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Jiménez-Candil J, Oterino A, Cruz Galbán A, Hernández J, Moriñigo JL, Sánchez García M, Sánchez PL. Outcomes of a 24/7 service for urgent permanent pacemaker implantation. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024:S1885-5857(24)00102-6. [PMID: 38521441 DOI: 10.1016/j.rec.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION AND OBJECTIVES Most of the complications associated with acute and symptomatic bradyarrhythmia (ASB) occur in the time from diagnosis to permanent pacemaker implantation (PPI). We aimed to evaluate the outcomes of an urgent 24/7 PPI service (PPI-24/7) for patients with ASB. METHODS A total of 664 patients undergoing first-time PPI for ASB were prospectively assessed during 2 periods of identical length (18 months): 341 patients who underwent the procedure during working hours only (PPI-WH), and 323 patients who underwent the procedure after the implementation of the PPI-24/7 service. The primary safety endpoint was established as the cumulative 180-day incidence of complications related to the index arrhythmia and device implant. The primary efficacy endpoint was determined as the average number of hospital stays per patient. RESULTS The PPI-24/7 period was associated with a significant shortening of the time from diagnosis to implantation (median [interquartile range]): 3hours [2-6] vs 16 [5-21]). The cumulative incidence of patients with complications at 180 days was lower in the PPI-24/7 period: 9% vs 17% (adjusted odds ratio, 0.5; P=.002), due to a significant reduction in preimplant complications: 2.5% vs 12% (P <.001). The average number of hospital stays was reduced by 2 per patient in the PPI-24/7 period (nonparametric P <.001). PPI-24/7 implants performed outside working hours (n=178) were safe, with a 180-day cumulative incidence in procedure-related complications of 3.9%. CONCLUSIONS Among patients with ASB, PPI-24/7 was associated with a significant reduction in patient morbidity and efficient hospital resource use.
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Affiliation(s)
- Javier Jiménez-Candil
- Servicio de Cardiología, Instituto de Investigación Biomédica de Salamanca (IBSAL), Hospital Universitario de Salamanca, Salamanca, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain.
| | - Armando Oterino
- Servicio de Cardiología, Instituto de Investigación Biomédica de Salamanca (IBSAL), Hospital Universitario de Salamanca, Salamanca, Spain
| | - Alba Cruz Galbán
- Servicio de Cardiología, Instituto de Investigación Biomédica de Salamanca (IBSAL), Hospital Universitario de Salamanca, Salamanca, Spain
| | - Jesús Hernández
- Servicio de Cardiología, Instituto de Investigación Biomédica de Salamanca (IBSAL), Hospital Universitario de Salamanca, Salamanca, Spain
| | - José Luis Moriñigo
- Servicio de Cardiología, Instituto de Investigación Biomédica de Salamanca (IBSAL), Hospital Universitario de Salamanca, Salamanca, Spain; Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - Manuel Sánchez García
- Servicio de Cardiología, Instituto de Investigación Biomédica de Salamanca (IBSAL), Hospital Universitario de Salamanca, Salamanca, Spain
| | - Pedro L Sánchez
- Servicio de Cardiología, Instituto de Investigación Biomédica de Salamanca (IBSAL), Hospital Universitario de Salamanca, Salamanca, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
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Mustafa B, Butt H, Khan MS, Rashid S, Noor TA, Alam S, Ashraf W, Malik J. Social determinants of pacemaker reuse among patients and family members in Pakistan. Expert Rev Cardiovasc Ther 2023; 21:145-150. [PMID: 36745028 DOI: 10.1080/14779072.2023.2177636] [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] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This survey aimed to quantify the opinions of CIED reuse among patients and family members in Pakistan and to identify the social determinants which may predict these views. METHODS A questionnaire formulating attitudes toward PPM reuse was administered to patients and family members at cardiology institutes in Pakistan from 1 July 2022 to 30 September 2022. The eligibility criteria (age > 18 years; inline for PPM placement) were taken into account and incomplete responses were excluded from the final analysis. RESULTS A total of 9,246 participants recorded their responses, of which 7,152 (78.16%) accepted pre-used PPMs. The lower social class had more PPM reuse acceptance rate than the middle and upper class (92.72% vs. 60.52% vs. 35.38%), respectively. Age ≥ 65 (OR(95%CI): 0.68 (0.41-0.99); P-value = 0.023), male gender (OR(95%CI): 0.55 (0.35-0.72), P-value = 0.016), unemployment (OR(95%CI): 0.47 (0.25-0.64); P-value = 0.007), poor health status (OR(95%CI): 0.72 (0.53-0.92); P-value = 0.041), and lower social class (OR(95%CI): 0.36 (0.28-0.53); P-value = 0.003) were social determinants of PPM reuse acceptance. CONCLUSION Patients and their family members endorse the concept of PPM reuse in Pakistan who cannot afford new devices.
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Affiliation(s)
- Bilal Mustafa
- Department of Cardiology, Akbar Niazi Teaching Hospital, Islamabad, Pakistan
| | - Hamza Butt
- Department of Medicine, Services Hospital, Lahore, Pakistan
| | | | - Sarim Rashid
- Department of General Surgery, East Lancashire NHS Trust, Lancashire, UK
| | | | - Shafiq Alam
- Department of Cardiology, Mardan Medical Complex, Mardan, Pakistan
| | - Waheed Ashraf
- Department of Cardiology, Abbas Institute of Medical Sciences, Muzaffarabad, Pakistan
| | - Jahanzeb Malik
- Department of Clinical Electrophysiology, Cardiovascular Analytics Group, Hong Kong, China
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Barbosa MC, Cirillo W, Piza F, Figueiredo MJO, Silvestre OM, Fernandes-Silva MM, Schreiber R, Oliveira MFRA, Oliveira PPM, Silveira-Filho LM, Petrucci O, Coelho-Filho OR, Matos-Souza JR, Sposito AC, Nadruz W. Determinants and prognostic value of in-hospital infection in patients waiting for permanent pacemaker implantation. Int J Cardiol 2023; 370:204-208. [PMID: 36288783 DOI: 10.1016/j.ijcard.2022.10.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 09/08/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND In-hospital delays in permanent cardiac pacemaker (PPM) implantation are common and may result in in-hospital infection among patients waiting for PPM implantation (pre-PPM-HI). This study investigated the predictors and prognostic impact of these events. METHODS We retrospectively evaluated 905 consecutive patients (68.2 ± 16.0 years; 54% males) who underwent PPM implantation. Clinical characteristics, pre-PPM-HI and 30-day mortality were recorded and a risk score for pre-PPM-HI was generated using multivariable logistic regression coefficients. RESULTS Eigthy-nine patients (10% of the sample) developed pre-PPM-HI. Multivariable logistic regression analysis identified urinary catheter use, complete atrioventricular block, implantation of temporary pacemaker and diabetes mellitus as independent predictors of pre-PPM-HI. The generated score (range 0-10.1) played a better role in predicting pre-PPM-HI than individual factors, yielding an area under the curve [95%CI] of 0.754 [0.705-0.803]. Patients with score ≥ 7.5 had 18-fold greater risk of developing pre-PPM-HI than those with score < 2.5. Furthermore, multivariable Cox-regression analysis showed that patients who developed pre-PPM-HI had greater 30-day mortality after PPM implantation (hazard ratio [95%CI] = 2.90 [1.18-7.16], p = 0.021) compared with their counterparts. CONCLUSIONS This study reveals that pre-PPM-HI is an independent predictor of early mortality after PPM implantation. In addition, a clinical score developed from simple clinical variables accurately identified patients at high risk of pre-PPM-HI. In scenarios where delays in PPM implantation are unavoidable, such as reference hospitals with high demand, the use of this tool can potentially help in the hierarchy of patients and in the reduction of this adverse event.
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Affiliation(s)
- Matheus C Barbosa
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | - Willian Cirillo
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | - Fernando Piza
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | - Marcio J O Figueiredo
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | | | | | - Roberto Schreiber
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | - Matheus F R A Oliveira
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | - Pedro P M Oliveira
- Department of Surgery, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | | | - Orlando Petrucci
- Department of Surgery, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | - Otavio R Coelho-Filho
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | - José R Matos-Souza
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | - Andrei C Sposito
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | - Wilson Nadruz
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo, Brazil.
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Papp SER, Torres ALNE, Vasquez AEL, Gioli-Pereira L. Complications associated with the use of temporary pacemaker in patients waiting for definitive device implantation. EINSTEIN-SAO PAULO 2022; 20:eAO8013. [PMID: 35766673 PMCID: PMC9239569 DOI: 10.31744/einstein_journal/2022ao8013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/02/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To determine the rate of complications associated with the use of temporary pacemakers in patients in the waiting list for the definitive pacemaker implantation in a public hospital located in São Paulo, SP, Brazil. METHODS Retrospective observational study based on data extracted from medical records of patients admitted to Hospital Municipal Dr. Moyses Deutsch, Hospital Israelita Albert Einstein from January 2014 to December 2018. Patients aged 18 years or older, diagnosed with high degree atrioventricular block upon admission and with indications for definitive pacemaker implantation were included. All-cause mortality, clinical and surgical complications and length of hospital stay while waiting for the procedure were defined as primary outcomes. RESULTS The sample comprised 66 patient allocated to one of two groups: with and without the need of temporary pacemaker while in hospital (n=45 and n=21, respectively). The rate of complications was higher in patients who used a temporary pacemaker (p<0.001). These included primarily pneumonia (p=0.048) and length of hospital stay (p=0.029). CONCLUSION Patients who required a temporary pacemaker stayed longer in hospital. Longer hospital stay is associated with higher rates of general complications and all-cause mortality.
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Affiliation(s)
- Silvana Ellen Ribeiro Papp
- Hospital Municipal Dr. Moysés Deutsch Hospital Municipal Dr. Moysés Deutsch; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Hospital Israelita Albert EinsteinSão PauloSPBrazil
| | - Aymée Lustosa Nogueira e Torres
- Hospital Municipal Dr. Moysés Deutsch Hospital Municipal Dr. Moysés Deutsch; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Hospital Israelita Albert EinsteinSão PauloSPBrazil
| | - Andres Eduardo Larrovere Vasquez
- Hospital Municipal Dr. Moysés Deutsch Hospital Municipal Dr. Moysés Deutsch; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Hospital Israelita Albert EinsteinSão PauloSPBrazil
| | - Luciana Gioli-Pereira
- Hospital Municipal Dr. Moysés Deutsch Hospital Municipal Dr. Moysés Deutsch; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Hospital Israelita Albert EinsteinSão PauloSPBrazil
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Chatterjee P, Sharma AK, Pratap P, Dabas A, Mishra B, Mehare S. Salvage of Infected Cardiac Implantable Electrical Devices with Subpectoral Plane Pocket Revision. Indian J Plast Surg 2021; 54:344-349. [PMID: 34667522 PMCID: PMC8515336 DOI: 10.1055/s-0041-1735417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction
Infection of cardiac implantable electrical devices (CIEDs) may lead to serious complications. Complete CIED explantation is expensive, requires expertise, not free from complications, and may not be an option in patients with device dependence.
Aim
To highlight that carefully selected infected CIEDs can be salvaged by placing the device in a subpectoral pocket below the pectoralis major muscle. We conducted a retrospective descriptive observational study.
Material and Methods
Twelve patients (10 male and two female) with erosion, exposure or infection of infraclavicular, subcutaneously placed CIED were treated over a 30-month period between July 2018 and December 2020. The technique involved debridement and excision of a peridevice capsule, creating a subpectoral pocket beneath the pectoralis major muscle, and placing the CIED in a new pocket with total muscle coverage and closure of skin without tension.
Results
Twelve patients (
m
= 10;
f
= 2) with a mean age of 65 years (range, 46–82 years) presented with infection of CIED within 9 months of implantation. None had sepsis or endocarditis. In nine patients, CIEDs were successfully salvaged with relocation to subpectoral pocket. Mean follow-up was 20 months (range, 8–30 months). Three out of 12 developed reinfection that ultimately required CIED explantation. There was no mortality.
Conclusion
In the absence of sepsis or endocarditis, infected CIEDs may be attempted at salvage by subpectoral pocket placement. This obviates the need for potentially risky explantation or replacement of expensive CIEDs.
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Affiliation(s)
- Pallab Chatterjee
- Department of Plastic and Reconstructive Surgery, Army Hospital (R & R) Delhi Cantt, India
| | | | - Pranay Pratap
- Department of Plastic and Reconstructive Surgery, Army Hospital (R & R) Delhi Cantt, India
| | - Ajay Dabas
- Department of Surgery, Command Hospital (NC), Udhampur, Jammu and Kashmir, India
| | - Bharat Mishra
- Department of Plastic and Reconstructive Surgery, Army Hospital (R & R) Delhi Cantt, India
| | - Samiksha Mehare
- Department of Plastic and Reconstructive Surgery, Army Hospital (R & R) Delhi Cantt, India
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Application of the improved simple bedside method for emergency temporary pacemaker implantation suitable for primary hospitals. Sci Rep 2021; 11:16850. [PMID: 34413394 PMCID: PMC8377026 DOI: 10.1038/s41598-021-96338-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/09/2021] [Indexed: 11/09/2022] Open
Abstract
The purpose of the research was to evaluate the safety and effectiveness of the X-ray-free improved simple bedside method for emergency temporary pacemaker implantation as well as the practicability of the method in primary hospitals. Patients [including those suffering from sick sinus syndrome and third-degree and advanced atrioventricular blockage (AVB)] who needed emergency temporary pacemaker implantation from July 2017 to August 2020 in Hunan Provincial People’s Hospital were selected. They were stochastically divided into a research group (95 cases) treated with the improved simple bedside method and a control group (95 cases) with X-ray guidance. The ordinary bipolar electrodes were used in both groups. On this condition, the operation duration, the first-attempt success rate of electrodes, pacing threshold, success rate of the operation, the rate of electrode displacement, and complications in the two groups were separately calculated. The comparison results of the research group with the control group are shown as follows: operation time [(18 ± 5.91) min vs. (43 ± 2.99) min, P < 0.05], the first-attempt success rate of the electrode (97% vs. 98%, P > 0.05), pacing threshold [(0.97 ± 0.35) vs. (0.97 ± 0.32) V, P > 0.05], success rate of the operation (98.9% vs. 100%, P > 0.05), the rate of electrode displacement (8.4% vs. 7.3%, P > 0.05) and complications (3.2% vs. 2.1%, P > 0.05). The emergency temporary pacemaker implantation based on the improved simple bedside method is as safe and effective as the surgical method under X-ray guidance, and the operation is simpler and easier to learn and requires a shorter operating time, therefore, it is more suitable for use in emergency and primary hospitals.
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Abrich VA, Le RJ, Mulpuru SK, Friedman PA, Barsness GW, Cha YM, Lennon RJ, Lewis BR, Yang EH. Clinical Outcomes of Various Management Strategies for Symptomatic Bradycardia. Clin Med Res 2020; 18:75-81. [PMID: 32060043 PMCID: PMC7428208 DOI: 10.3121/cmr.2019.1507] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 08/09/2019] [Accepted: 12/03/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To determine clinical outcomes of various management strategies for reversible and irreversible causes of symptomatic bradycardia in the inpatient setting. DESIGN Retrospective observational study. SETTING Emergency room and inpatient. PARTICIPANTS Patients presenting to the emergency department with symptomatic bradycardia. METHODS We retrospectively reviewed electronic health records of 518 patients from two Mayo Clinic campuses (Rochester and Phoenix) who presented to the emergency department with symptomatic bradycardia (heart rate ≤50 beats/minute) from January 1, 2010 through December 31, 2015. Sinus bradycardia was excluded. The following management strategies were compared: observation, non-invasive management (medications with/without transcutaneous pacing), early permanent pacemaker (PPM) implantation (≤2 days), and delayed PPM implantation (≥3 days). Study endpoints included length of stay and adverse events related to bradycardia (syncope, central line-associated bloodstream infections, cardiac arrest, and in-hospital mortality). Patients who received a PPM were further stratified by weekend hospital admission. RESULTS Heart block occurred in 200 (38.6%) patients, and atrial arrhythmias with slow ventricular response occurred in 239 (46.1%) patients. Reversible causes of bradycardia included medication toxicity in 22 (4.2%) patients and hyperkalemia in 44 (8.5%) patients. Adverse events were similar in patients who underwent early compared to delayed PPM implantation (6.6% vs 12.5%, P=.20), whereas adverse events were higher in patients who received temporary transvenous pacing (19.1% vs 3.4%, P<.001). Weekend admissions were associated with increased temporary transvenous pacing, prolonged median time to PPM implantation by 1 day, and prolonged median length of stay by 2 days. CONCLUSIONS Delayed PPM implantation was not associated with an increase in adverse events. Weekend PPM implantation should be considered to reduce temporary transvenous pacing and shorten length of stay.
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Affiliation(s)
- Victor A Abrich
- Division of Cardiovascular Diseases, Mayo Clinic Hospital, Phoenix, Arizona, USA; Current affiliation: MercyOne Waterloo Heart Care, Waterloo, Iowa, USA
| | - Rachel J Le
- Providence Spokane Cardiology, Spokane, Washington, USA
| | - Siva K Mulpuru
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul A Friedman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Gregory W Barsness
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Yong-Mei Cha
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan J Lennon
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Bradley R Lewis
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric H Yang
- Division of Cardiovascular Diseases, Mayo Clinic Hospital, Phoenix, Arizona, USA; Current affiliation: MercyOne Waterloo Heart Care, Waterloo, Iowa, USA
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Irfan M, Khan I, Ullah Bacha K. Delays in Temporary and Permanent Pacemakers: Causes and In-Hospital Outcomes. Cureus 2020; 12:e6953. [PMID: 32190503 PMCID: PMC7067517 DOI: 10.7759/cureus.6953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Temporary pacemakers frequently serve as a bridge to permanent pacemakers, but placement of the latter may be delayed. This study assessed the causes and in-hospital outcomes of patients with delayed placement of permanent pacemakers. Methods This retrospective study included all patients admitted to the Emergency Department who underwent temporary transvenous pacing in the Department of Cardiology, Lady Reading Hospital, Peshawar, Pakistan. The duration of hospitalization and the time from temporary to permanent placement were calculated in days. Asystole, infections, cardiac arrest, and death were recorded during the waiting period. Results Of the 260 patients who underwent temporary transvenous pacing, 136 (52.3%) were males and 124 (47.7%) were females, with an age range of 46-78 years. Coronary artery disease was prevalent in 34% of the patients. Only 5% of the patients were on arteriovenous (AV) nodal blocking agents, 44% had complete AV block, 22% had sinus node disease, and 14% had slow atrial fibrillation. The cause of high-degree AV block could not be determined in most patients. Most patients with ischemia- and hyperkalemia-induced AV block recovered. AV blocks induced by ischemia and with no known cause were not reversible, with most of these patients receiving permanent pacemakers. Of the 260 patients with high-degree AV block, 165 (63.5%) recovered. The mean waiting time for permanent pacemaker implantation was 8.7 ± 5.4 days. The waiting time was associated with increased infections and adverse hospital course. Conclusion A longer waiting period between permanent pacemaker indication and implantation is dangerous, as it is associated with an increased risk of adverse events such as infections, syncope, asystole, malignant arrhythmias, cardiac arrest, and death.
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Affiliation(s)
| | - Imran Khan
- Cardiology/Clinical Cardiac Electrophysiology, Lady Reading Hospital, Peshawar, PAK
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay. Heart Rhythm 2019; 16:e128-e226. [DOI: 10.1016/j.hrthm.2018.10.037] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Indexed: 12/13/2022]
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10
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2019; 140:e382-e482. [DOI: 10.1161/cir.0000000000000628] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | | | - Kenneth A. Ellenbogen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- ACC/AHA Representative
| | - Michael R. Gold
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- HRS Representative
| | | | | | - José A. Joglar
- ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | | | | | | | | | | | | | - Cara N. Pellegrini
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- HRS Representative
- Dr. Pellegrini contributed to this article in her personal capacity. The views expressed are her own and do not necessarily represent the views of the US Department of Veterans Affairs or the US government
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11
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay. J Am Coll Cardiol 2019; 74:e51-e156. [DOI: 10.1016/j.jacc.2018.10.044] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Narasimhan C, Sanyal J, Sethi R, Kothari Y, Malik FTN, Pandurangi U, Khan N, Sahu S, Lande J, Sachanandani H, Naik A. Under-utilization of pacemaker therapy for sinus node dysfunction - Real world data from South Asia. Indian Heart J 2017; 69:607-612. [PMID: 29054184 PMCID: PMC5650562 DOI: 10.1016/j.ihj.2017.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 02/20/2017] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Chronic symptomatic sinus node dysfunction (SND), the most common bradyarrhythmia, can be effectively managed by permanent cardiac pacing. Yet the care pathway and barriers to adoption of pacing therapy are not well understood - particularly in low volume implanting countries. The IMPROVE Brady study is a quality improvement initiative being conducted at centers in South Asia, Latin America, and Russia. We assessed the rates of SND diagnosis and pacemaker treatment for SND in the South Asia cohort. METHODS The prospective study enrolled patients with heart rate of ≤50 beats per minute presenting with symptoms including syncope, dizziness, and/or dyspnea from ten centers in India and Bangladesh. Patients were followed to identify the proportion diagnosed with SND and subsequently treated with pacemaker therapy. RESULTS A total of 508 patients meeting criteria were enrolled and followed on average for 8.3±8.0months. Patients were on average 58 years of age, 77% were male, and 91% had completed at least primary education. An SND diagnosis was made in 368 (72%) of patients, with the majority (80%) of diagnoses occurring within 1 month of enrollment. Of the patients with an SND diagnosis, 63 (17%) were treated with a pacemaker. Reasons for not receiving treatment were: subject refusal or deferred decision (45%), unaffordability (34%), physician determined - not-indicated (20%), and other (1%). Older age, female gender, history of hypertension, lower resting heart rate, and syncopal or pre-syncopal symptoms were associated with a higher probability of implant. CONCLUSIONS In a care pathway assessment for the diagnosis and treatment of symptomatic SND in South Asia only 1 in 6 patients received pacemaker indicated therapy, largely due to patient refusal and physician decision. Phase II of the study will be aimed to improve this treatment rate.
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Affiliation(s)
- C Narasimhan
- Division of Electrophysiology, Department of Cardiology, CARE Hospitals and CARE Foundation, Hyderabad, India.
| | - J Sanyal
- Mission Hospital, Bidhannagar Durgapur, West Bengal, India
| | - R Sethi
- King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Y Kothari
- RajaRajeswari Medical College & Hospital, Bangalore, Karnataka, India
| | - F T N Malik
- National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - U Pandurangi
- Madras Medical Mission Institute of Cardiovascular Diseases, Chennai, Tamil Nadu, India
| | - N Khan
- United Hospital Limited, Dhaka, Bangladesh
| | - S Sahu
- India Medtronic Pvt. Ltd., Mumbai, Maharashtra, India
| | - J Lande
- Medtronic plc, Mounds View, MN, USA
| | | | - A Naik
- Care Institute of Medical Sciences, Ahmedabad, Gujarat, India
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Freitas Nunes Goldoni L, Louise Sales R, Scarduelli Luciano K, Kraus A, de March Ronsoni R. Registro Epidemiológico de Implante de Marcapasso Cardíaco Permanente em um Centro de Referência. JOURNAL OF CARDIAC ARRHYTHMIAS 2016. [DOI: 10.24207/jca.v32n4.112_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objetivo: Identificar o perfil dos pacientes que implantaram marcapasso e as suas complicações em um centro terciário de cardiologia do estado de Santa Catarina. Métodos: Estudo unicêntrico, observacional e prospectivo com 81 pacientes submetidos a implante de marcapasso pelo Serviço de Cirurgia Cardiovascular. Resultados: Marcapasso provisório foi necessário em 42 casos (51,8%) e o tempo médio de permanência do marcapasso provisório foi de 2,2 dias. Óbito ocorreu em 3 pacientes (3,7%), entretanto apenas 1 caso (1,2%) foi associado ao implante.Conclusão: As características clínicas e as indicações do implante da população do estudo foram semelhantes às encontradas na literatura, entretanto o número de complicações mostrou-se elevado e o tempo de permanência do marcapasso provisório está além do recomendado
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Affiliation(s)
| | - Rafaela Louise Sales
- Hospital Regional Hans Dieter Schmidt – Setor de Cardiologia – Joinville (SC), Brazil
| | | | - Alessandra Kraus
- Hospital Regional Hans Dieter Schmidt – Setor de Cardiologia – Joinville (SC), Brazil
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14
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Freitas Nunes Goldoni L, Louise Sales R, Scarduelli Luciano K, Kraus A, de March Ronsoni R. Epidemiological Record of Permanent Artificial Cardiac Pacemaker Implant at a Reference Center. JOURNAL OF CARDIAC ARRHYTHMIAS 2016. [DOI: 10.24207/jca.v32n4.112_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective: To identify the profile of patients who implanted pacemakers and their complications in a tertiary cardiology center in the state of Santa Catarina. Methods: Unicentric, observational and prospective study with 81 patients submitted to pacemaker implantation by the Cardiovascular Surgery Service. Results: Provisional pacemaker was necessary in 42 cases (51.8%) and the average time of temporary pacemaker insertion was 2.2 days. Death occurred in 3 patients (3.7%), however only 1 case (1.2%) was associated with the implant. Conclusion: The clinical characteristics and indications of the implant in the study population were similar to those found in the literature, however the number of complications was high and the length of stay of the provisional pacemaker is beyond that recommended.
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Affiliation(s)
| | - Rafaela Louise Sales
- Hospital Regional Hans Dieter Schmidt – Setor de Cardiologia – Joinville (SC), Brazil
| | | | - Alessandra Kraus
- Hospital Regional Hans Dieter Schmidt – Setor de Cardiologia – Joinville (SC), Brazil
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Sullivan BL, Bartels K, Hamilton N. Insertion and Management of Temporary Pacemakers. Semin Cardiothorac Vasc Anesth 2015; 20:52-62. [PMID: 26134176 DOI: 10.1177/1089253215584923] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Temporary pacemakers are used in a variety of critical care settings. These life-saving devices are reviewed in 2 major categories in this review: first, the insertion and management of epicardial pacemakers after and during cardiac surgery; and second, the insertion of transvenous temporary pacemakers for the emergent treatment of bradyarrhythmias. Temporary epicardial pacemakers are used routinely in patients recovering from cardiac surgery. Borrowing from advances in cardiac resynchronization therapy there are many theoretical and untested benefits to pacing the postoperative cardiac surgery patient. Temporary transvenous pacing is traditionally an emergency procedure to stabilize patients suffering from hemodynamically unstable bradyarrhythmia. We review the traditional and expanding use of transvenous pacemakers inside and outside the operating room.
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Bradshaw PJ, Stobie P, Einarsdóttir K, Briffa TG, Hobbs MST. Using quality indicators to compare outcomes of permanent cardiac pacemaker implantation among publicly and privately funded patients. Intern Med J 2015; 45:813-20. [PMID: 25851227 DOI: 10.1111/imj.12762] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 03/30/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Funding source/insurance status has been associated with disparity in the management and outcomes of cardiovascular disease, with poorer outcomes among disadvantaged groups. AIM Using proposed quality indicators for permanent pacemaker (PPM) implantation and administrative data, this study aimed to determine whether quality indicator-based outcomes of PPM implantation were comparable for publicly and privately funded patients within Australia's two-tier health system. METHODS A population-based cohort study of adults implanted with a PPM between 1995 and 2009 in Western Australia. The association of funding outcomes derived from linked administrative data was tested in multivariate logistic regression models. RESULTS There were 9748 PPMs implanted, 48% being among privately funded patients. The mean age was 75 years for both public and private patients. Private patients had better health status (fewer with cardiac conditions and lower non-cardiac comorbidity scores), were less likely to be an emergency admission (33% vs 60%, P < 0.001) and more likely to have dual- or triple-chamber pacing. Mean length of stay was significantly greater for private patients (4.3 (standard deviation 6.3) vs 5.1 (6.8) days <0.001), related to longer elective admissions. Crude mortality was lower for private patients in-hospital (0.7 vs 1.3%), 30-day post-procedure (1.3 vs 2.1%) and at 1 year (7.3 vs 9.5%). Emergency admission, comorbidity and other demographic and clinical factors, not funding source, were significant predictors of these outcomes. CONCLUSIONS There was no difference between publicly and privately funded patients in study outcomes, after adjustment for demographic and clinical factors. The exception was longer hospital stay for elective PPM among privately funded patients.
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Affiliation(s)
- P J Bradshaw
- Cardiovascular Research Group, The University of Western Australia, Perth, Western Australia, Australia
| | - P Stobie
- School of Medicine and Pharmacology, Sir Charles Gairdner Hospital and The University of Western Australia, Perth, Western Australia, Australia
| | - K Einarsdóttir
- Centre for Health Services Research, School of Population Health, The University of Western Australia, Perth, Western Australia, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - T G Briffa
- Cardiovascular Research Group, The University of Western Australia, Perth, Western Australia, Australia
| | - M S T Hobbs
- Cardiovascular Research Group, The University of Western Australia, Perth, Western Australia, Australia
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Nielsen JC, Gerdes JC, Varma N. Infected cardiac-implantable electronic devices: prevention, diagnosis, and treatment. Eur Heart J 2015; 36:2484-90. [DOI: 10.1093/eurheartj/ehv060] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 02/23/2015] [Indexed: 11/14/2022] Open
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18
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Association between hospital procedure volume and early complications after pacemaker implantation: results from a large, unselected, contemporary cohort of the German nationwide obligatory external quality assurance programme. Europace 2015; 17:787-93. [DOI: 10.1093/europace/euv003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 01/05/2015] [Indexed: 11/14/2022] Open
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Palmisano P, Accogli M, Zaccaria M, Vergari A, De Masi GDL, Negro L, De Blasi S. Relationship between seasonal weather changes, risk of dehydration, and incidence of severe bradyarrhythmias requiring urgent temporary transvenous cardiac pacing in an elderly population. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2014; 58:1513-1520. [PMID: 24146304 DOI: 10.1007/s00484-013-0755-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 07/27/2013] [Accepted: 09/29/2013] [Indexed: 06/02/2023]
Abstract
There is little information on any seasonal variations or meteorological factors associated with symptomatic bradyarrhythmias requiring cardiac pacing. The aim of this single-center study was to investigate the seasonal distribution of the incidence of severe, life-threatening bradyarrhythmias requiring urgent temporary transvenous cardiac pacing in an elderly population. Consecutive patients who underwent urgent temporary transvenous cardiac pacing between 2007 and 2012 were enrolled. The baseline characteristics of the patients and some meteorological parameters, including the calculation the daily heat index (HI), were recorded. During the study period, 79 consecutive patients (mean age 82 ± 8 years, 41% male) underwent urgent temporary transvenous cardiac pacing, mainly for third-degree atrioventricular block (79%). The incidence of bradyarrhythmias was significantly higher in summer than in the other seasons (P < 0.001). Moreover, the highest incidence was observed in months with HI > 90 °F for >3 h per day for at least 10 days (P < 0.001). A direct correlation was found between the average monthly temperature and the monthly number of patients undergoing temporary cardiac pacing (r = 0.54, P < 0.001). Compared with other patients, those observed during the hottest months were significantly older and more frequently affected by chronic disabling neurological diseases (all P < 0.05). In addition, they more frequently showed biochemical indices of dehydration, renal function impairment and hyperkalemia (all P < 0.05). This study showed an increased incidence of severe bradyarrhythmias in an elderly population during the hottest months of the year. In these months, in subjects characterized by increased susceptibility to dehydration, the risk of developing bradyarrhythmias was increased significantly.
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Affiliation(s)
- Pietro Palmisano
- Cardiology Unit, "Card. G. Panico" Hospital, Via S. Pio X, 4, 73039, Tricase, Lecce, Italy,
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Kossaify A. Temporary Endocavitary Pacemakers and their Use and Misuse: the Least is Better. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2014; 8:9-11. [PMID: 24453502 PMCID: PMC3891625 DOI: 10.4137/cmc.s13272] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 11/11/2013] [Accepted: 11/19/2013] [Indexed: 11/11/2022]
Abstract
Temporary pacemakers are classically indicated for severe bradydysrhythmia, especially when the clinical settings require prompt intervention. Implantation of a temporary pacemaker is not a benign procedure since it may be associated with serious adverse events such as infection, cardiac perforation, and lead dislodgment. Accordingly, we recommend, when the clinical condition allows, to proceed directly with permanent pacemaker implantation without prior use of a temporary pacemaker. However, if a temporary pacemaker is required, it should be maintained for the shortest time possible. This policy allows avoiding or decreasing the potential complications associated with temporary pacemaker implantation.
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Affiliation(s)
- Antoine Kossaify
- Electrophysiology Unit, Cardiology division, USEK-University Hospital Notre Dame de Secours, St Charbel Street, Byblos, Lebanon
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21
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Wiegand UKH. A risk on an unprecedented scale in pacemaker implantation: prolonged waiting periods for urgent pacing indications. Europace 2012; 14:923-4. [DOI: 10.1093/europace/eus071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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