1
|
Benoit J, Squara F, Bourg V, Thomas P. Atrial fibrillation radiofrequency ablation in a patient with vagus nerve stimulation. Neurophysiol Clin 2024; 54:102996. [PMID: 38991469 DOI: 10.1016/j.neucli.2024.102996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/11/2024] [Accepted: 06/11/2024] [Indexed: 07/13/2024] Open
Abstract
Vagus nerve stimulation (VNS) is an effective neuromodulatory treatment for patients with drug resistant epilepsy who cannot undergo curative surgical resection. Safety information states that the use of radiofrequency ablation devices may damage the VNS generator and leads. However, documented cases are scarce. This 62-year-old patient with bitemporal lobe epilepsy treated with VNS underwent radiofrequency ablation of an atrial fibrillation without any perioperative or postoperative complications.
Collapse
Affiliation(s)
- Jeanne Benoit
- UF EEG-Épileptologie, Service de Neurologie, University Hospitals of Nice, France; Université Nice Côte d'Azur, CHU Nice, UR2CA-URRIS, Nice, France.
| | - Fabien Squara
- Service de Cardiologie, University Hospitals of Nice, France
| | - Véronique Bourg
- UF EEG-Épileptologie, Service de Neurologie, University Hospitals of Nice, France
| | - Pierre Thomas
- UF EEG-Épileptologie, Service de Neurologie, University Hospitals of Nice, France
| |
Collapse
|
2
|
Coraducci F, De Zan G, Fedele D, Costantini P, Guaricci AI, Pavon AG, Teske A, Cramer MJ, Broekhuizen L, Van Osch D, Danad I, Velthuis B, Suchá D, van der Bilt I, Pizzi C, Russo AD, Oerlemans M, van Laake LW, van der Harst P, Guglielmo M. Cardiac magnetic resonance in advanced heart failure. Echocardiography 2024; 41:e15849. [PMID: 38837443 DOI: 10.1111/echo.15849] [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: 04/18/2024] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 06/07/2024] Open
Abstract
Heart failure (HF) is a chronic and progressive disease that often progresses to an advanced stage where conventional therapy is insufficient to relieve patients' symptoms. Despite the availability of advanced therapies such as mechanical circulatory support or heart transplantation, the complexity of defining advanced HF, which requires multiple parameters and multimodality assessment, often leads to delays in referral to dedicated specialists with the result of a worsening prognosis. In this review, we aim to explore the role of cardiac magnetic resonance (CMR) in advanced HF by showing how CMR is useful at every step in managing these patients: from diagnosis to prognostic stratification, hemodynamic evaluation, follow-up and advanced therapies such as heart transplantation. The technical challenges of scanning advanced HF patients, which often require troubleshooting of intracardiac devices and dedicated scans, will be also discussed.
Collapse
Affiliation(s)
| | - Giulia De Zan
- Division Heart and Lung, Cardiology Department, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Damiano Fedele
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC, University of Bologna, Bologna, Italy
| | - Pietro Costantini
- Department of Radiology, Ospedale Universitario Maggiore della Carità di Novara, University of Eastern Piedmont, Novara, Italy
| | - Andrea Igoren Guaricci
- Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico of Bari, Bari, Italy
| | - Anna Giulia Pavon
- Division of Cardiology, Cardiocentro Ticino Institute Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Arco Teske
- Division Heart and Lung, Cardiology Department, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Maarten Jan Cramer
- Division Heart and Lung, Cardiology Department, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Lysette Broekhuizen
- Division Heart and Lung, Cardiology Department, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Dirk Van Osch
- Division Heart and Lung, Cardiology Department, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Ibrahim Danad
- Division Heart and Lung, Cardiology Department, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Birgitta Velthuis
- Division of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dominika Suchá
- Division of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ivo van der Bilt
- Division Heart and Lung, Cardiology Department, University Medical Centre Utrecht, Utrecht, The Netherlands
- Cardiology Department, HAGA Ziekenhuis, Den Haag, The Netherlands
| | - Carmine Pizzi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC, University of Bologna, Bologna, Italy
| | | | - Marish Oerlemans
- Division Heart and Lung, Cardiology Department, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Linda W van Laake
- Division Heart and Lung, Cardiology Department, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Pim van der Harst
- Division Heart and Lung, Cardiology Department, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Marco Guglielmo
- Division Heart and Lung, Cardiology Department, University Medical Centre Utrecht, Utrecht, The Netherlands
- Cardiology Department, HAGA Ziekenhuis, Den Haag, The Netherlands
| |
Collapse
|
3
|
Deneke T, Kutyifa V, Hindricks G, Sommer P, Zeppenfeld K, Carbucicchio C, Pürerfellner H, Heinzel FR, Traykov VB, De Riva M, Pontone G, Lehmkuhl L, Haugaa K. Pre- and post-procedural cardiac imaging (computed tomography and magnetic resonance imaging) in electrophysiology: a clinical consensus statement of the European Heart Rhythm Association and European Association of Cardiovascular Imaging of the European Society of Cardiology. Europace 2024; 26:euae108. [PMID: 38743765 PMCID: PMC11104536 DOI: 10.1093/europace/euae108] [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: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 05/16/2024] Open
Abstract
Imaging using cardiac computed tomography (CT) or magnetic resonance (MR) imaging has become an important option for anatomic and substrate delineation in complex atrial fibrillation (AF) and ventricular tachycardia (VT) ablation procedures. Computed tomography more common than MR has been used to detect procedure-associated complications such as oesophageal, cerebral, and vascular injury. This clinical consensus statement summarizes the current knowledge of CT and MR to facilitate electrophysiological procedures, the current value of real-time integration of imaging-derived anatomy, and substrate information during the procedure and the current role of CT and MR in diagnosing relevant procedure-related complications. Practical advice on potential advantages of one imaging modality over the other is discussed for patients with implanted cardiac rhythm devices as well as for planning, intraprocedural integration, and post-interventional management in AF and VT ablation patients. Establishing a team of electrophysiologists and cardiac imaging specialists working on specific details of imaging for complex ablation procedures is key. Cardiac magnetic resonance (CMR) can safely be performed in most patients with implanted active cardiac devices. Standard procedures for pre- and post-scanning management of the device and potential CMR-associated device malfunctions need to be in place. In VT patients, imaging-specifically MR-may help to determine scar location and mural distribution in patients with ischaemic and non-ischaemic cardiomyopathy beyond evaluating the underlying structural heart disease. Future directions in imaging may include the ability to register multiple imaging modalities and novel high-resolution modalities, but also refinements of imaging-guided ablation strategies are expected.
Collapse
Affiliation(s)
- Thomas Deneke
- Clinic for Rhythmology at Klinikum Nürnberg Campus Süd, University Hospital of the Paracelsus Medical University, Nuremberg, Germany
| | | | | | | | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | | | - Helmut Pürerfellner
- Department of Clinical Electrophysiology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Frank R Heinzel
- Städtisches Klinikum Dresden, Department of Cardiology, Angiology and Intensive Care Medicine, Dresden, Germany
| | - Vassil B Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Marta De Riva
- Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Lukas Lehmkuhl
- Department of Radiology, Heart Center RHÖN-KLINIKUM Campus Bad Neustadt, Germany
| | | |
Collapse
|
4
|
Kewcharoen J, Shah K, Bhardwaj R, Contractor T, Turagam MK, Mandapati R, Lakkireddy D, Garg J. New-generation electronic appliances and cardiac implantable electronic devices: a systematic literature review of mechanisms and in vivo studies. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01777-z. [PMID: 38443707 DOI: 10.1007/s10840-024-01777-z] [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: 12/04/2023] [Accepted: 02/27/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Cardiac implantable electronic device (CIED) functions are susceptible to electromagnetic interference (EMI) from electromagnetic fields (EMF). Data on EMI risks from new-generation electronic appliances (EA) are limited. OBJECTIVE We performed a systematic literature review on the mechanisms of EMI, current evidence, and recently published trials evaluating the effect of EMF on CIEDs from electric vehicles (EV), smartphone, and smartwatch technology and summarize its safety data. METHODS Electronic databases, including PubMed and EMBASE, were searched for in vivo studies evaluating EMF strength and incidence between CIEDs and commercial EVs, new-generation smartphones, and new-generation smartwatches. RESULTS A total of ten studies (three on EVs, five on smartphones, one on smartphones, one on smartphones and smartwatches) were included in our systematic review. There was no report of EMI incidence associated with EVs or smartwatches. Magnet-containing smartphones (iPhone 12) can cause EMI when placed directly over CIEDs - thereby triggering the magnet mode; otherwise, no report of EMI was observed with other positions or smartphone models. CONCLUSION Current evidence suggests CIED recipients are safe from general interaction with EVs/HEVs, smartphones, and smartwatches. Strictly, results may only be applied to commercial brands or models tested in the published studies. There is limited data on EMI risk from EVs wireless charging and smartphones with MagSafe technology.
Collapse
Affiliation(s)
- Jakrin Kewcharoen
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Kuldeep Shah
- Division of Cardiology, Cardiac Arrhythmia Service, MercyOne Siouxland Heart and Vascular Center, Sioux City, IA, USA
| | - Rahul Bhardwaj
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Tahmeed Contractor
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Mohit K Turagam
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ravi Mandapati
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | | | - Jalaj Garg
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA.
| |
Collapse
|
5
|
Sticherling C, Ellenbogen KA, Burri H. Stepping back for good reasons: a reappraisal of the DF-1 connector for defibrillator leads. Europace 2024; 26:euae057. [PMID: 38412340 PMCID: PMC10919383 DOI: 10.1093/europace/euae057] [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: 01/04/2024] [Accepted: 02/22/2024] [Indexed: 02/29/2024] Open
Abstract
The DF-4 defibrillator standard has been rapidly adopted due to its convenience at implantation. There are however trade-offs compared to the traditional DF-1 standard that are underappreciated. This viewpoint outlines the advantages and limitations of current defibrillator lead standards that should be kept in mind, as they impact the options that are available to deal with issues that may arise.
Collapse
Affiliation(s)
- Christian Sticherling
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4059 Basel, Switzerland
| | - Kenneth A Ellenbogen
- Department of Electrophysiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Haran Burri
- Department of Cardiology, University Hospital Geneva, Geneva, Switzerland
| |
Collapse
|
6
|
Mircea AA, Donisan T, Feigenberg S, Fradley MG. What do national radiotherapy guidelines for patients with cardiac devices teach us? Heart Rhythm O2 2024; 5:189-193. [PMID: 38560371 PMCID: PMC10980919 DOI: 10.1016/j.hroo.2024.01.008] [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] [Indexed: 04/04/2024] Open
Abstract
The incidence of cardiac implantable electronic device (CIED) malfunctions caused by radiotherapy (RT) is approximately 5%. Although individual national guidelines and expert consensus documents exist, the increased use of RT to treat various cancers points out the need for a standardized document to guide risk assessment and management of CIEDs during RT. We describe potential adverse RT-related events on CIEDs as well as the proposed mechanism of dysfunction. We review the main current guidelines and recommendations, emphasizing similarities and differences.
Collapse
Affiliation(s)
- Andrei Alexandru Mircea
- Electrophysiology and Heart Modeling Institute, Heart Rhythm Disease Institute, Bordeaux, France
| | - Teodora Donisan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Steven Feigenberg
- Radiation Oncology Department, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael G. Fradley
- Thalheimer Center for Cardio-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
7
|
Stankovic I, Voigt JU, Burri H, Muraru D, Sade LE, Haugaa KH, Lumens J, Biffi M, Dacher JN, Marsan NA, Bakelants E, Manisty C, Dweck MR, Smiseth OA, Donal E. Imaging in patients with cardiovascular implantable electronic devices: part 2-imaging after device implantation. A clinical consensus statement of the European Association of Cardiovascular Imaging (EACVI) and the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J Cardiovasc Imaging 2023; 25:e33-e54. [PMID: 37861420 DOI: 10.1093/ehjci/jead273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 10/15/2023] [Accepted: 10/15/2023] [Indexed: 10/21/2023] Open
Abstract
Cardiac implantable electronic devices (CIEDs) improve quality of life and prolong survival, but there are additional considerations for cardiovascular imaging after implantation-both for standard indications and for diagnosing and guiding management of device-related complications. This clinical consensus statement (part 2) from the European Association of Cardiovascular Imaging, in collaboration with the European Heart Rhythm Association, provides comprehensive, up-to-date, and evidence-based guidance to cardiologists, cardiac imagers, and pacing specialists regarding the use of imaging in patients after implantation of conventional pacemakers, cardioverter defibrillators, and cardiac resynchronization therapy (CRT) devices. The document summarizes the existing evidence regarding the role and optimal use of various cardiac imaging modalities in patients with suspected CIED-related complications and also discusses CRT optimization, the safety of magnetic resonance imaging in CIED carriers, and describes the role of chest radiography in assessing CIED type, position, and complications. The role of imaging before and during CIED implantation is discussed in a companion document (part 1).
Collapse
Affiliation(s)
- Ivan Stankovic
- Clinical Hospital Centre Zemun, Department of Cardiology, Faculty of Medicine, University of Belgrade, Vukova 9, 11080 Belgrade, Serbia
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospitals Leuven/Department of Cardiovascular Sciences, Catholic University of Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Haran Burri
- Cardiac Pacing Unit, Cardiology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Leyla Elif Sade
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, PA, USA
- University of Baskent, Department of Cardiology, Ankara, Turkey
| | - Kristina Hermann Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway
- Faculty of Medicine, Karolinska Institutet and Cardiovascular Division, Karolinska University Hospital, Stockholm, Sweden
| | - Joost Lumens
- Cardiovascular Research Center Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Mauro Biffi
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Bologna, Italy
| | - Jean-Nicolas Dacher
- Department of Radiology, Normandie University, UNIROUEN, INSERM U1096-Rouen University Hospital, F 76000 Rouen, France
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, The Netherlands
| | - Elise Bakelants
- Cardiac Pacing Unit, Cardiology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Charlotte Manisty
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Little France Crescent, Edinburgh EH16 4SB, UK
| | - Otto A Smiseth
- Institute for Surgical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, Rennes, France
| |
Collapse
|
8
|
Arbelo E, Protonotarios A, Gimeno JR, Arbustini E, Barriales-Villa R, Basso C, Bezzina CR, Biagini E, Blom NA, de Boer RA, De Winter T, Elliott PM, Flather M, Garcia-Pavia P, Haugaa KH, Ingles J, Jurcut RO, Klaassen S, Limongelli G, Loeys B, Mogensen J, Olivotto I, Pantazis A, Sharma S, Van Tintelen JP, Ware JS, Kaski JP. 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J 2023; 44:3503-3626. [PMID: 37622657 DOI: 10.1093/eurheartj/ehad194] [Citation(s) in RCA: 279] [Impact Index Per Article: 279.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
|
9
|
Defaye P, Biffi M, El-Chami M, Boveda S, Glikson M, Piccini J, Vitolo M. Cardiac pacing and lead devices management: 25 years of research at EP Europace journal. Europace 2023; 25:euad202. [PMID: 37421338 PMCID: PMC10450798 DOI: 10.1093/europace/euad202] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 07/10/2023] Open
Abstract
AIMS Cardiac pacing represents a key element in the field of electrophysiology and the treatment of conduction diseases. Since the first issue published in 1999, EP Europace has significantly contributed to the development and dissemination of the research in this area. METHODS In the last 25 years, there has been a continuous improvement of technologies and a great expansion of clinical indications making the field of cardiac pacing a fertile ground for research still today. Pacemaker technology has rapidly evolved, from the first external devices with limited longevity, passing through conventional transvenous pacemakers to leadless devices. Constant innovations in pacemaker size, longevity, pacing mode, algorithms, and remote monitoring highlight that the fascinating and exciting journey of cardiac pacing is not over yet. CONCLUSION The aim of the present review is to provide the current 'state of the art' on cardiac pacing highlighting the most important contributions from the Journal in the field.
Collapse
Affiliation(s)
- Pascal Defaye
- Cardiology Department, University Hospital and Grenoble Alpes University, CS 10217, Grenoble Cedex 9, Grenoble 38043, France
| | - Mauro Biffi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Mikhael El-Chami
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Serge Boveda
- Clinique Pasteur, Heart Rhythm Department, Toulouse, France
| | - Michael Glikson
- Cardiology Department, Jesselson Integrated Heart Center Shaare Zedek Medical Center and Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Jonathan Piccini
- Duke University, Duke Clinical Research Institute, Durham, NC, USA
| | - 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 Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
10
|
Varma N, Braunschweig F, Burri H, Hindricks G, Linz D, Michowitz Y, Ricci RP, Nielsen JC. Remote monitoring of cardiac implantable electronic devices and disease management. Europace 2023; 25:euad233. [PMID: 37622591 PMCID: PMC10451003 DOI: 10.1093/europace/euad233] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 08/26/2023] Open
Abstract
This reviews the transition of remote monitoring of patients with cardiac electronic implantable devices from curiosity to standard of care. This has been delivered by technology evolution from patient-activated remote interrogations at appointed intervals to continuous monitoring that automatically flags clinically actionable information to the clinic for review. This model has facilitated follow-up and received professional society recommendations. Additionally, continuous monitoring has provided a new level of granularity of diagnostic data enabling extension of patient management from device to disease management. This ushers in an era of digital medicine with wider applications in cardiovascular medicine.
Collapse
Affiliation(s)
- Niraj Varma
- Cardiac Pacing and Electrophysiology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44118, USA
| | | | - Haran Burri
- University Hospital of Geneva, 1205 Geneva, Switzerland
| | | | - Dominik Linz
- Maastricht University Medical Center, 6211 LK Maastricht, The Netherlands
| | - Yoav Michowitz
- Department of Cardiology, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University, Jerusalem 9112001, Israel
| | | | | |
Collapse
|
11
|
Suhail Arain S, Cretnik A, Huemer M, Attanasio P, Nagel P, Landmesser U, Hardt J, Sidhu K, Tscholl V, Roser M. Risk of occurrence of electromagnetic interference from the application of transcutaneous electrical nerve stimulation on the sensing function of implantable defibrillators. Europace 2023; 25:euad206. [PMID: 37487241 PMCID: PMC10365842 DOI: 10.1093/europace/euad206] [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: 12/30/2022] [Accepted: 06/28/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Transcutaneous electrical nerve stimulation (TENS) is an established method for pain relief. But electrical TENS currents are also a source of electromagnetic interference (EMI). Thus, TENS is considered to be contraindicated in implantable cardioverter-defibrillator (ICD) patients. However, data might be outdated due to considerable advances in ICD and cardiac resynchronization therapy (CRT) filtering and noise protection algorithm technologies. The aim of this pilot safety study was to re-evaluate the safety of TENS in patients with modern ICDs. METHODS AND RESULTS One hundred and seven patients equipped with 55 different models of ICD/CRT with defibrillators from 4 manufacturers underwent a standardized test protocol including TENS at the cervical spine and the thorax, at 2 stimulation modes-high-frequency TENS (80 Hz) and burst-mode TENS (2 Hz). Potential interference monitoring included continuous documentation of ECG Lead II, intracardiac electrograms and the marker channel. Electromagnetic interference was detected in 17 of 107 patients (15.9%). Most frequent were: interpretations as a premature ventricular beats (VS/S) in 15 patients (14%), noise reversion in 5 (4.6%) which resulted in temporary asynchronous pacing in 3 (2.8%), interpretation as ventricular tachycardia/ventricular fibrillation in 2 (1.9%), and premature atrial beat in 2 (1.9%) patients. Electromagnetic interference occurrence was influenced by position (chest, P < 0.01), higher current intensity (P < 0.01), and manufacturer (P = 0.012). CONCLUSION Overall, only intermittent and minor EMI were detected. Prior to the use of TENS in patients with ICDs, they should undergo testing under the supervision of a cardiac device specialist.
Collapse
Affiliation(s)
- Saba Suhail Arain
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Hindenburgdamm 30, 12203 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Anja Cretnik
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Hindenburgdamm 30, 12203 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Martin Huemer
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Hindenburgdamm 30, 12203 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Philipp Attanasio
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Hindenburgdamm 30, 12203 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Patrick Nagel
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Ulf Landmesser
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Hindenburgdamm 30, 12203 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Juliane Hardt
- Department of Biometry, Epidemiology and Information Processing, WHO Collaborating Centre for Research and Training for Health in the Human-Animal-Environment Interface, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Kiran Sidhu
- Penn Heart and Vascular Center, Perelman Center for Advanced Medicine, 3400 Civic Center Boulevard, Philadelphia, PA, USA
| | - Verena Tscholl
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Hindenburgdamm 30, 12203 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Mattias Roser
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Hindenburgdamm 30, 12203 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Cardiologisches Centrum Nuernberg, Nuernberg, Germany
| |
Collapse
|
12
|
Prasertwitayakij N, Komolmis T, Gunaparn S, Pisespongsa C, Phrommintikul A, Wongcharoen W, Nantsupawat T. Electromagnetic interference from automobile passive keyless entry in cardiovascular implantable electronic devices. Expert Rev Med Devices 2023; 20:973-977. [PMID: 37668539 DOI: 10.1080/17434440.2023.2255126] [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: 05/30/2023] [Accepted: 08/06/2023] [Indexed: 09/06/2023]
Abstract
INTRODUCTION The automobile passive keyless entry (PKE) system is a potential source of electromagnetic interference (EMI). We aim to determine the incidence and significance of EMI from automobile PKE system in cardiovascular implantable electronic device (CIED) patients. METHODS This was a single-center cross-sectional study conducted at Maharaj Nakorn Chiang Mai hospital, Thailand. Patients with CIED were instructed to lock and unlock two automobiles using the PKE system. Any EMI or arrhythmias were detected by CIED interrogation and single-lead electrocardiogram event recorder. We also used a spectrum analyzer to identify the automobiles working frequency bandwidth. RESULTS There was a total of 102 CIED patients. Device types included 48.0% defibrillators, 37.3% permanent pacemakers, and 14.7% cardiac resynchronization therapy device. Both interrogated data from device and event monitor revealed no incidence of EMI during the PKE activation. We failed to identify the working frequency bandwidth of the two studied cars due to very low signal strength, thus blended in with the background noise. CONCLUSIONS Automobile PKE systems transmitted very low power signals. Therefore, under normal circumstances, CIED patients can use automobile PKE system safely without any EMI regardless of key fob positions in relation to the CIED pulse generator. TRIAL REGISTRATION The study was registered at ClinicalTrials.gov (https://clinicaltrials.gov), and the identification number is NCT03016390.
Collapse
Affiliation(s)
- Narawudt Prasertwitayakij
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Taradol Komolmis
- Department of Electrical Engineering, Faculty of Engineering, Chiang Mai University, Chiang Mai, Thailand
| | - Siriluck Gunaparn
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Cheeranun Pisespongsa
- Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Arintaya Phrommintikul
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wanwarang Wongcharoen
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Teerapat Nantsupawat
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
13
|
Guenneugues R, Henckes A, Mansourati V, Mansourati J. Effects of hyperbaric exposure on mechanical and electronic parameters of implantable cardioverter-defibrillators. Europace 2023; 25:euad134. [PMID: 37208302 PMCID: PMC10198771 DOI: 10.1093/europace/euad134] [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: 03/23/2023] [Accepted: 04/28/2023] [Indexed: 05/21/2023] Open
Abstract
AIMS Hyperbaric oxygen therapy (HBOT) is the standard adjuvant treatment for life-threatening or disabling pathologies. Currently, mechanical and electronic variations of implantable cardioverter-defibrillators (ICD) in hyperbaric conditions have not been evaluated. As a result, many patients eligible for HBOT but ICD recipients cannot undergo this therapy, even in emergency situations. METHODS AND RESULTS Twenty-two explanted ICD of various brands and models were randomized in two groups: single hyperbaric exposure at an absolute pressure of 4000 hPa and 30 iterative hyperbaric exposures at an absolute pressure of 4000 hPa. Mechanical and electronic parameters of these ICD were blindly assessed before, during, and after hyperbaric exposures. Regardless of the hyperbaric exposure, we could not find any mechanical distortion, inappropriate occurrence of anti-tachycardia therapies, dysfunction of tachyarrhythmia therapeutic programming, or dysfunction of programmed pacing parameters. CONCLUSION Dry hyperbaric exposure seems harmless on ICD tested ex vivo. This result may lead to a reconsideration of the absolute contraindication of emergency HBOT to ICD recipients. A real-life study in these patients with an indication to HBOT should be performed to assess their tolerance to the treatment.
Collapse
Affiliation(s)
- Romain Guenneugues
- Hyperbaric Medicine Unit, University Hospital of Brest, Bvd Tanguy Prigent, 29609 Brest Cedex, France
| | - Anne Henckes
- Hyperbaric Medicine Unit, University Hospital of Brest, Bvd Tanguy Prigent, 29609 Brest Cedex, France
| | - Vincent Mansourati
- Department of Cardiology, University Hospital of Brest, Bvd Tanguy Prigent, 29609 Brest Cedex, France
| | - Jacques Mansourati
- Department of Cardiology, University Hospital of Brest, Bvd Tanguy Prigent, 29609 Brest Cedex, France
| |
Collapse
|
14
|
The impact of particle radiotherapy on the functioning of cardiac implantable electronic devices: a systematic review of in vitro and in vivo studies according to PICO criteria. Radiol Med 2022; 127:1046-1058. [PMID: 35871428 PMCID: PMC9508006 DOI: 10.1007/s11547-022-01520-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 06/20/2022] [Indexed: 12/24/2022]
Abstract
The number of oncological patients who may benefit from proton beam radiotherapy (PBT) or carbon ion radiotherapy (CIRT), overall referred to as particle radiotherapy (RT), is expected to strongly increase in the next future, as well as the number of cardiological patients requiring cardiac implantable electronic devices (CIEDs). The management of patients with a CIED requiring particle RT deserves peculiar attention compared to those undergoing conventional photon beam RT, mostly due to the potential generation of secondary neutrons by particle beams interactions. Current consensus documents recommend managing these patients as being at intermediate/high risk of RT-induced device malfunctioning regardless of the dose on the CIED and the beam delivery method used, despite the last one significantly affects secondary neutrons generation (very limited neutrons production with active scanning as opposed to the passive scattering technique). The key issues for the current review were expressed in four questions according to the Population, Intervention, Control, Outcome criteria. Three in vitro and five in vivo studies were included. Based on the available data, PBT and CIRT with active scanning have a limited potential to interfere with CIED that has only emerged from in vitro study so far, while a significant potential for neutron-related, not severe, CIED malfunctions (resets) was consistently reported in both clinical and in vitro studies with passive scattering.
Collapse
|