies involving 999 patients met inclusion criteria and were included in the meta-analysis. The majority of patients were men, of mean age of 64 ± 4.6 years. Sensitivity of cardiac implants for sleep apnoea diagnosis ranged from 60 to 100%, specificity from 50 to 100% with a prevalence of sleep apnoea varying from 22 to 91%. For an apnoea-hypopnoea index threshold ≥30 events/h during polysomnography (corresponding to severe sleep apnoea), the overall performance of the implants was relevant with a sensitivity of 78% and a specificity of 79%. Subgroup analyses on implant type and brand provided no additional information owing to the small number of studies. CONCLUSION The respiratory disturbance index provided by cardiac implants is clinically relevant and might improve access to sleep apnoea diagnosis in at-risk cardiovascular populations. PROSPERO Registration number: CRD42020181656.
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Affiliation(s)
- Raoua Ben Messaoud
- HP2 Laboratory, Inserm U1300, Grenoble Alpes University, Grenoble, France.
| | - Charles Khouri
- HP2 Laboratory, Inserm U1300, Grenoble Alpes University, Grenoble, France; Regional Pharmacovigilance Center, Grenoble Alpes University Hospital, Grenoble, France.
| | - Jean Louis Pépin
- HP2 Laboratory, Inserm U1300, Grenoble Alpes University, Grenoble, France; EFCR Laboratory, Thorax and Vessels division, Grenoble Alpes University Hospital, Grenoble, France.
| | - Jean Luc Cracowski
- HP2 Laboratory, Inserm U1300, Grenoble Alpes University, Grenoble, France; Regional Pharmacovigilance Center, Grenoble Alpes University Hospital, Grenoble, France.
| | - Renaud Tamisier
- HP2 Laboratory, Inserm U1300, Grenoble Alpes University, Grenoble, France; EFCR Laboratory, Thorax and Vessels division, Grenoble Alpes University Hospital, Grenoble, France.
| | - Fabian Barbieri
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Austria.
| | - Anna Heidbreder
- Sleep Disorders Clinic, Department of Neurology, Medical University Innsbruck, Austria.
| | - Marie Joyeux-Faure
- HP2 Laboratory, Inserm U1300, Grenoble Alpes University, Grenoble, France; EFCR Laboratory, Thorax and Vessels division, Grenoble Alpes University Hospital, Grenoble, France.
| | - Pascal Defaye
- Arrhythmia Unit, Cardiology Department, Grenoble Alpes University Hospital, Grenoble, France.
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