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Alam F, Ashfaq Ahmed M, Jalal AH, Siddiquee I, Adury RZ, Hossain GMM, Pala N. Recent Progress and Challenges of Implantable Biodegradable Biosensors. MICROMACHINES 2024; 15:475. [PMID: 38675286 PMCID: PMC11051912 DOI: 10.3390/mi15040475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024]
Abstract
Implantable biosensors have evolved to the cutting-edge technology of personalized health care and provide promise for future directions in precision medicine. This is the reason why these devices stand to revolutionize our approach to health and disease management and offer insights into our bodily functions in ways that have never been possible before. This review article tries to delve into the important developments, new materials, and multifarious applications of these biosensors, along with a frank discussion on the challenges that the devices will face in their clinical deployment. In addition, techniques that have been employed for the improvement of the sensitivity and specificity of the biosensors alike are focused on in this article, like new biomarkers and advanced computational and data communicational models. A significant challenge of miniaturized in situ implants is that they need to be removed after serving their purpose. Surgical expulsion provokes discomfort to patients, potentially leading to post-operative complications. Therefore, the biodegradability of implants is an alternative method for removal through natural biological processes. This includes biocompatible materials to develop sensors that remain in the body over longer periods with a much-reduced immune response and better device longevity. However, the biodegradability of implantable sensors is still in its infancy compared to conventional non-biodegradable ones. Sensor design, morphology, fabrication, power, electronics, and data transmission all play a pivotal role in developing medically approved implantable biodegradable biosensors. Advanced material science and nanotechnology extended the capacity of different research groups to implement novel courses of action to design implantable and biodegradable sensor components. But the actualization of such potential for the transformative nature of the health sector, in the first place, will have to surmount the challenges related to biofouling, managing power, guaranteeing data security, and meeting today's rules and regulations. Solving these problems will, therefore, not only enhance the performance and reliability of implantable biodegradable biosensors but also facilitate the translation of laboratory development into clinics, serving patients worldwide in their better disease management and personalized therapeutic interventions.
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Affiliation(s)
- Fahmida Alam
- Department of Electrical and Computer Engineering, University of Texas Rio Grande Valley, Edinburg, TX 78539, USA; (A.H.J.); (G.M.M.H.)
| | | | - Ahmed Hasnain Jalal
- Department of Electrical and Computer Engineering, University of Texas Rio Grande Valley, Edinburg, TX 78539, USA; (A.H.J.); (G.M.M.H.)
| | - Ishrak Siddiquee
- Institute of Microsystems Technology, University of South-Eastern Norway, Horten, 3184 Vestfold, Norway;
| | - Rabeya Zinnat Adury
- Department of Applied Physiology and Kinesiology, College of Health and Human Performance, University of Florida, Gainesville, FL 32611, USA;
| | - G M Mehedi Hossain
- Department of Electrical and Computer Engineering, University of Texas Rio Grande Valley, Edinburg, TX 78539, USA; (A.H.J.); (G.M.M.H.)
| | - Nezih Pala
- Department of Electrical and Computer Engineering, Florida International University, Miami, FL 33174, USA;
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Wu SJ, Zhao X. Bioadhesive Technology Platforms. Chem Rev 2023; 123:14084-14118. [PMID: 37972301 DOI: 10.1021/acs.chemrev.3c00380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Bioadhesives have emerged as transformative and versatile tools in healthcare, offering the ability to attach tissues with ease and minimal damage. These materials present numerous opportunities for tissue repair and biomedical device integration, creating a broad landscape of applications that have captivated clinical and scientific interest alike. However, fully unlocking their potential requires multifaceted design strategies involving optimal adhesion, suitable biological interactions, and efficient signal communication. In this Review, we delve into these pivotal aspects of bioadhesive design, highlight the latest advances in their biomedical applications, and identify potential opportunities that lie ahead for bioadhesives as multifunctional technology platforms.
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Affiliation(s)
- Sarah J Wu
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| | - Xuanhe Zhao
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
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3
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Pascual D, Brauns L, Domes R, Tisler M, Kögel M, Stumpf A, Kirschniak A, Rolinger J, Kraushaar U, Jones PD. A flexible implant for acute intrapancreatic electrophysiology. Biomed Microdevices 2023; 25:35. [PMID: 37646842 DOI: 10.1007/s10544-023-00662-2] [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: 05/30/2023] [Indexed: 09/01/2023]
Abstract
Microelectrode arrays (MEAs) have proven to be a powerful tool to study electrophysiological processes over the last decades with most technology developed for investigation of the heart or brain. Other targets in the field of bioelectronic medicine are the peripheral nervous system and its innervation of various organs. Beyond the heart and nervous systems, the beta cells of the pancreatic islets of Langerhans generate action potentials during the production of insulin. In vitro experiments have demonstrated that their activity is a biomarker for blood glucose levels, suggesting that recording their activity in vivo could support patients suffering from diabetes mellitus with long-term automated read-out of blood glucose concentrations. Here, we present a flexible polymer-based implant having 64 low impedance microelectrodes designed to be implanted to a depth of 10 mm into the pancreas. As a first step, the implant will be used in acute experiments in pigs to explore the electrophysiological processes of the pancreas in vivo. Beyond use in the pancreas, our flexible implant and simple implantation method may also be used in other organs such as the brain.
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Affiliation(s)
- Domenic Pascual
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Lisa Brauns
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Ruth Domes
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | | | - Marco Kögel
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Angelika Stumpf
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Andreas Kirschniak
- Department of Surgery and Transplantation, Tübingen University Hospital, Tübingen, Germany
- Department of General and Visceral Surgery, Maria Hilf Hospital Mönchengladbach, Mönchengladbach, Germany
| | - Jens Rolinger
- Department of Surgery and Transplantation, Tübingen University Hospital, Tübingen, Germany
- Department of General and Visceral Surgery, Maria Hilf Hospital Mönchengladbach, Mönchengladbach, Germany
| | - Udo Kraushaar
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Peter D Jones
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany.
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Chen Z, Lin Z, Obaid SN, Rytkin E, George SA, Bach C, Madrid M, Liu M, LaPiano J, Fehr A, Shi X, Quirion N, Russo B, Knight H, Aduwari A, Efimov IR, Lu L. Soft, bioresorbable, transparent microelectrode arrays for multimodal spatiotemporal mapping and modulation of cardiac physiology. SCIENCE ADVANCES 2023; 9:eadi0757. [PMID: 37406128 DOI: 10.1126/sciadv.adi0757] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 06/01/2023] [Indexed: 07/07/2023]
Abstract
Transparent microelectrode arrays (MEAs) that allow multimodal investigation of the spatiotemporal cardiac characteristics are important in studying and treating heart disease. Existing implantable devices, however, are designed to support chronic operational lifetimes and require surgical extraction when they malfunction or are no longer needed. Meanwhile, bioresorbable systems that can self-eliminate after performing temporary functions are increasingly attractive because they avoid the costs/risks of surgical extraction. We report the design, fabrication, characterization, and validation of a soft, fully bioresorbable, and transparent MEA platform for bidirectional cardiac interfacing over a clinically relevant period. The MEA provides multiparametric electrical/optical mapping of cardiac dynamics and on-demand site-specific pacing to investigate and treat cardiac dysfunctions in rat and human heart models. The bioresorption dynamics and biocompatibility are investigated. The device designs serve as the basis for bioresorbable cardiac technologies for potential postsurgical monitoring and treating temporary patient pathological conditions in certain clinical scenarios, such as myocardial infarction, ischemia, and transcatheter aortic valve replacement.
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Affiliation(s)
- Zhiyuan Chen
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Zexu Lin
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Sofian N Obaid
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Eric Rytkin
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Sharon A George
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Christopher Bach
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Micah Madrid
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Miya Liu
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Jessica LaPiano
- MedStar Georgetown University Hospital, Washington, DC 20037, USA
| | - Amy Fehr
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Xinyu Shi
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Nathaniel Quirion
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Benjamin Russo
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Helen Knight
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Anthony Aduwari
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Igor R Efimov
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Medicine (Cardiology), Northwestern University, Chicago, IL 60611, USA
| | - Luyao Lu
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
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Trohman RG, Huang HD, Sharma PS. Atrial fibrillation: primary prevention, secondary prevention, and prevention of thromboembolic complications: part 1. Front Cardiovasc Med 2023; 10:1060030. [PMID: 37396596 PMCID: PMC10311453 DOI: 10.3389/fcvm.2023.1060030] [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: 10/02/2022] [Accepted: 03/14/2023] [Indexed: 07/04/2023] Open
Abstract
Atrial fibrillation (AF), is the most common sustained cardiac arrhythmia. It was once thought to be benign as long as the ventricular rate was controlled, however, AF is associated with significant cardiac morbidity and mortality. Increasing life expectancy driven by improved health care and decreased fertility rates has, in most of the world, resulted in the population aged ≥65 years growing more rapidly than the overall population. As the population ages, projections suggest that the burden of AF may increase more than 60% by 2050. Although considerable progress has been made in the treatment and management of AF, primary prevention, secondary prevention, and prevention of thromboembolic complications remain a work in progress. This narrative review was facilitated by a MEDLINE search to identify peer-reviewed clinical trials, randomized controlled trials, meta-analyses, and other clinically relevant studies. The search was limited to English-language reports published between 1950 and 2021. Atrial fibrillation was searched via the terms primary prevention, hyperthyroidism, Wolff-Parkinson-White syndrome, catheter ablation, surgical ablation, hybrid ablation, stroke prevention, anticoagulation, left atrial occlusion and atrial excision. Google and Google scholar as well as bibliographies of identified articles were reviewed for additional references. In these two manuscripts, we discuss the current strategies available to prevent AF, then compare noninvasive and invasive treatment strategies to diminish AF recurrence. In addition, we examine the pharmacological, percutaneous device and surgical approaches to prevent stroke as well as other types of thromboembolic events.
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Richman T, Stanton T, Fryer M, Dayananda N, Tung M. Evaluating the magnet response in deep subcutaneous implanted cardioverter defibrillator implants. Pacing Clin Electrophysiol 2023; 46:93-99. [PMID: 36269082 DOI: 10.1111/pace.14609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 10/04/2022] [Accepted: 10/08/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The manufacturer of subcutaneous implantable cardioverter defibrillators (S-ICDs) acknowledges that 'deep implants' may fail to elicit a magnet response, however, does not define 'deep implant' or recommend a maximum implant depth. This study aims to systematically evaluate the effect of subcutaneous tissue depth and magnet types on evoked magnet response. METHODS Sunshine Coast University Hospital's S-ICD cohort underwent magnet response evaluation; where bar and donut magnets were compared and the evoked magnet response was recorded in three separate zones, guided by a template. Ordinal regression (OR) models assessed the relationship between the evoked magnet response and tissue depth (TD), measured via post-implant X-Ray. The patient's ability to hear the magnet response audible tone was recorded. RESULTS Patients (n = 39) with measurable TD (n = 30) were analyzed. The bar magnet evoked a magnet response in all zones in 53% of patients, compared with 73% of patients with the donut magnet (p = 0.18). The relationship between bar magnet response and TD showed the odds of an evoked magnet response decreased by 11% every 1 mm increase in TD (OR of 0.89, p < 0.01), whereas the donut magnet decreased by 16% per 1 mm (OR of 0.84, p < 0.01). Directly over the S-ICD was the most effective in evoking magnet response with the bar (85% of patients), and off-centre was most effective for the donut magnet (100%). BMI and Praetorian score were not significantly associated with magnet response. We found 23% of patients were unable to detect the audible tone. CONCLUSION We observed a statistically significant association between TD and ability to evoke magnet response. The bar magnet was less reliable than the donut magnet for therapy inhibition in deep implants.
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Affiliation(s)
| | - Tony Stanton
- Sunshine Coast University Hospital, Birtinya, Australia.,University of the Sunshine Coast, Sippy Downs, Australia
| | - Michael Fryer
- Sunshine Coast University Hospital, Birtinya, Australia
| | | | - Matthew Tung
- Sunshine Coast University Hospital, Birtinya, Australia.,School of Medicine and Dentistry, Griffith University, Sunshine Coast, Australia
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Veletić M, Apu EH, Simić M, Bergsland J, Balasingham I, Contag CH, Ashammakhi N. Implants with Sensing Capabilities. Chem Rev 2022; 122:16329-16363. [PMID: 35981266 DOI: 10.1021/acs.chemrev.2c00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Because of the aging human population and increased numbers of surgical procedures being performed, there is a growing number of biomedical devices being implanted each year. Although the benefits of implants are significant, there are risks to having foreign materials in the body that may lead to complications that may remain undetectable until a time at which the damage done becomes irreversible. To address this challenge, advances in implantable sensors may enable early detection of even minor changes in the implants or the surrounding tissues and provide early cues for intervention. Therefore, integrating sensors with implants will enable real-time monitoring and lead to improvements in implant function. Sensor integration has been mostly applied to cardiovascular, neural, and orthopedic implants, and advances in combined implant-sensor devices have been significant, yet there are needs still to be addressed. Sensor-integrating implants are still in their infancy; however, some have already made it to the clinic. With an interdisciplinary approach, these sensor-integrating devices will become more efficient, providing clear paths to clinical translation in the future.
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Affiliation(s)
- Mladen Veletić
- Department of Electronic Systems, Norwegian University of Science and Technology, 7491 Trondheim, Norway.,The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, 0372 Oslo, Norway
| | - Ehsanul Hoque Apu
- Institute for Quantitative Health Science and Engineering (IQ) and Department of Biomedical Engineering (BME), Michigan State University, East Lansing, Michigan 48824, United States.,Division of Hematology and Oncology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan 48105, United States
| | - Mitar Simić
- Faculty of Electrical Engineering, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Jacob Bergsland
- The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, 0372 Oslo, Norway
| | - Ilangko Balasingham
- Department of Electronic Systems, Norwegian University of Science and Technology, 7491 Trondheim, Norway.,The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, 0372 Oslo, Norway
| | - Christopher H Contag
- Institute for Quantitative Health Science and Engineering (IQ) and Department of Biomedical Engineering (BME), Michigan State University, East Lansing, Michigan 48824, United States
| | - Nureddin Ashammakhi
- Institute for Quantitative Health Science and Engineering (IQ) and Department of Biomedical Engineering (BME), Michigan State University, East Lansing, Michigan 48824, United States.,Department of Bioengineering, University of California, Los Angeles, California 90095, United States
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8
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Ahmed M. Patients characteristic, indications, and complications of permanent pacemaker implantation: A prospective single-center study. MEDICAL JOURNAL OF BABYLON 2022. [DOI: 10.4103/mjbl.mjbl_3_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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Patel MH, Sampath S, Kapoor A, Damani DN, Chellapuram N, Challa AB, Kaur MP, Walton RD, Stavrakis S, Arunachalam SP, Kulkarni K. Advances in Cardiac Pacing: Arrhythmia Prediction, Prevention and Control Strategies. Front Physiol 2021; 12:783241. [PMID: 34925071 PMCID: PMC8674736 DOI: 10.3389/fphys.2021.783241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 11/08/2021] [Indexed: 02/01/2023] Open
Abstract
Cardiac arrhythmias constitute a tremendous burden on healthcare and are the leading cause of mortality worldwide. An alarming number of people have been reported to manifest sudden cardiac death as the first symptom of cardiac arrhythmias, accounting for about 20% of all deaths annually. Furthermore, patients prone to atrial tachyarrhythmias such as atrial flutter and fibrillation often have associated comorbidities including hypertension, ischemic heart disease, valvular cardiomyopathy and increased risk of stroke. Technological advances in electrical stimulation and sensing modalities have led to the proliferation of medical devices including pacemakers and implantable defibrillators, aiming to restore normal cardiac rhythm. However, given the complex spatiotemporal dynamics and non-linearity of the human heart, predicting the onset of arrhythmias and preventing the transition from steady state to unstable rhythms has been an extremely challenging task. Defibrillatory shocks still remain the primary clinical intervention for lethal ventricular arrhythmias, yet patients with implantable cardioverter defibrillators often suffer from inappropriate shocks due to false positives and reduced quality of life. Here, we aim to present a comprehensive review of the current advances in cardiac arrhythmia prediction, prevention and control strategies. We provide an overview of traditional clinical arrhythmia management methods and describe promising potential pacing techniques for predicting the onset of abnormal rhythms and effectively suppressing cardiac arrhythmias. We also offer a clinical perspective on bridging the gap between basic and clinical science that would aid in the assimilation of promising anti-arrhythmic pacing strategies.
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Affiliation(s)
- Mehrie Harshad Patel
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
| | - Shrikanth Sampath
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
| | - Anoushka Kapoor
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
| | | | - Nikitha Chellapuram
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States
| | | | - Manmeet Pal Kaur
- Department of Medicine, GAIL, Mayo Clinic, Rochester, MN, United States
| | - Richard D. Walton
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
- INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Stavros Stavrakis
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Shivaram P. Arunachalam
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States
- Department of Medicine, GAIL, Mayo Clinic, Rochester, MN, United States
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Kanchan Kulkarni
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, Bordeaux, France
- INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
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10
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Porciello F, Marchesi MC, Birettoni F, Spina F, Knafelz P, Bufalari A, Rishniw M, Moise NS, Caivano D. Transthoracic echo-guided pacemaker implantation reduces fluoroscopic use in dogs. Vet J 2021; 277:105762. [PMID: 34655788 DOI: 10.1016/j.tvjl.2021.105762] [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: 04/16/2021] [Revised: 09/21/2021] [Accepted: 10/10/2021] [Indexed: 10/20/2022]
Abstract
Echocardiographic guidance provides an alternative method when fluoroscopy is unavailable, equipment or power failure of fluoroscopic equipment during a procedure occurs or to decrease radiation risk. Recently, transthoracic (TTE) and transesophageal echocardiography were reported as an alternative method to guide interventional procedures in dogs. Therefore, we hypothesized that TTE could be used as an alternative method to visualize endocardial leads during pacemaker implantation in dogs, largely avoiding the use of fluoroscopy. A prospective consecutive case series of pacemaker implantation was performed using TTE guidance. The endocardial lead was imaged by TTE during its intracardiac advancement until the lead tip was positioned at the right ventricular apex. Echocardiographic right parasternal views, optimized to visualize the pacing lead, were used, starting with a short axis image of the right atrium and ending with a long axis view of the right ventricle (RV) optimized to image the RV apex. Proper lead placement was confirmed by both capture threshold, impedance and fluoroscopy. Twenty-one pacemaker implantation procedures by TTE monitoring were successfully performed. The TTE guidance provided images of a quality sufficient to clearly monitor implantation in real-time and allowed for immediate corrections to pacing lead malpositioning or excessive looping. Fluoroscopy was used to confirm the correct placement of the lead that was guided echocardiographically in the initial three procedures, after which a single radiographic image (no cine-mode) was used to identify lead placement and redundancy in the remaining eighteen cases. Static imaging (radiography using the fluoroscope) was used to assess the proper lead redundancy in all procedures because this cannot be evaluated echocardiographically. Pacemaker leads were successfully implanted in the RV of dogs using TTE monitoring. A larger cases series is needed for validation of safety and effectiveness of TTE during this interventional procedure in dogs.
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Affiliation(s)
- F Porciello
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, Perugia, 06126 Italy.
| | - M C Marchesi
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, Perugia, 06126 Italy
| | - F Birettoni
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, Perugia, 06126 Italy
| | - F Spina
- Veterinary Hospital 'Etiopia', Viale Etiopia 16, Rome, 00199 Italy
| | - P Knafelz
- Veterinary Hospital 'GregorioVII', Piazza di Villa Carpegna 52, Rome, 00165 Italy
| | - A Bufalari
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, Perugia, 06126 Italy
| | - M Rishniw
- Veterinary Information Network, Davis, CA 95616, USA; Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
| | - N S Moise
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
| | - D Caivano
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, Perugia, 06126 Italy
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11
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Precision medicine in human heart modeling : Perspectives, challenges, and opportunities. Biomech Model Mechanobiol 2021; 20:803-831. [PMID: 33580313 PMCID: PMC8154814 DOI: 10.1007/s10237-021-01421-z] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/07/2021] [Indexed: 01/05/2023]
Abstract
Precision medicine is a new frontier in healthcare that uses scientific methods to customize medical treatment to the individual genes, anatomy, physiology, and lifestyle of each person. In cardiovascular health, precision medicine has emerged as a promising paradigm to enable cost-effective solutions that improve quality of life and reduce mortality rates. However, the exact role in precision medicine for human heart modeling has not yet been fully explored. Here, we discuss the challenges and opportunities for personalized human heart simulations, from diagnosis to device design, treatment planning, and prognosis. With a view toward personalization, we map out the history of anatomic, physical, and constitutive human heart models throughout the past three decades. We illustrate recent human heart modeling in electrophysiology, cardiac mechanics, and fluid dynamics and highlight clinically relevant applications of these models for drug development, pacing lead failure, heart failure, ventricular assist devices, edge-to-edge repair, and annuloplasty. With a view toward translational medicine, we provide a clinical perspective on virtual imaging trials and a regulatory perspective on medical device innovation. We show that precision medicine in human heart modeling does not necessarily require a fully personalized, high-resolution whole heart model with an entire personalized medical history. Instead, we advocate for creating personalized models out of population-based libraries with geometric, biological, physical, and clinical information by morphing between clinical data and medical histories from cohorts of patients using machine learning. We anticipate that this perspective will shape the path toward introducing human heart simulations into precision medicine with the ultimate goals to facilitate clinical decision making, guide treatment planning, and accelerate device design.
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12
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Trohman RG, Huang HD, Larsen T, Krishnan K, Sharma PS. Sensors for rate-adaptive pacing: How they work, strengths, and limitations. J Cardiovasc Electrophysiol 2020; 31:3009-3027. [PMID: 32877004 DOI: 10.1111/jce.14733] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/19/2020] [Accepted: 08/19/2020] [Indexed: 12/21/2022]
Abstract
Chronotropic incompetence is the inability of the sinus node to increase heart rate commensurate with increased metabolic demand. Cardiac pacing alone may be insufficient to address exercise intolerance, fatigue, dyspnea on exertion, and other symptoms of chronotropic incompetence. Rate-responsive (adaptive) pacing employs sensors to detect physical or physiological indices and mimic the response of the normal sinus node. This review describes the development, strengths, and limitations of a variety of sensors that have been employed to address chronotropic incompetence. A mini-tutorial on programming rate-adaptive parameters is included along with emphasis that patients' lifestyles and underlying medical conditions require careful consideration. In addition, special sensor applications used to respond prophylactically to physiologic signals are detailed and an in-depth discussion of sensors as a potential aid in heart failure management is provided.
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Affiliation(s)
- Richard G Trohman
- Department of Medicine, Section of Electrophysiology, Arrhythmia and Pacemaker Services, Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Henry D Huang
- Department of Medicine, Section of Electrophysiology, Arrhythmia and Pacemaker Services, Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Timothy Larsen
- Department of Medicine, Section of Electrophysiology, Arrhythmia and Pacemaker Services, Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Kousik Krishnan
- Department of Medicine, Section of Electrophysiology, Arrhythmia and Pacemaker Services, Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Parikshit S Sharma
- Department of Medicine, Section of Electrophysiology, Arrhythmia and Pacemaker Services, Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
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Endovascular Repair of a Common Carotid Artery Perforation during Pacemaker Insertion. Ann Vasc Surg 2020; 68:568.e11-568.e15. [PMID: 32283301 DOI: 10.1016/j.avsg.2020.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 03/30/2020] [Accepted: 04/01/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND We report the percutaneous endovascular management of an iatrogenic perforation of the left common carotid artery (LCCA) during an attempted trans-subclavian pacemaker (PM) placement. METHODS An 87-year-old woman was urgently transferred after an attempted left subclavian vein PM implantation. Computed tomography angiography scan showed the accidental cannulation of LCCA in its most proximal segment. Owing to the significant surgical risks, the mortality rate, and the distal position of the vessel from the skin, we opted for an endovascular strategy with a balloon-expandable stent graft. The Advanta 8 × 38 mm V12 was inserted via a 7 French Flexor Introducer sheath through the right common femoral artery. RESULTS The patient was discharged on postoperative day 2 without complications. A 6-month follow-up computed tomography angiography demonstrated stent graft and LCCA patency and the patient was in a good stable condition. CONCLUSIONS This case highlights the effectiveness of a minimal invasive endovascular approach to treat this uncommon but potentially lethal injury.
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Trohman RG, Huang HD, Sharma PS. The Miniaturization of Cardiac Implantable Electronic Devices: Advances in Diagnostic and Therapeutic Modalities. MICROMACHINES 2019; 10:E633. [PMID: 31546646 PMCID: PMC6843667 DOI: 10.3390/mi10100633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 09/15/2019] [Accepted: 09/17/2019] [Indexed: 12/24/2022]
Abstract
The Fourth Industrial Revolution, characterized by an unprecedented fusion of technologies that is blurring the lines between the physical, digital, and biological spheres, continues the trend to manufacture ever smaller mechanical, optical and electronic products and devices. In this manuscript, we outline the way cardiac implantable electronic devices (CIEDs) have evolved into remarkably smaller units with greatly enhanced applicability and capabilities.
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Affiliation(s)
- Richard G Trohman
- Section of Electrophysiology, Arrhythmia and Pacemaker Services, Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL 60612, USA.
| | - Henry D Huang
- Section of Electrophysiology, Arrhythmia and Pacemaker Services, Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL 60612, USA.
| | - Parikshit S Sharma
- Section of Electrophysiology, Arrhythmia and Pacemaker Services, Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL 60612, USA.
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Abstract
OBJECTIVE Physiologic cardiac pacing is a novel technique which has been largely popularized in recent decades. His bundle pacing (HBP) has been long considered the most physiologic pacing method; however, with the widespread implementation of this method, its disadvantages have become apparent. In this context, left bundle branch pacing (LBBP)-directly engaged in the His-Purkinje system-has been foreseen as the best pacing method to mimic physiologic activation patterns. This review aimed to summarize recent approaches to physiologic cardiac pacing. DATA SOURCES This review included fully peer reviewed publications up to July 2018, found in the PubMed database using the keywords "His bundle branch pacing," "right ventricular pacing," and "physiologic pacing." STUDY SELECTION All selected articles were in English, with no restriction on study design. RESULTS The HBP has been studied worldwide, and is currently considered the most physiologic pacing method. However, it has disadvantages, such as high pacing threshold, unsatisfactory sensing and long procedure times, among others. Although LBBP is theoretically superior to HBP, the clinical relevance of this difference remains under debate, as few large randomized clinical trials with LBBP have been published. CONCLUSIONS Although HBP indeed appears to be the most physiologic pacing method, it has certain shortcomings, such as high pacing threshold, difficult implantation due to specific anatomic features, and others. Further studies are required to clarify the clinical significance of LBBP.
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Polikandrioti M, Tzirogiannis K, Zyga S, Gerogianni G, Stefanidou S, Tsami A, Panoutsopoulos G. Assessment of fatigue in patients with a permanent cardiac pacemaker: prevalence and associated factors. Arch Med Sci Atheroscler Dis 2018; 3:e166-e173. [PMID: 30775608 PMCID: PMC6374640 DOI: 10.5114/amsad.2018.81085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 12/11/2018] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Fatigue is a debilitating symptom of subjective nature which lacks effective therapy. The aim of the study was to assess levels of fatigue and the associated factors among patients with permanent cardiac pacemaker (PCM). MATERIAL AND METHODS This was a cross-sectional study carried out in Athens. The study sample consisted of 250 patients with a PCM. RESULTS Data indicated moderate to low levels of fatigue. Furthermore, women (median: 24, p = 0.001), those with primary school education (median: 21, p = 0.001), those who were "a little-not at all" informed about PCM (median: 31, p = 0.001), those who had someone to help them in daily activities (median: 23, p = 0.001), those who did not believe that PCM solved their cardiac problem (median: 36, p = 0.001), and those who did not believe that their quality of life was improved (median: 35, p = 0.001) had high levels of fatigue. Moreover, high levels of fatigue were felt by those who characterized themselves as anxious and those who reported to be very anxious about their heart rate and the proper function of PCM (medians: 21.5, 25 and 25 respectively). Additionally, more fatigue was felt by participants who did not smoke after implantation and did not exercise at all (medians: 20 and 24 respectively). Finally, older patients felt more fatigue (rho = 0.248) while the later the implantation device was inserted the more fatigue the patients felt (rho = 0.274). CONCLUSIONS The present results will help clinicians to acquire an in-depth knowledge of factors associated with fatigue after implantation.
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Affiliation(s)
| | - Konstantinos Tzirogiannis
- Laboratory of Physiology and Pharmacology, Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta Lakonias, Greece
| | - Sofia Zyga
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta Lakonias, Greece
| | | | | | - Athanasia Tsami
- University General Hospital of Athens “Laiko”, Athens, Greece
| | - Georgios Panoutsopoulos
- Laboratory of Physiology and Pharmacology, Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta Lakonias, Greece
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Bodagh N, Pappa E, Farooqi F. Multidisciplinary surgical team approach for excision of squamous cell carcinoma overlying pacemaker site. BMJ Case Rep 2018; 2018:bcr-2017-221660. [PMID: 29437678 DOI: 10.1136/bcr-2017-221660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report an unusual case of an elderly man presenting with a fast-growing large malignant tumour involving the skin overlying his permanent pacemaker site. The fast-growing cutaneous squamous cell carcinoma appeared 2 years after pacemaker implantation. Joint specialist input was required to tackle this complex problem as a wide surgical excision would expose the pacemaker generator risking device infection particularly if the skin graft reconstruction failed. Having established that the patient had minimal pacing needs, it was determined through expedited multidisciplinary discussion that the best option was excision of the lesion with skin grafting of the defect by maxillofacial surgical team and pacemaker generator removal by a cardiologist in a joint surgical procedure. The procedure was successful and uneventful. This case highlights how effective multidisciplinary planning can help achieve a favourable clinical outcome in a patient with a rare case of a squamous cell carcinoma overlying a pacemaker site.
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Affiliation(s)
- Neil Bodagh
- Department of Cardiology, Barts Health NHS Trust, London, UK
| | - Elena Pappa
- Department of Maxillofacial Surgery, Barking, Havering and Redbridge University Hospitals Trust, Romford, UK
| | - Fahad Farooqi
- Department of Cardiology, Barking, Havering and Redbridge University Hospitals Trust, Romford, UK
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18
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Ellison K, Sharma PS, Trohman R. Advances in cardiac pacing and defibrillation. Expert Rev Cardiovasc Ther 2017; 15:429-440. [DOI: 10.1080/14779072.2017.1329011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kristin Ellison
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | | | - Richard Trohman
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
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Li YJ, Zhang WW, Yang XX, Li N, Qiu XB, Qu XK, Fang WY, Yang YQ, Li RG. Impact of prior permanent pacemaker on long-term clinical outcomes of patients undergoing percutaneous coronary intervention. Clin Cardiol 2016; 40:205-209. [PMID: 27879000 DOI: 10.1002/clc.22645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 10/22/2016] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The impact of permanent pacemaker (PPM) on long-term clinical outcomes of patients undergoing percutaneous coronary intervention (PCI) has not been studied. HYPOTHESIS PPM may increase heart failure (HF) burden on patients undergoing PCI. METHODS We recruited consecutive patients undergoing PCI and carried out a nested case-control study. Patients with confirmed PPM undergoing first PCI were identified and matched by age and sex in 1:1 fashion to patients without PPM undergoing first PCI. Clinical data were collected and analyzed. The primary endpoint outcomes were all-cause mortality and hospitalization for HF. RESULTS The final analysis included 156 patients. The mean follow-up period was 4.6 ± 2.9 years. The overall all-cause mortality was 21.15%, without significant difference between the 2 groups (21.79% vs 20.51%; P = 0.85). However, the rate of HF-related hospitalization was significantly higher in patients with PPM than in controls (26.92% vs 10.26%; P = 0.008). After adjustment for hypertension, type 2 diabetes mellitus, hyperlipidemia, chronic kidney disease, stroke, left ventricular ejection fraction, brain natriuretic peptide, and acute coronary syndrome (ACS), PCI patients with PPM were still associated with a greater hospitalization rate for HF (odds ratio: 4.31, 95% confidence interval: 0.94-19.80, P = 0.061). Further analysis in the ACS subgroup showed VVI-mode pacing enhanced the risk for HF-associated hospitalization (adjusted odds ratio: 8.27, 95% confidence interval: 1.37-49.75, P = 0.02). CONCLUSIONS PPM has no effect on all-cause mortality in patients undergoing first PCI but significantly increases the HF-associated hospitalization rate, especially in ACS patients.
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Affiliation(s)
- Yan-Jie Li
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Cardiovascular Research Laboratory, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wei-Wei Zhang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiao-Xiao Yang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ning Li
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Cardiovascular Research Laboratory, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xing-Biao Qiu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xin-Kai Qu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wei-Yi Fang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yi-Qing Yang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Cardiovascular Research Laboratory, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Central Laboratory, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ruo-Gu Li
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Gözübüyük G, Koç M, Kaypaklı O, Şahin DY. Increased hs-CRP and decreased 1,25-dihydroxyvitamin D are associated with increased left ventricle lead threshold. J Interv Card Electrophysiol 2016; 47:177-183. [PMID: 27236654 DOI: 10.1007/s10840-016-0152-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 05/24/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE There are not enough data about threshold changes in patients with CRT. In this study, we aimed to investigate frequency of significant threshold increase of left ventricle lead and to determine clinical, demographic, medical and laboratory parameters that associated with threshold increase in CRT implanted patients. METHODS We included CRT implanted 200 patients (124 males, 76 females; mean age 65.8 ± 10.3 years) to this study. Basal and third month LV R wave amplitude, electrode impedance, and threshold values were recorded. Threshold increase was accepted as ≥0.1 V and significant increase as >1 V. Patients were divided into two groups: increased threshold and non-increased threshold for LV lead. RESULTS Number of patients with increased LV threshold was 68 (37.6 %). Furthermore, 8 % of patients had severe increase (≥1 V) in LV threshold. We observed that serum levels of hs-CRP and 1,25 (OH)2 vitamin D were independently associated with increased LV threshold. We showed that 1 mg/dl increase in hs-CRP and the 1 mg/dl decrease in vitamin D are associated with 25.3 and 4.5 % increase in the odds of increased LV threshold, respectively. CONCLUSIONS Increased hs-CRP and decreased 1,25 (OH)2 vitamin D are the strongest predictors of increased LV lead thresholds. We suggest that hs-CRP and 1,25 (OH)2 vitamin D may be used as markers to predict and follow the patients with increased thresholds. It may be useful to finalize CRT procedure with more appropriate basal threshold in patients with high serum hs-CRP and low 1,25 (OH)2 vitamin D levels.
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Affiliation(s)
- Gökhan Gözübüyük
- Department of Cardiology, University of Health Sciences - Adana Health Practices and Research Center, Adana, Turkey
| | - Mevlüt Koç
- Department of Cardiology, University of Health Sciences - Adana Health Practices and Research Center, Adana, Turkey
| | - Onur Kaypaklı
- Department of Cardiology, University of Health Sciences - Adana Health Practices and Research Center, Adana, Turkey.
| | - Durmuş Yıldıray Şahin
- Department of Cardiology, University of Health Sciences - Adana Health Practices and Research Center, Adana, Turkey
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21
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Right ventricular outflow tract septal pacing versus apical pacing: A prospective, randomized, single-blind 5-years follow-up study of ventricular lead performance and safety. ACTA ACUST UNITED AC 2015; 35:858-861. [DOI: 10.1007/s11596-015-1518-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 10/29/2015] [Indexed: 10/22/2022]
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22
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Kotsakou M, Kioumis I, Lazaridis G, Pitsiou G, Lampaki S, Papaiwannou A, Karavergou A, Tsakiridis K, Katsikogiannis N, Karapantzos I, Karapantzou C, Baka S, Mpoukovinas I, Karavasilis V, Rapti A, Trakada G, Zissimopoulos A, Zarogoulidis K, Zarogoulidis P. Pacemaker insertion. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:42. [PMID: 25815303 DOI: 10.3978/j.issn.2305-5839.2015.02.06] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 01/28/2015] [Indexed: 01/13/2023]
Abstract
A pacemaker (PM) (or artificial PM, so as not to be confused with the heart's natural PM) is a medical device that uses electrical impulses, delivered by electrodes contracting the heart muscles, to regulate the beating of the heart. The primary purpose of this device is to maintain an adequate heart rate, either because the heart's natural PM is not fast enough, or there is a block in the heart's electrical conduction system. Modern PMs are externally programmable and allow the cardiologist to select the optimum pacing modes for individual patients. Some combine a PM and defibrillator in a single implantable device. PMs can be temporary or permanent. Temporary PMs are used to treat short-term heart problems, such as a slow heartbeat that's caused by a heart attack, heart surgery, or an overdose of medicine. Permanent PMs are used to control long-term heart rhythm problems. A PM can relieve some arrhythmia symptoms, such as fatigue and fainting. A PM also can help a person who has abnormal HRs resume a more active lifestyle. In the current mini review we will focus on the insertion of a PM and the possible pneumothorax that can be caused.
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Affiliation(s)
- Maria Kotsakou
- 1 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 5 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 9 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 10 Pulmonary Laboratory, Alexandra Hospital University, Athens, Greece ; 11 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Ioannis Kioumis
- 1 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 5 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 9 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 10 Pulmonary Laboratory, Alexandra Hospital University, Athens, Greece ; 11 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - George Lazaridis
- 1 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 5 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 9 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 10 Pulmonary Laboratory, Alexandra Hospital University, Athens, Greece ; 11 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Georgia Pitsiou
- 1 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 5 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 9 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 10 Pulmonary Laboratory, Alexandra Hospital University, Athens, Greece ; 11 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Sofia Lampaki
- 1 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 5 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 9 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 10 Pulmonary Laboratory, Alexandra Hospital University, Athens, Greece ; 11 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Antonis Papaiwannou
- 1 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 5 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 9 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 10 Pulmonary Laboratory, Alexandra Hospital University, Athens, Greece ; 11 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Anastasia Karavergou
- 1 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 5 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 9 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 10 Pulmonary Laboratory, Alexandra Hospital University, Athens, Greece ; 11 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Kosmas Tsakiridis
- 1 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 5 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 9 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 10 Pulmonary Laboratory, Alexandra Hospital University, Athens, Greece ; 11 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Nikolaos Katsikogiannis
- 1 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 5 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 9 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 10 Pulmonary Laboratory, Alexandra Hospital University, Athens, Greece ; 11 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Ilias Karapantzos
- 1 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 5 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 9 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 10 Pulmonary Laboratory, Alexandra Hospital University, Athens, Greece ; 11 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Chrysanthi Karapantzou
- 1 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 5 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 9 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 10 Pulmonary Laboratory, Alexandra Hospital University, Athens, Greece ; 11 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Sofia Baka
- 1 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 5 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 9 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 10 Pulmonary Laboratory, Alexandra Hospital University, Athens, Greece ; 11 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Ioannis Mpoukovinas
- 1 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 5 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 9 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 10 Pulmonary Laboratory, Alexandra Hospital University, Athens, Greece ; 11 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Vasilis Karavasilis
- 1 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 5 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 9 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 10 Pulmonary Laboratory, Alexandra Hospital University, Athens, Greece ; 11 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Aggeliki Rapti
- 1 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 5 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 9 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 10 Pulmonary Laboratory, Alexandra Hospital University, Athens, Greece ; 11 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Georgia Trakada
- 1 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 5 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 9 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 10 Pulmonary Laboratory, Alexandra Hospital University, Athens, Greece ; 11 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Athanasios Zissimopoulos
- 1 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 5 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 9 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 10 Pulmonary Laboratory, Alexandra Hospital University, Athens, Greece ; 11 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Konstantinos Zarogoulidis
- 1 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 5 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 9 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 10 Pulmonary Laboratory, Alexandra Hospital University, Athens, Greece ; 11 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Paul Zarogoulidis
- 1 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 5 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 6 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 9 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 10 Pulmonary Laboratory, Alexandra Hospital University, Athens, Greece ; 11 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
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Ferrari ADL, Borges AP, Albuquerque LC, Pelzer Sussenbach C, Rosa PRD, Piantá RM, Wiehe M, Goldani MA. Cardiomyopathy induced by artificial cardiac pacing: myth or reality sustained by evidence? Braz J Cardiovasc Surg 2014; 29:402-13. [PMID: 25372916 PMCID: PMC4412332 DOI: 10.5935/1678-9741.20140104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 08/05/2014] [Indexed: 01/27/2023] Open
Abstract
Implantable cardiac pacing systems are a safe and effective treatment for symptomatic
irreversible bradycardia. Under the proper indications, cardiac pacing might bring
significant clinical benefit. Evidences from literature state that the action of the
artificial pacing system, mainly when the ventricular lead is located at the apex of
the right ventricle, produces negative effects to cardiac structure (remodeling,
dilatation) and function (dissinchrony). Patients with previously compromised left
ventricular function would benefit the least with conventional right ventricle apical
pacing, and are exposed to the risk of developing higher incidence of morbidity and
mortality for heart failure. However, after almost 6 decades of cardiac pacing, just
a reduced portion of patients in general would develop these alterations. In this
context, there are not completely clear some issues related to cardiac pacing and the
development of this cardiomyopathy. Causality relationships among QRS widening with a
left bundle branch block morphology, contractility alterations within the left
ventricle, and certain substrates or clinical (previous systolic dysfunction,
structural heart disease, time from implant) or electrical conditions (QRS duration,
percentage of ventricular stimulation) are still subjecte of debate. This review
analyses contemporary data regarding this new entity, and discusses alternatives of
how to use cardiac pacing in this context, emphasizing cardiac resynchronization
therapy.
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Affiliation(s)
| | - Anibal Pires Borges
- São Lucas Hospital, Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | | | | | | | - Mario Wiehe
- São Lucas Hospital, Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Marco Antônio Goldani
- São Lucas Hospital, Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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Chao TF, Liu CJ, Tuan TC, Liao JN, Lin YJ, Chen TJ, Kong CW, Chen SA. Long-term prognosis of patients older than ninety years after permanent pacemaker implantation: does the procedure save the patients? Can J Cardiol 2014; 30:1196-201. [PMID: 25262861 DOI: 10.1016/j.cjca.2014.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 04/08/2014] [Accepted: 04/09/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The implantation of a permanent pacemaker (PPM) is life-saving for patients with life-threatening bradycardia. However, the effectiveness and prognosis of PPM implantations for extremely old patients (≥ 90 years old) have not been investigated. METHODS From 2001-2012, a total of 108 patients older than 90 years were identified from 2630 consecutive patients receiving PPM implantations in our hospital as the study group. For each study patient, 4 age-, sex-, and comorbidity-matched subjects who did not have the diagnoses of bradyarrhythmias indicated for PPM implantations were selected from the "Taiwan National Health Research Database" to constitute the control group (n = 432). The study end point was all-cause mortality. RESULTS The median age of the study population was 91 (interquartile range, 90-93) years. Among the PPM group, 45 patients died during the follow-up with an annual mortality rate of 18.7%. The risk of mortality did not differ significantly between the study and control groups with a hazard ratio of 1.020 (95% confidence interval, 0.724-1.437; P = 0.912) after the adjustment for age and sex. Procedure-related complications occurred in 7.4% of the patients receiving PPM implants, and pocket hematoma was the most common. The preimplantation history of heart failure and cerebrovascular accident, rather than age, were significant predictors of mortality among PPM recipients. CONCLUSIONS Nonagenarians with severe bradyarrhythmias could retain the same life expectancies as those without bradyarrhythmias through PPM implantations. Extremely old age (≥90 years) should not be a barrier for PPM implants when indications are present.
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Affiliation(s)
- Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Jen Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Public Health and School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Division of Cardiology, Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan.
| | - Jo-Nan Liao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chi-Woon Kong
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Division of Cardiology, Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
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Schulman PM, Rozner MA, Sera V, Stecker EC. Patients with pacemaker or implantable cardioverter-defibrillator. Med Clin North Am 2013; 97:1051-75. [PMID: 24182719 DOI: 10.1016/j.mcna.2013.05.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The preparation of patients with a cardiac implantable electronic device (CIED) for the perioperative period necessitates familiarity with recommendations from the American Society of Anesthesiologists and Heart Rhythm Society. Even clinicians who are not CIED experts should understand the indications for implantation, as well as the basic functions, operations, and limitations of these devices. Before any scheduled procedure, proper CIED function should be verified and a specific CIED prescription obtained. Acquiring the requisite knowledge base and developing the systems to competently manage the CIED patient ensures safe and efficient perioperative care.
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Affiliation(s)
- Peter M Schulman
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Mail Code: UHS-2, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239, USA.
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Nakou E, Simantirakis E, Chrysostomakis S, Vardas P. A case report of hemosiderosis-induced ventricular pacing exit block. Int J Cardiol 2013; 168:4912-4. [DOI: 10.1016/j.ijcard.2013.07.096] [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: 07/04/2013] [Accepted: 07/08/2013] [Indexed: 11/25/2022]
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Schulman PM, Rozner MA. Use Caution When Applying Magnets to Pacemakers or Defibrillators for Surgery. Anesth Analg 2013; 117:422-7. [DOI: 10.1213/ane.0b013e31829003a1] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Hemodynamic changes in left anterior descending coronary artery and anterior interventricular vein during right ventricular apical pacing: a doppler ultrasound study in open chest beagles. PLoS One 2013; 8:e67196. [PMID: 23825640 PMCID: PMC3692435 DOI: 10.1371/journal.pone.0067196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 05/15/2013] [Indexed: 01/09/2023] Open
Abstract
Objective The aim of this study was to quantify the effects of right ventricular apical pacing (RVAP) on hemodynamics in left anterior descending coronary artery (LAD) and anterior interventricular vein (AIV) contrast to baseline condition in open chest beagles using Doppler ultrasound imaging. Methods In 6 anesthetized open chest beagles, the spectral Doppler waveforms of the middle segmental LAD and the AIV were acquired with a 5 MHz linear array transducer at baseline condition and during RVAP. The aortic pressure-time curves were recorded synchronously. The Doppler hemodynamic parameters of the LAD and AIV at both states were derived and compared. Results The spectral Doppler waveforms of the LAD had a principal diastolic positive wave (Dp), which heelled by a momentary negative wave and a positive wave during early systole at baseline condition. During RVAP, an additional negative wave appeared in the LAD at late systole. The duration of the Dp shortened (227.83±12.16 ms vs 188.50±8.97 ms, P<0.001), and the acceleration of the Dp decreased (11.85±2.22 m/s2 vs 3.54±0.42 m/s2, P<0.001). The spectral Doppler waveforms of the AIV only had a principal positive wave (Sp) at baseline condition, but an additional diastolic negative wave appeared during RVAP. The duration of the Sp shortened (242.99±7.98 ms vs 215.38±15.44 ms, P<0.001), and the acceleration of the Sp decreased (9.61±1.93 m/s2 vs 1.01±0.11 m/s2, P<0.001). Conclusions Obvious hemodynamic changes in the LAD and AIV during RVAP were observed, and these abnormal flow patterns in epicardial coronary arteries and vena coronaria may be sensitive and important hints of the disturbed cardiac electrical and mechanical activity sequences.
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Costa PD, Reis AH, Rodrigues PP. Clinical and Economic Impact of Remote Monitoring on the Follow-Up of Patients with Implantable Electronic Cardiovascular Devices: An Observational Study. Telemed J E Health 2013; 19:71-80. [DOI: 10.1089/tmj.2012.0064] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Paulo Dias Costa
- Cardiology Service, Department of Medicine, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - A. Hipólito Reis
- Cardiology Service, Department of Medicine, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Pedro P. Rodrigues
- Department of Health Information and Decision Sciences, University of Porto, Porto, Portugal
- Centre for Research in Health Technologies and Information Systems, Faculty of Medicine, University of Porto, Porto, Portugal
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Trohman RG. Temporary left ventricular resynchronization therapy in cardiogenic shock: A new pacing paradigm to fight an old foe? Heart Rhythm 2013; 10:53-4. [DOI: 10.1016/j.hrthm.2012.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Indexed: 10/27/2022]
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Qintar M, Morad A, Alhawasli H, Shorbaji K, Firwana B, Essali A, Kadro W. Pacing for drug-refractory or drug-intolerant hypertrophic cardiomyopathy. Cochrane Database Syst Rev 2012; 2012:CD008523. [PMID: 22592731 PMCID: PMC8094451 DOI: 10.1002/14651858.cd008523.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is a genetic disease with an autosomal-dominant inheritance for which negative inotropes are the most widely used initial therapies. Observational studies and small randomised trials have suggested symptomatic and functional benefits using pacing and several theories have been put forward to explain why. Pacing, although not the primary treatment for HCM, could be beneficial to patients with relative or absolute contraindications to surgery or alcohol ablation. Several randomised controlled trials comparing pacing to other therapeutic modalities have been conducted but no Cochrane-style systematic review has been done. OBJECTIVES To assess the effects of pacing in drug-refractory or drug-intolerant hypertrophic cardiomyopathy patients. SEARCH METHODS We searched the following on the 14/4/2010: CENTRAL (The Cochrane Library 2010, Issue 1), MEDLINE OVID (from 1950 onwards ), EMBASE OVID (from 1980 onwards ), Web of Science with Conference Proceedings (from 1970 onwards). No language restrictions were applied. SELECTION CRITERIA Randomised controlled trials of either parallel or crossover design that assess the beneficial and harmful effects of pacing for hypertrophic cardiomyopathy were included. When crossover studies were identified, we considered data only from the first phase. DATA COLLECTION AND ANALYSIS Data from included studies were extracted onto a pre-formed data extraction paper by two authors independently. Data was then entered into Review Manager 5.1 for analysis. Risk of bias was assessed using the guidance provided in the Cochrane Handbook. For dichotomous data, relative risk was calculated; and for continuous data, the mean differences were calculated. Where appropriate data were available, meta-analysis was performed. Where meta-analysis was not possible, a narrative synthesis was written. A QUROUM flow chart was provided to show the flow of papers. MAIN RESULTS Five studies (reported in 10 papers) were identified. However, three of the five studies provided un-usable data. Thus the data from only two studies (reported in seven papers) with 105 participants were included for this review. There was insufficient data to compare results on all-cause mortality, cost effectiveness, exercise capacity, Quality of life and Peak O2 consumption.When comparing active pacing versus placebo pacing on exercise capacity, one study showed that exercise time decreased from (13.1 ± 4.4) minutes to (12.6 ± 4.3) minutes in the placebo group and increased from (12.1 ± 5.6) minutes to (12.9 ± 4.2) minutes in the treatment group (MD 0.30; 95% CI -1.54 to 2.14). Statistically significant data from the same study showed that left ventricular outflow tract obstruction decreased from (71 ± 32) mm Hg to (52 ± 34) mm Hg in the placebo group and from (70 ± 24) mm Hg to (33 ± 27) mm Hg in the active pacing group (MD -19.00; 95% CI -32.29 to -5.71). This study was also able to show that New York Heart Association (NYHA) functional class decreased from (2.5 ± 0.5) to (2.2 ± 0.6) in the inactive pacing group and decreased from (2.6 ± 0.5) to (1.7 ± 0.7) in the placebo group (MD -0.50; 95% CI -0.78 to -0.22).When comparing active pacing versus trancoronary ablation of septal hypertrophy (TASH), data from one study showed that NYHA functional class decreased from (3.2 ± 0.7) to (1.5 ± 0.5) in the TASH group and decreased from (3.0 ± 0.1) to (1.9 ± 0.6) in the pacemaker group. This study also showed that LV wall thickness remained unchanged in the active pacing group compared to reduction from (22 ± 4) mm to (17 ± 3) mm in the TASH group (MD 0.60; 95% CI -5.65 to 6.85) and that LV outflow tract obstruction decreased from (80 ± 35.5) mm Hg in the TASH group to (49.3 ± 37.7) mm Hg in the pacemaker group. AUTHORS' CONCLUSIONS Trials published to date lack information on clinically relevant end-points. Existing data is derived from small trials at high risk of bias, which concentrate on physiological measures. Their results are inconclusive. Further large and high quality trials with more appropriate outcomes are warranted.
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Affiliation(s)
- Mohammed Qintar
- Cleveland Clinic, OH, USA, Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic.
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Liu IF, Chang SL, Lo LW, Hu YF, Tuan TC, Kong CW, Wu TJ, Chiang CE, Chen SA, Lin YJ. Relationship between temperature change and the requirement for a permanent pacemaker implantation in bradyarrhythmias. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2011; 55:733-739. [PMID: 21207070 DOI: 10.1007/s00484-010-0388-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Revised: 10/26/2010] [Accepted: 10/29/2010] [Indexed: 05/30/2023]
Abstract
Some cardiovascular diseases are associated with seasonal or meteorological factors. We tried to identify the relationship between meteorological parameters and the requirement for a permanent pacemaker (PPM) implantation for advanced sinus node dysfunction (SND) and atrioventricular block (AVB). This study enrolled 656 patients (67% male, age = 76 ± 11 years) who underwent a PPM implantation due to SND or AVB from January 2004 to December 2008. Using daily temperature, barometric pressure, humidity, and daylight hour records from Taipei, we evaluated the effect of these meteorological parameters within different time periods on the occurrence of SND and AVB. There were 355 patients in the SND group and 301 in the AVB group. In the AVB group, more patients presented in the spring than in other seasons (P = 0.003). In the SND group, there was no relationship with the seasons (P = 0.137). The proportion of patients with AVB did not depend on the average temperature, barometric pressure, humidity, or daylight hours within 3, 7, and 14 days prior to admission (P = NS). A temperature change of greater than 11°C within 30 days prior to admission was associated with a significantly higher proportion of patients with advanced AVB compared to those with advanced SND (P = 0.009). Extreme change in temperature was the most independent predictor of the development of advanced AVB. The peak occurrence of advanced AVB was in the spring. The occurrence of advanced AVB was associated with extreme temperature changes within 30 days, especially in the spring.
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Affiliation(s)
- I-Fan Liu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan
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Jacob S, Panaich SS, Maheshwari R, Haddad JW, Padanilam BJ, John SK. Clinical applications of magnets on cardiac rhythm management devices. Europace 2011; 13:1222-30. [PMID: 21616944 DOI: 10.1093/europace/eur137] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The growing indications for permanent pacemaker and implantable cardioverter defibrillator (ICD) implantation have increased the number of patients with these cardiac rhythm management devices (CRMDs). Cardiac rhythm management devices occasionally perform inappropriately in response to electromagnetic interference (e.g. surgical electrocautery) or lead noise over-sensing (e.g. lead fracture). Temporary reprogramming of the CRMDs using device programmers can prevent these untoward device responses. However, these programmers are device manufacturer specific and require technically qualified personnel to operate. This could cause delayed patient care and increased use of resources in certain clinical situations. Alternatively, clinical magnets, when appropriately positioned over the device site, can change the pacing to an asynchronous mode in pacemakers and suspend tachycardia therapies in ICDs. Although readily available, clinical magnets have not been widely used for this purpose, perhaps due to the unfamiliarity with the variable responses of CRMDs to magnet application. This article provides a comprehensive overview of the current literature on the mechanism of action and the specific responses of various CRMDs to clinical magnets.
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Affiliation(s)
- Sony Jacob
- Division of Cardiology/Electrophysiology, Department of Internal Medicine, Harper University Hospital, Wayne State University, Detroit, MI 48201, USA.
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Costa PD, Rodrigues PP, Reis AH, Costa-Pereira A. A review on remote monitoring technology applied to implantable electronic cardiovascular devices. Telemed J E Health 2010; 16:1042-50. [PMID: 21070132 DOI: 10.1089/tmj.2010.0082] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Implantable electronic cardiovascular devices (IECD) include a broad spectrum of devices that have the ability to maintain rhythm, provide cardiac resynchronization therapy, and/or prevent sudden cardiac death. The incidence of bradyarrhythmias and other cardiac problems led to a broader use of IECD, which turned traditional follow-up into an extremely heavy burden for healthcare systems to support. Our aim was to assess the impact of remote monitoring on the follow-up of patients with IECD. We performed a review through PubMed using a specific query. The paper selection process included a three-step approach in which title, abstract, and cross-references were analyzed. Studies were then selected using previously defined inclusion criteria and analyzed according to the country of origin of the study, year, and journal of publication; type of study; and main issues covered. Twenty articles were included in this review. Eighty percent of the selected papers addressed clinical issues, from which 94% referred clinical events identification, clinical stability, time savings, or physician satisfaction as advantages, whereas 38% referred disadvantages that included both legal and technical issues. Forty-five percent of the papers referred patient issues, from which 89% presented advantages, focusing on patient acceptance/satisfaction, and patient time-savings. The main downsides were technical issues but patient privacy was also addressed. All the papers dealing with economic issues (20%) referred both advantages and disadvantages equally. Remote monitoring is presently a safe technology, widely accepted by patients and physicians, for its convenience, reassurance, and diagnostic potential. This review summarizes the principles of remote IECD monitoring presenting the current state-of-the-art. Patient safety and device interaction, applicability of current technology, and limitations of remote IECD monitoring are also addressed. The use of remote monitor should consider the selection of patients, the type of disease, and centers' availability to receive, interpret and respond to device alerts. Before remote IECD monitoring can be routinely used, technical, procedure, and ethical/legal issues should be addressed.
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Affiliation(s)
- Paulo Dias Costa
- Department of Biostatistics and Medical Informatics-Faculty of Medicine, University of Porto, Porto, Portugal.
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HIV Protease Inhibitors Induced Prolongation of the QT Interval: Electrophysiology and Clinical Implications. Am J Ther 2010; 17:e193-201. [DOI: 10.1097/mjt.0b013e3181ad3437] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tranquillo JV, Badie N, Henriquez CS, Bursac N. Collision-based spiral acceleration in cardiac media: roles of wavefront curvature and excitable gap. Biophys J 2010; 98:1119-28. [PMID: 20371311 DOI: 10.1016/j.bpj.2009.12.4281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Revised: 11/03/2009] [Accepted: 12/01/2009] [Indexed: 11/16/2022] Open
Abstract
We have previously shown in experimental cardiac cell monolayers that rapid point pacing can convert basic functional reentry (single spiral) into a stable multiwave spiral that activates the tissue at an accelerated rate. Here, our goal is to further elucidate the biophysical mechanisms of this rate acceleration without the potential confounding effects of microscopic tissue heterogeneities inherent to experimental preparations. We use computer simulations to show that, similar to experimental observations, single spirals can be converted by point stimuli into stable multiwave spirals. In multiwave spirals, individual waves collide, yielding regions with negative wavefront curvature. When a sufficient excitable gap is present and the negative-curvature regions are close to spiral tips, an electrotonic spread of excitatory currents from these regions propels each colliding spiral to rotate faster than the single spiral, causing an overall rate acceleration. As observed experimentally, the degree of rate acceleration increases with the number of colliding spiral waves. Conversely, if collision sites are far from spiral tips, excitatory currents have no effect on spiral rotation and multiple spirals rotate independently, without rate acceleration. Understanding the mechanisms of spiral rate acceleration may yield new strategies for preventing the transition from monomorphic tachycardia to polymorphic tachycardia and fibrillation.
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Affiliation(s)
- Joseph V Tranquillo
- Biomedical Engineering Department, Bucknell University, Lewisburg, Pennsylvania, USA
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Osman F, Krishnamoorthy S, Nadir A, Mullin P, Morley-Davies A, Creamer J. Safety and cost-effectiveness of same day permanent pacemaker implantation. Am J Cardiol 2010; 106:383-5. [PMID: 20643250 DOI: 10.1016/j.amjcard.2010.03.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 03/17/2010] [Accepted: 03/17/2010] [Indexed: 10/19/2022]
Abstract
An overnight stay after permanent pacemaker implantation has major cost implications for healthcare systems. Same day pacing could be effective in alleviating this. We evaluated our elective same day pacing practice to determine safety and cost-effectiveness. A total of 780 patients were scheduled for elective new permanent pacemaker implantation as a same day procedure at the University Hospital, North Staffordshire, from April 2001 to December 2006. The mean age +/- SEM of the cohort was 73.8 +/- 0.4 years (464 men and 316 women). Single-chamber devices were implanted in 272 (27 atrial and 245 ventricular) and dual chamber in 508 patients. Vascular access was by the subclavian vein in 431 patients and the cephalic vein in 349. Preimplant intravenous antibiotics were administered to 28% and perioperative antibiotics to the remainder; all patients received oral antibiotics after implantation. Of the 780 patients, 41 (5.3%) required an in-hospital stay after implantation because of hematoma formation in 12, pneumothorax in 3, social reasons for 7, observation at the physicians request but no complication for 13, angina in 3, arrhythmia in 1, and warfarin therapy in 2. Immediate complications (<24 hours) occurred in 6 patients and early complications (>24 hours to 6 weeks) developed in 17. Of the 780 patients, 94 had died at mean follow-up of 2.4 +/- 0.1 years; none were related to pacemaker implantation. An overnight stay at our hospital costs pound203.60 ( approximately US$305). From November 2005 to November 2006, 109 patients underwent same day implantation, resulting in a cost saving of pound22,192.40 ( approximately US$34,500). In conclusion, same day permanent pacemaker implantation was feasible, safe, and cost-effective. It was associated with a low prevalence of complications and only a few patients required an overnight stay.
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McLeod CJ, Attenhofer Jost CH, Warnes CA, Hodge D, Hyberger L, Connolly HM, Asirvatham SJ, Dearani JA, Hayes DL, Ammash NM. Epicardial versus endocardial permanent pacing in adults with congenital heart disease. J Interv Card Electrophysiol 2010; 28:235-43. [PMID: 20563634 DOI: 10.1007/s10840-010-9494-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 05/07/2010] [Indexed: 12/01/2022]
Abstract
BACKGROUND Permanent pacing (PM) in patients with congenital heart disease (CHD) presents unique challenges-with little known about the long-term outcomes. METHODS Pacemaker complications and reinterventions were reviewed over a 38-year period and were grouped by epicardial or endocardial approaches. RESULTS The average age at intervention was 37 ± 19 years for 106 patients and 259 PM procedures were performed (2.4 ± 2 per patient). From the first PM procedure, patients were followed for 11.6 ± 14 years. The most common indications for initial PM intervention were heart block (25%) and sinus node dysfunction (20%), yet reintervention was driven primarily by lead failure (49%). Endocardial systems were initially implanted in 73 patients (67%). Epicardial pacing was more common in patients with complex CHD (p = 0.006), cyanosis (p < 0.001), residual shunts (0.01), or Ebstein's anomaly (p = 0.01). Fifty-one devices (28%) developed lead or generator complications. Epicardial systems were most likely to develop lead failure (p < 0.0001), predominantly in the ventricular lead (p < 0.0001). Endocardial systems were found to be more durable than the epicardial systems (p = 0.023), and Ebstein's anomaly or an epicardial system was an independent predictor of lead failure. CONCLUSIONS Permanent pacing in CHD is associated with considerable morbidity and the need for repeat intervention, especially in those with Ebstein's anomaly. Epicardial pacing systems appear to have a higher incidence of lead failure and are significantly less durable in this group.
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Affiliation(s)
- Christopher John McLeod
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Golzio PG, Gabbarini F, Anselmino M, Vinci M, Gaita F, Bongiorni MG. Gram-positive occult bacteremia in patients with pacemaker and mechanical valve prosthesis: a difficult therapeutic challenge. Europace 2010; 12:999-1002. [DOI: 10.1093/europace/euq117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Smithburger PL, Seybert AL, Armahizer MJ, Kane-Gill SL. QT prolongation in the intensive care unit: commonly used medications and the impact of drug–drug interactions. Expert Opin Drug Saf 2010; 9:699-712. [DOI: 10.1517/14740331003739188] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Proclemer A, Ghidina M, Gregori D, Facchin D, Rebellato L, Zakja E, Gulizia M, Esente P. Trend of the main clinical characteristics and pacing modality in patients treated by pacemaker: data from the Italian Pacemaker Registry for the quinquennium 2003-07. Europace 2009; 12:202-9. [DOI: 10.1093/europace/eup346] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
The success of modern neural prostheses is dependent on a complex interplay between the devices' hardware and software and the dynamic environment in which the devices operate: the patient's body or 'wetware'. Over 120 000 severe/profoundly deaf individuals presently receive information enabling auditory awareness and speech perception from cochlear implants. The cochlear implant therefore provides a useful case study for a review of the complex interactions between hardware, software and wetware, and of the important role of the dynamic nature of wetware. In the case of neural prostheses, the most critical component of that wetware is the central nervous system. This paper will examine the evidence of changes in the central auditory system that contribute to changes in performance with a cochlear implant, and discuss how these changes relate to electrophysiological and functional imaging studies in humans. The relationship between the human data and evidence from animals of the remarkable capacity for plastic change of the central auditory system, even into adulthood, will then be examined. Finally, we will discuss the role of brain plasticity in neural prostheses in general.
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Affiliation(s)
- James B Fallon
- Bionic Ear Institute, 384-388 Albert Street, East Melbourne, VIC 3002, Australia.
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Images in radiology. Post-pacemaker pulsations. Am J Med 2009; 122:345-7. [PMID: 19332229 DOI: 10.1016/j.amjmed.2008.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Revised: 10/08/2008] [Accepted: 10/09/2008] [Indexed: 11/21/2022]
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WIENEKE HEINRICH, KONORZA THOMAS, ERBEL RAIMUND, KISKER ERHARD. Leadless Pacing of the Heart Using Induction Technology: A Feasibility Study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:177-83. [DOI: 10.1111/j.1540-8159.2008.02200.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Heart Rhythm and Cardiac Pacing: An Integrated Dual-Chamber Heart and Pacer Model. Ann Biomed Eng 2008; 37:64-81. [DOI: 10.1007/s10439-008-9585-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Accepted: 10/10/2008] [Indexed: 11/27/2022]
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Bruchez P, Sarre A, Kappenberger L, Raddatz E. The L-Type Ca+ and KATP channels may contribute to pacing-induced protection against anoxia-reoxygenation in the embryonic heart model. J Cardiovasc Electrophysiol 2008; 19:1196-202. [PMID: 18554212 DOI: 10.1111/j.1540-8167.2008.01218.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
UNLABELLED L-Type Ca(2+) and K(ATP) Channels in Pacing-Induced Cardioprotection. AIMS The L-type Ca(2+) channel, the sarcolemmal (sarcK(ATP)), and mitochondrial K(ATP) (mitoK(ATP)) channels are involved in myocardial preconditioning. We aimed at determining to what extent these channels can also participate in pacing-induced cardioprotection. METHODS Hearts of 4-day-old chick embryos were paced in ovo during 12 hour using asynchronous intermittent ventricular stimulation at 110% of the intrinsic rate. Sham operated and paced hearts were then submitted in vitro to anoxia (30 minutes) and reoxygenation (60 minutes). These hearts were exposed to L-type Ca(2+) channel agonist Bay-K-8644 (BAY-K) or blocker verapamil, nonselective K(ATP) channel antagonist glibenclamide (GLIB), mitoK(ATP) channel agonist diazoxide (DIAZO), or antagonist 5-hydroxydecanoate. Electrocardiogram, electromechanical delay (EMD) reflecting excitation-contraction (E-C) coupling, and contractility were determined. RESULTS Under normoxia, heart rate, QT duration, conduction, EMD, and ventricular shortening were similar in sham and paced hearts. During reoxygenation, arrhythmias ceased earlier and ventricular EMD recovered faster in paced hearts than in sham hearts. In sham hearts, BAY-K (but not verapamil), DIAZO (but not 5-hydroxydecanoate) or GLIB accelerated recovery of ventricular EMD, reproducing the pacing-induced protection. By contrast, none of these agents further ameliorated recovery of the paced hearts. CONCLUSION The protective effect of chronic asynchronous pacing at near physiological rate on ventricular E-C coupling appears to be associated with subtle activation of L-type Ca(2+) channel, inhibition of sarcK(ATP) channel, and/or opening of mitoK(ATP) channel.
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Affiliation(s)
- Philippe Bruchez
- Department of Physiology, Faculty of Biology and Medicine, University Hospital, Lausanne, Switzerland
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Christiaens L, Ardilouze P, Ragot S, Mergy J, Allal J. Prospective evaluation of the anatomy of the coronary venous system using multidetector row computed tomography. Int J Cardiol 2008; 126:204-8. [PMID: 17493696 DOI: 10.1016/j.ijcard.2007.03.128] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2006] [Revised: 01/23/2007] [Accepted: 03/30/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Multidetector row computed tomography (MDCT) is a developing technique mainly used to evaluate the coronary arteries, but less attention has been paid to the coronary venous system. However, with the dramatic technological advancement of percutaneous therapies for heart failure or mitral insufficiency, a better knowledge about the anatomy of the coronary venous system may be of great utility. We sought the efficacy of MDCT imaging to delineate the coronary venous system. METHODS 16 row MDCT scans were performed in 50 consecutive patients (42 men, age 61+/-15 years, all in sinus rhythm). The inter-individual variability in terms of diameter, distance, angle of the main tributaries of the coronary venous system was reported. RESULTS The coronary venous system was always visualized. A remnant Thebesian valve was observed in 18 patients, the diameter of the coronary sinus ostium was found 12.2+/-3.6 mm and 15.3+/-3.7 mm respectively in the antero-posterior and supero-inferior directions, the distance between the posterior vein of the left ventricle (PVLV) and the anterior interventricular vein (AIV) was found 108.6+/-15.2 mm with a significant correlation with the mitral annulus diameter (p<.002) and the left ventricular diameter (p<0.01). The left marginal vein (LMV) was more often tortuous when the angle between the LMV and the great cardiac vein was less than 60 degrees (p<0.01). CONCLUSION 16 row MDCT imaging can be used to investigate non-invasively the coronary venous anatomy and may serve as a useful tool before percutaneous therapies involving the coronary veins.
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Affiliation(s)
- Luc Christiaens
- Department of Cardiology, University Hospital of Poitiers, France.
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