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Papasteriadis E, Margos NP. The world's longest lasting VVI pacemaker device for over 40 years. J Cardiovasc Electrophysiol 2024. [PMID: 38736203 DOI: 10.1111/jce.16305] [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: 12/14/2023] [Revised: 04/24/2024] [Accepted: 05/02/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION Implantable permanent pacemaker function is supported by their energy sources for a mean period of 8.8-12.4 years. We previously published this case of a patient with a normally functioning VVI pacemaker, 31 years after implantation. METHODS AND RESULTS In this report, we state that the device is still functioning normally 40 years after implantation. The most recent device interrogation revealed pacing threshold of 0.9 V/0.5 ms. Holter monitoring for 24 hours recorded a total of 98.707 beats with 97.78% paced beats, without any indication of pacemaker malfunction and with stable heart rate at 70-71 bpm. CONCLUSION Most patients with implantable devices have the appropriate follow-up and settings of low energy consumption. Manufacturing companies should focus on prolonging device longevity, to produce future devices with higher energy capacity.
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Mainwaring E, Patel R, Desai C, Acharya R, Raveshia D, Shah S, Panesar H, Patel N, Singh R. Five historical innovations that have shaped modern cardiothoracic surgery. J Perioper Pract 2023:17504589231212967. [PMID: 38149619 DOI: 10.1177/17504589231212967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Throughout history, many innovations have contributed to the development of modern cardiothoracic surgery, improving patient outcomes and expanding the range of treatment options available to patients. This article explores five key historical innovations that have shaped modern cardiothoracic surgery: cardiopulmonary bypass, surgical pacemakers, video assisted thoracic surgery, robotic surgery and mechanical circulatory support. We will review the development, impact and significance of each innovation, highlighting their contributions to the field of cardiothoracic surgery and their ongoing relevance in contemporary and perioperative practice.
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Affiliation(s)
- Elizabeth Mainwaring
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Addenbrooke's Hospital, Cambridge, UK
| | - Ravi Patel
- Department of Trauma and Orthopaedics, Shrewsbury and Telford Trust, The Princess Royal Hospital, Telford, UK
- Department of Trauma and Orthopaedics, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Chaitya Desai
- Department of Urology, Walsall Manor Hospital, Walsall Healthcare NHS Trust, Walsall, UK
| | - Radhika Acharya
- Department of Intensive Care, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Dimit Raveshia
- Department of General Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Saumil Shah
- Department of Otolaryngology, The Princess Royal Hospital, Telford, UK
| | - Harrypal Panesar
- Department of Otolaryngology, The Princess Royal Hospital, Telford, UK
| | | | - Rohit Singh
- Department of Trauma and Orthopaedics, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
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3
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Seeger W. [Sixty-five years of pacemaker therapy]. Herzschrittmacherther Elektrophysiol 2023; 34:229-231. [PMID: 37523009 DOI: 10.1007/s00399-023-00958-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 08/01/2023]
Abstract
Sixty-five years ago, the first pacemakers were implanted. Swedish developments paved the way for implantation of the first epicardial pacemaker with a rechargeable battery unit; however, there was a battery defect within 3 h. Further developments in the USA allowed for the first transvenous, endocardial lead to be implanted with an external pacemaker battery. Following these pioneering implantations, further improvements of the battery and electrical elements and also of lead technology (flexibility and fixation mechanism) allowed the implantation of pacemaker systems similar to those we still implant today.
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Ploneda Valencia RG, Levinstein Jacinto M, Sánchez Contreras CA, Ruiz González G, Neach de la Vega D, Márquez Murillo MF, Nava S. Case report: Challenges and implications of conduction system pacing in pediatrics: Case series. Front Pediatr 2023; 11:1160335. [PMID: 37215597 PMCID: PMC10192706 DOI: 10.3389/fped.2023.1160335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/10/2023] [Indexed: 05/24/2023] Open
Abstract
Cardiac electrical stimulation in children usually is needed in the setting of complete congenital atrioventricular block, atrioventricular block after heart surgery, and bradycardia associated with some specific channelopathies. In cases of atrioventricular block, the high percentage of ventricular stimulation raises concern on the deleterious effects of chronic stimulation of the right ventricle. In recent years, physiologic stimulation has developed as a valid approach for adult patients and a great interest has risen in offering conduction system pacing also to the pediatric population. We present three pediatric cases of stimulation of the conduction system (His bundle or left bundle branch), in order to show the intrinsic particularities and challenges implied in these new techniques.
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5
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Jafry AH, Raza SM, Bajwa A, Hassan A, Akhtar KH, Salat H, Abdo T. Pulmonary hemorrhage after cardiac resynchronization therapy device implantation - A systematic review. Am J Med Sci 2022; 364:796-802. [PMID: 35798057 DOI: 10.1016/j.amjms.2022.06.018] [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: 08/10/2021] [Revised: 03/09/2022] [Accepted: 06/28/2022] [Indexed: 01/25/2023]
Abstract
Cardiac implantable electronic devices are being increasingly used for a variety of cardiovascular diseases. We describe a rare case of massive hemoptysis after device implantation. The patient was managed conservatively with reversal of anticoagulation and inhaled tranexamic acid and had a successful recovery. A systematic review accompanies the case presentation. The modality and difficulty of access appear to play a significant role in precipitating bleeding, believed to be the result of direct injury to the pulmonary parenchyma and vasculature. The condition is often self-limiting; however, anticoagulation reversal, intubation, endobronchial intervention, and transarterial embolization may be indicated in more severe pulmonary hemorrhage.
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Affiliation(s)
- Ali Haider Jafry
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
| | - Syeda Maheen Raza
- Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | - Awais Bajwa
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Ahmad Hassan
- Department of Medicine-Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Khawaja Hassan Akhtar
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Huzaifah Salat
- Department of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, University of Oklahoma Health Sciences Center and Oklahoma City VA Health Care System, Oklahoma City Oklahoma, USA
| | - Tony Abdo
- Department of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, University of Oklahoma Health Sciences Center and Oklahoma City VA Health Care System, Oklahoma City Oklahoma, USA
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6
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Proietti M, Romiti GF, Vitolo M, Borgi M, Rocco AD, Farcomeni A, Miyazawa K, Healey JS, Lane DA, Boriani G, Basili S, Lip GYH. Epidemiology of subclinical atrial fibrillation in patients with cardiac implantable electronic devices: A systematic review and meta-regression. Eur J Intern Med 2022; 103:84-94. [PMID: 35817660 DOI: 10.1016/j.ejim.2022.06.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/07/2022] [Accepted: 06/30/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND In recent years, attention to subclinical atrial fibrillation (SCAF), defined as the presence of atrial high-rate episodes (AHREs), in patients with cardiac implantable electronic devices (CIEDs), has gained much interest as a determinant of clinical AF and stroke risk. We aim to perform a systematic review and meta-regression of the available scientific evidence regarding the epidemiology of SCAF in patients receiving CIEDs. METHODS PubMed and EMBASE were searched for all studies documenting the prevalence of AHREs in patients (n=100 or more, <50% with history of AF) with CIEDs from inception to 20th August 2021, screened by two independent blind reviewers. This study was registered in PROSPERO: CRD42019106994. RESULTS Among the 2614 results initially retrieved, 54 studies were included, with a total of 72,784 patients. Meta-analysis of included studies showed a pooled prevalence of SCAF of 28.1% (95%CI: 24.3-32.1%), with high heterogeneity between studies (I2=98%). A multivariable meta-regression was able to explain significant proportion of heterogeneity (R2=61.9%, p<0.001), with age and follow-up time non-linearly, directly and independently associated with occurrence of SCAF. Older age, higher CHA2DS2-VASc score, history of AF, hypertension, CHF, and stroke/TIA were all associated with SCAF occurrence. CONCLUSIONS In this systematic review and meta-regression analysis, SCAF was frequent among CIED recipients and was non-linearly associated with age and follow-up time. Older age, higher thromboembolic risk, and several cardiovascular comorbidities were associated with presence of SCAF.
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Affiliation(s)
- Marco Proietti
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Giulio Francesco Romiti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Translational and Precision Medicine, Sapienza-University of Rome, Rome, Italy
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy; Clinical and Experimental PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Borgi
- Department of Clinical and Experimental Medicine, Policlinic "G Martino," University of Messina, Messina, Italy
| | - Arianna Di Rocco
- Department of Public Health and Infectious Diseases, Sapienza-University of Rome, Rome, Italy
| | - Alessio Farcomeni
- Department of Economics and Finance, University of Rome "Tor Vergata", Rome, Italy
| | - Kazuo Miyazawa
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Jeff S Healey
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada; Division of Cardiology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Stefania Basili
- Department of Translational and Precision Medicine, Sapienza-University of Rome, Rome, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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7
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ZHENG CL, ZHAO L, CHEN Y, XU ZM, LIU L, WANG LL, LIU YM. The feasibility of leadless pacemaker implantation in nonagenarians: case report and literature review. J Geriatr Cardiol 2022; 19:626-630. [PMID: 36339472 PMCID: PMC9629999 DOI: 10.11909/j.issn.1671-5411.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Affiliation(s)
- Chun-Ling ZHENG
- Department of Cardiology, the Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Li ZHAO
- Department of Cardiology, the Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yu CHEN
- Department of Cardiology, the Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zheng-Ming XU
- Department of Cardiology, the Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ling LIU
- Department of Cardiology, the Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Li-Li WANG
- Department of Cardiology, the Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ying-Ming LIU
- Department of Cardiology, the Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
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8
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Gelves-Meza J, Lang RM, Valderrama-Achury MD, Zamorano JL, Vargas-Acevedo C, Medina HM, Salazar G. Tricuspid Regurgitation Related to Cardiac Implantable Electronic Devices: An Integrative Review. J Am Soc Echocardiogr 2022; 35:1107-1122. [PMID: 35964911 DOI: 10.1016/j.echo.2022.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 10/15/2022]
Abstract
The use of cardiac implantable electronic devices, including permanent pacemakers, implantable cardiac defibrillators and cardiac resynchronization therapy, has dramatically increased in recent years. The interaction between the device lead and tricuspid valve leaflets is a potential cause of tricuspid regurgitation which in turn has an impact on morbidity and mortality. Echocardiography is necessary for grading of tricuspid regurgitation severity. The use of three-dimensional imaging helps determine whether the device lead is interfering with normal leaflet coaptation. Early identification of lead-related tricuspid regurgitation is critical to select the optimal treatment, which may include lead extraction or even tricuspid valve repair/replacement in severe cases. This review aims to provide a thorough assessment of the evidence about lead-associated tricuspid regurgitation, the benefits of using 3D echocardiography with some technical considerations, and finally, propose a treatment algorithm.
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Affiliation(s)
- Julián Gelves-Meza
- Cardiologist, Echocardiography Laboratory, Fundación Cardioinfantil - Instituto de Cardiología. Universidad del Rosario, Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia.
| | - Roberto M Lang
- Section of Cardiology, Department of Medicine, Cardiac Imaging Center, the University of Chicago Medicine, Chicago, Illinois, USA
| | | | | | - Catalina Vargas-Acevedo
- Pediatrician, Research Assistant, Institute of Congenital Heart Disease. Fundación Cardioinfantil - Instituto de Cardiología. Bogotá, Colombia
| | - Hector Manuel Medina
- Cardiologist, Section Head, Cardiac Imaging. Fundación Cardioinfantil - Instituto de Cardiología. Bogotá, Colombia
| | - Gabriel Salazar
- Cardiologist, Section Head, Echocardiography Laboratory. Fundación Cardioinfantil - Instituto de Cardiología. Bogotá, Colombia
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9
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Gill J. Emerging Technologies in Electrophysiology: From Single Chamber to Biventricular Leadless Pacemakers. Cardiology 2022; 147:179-190. [PMID: 35038698 DOI: 10.1159/000521976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 12/31/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Transvenous pacemakers have been shown to improve quality of life and mortality in patients with bradycardia and cardiac conduction blocks. However, they possess inevitable drawbacks as they have a relatively high incidence of lead and device pocket-related complications. Therefore, leadless pacemakers have emerged as a solution to reduce the complications seen with conventional pacemakers. However, there have been no clinical trials to date comparing transvenous to leadless pacemakers. SUMMARY Currently, the Micra TPS or AV device has been approved for commercial use worldwide but is limited to single-chamber pacing with single or dual-chamber sensing. Although the leadless pacemaker, Nanostim, was initially promising, it has been recalled due to concerns of battery failures and is no longer approved in Europe. In addition, the lack of defibrillation capabilities with leadless pacemakers has been a limiting factor; therefore, a leadless pacemaker with the already approved subcutaneous cardioverter-defibrillator system is currently being studied in humans. Moreover, the WiSE-CRT device has been approved in Europe, with the capabilities for leadless cardiac resynchronization therapy (CRT), to provide CRT for patients with unsuitable coronary sinus anatomy. Furthermore, retrieval of leadless pacemakers has been an area of concern; however, clinic data has signaled towards safe extraction of these devices with minimal complications. Key messages: This review will encompass the current literature regarding clinical safety and outcomes of these novel leadless pacemakers and discuss the evolving technologies in the field of cardiac pacing.
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Affiliation(s)
- Jashan Gill
- Department of Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
- Department of Medicine, Northwestern Medicine McHenry Hospital, McHenry, Illinois, USA
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10
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Lappegård KT, Moe F. Remote Monitoring of CIEDs-For Both Safety, Economy and Convenience? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010312. [PMID: 35010572 PMCID: PMC8751026 DOI: 10.3390/ijerph19010312] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/17/2021] [Accepted: 12/25/2021] [Indexed: 05/17/2023]
Abstract
Cardiac implantable electronic devices such as pacemakers and defibrillators are increasingly monitored by systems transmitting information directly from the patient to the hospital. This may increase safety and patient satisfaction and also under certain circumstances represent an economic advantage. The review summarizes some of the recent research in the field of remote monitoring of cardiac devices.
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Affiliation(s)
- Knut Tore Lappegård
- Department of Medicine, Nordland Hospital, N-8092 Bodo, Norway;
- Department of Clinical Medicine, UiT The Arctic University of Norway, N-9037 Tromso, Norway
- Correspondence:
| | - Frode Moe
- Department of Medicine, Nordland Hospital, N-8092 Bodo, Norway;
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Brad Meers J, Snyder SW, Hasan R, Zheng Y, Davies J, Zaky A. Hemodynamic Instability Resulting From Pseudomalfunction of a Leadless Pacemaker During Off-Pump Coronary Artery Bypass Grafting. J Cardiothorac Vasc Anesth 2021; 36:2588-2592. [PMID: 34895966 DOI: 10.1053/j.jvca.2021.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/19/2021] [Accepted: 10/26/2021] [Indexed: 11/11/2022]
Affiliation(s)
- J Brad Meers
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL.
| | - Scott W Snyder
- Center of Educational Accountability, School of Education, University of Alabama at Birmingham, Birmingham, AL
| | - Ragib Hasan
- Department of Computer Science, University of Alabama at Birmingham, Birmingham, AL
| | - Yuliang Zheng
- Department of Computer Science, University of Alabama at Birmingham, Birmingham, AL
| | - James Davies
- Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Ahmed Zaky
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
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12
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Doldi F, Biller B, Reinke F, Eckardt L. [New developments in leadless pacing systems]. Herz 2021; 46:513-519. [PMID: 34686910 DOI: 10.1007/s00059-021-05075-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 11/29/2022]
Abstract
Leadless pacing systems, especially the Micra™ TPS system, deliver an effective and safe alternative to the previous conventional transvenous systems in patients with impossible transvenous access and seem to be compatible with other implantable devices (S-ICD, deep brain stimulators) with no limitations in efficacy or safety. Also, new outlooks on leadless resynchronization therapy seem promising and could prevent future patients from lead- or operation-associated complications. Current limits to the implementation in everyday clinical practice are mostly the unavailability of the devices or cost issues through lack of health insurance reimbursement. However, more promising data through further studies and rising implantation rates are expected based on the positive current clinical data.
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Affiliation(s)
- Florian Doldi
- Klinik für Kardiologie II - Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149, Münster, Deutschland.
| | - Benedikt Biller
- Klinik für Kardiologie II - Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149, Münster, Deutschland
| | - Florian Reinke
- Klinik für Kardiologie II - Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149, Münster, Deutschland
| | - Lars Eckardt
- Klinik für Kardiologie II - Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149, Münster, Deutschland
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13
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Huang Y, Dearani JA, Saran N, Stulak JM, Greason KL, Crestanello JA, Daly RC, Pochettino A, Lahr BD, Lin G, Schaff HV. Outcomes and Echocardiographic Follow-up After Surgical Management of Tricuspid Regurgitation in Patients With Transvenous Right Ventricular Leads. Mayo Clin Proc 2021; 96:2133-2144. [PMID: 34226024 DOI: 10.1016/j.mayocp.2020.11.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/21/2020] [Accepted: 11/25/2020] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate outcomes of elective surgical management of tricuspid regurgitation (TR) in patients with transvenous right ventricular leads, and compare results between non-lead-induced and lead-induced TR patients. PATIENTS AND METHODS We studied patients with right ventricular leads who underwent tricuspid valve surgery from January 1, 1993, through December 31, 2015, and categorized them as non-lead-induced and lead-induced TR. Propensity score (PS) for the tendency to have lead-induced TR was estimated from logistic regression and was used to adjust for group differences. RESULTS From the initial cohort of 470 patients, 444 were included in PS-adjustment analyses (174 non-lead-induced TRs [123 repairs, 51 replacements], 270 lead-induced TRs [129 repairs, 141 replacements]). In PS-adjusted multivariable analysis, lead-induced TR was not associated with mortality (P=.73), but tricuspid valve replacement was (hazard ratio, 1.59; 95% CI, 1.13 to 2.25; P=.008). Five-year freedom from tricuspid valve re-intervention was 100% for non-lead-induced TR and 92.3% for lead-induced TR; rates adjusted for PS differed between groups (P=.005). There was significant improvement in TR postoperatively in each group (P<.001). In patients having tricuspid valve repair, TR grades tended to worsen over time, but the difference in trends was not significantly different between groups. CONCLUSION Lead-induced TR did not affect long-term survival after elective tricuspid valve surgery. In patients with lead-induced TR, tricuspid valve re-intervention was more common. Improvement in TR was achieved in both groups after surgery; however, severity of TR tended to increase over follow-up after tricuspid valve repair.
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Affiliation(s)
- Ying Huang
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN.
| | - Nishant Saran
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | | | - Richard C Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | | | - Brian D Lahr
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Grace Lin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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14
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Zhang Y, Gao X, Wu Y, Gui J, Guo S, Zheng H, Wang ZL. Self-powered technology based on nanogenerators for biomedical applications. EXPLORATION (BEIJING, CHINA) 2021; 1:90-114. [PMID: 37366464 PMCID: PMC10291576 DOI: 10.1002/exp.20210152] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/09/2021] [Indexed: 06/28/2023]
Abstract
Biomedical electronic devices have enormous benefits for healthcare and quality of life. Still, the long-term working of those devices remains a great challenge due to the short life and large volume of conventional batteries. Since the nanogenerators (NGs) invention, they have been widely used to convert various ambient mechanical energy sources into electrical energy. The self-powered technology based on NGs is dedicated to harvesting ambient energy to supply electronic devices, which is an effective pathway to conquer the energy insufficiency of biomedical electronic devices. With the aid of this technology, it is expected to develop self-powered biomedical electronic devices with advanced features and distinctive functions. The goal of this review is to summarize the existing self-powered technologies based on NGs and then review the applications based on self-powered technologies in the biomedical field during their rapid development in recent years, including two main directions. The first is the NGs as independent sensors to converts biomechanical energy and heat energy into electrical signals to reflect health information. The second direction is to use the electrical energy produced by NGs to stimulate biological tissues or powering biomedical devices for achieving the purpose of medical application. Eventually, we have analyzed and discussed the remaining challenges and perspectives of the field. We believe that the self-powered technology based on NGs would advance the development of modern biomedical electronic devices.
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Affiliation(s)
- Yuanzheng Zhang
- Key Laboratory of Artificial Micro‐ and Nano‐structures of Ministry of EducationSchool of Physics and TechnologyWuhan UniversityWuhanP. R. China
- International Joint Research Laboratory of New Energy Materials and Devices of Henan ProvinceHenan UniversityKaifengP. R. China
| | - Xiangyang Gao
- Key Laboratory of Artificial Micro‐ and Nano‐structures of Ministry of EducationSchool of Physics and TechnologyWuhan UniversityWuhanP. R. China
| | - Yonghui Wu
- International Joint Research Laboratory of New Energy Materials and Devices of Henan ProvinceHenan UniversityKaifengP. R. China
| | - Jinzheng Gui
- Key Laboratory of Artificial Micro‐ and Nano‐structures of Ministry of EducationSchool of Physics and TechnologyWuhan UniversityWuhanP. R. China
| | - Shishang Guo
- Key Laboratory of Artificial Micro‐ and Nano‐structures of Ministry of EducationSchool of Physics and TechnologyWuhan UniversityWuhanP. R. China
| | - Haiwu Zheng
- International Joint Research Laboratory of New Energy Materials and Devices of Henan ProvinceHenan UniversityKaifengP. R. China
| | - Zhong Lin Wang
- Beijing Institute of Nanoenergy and NanosystemsChinese Academy of SciencesBeijingP. R. China
- School of Materials Science and EngineeringGeorgia Institute of TechnologyAtlantaGeorgiaUSA
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15
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Lenarczyk R, Boveda S, Mansourati J, Russo V, Marijon E, Lane DA, Dagres N, Potpara TS. Peri-procedural management, implantation feasibility, and short-term outcomes in patients undergoing implantation of leadless pacemakers: European Snapshot Survey. Europace 2021; 22:833-838. [PMID: 32073116 DOI: 10.1093/europace/euaa023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 01/23/2020] [Indexed: 12/12/2022] Open
Abstract
The aim of this European Heart Rhythm Association (EHRA) prospective snapshot survey is to assess procedural settings, safety measures, and short-term outcomes associated with implantation of leadless pacemakers (LLPM), across a broad range of tertiary European electrophysiology centres. An internet-based electronic questionnaire (30 questions) concerning implantation settings, peri-procedural routines, complications, and in-hospital patient outcomes was circulated to centres routinely implanting both LLPMs and transvenous pacemakers (TV-PM). The centres were requested to prospectively include consecutive patients implanted with either LLPMs or TV-PMs during the 10-week enrolment period. Overall, 21 centres from four countries enrolled 825 consecutive patients between November 2018 and January 2019, including 69 (9%) implanted with LLPMs. Leadless pacemakers were implanted mainly under local anaesthesia (69%), by an electrophysiologist (60%), in the electrophysiology laboratory (71%); 95% of patients received prophylactic antibiotics prior to implantation. Most patients on chronic oral anticoagulation were operated on-drug (35%), or during short-term (to 48 h) drug withdrawal (54%). Implantation was successful in 98% of patients and the only in-hospital procedure-related complication was groyne haematoma in one patient. This EHRA snapshot survey provides important insights into LLPM implantation routines and patient outcomes. These findings suggest that despite the unfavourable clinical profile of pacemaker recipients, LLPM implantation is associated with relatively low risk of complications and good short-term outcomes.
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Affiliation(s)
- Radosław Lenarczyk
- First Department of Cardiology and Angiology, Silesian Centre for Heart Disease, Curie-Sklodowskiej Str 9, 41-800 Zabrze, Poland
| | - Serge Boveda
- Cardiology - Heart Rhythm Management Department, Clinique Pasteur, 45 Avenue de Lombez, 31076 Toulouse, France.,Universiteit Ziekenhuis, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Jette Brussels, Belgium.,Paris University, PARCC-INSERM, 56 Rue Leblanc, 75908 Paris Cedex 15, France
| | - Jacques Mansourati
- Department of Cardiology, University Hospital of Brest, 9 Rue Félix le Dantec, 29200 Brest, France.,ORPHY, Université de Bretagne Occidentale, 3 Rue des Archives, 29238 Brest, France
| | - Vincenzo Russo
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Via Santa Maria di Costantinopoli 104, Napoli, NA 80138, Italy
| | - Eloi Marijon
- Paris University, PARCC-INSERM, 56 Rue Leblanc, 75908 Paris Cedex 15, France.,Cardiology Department, European Georges Pompidou Hospital, AP-HP, 20 Rue Leblanc, 75908 Paris Cedex 15, France
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX, UK.,Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Aalborg University, Søndre Skovvej 15, Forskningens Hus, 9000 Aalborg, Denmark
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstrasse 39, 04289 Leipzig, Germany
| | - Tatjana S Potpara
- School of Medicine, University of Belgrade, dr Subotića Starijeg 8, 11000 Belgrad, Serbia.,Cardiology Clinic, Clinical Center of Serbia, Visegradska 26, 11000 Belgrade, Serbia
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16
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Deichl AS, Lacour P, Belyavskiy E, Pieske B, Pieske-Kraigher E, Blaschke F, Schneider M. Case Report: Assessing the Position of Pacemaker Leads via Transthoracic Echocardiography: Additional Value of the Subcostal En Face View. Front Cardiovasc Med 2021; 8:697052. [PMID: 34150875 PMCID: PMC8213207 DOI: 10.3389/fcvm.2021.697052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 05/13/2021] [Indexed: 11/18/2022] Open
Abstract
There is an association between presence of cardiac implantable electronic devices (CIED) and development of tricuspid regurgitation (TR). Mechanisms proposed to explain CIED-induced TR can be classified as implantation-related, lead-related, and pacing-related. Lead-related TR results from the direct interaction of the lead with the tricuspid valve (TV). The localization of the lead at the TV level directly influences the probability of subsequent development of significant TR. A transthoracic subcostal en face view of the TV can be acquired in most patients through a 90° rotation from the subcostal 4-chamber view with clear anatomic delineation of the TV and the commissures including lead position. This case-series presents three examples where the transthoracic en face view could add incremental information on the position of the pacemaker leads and on the mechanism of TR. Conclusion: When performing transthoracic echocardiography in patients with trans-tricuspid CIED lead(s), an en face view of the TV with exact reporting of the position of the lead(s) should be included.
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Affiliation(s)
- Andrea Simone Deichl
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin (Campus Virchow-Klinikum), Berlin, Germany.,DZHK (German Center for Cardiovascular Research) Partner Site Berlin, Berlin, Germany
| | - Philipp Lacour
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin (Campus Virchow-Klinikum), Berlin, Germany
| | - Evgeny Belyavskiy
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin (Campus Virchow-Klinikum), Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin (Campus Virchow-Klinikum), Berlin, Germany.,DZHK (German Center for Cardiovascular Research) Partner Site Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,German Heart Center Berlin, Berlin, Germany
| | - Elisabeth Pieske-Kraigher
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin (Campus Virchow-Klinikum), Berlin, Germany.,DZHK (German Center for Cardiovascular Research) Partner Site Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Florian Blaschke
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin (Campus Virchow-Klinikum), Berlin, Germany
| | - Matthias Schneider
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin (Campus Virchow-Klinikum), Berlin, Germany.,German Heart Center Berlin, Berlin, Germany
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17
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Abstract
Cardiac implantable electronic devices (CIEDs) are essential for the management of a variety of cardiac conditions, including tachyarrhythmias, bradyarrhythmias, and medically refractory heart failure (HF). Recent advancements in CIED technology have led to innovative solutions that overcome shortcomings associated with traditional devices or address unmet needs. Leadless pacemakers, subcutaneous implantable cardioverter defibrillators (ICDs), and extravascular ICDs eliminate lead-related complications common with conventional pacemakers or ICDs. Conduction system pacing (His bundle pacing and left bundle branch pacing) is a more physiologic method of pacing and avoids the deleterious consequences associated with long-term right ventricular pacing. For HF-related devices, cardiac contractility modulation is an emerging therapy that bridges a gap for many patients ineligible for cardiac resynchronization therapy and has been shown to improve HF symptoms and decrease hospitalizations and mortality in select patients. Implantable pulmonary artery pressure monitors help guide HF management and reduce hospitalizations. Lastly, new phrenic nerve stimulating devices are being utilized to treat central sleep apnea, a common comorbidity associated with HF. While further long-term studies are still underway for many of these new technologies, it is anticipated that these devices will become indispensable therapeutics in the expanding cardiovascular armamentarium.
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18
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Reliability of Neural Implants-Effective Method for Cleaning and Surface Preparation of Ceramics. MICROMACHINES 2021; 12:mi12020209. [PMID: 33669493 PMCID: PMC7922903 DOI: 10.3390/mi12020209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 02/06/2023]
Abstract
Neural implants provide effective treatment and diagnosis options for diseases where pharmaceutical therapies are missing or ineffective. These active implantable medical devices (AIMDs) are designed to remain implanted and functional over decades. A key factor for achieving reliability and longevity are cleaning procedures used during manufacturing to prevent failures associated with contaminations. The Implantable Devices Group (IDG) at University College London (UCL) pioneered an approach which involved a cocktail of reagents described as “Leslie’s soup”. This process proved to be successful but no extensive evaluation of this method and the cocktail’s ingredients have been reported so far. Our study addressed this gap by a comprehensive analysis of the efficacy of this cleaning method. Surface analysis techniques complemented adhesion strengths methods to identify residues of contaminants like welding flux, solder residues or grease during typical assembly processes. Quantitative data prove the suitability of “Leslie’s soup” for cleaning of ceramic components during active implant assembly when residual ionic contaminations were removed by further treatment with isopropanol and deionised water. Solder and flux contaminations were removed without further mechanical cleaning. The adhesive strength of screen-printed metalisation layers increased from 12.50 ± 3.83 MPa without initial cleaning to 21.71 ± 1.85 MPa. We conclude that cleaning procedures during manufacturing of AIMDs, especially the understanding of applicability and limitations, is of central importance for their reliable and longevity.
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19
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Co ML, Khouzam JP, Pour-Ghaz I, Minhas S, Basu-Ray I. Emerging Technologies in Cardiac Pacing From Leadless Pacers to Stem Cells. Curr Probl Cardiol 2021; 46:100797. [PMID: 33561694 DOI: 10.1016/j.cpcardiol.2021.100797] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/10/2021] [Indexed: 01/28/2023]
Abstract
Modern pacemakers can sense and pace multiple chambers of the heart. These pacemakers have different modes and features to optimize atrioventricular synchrony and promote intrinsic conduction. Despite recent advancements, current pacemakers have several drawbacks that limit their feasibility. In this review article, we discuss several of these limitations and detail several emerging technologies in cardiac pacing aimed to solve some of these limitations. We present several technological advancements in cardiac pacing, including the use of leadless pacemakers, physiologic pacing, battery improvements, and bioartificial pacemakers. More research still needs to be done in testing the safety and efficacy of these new developments.
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Affiliation(s)
- Michael Lawren Co
- Department of Cardiology, Loma Linda University Medical Center, Loma Linda, CA
| | | | - Issa Pour-Ghaz
- Department of Cardiology, University of Tennessee Health Science Center, Memphis, TN
| | - Sheharyar Minhas
- Department of Internal Medicine, Baptist Memorial Hospital, Memphis, TN
| | - Indranill Basu-Ray
- Arrythmia Service, Department of Cardiology, Memphis VA Medical Center, The University of Memphis, Memphis, TN.
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20
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The impact of permanent pacemaker implantation on thallium myocardial perfusion examination detecting ischemic heart disease. Nucl Med Commun 2020; 42:190-197. [PMID: 33165253 DOI: 10.1097/mnm.0000000000001319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Patients with permanent pacemaker (PPM) implantation may have altered coronary perfusion patterns that may influence the accuracy of myocardial perfusion examination modalities, which was observed in previous studies but with limited statistic power. Our aim was to examine the performance of thallium-201 (TL-201) myocardial perfusion examination in patients with implanted PPM. METHODS Data of consecutive patients from our institution who had coronary angiography examination followed by TL-201 myocardial perfusion examination in pairs within 1 year were collected between January 2010 and December 2016 and were divided into PPM and control groups. Propensity score matching (PSM) was performed to compare the positive predictive value (PPV) of perfusion examinations. RESULTS A total of 934 pairs of studies were evaluated, with 81 in the PPM group and 853 controls. The PPV decreased significantly in the PPM group (28.2 vs. 62.9%, P < 0.001). The finding of large (>20%) ischemic areas correlated significantly with all-cause mortality in the control group (OR, 2.34; P = 0.001), but not in the PPM group (OR,1.05; P = 0.943). After PSM, the PPV was still significantly lower in the PPM group than in the non-PPM group (28.6 vs. 66.2%, P < 0.001). CONCLUSION Study results do not support the appropriateness of using TL-201 perfusion examinations for risk stratification in patients with implanted PPM.Video Abstract: http://links.lww.com/NMC/A181.
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21
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Zheng Q, Tang Q, Wang ZL, Li Z. Self-powered cardiovascular electronic devices and systems. Nat Rev Cardiol 2020; 18:7-21. [PMID: 32895536 DOI: 10.1038/s41569-020-0426-4] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2020] [Indexed: 01/24/2023]
Abstract
Cardiovascular electronic devices have enormous benefits for health and quality of life but the long-term operation of these implantable and wearable devices remains a huge challenge owing to the limited life of batteries, which increases the risk of device failure and causes uncertainty among patients. A possible approach to overcoming the challenge of limited battery life is to harvest energy from the body and its ambient environment, including biomechanical, solar, thermal and biochemical energy, so that the devices can be self-powered. This strategy could allow the development of advanced features for cardiovascular electronic devices, such as extended life, miniaturization to improve comfort and conformability, and functions that integrate with real-time data transmission, mobile data processing and smart power utilization. In this Review, we present an update on self-powered cardiovascular implantable electronic devices and wearable active sensors. We summarize the existing self-powered technologies and their fundamental features. We then review the current applications of self-powered electronic devices in the cardiovascular field, which have two main goals. The first is to harvest energy from the body as a sustainable power source for cardiovascular electronic devices, such as cardiac pacemakers. The second is to use self-powered devices with low power consumption and high performance as active sensors to monitor physiological signals (for example, for active endocardial monitoring). Finally, we present the current challenges and future perspectives for the field.
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Affiliation(s)
- Qiang Zheng
- CAS Center for Excellence in Nanoscience, Beijing Key Laboratory of Micro-Nano Energy and Sensor, Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing, China.,School of Nanoscience and Technology, University of Chinese Academy of Sciences, Beijing, China
| | - Qizhu Tang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhong Lin Wang
- CAS Center for Excellence in Nanoscience, Beijing Key Laboratory of Micro-Nano Energy and Sensor, Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing, China. .,School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, GA, USA.
| | - Zhou Li
- CAS Center for Excellence in Nanoscience, Beijing Key Laboratory of Micro-Nano Energy and Sensor, Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing, China. .,School of Nanoscience and Technology, University of Chinese Academy of Sciences, Beijing, China.
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22
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Gundelach LA, Hüser MA, Beutner D, Ruther P, Bruegmann T. Towards the clinical translation of optogenetic skeletal muscle stimulation. Pflugers Arch 2020; 472:527-545. [PMID: 32415463 PMCID: PMC7239821 DOI: 10.1007/s00424-020-02387-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 03/05/2020] [Accepted: 04/28/2020] [Indexed: 12/27/2022]
Abstract
Paralysis is a frequent phenomenon in many diseases, and to date, only functional electrical stimulation (FES) mediated via the innervating nerve can be employed to restore skeletal muscle function in patients. Despite recent progress, FES has several technical limitations and significant side effects. Optogenetic stimulation has been proposed as an alternative, as it may circumvent some of the disadvantages of FES enabling cell type–specific, spatially and temporally precise stimulation of cells expressing light-gated ion channels, commonly Channelrhodopsin2. Two distinct approaches for the restoration of skeletal muscle function with optogenetics have been demonstrated: indirect optogenetic stimulation through the innervating nerve similar to FES and direct optogenetic stimulation of the skeletal muscle. Although both approaches show great promise, both have their limitations and there are several general hurdles that need to be overcome for their translation into clinics. These include successful gene transfer, sustained optogenetic protein expression, and the creation of optically active implantable devices. Herein, a comprehensive summary of the underlying mechanisms of electrical and optogenetic approaches is provided. With this knowledge in mind, we substantiate a detailed discussion of the advantages and limitations of each method. Furthermore, the obstacles in the way of clinical translation of optogenetic stimulation are discussed, and suggestions on how they could be overcome are provided. Finally, four specific examples of pathologies demanding novel therapeutic measures are discussed with a focus on the likelihood of direct versus indirect optogenetic stimulation.
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Affiliation(s)
- Lili A Gundelach
- Institute of Cardiovascular Physiology, University Medical Center, Göttingen, Germany
| | - Marc A Hüser
- Institute of Cardiovascular Physiology, University Medical Center, Göttingen, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center, Göttingen, Germany
| | - Dirk Beutner
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center, Göttingen, Germany
| | - Patrick Ruther
- Microsystem Materials Laboratory, Department of Microsystems Engineering (IMTEK), University of Freiburg, Freiburg, Germany
- BrainLinks-BrainTools Cluster of Excellence at the University of Freiburg, Freiburg, Germany
| | - Tobias Bruegmann
- Institute of Cardiovascular Physiology, University Medical Center, Göttingen, Germany.
- DZHK e.V. (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany.
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23
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Steinwender C, Lercher P, Schukro C, Blessberger H, Prenner G, Andreas M, Kraus J, Ammer M, Stühlinger M. State of the art: leadless ventricular pacing : A national expert consensus of the Austrian Society of Cardiology. J Interv Card Electrophysiol 2019; 57:27-37. [PMID: 31863250 PMCID: PMC7036055 DOI: 10.1007/s10840-019-00680-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 12/02/2019] [Indexed: 01/25/2023]
Abstract
Background Cardiac pacing has been shown to improve quality of life and prognosis of patients with bradycardia for almost 60 years. The latest innovation in pacemaker therapy was miniaturization of generators to allow leadless pacing directly in the right ventricle. There is a long history and extensive experience of leadless ventricular pacing in Austria. However, no recommendations of national or international societies for indications and implantation of leadless opposed to transvenous pacing systems have been published so far. Results A national expert panel of skilled implanters gives an overview on the two utilized leadless cardiac pacing systems and highlights clinical advantages as well as current knowledge of performance and complication rates of leadless pacing. Furthermore, a national consensus for Austria is presented, based on recent studies and current know-how, specifically including indications for leadless pacing, management of infection, suggestions for qualification, and training of the operators and technical standards. Conclusions Leadless pacing systems can be implanted successfully with a low complication rate, if suggestions for indications and technical requirements are followed. Condensed abstract An overview of the two utilized leadless cardiac pacing systems is given, specifically highlighting clinical advantages as well as current knowledge of performance and complication rates. Furthermore, a national consensus for Austria is presented, specifically including indications for leadless pacing, management of infection, and suggestions for qualification and technical standards.
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Affiliation(s)
- C Steinwender
- Department of Cardiology and Internal Intensive Medicine, Kepler University Hospital, Johannes Kepler University Linz, Medical Faculty, Linz, Austria
| | - P Lercher
- Department of Cardiology, Medical University Graz, Graz, Austria
| | - C Schukro
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - H Blessberger
- Department of Cardiology and Internal Intensive Medicine, Kepler University Hospital, Johannes Kepler University Linz, Medical Faculty, Linz, Austria
| | - G Prenner
- Department of Cardiology, Medical University Graz, Graz, Austria
| | - M Andreas
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - J Kraus
- Universitätsklinik für Innere Medizin II, Cardiology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - M Ammer
- Cardiology Department, Klinikum Wels-Grieskirchen, Wels, Austria
| | - M Stühlinger
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria.
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24
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Bencardino G, Spera FR, Pinnacchio G, Perna F, Narducci ML, Comerci G, Pelargonio G, Gabrielli FA, La Rosa G, Lanza GA, Crea F. Prognostic significance of non-sustained ventricular tachycardia on stored electrograms in pacemaker recipients. PLoS One 2019; 14:e0225059. [PMID: 31730671 PMCID: PMC6857919 DOI: 10.1371/journal.pone.0225059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/27/2019] [Indexed: 11/22/2022] Open
Abstract
Background Little is known about the prognostic significance of non-sustained ventricular tachycardia (NS-VT) in outpatients scheduled for routine pacemaker controls. We therefore sought to investigate the prognostic significance of non-sustained ventricular tachycardia on stored electrograms in pacemaker recipients. Methods We enrolled patients implanted with dual chamber pacemaker for atrioventricular block or sinus node dysfunction from 2010 to 2016, with LVEF> 45%, older than 18 years, with at least 3 device interrogations at follow-up. Data were collected about medical history, pharmacological therapy at implantation, pacemaker programming, NS-VT occurrence, long-term survival. Results A total of 308 patients were included in the final analysis, with median follow-up time of 56 months. No ventricular arrhythmic episodes were documented in 221 patients (Group 1), whereas 87 had at least 1 episode of NS-VT during follow-up (Group 2). As a whole, 282 episodes of NS-VT were documented. There was a higher prevalence of previous myocardial infarction and slightly lower left ventricular ejection fraction (LVEF) in Group 2. The primary endpoint (all-cause mortality) occurred in 50 patients (22%) of Group 1 and 12 (14%) patients of Group 2 (p = 0.07). Clinical predictors of all-cause mortality at univariate analysis included age, LVEF and coronary artery disease (CAD). Only age and CAD, however, remained as predictors of mortality at multivariable analysis. A sizeable, but not statistically significant, portion of patients who died had a de novo occurrence of NS-VT at the last pacemaker check. Conclusion Our data do not support a prognostic role for the detection of NS-VT during pacemaker controls.
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Affiliation(s)
- Gianluigi Bencardino
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- * E-mail:
| | - Francesco Raffaele Spera
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Gaetano Pinnacchio
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Francesco Perna
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Maria Lucia Narducci
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Gianluca Comerci
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Gemma Pelargonio
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Francesca Augusta Gabrielli
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Giulio La Rosa
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Gaetano Antonio Lanza
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Filippo Crea
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
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25
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Koch J, Schuettler M, Pasluosta C, Stieglitz T. Electrical connectors for neural implants: design, state of the art and future challenges of an underestimated component. J Neural Eng 2019; 16:061002. [PMID: 31362277 DOI: 10.1088/1741-2552/ab36df] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Technological advances in electrically active implantable devices have increased the complexity of hardware design. In particular, the increasing number of stimulation and recording channels requires innovative approaches for connectors that interface electrodes with the implant circuitry. OBJECTIVE This work aims to provide a common theoretical ground for implantable connector development with a focus on neural applications. APPROACH Aspects and experiences from several disciplines are compiled from an engineering perspective to discuss the state of the art of connector solutions. Whenever available, we also present general design guidelines. MAIN RESULTS Degradation mechanisms, material stability and design rules in terms of biocompatibility and biostability are introduced. Considering contact physics, we address the design and characterization of the contact zone and review contaminants, wear and contact degradation. For high-channel counts and body-like environments, insulation can be even more crucial than the electrical connection itself. Therefore, we also introduce the requirements for electrical insulation to prevent signal loss and distortion and discuss its impact on the practical implementation. SIGNIFICANCE A final review is dedicated to the state of the art connector concepts, their mechanical setup, electrical performance and the interface to other implant components. We conclude with an outlook for possible approaches for the future generations of implants.
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Affiliation(s)
- Julia Koch
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
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26
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Boriani G, Vitolo M, Proietti M. Cardiomyopathy associated with long-term right ventricular pacing: an intriguing clinical issue. Eur J Heart Fail 2019; 21:652-654. [PMID: 30861239 DOI: 10.1002/ejhf.1449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/05/2019] [Indexed: 01/08/2023] Open
Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Marco Proietti
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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27
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Zhang G, Geng F, Zhao T, Zhou F, Zhang N, Zhang S, Deng C. Biocompatible Symmetric Na-Ion Microbatteries with Sphere-in-Network Heteronanomat Electrodes Realizing High Reliability and High Energy Density for Implantable Bioelectronics. ACS APPLIED MATERIALS & INTERFACES 2018; 10:42268-42278. [PMID: 30457330 DOI: 10.1021/acsami.8b14918] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The prolonged life expectancy accelerates the development of implantable bioelectronic devices. However, conventional batteries with limited lifetime, rigid architecture, and inferior energy density greatly restrict their applications in patient's body. Herein, a novel flexible symmetric Na-ion microbattery based on the heteronanomat electrode and the biocompatible electrolyte has been developed. The film electrodes with sphere-in-network architecture are synthesized by simultaneously electrospinning and electrospraying followed by carbonization. The combined technologies allow a uniform incorporation of active materials/C spheres into the carbon nanofiber matrix, which results in the heteronanomat electrodes with robust structure, fast electron/ion transport, and compact mass loading. The flexible microbatteries are fabricated based on the interdigitated microelectrodes and the biocompatible electrolytes, which provides a new implantable power source for bioelectronics. As a proof-of-concept study, the symmetric sodium-ion microbatteries are constructed from the heteronanomat bifunctional electrodes (based on Na2VTi(PO4)3) and the biocompatible electrolyte. The high reversibility, fast kinetics, and high energy density of the symmetric system in the biocompatible electrolytes reveal their superior performance in bioenvironments. Moreover, the high capacity retention (over 98%) and the high stability of microbattery implanted in a living SD rat for a month further demonstrate its high reliability for long-term in vivo diagnosis. Therefore, this work not only presents a new sphere-in-net heteronanomat structure for fabricating high-performance electrode but also gives significant contributions to develop high-energy-density and high safety biocompatible power sources of implantable bioelectronics.
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Affiliation(s)
- Guoming Zhang
- Key Laboratory for Photonic and Electronic Bandgap Materials, Ministry of Education, College of Chemistry and Chemical Engineering , Harbin Normal University , Harbin 150025 , Heilongjiang , China
| | - Fang Geng
- Key Laboratory for Photonic and Electronic Bandgap Materials, Ministry of Education, College of Chemistry and Chemical Engineering , Harbin Normal University , Harbin 150025 , Heilongjiang , China
| | - Tao Zhao
- Key Laboratory for Photonic and Electronic Bandgap Materials, Ministry of Education, College of Chemistry and Chemical Engineering , Harbin Normal University , Harbin 150025 , Heilongjiang , China
| | - Fangshuo Zhou
- Key Laboratory for Photonic and Electronic Bandgap Materials, Ministry of Education, College of Chemistry and Chemical Engineering , Harbin Normal University , Harbin 150025 , Heilongjiang , China
- College of Material Science and Chemical Engineering , Harbin Engineering University , Harbin 150001 , Heilongjiang , China
| | - Ning Zhang
- College of Jiamusi , Heilongjiang University of Chinese Medicine , Jiamusi 154007 , Heilongjiang , China
| | - Sen Zhang
- College of Material Science and Chemical Engineering , Harbin Engineering University , Harbin 150001 , Heilongjiang , China
| | - Chao Deng
- Key Laboratory for Photonic and Electronic Bandgap Materials, Ministry of Education, College of Chemistry and Chemical Engineering , Harbin Normal University , Harbin 150025 , Heilongjiang , China
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Krzemień-Wolska K, Tomasik A, Nowalany-Kozielska E, Jacheć W. Prognosis of patients with implanted pacemakers in 4‑year follow-up : Impact of right ventricular pacing site. Herz 2018; 43:315-324. [PMID: 28396904 PMCID: PMC5999135 DOI: 10.1007/s00059-017-4561-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 03/08/2017] [Indexed: 10/26/2022]
Abstract
BACKGROUND Pacing remains the method of choice for treatment of cardiac electrical conduction disorders. This study examined the interrelationship between the site of the right ventricular lead tip and patient prognosis in association with other cardiovascular risk factors over a 4‑year follow-up period. PATIENTS AND METHODS The study comprised 450 consecutive patients (223 women; aged 69.16 ± 9.63 years) who had their first SSI or DDD pacemaker implanted for typical indications. RESULTS During follow-up, 91 (20.2%) patients died. The positive prognostic factors were: female sex (hazard ratio [HR] = 0.426), DDD pacemaker (HR = 0.526), oral anticoagulant use (HR = 0.330; all groups), sodium concentration (HR = 0.926), oral anticoagulant (HR = 0.115) and statin (HR = 0.260) use (female group), and non-apical location of the right ventricular lead tip (HR = 0.549; male group). Risk factors for death were: age (HR = 1.063), diabetes requiring insulin (HR = 2.832), creatinine concentration (HR = 1.005; all groups), age (HR = 1.11; female group), and elevated creatinine level (HR = 1.012; male group). In all patients, the non-apical location of the right ventricular lead tip was associated with an 18.92% reduced mortality rate during the 4‑year follow-up, which was statistically significant for the male group. CONCLUSION The non-apical location of the right ventricular lead tip was a positive prognostic factor and was statistically significant in the male subgroup.
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Affiliation(s)
| | - A Tomasik
- Szpital Specjalistyczny w Zabrzu, Zabrzu, Poland
- Second Department of Cardiology, Medical University of Silesia, ul. Skłodowskiej 10, 41-800, Zabrzu, Poland
| | - E Nowalany-Kozielska
- Szpital Specjalistyczny w Zabrzu, Zabrzu, Poland
- Second Department of Cardiology, Medical University of Silesia, ul. Skłodowskiej 10, 41-800, Zabrzu, Poland
| | - W Jacheć
- Szpital Specjalistyczny w Zabrzu, Zabrzu, Poland.
- Second Department of Cardiology, Medical University of Silesia, ul. Skłodowskiej 10, 41-800, Zabrzu, Poland.
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Abstract
Electrogenesis in the heart begins in the sinoatrial node and proceeds down the conduction system to originate the heartbeat. Conduction system disorders lead to slow heart rates that are insufficient to support the circulation, necessitating implantation of electronic pacemakers. The typical electronic pacemaker consists of a subcutaneous generator and battery module attached to one or more endocardial leads. New leadless pacemakers can be implanted directly into the right ventricular apex, providing single-chamber pacing without a subcutaneous generator. Modern pacemakers are generally reliable, and their programmability provides options for different pacing modes tailored to specific clinical needs. Advances in device technology will probably include alternative energy sources and dual-chamber leadless pacing in the not-too-distant future. Although effective, current electronic devices have limitations related to lead or generator malfunction, lack of autonomic responsiveness, undesirable interactions with strong magnetic fields, and device-related infections. Biological pacemakers, generated by somatic gene transfer, cell fusion, or cell transplantation, provide an alternative to electronic devices. Somatic reprogramming strategies, which involve transfer of genes encoding transcription factors to transform working myocardium into a surrogate sinoatrial node, are furthest along in the translational pipeline. Even as electronic pacemakers become smaller and less invasive, biological pacemakers might expand the therapeutic armamentarium for conduction system disorders.
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Affiliation(s)
- Eugenio Cingolani
- Cedars-Sinai Heart Institute, 8700 Beverly Boulevard, Los Angeles, California 90048, USA
| | - Joshua I Goldhaber
- Cedars-Sinai Heart Institute, 8700 Beverly Boulevard, Los Angeles, California 90048, USA
| | - Eduardo Marbán
- Cedars-Sinai Heart Institute, 8700 Beverly Boulevard, Los Angeles, California 90048, USA
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Wiles BM, Illingworth CA, Paisey JR, Roberts PR, Harden SP. Keeping up appearances: the radiographic evolution of cardiovascular implantable electronic devices. Br J Radiol 2017; 91:20170506. [PMID: 28936891 DOI: 10.1259/bjr.20170506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
In recent years, there has been a significant evolution in the field of cardiovascular implantable electronic devices (CIEDs). Pacemakers can now be leadless, implantable cardioverter defibrillators can be entirely subcutaneous and implantable loop recorders have become miniaturized. Driven by technological advances and an ageing population implant numbers have also steadily increased. These highly prevalent systems are all radio-opaque and are frequently observed on chest radiographs, yet the devices are neither well recognized nor understood. We present a pictorial review of CIEDs; describing the chest radiograph appearances of both newer generation systems and their traditional predecessors. Furthermore, we discuss the clinical role of chest radiography in both CIED implantation and follow up, with the aim of improving understanding in this important and expanding field. Finally, we present a collection of interesting and challenging radiographs, where multiple CIED systems have been implanted.
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Affiliation(s)
- Benedict M Wiles
- 1 Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Caroline A Illingworth
- 2 Cardiothoracic Radiology Department, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - John R Paisey
- 1 Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Paul R Roberts
- 1 Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Stephen P Harden
- 2 Cardiothoracic Radiology Department, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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Burks S, Kolcun JP, Wang MY. Subcutaneous Solar Cells Harvest Energy for Pulse Generation. Neurosurgery 2017; 81:N24. [PMID: 28859454 DOI: 10.1093/neuros/nyx371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shelby Burks
- Department of Neurological Surgery University of Miami Miller School of Medicine Miami, Florida
| | - John Paul Kolcun
- Department of Neurological Surgery University of Miami Miller School of Medicine Miami, Florida
| | - Michael Y Wang
- Department of Neurological Surgery University of Miami Miller School of Medicine Miami, Florida
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Danilov AA, Mindubaev EA, Selishchev SV. Methods for Compensation of Coil Misalignment in Systems for Inductive Transcutaneous Power Transfer to Implanted Medical Devices. BIOMEDICAL ENGINEERING-MEDITSINSKAYA TEKNIKA 2017. [DOI: 10.1007/s10527-017-9684-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Implantable cardiac devices have an increasingly important role. Pacemakers remain the only effective treatment for symptomatic bradycardia; cardiac resynchronisation therapy is a proven treatment for heart failure; and implantable cardioverter defibrillators (ICD) are superior to medical therapy in prevention of sudden cardiac death. Our ageing population has led to a rising number of device implants. Physicians in all specialties increasingly encounter patients with cardiac devices and require an understanding of their capabilities and functions. The rising prevalence of implantable devices has been matched by a parallel expanse in device technology. Leadless devices have become a reality and represent the future of device therapy. The absence of a transvenous lead offers a significant clinical advantage because of many well established issues related to lead complications. The leadless pacemaker and subcutaneous ICD are significant new products that are currently not well recognised or understood by general physicians.
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Affiliation(s)
- Benedict M Wiles
- Cardiac Rhythm Management, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Paul R Roberts
- Cardiac Rhythm Management, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Gabriels J, Wu M, Rosen L, Patel A, Goldner B. Clinical Significance of Nonsustained Ventricular Tachycardia on Stored Electrograms in Permanent Pacemaker Patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:1335-1339. [PMID: 27809339 DOI: 10.1111/pace.12968] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 09/23/2016] [Accepted: 10/25/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Permanent pacemaker electrograms record a variety of arrhythmias, including nonsustained ventricular tachycardia (NSVT). Little has been reported regarding incidence and clinical significance of NSVT in pacemaker patients after long-term monitoring. METHODS Records from all patients implanted with Medtronic pacemakers (Medtronic, Minneapolis, MN, USA) at a single institution from January 1, 2009 to February 27, 2012 were reviewed. Demographic characteristics, imaging studies, pacemaker interrogations, and the Social Security Death Index were examined in patients older than 18 years of age who had ≥ 2 follow-up device interrogations. RESULTS A total of 262 patients with an ejection fraction (EF) >40% were included in the final analysis with a mean follow-up of 29.2 months. Of these patients, 83.2% (n = 218) had hypertension (HTN) and 45.4% (n = 119) had NSVT. Among patients with an EF ≥ 55%, hypertensive patients had a NSVT burden 2.46 times greater than normotensive patients (incidence rate ratio: 2.46, 95% confidence interval: 1.10-5.50; P < 0.028). NSVT was not associated with increased mortality (P < 0.1229). CONCLUSION In this cohort of patients, there was a high prevalence of HTN and while hypertensive subjects had a significantly higher NSVT burden, NSVT was not associated with an increased mortality.
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Affiliation(s)
- James Gabriels
- Department of Cardiology, Long Island Jewish Hospital, New Hyde Park, New York
| | - Michael Wu
- Department of Cardiology, Long Island Jewish Hospital, New Hyde Park, New York
| | - Lisa Rosen
- Department of Cardiology, Long Island Jewish Hospital, New Hyde Park, New York
| | - Apoor Patel
- Department of Cardiology, Long Island Jewish Hospital, New Hyde Park, New York
| | - Bruce Goldner
- Department of Cardiology, Long Island Jewish Hospital, New Hyde Park, New York
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Magjarevic R, Zequera Diaz ML. Biomedical engineering education--status and perspectives. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2014:5149-52. [PMID: 25571152 DOI: 10.1109/embc.2014.6944784] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Biomedical Engineering programs are present at a large number of universities all over the world with an increasing trend. New generations of biomedical engineers have to face the challenges of health care systems round the world which need a large number of professionals not only to support the present technology in the health care system but to develop new devices and services. Health care stakeholders would like to have innovative solutions directed towards solving problems of the world growing incidence of chronic disease and ageing population. These new solutions have to meet the requirements for continuous monitoring, support or care outside clinical settlements. Presence of these needs can be tracked through data from the Labor Organization in the U.S. showing that biomedical engineering jobs have the largest growth at the engineering labor market with expected 72% growth rate in the period from 2008-2018. In European Union the number of patents (i.e. innovation) is the highest in the category of biomedical technology. Biomedical engineering curricula have to adopt to the new needs and for expectations of the future. In this paper we want to give an overview of engineering professions in related to engineering in medicine and biology and the current status of BME education in some regions, as a base for further discussions.
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Braunschweig F, Linde C. Biventricular Stimulation: A BLOCKbuster in Cardiac Pacing? J Am Coll Cardiol 2016; 67:2158-2160. [PMID: 27151348 DOI: 10.1016/j.jacc.2016.01.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 01/05/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Frieder Braunschweig
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden; and the Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Cecilia Linde
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden; and the Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
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Zaremba T, Jakobsen AR, Søgaard M, Thøgersen AM, Riahi S. Radiotherapy in patients with pacemakers and implantable cardioverter defibrillators: a literature review. Europace 2015; 18:479-91. [PMID: 26041870 DOI: 10.1093/europace/euv135] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 04/16/2015] [Indexed: 11/14/2022] Open
Abstract
An increasing number of patients with implantable cardiac rhythm devices undergo radiotherapy (RT) for cancer and are thereby exposed to the risk of device failure. Current safety recommendations seem to have limitations by not accounting for the risk of pacemakers and implantable cardioverter defibrillators malfunctioning at low radiation doses. Besides scant knowledge about optimal safety measures, only little is known about the exact prevalence of patients with devices undergoing RT. In this review, we provide a short overview of the principles of RT and present the current evidence on the predictors and mechanisms of device malfunctions during RT. We also summarize practical recommendations from recent publications and from the industry. Strongly associated with beam energy of photon RT, device malfunctions occur at ∼3% of RT courses, posing a substantial issue in clinical practice. Malfunctions described in the literature typically consist of transient software disturbances and only seldom manifest as a permanent damage of the device. Through close cooperation between cardiologists and oncologists, a tailored individualized approach might be necessary in this patient group in waiting time for updated international guidelines in the field.
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Affiliation(s)
- Tomas Zaremba
- Department of Cardiology, Center for Cardiovascular Research, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9000, Denmark
| | - Annette Ross Jakobsen
- Department of Medical Physics, Oncology Department, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9000, Denmark
| | - Mette Søgaard
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N 8200, Denmark
| | - Anna Margrethe Thøgersen
- Department of Cardiology, Center for Cardiovascular Research, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9000, Denmark
| | - Sam Riahi
- Department of Cardiology, Center for Cardiovascular Research, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9000, Denmark Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Sdr. Skovvej 15, Aalborg 9000, Denmark
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38
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Lin G, Brady PA. Device lead-induced tricuspid regurgitation: does it matter? BRITISH HEART JOURNAL 2014; 100:900-1. [DOI: 10.1136/heartjnl-2013-305459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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39
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Development of implantable medical devices: from an engineering perspective. Int Neurourol J 2013; 17:98-106. [PMID: 24143287 PMCID: PMC3797898 DOI: 10.5213/inj.2013.17.3.98] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 09/26/2013] [Indexed: 11/24/2022] Open
Abstract
From the first pacemaker implant in 1958, numerous engineering and medical activities for implantable medical device development have faced challenges in materials, battery power, functionality, electrical power consumption, size shrinkage, system delivery, and wireless communication. With explosive advances in scientific and engineering technology, many implantable medical devices such as the pacemaker, cochlear implant, and real-time blood pressure sensors have been developed and improved. This trend of progress in medical devices will continue because of the coming super-aged society, which will result in more consumers for the devices. The inner body is a special space filled with electrical, chemical, mechanical, and marine-salted reactions. Therefore, electrical connectivity and communication, corrosion, robustness, and hermeticity are key factors to be considered during the development stage. The main participants in the development stage are the user, the medical staff, and the engineer or technician. Thus, there are three different viewpoints in the development of implantable devices. In this review paper, considerations in the development of implantable medical devices will be presented from the viewpoint of an engineering mind.
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40
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Beck H, Boden WE, Patibandla S, Kireyev D, Gupta V, Campagna F, Cain ME, Marine JE. 50th Anniversary of the first successful permanent pacemaker implantation in the United States: historical review and future directions. Am J Cardiol 2010; 106:810-8. [PMID: 21391322 DOI: 10.1016/j.amjcard.2010.04.043] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
June 2010 marks the 50th anniversary of the first successful human cardiac pacemaker implantation in the United States. On June 6, 1960, in Buffalo, New York, Dr. William Chardack implanted a pacemaker, designed and built by Wilson Greatbatch, an electrical engineer and inventor, in a 77-year old man with complete atrioventricular block, extending the patient's life by 18 months. This landmark event ushered in a new era of implantable cardiac pacemakers with batteries and leads of high reliability and increasing durability. Over the past half century, the field of electrophysiology and implantable devices for the management of cardiac conduction disturbances has evolved dramatically. Today's pacemakers include increasingly complex features such as telemetry monitoring, auto programmability, and hemodynamic sensors. New-generation leads present a sophisticated design with improved geometry and steroid-eluting tips to reduce chronic inflammation, maintaining a low pacing threshold and high sensing capability. The lithium iodide battery remains the mainstay of implantable pacemaker systems, exhibiting a multiple-year lifespan, slow terminal decay, and a reduced size and cost of production. Although Greatbatch's first successful pacemaker implantation remains a seminal scientific contribution to modern cardiovascular disease management, emerging developments in this field may challenge its preeminence. Important challenges such as imaging compatibility, lead durability, and infection prevention are being addressed. Novel concepts such as leadless and biologic pacing are under active investigation. In conclusion, Greatbatch's historic achievement 50 years ago reminds us that technologic progress is timeless, as efforts to enhance clinical outcomes and the quality of life continue unimpeded into the 21st century.
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41
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Tutarel O, Westhoff-Bleck M. Ake Senning. Clin Cardiol 2009; 32:E66-7. [PMID: 19610120 DOI: 10.1002/clc.20538] [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: 11/08/2022] Open
Affiliation(s)
- Oktay Tutarel
- Department of Cardiology & Angiology, Hannover Medical School, Hannover, Germany.
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42
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de Cock CC. Parallel import and pacemakers: who pays the ferryman? Neth Heart J 2008; 16:237-8. [PMID: 18711608 DOI: 10.1007/bf03086152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- C C de Cock
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
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43
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The first 20 years of bradypacing in the Netherlands - with special reference to organisational structures. Neth Heart J 2008. [DOI: 10.1007/bf03086196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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44
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van Hemel NM, van der Wall EE. 8 October 1958, D Day for the implantable pacemaker. Neth Heart J 2008. [DOI: 10.1007/bf03086195] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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46
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Affiliation(s)
- Seymour Furman
- Arrhythmia Service, Division of Cardiology, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York 10467, USA.
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