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Jami O, Oussama EA, Mohammed Z, Soulaymane I, Ilhaam BS, Tijani Y, Aziz E. Device's design and clinical perspectives for resistant hypertension therapy. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2024; 20:200240. [PMID: 38352851 PMCID: PMC10862014 DOI: 10.1016/j.ijcrp.2024.200240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 12/13/2023] [Accepted: 01/19/2024] [Indexed: 02/16/2024]
Abstract
Introduction Hypertension is the leading cause of death in the cardiovascular system. Indeed, untreated hypertension can affect one's general health, but medicine can help hypertensive people reduce their chance of developing high blood pressure. However, secondary hypertension remains an unresolved illness. Areas covered This review will go through the typical and unusual device-based therapies for resistant hypertension that have arisen in recent years. Further to that, the innovations developed in device-based RH treatment will be covered, as well as the research and studies assessing these novel technologies. Expert opinion The innovative device-based techniques that target resistant hypertension provide a potential therapy that has been backed by a number of studies and clinical trials, whereas pharmacological non-adherence and increased sympathetic activity are recognized to be the primary causes of resistant hypertension. Nevertheless, some limitations will be critical for the future of these RH systems, with the device's design and larger RCTs playing a significant role in determining whether a position in routine treatment could be warranted.
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Affiliation(s)
- Oussama Jami
- Mohammed V University in Rabat, High School of Technology in Salé; Materials, Energy and Acoustics Team, Rabat, Morocco
- Mohammed VI University of Health Sciences, Biomedical Engineering Department, Casablanca, Morocco
| | - El Allam Oussama
- National High School of Arts and Crafts of Casablanca, Hassan II University of Casablanca, Morocco
| | - Zaki Mohammed
- Mohammed VI University of Health Sciences, Biomedical Engineering Department, Casablanca, Morocco
| | - Imai Soulaymane
- Mohammed VI University of Health Sciences, Biomedical Engineering Department, Casablanca, Morocco
| | - Ben Sahi Ilhaam
- Mohammed VI University of Health Sciences, Faculty of Medicine, Casablanca, Morocco
| | - Youssef Tijani
- Mohammed VI University of Health Sciences, Faculty of Medicine, Casablanca, Morocco
| | - Ettahir Aziz
- Mohammed V University in Rabat, High School of Technology in Salé; Materials, Energy and Acoustics Team, Rabat, Morocco
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Abstract
In the past decade, efforts to improve blood pressure control have looked beyond conventional approaches of lifestyle modification and drug therapy to embrace interventional therapies. Based upon animal and human studies clearly demonstrating a key role for the sympathetic nervous system in the etiology of hypertension, the newer technologies that have emerged are predominantly aimed at neuromodulation of peripheral nervous system targets. These include renal denervation, baroreflex activation therapy, endovascular baroreflex amplification therapy, carotid body ablation, and pacemaker-mediated programmable hypertension control. Of these, renal denervation is the most mature, and with a recent series of proof-of-concept trials demonstrating the safety and efficacy of radiofrequency and more recently ultrasound-based renal denervation, this technology is poised to become available as a viable treatment option for hypertension in the foreseeable future. With regard to baroreflex activation therapy, endovascular baroreflex amplification, carotid body ablation, and programmable hypertension control, these are developing technologies for which more human data are required. Importantly, central nervous system control of the circulation remains a poorly understood yet vital component of the hypertension pathway and mandates further investigation. Technology to improve blood pressure control through deep brain stimulation of key cardiovascular control territories is, therefore, of interest. Furthermore, alternative nonsympathomodulatory intervention targeting the hemodynamics of the circulation may also be worth exploring for patients in whom sympathetic drive is less relevant to hypertension perpetuation. Herein, we review the aforementioned technologies with an emphasis on the preclinical data that underpin their rationale and the human evidence that supports their use.
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Affiliation(s)
- Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany (F.M.)
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology (MIT), Cambridge, MA (F.M.)
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Unit, The University of Western Australia, Australia (M.S.)
- Departments of Cardiology (M.S.), Royal Perth Hospital, Australia
- Nephrology (M.S.), Royal Perth Hospital, Australia
- Neurovascular Hypertension and Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia (M.S.)
| | - Melvin D Lobo
- William Harvey Research Institute and Barts NIHR Cardiovascular Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.D.L.)
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (M.D.L.)
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Neuzil P, Merkely B, Erglis A, Marinskis G, de Groot JR, Schmidinger H, Rodriguez Venegas M, Voskuil M, Sturmberger T, Petru J, Jongejan N, Aichinger J, Kamzola G, Aidietis A, Gellér L, Mraz T, Osztheimer I, Mika Y, Evans S, Burkhoff D, Kuck KH. Pacemaker-Mediated Programmable Hypertension Control Therapy. J Am Heart Assoc 2017; 6:JAHA.117.006974. [PMID: 29275370 PMCID: PMC5779015 DOI: 10.1161/jaha.117.006974] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Many patients requiring a pacemaker have persistent hypertension with systolic blood pressures above recommended levels. We evaluated a pacemaker‐based Programmable Hypertension Control (PHC) therapy that uses a sequence of variably timed shorter and longer atrioventricular intervals. Methods and Results Patients indicated for dual‐chamber pacing with office systolic blood pressure (oSBP) >150 mm Hg despite stable medical therapy were implanted with a Moderato™ pulse generator that delivers PHC therapy. Patients were followed for 1 month (Run‐In period) with conventional pacing; those with persistent oSBP >140 mm Hg were included in the study and had PHC therapy activated. The co‐primary efficacy end points were changes in 24‐hour ambulatory systolic blood pressure and oSBP between baseline and 3 months. Safety was assessed by tracking adverse events. Thirty‐five patients met the initial inclusion criteria and underwent Moderato implantation. At 1 month, oSBP was <140 mm Hg in 7 patients who were excluded. PHC was activated in the remaining 27 patients with baseline office blood pressure 166±11/80±10 mm Hg despite an average of 3.2 antihypertensive medications. During the Run‐In period, oSBP and 24‐hour ambulatory systolic blood pressure decreased by 8±13 and 5±12 mm Hg (P<0.002), respectively. Compared with pre‐PHC activation measurements, oSBP decreased by another 16±15 mm Hg and 24‐hour ambulatory systolic blood pressure decreased by an additional 10±13 mm Hg (both P<0.01) at 3 months. No device‐related serious adverse effects were noted. Conclusions In pacemaker patients with persistent hypertension despite medical therapy, oSBP and 24‐hour ambulatory systolic blood pressure are decreased by PHC therapy. Initial indications are that this therapy is a safe and promising therapy for such patients. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02282033.
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Affiliation(s)
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University Budapest, Budapest, Hungary
| | - Andrejs Erglis
- Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | | | - Joris R de Groot
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Herwig Schmidinger
- Abteilung für Kardiologie, AKH - Universitätsklinik für Innere Medizin II, Vienna, Austria.,Sigmund Freud Private University of Vienna, Austria
| | | | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thomas Sturmberger
- Interne 2 - Kardiologie, Angiologie & Interne Intensivmedizin, Krankenhaus der Elisabethinen Linz GmbH, Linz, Austria
| | - Jan Petru
- Na Homolce Hospital, Prague, Czech Republic
| | - Niels Jongejan
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Josef Aichinger
- Interne 2 - Kardiologie, Angiologie & Interne Intensivmedizin, Krankenhaus der Elisabethinen Linz GmbH, Linz, Austria
| | - Ginta Kamzola
- Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Audrius Aidietis
- Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania
| | - Laszlo Gellér
- Heart and Vascular Center, Semmelweis University Budapest, Budapest, Hungary
| | - Tomas Mraz
- Na Homolce Hospital, Prague, Czech Republic
| | - Istvan Osztheimer
- Heart and Vascular Center, Semmelweis University Budapest, Budapest, Hungary
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Krychtiuk KA, Nürnberg M, Volker R, Pachinger L, Jarai R, Freynhofer MK, Wojta J, Huber K, Weiss TW. Effects of AV-delay optimization on hemodynamic parameters in patients with VDD pacemakers. Wien Klin Wochenschr 2014; 126:270-7. [PMID: 24652015 DOI: 10.1007/s00508-014-0520-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 02/04/2014] [Indexed: 02/05/2023]
Abstract
AIM Atrioventricular (AV) delay optimization improves hemodynamics and clinical parameters in patients treated with cardiac resynchronization therapy and dual-chamber-pacemakers (PM). However, data on optimizing AV delay in patients treated with VDD-PMs are scarce. We, therefore, investigated the acute and chronic effects of AV delay optimization on hemodynamics in patients treated with VDD-PMs due to AV-conduction disturbances. METHODS In this prospective, single-center interventional trial, we included 64 patients (38 men, 26 women, median age: 77 (70-82) years) with implanted VDD-PM. AV-delay optimization was performed using a formula based on the surface electrocardiogram (ECG). Hemodynamic parameters (stroke volume (SV), cardiac output (CO), heart rate (HR), and blood pressure (BP)) were measured at baseline and follow-up after 3 months using impedance cardiography. RESULTS Using an ECG formula for AV-delay optimization, the AV interval was decreased from 180 (180-180) to 75 (75-100) ms. At baseline, AV-delay optimization led to a significant increase of both SV (71.3 ± 15.8 vs. 55.3 ± 12.7 ml, p < 0.001, for optimized AV delay vs. nominal AV interval, respectively) and CO (5.1 ± 1.4 vs. 3.9 ± 1.0 l/min, p < 0.001), while HR and BP remained unchanged. At follow-up, the improvement in CO remained stable (4.9 ± 1.3 l/min, p = 0.09), while SV slightly, but significantly, decreased (to 65.1 ± 17.6, p < 0.01). CONCLUSION AV-delay optimization in patients treated with VDD-PMs exhibits immediate beneficial effects on hemodynamic parameters that are sustained for 3 months.
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Affiliation(s)
- Konstantin A Krychtiuk
- Department of Internal Medicine II-Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria,
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The effect of right ventricular pacing on myocardial oxidative metabolism and efficiency: relation with left ventricular dyssynchrony. Eur J Nucl Med Mol Imaging 2009; 36:2042-8. [DOI: 10.1007/s00259-009-1200-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Accepted: 06/03/2009] [Indexed: 10/20/2022]
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Diaconescu D, Eyvazzadeh JA, Alston TA. A couple of long intervals in intraoperative cardiac pacing. J Cardiothorac Vasc Anesth 2006; 20:117-8. [PMID: 16458231 DOI: 10.1053/j.jvca.2005.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2005] [Indexed: 11/11/2022]
Affiliation(s)
- Dragos Diaconescu
- Cardiac Anesthesia Group, Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Bourke JP. Atrioventricular block and problems with atrioventricular conduction. Clin Geriatr Med 2002; 18:229-51. [PMID: 12180245 DOI: 10.1016/s0749-0690(02)00007-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This chapter has summarized briefly the current state of our knowledge on the incidence, etiology, presentation, investigation, and management of patients with AV block. The scope of the material covered has been widened intentionally to include a plethora of AV-conduction abnormalities because of the increases in the understanding of their clinical importance and contribution to left ventricular dysfunction. Under this heading, the critical importance of heart rate, maintenance of AV synchrony, and the sequence of ventricular activation and relaxation have been introduced and summarized briefly. The authors make a strong plea that, in the future, the reader consider AV-conduction abnormalities to be the parent topic, with the more-traditional, narrower subject of AV block forming a subunit thereof.
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Affiliation(s)
- John P Bourke
- Department of Cardiology, University of Newcastle upon Type, Freeman Hospital, Freeman Road, Newcastle upon Tyne, UK.
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Kleine P, Doss M, Aybek T, Wimmer-Greinecker G, Moritz A. Biventricular pacing for weaning from extracorporeal circulation in heart failure. Ann Thorac Surg 2002; 73:960-2. [PMID: 11899211 DOI: 10.1016/s0003-4975(01)03118-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Resynchronization of the intra- and interventricular conduction by biventricular pacing has been suggested in patients with end-stage heart failure. We present a case in which extracorporeal circulation could only be weaned after placement of an additional left ventricular pacing wire. Biventricular stimulation led to normal motion of the anterior wall and a previously bulging interventricular septum; this improved the hemodynamic situation significantly.
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Affiliation(s)
- Peter Kleine
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.
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Breithardt OA, Stellbrink C, Franke A, Balta O, Diem BH, Bakker P, Sack S, Auricchio A, Pochet T, Salo R. Acute effects of cardiac resynchronization therapy on left ventricular Doppler indices in patients with congestive heart failure. Am Heart J 2002; 143:34-44. [PMID: 11773910 DOI: 10.1067/mhj.2002.119616] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patients with heart failure frequently exhibit intraventricular conduction delays, which contribute to asynchronous contraction patterns and impaired hemodynamic performance. Cardiac resynchronization therapy (CRT) with biventricular (BV) and left ventricular (LV) pacing has been shown to improve both hemodynamic and clinical performance. This study investigated the effects of CRT on LV Doppler indices in these patients. METHODS AND RESULTS Thirty-two patients with advanced heart failure (New York Heart Association class > or =III, QRS >120 milliseconds, PR interval >150 milliseconds) were studied 4 weeks after implantation of a CRT system. Doppler echocardiography was conducted in 3 separate CRT modes, right ventricular, LV, and BV stimulation at 3 different atrioventricular delays. CRT resulted in significant improvement of Doppler parameters such as filling time (FT, 313 +/- 111 milliseconds at baseline --> 363 +/- 154 milliseconds [BV], P <.05), aortic velocity time integral (AO(VTI) 23.2 +/- 7.4 cm at baseline --> 26.8 +/- 8.8 cm [LV], P <.05), and the myocardial performance index (MPI, 1.21 +/- 0.51 at baseline --> 0.85 +/- 0.34 [BV], P <.05). The most improvement was observed with LV and BV stimulation at short and intermediate atrioventricular delays (80-120 milliseconds), independent of ischemic or idiopathic origin. CONCLUSIONS CRT improves hemodynamic performance in patients with heart failure with intraventricular conduction delays. Doppler echocardiography allows noninvasive evaluation of acute CRT effects in patients with heart failure. In particular, FT, AO(VTI), and MPI are useful parameters for noninvasive follow-up and optimization of pacing parameters.
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MESH Headings
- Analysis of Variance
- Atrioventricular Node/physiopathology
- Cardiac Pacing, Artificial/methods
- Cardiomyopathy, Dilated/complications
- Cardiomyopathy, Dilated/diagnostic imaging
- Cross-Over Studies
- Echocardiography, Doppler
- Female
- Heart Failure/diagnostic imaging
- Heart Failure/physiopathology
- Heart Failure/therapy
- Humans
- Male
- Middle Aged
- Myocardial Contraction/physiology
- Pacemaker, Artificial
- Single-Blind Method
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Left/therapy
- Ventricular Dysfunction, Right/diagnostic imaging
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Dysfunction, Right/therapy
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Affiliation(s)
- Ole-A Breithardt
- Department of Cardiology, RWTH University of Technology, Aachen, Germany
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Liebold A, Rödig G, Birnbaum DE. Performance of temporary epicardial stainless steel wire electrodes used to treat atrial fibrillation: a study in patients following open heart surgery. Pacing Clin Electrophysiol 1999; 22:315-9. [PMID: 10087546 DOI: 10.1111/j.1540-8159.1999.tb00444.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AF is the most common arrhythmia following open heart surgery. Transthoracic cardioversion is used when pharmacological treatment fails to restore SR, or is ineffective in controlling ventricular response rate. We report on the performance of temporary atrial defibrillation wire electrodes implanted on the epicardium of patients undergoing open heart surgery. Epicardial stainless steel wire electrodes for both pacing/sensing and atrial defibrillation were placed at the left and right atrium during open heart surgery in 100 consecutive patients (age 65 +/- 9 years; male/female 77/23). Electrophysiological studies performed postoperatively revealed a test shock (0.3 J) impedance of 96 +/- 12 omega (monophasic) and 97 +/- 13 omega (biphasic). AF was induced by burst stimulation in 84 patients. All patients were successfully converted to SR. The mean energy of successful shocks was 3.1 +/- 1.9 J. Atrial pacing and sensing were accomplished in all patients. Pacing threshold was 1.9 +/- 1.7 V (0.5 ms) in the left atrium and 2.1 +/- 2 V in the right atrium. P wave sensing was 2.5 +/- 1.6 mV in the left atrium and 2.3 +/- 1.4 mV in the right atrium. No complications were observed with shock application, nor with lead extraction. Atrial defibrillation using temporary epicardial wire electrodes can be performed successfully and safely in patients following cardiac operations. The shock energy required to restore SR is low. Electrical cardioversion in the absence of anesthesia should be feasible.
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Affiliation(s)
- A Liebold
- Department of Cardiothoracic Surgery, University of Regensburg, Germany.
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